Key Healthcare Policy Updates Employers Should Know

As a new administration takes shape, several policy and regulatory shifts are on the horizon that could impact employer-sponsored health plans. Here are the most important updates to watch:

Regulatory Flexibility for Employers under Affordable Care Act

Employers now have more time (90 days vs. 30) to respond to IRS penalty letters.
Individual statements to participants are no longer required unless requested.
When SSNs are unavailable, full names and birthdates can now be used—helpful for high-turnover industries.

RxDC Reporting Reminder

Fully insured groups should watch for carriers request for information to complete prescription drug reporting on their behalf.
Self-funded groups are responsible for the entire report and should coordinate with TPAs or PBMs.

HSA & Telehealth Clarification

The pandemic-era telehealth exception, allowing pre-deductible coverage for telehealth, has expired for HSA Eligible High-Deductible Health Plans for plan years beginning on/after January 1, 2025.
Employers offering telemedicine before the deductible, disqualifying HSA contributions.

New Leadership, New Priorities

Robert F. Kennedy, Jr. is expected to focus on childhood wellness and prevention efforts through HHS, the United States Department of Health and Human Services.
Dr. Oz will lead CMS, Centers for Medicare and Medicaid Services, bringing a nontraditional approach that may influence public health policy around preventive care and chronic disease management.

Regulatory Freeze & Reversals

A 60-day government-wide freeze was placed on proposed or finalized regulations from the Biden administration, including HIPAA updates and Medicare Advantage & Medicare Part D reforms.
Expect policy shifts around health care price transparency, Subsidy eligibility and funding cuts, and ACA enrollment.

Employer Tax Exclusion on Employer-paid Benefits Under Review

The tax-exempt status of employer-paid benefits is being reexamined.
Changes could mean employer contributions toward employee coverage could be taxable to the employee and increase costs for employers and more.

Other Watchlist Issues

Mental Health Parity Expansion: Could require employers to analyze how benefits are used, not just designed. Still on hold but not withdrawn.
Site-Neutral Payments: May equalize reimbursement across care settings, impacting plan costs.
Primary Care Enhancement Act of 2023 (H.R. 3029): Allowing HSA funds to be used for Direct Primary Care fees. Expected to gain traction with bipartisan support.
Lower Cost, More Transparency Act (H.R. 5378): Reforms likely around price transparency including PBMs, but pace remains slow.

Impact on Employers

With regulatory complexity rising and many changes possible through executive or agency action alone, employers must stay informed and ready to adjust. Key areas to monitor include cost transparency, reporting requirements, tax implications, and funding cuts especially around federal ACA subsidies.

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