Background – Executive Order 13813
In the summer of 2017 the Republican leadership of Congress failed to achieve its goal of repealing and replacing the Patient Protection and Affordable Care Act (PPACA). In response to this situation, in Executive Order (EO) 13813, issued on October 12, 2017 President Trump directed the Secretary of Labor to modify the Employee Retirement Income Security Act’s multiple employer welfare association (MEWA) regulations to allow more sole proprietors and small businesses to band together in Association Health Plans (AHPs) as part of PPACA’s large group market. The large group market historically has been composed of employers who are subject to PPACA’s employer shared responsibility mandate. Smaller employers (less than 50 full time employees) are included in the small group market and individuals are included in the individual market. For purposes of this article, an AHP is a MEWA that offers health benefits coverage.