Finding innovative ways to curb health plan costs without increasing compliance burdens or litigation risks is a key 2019 policy goal shared by employers and the federal government. Plan sponsors are looking for innovative ways to design health benefits — including prescription and specialty drug coverage — that will help control medical spending. While some of the largest employers have been pursuing alternative programs for some time, last year’s announced alliance of Berkshire Hathaway, Amazon and JP Morgan to tackle healthcare costs and quality has employers focusing in 2019 on new ways to provide health coverage. Even smaller employers are considering referenced-based pricing and other mechanisms that are easy to understand and administer. Before heading down these new paths, however, employers need to pay attention to the evolving compliance challenges that these initiatives bring.
In Congress, bipartisan support could overcome party divisions and push through a few health-related measures, including changes to rein in drug prices and surprise medical bills and to expand health savings accounts (HSAs). Although major Affordable Care Act (ACA) or any other type of health care reform (like “Medicare-for-All”) legislation is unlikely, there will probably be hearings on health care issues over the next year and in 2020. While the agencies likely have been slowed down by the recent shutdown, ongoing efforts to implement President Trump’s 2017 healthcare executive order could lead to new or revised federal rules affecting health benefit strategies later this year, like relaxing the current rules that limit the use of health reimbursement arrangements (HRAs) for active employees. While employers must continue to comply with ACA’s employer shared-responsibility mandate, they should track lawsuits that could strike down the entire law or recent regulations, such as the final association health plan (AHP) rules. At the state level, employers can expect new health coverage mandates, plan assessments, and leave laws to increase the complexity of administering uniform benefit programs across jurisdictions.
By Dorian Z. Smith and Cheryl Hughes