Election Takeaways for Employers Sponsoring Group Health Plans

As the United States looks to 2025 and the inauguration of President Donald Trump, employers that sponsor employee benefit plans might be wondering what changes related to health benefits in America could be on the horizon. Although the President-elect has not issued in-depth policy proposals, we can look to his past administration’s efforts to influence healthcare, as well as to what was said during the election cycle, to glean ideas of what could be the next administration’s key issues. 

President-elect Trump has touted his successes from 2016-2020 on lowering drug prices and has promised to stop COVID-19 mandates, end surprise medical billing, increase fairness through price transparency, lower prescription drug costs and health insurance premiums, protect patients with pre-existing conditions and protect Medicare. Historically, President-elect Trump has been a proponent of Medicare Advantage. 

During the past Trump administration, there was significant emphasis on price transparency, and we can expect that to continue into this term. There is always potential for further scrutiny on pharmacy benefit manager (PBM) companies that serve as intermediaries in the U.S. health system for drug pricing, formularies, claims processing and more. Additional regulations relating to hospital pricing transparency could be on the horizon as well, as a continuation of efforts from the first Trump administration. 

President-elect Trump’s past administration made strides to loosen regulations relating to the formation and implementation of association health plans, or AHPs. The regulations issued during his past term were revoked during the Biden-Harris administration, but this could be a topic that is revisited in the coming years. AHPs are seen by some as a more effective way for small businesses to purchase health benefits for employees, while others remain concerned about the fraud that had plagued AHPs prior to the strict regulations that were implemented beginning in 1983. 

President-elect Trump has been an outspoken critic of the Patient Protection and Affordable Care Act (ACA), while also promising not to undo one of its key provisions: ensuring insurance access protections for Americans with pre-existing health conditions. It remains unclear what components of the ACA could be impacted in the new administration, or if Congress will attempt to pass laws undoing or changing any of its components. The ACA is an expansive piece of law, with many provisions impacting employer-sponsored healthcare, preventive care, market reforms, food labeling and more. 

In the week leading up to the election some news outlets reported that, if elected, Trump would name Robert F. Kennedy Jr., as the head of the Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA). Kennedy has been an outspoken critic of vaccines, which could impact employer wellness programs that incentivize employees to receive influenza and/or COVID-19 vaccinations. 

Although much remains to be seen on the specific focus of the incoming administration, Alera Group will continue to assess regulations, both existing and proposed, and provide timely guidance to our clients as more information becomes available.