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S1847119th CongressWALLET

Association Health Plans Act

Sponsored By: Senator Paul, Rand [R-KY]

Introduced

Summary

Treat certain employer groups as employers under ERISA so they can offer association health plans under a single federal framework. The bill sets tests for size and governance, allows pooled premium-setting with member-level risk adjustments, and preserves protections against health-status discrimination and pre-existing-condition denials.

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  • Groups that run a group health plan would be treated as an "employer" under ERISA if they meet governance and size rules. The group must cover at least 51 employees and have been in active existence for at least 2 years.
  • Self-employed individuals could join these plans as employer members and as plan participants if they own the business and work at least 10 hours per week (or 40 hours per month). Plan boards must determine initial eligibility and regularly monitor continued eligibility.
  • Plans could pool all participant claims to set a base premium and then actuarially adjust each employer member's contribution using the member's risk profile where state law allows. Plans are barred from eligibility rules or premium differences based on health status and cannot deny coverage for pre-existing conditions.

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 1 benefits, 0 costs, 4 mixed.

Protections for people in association plans

If enacted, association plans could not use health status to deny eligibility or continued eligibility. Plans could not charge higher premiums or contributions based on health status. Plans also could not deny coverage for pre-existing conditions, consistent with current federal law. The bill would also say these plans remain subject to Part 7 of ERISA and the Public Health Service Act protections.

How association plans set premiums

If enacted, association plans could set a pooled, actuarially sound base premium that pools all participants' claims. Plans could then adjust each employer member's contribution up or down for that employer's risk profile. If the plan covers only self-employed members (no common-law employers), the plan would have to pool them as a single risk pool and charge each participant the same rate. These rating rules would apply only to the extent State law allows them.

New rules for self-employed coverage

If enacted, self-employed people could join association plans as both employer-members and plan participants if they meet tests. To qualify they must have no common-law employees, own a business, earn wages or self-employment income from it, and work at least 10 hours per week (or 40 hours per month) providing services. A group's board must check eligibility at enrollment and periodically, and coverage must be suspended for the next plan year if a person no longer meets the tests. A group made only of self-employed people can count as one employer-member only if it has at least 20 self-employed members.

Qualifying association health plan rules

If enacted, a group or association could be treated as the 'employer' for its group health plan if it meets listed rules. The group would need to have a group health plan covering at least 51 aggregated employees, exist at least 2 years, have a formal board with at least 75% employer-member board members, and not be owned or controlled by an insurer. The Secretary could allow alternate regulatory criteria. If enacted, all employees of member employers would be counted together as participants in a single plan for regulatory purposes.

Coverage won't prove employer status

If enacted, simply giving someone association health coverage would not by itself count as proof that an employer or joint employer relationship exists under Federal or State law. Courts and agencies could not use only that coverage as legal evidence in disputes.

Sponsors & CoSponsors

Sponsor

Paul, Rand [R-KY]

KY • R

Cosponsors

  • Sen. Wicker, Roger F. [R-MS]

    MS • R

    Sponsored 5/21/2025

  • Sen. Scott, Tim [R-SC]

    SC • R

    Sponsored 7/15/2025

  • Sen. Scott, Rick [R-FL]

    FL • R

    Sponsored 10/16/2025

  • Sen. Moody, Ashley [R-FL]

    FL • R

    Sponsored 12/17/2025

  • Sen. Banks, Jim [R-IN]

    IN • R

    Sponsored 2/11/2026

  • Sen. Young, Todd [R-IN]

    IN • R

    Sponsored 6/2/2026

  • Sen. Graham, Darline [R-SC]

    SC • R

    Sponsored 9/30/2026

Roll Call Votes

No roll call votes available for this bill.

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