The arrival of each new year brings a fresh slate of opportunities and challenges. As individuals, we may pledge to lose weight, read more or spend quality time with family and friends. For employers, it’s a time to revisit goals and policies, as they strive for success in the coming year.
Change is a constant in life and business, necessitating ongoing reassessment and retooling. Nowhere is this truer than in healthcare. As costs continue to rise — and employees increasingly turn to their employer to help them navigate the complex healthcare landscape — HR and benefits professionals are laser-focused on improving their company’s healthcare strategies. This task is compounded when there’s a changing of the guard in Washington, D.C. Employers will have to consider the priorities of the new administration and the impact anticipated legislative changes could mean for their organization.
A variety of healthcare regulations were issued in 2024. In September, for example, the Biden administration issued a Final Rule clarifying requirements on health plans to provide coverage for mental health and Substance Use Disorder (SUD) care on the same level as physical health benefits as required by the Mental Health Parity and Addiction Equity Act of 2008. The new rule took effect in January, although some requirements won’t be implemented until 2026.
There are also legislative changes taking effect at the state level. In New York, for example, the new paid prenatal leave policy mandates that privately employed pregnant New Yorkers be provided with an additional 20 hours of paid sick leave for physical exams, testing, medical procedures and other prenatal care.
Looking ahead
As we look to the next four years, we anticipate changes to healthcare regulation and new legislation representing a continuation of policy priorities from the first Trump administration, including hospital and health plan price transparency, allowing Medicare to negotiate prescription drug prices and providing states flexibility in Medicaid and ACA reforms, including reinstating prior policies on enrollment timelines, outreach efforts and enrollment support.
The administration appears focused on chronic disease, which is a primary driver of healthcare cost increases. Interestingly, many employers have already been focusing on some of these very issues, investing in strategies that have been proven to show long-term positive health outcomes. Recognizing the value of preventative care, for example, employers are promoting annual exams, mammograms, colonoscopies and other preventive screenings to aid in the early detection of cancer and other conditions.
Many employers are covering or considering covering GLP-1 drugs for obesity due to their potential to reduce the risk of heart disease and other related health problems down the road. And since COVID revealed the prevalence of Alcohol Use Disorder (AUD), employers have been expanding their support for individuals struggling with the breadth of Substance Use Disorders through no-/low-cost telehealth, digital programs, and many are even considering expanded out-of-network coverage according to Business Group on Health’s 2025 Large Employer Health Care Strategy Survey.
Additionally, the survey found employers are highly focused on increasing access to mental health services by providing more options for support, including digital solutions as well as working with health plans to expand their mental health networks. Other priorities include managing rising pharmacy costs, especially expensive medications and treatments, as well as chronic conditions such as cancer.
Staying the course
The healthcare agenda for the new administration is just starting to take shape. As we wait for those policies that could impact employer-sponsored health plans, it is crucial to stay focused on helping employees navigate their personal health journeys.
All too often, employees don’t know what benefits they have, much less how to utilize them for the best clinical outcome and cost savings. Our 2024 Alight International Workforce and Wellbeing Mindset Report reveals that 39% of employees don’t fully understand the benefits available to them. Consequently, they don’t feel confident when using their benefits. What’s more, nearly 60% regretted a healthcare decision in the last year, often because they rushed into treatments without asking the right questions or took advice from someone who was not a healthcare professional. Other times, they delayed or forewent necessary treatments because of the cost.
It is incumbent upon employers to simplify the experience, address accessibility and provide decision-making support so employees can unlock the full value of their benefits. By connecting employees to the right resources and delivering personalized support, employers can guide their people toward affordable, high-value care, while giving them the confidence to make decisions that will result in lower costs and better-quality outcomes.
While technology is playing an increasingly important role in delivering targeted, timely resources and recommendations, it is merely the enabler. The guidance, empathy and high-touch support delivered by highly trained experts is key to empowering employees and their families to navigate the healthcare system. As we begin to see anticipated changes in healthcare legislation become reality, it will be even more crucial to ensure employees are given the tools and resources they need to understand and utilize their benefits to the greatest advantage.
