Insurance / Health Insurance Reform

Congress should provide high-quality, low-cost health coverage options for small businesses and self employed individuals, including real estate professionals.

REALTORS® and other self-employed individuals often face significant financial challenges when purchasing health insurance or accessing medical care. While the Affordable Care Act (ACA) made important strides in reforming insurance underwriting and rating practices, rising health care costs remain a concern—especially for those who don’t qualify for ACA premium tax credits, which help reduce coverage costs for low- and moderate-income households.

Supports improving access to affordable health insurance options for self-employed individuals and small employers, including allowing bona fide trade associations to offer association health plans (AHPs) to NAR members. NAR's health advocacy efforts are guided by the following public policy principles:

1. The Nation and its health care system are best served by having all citizens covered by health insurance.
2. Health care coverage and/or insurance should be made available to all.
3. Individuals should have health care coverage that is continuous, i.e. allows for no gaps in coverage.
4. Individuals should have the ability to choose their preferred health insurance plan from an array of policy options that offer choices in the scope of covered services and policy costs.
5. Health care coverage should enhance health and well-being by providing preventive health services and chronic disease management services.
6. The health care delivery system must provide cost effective, quality care in an efficient and timely manner in order to be affordable and sustainable for society.  Cost containment, therefore, must be a component of any reform effort.
7. A “single payer” health care system in which the government pays for and allocates health care services should be opposed.
8. Employers should not be required to offer employee health insurance programs.

Opponents of federal efforts to address health insurance reforms believe that insurance is the rightful purview of state governments. Since the passage of the McCarren-Ferguson Act, state governments have had the responsibility for insurance market regulation.

For decades, NAR has advocated for health insurance reforms to support self-employed individuals and small employers, including Small Business Health Options Plans (SHOP), Small Business Health Plans (SBHPs), and Association Health Plans (AHPs).

Affordable Care Act (ACA)

Before the ACA, NAR surveys showed that 28–33% of REALTORS® were uninsured. The ACA significantly improved access to health insurance by reforming underwriting and rating practices. Insurers can no longer deny coverage based on health status, preexisting conditions, age, gender, occupation, or past claims. Pricing is now limited to factors such as location, age, number of covered individuals, coverage level, and tobacco use.

While the ACA expanded coverage, 10–15% of NAR members remain uninsured, and challenges like high deductibles and narrow provider networks persist. NAR continues to support key ACA protections and the preservation of enhanced premium tax credits, which help offset the cost of ACA plans and are set to expire at the end of 2025 unless extended by Congress.

Association Health Plans (AHPs)

NAR supports the Association Health Plans Act (H.R. 2528 / S. 1847) and continues to advocate for policies that improve access to affordable health care for REALTORS® and other self-employed individuals. Here is a timeline of NAR's AHP advocacy:

• June 21, 2018: The Department of Labor expanded the definition of “employer” under ERISA to include self-employed individuals and small employers in AHPs. NAR supported the rule.
• March 28, 2019: A federal court ruled parts of the rule unlawful, including the “working owner” provision. The Department of Labor appealed.
• November 14, 2019: The D.C. Circuit Court heard the appeal. NAR supported it, but the Biden administration later withdrew the appeal.
• April 29, 2024: The Department of Labor rescinded the 2018 AHP rule. NAR opposed the rescission and submitted comments highlighting the value of AHPs for small businesses and self-employed individuals, including real estate professionals.
• June 25, 2025: The House Education and Workforce Committee voted on party lines to report the Association Health Plans Act (H.R. 2528), which now awaits full House consideration.
• May 21, 2025: The companion bill, S. 1847, was introduced in the Senate and referred to the Committee on Health, Education, Labor, and Pensions.

NAR will continue to advocate for key ACA protections and for AHPs, which would allow trade associations to offer high-quality, affordable health coverage options to their self-employed and small-employer members.

US HR 2528: Association Health Plans Act

US S. 1847:  Association Health Plans Act