AVMA Life, the American Veterinary Medical Association's insurance trust, is considering reinstating group medical insurance for members, following a recent executive order by President Trump promoting access to association health plans.

"We're keeping abreast of discussions in Washington," said Libby Wallace, CEO of AVMA Life. "It remains to be seen what actually will come of the executive order. Our hope is that it will come to fruition."

If the plan moves forward — and doesn't, for example, stall in court or Congress — Wallace said, "AVMA Life will be very interested in being able to offer member veterinarians health insurance again. ... If we can, we will."

AVMA Life, previously known as AVMA Group Health and Life Insurance Trust, stopped offering group health insurance after 2013, owing to changes brought about by the federal Patient Protection and Affordable Care Act (PPACA).

AVMA's carrier at the time, New York Life Insurance Company, was compelled by the law to offer its brand of association medical coverage to the general public. New York Life chose instead to leave the medical insurance market. The change affected some 17,500 veterinarians and their families.

The law also made association health insurance plans and premiums subject to approval by departments of insurance in each state and the District of Columbia.

In an executive order on Oct. 12, Trump identified access to association health plans (AHPs) as one of three near-term priorities of his administration in the area of medical insurance.

The order states in part:

"Large employers often are able to obtain better terms on health insurance for their employees than small employers because of their larger pools of insurable individuals across which they can spread risk and administrative costs. Expanding access to AHPs can help small businesses overcome this competitive disadvantage by allowing them to group together to self-insure or purchase large group health insurance. Expanding access to AHPs will also allow more small businesses to avoid many of the PPACA's costly requirements. Expanding access to AHPs would provide more affordable health insurance options to many Americans, including hourly wage earners, farmers, and the employees of small businesses and entrepreneurs that fuel economic growth."

The order directs the labor secretary to, within 60 days, "consider proposing regulations or revising guidance, consistent with law, to expand access to health coverage by allowing more employers to form AHPs." Any regulations proposed by the labor secretary would be subject to public comment.

In short, Wallace said, "The president has given the green light ... to re-enter the marketplace, but we don't have any of the rules that will allow that to happen. We don't know what the timing will be."

Considering the process involved and the many competing interests at play in federal health-insurance policy, Wallace doesn't anticipate that AVMA Life would have coverage to offer before January 2019.

Although it doesn't have a group plan now, AVMA Life does host a health-insurance exchange through which 3,500 members have obtained individual coverage, Wallace said. She noted that those buying insurance through the private exchange can't access government subsidies available to low-income households, but for people who don't qualify for subsidies, the private exchange is a place for members to shop for insurance beyond state and federal insurance exchanges.

Besides enabling existing associations to provide coverage, changes in the rules governing AHPs potentially could allow employers to join together "for the express purpose of offering group insurance," according to a White House news release about the executive order.

The news release adds, "Employers participating in an AHP cannot exclude any employee from joining the plan and cannot develop premiums based on health conditions."

An issue brief by the American Academy of Actuaries dated February 2017 describes several concerns with AHPs. For example, the brief says that if AHPs are allowed to operate under different rules from other insurance plans, that would fragment the market and put other plans at a competitive disadvantage. To protect those buying the insurance, AHPs also need to come under a clearly defined regulatory authority and be subject to state-level consumer protection laws, the brief says.