IA - adopts rules to allow the creation of association that follows the rules in the final AHP regulation
PA - prohibits expansion of associations under the new rules until lawsuit is settled – existing state rules govern
UT - requires associations to pre-authorize with insurance commissioner before purchasing health insurance, and sets different rules for the creation of an association

Individual Mandate
Parties to the lawsuit - AL, AR, AZ, FL, GA, IN, KS, LA, ME, MS, MO, NE, ND, SC, SD, TN, TX, UT, WV, WI
States enacting their own individual mandate law
DC - enacts mandate June of 2018 requiring minimum essential coverage – effective 2019
MA - currently has an individual mandate penalty since 2006 with intentions to remain in place
NJ - enacts mandate law May 2018 similar to the ACA mandate - effective 2019
VT - effective in 2020
States considering enactment of individual mandate law - CA, CT, HI, MD, MN, RI, WA

In addition to these initiatives, at least 35 states are taking a hard look at the ACA’s 1332 waivers that allow states to request modifications to certain ACA requirements. In a new proposed rule, HHS modifies some of these requirements to provide additional flexibility. As a result, we will see more states consider this option to make the ACA work better for the people of their state. So far, eight states enjoy modifications to the ACA rules in their state.

What’s next in the near-term?
The next two years should bring a number of proposals and modifications to different provisions of the ACA, Medicare, and Medicaid, along with various other laws impacting the implementation of employer-sponsored benefit plans. I am hopeful that Congress will find ways to improve this law and some areas of concentration should include:
• Repeal the current and looming taxes that directly affect the cost of health insurance, like the Cadillac and health insurance (HIT) taxes.
• Focus on expanding health savings accounts (HSAs). By adding flexibility to the current law that limits who can participate and contribute to these personal bank accounts, it will provide more individuals with the opportunity to use this tax-preferred method to finance their out-of-pocket expenses.
• Reducing the additional financial burdens the ACA places on employers who provide health insurance premium subsidies to approximately 177 million employees through their employer-sponsored plan. Returning the definition of full-time employees to 40 hours per week, rather than the 30-hour ACA definition, and simplifying the IRS reporting requirements on the health insurance provided to employees are two areas that have a direct impact on employers’ ability to continue to provide these benefits in the future.

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