In an election year where the burning topics are immigration, national security and an uneven economic recovery, one topic that has not received much attention is healthcare.
One would think that a sector of the U.S. economy that has an impact on every American citizen young and old would be a hot-button issue in the political debate. But even six and a half years after the passage of President Barack Obama’s Affordable Care Act, the topic has barely received the same amount of airtime as a proposed border wall with Mexico and a ban on immigrants who adhere to the Muslim faith. So far, politicians and pundits have been mum on the topic in the race for the White House and the control of Congress.
Not that the Affordable Care Act has stopped making headlines. In late summer, insurance giant Aetna announced that it would no longer offer ACA policies in 11 of the 15 states where it operates. With this decision, Aetna joins UnitedHealthcare and Humana as major insurers opt out of participating in the ACA. One healthcare commissioner in Tennessee said recently, “Obamacare is near collapse.”
Alan Schulman is not surprised.
Also see: “10 states with the worst healthcare.”
As an insurance broker and consultant in the Maryland area, the 64-year-old Schulman serves as a lobbyist for insurance firms based in the state and the Northern Virginia area. Schulman’s title is relationship manager for The Meltzer Group, the firm that acquired his firm, Insurance Benefits and Advisors, in August 2015.
Schulman is a past president of The Greater Washington Association of Health Underwriters and currently serves as president of the Maryland Association of Health Underwriters. In 2010, he was appointed to the board of the Health Underwriters Political Action Committee for the National Association of Health Underwriters. Starting in 2017, Schulman will be the national chairman for HUPAC. He is also a member of the Maryland and D.C. Health Insurance Exchange Advisory Committees.
If that weren’t enough, he’s also one of the lobbyists leading the charge to change the landmark healthcare legislation in his clients’ favor. In his work, he has a politician as a client, as well NAHU and the Council for Affordable Health Coverage.
“I call myself a consultant because of my involvement with NAHU, which actually is my client. I’m their broker. Because of my involvement with NAHU over the years, I have constantly lobbied for healthcare. I believe it’s very important that every person out there have access to affordable healthcare,” he says.
As president of CAHC, Joel White is a client of Schulman’s. According to White, Schulman brings years of industry expertise and personal skills to his job. He adds that Schulman has a sense of the policy environment and knows how to grasp the different policy issues and what might work for his clients in the context of what’s happening in the political arena.
“What he brings to any kind of discussion about employee benefits is years and years of experience. He’s been around a long time, and he’s been able to see the changes in the marketplace and how that impacts his clients, which is invaluable. Especially right now with all the change in the marketplace,” says White.
According to both White and Schulman, today’s brokers need to become involved in educating lawmakers, who play a huge role in the benefits that they offer their clients. It not only has an impact on their bottom line, but it also helps them to give lawmakers a sense of what happens after a law has been passed and has to be implemented in the real world. White testified before the House Ways and Means Committee in July and recalls the testimony of a fellow insurance agent from Minnesota. “He did a really great job because he brings that blend of experience and on-the-ground knowledge with policy expertise. That’s invaluable,” says White.
Also see: “10 states with the best healthcare.”
Schulman says some brokers embrace lobbying practices while others do not. Each year, NAHU holds a conference in Washington, D.C., that draws an audience of 600-700 brokers from around the country. They spend two days visiting their local members of Congress. “Part of being on the NAHU board is getting other brokers and consultants to see that we needed a political action committee to educate legislators, and get them to give to that committee. Because, as we all know, the way to get into a politician’s office is to write him a check,” he says, declining to share how much he contributes personally. “So, yes, I have heard some brokers and consultants embrace it, and some say, no, I’m not going to do it, I’m just going to do my job and I don’t think I need to do that,” he says.
White has advice for advisers who are thinking about lobbying: Make sure you read up and do your homework. “It’s a complicated space. But your skills and assistance are needed now more than ever because it is so complicated,” says White.
The siren song of lobbying
Schulman’s lobbying efforts dovetail with his work as a consultant for a variety of employers that range, in his words, “from a plumbing contractor to a 1,000-person building contractor.” For his clients, his firms can put together plans for what he calls “good old employee benefits” like life, health, dental, vision and voluntary benefits, as well as wealth management solutions. Meltzer Group has employees across the country, but half of Schulman’s clients hail from Maryland, with 25% based in Washington and the remaining 25% in Northern Virginia. He adds that his strongest segment is nonprofits. “In Washington, you run into a lot of nonprofits. And The Meltzer Group is known for its philanthropy,” he says.
