Healthcare law and policy outlook for 2020 

A wide variety of healthcare and paid leave reforms appear poised to move forward in 2020, with Congress, the Trump administration, state legislatures and the courts shaping these initiatives. Controlling costs, modernizing privacy and digital initiatives, improving competition in the healthcare marketplace, and expanding access to paid family and medical leave are key goals driving many reforms. Healthcare access and affordability also rank as top campaign issues in this presidential election year.

At the federal level, rules on drug importation, coupons and an international reference-based drug pricing model could advance this year. Other transparency rules in the works would make negotiated rates — including for prescriptions drugs — available to group health plans, participants and even the general public for the first time. Despite ongoing party divisions in Congress, bipartisan support could bring changes to rein in drug prices and curb surprise medical bills, among other healthcare issues. While paid leave proposals have bipartisan support, the parties differ significantly on their approaches, making enactment a challenge.

The employer shared-responsibility (ESR) mandate and reporting requirements under the Affordable Care Act (ACA) remain in place, but litigation could strike down the entire law — 10 years after its enactment. Other lawsuits challenge recent ACA regulations, including the final rules governing association health plans (AHPs), short-term limited duration insurance (STLDI) plans, and accommodations for employers with religious or moral objections to contraceptive coverage. In addition, litigation will force the courts to interpret a number of other issues that could affect health plans, such as gender discrimination.

At the state level, employers can expect new individual health coverage mandates, plan assessments and paid leave laws, which will increase the complexity of administering uniform benefit programs across jurisdictions. Rather than wait for federal legislation or regulation, states are also acting to curb drug costs and surprise medical bills.

While the variety of behavioral health and wellness programs in the marketplace has grown, the laws and regulations governing these offerings continue to evolve. Employers will need to track the shifting legal landscape to ensure their wellness plans and behavioral health programs comply.

This 49-page GRIST summarizes expected 2020 compliance and policy developments affecting health and leave benefits and suggests action steps for employers. Topics covered include:

• Regulatory outlook

─     Prescription drug reforms

─     Transparency for group health plans

─     Other healthcare regulations

• Legislative outlook

─     Federal health and leave proposals

─     State health and leave issues

• Litigation and enforcement

─     Litigation to strike down the ACA

─     Other healthcare litigation

─     ESR reporting and enforcement

• Behavior health and wellness

─     Behavioral health trends

─     Wellness strategies