Health Care Reform 2018 - ACA Legislation & Regulatory Compliance
  • Health Care Policy & Compliance

Your Mid-Year Health Care Reform Update

Change remains constant in American health care. For those who work in the employee benefits profession, keeping abreast of the latest regulatory and legislative developments is a challenging imperative.

That's why Benefitfocus provides the benefits community with regular health care reform updates in the form of quarterly webinars, which feature insight from leading authorities on the ACA, COBRA and other key pieces of the compliance puzzle.

Our latest update at the end of June included a discussion led by ACA and health care policy expert Christopher Condeluci, who presented a rundown of what's happening on both the regulatory and legislative side of health care reform.

Here are just a few highlights from Christopher's presentation:

Executive Actions on Health Care

Association Health Plans

In mid-June, the Department of Labor issued its final rules on Association Health Plans (AHPs), which enable small employers to band together to offer fully-insured "large-group” or self-insured health coverage to employees. Among other things, the new rules state that:

  • AHPs can be formed through a commonality of interest on the basis of geography or industry
  • Self-employed individuals can participate in AHPs
  • AHP coverage will not be subject to the ACA’s essential health benefits and premium rating rules (but ERISA, HIPAA, COBRA and the ACA’s consumer protections will apply)

The Congressional Budget Office estimates that 400,000 previously uninsured people will gain coverage under AHPs, but it remains to be seen if AHPs will be a viable market in the long run.

ACA Employer Mandate Reporting

It's worth noting that the IRS is stepping up enforcement of the ACA's so-called employer mandate.

As IRS agents become more sophisticated and educated with ACA rules, it's possible that we'll continue to see an increase of citations (i.e., L226J letters), along with higher standards for employers' responses to those citations.

And since it looks like the ACA is not going away anytime soon (but more on that below), organizations need to take proper steps to ensure that they're compliant with the employer mandate and reporting that information accurately—so they can avoid unnecessary scrutiny.

Additional Regulatory Activity 

A few other items of note:

  • Final rules on short-term insurance are expected sometime in September 2018 and likely to reinstate pre-ACA policy.
  • Expansion of health reimbursement arrangements (HRAs), which would allow groups with more than 50 full-time employees to offer HRAs without an accompanying health plan, is expected by the end of 2018.
  • A legal challenge filed by the AARP resulted in a court striking down the EEOC's current employer wellness program regulations, effective Jan. 1, 2019. EEOC plans to write a new set of regulations targeted to go into effect in 2020 or 2021.

Learn more in the full health care reform update webinar. 

Legislative Actions on Health Care

There hasn't been and likely won't be too much legislative activity around health care reform before the 2018 midterm elections in November, but there could be some movement in health savings account (HSA) policy.

A recent bipartisan Congressional hearing examined ways 1) to make high-deductible health plans (HDHPs) more consumer-friendly and 2) to allow employers to develop innovative new plan designs while preserving an HDHP policyholder’s eligibility to contribute to an HSA.

We could soon see legislation that would preserve HSA eligibility even in cases where:

  • The HDHP pays first-dollar coverage for certain chronic care services
  • Employers offer direct-primary services to HDHP policyholders
  • Employers provide access to onsite/near-site clinics

For more insight into the current state of affairs in health care reform and the ACA, as well as a look at the policy implications of November's midterms, watch the full recording of Health Care Policy Summer Scoop: HSAs, AHPs and Medicare Part E.


Note: Benefitfocus is not a law firm, and the employees of Benefitfocus are not acting as your attorney. Benefitfocus does not practice law and does not give legal advice. At no time does Benefitfocus draw legal conclusions, provide legal advice or apply the law to the facts of your particular situation. This website is not a substitute for the professional advice of your attorney and tax professional, which you should seek if you have any questions about your particular situation.