A House proposal seeks to require self-funded health plans to comply with state-based insurance and consumer protection laws, eliminating what the American Dental Association (ADA) describes as a loophole used by some dental carriers to avoid state rules.
The ADA said some dental carriers use the Employee Retirement Income Security Act (ERISA) to claim federal pre-emption from state insurance laws. The association added that closing the loophole would return health insurance regulatory authority to the states.
ADA president Rich Rosato said the problem has worsened as more carriers have moved to self-funded health plans under ERISA, allowing them to assert federal pre-emption over state rules.
“We need to fix this ERISA loophole that keeps state regulators from enforcing pro-consumer insurance laws enacted in their states,” Rosato said. “Patients and providers should not be left unprotected based simply on how their dental benefits are purchased.”
Rep. Herb Conaway introduced the bill, named Improving Dental Admission (IDA) Act, alongside Rep. Jefferson Van Drew. Conaway represents New Jersey’s 3rd Congressional District, while Van Drew represents the 2nd.
Conaway said closing the loophole would ensure that insurance standards are applied uniformly and that patient care remains the priority.
“Dentists across the country want to focus on caring for their patients, but too often they are forced to navigate a system where certain insurance companies are not playing by the same rules,” Conaway said. “When companies take advantage of loopholes in federal law, it creates confusion, higher costs, and unfair treatment for both providers and the people they serve.”
The House bill comes as state-level dental insurance reform has accelerated. Eighteen states enacted a total of 37 dental insurance reform laws in 2025, according to the ADA, with dental loss ratios among the most commonly addressed issues. The American Dental Association said legislation was filed in 15 states to establish a dental loss ratio that year, with three - Montana, North Dakota, and Washington - successfully doing so.
According to the new bill’s supporters, nearly half of all dental plan enrollees in the country receive coverage through self-funded plans, creating a system in which patient and provider protections can vary depending on how a dental plan is financed. Twelve dental organizations, including the American Association of Orthodontists, expressed support for the IDA Act in a letter to its sponsors, stating it would help close what they described as a bifurcated system in which some patients and providers are protected by state law while many others are not.
While Congress considers the measure, Alabama state legislators are separately weighing a bill that would establish a dental loss ratio of 75% for stand-alone individual dental plans and 83% for stand-alone group plans. Under that proposal, excess premiums would be refunded to policyholders, BestWire reported.
