Association Health Plans

Position
ANA opposes association health plans (AHPs), which will remove guarantees of access to Advanced Practice Registered Nurses (APRNs), and will harm consumers.

  • The vast majority of patient protection and access laws have been enacted at the state level. Therefore, health plans that bypass state insurance laws are not forced to meet important consumer protections such as malpractice laws that allow insurance plans to be sued for harmful denials of health care coverage.

  • These types of plans have a history of fraud and undercapitalization. An experiment in the 1980s and early 1990s with similar Multi-Employer Welfare Associations (MEWAs) resulted in mass disruptions from plan insolvencies. (In a 1992 report, the General Accounting Office states that MEWA failures left at least 398,000 consumers with over $123 million in unpaid claims.)

  • There have been efforts in recent years to exempt Multiple Employer Welfare Arrangements (MEWAs) and Association Health Plans (AHPs) from state regulation. These proposals would allow small employers to band together to purchase employee health coverage exempt from state-level protections.

  • Given the lack of movement on Federal patient protection legislation, the important patient protections provided by state-based health insurance laws should be maintained. These protections ensure that plans cover services such as maternity care, mental health services, and home health care.

  • Importantly, AHPs would be exempt from state laws that guarantee access to Advanced Practice Registered Nurses such as nurse midwives, family nurse practitioners, and nurse anesthetists.

  • In addition, AHPs would do little to cover the uninsured. In fact, AHPs are expected to result in higher premiums for those who currently have health insurance. The Congressional Budget Office (CBO) estimates that AHPs would cover less than 1 percent of the 44.3 million uninsured Americans, while actually raising premiums for four out of five workers. Disturbingly, CBO estimates that 10,000 workers with expensive health care needs would lose their insurance if AHP provisions were enacted.

Additional Information

  • Download ANA's position paper on Association Health Plans (PDF: 36KB)

  • Visit the Protect Your Healthcare Coalition Website for great information, including details on what is at stake in your state. ANA is a member of this diverse coalition opposing AHPs.