S.2086 - Health Marketplace for All Act of 2025 (119th Congress)
Summary
The Health Marketplace for All Act of 2025 (S.2086) aims to amend the Employee Retirement Income Security Act (ERISA) of 1974. It seeks to allow health marketplace pools to be considered as employers under ERISA, enabling them to offer group health plans and insurance coverage. This includes the possibility of offering plans that cover only prescription or non-prescription drugs.
The bill outlines requirements for health marketplace pools, including non-discrimination in membership based on health status. It also addresses the establishment and operation of these pools in different geographic areas. The Act clarifies that participation in these pools does not automatically establish an employer or joint employer relationship under federal or state law.
Ultimately, the bill intends to expand access to group health plans and insurance coverage through health marketplace pools, potentially affecting individuals, employers, and health insurance issuers.
Expected Effects
The primary effect of this bill would be to broaden the definition of "employer" under ERISA to include health marketplace pools. This change would allow these pools to offer group health plans and insurance coverage, potentially increasing access to healthcare for individuals and small businesses.
It could also lead to the creation of new health insurance products and services tailored to the needs of pool members. The bill's provisions regarding drug coverage could specifically impact access to prescription and over-the-counter medications.
However, the actual impact will depend on the implementation and adoption of these health marketplace pools by various entities and the specific regulations that are developed.
Potential Benefits
- Increased Access to Healthcare: By allowing health marketplace pools to offer group health plans, more individuals, especially those not traditionally covered by employer-sponsored plans, may gain access to health insurance.
- Potential for Lower Costs: Pooling risk across a larger group could lead to lower insurance premiums for members of the health marketplace pools.
- Flexibility in Coverage Options: The bill allows for the possibility of offering drug coverage as the sole benefit, which could be beneficial for individuals with specific medication needs.
- Administrative Efficiencies: Health marketplace pools can provide administrative services, such as accounting and billing, potentially reducing the burden on small businesses and individuals.
- Promotes Competition: The establishment of multiple health marketplace pools in a geographic area could foster competition among insurers, potentially leading to better coverage and lower prices.
Potential Disadvantages
- Potential for Adverse Selection: If healthier individuals opt out of the pools, the risk pool could become skewed towards those with higher healthcare needs, potentially driving up premiums.
- Complexity and Regulatory Burden: Establishing and maintaining health marketplace pools could involve complex regulatory requirements, potentially discouraging participation.
- Limited Coverage Options: While the bill allows for drug-only coverage, it may not meet the comprehensive healthcare needs of all individuals.
- Potential for Market Instability: The introduction of health marketplace pools could disrupt existing insurance markets, potentially leading to instability.
- Lack of Portability: Coverage obtained through a health marketplace pool may not be easily portable if an individual moves to a different geographic area or changes employment.
Constitutional Alignment
The bill's alignment with the US Constitution is primarily related to the Commerce Clause (Article I, Section 8), which grants Congress the power to regulate interstate commerce. Health insurance and healthcare markets are generally considered to fall under this purview.
The bill does not appear to infringe upon individual liberties or rights protected by the Bill of Rights. It aims to expand access to healthcare, which could be argued to promote the general welfare, as stated in the Preamble of the Constitution.
However, the extent to which the bill aligns with principles of federalism could be debated, as it involves federal regulation of health insurance markets that are also subject to state regulation.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).