Realtors, small-business witnesses urge Congress to restore association health plans

Witnesses testifying before the House Education and Labor subcommittee described association health plans and other employer-driven alternatives as tools that helped some self-employed workers and small employers obtain lower deductibles, broader networks and, in some cases, cheaper premiums.

Angela Shields, chief executive officer for Tennessee Realtors, told the subcommittee that a realtor-sponsored AHP the association created in 2019 offered ‘‘comprehensive health coverage for preexisting conditions’’ and included all 10 of the Affordable Care Act’s essential health benefits. ‘‘We did not negatively affect the ACA markets,’’ Shields said. She said the program reduced deductibles and kept members with their existing doctors.

Supporters said the 2018 federal rule that expanded AHP availability produced measurable savings while it was in effect and that subsequent litigation and a federal regulatory reversal forced many groups to end plans their members relied on. ‘‘While the [Trump-era] rule was in effect, new AHPs produced savings of up to 29% on average,’’ Shields said, adding that realtor-sponsored plans saw average savings in the mid-teens.

Why it matters: witnesses and members framed AHPs and similar arrangements as market-based options that can increase choices for small employers and self-employed people who often lack access to employer-sponsored coverage. Proponents argued such options help small firms compete for workers and reduce out-of-pocket exposure for employees.

Details from testimony and questions: Marcy Strauss, a benefits consultant who testified on behalf of the National Federation of Independent Businesses, described stop‑loss (reinsurance) and level‑funded arrangements that let small employers self‑insure while limiting catastrophic exposure. Strauss said one two-person client saved about $17,500 over three years after moving to a level‑funded plan and purchasing stop‑loss protection. She warned that state rules classifying stop‑loss as fully insured could make these options impractical for small employers.

Committee members asked witnesses whether AHPs competed with the ACA marketplace and how recent expansions of premium subsidies under the American Rescue Plan and Inflation Reduction Act affected the marketplace. Shields said members chose plans because of lower deductibles, broader networks and coverage of preexisting conditions; she added that many of her association’s members had been uninsured or obtained coverage through a spouse before the AHP was available.

Bills discussed: lawmakers and witnesses cited the Association Health Plan Act (legislation to restore or expand AHP access) and the Self Insurance Protection Act (which would clarify federal preemption and the regulatory status of stop‑loss insurance). The hearing also referenced Chairman Wahlberg’s Telehealth Benefit Expansion for Workers Act and other proposals to preserve ERISA preemption and promote innovative coverage models such as direct contracting and direct primary care.

What was not decided: the hearing was a fact‑finding and oversight event; no committee votes or formal actions were taken on the bills discussed.

Ending: Witnesses urged Congress to act to preserve or restore AHPs and stop‑loss protections and to protect small‑business access to innovative plan designs, while several committee members signaled interest in pursuing legislation to expand choices for small employers and self‑employed workers.