As we close in on the midway point of President Biden’s term, it is a good time to reflect on policy changes to date, as well as expected shifts in the near future related to employee benefits.

Ooh, We’re Halfway There: Key Changes From Biden’s Presidency So Far

With a focus on healthcare and employee benefits, here are some key Presidential activities that have occurred during the last two years (please note, this is not an exhaustive list).

Let’s dive a little deeper into some of these:

  • The Strengthening Medicaid and the Affordable Care Act resulted in a special enrollment period for those impacted by the pandemic to allow additional opportunities for individuals to obtain health insurance.
  • The American Rescue Plan was a COVID-19 stimulus package that included funding for:
    • Vaccine distribution and testing
    • Direct payments to eligible Americans
    • Support for unemployment
    • An expansion of the child tax credit
    • Budget allocated toward schools and higher education for the purposes of reopening
  • The Consolidated Appropriations Act (CAA), 2022, has many provisions, among which include a safe harbor allowing high deductible health plans (HDHPs) to cover medical and behavioral health services before meeting the deductible. This safe harbor ended on December 31, 2022. Another component of the CAA 2022 is the Prescription Drug and Health Care Spending rule, which requires that health insurance carriers in group and individual markets report information on prescription drug and health care expenses to various federal governmental departments. This will be turned into a biannual report summarizing prescription drug price trends with the end goal of increased transparency.
  • In response to the Supreme Court’s overruling of Roe vs. Wade, the Protecting Access to Reproductive Health Care Services executive order directed the Department of Health and Human Services (HHS) to expand access to medication, abortion, and emergency contraception, as well as to establish an interagency task force on reproductive health care access, among other provisions. However, laws around abortion still largely remain in the hands of state governments.
  • The withdrawal of the Sunset Rule means that the HHS regulations will not automatically expire after ten years if not assessed based on the criteria in the Regulatory Flexibility Act of 1980.
  • As a means to reduce the deficit, the Inflation Reduction Act is aimed at cutting healthcare costs, including prescription drugs, clean energy initiatives, and introducing a new tax on the wealthy.
  • With the new ACA marketplace, consumers can preview their healthcare coverage options to understand what the costs will be and what savings might be available in advance of open enrollment.

Looking ahead, we can’t be sure what President Biden will prioritize during the second half of his term, but in the healthcare sphere we are likely to see a renewal of healthcare extenders, a debate around the topic of healthcare sector consolidation, substance abuse solutions, and strategies for managing the healthcare labor shortage. The COVID-19 Public Health Emergency (PHE) may or may not end in January 2023, which would impact Medicaid, as well as support programs and flexibilities offered, such as those related to telehealth.

A Split Congress

With a Republican-led House of Representatives and a majority Democratic Senate, we may be facing some standoffs at the federal level in the years to come. However, like Biden’s infrastructure law, there are some bipartisan issues that may see movement. Policies around paid leave, including sick leave, healthcare technology, and pharmacy costs may have enough support from both sides of the aisle to see progress.


November’s midterm elections had many of us holding our breath, with several tight races in a divisive environment. The overturning of Roe vs. Wade meant many states had abortion-related questions on the ballot, with California, Michigan and Vermont passing measures that would protect abortion access and Kentucky failing to pass a law that would outright deny the right to an abortion. Health plans and employers alike have had to reassess their coverage related to these changes and consider new components, such as travel costs.

In other state election results, interesting activity was not in short supply. South Dakota approved a constitutional amendment that will extend Medicaid eligibility under the ACA to those with income below 138% of the federal poverty level., which is $26,500 for a household of four. This will take effect on July 1, 2023. Arizona passed an initiative that will limit interest rates to 3% for debt resulting from healthcare services, a cap that previously fell at 10%. Maryland voted to form a workgroup to advise on a subsidy program to support small businesses and is exploring a single-payer commission platform. Massachusetts also voted in favor of looking into a single-payer system and a public option, as well as a pilot program expanding eligibility for the Massachusetts health insurance subsidy program, and became the first state to regulate dental insurance. Meanwhile, newly elected Governor Lombardo of Nevada may be seeking to disrupt the 2021 bill calling for a public option for individual and small group markets.

At Spring, we take an objective stance on employee benefits and health plan design, always looking out for the best interests of our clients. Federal political stalemate aside, we do think changes in employee benefits will keep coming, and it’s best to be as proactive as possible. We will continue to keep you updated on changes in the employee benefits and healthcare spheres, if you have questions about recent legislature or need compliance guidance, please get in touch.