Trump’s Early Initiatives May Impact Health Plan Compliance

In the first months of his second term, President Donald Trump and his administration have issued executive orders (EOs) and policy changes that may have significant implications for employer-sponsored health plans. These initiatives include:

An EO prioritizing increased health care price transparency and directing federal agencies to further implement and enforce transparency rules;
An EO directing policy changes to protect access to in vitro fertilization (IVF) and reduce out-of-pocket and health plan costs for such treatments; and
A recission of Biden-era guidance related to gender-affirming care for minors by the Department of Health and Human Services (HHS).

These actions do not change any existing legal requirements. However, they serve as important indicators and directives to federal agencies regarding Trump’s health policy priorities. It is likely that the Trump administration will issue proposed rules or take other regulatory action on these topics in the coming months. Already, HHS has issued a proposed rule that, if finalized, would place new restrictions on eligibility and enrollment opportunities in the Affordable Care Act (ACA) Health Insurance Marketplaces.

Early Initiatives

Trump issued an EO directing federal agencies to issue new guidance to improve health care price transparency.
Trump issued an EO calling for policy changes to protect IVF access and reduce costs.
HHS rescinded guidance it issued in 2022 regarding the application of federal civil rights and privacy laws to gender-affirming care for minors.
HHS issued a proposed rule that would restrict Marketplace eligibility and enrollment.

Other Possible Changes

Other possible priorities of the Trump administration may include:

Expanding the availability of short-term, limited-duration health coverage;
Expanding access to association health plans; and
Weakening (or rescinding) privacy protections for reproductive health care.

Action Items

Employers should expect new regulatory action over the next several months implementing Trump’s health policy priorities, including those outlined above. Employers should watch for developments and assess the impact of any new regulatory action on their health plan coverage. For example, federal agencies will likely enhance health plan price transparency measures in the future, which may require employers to work with their third-party vendors regarding updates to plan communications and tools.

Restrict Marketplace Eligibility and Enrollment

On March 10, 2025, HHS released a proposed rule that would implement new standards for the ACA’s Marketplaces to address improper enrollments and promote stable and affordable health insurance markets. If finalized, the changes could make it more difficult for consumers to enroll in coverage, potentially reducing Marketplace enrollment. Key reforms of the proposed rule include:

Ending the availability of the monthly special enrollment period for individuals with household incomes below 150% of the federal poverty level;
Shortening the annual open enrollment period for all individual market coverage so it runs from Nov. 1 through Dec. 15 preceding the coverage year (instead of through Jan. 15 of the coverage year);
Eliminating Marketplace eligibility for Deferred Action for Childhood Arrivals recipients;
Requiring Marketplaces to determine an individual ineligible for the advance premium tax credit (APTC) if they failed to file their federal income tax return and reconcile APTC for one year (instead of two consecutive tax years);
Allowing insurers to require payment of past-due premiums before effectuating new coverage; and
Requiring consumers who are automatically renewed in Marketplace coverage with no premium (i.e., consumers who are eligible for APTC that fully cover their premiums) to pay $5 per month until they confirm their eligibility information.

Although these proposed changes would not affect employers directly, they may make it more difficult for employees to enroll in Marketplace coverage. Employers that offer individual coverage health reimbursement arrangements (ICHRAs) may find this problematic, while employers subject to the ACA’s employer shared responsibility penalties (“pay-or-play” penalties) may reduce their penalty risk if fewer employees enroll in Marketplace coverage.

Please connect with BenePro to find out how these changes impact your current and future benefit plan.