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  • Council Alerts
  • Federal Legislation Tracker

    Federal Insurance Regulatory COVID-19 Updates(Last Updated October 15)

  • ACA Guidelines and Information

    CMS: Essential Health Benefit Coverage and COVID-19.

    4/15/20 | The ACA Will Be a Backstop for Newly Uninsured
    The ACA market is stable right now, posting a 3% decrease in monthly premiums this year. A dozen Democratic governors called on the Trump administration to open a special ACA enrollment period, stressing the necessity of health coverage for their uninsured or underinsured constituents who may choose to forgo COVID-19 testing and treatment over fear of potential costs. The governors are requesting the administration reconsider its decision and immediately open a special enrollment of at least 30 days on the federal exchange. Meanwhile, states that run their own exchanges have seen a major uptick in ACA plan enrollments. California’s public insurance exchange has seen almost 60,000 new enrollees since the state opened up the exchanges again in March.

    4/9/20 | The Fate of the ACA
    The coronavirus could shift the outcome of the pending lawsuit against the Affordable Care Act. Experts predict that lawyers for both the U.S. House of Representatives and the coalition of blue states defending the ACA will raise the impact of dismantling a law that helps Americans get healthcare coverage during a massive health emergency.

    4/6/20  | Trump Rejects Special ACA Enrollment Period Amid Pandemic
    The Trump administration rejected the option to open a special enrollment period for uninsured people to sign up for health insurance under the ACA amid the COVID-19 pandemic. Several states with their own marketplaces have moved to reopen enrollment, but the Trump administration has authority over enrollment in roughly two-thirds of states.

    Major insurers selling Obamacare plans were initially reluctant to reopen the law’s marketplaces, fearing they would be crushed by a wave of costs from the coronavirus outbreak. But the main insurance lobby, America’s Health Insurance Plans, endorsed the special enrollment period roughly two weeks ago while also urging lawmakers to expand premium subsidies to make coverage more affordable for middle-income people.


    4/3/20  | President Trump May Use Federal Programs to Provide Insurance Coverage
    After his decision to not facilitate a special ACA enrollment period to address the coronavirus crisis, the President is considering using federal programs like Medicare and Medicaid to cover the rising number of uninsured Americans. Nearly all of the 13 states running their own ACA marketplaces, including DC, have reopened enrollment in recent weeks — and some are reporting sharp increases. For example, in Maryland more than 10,000 people enrolled in Medicaid or an Obamacare plan in the past two weeks, and nearly half were under 34, which is typically the least likely age group to buy coverage. The state on Wednesday extended its sign-up window another two months until mid-June.

    3/23/20  |  Don’t Have Health Insurance? You Could Purchase it Outside of ACA Open Enrollment
    The Trump administration is considering whether to design a special enrollment period for Obamacare coverage given the COVID-19 emergency. Many Americans face losing their jobs and their employer-sponsored insurance as a result of the virus. The move by the administration—who has in some ways worked to thwart the ACA—means that they recognize insurance coverage provides greater access to coronavirus testing and treatment, and that using the ACA as the vehicle to provide access to care is a means to an end.

    Major health insurance trade associations voiced support for reopening enrollment in Obamacare markets to accommodate uninsured people who need treatment during the coronavirus pandemic — as long as the government covers some of the anticipated losses.

    A total of 32 states rely on the federal government to run their health exchanges, while nine other states who run their own exchanges indicated that they would reopen their exchanges to allow individuals to gain coverage. During the latest open enrollment, about eight million Americans signed up for ACA coverage through the federal exchange, which is almost 40% of the total (22 million) number of Americans who receive coverage through the individual insurance market.


  • Business and Employee Continuity and Recovery Fund

    3/31/20 | APCIA Press Release on Recovery Fund
    On March 31, APCIA joined NAMIC, RAA, and the policyholder community in the attached letter to call upon Congress and the Administration to enact the COVID-19 Business and Employee Continuity and Recovery Fund. The “Recovery Fund” would create a streamlined and tailored federal fund to provide rapid liquidity to small businesses and commercial sectors impaired by COVID-19. The requested relief is targeted to help businesses retain and rehire employees, maintain worker benefits, and resume or continue economic activity. The fund includes strong anti-abuse provisions, including audits and a Special Inspector General oversight, and would be leveraged through private sector servicers.

    Click here to read APCIA’s press release.

    3/14/2020  |  Response delivered by The Council, the American Property Casualty Insurance Association, the Independent Insurance Agents of America and the National Association of Mutual Insurance Companies, following this March 18 letter authored by Rep. Nydia Velazquez (D-NY) and 17 other members of Congress, which urged the industry to pay BI costs regardless of any exclusions.

    Surprise Billing During Coronavirus: Amid the development of a third government relief package, provisions to prohibit surprise medical billing and establish a drug price overhaul have resurfaced. Lawmakers remain split on both issues. A host of conservative groups cited COVID-19 as reason to reject a bipartisan surprise billing fix opting for a local benchmark rate setting approach, arguing in a letter to congressional leaders that it would only further strain the healthcare system.

