HR-9081-119
Referred to the House Committee on Education and Workforce.
Sponsored by Beth Van Duyne (R-TX)
What it does
This bill would amend the Employee Retirement Income Security Act of 1974 (ERISA) to allow newly defined entities called "health marketplace pools" to be treated as employers for the purpose of offering group health insurance plans. Any organization that forms in good faith to create a risk pool — and does not screen members based on health status — could qualify. Qualifying pools could offer traditional group health coverage, self-insured plans, or drug-only coverage (including over-the-counter drugs), and could serve individuals, employees of member businesses, and their dependents.
Who benefits
Self-employed individuals and gig workers who currently lack access to employer-sponsored group coverage. Small businesses that cannot afford individual group plans but could pool purchasing power with others. Associations, trade groups, and other organizations that want to sponsor health coverage for members. Individuals seeking lower-cost, drug-only coverage plans. Health insurance issuers and third-party administrators who would gain new customers and markets. Dependents of pool members who gain access to group-rate coverage.
Who is hurt
State insurance regulators, who would lose oversight authority over plans that qualify under ERISA's federal preemption — a longstanding tension in insurance law. Insurers operating in the individual and small-group ACA marketplace, who could lose enrollees to these new pools. ACA marketplace enrollees who remain behind could face a less healthy risk pool and potentially higher premiums. Consumers who join pools offering limited or drug-only coverage may find themselves underinsured for major medical events. State consumer protection laws (e.g., mandated benefits) would not apply to ERISA-governed pool plans.
Supporters argue
Supporters argue that millions of self-employed workers and small business employees are priced out of health coverage because they cannot access the group rates available to large employers. By allowing flexible risk pools to qualify as employers under ERISA, the bill would extend group-market purchasing power to these workers — potentially reducing premiums through larger, more diverse risk pools. They contend that the bill's nondiscrimination requirement (no health-status screening for membership) protects against adverse selection while preserving consumer choice, and that drug-only coverage options could serve as an affordable entry point for the currently uninsured.
Opponents argue
Opponents argue that because ERISA preempts state insurance law, these pools would operate largely outside state consumer protections — including mandated benefits, network adequacy standards, and solvency requirements — creating a risk of inadequate coverage or pool insolvency that leaves members with unpaid claims. They contend that allowing healthier individuals to exit ACA-compliant markets into loosely regulated pools would fragment the risk pool, driving up premiums for those who remain — a dynamic seen when similar association health plan rules were expanded under a 2018 DOL rule that was subsequently struck down in federal court for exceeding statutory authority.
Constitutional context
Congress regulates employer-sponsored health plans under the Commerce Clause and the Taxing and Spending Clause. ERISA's broad preemption of state insurance law has been upheld under the Supremacy Clause (Art. VI, cl. 2). Post-Loper Bright (2024), any agency regulations implementing this bill's provisions would face independent judicial scrutiny rather than deference, meaning courts would assess whether implementing rules stay within the statute's boundaries.
Checks and balances
Congress expands the statutory definition of "employer" under ERISA, giving the executive branch (DOL) rulemaking authority to implement the new pool framework; federal courts retain review authority over agency rules under the post-Loper Bright independent-judgment standard, and state regulators retain limited authority over fully insured products within the pools.
Historical precedent
A 2018 Department of Labor rule similarly expanded the definition of "employer" under ERISA to allow association health plans; a federal district court struck it down in 2019 (State of New York v. United States Department of Labor) for exceeding the agency's statutory authority, a ruling that would now be reviewed under the heightened post-Loper Bright standard.