December 2018

Evolving Health Care Dynamics Heading into 2019

The results of the recent 2018 midterm elections could have a significant impact on the direction of health care in the United States. With Republicans maintaining control in the U.S. Senate, and Democrats gaining the majority in the U.S. House of Representatives, the split Congress will be challenged with crafting legislation that garners bipartisan support. Health care issues, including affordability, access and market stabilization remain key areas of focus for Congress in 2019. And, the newly elected Democratic majority in the U.S. House is also expected to support the appeal for a recent judicial ruling in Texas focused on whether the Affordable Care Act (ACA) is constitutional after last year's change to the federal tax law that zeroed out the ACA's individual mandate penalty. See below for additional details as well as some reminders of recent developments that could impact your clients in 2019.

Important Things to Know 

ACA Ruled Unconstitutional - Law Remains in Effect During Appeal

On December 14, 2018, U.S. District Judge Reed O'Connor issued a ruling that determined the ACA is unconstitutional because of last year's change to the federal tax law that zeroed out the ACA's individual mandate penalty. The ruling was in favor of Texas and a number of states in Texas v. United States, which is the most recent in a series of judicial challenges to the ACA. The ruling is expected to be appealed, and the ACA remains in effect. Cigna's full news alert can be read here.

Reminder: Large Employer and Minimum Essential Coverage (MEC) Reporting

Reporting season is just around the corner for annual large employer and minimum essential coverage (MEC) reporting. On November 29, 2018, the IRS announced extended deadlines for 2018 1095 Forms due to individuals, delaying them from January 31 to March 4. No extension was provided for the deadline for filing with the IRS. That deadline remains March 31, if filing electronically, or by February 28, if filing by paper.

Our Reporting Requirements Toolkit provides additional information on these responsibilities. Cigna's ASO PPACA Fees and Reporting team consists of trained service professionals who are available to support self-funded employers with questions regarding these reporting requirements. The team can be reached by calling 855.275.0555, 9:00 a.m. – 6:30 p.m. EST, Monday through Friday, or via email at ASO_PPACA_Fees&

Updated Section 1332 Guidance Increases State Flexibility

On October 22, 2018, the Centers for Medicare & Medicaid Services (CMS) issued updated guidance on Section 1332 waivers, which replaces guidance published in 2015. Under the ACA, states can apply to waive key ACA provisions in order to implement innovative, alternate health coverage rules or programs while retaining basic consumer protections.

The new guidance makes changes to the principles that CMS will use when reviewing and approving applications. While the original “guardrails” that ensure comprehensiveness, affordability, scope of coverage and deficit neutrality will remain in place, CMS will interpret some of them differently in order to loosen restrictions. For example:

  • 2015 guidance: Focused on the number of individuals estimated to receive comprehensive and affordable coverage
  • 2018 guidance: Focuses on the availability of comprehensive and affordable coverage

Beyond the basic guardrails, CMS has identified five new principles that future waiver requests should aim to achieve.

  • Provide increased access to affordable private health plan coverage (including Association Health Plans and Short-Term, Limited Duration Insurance plans)
  • Limit cost increases for consumers and the federal government
  • Foster state innovation
  • Support and empower those in need
  • Promote consumer-driven health care

Changes were also made to streamline the state waiver application process. 

To date, eight states have received waivers. Read our Section 1332 Waivers Fact Sheet for more information.

Proposed Rule Would Allow HRAs to be used with Individual Coverage

On October 23, 2018, the Departments of Treasury, Labor, and Health and Human Services (HHS) issued proposed rules that would allow employees to use the dollars in employer-funded Health Reimbursement Arrangements (HRAs, which are also referred to as Health Reimbursement Accounts) to purchase individual coverage both on and off the public Marketplace (or Exchange). The proposed rule can be read in detail here. Cigna is in the process of analyzing the proposed rules and drafting a comment letter to be submitted to the tri-agencies by the December 28, 2018 deadline.

We encourage you to bookmark Cigna’s health care reform website,, where we continuously update information as it becomes available.