2026-09-15T05:00:02-0400 / 哥伦比亚广播公司新闻
一场长期以来针对“雇员”定义、进而关乎职场医保计划准入资格的诉讼正受到医疗政策分析师的密切关注。其判决结果可能会推动更多低成本但保障可能缩水的医保计划出现，这类计划会规避部分消费者保护条款。
法庭文件显示，针对美国劳工部的这起诉讼可能正在达成和解，但此类协议的具体条款尚不明朗。
此次诉讼的背景是，《平价医疗法案》医保市场保费飙升，导致今年已有数百万人放弃医保覆盖。特朗普政府也一直致力于扩大替代医保的覆盖范围，例如无需遵守《平价医疗法案》关于既往病史和福利要求的短期医保计划。
“根据和解协议的内容，这可能会成为更大规模的医保扩张，”乔治城大学法学院健康政策与法律中心主任凯蒂·基斯说道，“人们担心这会成为推广不符合《平价医疗法案》要求的‘垃圾医保’的开端。”
原告数据营销合伙公司于2019年特朗普首届政府期间起诉美国劳工部，希望官方认可其雇主身份，以便继续允许其有限合伙人购买一类无需遵守州保险法规、也无需提供《平价医疗法案》要求的全面保障的职场医保计划。
但要理解这一诉求，还需先了解这类医保计划的运作方式。
消费者在网购或通过营销人员了解到这类被称为“有限合伙制”的医保计划时，其宣传卖点是：购买由数据营销合伙公司提供、LP管理服务公司经办的医保，即可获得相关保障。但要符合参保资格，消费者必须下载一款能追踪其互联网搜索记录的应用程序，随后该公司可将这些数据出售获利。
部分潜在消费者可能会因自己的网络搜索记录被追踪而却步，但另一些人可能会觉得这一方案很有吸引力，因为他们可以借此成为有限合伙人，有资格购买该公司的员工医保计划。但这些合伙人能否被认定为雇员？
法院对此的判决将对监管机构和消费者产生潜在影响。一些医疗政策和市场专家警告称，如果法院支持这一诉求，可能会导致大量营销激进、存疑的医保计划泛滥，消费者将难以维权，因为这类计划将不受州政府监管。
“如果这类计划大行其道，从逻辑上讲，我们将看到一大批实质上不受监管的保险公司崛起，”阿里·卡瓦尔说道，他曾在拜登政府时期担任美国劳工部员工福利安全管理局首席副助理部长，目前经营着自己的咨询公司。
目前无人知晓劳工部是否会改变长期以来为这起诉讼辩护的立场。但任何和解协议都可能给医保市场带来更多不确定性。
保险公司已经再次申请明年的《平价医疗法案》保费上调两位数百分比，部分原因是参保人数下降意味着最健康的投保人纷纷退保。未来几年，随着更多人转向有限合伙制医保等替代方案，这一趋势可能会加剧。
联邦诉讼审理期间各州采取行动
美国劳工部在特朗普首届政府及拜登执政期间始终为这起诉讼辩护，并在2020年初发布措辞严厉的咨询意见，称仅下载软件“以捕获用户浏览互联网数据”的人不属于“雇员或真正合伙人”。
得克萨斯州一名地区法院法官曾在一项最终被最高法院驳回的判决中裁定《平价医疗法案》违宪，他在2020年支持数据营销公司的判决中称该咨询意见“专断且反复无常”。美国第五巡回上诉法院基本维持了下级法院的判决，但要求其重新考虑下载软件的人是否属于“在职所有者”或“真正合伙人”。
这起案件的核心是雇佣关系认定，原因是1974年出台的一项联邦法律，该法律旨在帮助大型自我保险雇主为员工提供退休和健康福利，而无需遵守多个州的不同规定。
这项名为《员工退休收入保障法案》的法律允许此类医保计划规避大多数州级监管规定——而各州通常对绝大多数其他类型的保险进行监管，并会协助消费者投诉保单问题。作为自我保险的雇主计划，这类保单还无需遵守《平价医疗法案》的部分条款，例如必须涵盖10大类“基本健康福利”的要求。
“如果案件判决出现偏差，可能会影响消费者权益，或削弱州政府的监管能力，”马里兰州保险专员玛丽·格兰特说道。
关于何为雇主计划的争议并非首次出现，其他机构也曾尝试提供此类医保覆盖。部分州已采取行动打击有限合伙制医保的提供商。
马里兰州于2024年对一家名为The Vitamin Patch的公司处以罚款，原因是该公司在未经州许可的情况下提供有限合伙制医保，州政府经调查投诉后确认了这一违规行为。
华盛顿州于2021年勒令另一家公司停止在该州提供医保计划，并罚款2.5万美元。
缅因州和康涅狄格州于2024年向消费者发出此类医保计划的预警。
“此类计划无法提供全面的医疗保障，可能会让消费者面临巨额未付医疗账单，”康涅狄格州的预警公告中写道。
