State Options to Protect Consumers and Stabilize the Market

An analysis examines how association health plans (AHPs) could be regulated under an Executive Order and what states can do to protect consumers.

The Issue

Current federal rules require insurance sold through associations to comply with the Affordable Care Act's (ACA) suite of consumer protections, but an Executive Order suggests that the federal government will allow more AHPs to be regulated as large-employer health plans, meaning AHPs could become exempt from ACA protections that apply to small-group and individual market insurance.

Key Findings

If exempt, AHPs could experience limits on:

  • Premium rate increases for individuals and employers based on their health status;

  • The requirement to offer essential health benefits.


The Administration also signaled that it may preempt state laws as they apply to certain AHPs, limiting the ability of states to regulate these plans. The report authors provide a range of options for state regulation of AHPs under two scenarios (1) state regulation is not preempted, and (2) state regulation is preempted, but states retain some authority to regulate AHPs' financial solvency.


About Georgetown's Health Policy Institute–Center on Health Insurance Reforms

The Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute is a nonpartisan, expert team of faculty and staff dedicated to conducting research on the complex and developing relationship between state and federal oversight of the health insurance marketplace.