Association Health Plan Regulations Invalidated

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The U.S. District Court for the District of Columbia has set aside the most significant portions of the U.S. Department of Labor's (DOL) regulations on Association Health Plans (AHPs). The court's ruling invalidates regulatory provisions that sought to broaden the groups of employers that could be treated as if they were a single employer, allowing them to establish health plans that did not need to meet certain Affordable Care Act (ACA) requirements. The ruling will very likely be appealed, but may—at least temporarily—dampen interest in AHPs, particularly among groups of employers that are loosely affiliated.

Although the court characterized the regulations as an "end-run around the ACA," the decision is grounded mostly in the Employee Retirement Income Security Act (ERISA). The regulations themselves sought to expand the scope of AHPs by amending ERISA's definition of "employer." That definition includes an association of employers acting in the interest of those employers in relation to an employee benefit plan. While giving deference to the DOL's authority to interpret ERISA, the court found the new regulations to be unreasonable in view of ERISA's focus on benefit arrangements that arise in the context of an employment relationship.

The court found that the new regulations did not adequately distinguish AHPs from commercial insurance arrangements. Specifically, it ruled that:

  • Although the regulations formally required associations to have a substantial purpose beyond the establishment of a health plan, the regulations recognized purposes with little substance, such as the issuance of a newsletter.
  • The regulatory provisions inappropriately recognized employers in the same state or metropolitan area as having a commonality of interest, when such geographic connections often do not create much of a connection among employers.
  • Sole proprietors, which are not considered to be employers under ERISA on their own, do not become employers simply by associating with other sole proprietors or organizations that employ individuals.

The ACA remains a battleground with various states filing lawsuits to stop Trump administration efforts to cut back ACA programs and their effect, while other states seek to overturn the ACA completely. Last week saw two other developments as the Trump administration fully aligned its position with those states that claim that the ACA should be overturned in its entirety as unconstitutional, and the D.C. District Court found that the state of Arkansas could not require individuals to meet a work requirement to qualify for Medicaid—which the state had previously elected to expand under the ACA.

 

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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