  • Health and Human Services

    4/22/20 | Surprise Billing Practices Disrupted For Good?
    The Department of Health & Human Services (HHS) included surprise billing language in its emergency funding terms and conditions that could disrupt the longtime practice of balance billing. Federal officials offering funding to hospitals, clinics and doctors’ practices have included this stipulation: They cannot surprise bill COVID-19 patients. But within eligibility language laid out by HHS is language that could carry much broader implications. It says “HHS broadly views every patient as a possible case of COVID-19,” the guidance states.

    4/13/20 | Relief for providers fighting COVID-19 pandemic
    President Trump is providing support to healthcare providers fighting the COVID-19 pandemic. On March 27, 2020, the President signed the bipartisan CARES Act that provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19.

  • IRS

    5/15/20 | IRS Quietly Updates Guidance Allowing Employees to Make Mid-Year Plan Changes
    The IRS released new guidance that eases restrictions on employers so they can allow their workers to amend their health insurance and flexible spending accounts without waiting for the usual enrollment period. Employers will be able to allow their workers to drop out of their insurance if they have another available option, sign up for coverage if they didn’t earlier in the year and add family members to their plan.

  • Small Business Administration Guidelines and Information

    4/10/20  |  Client Webinar: Unpacking the CARES Act Paycheck Protection Loan Program

    Click here to view the slides from the presentation

    4/6/20  |  Client Webinar: Unpacking the CARES Act Paycheck Protection Loan Program

    Click here to view the slides from the presentation

    4/1/20  |  Overview of the SBA Paycheck Protection Loan Program

  • Other Resources

    5/12/20 | White House – Opening America guidelines
    President Trump has unveiled Guidelines for Opening Up America Again, a three-phased approach based on the advice of public health experts. These steps will help state and local officials when reopening their economies, getting people back to work, and continuing to protect American lives.

    3/27/20  |  Updated 3/27/20  Steptoe dissects the $2.2 trillion Coronavirus Aid, Relief and Economic Security Act (the CARES Act)

    3/26/20  |  What Phase 3/CARES Act means for the healthcare industry
    While some argue that this legislation is not really an economic “stimulus” at all and just a mechanism to protect Americans and businesses from sliding faster toward bankruptcy, the package—which the House votes on March 28—arrives just in time. In New York City, every single ICU bed (1,800) is expected to be full by that day.

    For employers: Group health plans will be required to pay providers the cash price they list on their website for services related to COVID-19 testing and other diagnostic visits if they do not have a contract in place. If there is a contract in place, the plan or the issuer will pay the negotiated rate.

    • Payroll: Employers receive a tax credit for keeping workers on payroll during this time and would get a refund for half of what they spend on wages up to $5,000/employee if they can prove that they took a 50% hit compared to the same quarter in previous years. In addition, they would be able to defer the 6.2% payroll tax they pay on wages used to fund Social Security.
    • Paid Sick Leave: Employers can receive advances on anticipated tax credits for paid family leave costs. There is a $200 per day and $10,000 total cap on paid leave per employee.
    • Unemployment: Workers who lose their jobs can receive $600 per week on top of state unemployment benefits for up to four months. 3.3 million people filed for unemployment between March 16-19, which is the biggest spike in filings in U.S. history. Of note: Workers who are laid off have the ability to sign up for a health plan on the Affordable Care Act’s marketplaces.

    Why this is significant: The stimulus package and the previous two relief bills passed by Congress prioritize patients and consumers—and help to ease the liquidity gap many companies are facing. While there is some relief for employers, there is still much to be addressed, including clarification on premium grace periods, mandatory coverage items, and what qualifies as a 500-life group.

    For insurers: While the industry asked for an emergency fund to offset a still unknown amount of losses as well as premium subsidies to help fund COBRA coverage, they did not receive it.

    Why this is significant: Health insurers and other stakeholders do not yet know how much money health plans stand to lose during this pandemic because of the potential number of hospitalizations.

    For hospitals: More than $100 billion would be directed—no strings attached—to hospitals and providers, especially hospitals in rural or low income areas. For hospitals treating Medicare patients for the coronavirus, they will receive a 20% increase in payment for all services.

    Why this is significant: Those facilities were already struggling before this global health crisis as a result of narrowing Medicare reimbursements and a lack of patients with lucrative private insurance. The hospitals serving small-town America survive on elective surgeries, physical therapy and lab tests—services that have for the most part been postponed or suspended as the healthcare system turns its full attention to COVID-19. One note: The Trump administration will receive $200 million to invest in services and tools that enable providers to virtually connect with patients.

    The stimulus package gaps:

    • Patients who become hospitalized as a result of contracting the virus could receive surprise medical bills.
    • There are no subsidies provided for COBRA coverage, which employers wanted for individuals who lost their jobs.