缅因州的公告指出，提供此类医保的机构包括The Vitamin Patch、Affiliated Workers Alliance、Consumer Data Partners、Employers Business Alliance、Socios Buenos以及Strategic Limited Partners。
各州保险专员已在劳工部的诉讼中提交法律意见，表达对自身执行消费者保护的权力可能被削弱的担忧。
“这并非共和党与民主党之争，”卡瓦尔说道，“这本质上关乎州政府监管权——如果这类医保计划大行其道，保险市场的州监管权将受到严重侵蚀。”
风险何在？
尽管如此，支持有限合伙制医保的人士认为，这类计划为消费者提供了急需的额外选择，且价格可能低于《平价医疗法案》医保计划。
例如，在案件提起诉讼时，七个倾向保守的州的总检察长曾敦促劳工部支持数据营销公司的诉求，将其有限合伙人认定为雇员。他们在信函中写道，这将为“收入过高无法享受《平价医疗法案》补贴”的人群提供一种选择，并在《平价医疗法案》被废除和替换前作为过渡方案。他们辩称，各州仍将保留部分监管权，并补充称，负责监管自我保险雇主计划的劳工部可以设定相关要求，以“鼓励”稳定企业进入该市场。
总检察长们在信函中写道，批评人士可能会担心，《平价医疗法案》的替代计划会吸引更年轻、更健康的人群，从而影响留在医保市场的投保人，但他们辩称这种情况早已发生。
数据营销公司的律师通过电子邮件向KFF健康新闻表示，由于案件仍在审理中，他们无法置评。白宫以及负责监管《平价医疗法案》医保市场的医疗保险和医疗补助服务中心也未回应KFF健康新闻关于劳工部是否改变立场、以及本届政府如何看待有限合伙制医保计划的提问。
但在法庭文件中，数据营销公司表示，如果无法获得雇主身份认定，他们将不得不终止医保覆盖，影响约5万名投保人。该公司还辩称，这也会损害其创收能力，因为提供医保是“重要的吸引力点”，可以吸引人们加入其合伙计划，使其能够获取用户的电子数据。
曾在拜登政府协助推进《平价医疗法案》实施、目前担任曼特特健康咨询公司董事总经理的艾伦·蒙茨则持有不同看法。“这类产品之所以存在，唯一原因是它们不受《平价医疗法案》消费者保护规则的约束，本质上可以通过吸引健康人群这类优质投保人来盈利，”她说道。
马里兰州的格兰特也呼应了这一警告，称如果留在《平价医疗法案》医保市场的投保人年龄更大、健康状况更差，这类计划的泛滥可能会进一步推高保费。
19个患者维权组织于8月11日致信美国劳工部，敦促其继续为这起诉讼辩护，警告称如果和解协议认定此类安排构成雇佣关系，可能会“严重”削弱“州监管权威以及数十年来两党为打造稳定、健康运转的医保市场所付出的努力”。其中部分组织曾在2021年提交法律简报支持劳工部。
在发出这封信后的几天，众议院教育与劳工委员会 ranking member（注：资深少数党议员）、来自弗吉尼亚州的民主党众议员鲍比·斯科特警告劳工部，不要增加“可疑雇佣关系”及其提供的医保计划的覆盖面。
他援引报告称，呼叫中心存在误导消费者的行为，“消费者以为自己在注册全面健康保险，实则是在所谓与传统健康保险公司建立雇佣关系的幌子下，签署了垃圾医保协议”。
KFF健康新闻是一家专注医疗问题深度报道的全国性新闻机构，也是独立医疗政策研究、民调与新闻机构KFF的核心运营项目之一。
Outcome of employment lawsuit could promote use of skimpy health plans
2026-09-15T05:00:02-0400 / CBS News
A long-running lawsuit challenging what it means to be an employee and therefore have access to work-based health plans is being closely watched by health policy analysts. Its outcome could spur the availability of lower-cost but potentially skimpier health coverage that skirts some consumer protections.
