New Marketplace Act Creates ‘Employer’ Health Pools: Opens Door for Drug-Only Insurance Plans

The Health Marketplace for All Act of 2025 is looking to shake up how people get health coverage by creating a new category of group insurance. Specifically, this bill amends the federal law governing employee benefits (ERISA) to treat certain “health marketplace pools” as if they were employers. Why is that a big deal? Because it allows these pools to offer group health plans or insurance to their members, just like your company does, potentially opening up new options for freelancers, small business employees, or people who buy insurance on their own.

The New Group Health Game

Here’s the core change: the bill creates a pathway (Section 2) for entities to form a “health marketplace pool” specifically to pool risk and offer group health coverage. To qualify, these pools must be set up in good faith, and crucially, they cannot use health status to decide who gets to join the pool in the first place. Once formed, the pool can contract with an insurance company or even self-insure to provide coverage to all its members, including their dependents. For a small business owner or a contractor who has struggled to find affordable group rates, this could mean access to coverage that was previously out of reach.

The Fine Print: What’s Covered and Who’s Liable

The bill introduces two major provisions that will impact everyday people. First, while the pool must offer the same coverage to all members, the rates can still vary based on existing federal rules (Sections 701 and 702), meaning prices aren't necessarily uniform across the board. Second, and this is a big one: the pool can choose to offer only drug coverage (prescription and over-the-counter) as the sole benefit, overriding other laws if necessary (Section 2, Drug Coverage Options). While this might sound great for someone who only needs help with costly medications, it means they might be signing up for a plan that leaves them completely exposed to hospital bills or specialist visits.

Another important detail, tucked away in Section 3, deals with liability. If you’re a member of an entity that joins one of these pools, simply being a member won’t automatically make you a “fiduciary” for the health plan. That’s a relief for busy people who don't want the legal responsibility that comes with managing a health plan, but it also highlights that the people running the plan itself will have significant fiduciary duties.

The Real-World Trade-Offs

For consumers, this is a mixed bag. On one hand, more options are generally good. If you’re a freelance web designer and your trade association forms a pool, you might finally get access to group rates. On the other hand, the ability to offer drug-only plans creates a risk. If too many healthy people choose these cheaper, limited plans, it could destabilize the broader insurance market by leaving comprehensive plans with a higher concentration of sicker, more expensive members. This is called adverse selection, and it can drive up premiums for everyone else.

Furthermore, by treating these pools as “employers” under federal ERISA law, the bill might shift regulatory oversight away from state insurance departments—which often provide strong consumer protections—to the federal level. This could mean fewer state-level safeguards for individuals enrolling in these new group plans. As often happens with federal legislation, the devil will be in the details of how the government defines “in good faith” and enforces the rules designed to prevent these pools from cherry-picking healthy members.