The 2024 U.S. Presidential campaigns and election brought forth some of the most heated debates in the history of the country, and one key area was the topic of healthcare. With the election resulting in a change of leadership from a different political party, this new administration will have many significant policy changes that impact businesses and organizations offering group healthcare plans for their teams.
Here are five areas that Mitigate Partners is following:
- Major medical alternatives – The current administration largely has tried to protect fully insured plans and ACA against “antiselection pressure”, which in summary could have a negative impact on risk assessments for those staying in fully insured plans due to smaller organizations opting for more affordable options. It’s very likely that there will be a push for ACA adjustments that provide groups with more flexibility and choices, and particularly with self-insured plans.
- Stop-loss insurance – Governed under federal ERISA law, plan provisions that reduces exposure to self-insured plans have more recently been under pressure as it has the potential to inflate risk within the fully insured market. The new administration is less likely to suppress this innovative approach to keeping the cost of group plan coverage affordable.
- Fiduciary compliance and training – The general policy of lower federal oversight with more control pushed down to state levels will likely provide more flexibility for employers. But concurrently, there are federal laws designed to drive full transparency of costs that require plan sponsors to attest to their fiduciary compliance and responsibility that plan decisions have been made with full and accurate data. It will continue to be a growing area of focus for businesses to be fully trained and compliant that they are receiving cost data as mandated by federal law.
- Health accounts – While the current administration has had little focus on the general category of health accounts, it’s likely that the new administration will be supportive and endorse current health savings/reimbursement accounts along with potential new accounts which are generally focused on reducing costs and unexpected expenses associated with individual healthcare.
- Pharma and PBMs – Although the current administration has advocated for price caps on medications – particularly for Medicare plan participants – there has been less of a focus on the role of big Pharma and Pharmacy Benefit Managers (PBMs) who continue to push for consolidated distribution through PBM networks and effectively squeezing out independent providers. The new administration will likely have more focus on open-market competition which does not require semi-exclusive distribution through closed networks owned by very large PBMs.
There are likely MANY areas that will present opportunities for employers looking to manage (and reduce) the costs of their group healthcare plan. For sound advice, employers should look to experienced advisors to help navigate the new path forward.
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