Health Marketplace for All Act of 2025

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2086 Introduced in Senate (IS)]

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119th CONGRESS
  1st Session
                                S. 2086

 To amend the Employee Retirement Income Security Act of 1974 to allow
health marketplace pools to be deemed an employer under section 3(5) of
 such Act for purposes of offering a group health plan or group health
              insurance coverage, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             June 17, 2025

   Mr. Paul introduced the following bill; which was read twice and
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 To amend the Employee Retirement Income Security Act of 1974 to allow
health marketplace pools to be deemed an employer under section 3(5) of
 such Act for purposes of offering a group health plan or group health
              insurance coverage, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Marketplace for All Act of
2025''.

SEC. 2. HEALTH MARKETPLACE POOLS DEEMED AN ``EMPLOYER'' FOR PURPOSES OF
              OFFERING GROUP HEALTH PLANS OR GROUP HEALTH INSURANCE
              COVERAGE.

    (a) Definition of Employer.--Section 3(5) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1002(5)) is amended
by adding at the end the following: ``Such term shall be deemed to
include, for purposes of offering a group health plan (as defined in
section 733(a)(1)) or group health insurance coverage (as defined in
section 733(b)(4)) (which, notwithstanding any other provision of law,
may include such a plan or coverage covering prescription or
nonprescription drugs as the only benefit offered by the plan or
coverage in accordance with section 736(b)(5)(B)), any entity that
meets the requirements under section 736(b).''.
    (b) Group Health Plans and Group Health Insurance Coverage.--Part 7
of subtitle B of title I of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1181 et seq.) is amended by adding at the end the
following:

``SEC. 736. HEALTH MARKETPLACE POOLS DEEMED AN `EMPLOYER' FOR PURPOSES
              OF OFFERING GROUP HEALTH PLANS OR GROUP HEALTH INSURANCE
              COVERAGE.

