Spence v. American Airlines: Expanding the Playing Field for Fiduciary Liability?

I have described the likelihood that, in a post-ACA world, the federal government will step back and the states will have more flexibility and responsibility. The next key player in this equation is the insurance industry.
The ACA created a substantial web of requirements and prohibitions that applied to insurance companies—including rules requiring that carriers insure all applicants, that premiums could not vary based on applicants’ health status, that (in effect) younger applicants subsidize the cost of older applicants, and that limited the companies’ profits from health insurance.

If the federal government reduces its role in US health insurance markets in the post-ACA world, many of the rules imposed on insurance companies by the federal government under ACA will be eliminated or reduced. For example, the ACA contains rules on benefits that must be covered by individual and small group insurance policies and rules limiting insurance carriers’ ability to underwrite policies based on preexisting conditions. In a post-ACA world with a diminished federal role, regulation of insurance companies will be a state matter—which was the status of these areas before the enactment of ACA.

The role of the federal government will decrease in other ways. For example, federal subsidies to enable lower- and middle- income to purchase health insurance are likely to be scaled back, converted to tax credits or eliminated.