In March 2010, new federal laws were enacted that will bring about significant changes to the U.S. healthcare system. Employers, individuals, health plans, and other stakeholders will be affected by this new legislation. In this Healthcare Reform Briefing Paper, Milliman lists some strategic decisions confronting employers—both in the coming years and right now. Employers, for example, must carefully weigh desired changes to their healthcare programs with the impact of losing grandfathered status if those changes are outside the ranges of allowed grandfathered changes. They must make decisions regarding dependent coverage, lifetime and annual benefit limits, changes to medical savings accounts, and more. In the coming years, employers will need to think about levels of benefits to offer, how to control costs and manage employee health, various new reporting requirements.