Health insurance is back on the legislative agenda in Washington, with several proposals that could reshape how employers provide coverage to their workers.
Three bills gaining traction in the House aim to overhaul parts of the Affordable Care Act (ACA), expand access to group health plans for small employers and protect the use of stop-loss insurance for self-insured plans.
Here’s a summary of what’s on the table and how it could affect employers.
Health Care Fairness for All Act
Key change: Repeals the ACA employer mandate
Introduced by Rep. Pete Sessions (R-Texas), this bill would eliminate the ACA’s employer health coverage mandate, the requirement that companies with 50 or more full-time employees offer affordable coverage or face penalties.
While the bill removes this mandate, it maintains several popular ACA provisions, including protections for preexisting conditions and guaranteed issue requirements.
To prevent people from enrolling in coverage only after becoming ill, the bill would impose a 20% late-enrollment penalty on individuals who join a plan without maintaining prior coverage for at least 12 months.
Another significant provision is the introduction of “Roth HSAs,” which would replace traditional health savings accounts. Unlike HSAs now, contributions would be made with after-tax dollars, but unlike current HSAs, they could be paired with low-deductible plans and not only high-deductible health plans.
Association Health Plans Act
Key change: Allows small businesses to band together for group health insurance
Backed by Rep. Tim Walberg (R-Mich.) in the House and Sens. Roger Wicker (R-Miss.) and Rand Paul (R-Ky.) in the Senate, the AHPA would revive and expand rules allowing small employers and self-employed individuals to purchase health insurance as a single group.
By pooling together, these employers could access large-group health plans that often offer better rates and more plan options than small-group or individual plans. Supporters argue this would increase access to affordable coverage for millions of workers who currently lack employer-sponsored insurance.
Self-Insurance Protection Act
Key change: Shields stop-loss insurance from state and federal regulation
This bill, introduced by Rep. Robert Onder (R-Mo.), aims to preserve small employers’ ability to self-insure their group health plans by protecting stop-loss insurance arrangements from being classified or regulated as traditional health insurance. Some states have attempted such reclassification to restrict their use among small employers.
Stop-loss insurance reimburses self-insured employers for catastrophic claims beyond a certain threshold. These arrangements make self-funding viable even for smaller businesses with less predictable health care costs.
Proponents say the bill levels the playing field for small employers that want to use self-insurance to control costs. Detractors argue that such plans, when not subject to the same rules as fully insured policies, may not offer sufficient consumer protections or minimum benefits.
The takeaway for employers
Currently, all three bills are awaiting a hearing in the House Education and Workforce Committee, and as of this writing, there have been no votes on the measures.
If these bills gain momentum, employers — especially smaller ones — could see more flexibility and options when it comes to providing health benefits.
While these bills still face political hurdles, they signal where health policy may be headed and what strategies employers may want to prepare for in the years ahead.
