Executive order, part one: Association health plans
The idea of association health plans has been around for a long time. George W. Bush included them in his 2007 health-reform proposal. The concept is that individuals could get insurance from voluntary associations, like the Sierra Club or a church group, and receive the same tax benefit that people get for obtaining their coverage through their employers.
The Trump executive order claims to legalize association health plans, but in reality is much more limited. The order allows small businesses—but not voluntary associations—to pool together to buy insurance in bulk.
The thing is, the order is even more modest than that. Small businesses already have the ability to pool together to buy insurance and other benefits, through professional employer organizations, or PEOs. The Employee Retirement Income Security Act of 1974 (ERISA) enables these “multiple employer welfare arrangements,” whereby the PEO becomes the “employer” for purposes of providing health coverage and other fringe benefits. Millions of Americans get their health insurance this way already.
Hence, the likely policy impact of this part of the executive order is minimal to zero.