By Suzanne D’Amato, Employee Benefits Attorney – Hilb Group

National Practice Leader, EB Compliance

November 21, 2025

• President-elect Trump

• Senate – R’s have 3-seat majority

• House of Representatives – R’s control

Pre-election:  214D – 221-R

Post-election:  215D-220-R

• The filibuster requires 60 votes to overcome procedural objections in the Senate and pass most legislation in the Senate

• Both parties have discussed modifying or eliminating it when their parties have the majority, to date the only exceptions are for judicial nominations and some budget bills

• President-elect Trump previously pressured GOP lawmakers to get rid of the filibuster and may push to get rid of it to make it easier to pass legislation through the Senate

• Mitch McConnell, John Thune and other Senate Republicans have indicated they are not in favor of eliminating the filibuster, stay tuned

• If filibuster remains, the Senate will have to use workarounds (e.g., reconciliation) to pass legislation without 60 votes

• Two Republican factions with different views of the role of government

• Establishment Republicans typically support pro-business, small government ideology

• Populist Republicans including President-elect Trump support government intervention to address certain issues

• Despite his campaign’s emphasis on deregulation, some of his healthcare policies introduce more government oversight could be problematic for GOP traditionalists

• President-elect Trump’s campaign has not released a specific plan for his agenda for the first 100 days in office

• A key priority appears to be preparing for an extension of the Tax Cuts and Jobs Act, 2017, due to expire in 2025

• ACA repeal and replace unlikely–modifications more probable

• Four themes emerged from the campaign:

o Enhance flexibility and choice in healthcare to states and individuals

o Focus on deregulation by reversing or modifying Biden-era policies

o Enhance national security with “America first” principles

o Promote access to healthcare via market competition and transparency

• Reproductive healthcare

o Supports state control over abortion services to reflect local values

o Proposed free access to in vitro fertilization (IVF) treatments

• Medicaid

o May seek to impose work requirements, change eligibility thresholds, or establish flexible accounts for healthcare payment

o Increased state flexibility

• Medicare

o Promised to safeguard Medicare, no funding cuts, no increase in eligibility age

o Pledged to increase price transparency, strengthen efforts to address waste, fraud, and abuse within the system

• ACA Marketplace

o Support for marketplace ‘risk pools’ that would place individuals with high costs into a separate risk pool

• Expect to see President-elect Trump reverse or modify regulations put in place by the Biden administration.

• Potential targets include policies aimed at promoting health equity, providing transgender healthcare, and advancing women’s health.

• Address drug shortages and lack of domestic production of medication.

o Revoke China’s Most Favored Nation status.

o Phase out imports of essential goods from China.

o Incentivize US companies to manufacture critical goods domestically.

• Use taxes and tariffs to decrease reliance on foreign nations, mitigate drug shortages and secure supply chains.

o Tariffs on foreign-made goods.

o Lowering tax rate from 21% to 15% for companies producing goods domestically.

• Transparency requirements for health plans and insurers were introduced in first Trump administration.

o Online consumer price transparency tool

o Gag clause prohibition

o No Surprises Act

• Expand options for coverage through short-term, limited duration insurance, association health plans, ICHRAs.

• Expect to see further efforts to increase transparency, encourage competition, broaden access to affordable healthcare – details TBD

• A “lookback” mechanism that allows Congress to strike down regulations issued by federal agencies

• Not used often as it must be passed by both chambers of Congress and signed by the president

• Voids agency rule and the rule cannot be issued in “substantially the same form” in the future

• Estimated lookback period will begin August 1, 2024

• Could void the Final Mental Health Parity Regulations (issued September 9, 2024)

• Congress in a 5-week post-election lame duck session with pressing issues to be resolved

• Continuing Resolution expires December 20th

• Possibility healthcare legislation gets tacked onto a must-pass bill (e.g., extension of the telehealth relief for HSAs)

• Likely to pass another continuing resolution to avoid shutdown and then tackle budget bill under Republican majority

• Senate judicial confirmations are top Democratic priority

• Tax policy will be high priority as key provisions of TCJA expire December 2025

• Republican leaders say passing major tax bill is a top priority in the first 100 days of the Trump administration

