For more than a decade prior to the passage of the Affordable Care Act (ACA), NAR surveys indicated that 28-33 percent of REALTORS® were uninsured in any given year. Without health insurance, REALTORS® and other self-employed individuals are unable to seek necessary medical attention and/or face significant financial burdens when they or their dependents need medical care. As part of efforts to address the health insurance needs of members, NAR has advocated for reform of the health insurance markets that provide coverage to the self-employed and small employers since the health care reform debates of the mid-nineties.
Among the legislative approaches that NAR has advocated are small business health options plans (SHOP), small business health plans (SBHPs), and association health plans (AHPs). AHPs allow self-employed individuals and small employers to purchase health insurance through professional or trade associations. These plans are subject to different rules than plans in the individual and small group insurance markets, and tend to be less costly. NAR continues to represent the interests of the REALTOR® community in discussions on comprehensive health reform.
S.1170/HR 2294, the Association Health Plans Act of 2019
Dept. of Labor Final Rule, Definition of ‘‘Employer’’ Under Section 3(5) of ERISA—Association Health Plans
Letters to Congress - Deduction of Premium for Self-Employed
Letters to Congress - Health Care Reform
Congressional testimonies - Health Care Reform
Letters to federal agencies - Health Care Reform
Issue summary - Health Care Reform
NAR Federal Issues Tracker
What is the fundamental issue?
For more than a decade prior to the passage of the Affordable Care Act (ACA), NAR surveys indicated that 28-33 percent of REALTORS® were uninsured in any given year. Consequently, NAR has long advocated for reforms in the health insurance markets that self-employed individuals and small employers depend upon for coverage. Among the legislative approaches that NAR has supported are small business health options plans (SHOP), small business health plans (SBHPs), and association health plans (AHPs). NAR also represented the interests of the REALTOR® community during the comprehensive health reform debate and the subsequent ACA rulemaking.
I am a real estate professional. What does this mean for my business?
REALTORS® and other self-employed individuals can face significant financial burdens when they purchase health insurance or seek needed medical care. The ACA made significant changes to insurance company underwriting and rating practices including for the self-employed to address access to health insurance meeting minimum benefit requirements. Rising health care costs, however, continue to create problems for those who are not able to take advantage of the ACA premium tax credits that reduced the cost of coverage for low- and moderate-income households.
NAR policy supports improving access to affordable health insurance options for self-employed individuals and small employers. NAR also supports legislative/regulatory changes allowing bona fide trade associations to offer association health plans (AHPs) to their respective memberships, including working owners.
NAR's health advocacy efforts are guided by the following public policy principles:
- The Nation and its health care system are best served by having all citizens covered by health insurance.
- Health care coverage and/or insurance should be made available to all.
- Individuals should have health care coverage that is continuous, i.e. allows for no gaps in coverage.
- Individuals should have the ability to choose their preferred health insurance plan from an array of policy options that offer choices in the scope of covered services and policy costs.
- Health care coverage should enhance health and well-being by providing preventive health services and chronic disease management services.
- The health care delivery system must provide cost effective, quality care in an efficient and timely manner in order to be affordable and sustainable for society. Cost containment, therefore, must be a component of any reform effort.
- A “single payer” health care system in which the government pays for and allocates health care services should be opposed.
- Employers should not be required to offer employee health insurance programs.
The Affordable Care Act (ACA) generally reformed insurance company underwriting and rating practices to address access to health insurance meeting minimum benefits requirements. Of particular interest to self-employed individuals, under the ACA, insurance companies can no longer deny coverage to an applicant based on health status, preexisting conditions, past claims, age, gender, line of work or any other factors that the states have allowed. In addition, the ACA limits the factors used to price policies to an applicant's place of residence, age, number of covered individuals, level of coverage chosen and tobacco usage.
Since its passage in 2010, lawmakers have been either defending or fighting against the ACA. After the 2016 elections, Republicans controlling both Houses of Congress and the Administration attempted to repeal and replace the ACA. Today, Democrats have assumed the leadership in the House while Republicans retain both the Senate and White House. While there is renewed discussion in the House over how to stabilize and build on the ACA, the government remains divided over a way forward on this topic.
Association Health Plans
While Congressional health reform efforts continue, the Administration has issued executive orders directing agencies to improve access to affordable health insurance under current statutory authorities. On June 21, 2018, the Department of Labor (DOL) finalized regulations broadening the definition of “employer” so that “working owners” (i.e., self-employed individuals) and small employers can participate in Association Health Plans (AHPs) under the Employee Retirement Income Security Act (ERISA). ERISA is a federal law governing the conduct of employee benefit plans, including employer-sponsored group health plans, which sets minimum standards and protections for participants. NAR strongly supports the DOL final rule.
On March 28, 2019, the U.S. District Court for the District of Columbia ruled that several provisions in the final rule were unlawful under the Administrative Procedure Act. This includes the “working owner” provision enabling REALTORS® and other self-employed individuals to join AHPs. The U.S. Department of Justice (representing DOL) has since filed a notice of appeal. In light of this decision, DOL has issued guidance clarifying that current AHPs can remain in place until the policy year or contract term expires.
As part of a broad coalition, NAR is vigorously supporting DOL’s appeal of the district court decision. NAR has denounced a misguided, lower court ruling as jeopardizing access to affordable AHPs for thousands of members and their families who signed up through state or local REALTOR® associations. The AHP Coalition is also working to support federal legislation, spearheaded by Sen. Enzi (R-WI) and Rep. Walberg (R-MI), and state government decisions to codify the DOL final rule, which would be beyond the reach of any final federal court decision.
NAR will continue to protect and promote the DOL AHP final rule, as well as any other legislative/regulatory proposals to improve access to affordable health care options for NAR members.