As Schulman tells it, he became involved in lobbying two decades ago. At the time, Maryland instituted Maryland Small Group Reform, or MSGR, a new law before the advent of Obamacare. The reform law ordered every carrier to issue guaranteed coverage for groups under 50 lives. “No matter who they were, no more cherry-picking, no more redlining groups like bars, restaurants, hair salons. A lot of groups exited the market,” recalls Schulman. He realized that things were changing, and he decided to become involved in his local association of health underwriters. This eventually led to his role at NAHU. “I got to know our lobbyists in Maryland and in Annapolis very well. I got to meet the Maryland legislators and started educating them,” he says.
When he became more involved with NAHU, Schulman saw the need for increased political activity. “I felt that the only way to get legislation done correctly was to absolutely educate legislators,” he says.
Schulman currently does most of his lobbying with three politicians: Maryland state senators, both Democrats representing Montgomery County, Brian Feldman and Craig Zucker; and another Democrat, U.S. Rep. Chris Van Hollen, who represents Maryland’s 8th Congressional District. Van Hollen is running for U.S. Senate this year.
Schulman thinks of himself as an educator. Depending on his relationship with the politician, he will amend his approach. “Some politicians, I walk right into their office [and] they’ll see me. Others that don’t know me so well, you’re definitely meeting with the staff that is given a task of dealing with healthcare,” he says.
For the Maryland Legislature, Schulman dealt with issues that continue in the state. “In Maryland, we had a recent one concerning stop-loss insurance that was a big to-do, so I was meeting with Maryland legislators and my lobbyists would have me meet one-on-one with the Senate president,” says Schulman.
Against the ACA
When asked about his view of the ACA, Schulman is emphatic. “No, I’ve never been pro-Obamacare,” he says.
That said, he is not a member of the “end it” camp when it comes to the ACA, but rather on the “mend it” side. “So much has been implemented, I think that to repeal it is not logical or in the interest of anything,” he says.
White agrees, but notes that the Republican-led Congress has passed 24 amendments to the plan and will fight on with the help of lobbyists like Schulman.
Schulman makes a personal case. Since the ACA went into effect, his premiums rose from $989 to $1,624 for himself, his wife and his 23 year old in graduate school. “People have mortgages for less than that. How is that affordable healthcare?” he asks.
Schulman sees the subsidies as basically unfair for new enrollees who have health insurance for their first time in their lives, thanks to ACA. “I don’t know that tens of millions of people got insured, but there was a good 10 million. But at 90% subsidizing 10%, to me, there has to be another way to do it,” he says.
Also see: “10 healthcare differences between Clinton, Trump.”
“With Obamacare, if the government wants to give people health insurance, I absolutely agree with it. Raise my taxes a little bit, [but] don’t make me subsidize other premiums.” He suggests that the government create health clinics that are operated by new medical school graduates or staffers fresh out of the military. This way, the government could “leave the other 90% of the population on their own,” he says.
He cites the fact that people between the ages of 18 to 27 don’t think that they need health coverage. “When you get into the details of Obamacare and exchanges, there are still vast numbers of the population that aren’t using it,” he says.
“I have a little bit of a problem when my groups are getting 20% renewals every year. They’re pushing small employers not to be able to offer it to their employees and as an individual, my premium almost doubled. I’m in the business, so I see it happening every day. This is not a way to give more people access to healthcare.”
Don’t get Schulman started on single-payer. “If you’re in a country [with a single-payer healthcare plan], you find out that anybody that can afford it has private physicians. They do not use the government system,” he says. “In America, people seek healthcare in very different ways. Every day there’s a new discovery, something new to prevent illness, to cure cancer, to cure heart disease, and it drives costs up. I can’t imagine that anyone in America, when they want to be taken care of, [would not] go to any lengths to get that healthcare.”
The coming election
White says that although healthcare doesn’t seem to be the hot-button topic of the election, jobs and the economy clearly have been — and rising healthcare costs have an impact. “If the economy and jobs are as huge as national security is a huge issue, obviously that’s just what’s on Americans’ minds right now. I would say that the economy and jobs [are] impacted in a negative way right now by healthcare. Rising health costs are leading to lower incomes. It leads to less jobs and slower economic growth.” Hence, the need for lobbying efforts by brokers and advisers.
White adds that voters may start thinking about healthcare when the healthcare exchanges open on Nov. 1 — one week before the election. “People are going to start shopping and see these very significant premium increases, and I do believe that’s going to have an impact on the election,” he says.
Even though it’s just days before Americans go to the polls, White thinks it could change some minds. “I think people are going to go on that website and they’re going to get pretty angry,” he says.
Schulman wishes “good luck” to anyone who predicts the outcome of this roiling election. That said, no matter who wins the White House, he believes that the ACA and health insurance in general will come to be a sharp focus of the new administration. “I think foreign policy, economics, our defense, terrorism and Obamacare are going to be the top [five issues] under the microscope for whatever party comes in. [These are issues] that are going to have to be addressed,” says Schulman. “But premiums can’t keep increasing the way they are. They can’t.”
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