With President Trump back in office, healthcare policy is once again shifting—and employer-sponsored healthcare plans are feeling the ripple effects.
From revived ACA rollbacks to new trade tensions affecting drug prices, CFOs and HR leaders are facing a fast-changing environment that demands both agility and long-term strategy. Here’s what you need to know—and what to do next.
The ACA: Looser Rules, More Flexibility (and Uncertainty)
Trump’s second term has brought a return to many of his previous healthcare priorities.
Executive actions and agency moves so far have:
- Softened enforcement of the ACA employer mandate
- Re-expanded short-term, limited duration plans as an alternative to traditional coverage
- Reduced funding for ACA navigation and enrollment support
These shifts create more flexibility for businesses—but also more complexity. With different rules emerging across states, employers with national footprints may find compliance and communication more challenging.
More Leeway on Plan Design and Tax Strategy
The administration is also pushing for broader use of individual coverage HRAs (ICHRAs) and association health plans, giving employers new tools to offer benefits outside the ACA framework. Meanwhile, changes from the Treasury and DOL aim to ease reporting burdens and give businesses more room to customize wellness incentives and benefit designs.
For CFOs, that means opportunities for cost control—but also a need to revisit plan mechanics, documentation, and how changes are communicated to employees.
Tariffs Driving Up Prescription Drug Costs
One of the most immediate pain points? Rising drug costs driven by new import tariffs. Trump’s trade policies have targeted pharmaceutical ingredients and generic drugs from countries like China and India.
The result:
- Sharp price hikes on commonly used medications
- Delays in drug availability
- Increased pressure on PBMs and plan sponsors to adjust
If you're self-insured, those costs hit your balance sheet directly. Even fully insured employers will see pricing ripple effects in renewals.
Now’s the time to:
- Revisit your PBM agreements
- Audit your formulary and specialty drug strategy
- Prepare for higher employee out-of-pocket costs and questions
Direct Care and Value-Based Models Gaining Ground
In response to both policy uncertainty and cost volatility, many large employers are doubling down on:
- Direct primary care networks
- Onsite or near-site clinics
- Value-based payment models tied to outcomes, not volume
These approaches offer more control, better cost predictability, and improved employee access—but they take time to implement and require strong provider partnerships.
How to Stay Ahead
With healthcare shifting again, it’s time for HR and finance leaders to coordinate on a fresh employee benefits strategy.
Here’s where to start:
- Run updated financial models under multiple regulatory and cost scenarios
- Evaluate whether your current plan model (self-funded vs. fully insured) still makes sense
- Review pharmacy benefits to prepare for tariff-related cost changes
- Keep your employees informed—clear communication can help avoid frustration and build trust
Trump’s second term is reshaping the benefits landscape—but not in unfamiliar ways. We’ve seen many of these themes before deregulation, market-driven alternatives, and a preference for business flexibility over federal oversight.
For employers, the challenge now is balancing that flexibility with financial discipline and employee experience. Those who plan ahead and adapt early will be best positioned to manage rising costs and stay compliant in the years ahead.