Congress and some state policymakers are considering legislation to promote the growth of association health plans and other types of "multiple employer welfare arrangements" (MEWAs) as a way to expand access to affordable health insurance coverage. These plans band together self-employed people, small businesses, and, in some cases, larger businesses to purchase insurance&#8212all seeking to save money and maximize affordability of coverage by using their leverage as a large group to negotiate lower premiums. Some try to lower their costs by self-insuring and by pooling administrative functions.

MEWAs, however, have a long history marred by financial instability and even fraud. Due to licensing requirements that are often less stringent than those imposed on traditional insurers, they are at far greater risk of becoming insolvent when claims suddenly or unexpectedly exceed their ability to pay them. As thousands of Americans have found out, insolvency means that medical bills go unpaid, spelling financial ruin for many who are stuck with huge expenses. Meanwhile, doctors and hospitals are forced to contend with ways to finance uncompensated care; some pass these costs along to insured patients in the form of higher fees, which in turn can drive up already high insurance premiums.