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ISSUE: Certain forms of individual health coverage are not required to comply with the consumer protections of the Affordable Care Act (ACA). These “alternative coverage arrangements” — including transitional policies, short-term plans, health care sharing ministries, and association health plans — tend to have lower upfront costs and offer far fewer benefits than ACA-compliant insurance. While appealing to some healthy individuals, they are often unattractive, or unavailable, to people in lessthan-perfect health. By leveraging their regulatory advantages to enroll healthy individuals, these alternatives to marketplace coverage may contribute to a smaller, sicker, and less stable ACA-compliant market. The Trump administration recently has acted to reduce federal barriers to these arrangements. GOAL: To understand how states regulate coverage arrangements that do not comply with the ACA’s individual health insurance market reforms. METHODS: Analysis of the applicable laws, regulations, and guidance of the 50 states and the District of Columbia. FINDINGS AND CONCLUSIONS: No state’s regulatory framework fully protects the individual market from adverse selection by the alternative coverage arrangements studied. However, states have the authority to ensure a level playing field among coverage options to promote market stability. KEY TAKEAWAYS “Alternative coverage arrangements” that are not required to comply with the Affordable Care Act’s consumer protections tend to have lower upfront costs but offer fewer benefits than ACA-compliant insurance. Many of these alternative coverage options, including short-term plans and association plans, threaten the individualmarket risk pool by siphoning off healthier enrollees, leaving sicker and costlier enrollees in ACAcompliant plans. States may want to consider regulatory options for protecting their individual insurance markets and their insured beneficiaries from the effects of alternative coverage products. REPORT

State Regulation of Coverage Options Outside of the Affordable Care Act: Limiting the Risk to the Individual Market