Sponsor
Rick W. Allen
Representative · R-GA
Representative · R-GA
The bill increases employer flexibility to offer lower‑cost, non‑EHB employer plans and preserves several ERISA protections and legal continuity, but does so at the cost of greater variability in coverage and heightened financial and access risks for many workers and families.
Employers (including small businesses) can offer cheaper and more flexible group health plans by not being required to include ACA Essential Health Benefits, potentially lowering employer costs and premiums for some workers.
People covered by employer/group plans retain core federal protections—HIPAA portability and nondiscrimination, mental health and addiction parity, COBRA continuation rights, ERISA fiduciary duties, and existing preventive service coverage—helping preserve access and continuity of care for people with chronic conditions.
Plan participants will get clearer information about what their employer plan covers (which EHBs are excluded), cost‑sharing estimates, and how to obtain the full Summary Plan Description, improving members' ability to compare and use coverage.
Workers and families with employer-sponsored coverage may lose comprehensive benefits (e.g., maternity, mental-health, prescription coverage) if employers drop EHBs, increasing out-of-pocket costs and reducing access to needed care.
Individuals could face higher financial risk and gaps in coverage, shifting costs to patients and to hospitals/health systems when employer plans limit covered services.
The law creates uneven benefit standards between employer (ERISA) plans and individual/marketplace plans and leaves substantive choices to employers and states, increasing geographic and plan-to-plan variation and complicating portability and consumer expectations.
Based on analysis of 6 sections of legislative text.
Exempts ERISA‑governed employer group health plans from ACA Essential Health Benefits, requires annual participant notices, and preserves other federal obligations.
Official title: To amend the Employee Retirement Income Security Act of 1974 and the Public Health Service Act to exempt certain employer-sponsored group health plans governed by ERISA from the Affordable Care Act's Essential Health Benefits requirements, and for other purposes.
Introduced July 21, 2026 by Rick W. Allen · Last progress July 21, 2026
Creates a federal exemption allowing employer-sponsored group health plans governed by ERISA to opt out of the Affordable Care Act's Essential Health Benefits (EHB) requirements. Plans that claim the exemption must give annual written notices to participants describing covered benefits, any missing EHBs, cost-sharing, and how to get the plan's Summary Plan Description; other federal protections (HIPAA, COBRA, ERISA fiduciary duties, mental health parity, Internal Revenue Code rules, etc.) remain in force. The change applies to plan years beginning on or after January 1, 2028, and the Department of Health and Human Services is directed to update regulations accordingly.