Regulation and policy changes could reshape employer-sponsored health insurance in 2025 and beyond

January 13, 2025

This is the third in a series on issues facing employer-sponsored health insurance in 2025. See the bottom for links to the previous two posts.

Summary: Employer sponsored health plans could see increased enrollment and fewer regulations in 2025 and beyond.

Employer-sponsored health insurance faces a huge number of regulatory uncertainties as we enter 2025. The Supreme Court will determine whether to uphold the Fifth Circuit court decision that would eliminate some (or all) Affordable Care Act (ACA) requirements to waive cost sharing for evidence-based preventive care. The incoming Administration might decrease enforcement of certain Labor Department regulations. Decreases in exchange plan subsidies and Medicaid funding could lead to more employees choosing to cover themselves and their families through employer-sponsored health insurance.

Lawsuits against employers alleging that they did not exert adequate fiduciary responsibility on their self-funded health plans point to the importance of adequate vigilance about vetting, contracting with, and monitoring their medical carriers, pharmacy benefit managers, and other vendors and intermediaries.

Implications for employers:

• Employers can continue to waive cost sharing for recommended preventive care even if the ACA requirement is voided by a Supreme Court ruling. Total waived cost sharing represents only 0.1% of total premium, and childhood vaccinations and contraception both lower total medical claims.

• Employers can perform periodic competitive bidding for health plan, PBM, and vendors to fulfill their fiduciary responsibilities. Contracts can include competitive performance guarantees.

• Employers can perform periodic audits on their health plans, PBMs, and vendors.

Thanks for reading. You can find previous posts in the Employer Coverage archive

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The posts in this series:

1. Medical costs will continue to rise

2. Employers and health systems will continue to face labor shortages

   Coming later this week:

3. Regulation and policy changes could reshape employer sponsored health insurance

4. Artificial intelligence will continue to advance in health care delivery and administration

5. Climate change will adversely impact health and increase health care costs

6. Mental health will continue to require employer attention

7. Infectious disease will continue to pose serious risks