Tag Archives: association health plans

Judge strikes down association health plans

From The PBS News Hour, click here for the full article:

WASHINGTON — A federal judge has struck down a small-business health insurance plan widely touted by President Donald Trump, marking the second setback in a week for the administration’s health care initiatives.

U.S. District Judge John D. Bates wrote in his opinion late Thursday that so-called “association health plans” were “clearly an end-run” around consumer protections required by the Obama-era Affordable Care Act.

On Wednesday, another federal judge blocked the Trump administration’s Medicaid work requirements for low-income people.

The plans at issue in Bates’ ruling Thursday allow groups of small businesses and sole proprietors to band together to offer lower-cost coverage that doesn’t have to include all the benefits required by the ACA, often called “Obamacare.” They also can be offered across state lines, an attempt to deliver on a major Trump campaign promise.


On January 4, 2018, the U.S. Department of Labor (DOL) announced proposed rules to expand the
opportunity to offer employment-based health insurance to small businesses through Association
Health Plans.

On June 19, 2018, the Trump Administration released a final rule as well as a fact sheet on the new rule.
The rule was in response to an executive order issued by President Trump on October 12, 2017 directing
federal agencies to expand the availability of AHPs, short-term limited duration insurance policies and
Health Reimbursement Arrangements. The proposal calls for a revision to ERISA in order to redefine
“employer” to allow more groups to qualify as associations and treat health coverage sponsored by an
employer association as a single group health plan that would not be subject to the ACA’s ten essential
health benefits required in the consumer and small group markets.

The goal of the Administration’s rule is to provide small-business owners, employees of small businesses and
family members of working owners and their employees with more coverage options, more affordable pricing,
enhanced ability to self-insure, less regulatory burden and complexity and reduced administrative costs.

Under the final rule, self-employed individuals, sole proprietors and common-law employees would be
permitted to join an AHP.
The final rule does say that there must be at least one other service, e.g., education, offered to members
so that the association cannot solely exist to provide health insurance. Allowing the self-employed without
employees to join is beneficial as they were excluded in 2014 when they could no longer get group coverage,
but there is a risk of anti-selection. It was suggested that they should have one open enrollment season to
avoid any anti-selection. Although the final rule does not mandate one enrollment period, it does allow the
association to incorporate the suggested rule.

State laws are not preempted, which means the final rule will apply to them.

New York State DFS (New York State Department of Financial Services) has reported that the Trump
Administration’s final rule expanding the role of association health plans won’t prevent its authority to
regulate health insurance.

New Jersey DOBI (New Jersey Department of Banking and Insurance) has reported that it will not allow
non-compliant plans.

Delaware currently allows a Delaware-based employer to participate in an association plan from another
state if that state allows it and the Delaware group is a member of that association.

Blue States fight Association Health Plans

At least two states (Massachusetts and New York) are threatening to sue the Trump administration over this new rule…. In several states, group health insurance laws will need to be revised to permit individuals and small groups to participate in AHPs if they are not otherwise members of pre-existing tax-qualified bona fide associations…. Many states do not permit the inclusion of sole proprietors and individuals in group insurance arrangements.

This may shape up as a battle between Federal and State rights, Liberals and Conservatives.  In any event, no state to our knowledge has yet to approve any association health plans.


From Crains:  “The state Department of Financial Services said Tuesday that the Trump administration’s final rule expanding the role of association health plans won’t preempt its authority to regulate health insurance. ”  DFS Superintendent Maria Vullo said in a statement. “As always, DFS will enforce New York law and regulation to ensure consumers continue to enjoy the state’s robust health care consumer protections.” State officials and insurance experts have expressed concern that the expansion of association health plans will attract healthier customers seeking cheaper, less comprehensive coverage. That would leave behind a sicker pool of people seeking coverage in the state’s small-business and individual markets, which would lead to insurers’ raising prices for all customers.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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