H.R. 9081

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9081 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 9081

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 HOUSE OF REPRESENTATIVES

May 29, 2026

Ms. Van Duyne introduced the following bill; which was referred to the 
Committee on Education and Workforce

_______________________________________________________________________

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 ``Healthcare Freedom and Fairness 
Act''.

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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