Court papers indicate a settlement in the case against the Department of Labor may be in the works, although the parameters of any such deal are unknown.
It would come amid premium surges on Affordable Care Act marketplaces that have led millions to drop coverage this year. The Trump administration has also been sharply focused on expanding access to alternative coverage, such as short-term plans that avoid ACA rules on preexisting conditions and benefit requirements.
“Depending on what happens with the settlement, this could be an even bigger expansion,” said Katie Keith, director of the Center for Health Policy and the Law at the Georgetown University Law Center. “People are worried that it is the opening salvo into promoting junk plans that don’t meet the ACA requirements.”
The plaintiff, Data Marketing Partnership, filed its case against the Department of Labor in 2019, during the first Trump administration. It wants official recognition as an employer so it can continue to allow its limited partners to buy into a type of job-based health insurance that doesn’t have to comply with state insurance rules or offer coverage as robust as required under the ACA.
But to grasp the claim, one also has to understand how the coverage works.
A consumer shopping for health insurance may come across information online or from a marketer about this concept, sometimes called “limited partnership” coverage. The pitch? Buy insurance offered through Data Marketing Partnership and handled by LP Management Services. To qualify, the consumer must download an app that tracks their internet searches. The company could then sell that data.
Some potential consumers may be turned off by the thought of their internet searches being tracked, but others may find it appealing because it allows them to become a limited partner eligible to buy into the company’s employee health insurance plans. But can these partners be considered employees?
The court’s answer has potential implications for regulators and consumers. Some health policy and market experts warn that a green light could lead to a proliferation of aggressively marketed and potentially questionable insurance with limited recourse for consumers because the plans would be exempt from state oversight.
“If this took off, you logically could see the rise of a whole bunch of what, functionally, would be unregulated insurance companies,” said Ali Khawar, who was the principal deputy assistant secretary of the Department of Labor’s Employee Benefits Security Administration during Joe Biden’s presidency and now runs his own consulting outfit.
No one knows if the department is going to change its long-running stance defending the case. But any settlement could add more uncertainty to insurance markets.
Already insurers are requesting double-digit increases in ACA premiums again next year, partly because declining enrollment often means that the healthiest policyholders are leaving. That trend could accelerate in coming years as more people are drawn into alternatives such as limited-partnership policies.
States act as federal case plays out
The Department of Labor defended the case throughout the first Trump administration and the Biden era, issuing a sharply worded advisory opinion in early 2020 stating that people who simply download software to “capture data as they browse the Internet” are not “employees or bona fide partners.”
A district court judge in Texas, who had previously ruled the ACA unconstitutional in a decision ultimately rejected by the Supreme Court, called the advisory opinion “arbitrary and capricious” in a 2020 ruling in favor of the data marketer. The U.S. Court of Appeals for the 5th Circuit largely upheld the lower court’s decision but ordered it to reconsider whether someone who downloads software is either a “working owner” or a “bona fide partner.”
The employer-employee relationship is at the heart of the case because of a 1974 federal law designed to help large, self-insured employers offer retirement and health benefits to workers without having to meet varying rules from multiple states.