• TCJA increased the standard deduction/eliminated personal exemptions, lowered marginal tax rates, increased child tax credit, provided a 20% deduction for pass-through income for small business income, increased the alternative minimum tax (AMT) exemption, doubled estate tax exemption

• Inflation Reduction Act extended enhanced subsidies for marketplace coverage

• Large group of House Republicans issued a budget proposal that would cap the employee tax exclusion for employer-provided benefits

• Cap the tax exclusion at an unspecified level

• Repeal the ACA’s tax increases, reduce “regulatory mandates”

• Give states more leeway to pursue healthcare reforms

• Liberalize rules governing HSAs

• Expand association health plans

• Strengthen application of federal antitrust laws to health insurance industry

• Drug pricing and PBM reform

• Health price transparency

• HSA reforms

• Telehealth extension

• ACA reporting requirements

• Bipartisan support to reform PBMs by:

o Mandating semiannual PBM reports to plan sponsors detailing information on rebates, drug spending, total out-of-pocket spending, and formulary

o Mandating PBMs and TPAs disclose information about compensation to plan fiduciaries

o Banning PBMs from “spread pricing”

o Requiring PBMs to pass through all rebates, fees and discounts directly to health plans

o Limiting use of step therapy for prescription drugs

o Regulating pharmacy networks

• Bipartisan support to reduce the cost of drugs by:

o Accelerating the process of getting generic drugs to market

o Capping out-of-pocket costs for insulin in employer plans

• Strengthen current price transparency rules for health plans and hospitals

• Require new TiC rules for services like diagnostic lab tests, imaging, and hospital-owned ambulatory surgery centers

• Amend the gag clause provision to improve access to cost and quality-of-care data

• Other bills ban hospital facility fees for telehealth and other services, bar anticompetitive contract provisions

• Two bills approved by House Ways & Means in September 2023

o Expand the ability to contribute to HSAs and the services that HSAs can be used to pay for

o Eliminates a prohibition against an individual contributing to an HSA if their spouse has an existing health flexible spending account (FSA)

o Permits individuals to rollover unused FSA and HRA funds to an HSA

• New legislation introduced in July 2024

o Allows HSA contribution if covered by any health coverage, not just HDHP

o Increases contribution limits to $8,550 self-only/$17,100 family

• Bipartisan bills would make permanent relief allowing HDHPs to cover telehealth services on a

pre-or no-deductible basis

• Congress may grant temporary extension

• Without an extension, relief expires Dec. 31, 2024 (CY plans) and at the end of the current plan

year for all others

• Two bills with bipartisan support to watch streamline reporting requirements

• Modifies ACA so employers are no longer required to send 1095-B/C forms provided its website

contains a notice that paper copies are available upon request

• Allows employers to substitute a covered individual’s birthdate for their TIN and provides employers

90 days (vs. current 30 days) to respond to IRS for alleged violations

•Regulators are working to complete the Biden administration’s policy agenda by issuing new rules

• Rules may be struck down by the Congressional Review Act, others may be rolled back by the new administration if they have a different agenda

• Recently released rules that might be impacted include:

o HIPAA Privacy Rule to Support Reproductive Health Care Privacy

o MHPAEA – final rules regarding NTQLs

o Proposed Rules requiring plans cover over-the-counter (OTC) contraceptive items/services without cost-sharing, and without prescription

o IRS Notices regarding contraception and other preventive care, which treat condoms as medical care and allow HDHPs to cover OTC oral contraception and condoms prior to the deductible without affecting HAS eligibility

• Subsidies / tax credits for exchange coverage matter to employer plan sponsors

• Bipartisan legislation is currently pending in Congress on topics including PBM reform, price transparency, and provider billing reforms

• Republicans tend to be more supportive of giving authority to states rather than expanding federal programs

• Tax legislation could include a proposal to limit the employee tax exclusion for employer-provided coverage

• Keep an eye on Congress to see if they extend the telehealth relief for HDHPs before December 31, 2024

• Any other provisions in a year-end healthcare package will likely be effective in 2026 or later

The information presented here should not be construed as legal or tax advice. The contents are intended for general informational purposes only and are current as of the date presented. You should consult with a qualified legal or tax professional of your choice who is familiar with all the facts of your situation before making a decision about any legal or tax matter.