Congress could consider PBM reform, gig worker benefits

Congress is on recess after passing the “big beautiful bill” in early July, but a few health and retirement-related issues are expected to come before lawmakers when they get back to work in September.

Geoff Manville, partner in Mercer’s law and policy group, gave a rundown of some issues Congress is expected to take up later this year during a recent webinar.

Congress still has not acted to extend enhanced tax subsidies that enable consumers to buy health coverage on the Affordable Care Act exchanges, he said. Those enhanced credits will expire at the end of the year unless Congress renews them. In addition, congressional Republicans are discussing whether to introduce another reconciliation bill either this fall or next spring. “It’s hard to know whether that will get traction,” he said.

Some bipartisan health-care reforms from the last Congress are awaiting action, and Manville said that while Republicans want to revive the package of bills that lawmakers came close to passing in the last sessions, Democrats want to add extended ACA subsidies to the bill.

Among the health-care issues that Congress could take up are:

• Pharmacy benefit manager reforms. This includes extensive disclosure of business practices to plan sponsors and the government, a ban on “spread pricing” in Medicaid, and delinking list drug prices and PBM compensation in Medicare.
• Provider and hospital billing reforms. This would require hospital outpatient departments to provide unique identifiers on all bills, ban hospital facility fees for certain services, and implement site-neutral payment reforms in Medicare.
• Price transparency. This would codify rules requiring disclosure of out-of-pocket costs and ensure plan sponsors can obtain cost data from vendors.

“Getting this package over the finish line will require some cooperation from Democrats,” Manville said. He noted that Congress must take up a bill that keeps the government funded, and that funding bill could be a potential vehicle for health care reforms.

Pending bills in Congress take aim at benefits

Several pending bills aim to encourage benefits for independent contractors and gig workers, Manville said. These proposals aim to decouple the availability of benefits from a worker’s classification and promote portable benefits. Among them are:

• Association Health Plans Act. Would permit unrelated businesses and self-employed individuals to obtain coverage through association health plans.
• Independent Retirement Fairness Act. Would encourage pooled employer plans for independent contractors and direct the Treasury and the Department of Labor to set up pilot programs to promote the use of PEPs and 401(k) plans for gig workers.
• Unlocking Benefits for Independent Workers Act. Would remove the employer provision of benefits from federal worker classification tests to encourage benefits and new benefit platforms for independent contractors and gig workers.
• Modern Worker Empowerment Act. Would change the Fair Labor Standards Act test to determine worker classification as an employee or independent contractor; would generally make it easier for workers to be classified as independent contractors.
• Modern Worker Security Act. Would allow companies to voluntarily provide portable benefits to independent contractors without risk of those workers being classified as employees.

All quiet on the retirement front

This year has been relatively quiet on the retirement legislation front, Manville said.

The big beautiful bill made no changes to employer-sponsored retirement plans, but Congress is gathering ideas for its next package of laws, he said.

Republican lawmakers are focusing on DOL practices, plan litigation and investments, including the following:

• Employee Benefit Security Administration Investigations Transparency Act requires DOL reports to Congress on the status of investigations.
• Balance the Scales Act requires DOL to disclose information given to plaintiffs.
• Protecting America’s Retirement Savings Act restricts investments in foreign adversary nations.
• Financial Freedom Act clarifies that the Employee Retirement Income Security Act does not limit particular investment options.
• Protecting Prudent Investment of Retirement Savings Act aims to curb environmental, social and governance investing.

There is also renewed effort in Congress to let 403(b)s invest in collective trusts, Manville said. The Retirement Fairness for Charities and Educational Institutions Act of 2025 would amend securities laws to let 403(b) plans invest in collective investment trusts and unregistered insurance company separate accounts.

Congress is considering ideas for a potential SECURE 3.0 package. Manville said provisions under consideration include lowering plan eligibility age to 18, encouraging adoption of automatic re-enrollment and simplifying plan-to-plan rollovers.

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].