Employers with employees in the U.S. must be keenly aware of new activity in the White House and on Capitol Hill, now that the new U.S. administration and the 119th Congress have started to shape the health care policy agenda.
Policy developments, including legislative activity and regulatory moves, will impact employer-sponsored health care. As such, employers will need to fully comprehend how these changes will specifically affect their workforces, health plans and long-term strategies. For instance, while lawmakers are currently drafting legislation that on its face is primarily focusing on the government budget, overall debt and annual appropriations, the end result could include crucial health plan and other benefit changes, either directly or by using the underlying bill as a must-pass piece of legislation to which they could attach additional policy changes.
From a high-level perspective, Business Group on Health works to ensure that any reforms enhance affordability, maintain flexibility and preserve the strength of the employer-sponsored system. Priorities include safeguarding the long-standing tax-free status of employer-provided health care (See: Taxing or Limiting Tax-Free Benefits Policy Position Statement); and preserving ERISA preemption, which has offered a consistent and reliable statutory and regulatory structure for employer plan-sponsors for more than five decades. (See: Preserving ERISA Policy Position Statement)
On a more granular level, Congress and the White House are assessing many familiar policy and legislative proposals, as well as new and revised ones.
Some, such as resurrecting pre-deductible telehealth and allowing further enhancements like direct primary care for high deductible health plans (HDHPs), would likely be supported by employer plan sponsors. Others, like pharmacy benefit manager (PBM) transparency reforms, may be desirable in a general sense, though certain parts of the proposals need to be removed or modified to mitigate undue government intervention, maintain employer flexibility and control and avoid unnecessary and wasteful administrative burden. Moreover, some proposals, such as parity mandates for dialysis, government price and cost-sharing mandates on prescriptions and other items and services, and intrusions into plan design and utilization management (e.g.: step-therapy requirements), would undermine and overburden employer plans.
Beyond Capitol Hill, the president’s Executive Orders may also result in some direct changes for federal agencies and contractors. These orders also may have secondary impacts in terms of agency interpretations and implementations of regulations and guidance that directly affect employer plans . Additionally, incoming agency leadership appointed by President Trump will further shape the trajectory of health policy at the Department of Health and Human Services (HHS) and Department of Labor (DOL). The new administration and its advisors have also initiated significant measures aimed at streamlining federal operations and have taken some actions focused on DOL, HHS and the Department of Treasury – generally the Departments most relevant to employer plans. These shifts, combined with ongoing agency initiatives, may impact regulatory enforcement priorities, the scope of compliance obligations for employer-sponsored plans and agency guidance employers rely on for plan administration.
Under the purview of these agencies, the regulatory process and requirements also remain of paramount importance to employers and plan sponsors. The implementation of last year’s Mental Health Parity and Addiction Equity Act (MHPAEA) regulations, for instance, is essential as plan sponsors navigate new compliance. As employers seek to further expand access to mental health care, the Business Group advocates for reasonable implementation timelines and compliance assistance to ensure that these policies achieve their intended impact without unnecessary administrative burden.
While the pace of policy, legislative and regulatory change can prove unpredictable, employer-sponsored health insurance provides the bedrock of our health care system. Business Group on Health closely tracks policy developments of interest and engages with policymakers at the highest levels to ensure the inclusion of employer perspectives.
In the coming months, the Business Group will continue to share timely insights and analysis to help employers navigate the ever-evolving landscape and maintain high-quality, affordable coverage and benefits.
