The U.S. Capitol rotunda in Washington. Credit: Diego M. Radzinschi/ALM
Sen. Rand Paul has reintroduced a bill that could let any membership organization provide a self-insured, multi-state health plan.
The Kentucky Republican, who is a medical doctor, brought back the Health Marketplace for All Act bill.
Recommended For You
The federal Employee Retirement Income Security Act of 1974 lets large employers escape from state benefits mandates by setting up self-insured health plans that are exempt from state mandates and regulated by the U.S. Labor Department's Employee Benefits Security Administration.
Association health plans (AHPs) are arrangements that may let small employers and, in some cases, individuals join to form and get health coverage from self-insured health plans. The federal rules governing association health plans have been complicated and quick to change.
Rand's new bill, which was introduced last week, would classify any group that sets up a "health marketplace pool" as an "employer" for purposes of applying the ERISA rules that let large employers set up self-insured health plans.
The bill would prohibit a health marketplace pool from discriminating against would-be members based on any health status-related factor.
The bill would not affect a health insurer's ability to use medical underwriting.
Paul introduced a similar bill in 2022.
Related: Association health plans: A favorite GOP approach poised for comeback
Paul is the only sponsor of the new bill and was the only sponsor of the 2022 bill. The 2022 bill died in committee.
Supporters of association health plans and similar arrangements say they can help the members free themselves from state requirements that drive up the costs.
Opponents argue that the arrangements will weaken the fully insured group insurance market, by luring away the healthiest individuals and groups.
Congressional Budget Office analysts have estimated that another association health plan bill introduced in the House could lead to about 600,000 people having AHP coverage.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
