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A woman fills out paperwork while waiting in a doctor's office. Photo: Jason Connolly / AFP via Getty Images

The Trump administration was set on three primary health insurance ideas when it released its health care executive order last October.

Association health plans: Check. Short-term health plans: Check.

What's next: Health reimbursement arrangements, which allow workers to buy coverage with tax-free dollars.

Background on HRAs:

  • Companies create HRAs as a way to give their employees tax-free money to buy health insurance, instead offering traditional plans themselves.
  • The IRS previously said HRAs did not comply with Affordable Care Act coverage requirements, but the 21st Century Cures Act made it acceptable for small companies to fund HRAs so employees can buy health insurance on or off the ACA marketplaces.

Here's what the Department of Health and Human Services could do:

  • Relax rules so companies of all sizes can take advantage of HRAs. Medium-sized and large employers want the same option of setting up HRAs for workers to buy ACA coverage, said Chris Condeluci, who worked on the ACA as a Senate GOP staff attorney.
  • Now that the individual mandate has been repealed, the administration could open the door for companies "to provide funds to buy noncompliant coverage," said Gary Claxton, a vice president at the Kaiser Family Foundation.

The Trump administration has blown past the 120-day deadline it gave itself to propose new HRA regulations or revise past guidance. HHS did not respond to questions about when something might come.

Looking further ahead: Could this trigger employers to stop offering their traditional coverage and push workers toward the ACA marketplaces or elsewhere? It's possible, especially for companies that have sick employees or are in high-risk industries like logging or construction. The dumping could work the other way as well, Condeluci said, if startups with young workers want fewer benefits headaches.

Big companies may not rush to adopt any potential new HRA options if they don't want to risk an employee revolt. Job-based health plans generally have lower deductibles and more generous coverage than typical ACA plans. "The main reason why employers offer benefits through work is to attract and retain talent," Condeluci said.

The bottom line: This all sounds esoteric, and it is, but expanding HRAs could reshape how people get health insurance from their jobs.

Go deeper

Biden to tap telecom trio for NTIA, FCC posts

Jessica Rosenworcel. Photo: Bill Clark/CQ Roll Call

President Joe Biden on Tuesday is expected to name Alan Davidson as head of the telecom arm of the Commerce Department, Jessica Rosenworcel as chairwoman of the Federal Communications Commission and Gigi Sohn as a commissioner at the FCC, according to a person familiar with the process.

Why it matters: Internet availability and affordability has been a key policy priority for the White House, but the administration lagged in tapping people for the agency posts that oversee the issues.

1 hour ago - Technology

Facebook seeks fountain of youth

Data: Piper Sandler Taking Stock With Teens Study; Chart: Axios Visuals

Facebook CEO Mark Zuckerberg on Monday said that the company is pivoting its strategy to focus on young adults, following reports that teens have fled its apps.

Why it matters: A series of stories based on leaked whistleblower documents suggest the company sees the aging of its user base as an existential threat to its business.

Too big to cover alone: Newsrooms team up

Illustration: Annelise Capossela/Axios

News outlets are increasingly willing to work together on big, multifaceted stories — including this week's reporting on leaked documents from a Facebook whistleblower.

Why it matters: Collaborative efforts help bring more resources to bear on complex stories, some of which require a global reporting effort. But they require high degrees of coordination, and competition can sometimes get in the way.

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