    ``(a) In General.--An entity (referred to in this section as a
`health marketplace pool') that meets the requirements under subsection
(b) shall be deemed an employer under section 3(5) for purposes of
offering a group health plan or group health insurance coverage (which,
notwithstanding any other provision of law, may include such a plan or
coverage covering prescription or nonprescription drugs as the only
benefit offered by the plan or coverage in accordance with subsection
(b)(5)(B)).
    ``(b) Requirements for Health Marketplace Pools.--The requirements
under this subsection are each of the following:
            ``(1) Organization.--The health marketplace pool shall--
                    ``(A) be formed and maintained in good faith for a
                purpose that includes the formation of a risk pool in
                order to offer group health insurance coverage or a
                group health plan to its members; and
                    ``(B) not condition membership in the health
                marketplace pool on any health status-related factor
                relating to an individual (including an employee of an
                employer or a dependent of an employee).
            ``(2) Offering group health plans and group health
        insurance coverage.--
                    ``(A) Different groups.--
                            ``(i) In general.--The health marketplace
                        pool, which may be in conjunction with a health
                        insurance issuer that offers group health
                        insurance coverage through the health
                        marketplace pool, shall make available a group
                        health plan or group health insurance coverage
                        to all members of the health marketplace pool
                        (and, in the case of members that are
                        employers, employees of the employers) at rates
                        that--
                                    ``(I) are established by the health
                                marketplace pool, or a health insurance
                                issuer contracting with such health
                                marketplace pool, on a policy or
                                product specific basis; and
                                    ``(II) subject to sections 701 and
                                702, may vary for individuals covered
                                through the health marketplace pool.
                            ``(ii) Permissible coverage for
                        dependents.--Such group health plan or group
                        health insurance coverage may be made available
                        under clause (i) to any dependents of members
                        of the health marketplace pool or dependents of
                        employees of employers that are such members.
                    ``(B) Nondiscrimination in coverage offered.--
                            ``(i) In general.--Subject to clause (ii),
                        the health marketplace pool may not offer
                        coverage under a group health plan or group
                        health insurance coverage to a member of the
                        health marketplace pool unless the same
                        coverage is offered to all such members of the
                        health marketplace pool.
                            ``(ii) Construction.--Nothing in this
                        subsection shall be construed as requiring a
                        health insurance issuer or group health plan to
                        provide coverage outside the service area of
                        the issuer or plan, or preventing a health
                        insurance issuer or group health plan from
                        underwriting or from excluding or limiting the
                        coverage on any individual, subject to the
                        requirements under sections 701 and 702.
                    ``(C) Assumption of risk.--The health marketplace
                pool may provide--
                            ``(i) group health insurance coverage
                        through a contract with a health insurance
                        issuer; or
                            ``(ii) a group health plan through self-
                        insurance.
            ``(3) Geographic areas.--Nothing in this subsection shall
        be construed as preventing the establishment and operation of
        more than 1 health marketplace pool in a geographic area or as
        limiting the number of health marketplace pools that may
        operate in any area.
            ``(4) Provision of administrative services to purchasers.--
        The health marketplace pool may provide administrative services
        for members. Such services may include accounting, billing, and
        enrollment information.
            ``(5) Drug coverage.--The group health plan or group health
        insurance coverage offered by the health marketplace pool may
        offer--
                    ``(A) drug coverage, including coverage of over-
                the-counter drugs, in combination with other benefits
                covered by the group health plan or group health
                insurance coverage; or
                    ``(B) notwithstanding any other provision of law,
                drug coverage, including coverage of over-the-counter
                drugs, as the only benefit covered by the group health
                plan or group health insurance coverage.
            ``(6) Members.--
                    ``(A) In general.--With respect to an individual
                who is a member of the health marketplace pool--
                            ``(i) the individual may enroll for
                        coverage under the group health plan or group
                        health insurance coverage offered by the health
                        marketplace pool (including, if applicable,
                        enrollment for coverage for a dependent of such
                        individual); or
                            ``(ii) the employer of the individual may
                        enroll the individual for coverage under the
                        group health plan or group health insurance
                        coverage offered by the health marketplace pool
                        (including, if applicable, enrollment for
                        coverage for a dependent of such individual).
                    ``(B) Eligibility.--An individual shall be eligible
                to be a member of the health marketplace pool if such
                individual is--
                            ``(i) a member of an entity that
                        establishes or joins the health marketplace
                        pool (or a dependent of such a member, as
                        applicable);
                            ``(ii) an employee of a member of an entity
                        described in clause (i) (or a dependent of such
                        an employee, as applicable); or
                            ``(iii) an employee of an entity (or a
                        dependant of such an employee, as applicable)
                        controlled by a member of an entity described
                        in clause (i).
                    ``(C) Rules for enrollment.--Nothing in this
                paragraph shall preclude the health marketplace pool
                from establishing rules of enrollment and reenrollment
                of members. Such rules shall be applied consistently to
                all members within the health marketplace pool and
                shall not be based in any manner on health status-
                related factors in accordance with sections 701 and
                702.
    ``(c) Determination of Employer and Joint Employer Status.--
Participating in or facilitating a group health plan or group health
insurance coverage under this section shall not be construed as
establishing under any Federal or State law--
            ``(1) an employer relationship for any purpose other than
        offering the group health plan or group health insurance
        coverage; or
            ``(2) a joint employer relationship for any purpose.
    ``(d) Definition.--In this section, the term `dependent', as
applied to a group health plan or group health insurance coverage
offered in a State, shall have the meaning applied to such term with
respect to such plan or coverage under the State law applying to such
plan or coverage. Such term may include the spouse and children of the
individual involved in accordance with such State law.''.

SEC. 3. CONFORMING AMENDMENTS.

    Section 3 of the Employee Retirement Income Security Act of 1974
(29 U.S.C. 1002) is amended--
            (1) in paragraph (6), by inserting before the period ``,
        except (with respect to an entity meeting the requirements
        under section 736(b)) such term includes any member of such
        entity'';
            (2) in paragraph (21)--
                    (A) in subparagraph (A), by striking ``subparagraph
                (B)'' and inserting ``subparagraphs (B) and (C)''; and
                    (B) by adding at the end the following:
    ``(C) With respect to a person that is a member of an entity
(referred to in section 736 and this subparagraph as a `health
marketplace pool') that meets the requirements of section 736(b) and
offers a group health plan (as defined in section 733(a)(1)) or group
health insurance coverage (as defined in section 733(b)(4)) (which,
notwithstanding any other provision of law, may include such a plan or
coverage covering prescription or nonprescription drugs as the only
benefit offered by the plan or coverage), membership in the health
marketplace pool shall not by itself cause the person to be a fiduciary
with respect to the group health plan or group health insurance
coverage.''; and
            (3) in paragraph (40)(A)--
                    (A) in clause (ii), by striking ``, or'' and
                inserting ``,'';
                    (B) in clause (iii), by striking the period and
                inserting ``, or''; and
                    (C) by adding at the end the following:
            ``(iv) as a group health plan (as defined in section
        733(a)(1)), or group health insurance coverage (as defined in
        section 733(b)(4)), offered by an entity meeting the
        requirements under section 736(b) (which, notwithstanding any
        other provision of law, may include such an entity offering
        such a plan or coverage covering prescription or
        nonprescription drugs as the only benefit offered by the plan
        or coverage).''.
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