That law — the Employee Retirement Income Security Act — allows such plans to avoid most rules set by the states, which generally regulate most other types of insurance and assist consumers who report problems with their policies. As self-insured employer plans, the policies also don’t have to comply with some ACA rules, such as the requirement to cover 10 broad categories of “essential health benefits.”
“If the case goes the wrong way, it could impact consumers or hamstring the states,” said Marie Grant, Maryland’s insurance commissioner.
Arguments over what constitutes an employer plan are not new, and other organizations have tried offering such coverage. Some states have taken action against purveyors of limited-partner policies.
Maryland in 2024 fined a company, The Vitamin Patch, for offering limited-partnership insurance after investigating complaints and determining it was not licensed to sell coverage in the state.
Washington in 2021 ordered another company to stop offering its plans in the state and fined it $25,000.
Maine and Connecticut in 2024 warned consumers about this type of coverage.
“These plans do not provide comprehensive medical coverage and can leave consumers with large, unpaid medical bills,” according to Connecticut’s notice.
Maine’s announcement noted that entities offering these types of health insurance included The Vitamin Patch as well as Affiliated Workers Alliance, Consumer Data Partners, Employers Business Alliance, Socios Buenos, and Strategic Limited Partners.
State insurance commissioners filed legal arguments in the Department of Labor case citing their concerns about losing the ability to enforce consumer protections.
“This is not a Republican-Democrat thing,” Khawar said. “It’s really a story about state authority, the way such authority would be significantly undermined in insurance markets.”
What’s the risk?
Still, these limited-partnership plans are viewed by proponents as a needed additional choice for consumers, at potentially lower cost than ACA plans.
When the case was filed, attorneys general from seven right-leaning states, for example, urged the Department of Labor to back Data Marketing’s request to designate its limited partners as employees. That would provide an option for people who “earn too much to qualify” for ACA subsidies and be an interim solution until the ACA could be repealed and replaced, they wrote. They argued that states would retain some regulatory authority and added that the Department of Labor, which oversees self-insured employer plans, could set requirements to “encourage” stable companies to enter the market.
Critics, the attorneys general wrote, might fear that ACA alternatives will draw away younger or healthier people, thus affecting those who remain, but they argued that had already happened.
Data Marketing’s attorneys emailed KFF Health News that they could not provide a comment for this article because the case is in active litigation. Neither the White House nor the Centers for Medicare & Medicaid Services, which oversees the ACA marketplaces, responded to questions from KFF Health News about whether the Department of Labor has changed its stance and how the administration views limited-partnership health plans.
In court filings, however, Data Marketing said that without an employer designation, it would have to end the insurance coverage, affecting about 50,000 policyholders. That would also hurt its ability to generate revenue, it argued, because offering insurance is “a significant attractor” to get people to join its partnership and let it access their electronic data.
Ellen Montz, who helped oversee ACA implementation in the Biden administration and is now a managing director at consultancy Manatt Health, had a different take. “The only reason why these sorts of products exist is because they aren’t beholden to consumer protection rules of the ACA and can essentially make money by attracting good risk, people who are healthy,” she said.
Maryland’s Grant echoed this warning, saying that proliferation of such plans could lead to even higher premiums in the ACA markets, if those who remain are older or sicker than those who leave.
Nineteen patient advocacy groups sent a letter to the Department of Labor Aug. 11 urging it to continue its defense in the case, warning that a settlement that says such arrangements create an employer-employee relationship could “significantly” undermine “both state regulatory authority and decades of bipartisan efforts to promote stable, well-functioning health insurance markets.” Some of those groups had filed a legal brief in support of the department in 2021.
Days after the August letter, U.S. Rep. Bobby Scott (D-Va.), the ranking member of the House education and workforce committee, warned the department against increasing the availability of “questionable employment relationships” and the insurance they offer.
He cited reports of call centers’ misleading consumers “who think they are enrolling in comprehensive health insurance but instead sign up for junk coverage under the guise of creating an employment relationship with what the consumer believed to be a traditional health insurer.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.