The new year in the U.S. brings with it ball drops, resolutions, gym memberships… and a raft of new federal and state rules on everything, including healthcare.
Here’s a look at some of the laws and regulations taking effect nationally and in individual states in 2019:
Federal Laws & Regulations
Individual mandate repeal:
In December 2017, Congress passed a massive tax bill that included a provision scrapping the Affordable Care Act’s (ACA’s) individual mandate penalty requiring all eligible Americans to buy health insurance or pay a fine.
The change took effect Jan. 1, 2019, but even before its enactment most Americans had already made their enrollment decisions. The window for open enrollment on the ACA’s exchanges ended Dec. 15 with some exceptions. (Seven states and the District of Columbia have extended open enrollment periods, with New York, California, and D.C. boasting the widest window of roughly 3 months.)
Also, Massachusetts, New Jersey, Washington D.C., and Vermont have their own individual mandates and won’t be impacted by the change. (New Jersey’s and D.C.’s laws took effect Tuesday; Vermont’s mandate will become law in 2020; and the Massachusetts penalty was enacted over a decade ago.)
In the past, policy experts have cautioned that the ACA needs both “carrots” and “sticks” in order to remain in balance — with subsidies serving as the carrots — and many warned that stripping the law of the mandate while maintaining the guarantee that individuals can access insurance would lead to millions of people dropping out of the exchanges because healthy young people would stop buying insurance and only sick, older adults would enroll, causing premiums to rise and leading to a “death spiral” on the exchange.
For 2019, those predictions haven’t held true. Enrollment dropped only slightly below 2018 figures with 8.5 million Americans enrolling as of mid-December — about 300,000 less than the previous year, Vox reported.
Contraceptive coverage opt-out:
Also, late in 2018 the Trump administration issued two rules that chip away at the ACA’s contraceptive coverage mandate — the provision requiring employers to offer insurance coverage for all forms of contraception without a co-pay.
One rule offers exemptions to the mandate for entities that oppose such services due to “sincerely held religious beliefs,” while a second allows non-profit organizations with “non-religious moral convictions” to opt out of offering coverage.
Prior to both these rules, there had been exemptions to the mandate for some churches and religiously affiliated hospitals, with an important caveat: even if the employer didn’t pay for it, the employer’s insurer or another third-party administrator was required to provide employees with coverage for contraceptive services with no co-pay. Under the new rule, this type of work-around would be optional.
Advocates for women’s reproductive rights panned the rules immediately. “These rules threaten to erode decades of progress in increasing women’s reproductive autonomy,” said Lisa Hollier, MD, MPH, president of the American College of Obstetricians and Gynecologists, in a press statement.
Posting hospital prices:
In an effort to improve transparency and help patients make more informed choices, the Centers for Medicare & Medicaid Services (CMS) will require hospitals, beginning on January 1, to publicly share their prices online, after passage of a final rule in August.
While hospitals were previously required to make a list of standard charges publicly available or to make their policies regarding such a list available on request, the agency now requires that the information be posted online in a machine-readable format.
“The agency is considering future actions based on the public feedback it received on ways hospitals can display price information that would be most useful to stakeholders and how to create patient-friendly interfaces that allow consumers to more easily access relevant healthcare data and compare providers,” according to a CMS press release issued in August.
At the State Level
Several states, via legislation, ballot initiative, and executive order passed Medicaid expansion in 2019 — which raises Medicaid eligibility for qualified adults up to 138% of the federal poverty level. (A 2012 Supreme Court decision made expansion optional for states.)
The Virginia legislature voted in May to expand Medicaid under Gov. Ralph Northam, MD, (D), a pediatrician, who ran for election on the issue. Open enrollment began in November and already 200,000 Virginians have signed up, according to WSLS-TV, an NBC affiliate.
On Thursday, Gov. Janet Mills (D), signed an executive order to advance Medicaid expansion, according to the Associated Press. Constituents voted to expand eligibility to the program in 2017, but the previous governor, Paul LePage, a Republican, blocked expansion for months and went so far as to appeal a state judge’s order requiring the administration to expand the program to at least 70,000 low-income Mainers by February. Under Mills, that appeal is now moot.
Idaho, Nebraska, and Utah all voted to expand Medicaid by ballot initiative in November. Idaho’s measure requires the state to submit a state plan amendment (SPA) within 90 days of the ballot’s passage; Nebraska’s measure also requires an SPA or waiver approval from CMS before April 1, 2019 to implement expansion; and Utah similarly requires an expansion of Medicaid coverage by April 1, 2019, according to the Kaiser Family Foundation’s interactive map of each state’s expansion status.
New health insurance laws are taking effect in a number of states. In Maryland, a new law will mandate health insurers to cover elevated or impaired glucose levels caused by prediabetes; coverage must include equipment, supplies, and self-management training. A separate Maryland law will require insurers to cover treatment for lymphedema, while a third requires coverage for training in “fertility awareness” contraception methods, also known as the “rhythm method” of contraception. On a related note, health insurers in Maryland and in Illinois must now cover fertility preservation for people whose fertility is put at risk by medical treatments such as chemotherapy.
In Minnesota, a new law outlines a process that doctors and patients can use to override insurer requirements for using step therapy for various illnesses.
In Connecticut, the state now requires insurers to cover certain “essential health benefits” — the law was passed in case the ACA, which has a similar requirement, was repealed. The state also is mandating that insurers cover prosthetics, and both Connecticut and Louisiana now require insurers to cover 3D mammography. And to help more women get prenatal care, a new state law allows women to sign up for health insurance when they first become pregnant, rather than having to wait for an open enrollment period.
Diet and nutrition:
In California, it’s ixnay on the soda or juice on restaurants’ children’s menus: acceptable default options will now include water (with no sweeteners), milk, or a dairy-free milk substitute. Kids can still get juice or soda — if their parents request it for them. The state also now requires hospitals and prisons to offer vegan meals.
California already requires employers to give new moms a place for lactation outside a bathroom stall; the new law requires the lactation space to be outside the bathroom entirely.
A new California law requires physicians to tell patients if they have been disciplined for sexual misconduct involving a patient or inappropriate prescribing that ended up hurting a patient. Later this year, chiropractors, podiatrists, and naturopaths will also become subject to the law.
Hawaii’s law legalizing medical aid-in-dying went into effect January 1; one patient has already requested a prescription for life-ending medication under the new law.