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Health Plan Coverage Provisions in the 2021 Appropriations and COVID-19 Stimulus Package

"[T]he bill's coverage-related provisions ... include appropriations provisions relevant to the [ACA], protections from surprise medical bills, continuity of care protections, enhanced mental health parity requirements, and several new provisions designed to increase the transparency of health care costs."

IRS Issues New Proposed Rule on Health Care Sharing Ministries and Direct Primary Care

"On June 8, 2020, the [IRS] issued a short proposed rule that would allow employers to reimburse employees for fees for direct primary care and health care sharing ministries through a health reimbursement arrangement (HRA).... The proposed rule, by giving tax-advantaged status to these types of arrangements, could result in even higher enrollment in ministries. This could damage the [ACA] individual market by further segmenting the risk pool between ACA-compliant plans and ministries. Comments on the proposed rule are due in 60 days."

CBO Expects Higher Uninsured Rates, Defines Some Short-Term Plans as Private Health Coverage

"The new baseline incorporates the potential impact of recent federal proposed rules on [association health plans (AHPs)] and short-term, limited-duration insurance.... Beginning in 2023 -- the date when the effects of these rules are expected to be fully phased in -- an estimated six million additional people will enroll in either an AHP or a short-term plan. The CBO and JCT expect higher enrollment in AHPs (about 4 million people) than in short-term plans (about two million people)."

Appeals Court Upholds Rule Relaxing Restrictions on Short-Term Health Insurance

"Like the district court, the DC Circuit points to the history of the definition of [short-term, limited duration insurance (STLDI)]. Congress delegated authority to the federal government to define STLDI under HIPAA in 1996 ... The ACA did not alter the statutory STLDI exclusion when enacting the law in 2010. In part due to this history, the majority concludes that the federal government is entitled to deference in defining STLDI and that its interpretations were reasonable." [Association for Community Affiliated Plans v. U.S. Dept. of the Treasury, No. 19-5212 (D.C. Cir. Jul. 17, 2020)]

Court Upholds Final Regs on Short-Term Health Insurance Plans

"Judge Leon rejected the plaintiffs' arguments that the short-term plan rule is contrary to Congress's intent in adopting the [ACA] and [HIPAA].... Congress delegated authority to the federal government to define short-term, limited duration insurance under HIPAA in 1996.... [T]he ACA did not alter this definition.... Judge Leon concludes that the federal government is entitled to deference in defining short-term coverage and that its interpretations were reasonable." Assoc. for Community Affiliated Plans v. U.S. Dept. of Treasury , No. 18-2133 (D.D.C. Jul. 19, 2019)]

Health and Dental Insurers Now Subject to Federal Antitrust Laws

"[T]he new law amends 15 U.S.C. Section 1013 to state that nothing in the McCarran-Ferguson Act prevents federal antitrust laws from applying to the business of health insurance, which includes the business of dental insurance and limited-scope dental benefits.... With this exemption now gone, the Department of Justice and the Federal Trade Commission can more easily investigate antitrust concerns and enforce federal laws, even though antitrust regulation had previously been left to the states. The legislation makes clear that parts of the Federal Trade Commission Act apply to all health insurers, including those that are not for-profit companies."

ACA Round-Up: Health Insurance Tax, Mental Health Parity, and Special Enrollment Periods

"As we await the 2020 open enrollment period (which starts in November) and major rules like the notice of benefit and payment parameters for 2021 (which is expected this fall), federal agencies continue to release new guidance and analysis. Federal regulators have recently released an estimate of the health insurance tax plan for year 2020, frequently asked questions on mental health parity, and special enrollment periods for those affected by Hurricane Dorian."

ACA Developments: House Subcommittee Hearing, CMS RFI on Health Care Compacts

"[L]awmakers discussed three bills that would help strengthen the individual market through additional federal funding for reinsurance programs, navigators, and new state-based marketplaces.... [CMS] released its second request for information (RFI) in two weeks on the ACA.... This RFI asks for comment on ways to promote the sale of individual health insurance coverage across states lines, primarily through a 'health care choice compact' under Section 1333 of the ACA. Comments on the RFI are due within 60 days."

Open Enrollment Begins, New Basic Health Plan Methodology

"[T]he 2021 open enrollment period began in most states on November 1, 2020 and extends through December 15, 2020. This post discusses additional data and resources from the [CMS] in light of the open enrollment period and a new proposed methodology for the Basic Health Program (BHP) for 2022."

Validity of Association Health Plan Rules Argued at D.C. Court of Appeals

"The panel seemed particularly interested in the intersection between ERISA and the ACA under the final rule, which agency is tasked with interpreting each statute, and the [DOL's] rationale for adopting the rule in the first place.... If the D.C. Circuit affirms the lower court’s decision, much of the final rule would remain invalidated." [State of New York v. U.S. Dept. of Labor, No. 18-1747 (D.D.C. Mar. 28, 2019; notice of appeal filed by DOL on Apr. 26, 2019; oral argument (MP3 audio file) Nov. 14, 2019)]