Not even 24 hours after the latest “repeal and replace” proposal ran out of steam,Sen. Rand Paul (R-Ky.) ignited a new round of health policyspeculation by predicting, during a cable news interview, impendingTrump administration action on a longtime Republican go-to idea:association health plans.

“If [consumers] can join large groups, get protection and lessexpensive insurance … it will solve a lot of problems in theindividual market,” Paul said last week on the MSNBC show “MorningJoe.”

Later, President Donald Trump told reporters that he would“probably be signing a very major executive order” that couldaffect “millions of people.”

But what does all of this mean?

While providing few details, Paul’s comments suggest theadministration is considering changes to the rules surroundingthese plans.

Under association health plans, small businesses can join associations — basedon certain types of professional, trade or interest groups — thatoffer insurance to members.

Related: How broker consolidation is changing thebenefits landscape

Republicans for decades have favored such arrangements, seeingthem as a way for small groups to get more clout with insurers.

As part of the effort to repeal the Affordable Care Act, GOPlawmakers this year tried, but failed, to pass legislation thatwould create new federally certified associations that could besold across state lines with reduced state oversight.

Even so, these plans have always been controversial.

In the past, some had solvency problems and went bankrupt,leaving consumers on the hook with unpaid medical bills.

In several states, regulators investigated whether the planswere advertising that they had comprehensive coverage when, infact, they provided little or no coverage for such things as chemotherapyor doctor office visits.

“They have history of fraud, of insolvency, of segmenting markets andthere is often a loss of consumer protections,” said Kevin Lucia, aresearch professor at Georgetown’s Health Policy Institute.

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Kaiser Health News, a nonprofit health newsroom whosestories appear in news outlets nationwide, is an editoriallyindependent part of the Kaiser Family Foundation.

The ACA answered some of those concerns by setting minimumstandards for coverage on most insurance policies, including manyassociation plans, which prevents them from skimping on such thingsas doctor visits or prescription drugs.

But their effect on the insurance marketplace remains aconcern.

Some policy experts say that if eligibility for associationplans is broadened — as Paul would like — or granted exemption fromsome of the ACA’s coverage rules, they might siphon off thehealthiest consumers, which could drive up costs for othersmall-group or individual coverage.

“The bottom line is this could create an unlevel playing field,”with some insurers having to abide by all the rules and othersbeing exempt, said Cori Uccello, a senior health fellow at theAmerican Academy of Actuaries. The academy outlined its concernsabout association plans in a whitepaper in February.

Still, Paul, who has long promoted association plans, saidloosening the rules to allow more of them might find favor on bothsides of the aisle.

Supporters say expanding association plan availability couldoffer lower-cost coverage — mainly if the Trump administrationmakes it easier for them to qualify as large-group plans. (Mostassociation health plans are considered individual or small-groupplans.)

That’s because many large-group plans are exempt from a numberof the ACA’s consumer protections, such as offering coverage across10 broad “essential” categories of care, including hospitalization,prescription drugs and emergency care.

Large-group plans also have more leeway in setting premiums,which can be based on the health of the group, which is barredunder the ACA for individual and small-group plans. Associationsthat gain large-group status could therefore be less expensive ifthey are made up mainly of younger, healthier members. But suchpolicies might also not cover services consumers find theyneed.

Currently, these arrangements have to prove their “bona fides”as associations in order to qualify for the large-group designation under a federal law that regulatesemployer-sponsored benefits, called the Employee Retirement IncomeSecurity Act. To do this, they must demonstrate that their membersare employers with a common profession or interest.

Conversely, a group of people whose only commonality is theywear striped socks, or hunt or are sole proprietors would likelynot qualify.

In the past, Paul complained that these groups had too many hurdles to meet.

And, last week, he said Trump could fix that through a“reinterpretation of existing law with a more expansive definitionof who can form an association.”

And that’s when the speculation became frenzied — as some evenhinted that the executive action — meaning it would be done withoutcongressional action — could come as soon as this week.

In a statement Wednesday, America’s Health Insurance Plans saidit looks forward to seeing the details on any proposal by Rand orthe president. But it said the expansion of association plansraises some questions. Just like the association health plan idea,the concerns have been heard before.

“We need to be careful that the way in which [these plans] areused doesn’t create further instability in the market, increasepremiums, eliminate consumer and patient protections, or increaseopportunities for fraud and abuse,” the statement said.

Kaiser Health News, a nonprofit health newsroom whosestories appear in news outlets nationwide, is an editoriallyindependent part of the Kaiser Family Foundation.