On February 22, 2025, a federal court in the District of Maine dismissed a proposed class action lawsuit which sought to characterize obesity as a disability under Section 1557 of the ACA. The plaintiff brought the case against the insurance carrier that administered the health plan the plaintiff participated in. The plan does not provide prescription drug coverage for weight loss. The plaintiff claimed that this was discrimination based on a disability and a violation of Section 1557 of the ACA. 

The DOL's Advisory Council on Employee Welfare and Pension Benefit Plans (the Council) recently issued a report examining the group health plan benefit claims and appeals process. In particular, the report studies the reasons behind low participant appeal rates and makes recommendations to address this concern.

Among the proposals currently being considered is the taxation of certain employer-sponsored health plans. Under existing tax law, employer-paid premiums for group health plans are exempt from federal income and payroll taxes. The potential impact of taxing employer-sponsored insurance could be far-reaching.

the newly published executive order directs the DOL, HHS, and Treasury (including the IRS) to take certain steps within 90 days to improve and enforce existing price transparency requirements. Specifically, the agencies are tasked with two main directives. One is issuing updated guidance that ensures pricing information is standardized and easily comparable across health plans. The other is updating enforcement policies designed to ensure...

On January 28, 2025, the Trump administration issued Executive Order 14187, which declares that it is the policy of the United States not to “fund, sponsor, promote, assist, or support” gender transition for people under 19, which includes 18-year-olds who are legal adults in the states where they reside. Among other things, the order requires federal agencies, such as HHS, to take all appropriate actions to end the “chemical and surgical...

In a brief filed on February 18, 2025, the Trump-appointed secretaries of the DOL, IRS, and HHS (the departments) asked the US Supreme Court to reverse the Fifth Circuit Court of Appeals (Fifth Circuit) decision in Braidwood Management Inc. v. Becerra (Braidwood), which found some ACA preventive care coverage requirements to be unlawful.

On February 11, 2025, the Congressional Research Service (CRS) published an updated report on HSAs. The report noted that HSA-qualified HDHP enrollment generally increased from the mid-2000s to 2020. Large employers had a higher percentage of covered employees enrolled in HDHPs with a savings option in 2024 relative to small employers (28% to 23%). The report also cited a review by the Bureau of Labor Statistics, which was based...

The DOL, HHS, and IRS (the departments) issued FAQs Part 69, which provides additional guidance regarding the CAA 2021 gag clause prohibition and attestation requirement.

The DOL issued an opinion letter clarifying the “substitution” provision under the FMLA when it intersects with a state paid family and medical leave (PFML) program or local paid leave (e.g., paid sick leave) law. The term “substitute” means that either the employer or employee, on their own, can decide to have employer-provided paid leave (e.g., PTO, sick leave, vacation) run concurrently with the unpaid FMLA leave.

A federal court in the Northern District of Texas issued a preliminary injunction against HHS in a case concerning the 2024 HIPAA Privacy Rule to Support Reproductive Healthcare Privacy, preventing that agency from enforcing that rule against the plaintiffs pending the resolution of litigation.