The National Federation of Independent Businesses, supposedly a trade association for small business but really just one more arm of the Republican party, got what it wanted from the Trump administration. It got all the Affordable Care Act sabotage it could ask for, short of repeal, and also got something it has been clamoring for for decades: association health plans, a mechanism for small businesses to band together to provide health insurance to employees. Now that they have it, thanks to a new rule from Trump, they don't like it.
"We can't set up an AHP under the new rules any more than [we] could under the old rules," spokesman Adam Temple said.
They apparently now have decided that setting up AHPs is "too complex and not worth the effort," and won't be setting up its own plan for the hundreds of thousands of NFIB members. It's not just the NFIB. The National Retail Federation says that the "structure of the rule" makes it unlikely that it will create a national plan. The National Association of Realtors is exploring the idea, but not in any hurry to establish an AHP. The problem they all have is the reality of how health insurance works in the U.S. They want national plans, but can't have them because insurance plans are also regulated by states and what an insurer can sell in one state isn't necessarily what they can sell in another. Beyond that, they want to be able to have disparate industries covered by one plan, but coal miners and fast-food workers need differing coverage and health insurers aren't going to want to cover them under one single plan. Funnily enough, what all these groups seem to have in mind is some sort of nationalized health insurance. Go figure.
What this means in practice is a massive failure for Trump—he's already called the plans a huge success and said that "millions" are signing up (a lie, the plans can't even be sold until September 1). Without massive players like these participating, there aren't going to be that many takers. Which is some good news for the individual and small business markets under Obamacare; it's going to continue to be the most affordable option.