A federal court's decision to stay most provisions of the Trump administration's Affordable Care Act (ACA) eligibility and income verification rule is good news for benefits brokers. At least for now.
But with a raft of new rulemaking on the horizon covering everything from nondiscrimination protections to disclosure requirements, the legal landscape for employee benefits is anything but settled.
Lisa Campbell, Health and Welfare Practice Leader at Groom Law Group in Washington, DC, spoke to Insurance Business America following a recent decision to block several provisions in the administration's 2027 Notice of Benefit and Payment Parameters.
"From a broker standpoint, the decision is positive," Campbell said of the court's move to stay the rule's key provisions. "Individuals will be able to go through the system and get coverage easier than they would have if this rule's provisions would have gone into effect."
The litigation challenging the rule, what legal observers are calling Columbus II and the second major lawsuit challenging overlapping ACA provisions, would have required consumers to take additional steps to prove their eligibility for marketplace subsidies.
Had it taken effect, for example, individuals whose income could not be verified through government databases would have been cut off from premium tax credits if they could not provide documentation verifying income.
"The advocates were really thinking overall this is going to have a negative impact on consumers and coverage and eligibility for coverage, and on premiums that they will be paying,” Campbell said.
Campbell noted that premium increases would likely have accelerated.
"I still think overall the increases for premiums are there," she said. "Healthcare is getting more expensive and we are seeing employers concerned about the increases that they're seeing. But potentially it would have been worse if this rule would have gone in place as expected."
The stay in Columbus II follows a final decision in Columbus I, an earlier lawsuit challenging many of the same provisions.
Campbell said the dual outcomes make it harder to predict whether the Department of Health and Human Services (HHS) will pursue an appeal of some of the provisions or instead seek alternative regulatory pathways to achieve its goals.
"Even if the government doesn't appeal this decision, I do think they will look for other opportunities to try and accomplish, from their standpoint, program integrity," Campbell said. "I think the writing's on the wall with some of the provisions based on Columbus I."
"There is a very strong will in this administration to try and make change wherever possible," Campbell said. "They are plowing forward with all of their rules, and I don't really know that timing is a concern for this administration."
Beyond the Columbus cases, Campbell identified several other regulatory actions that benefits brokers should be monitoring closely.
Campbell also raised a recent executive order from President Trump on vaccine coverage, noting that while the order itself does not change existing coverage requirements, downstream actions by HHS and potential state-level actions could trigger fresh litigation.
"There's already litigation around the vaccine issue," she said. "I would expect that would be a hot topic for potential challenge depending on what the administration does."
For benefits brokers already navigating complex compliance obligations around employer-sponsored health plans, Campbell's message is that the regulatory pipeline is full, legal uncertainty is high, and staying current will require vigilance well beyond the ACA marketplace cases making headlines today.
"We do expect to see a lot of activity from a regulatory standpoint," she said. "And with that will probably come some additional litigation challenges. So keeping us all on our toes."
