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Photo: Jabin Botsford/The Washington Post via Getty Images

There are few surprises in the Labor Department's final rules expanding access to association health plans — the undercard in President Trump's effort to pull people out of Affordable Care Act coverage.

The big picture: Association health plans allow small businesses and similarly situated individuals to band together and buy coverage as if they worked for the same large employer.

  • As Trump's critics have been quick to note, these plans are not as tightly regulated as ACA coverage. They have more leeway to charge higher premiums because of age and gender, and they don't necessarily have to cover all of the ACA's essential health benefits.
  • But large-group plans — the way these will be categorized, legally — are by no means unregulated. They can't refuse coverage or vary their premiums due to pre-existing conditions.

“This is a fairly well regulated space," Avalere's Sean Creighton told me.

  • Many large employer plans end up with a higher actuarial value — that is, covering more services with less cost-sharing — than ACA coverage does, Creighton said.

The rule may not live up to Trump's expectations. For example, association plans can be sold across state lines — a priority Trump has mentioned frequently — but they still have to establish provider networks, which tend to be confined to specific metro areas.

The biggest concern I heard from insurance experts yesterday is fraud. The last time association health plans expanded, they were magnets for hucksters who would collect premiums and then vanish.

  • It'll be up to the states to police that now. The federal government simply doesn't have the resources to check in more than “once every couple hundred years," the Kaiser Family Foundation's Karen Pollitz said.

Again, this is the undercard. The main event from Trump's regulatory agenda — an expansion of short-term health plans — is still in the works. Those policies are far more bare-bones than association plans, and are more likely to pull healthy people out of the ACA's individual market.

  • Creighton notes that the ACA's market for small businesses, which would be most attracted to association plans, never really took off.
  • “It may be that the rules actually had been too restrictive, and this was an area where some flexibility was actually warranted," he said.

Go deeper: How AHPs could benefit those in the gig economy.

Go deeper

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Health: Large coronavirus outbreaks leading to high death rates — Coronavirus cases are at an all-time high ahead of Election Day — Fauci says U.S. may not return to normal until 2022
  2. Politics: Top HHS spokesperson pitched coronavirus ad campaign as "helping the president" — Space Force's No. 2 general tests positive for coronavirus
  3. World: Taiwan reaches a record 200 days with no local coronavirus cases — Europe faces "stronger and deadlier" wave France imposes lockdown Germany to close bars and restaurants for a month.
  4. Sports: Boston Marathon delayed MLB to investigate Dodgers player who joined celebration after positive COVID test.
Dan Primack, author of Pro Rata
2 hours ago - Economy & Business

Leon Black says he "made a terrible mistake" doing business with Jeffrey Epstein

Photo illustration: Sarah Grillo/Axios. Photo: Rick Friedman/Corbis/Getty Images

Apollo Global Management CEO Leon Black on Thursday said during an earnings call that he made a "terrible mistake" by employing Jeffrey Epstein to work on personal financial and philanthropic services.

Why it matters: Apollo is one of the world's largest private equity firms, and already has lost at least one major client over Black's involvement with Epstein.

3 hours ago - World

Jeremy Corbyn suspended by U.K. Labour Party over anti-Semitism report

Photo: Christopher Furlong/Getty Images

The U.K. Labour Party has suspended its former leader, Jeremy Corbyn, after a watchdog report found that the party failed to properly take action against allegations of anti-Semitism during his time in charge.

Why it matters: It represents a strong break by Keir Starmer, Labour's current leader, from the Corbyn era and one of the party's most persistent scandals.