"We support congressional action to bolster health coverage options for small businesses," the NAIC officers write in the letter. "But we remain opposed to legislation that would preempt state authority to regulate small group insurance."

NAIC officers say they can support the approach Sen. Mike Braun, R-Ind., took in a Multiple Employer Arrangement Act bill that was introduced in 2023. That bill, which died in committee, would have codified the traditional understanding that AHPs are multiple employer welfare arrangements, or MEWAs, and that state insurance regulators can regulate AHP solvency.

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The Braun bill would have also forbidden AHPs from denying applications for coverage based on an individual's health status or basing an individual's premiums on the individual's health status.

NAIC officials say they oppose another AHP bill introduced in 2023, the Custom Health Option and Individual Care Expense Arrangement Act, which passed in the House but failed to advance in the Senate.

Other AHP language considered in the House "would upend the longstanding authority of states to protect consumers and markets," the NAIC officers contend. "State regulation brings important protections; state regulations establish standards to prevent underfunded AHPs from defaulting on valid claims and protect against risk shifts that raise prices in a state's small group market."

In 2018, during President Donald Trump's first term in office, the U.S. Labor Department adopted AHP regulations that would have confirmed that AHPs were MEWAs and were subject to state regulation, the NAIC officers note.

The list of officers who signed the letter includes Jon Godfread, the North Dakota insurance commissioner and the NAIC's president; Scott White, the Virginia insurance commissioner and NAIC president-elect; Elizabeth Kelleher Dwyer, the Rhode Island insurance director and NAIC vice president; and Jon Pike, the Utah insurance commissioner and NAIC secretary-treasurer.

In the letter, the NAIC officers also ask Congress to extend the current, high level of Affordable Care Act premium tax credit subsidies, also known as the "enhanced premium tax credits"; keep new federal pharmacy benefit manager laws from preempting state PBM authority; and provide what the states see as full funding for their Mental Health Parity and Addiction Equity Act enforcement programs.