| There’s an obscure legal fight that could open a new path around the Affordable Care Act’s rules regarding health insurance coverage requirements. The case has the health industry watching — particularly as millions of Americans are losing or dropping their insurance and could be in search of cheaper alternatives. At issue is a company called Data Marketing Partnership, which has spent years arguing that people who sign up as its limited partners can qualify for employer-sponsored health insurance. The setup is unusual, to say the least. - People who join the partnership agree to let the company collect data about their online activity by downloading software onto a phone or computer, which the company then sells to third-party marketing firms. In return, those people may receive some of the proceeds of the sales and even the potential to access the company’s health plan.
- The argument Data Marketing Partnership makes is that these people are essentially “working owners” of the business because they agree to “contribute more than five hundred (500) hours of work per year through the generation, transmitting and sharing of their data.”
- That means, under the company’s interpretation of federal benefits law, they can participate in a single-employer health plan governed by the Employee Retirement Income Security Act, or ERISA.
- The Labor Department has disagreed, prompting a legal back-and-forth that’s stretched on for roughly six years.
Why it matters: If these partnerships are treated as ERISA plans, they can avoid Affordable Care Act-based requirements such as covering essential health benefits, accepting people regardless of health status and other consumer protections. Critics of the plans argue that state insurance regulators also could lose much of their ability to oversee the plans. Brian Webb, director of health and life policy at the National Association of Insurance Commissioners, said that the legal limbo has caused the number of “partnership” plans to increase — and that people often don’t know what they’re getting into. “Some of them are providing some coverage; most of them provide no coverage,” Webb said at a conference last month. “It’s just completely illegitimate in what they’re doing.” What to watch There’s a potential settlement between the federal government and Data Marketing Partnership on the table, according to a June court filing detailing that the two parties are in talks. The Labor Department and a lawyer for Data Marketing Partnership did not respond to a request for comment. → While it’s not certain that the federal government will settle the lawsuit, the talks have made consumer and patient advocacy groups nervous. “I can’t imagine that [Data Marketing Partnership] would agree to a settlement agreement that doesn’t give them what they want to a certain extent — and, in this instance, giving them what they want in any form is harmful for consumers,” Kinika Young, director of legal advocacy at Blood Cancer United, tells me. → Earlier this week, the group led a letter sent to the Labor Department also signed by 18 other organizations, warning that a settlement could hurt patients by legitimizing these types of “partnership” arrangements. The coalition includes groups representing people with cystic fibrosis, multiple sclerosis, kidney disease and bleeding disorders who “depend upon comprehensive benefits, robust prescription drug coverage, predictable cost-sharing, confidence that their medical claims will be paid, and meaningful regulatory oversight.” “Products that operate outside these protections place consumers at greater financial and medical risk while creating significant confusion about what coverage actually includes,” the letter reads. What’s next: The federal government and Data Marketing Partnership must update the court on how they plan to proceed by Aug. 21 — that’s next Friday. While the settlement talks could continue beyond next week, we could get an early sense of how aggressively the Trump administration intends to loosen the boundaries around employer-sponsored coverage. The broader backdrop There are also broader concerns that extend beyond this small corner of the insurance market. Critics of the “partnership plans” argue that these arrangements could attract younger and healthier people away from the Affordable Care Act marketplaces, leaving behind a sicker pool of people who need more expensive care. Should that happen, it could push monthly insurance premiums higher for those who retain coverage through the individual market. Katie Keith, founding director of the Center for Health Policy and the Law at Georgetown Law, has similarly warned that a settlement could have consequences outside of the companies involved — potentially giving other businesses a road map for creating similar arrangements. Keith, who has been tracking the litigation, has also said that a settlement “may be just the beginning of broader efforts by the Trump administration to expand access to coverage that does not meet Affordable Care Act requirements.” This includes short-term plans and association health plans, which allow groups of employers to band together to offer coverage. Such plans have drawn scrutiny over a lack of consumer protections, claims regarding misleading marketing and concerns about fraud. → It’s all coming as millions of Americans are set to lose their health insurance due to new Medicaid rules and increasing Affordable Care Act plan premiums following the expiration of enhanced subsidies that helped people pay for coverage. “It’s like a perfect storm,” said Young of Blood Cancer United. “While you have people losing comprehensive coverage through Medicaid or through the ACA marketplace, it’s going to create this influx of folks looking for alternatives.” 36.1 percent That’s the proportion of the country’s internal medicine doctors born outside the United States, according to updated data published in JAMA on Wednesday, while another 11.1 percent are non-U.S.-born physicians who graduated from U.S. medical schools. The share of physicians born outside the United States rose from about 35 percent among doctors certified between 1990 and 1994 to roughly 54 percent among those certified between 1995 and 1999. A decline began after 2015, culminating in 44.5 percent of non-U.S.-born clinicians among doctors certified between 2020 and 2025, according to the analysis from researchers at the American Board of Internal Medicine; the University of California, San Francisco; and the University of Texas Southwestern Medical Center. Foreign-born doctors account for more than half of physicians in several specialties, including geriatrics, kidney care and sleep medicine. Those doctors also play an outsize role in caring for patients who have fewer options for care, the analysis found. Why it matters: The findings underscore the health care workforce dimension to the Trump administration’s immigration policies. The authors of the report warn that policies affecting international doctors — including enhanced screening for immigrants — could hit specialties that already rely heavily on foreign-born physicians, and potentially widen access disparities in communities that have fewer providers to begin with. A Trump administration policy that increased skilled worker visa costs to $100,000, which medical groups worried could restrict hiring, was overturned by a federal judge in June. And although a 39-country travel ban eventually exempted clinicians, the JAMA analysis said the damage has been done: Some hospitals placed noncitizen physicians from these countries on administrative leave. → In 2026, the medical residency match rate for non-U.S. citizen international medical graduates fell to a five-year low. Foreign-born doctors treat patients who are also more likely to have a harder time getting care. - Compared with U.S.-born doctors, foreign-born international medical graduates see more Black and Latino patients, more patients on Medicare due to a disability, and those who are eligible for both Medicare and Medicaid.
- These physicians are also more likely to treat more patients living in high-poverty neighborhoods and areas with doctor shortages.
| “It’s kind of like you can sit there and talk to an expert. … You don’t know whether or not they’re 100 percent correct. But they put you on the right path.” Sen. Tommy Tuberville (R-Alabama), of chats with ChatGPT on long drives across his state. | | | | The quote is a small part of a story by my colleague Anna Liss-Roy in the WaPo newsroom about AI use in Congress, in which Anna writes that Tuberville — who sits on the Senate health committee — often asks the AI chatbot about Medicare and Medicaid. Read the full story: “Chatbots are doing the work of Congress with little oversight.” “Group sues AMA seeking transparency over Medicare billing codes,” The Post’s Dan Diamond reports. “ | 
