Health Policy Outlook: Key Legislative and Regulatory Changes Impacting Employers

One year after the 2024 elections, the health policy landscape is shifting. Self-funded employers are feeling the effects as they work to control rising healthcare costs. 

The Alliance’s latest webinar featured a panel discussion, where experts Ilyse Schuman and Melissa Duffy broke down why 2025 is a pivotal year for employer-sponsored health coverage and why employer voices are needed now more than ever. 

Additionally, you can watch the webinar here:

Ilyse Schuman is Senior Vice President of Health and Paid Leave Policy at the American Benefits Council, and former chief counsel on the U.S. Senate Health Committee. Melissa Duffy is owner of Duffy Communication Strategies. She previously advised the Wisconsin State Senate on health policy and now champions employer coalitions like The Alliance. 

Keep reading to learn how to stay ahead of policy shifts, protect your bottom line, and advocate for solutions that work for you and your employees.  

Why Getting Involved with Health Policy Matters

Melissa set the stage saying, “We’re at a crossroads. If employers aren’t paying attention, we’re going to miss a significant opportunity to advance healthcare in ways that protect both employers and employees.”  

Now is the time for employers to get engaged. Legislators and regulators are shaping rules that could either reduce healthcare costs or limit necessary flexibility. If employers don’t speak up, decisions will be made without their input. 

The Federal Health Policy Landscape

Ilyse explained how Washington, D.C. looks in 2025 under the Trump administration and a Republican-controlled Congress. 

“When one party controls the White House, the House, and the Senate, you often see big policy changes passed through budget reconciliation,” said Ilyse. “That’s how we got the Affordable Care Act (ACA) in 2010, and the 2017 tax cuts. Most recently, it’s how Republicans passed the One Big Beautiful Bill Act (OBBBA).” 

The OBBBA included sweeping federal changes, some positive for employers:  

Telehealth flexibility was made permanent:

Employers can now cover telehealth on a pre-deductible basis in Health Savings Account (HSA)-eligible plans. This expands access to mental health and rural healthcare.

Direct Primary Care (DPC) coverage:

HSA plans can now cover DPC services pre-deductible, recognizing the high value of primary care.

HSA expansion:

More flexibility for employers and employees to use tax-advantaged accounts.

Tax exclusion preserved:

Proposals to cap or limit the tax treatment of employer-sponsored coverage were defeated, protecting the foundation of the system.

However, site-neutral payment reforms and stronger transparency rules, two changes employers strongly support, did not make it into this bill. This means advocacy on these issues must continue. 

Executive Orders and Regulations

Beyond Congress, the Trump administration has issued directives that impact employers: 

Price transparency:

Building on prior rules, the administration is strengthening hospital price transparency requirements and exploring new rules for group health plans.

Prescription drug costs:

Agencies are directed to lower drug prices, though how that affects employers remains to be seen.

Regulatory relief:

Efforts are underway to simplify or roll back burdensome rules, while still advancing transparency and competition.

Schuman noted, “Some of the most important employer priorities, like transparency and competition, can be advanced through regulation, not just legislation.” 

The State Health Policy Landscape

While federal action is critical, state-level changes often hit closer to home. Melissa walked the audience through Wisconsin’s health policy environment: 

Divided government:

With a Democratic governor and Republican legislature, it is difficult to get bills passed. But when they do, they matter.

Workers’ compensation fee schedule:

A tenuous version was included in the state 2025-2027 budget. Though it only applies to hospital services and depends on future hospital tax revenues.

Pharmacy Benefit Manager (PBM) reform (SB 203):

Employers are concerned this bill tilts too far toward pharmacy benefit managers and drugmakers. Unlike Illinois’ law, Wisconsin’s bill lacks key employer protections like transparency and a ban on spread pricing.

Hospital price transparency bill:

A positive development, giving the state authority to enforce federal transparency rules.

Direct Primary Care bill:

Passed the Assembly with bipartisan support, but was vetoed by Governor Evers. Employers hope to revisit it under a future administration.

Data access legislation:

A priority for employers, this bill would clarify that employers own their claims data and that insurers and Third-Party Administrators (TPAs) must share it when requested.

Melissa emphasized that data is the currency of the future. Employers need access to their data to design high-value health benefit plans and bend the medical cost trend. 

Why Employer Voices Matter

Both panelists drove home a key message: employer engagement in health policy is critical to the future of employer-sponsored health benefits.  

Federal and state policy decisions directly affect costs and employer flexibility, so it is important for employers to tell lawmakers why affordability, transparency, and flexibility matter, for their businesses and for working families. 

At the federal level, employers should support bills like the Employers Deserve Price Tags Act, which guarantees access to claims data, and continue advocating for PBM reform and site-neutral payment policies. 

Employers should get involved at the state level. Melissa noted, “Even one employer voice matters. Multiply that by ten in a legislator’s district, and you have a grassroots movement that’s hard to ignore.” Finally, Ilyse added, “Nothing is as impactful as when a policymaker hears directly from an employer in their own district. Employers are critical stakeholders in this debate.” 

What You Can Do

Consider how different interventions can ripple through an organization: 

• Contact your legislators: A short email or phone call makes a difference.
• Sign on to coalition efforts: Add your organization’s name to letters supporting legislation that benefits employers like price transparency, PBM reform, and data access.
• Join Advancing Free Market Healthcare: Amplify your voice with other employers working toward positive change. This can range from signing letters to attending regional meetings with lawmakers. You can fill out a membership application here.
• Stay informed: Follow coalitions like Advancing Free Market Healthcare, the American Benefits Council, and The Alliance that track policy changes and offer simple ways to get involved.

Now is the time to get involved; use your voice to help shape the future of healthcare. Reach out to The Alliance to join other employers working to move healthcare forward.