NAHU wants piecemeal ACA adjustments under Trump
The National Association of Health Underwriters has been preparing for a potential Trump presidency for months. Having met with the now President-elect’s pre-transition team, the broker organization is ready to move forward promoting agent and employer interests in this new political landscape, says Vice President of Government Affairs Marcy Buckner.
EBA: What’s been your first step in planning for this presidency that a lot of people didn’t see coming?
Marcy Buckner: And we didn’t either. From one perspective, we did prepare for either administration. We have had meetings with both the Trump and Clinton pre-transition teams so we definitely didn’t write Trump off. We were engaged and are still engaged with their pre-transition and now transition team and did meet with the healthcare pre-transition team about a month ago and had some discussions with them. We also submitted testimony on their party’s platform this summer for the Republican National Convention. Although this isn’t really what anyone expected, we’re prepared from the standpoint that we have been working with the Trump team as well as working with the leadership in the House and Senate. [We were] not expecting a Republican Congress and a Republican president, but we are prepared for it.
Right now, what we’re doing is trying not to get too far ahead of ourselves. We obviously still have the lame duck session. We’re looking at pieces that may be in any kind of end of year legislation and also trying to examine and have meetings set up to look at any interest from Republicans at this point to try to put any changes into end of year healthcare legislation — regardless of whether they think Obama would sign it — just because it may lead to compromises that they may not have if they wait until the next congressional session with a Republican president. So we’re trying to hedge some of those things.
We’re also looking at the reconciliation package from 2015, from last year, as a possible blueprint of what Republicans could be asking for in the future. … So those are some of the things that we are looking at as indicators of what we could possibly see in the beginning of the year. Like I said, we don’t think they’d include it in this package because they’d anticipate Obama to veto it again, but it could be a foreshadowing of what we could see in January and February for those first steps.
EBA: There’s not a lot to go off of because he has not released too many details.
Buckner: Yes, and that’s why we’re looking in other places. ... We’re really trying to unearth what we think a lot of the congressional leadership will be doing because we do believe that Trump will be listening to those folks.
Trump has updated the healthcare section on his website. Well, if you print it out, it’s still a page. So it’s not a lot to go on and there’s still a lot of talk about selling across state lines, a lot about obviously repealing the ACA, trying to promote solutions with health savings accounts and certain things like that. So we are still waiting for a little bit more of that content.
We’re taking pieces from the actions that we’ve seen around Republican leadership in this congressional session in the last two years as well as pieces from A Better Way on the House side and the [Patient] CARE Act on the Senate side and then just some of what we’ve heard from the meetings that we’ve had.
In the pre-transition team meeting that I went to last month they were really focused on what they were going to do on day one, day 100, day 200 and then looking at long-term strategies. The one big policy piece that they mentioned was they want to start on a repeal plan. So we do know that’s going to be on the top of their list.
We don’t feel that the Republicans have the numbers in the Senate — because it is so close with the Democrats and Republicans — so we feel that a full across-the-board repeal would be unlikely. What we do think we’re looking at will be kind of piece by piece. I have heard that the subsidies are on that list if it goes piece by piece, but that Trump has been counseled by Pence and McConnell and Paul Ryan that that’s something that would be better to be phased out instead of something that is cut off all at once.
Those are the meetings that we are going to be trying to set up with the new administration and congressional leadership to make sure that some of those pieces that they’re looking at repealing or altering in any way are done with the best intentions of the market in mind. We do worry a bit that tinkering with certain pieces without having a full follow-through of the thought process of how it could affect the market overall could be detrimental. We just want to be sure that any changes are well thought through with the healthy marketplace in mind.
EBA: Do you have an official stance on whether or not it would be good to repeal and replace or are you more in favor of the piecemeal adjustments?
Buckner: We’re more of the piecemeal adjustments. Since the ACA passed we’ve said we just need to fix some things. There are things that have worked, like keeping kids on until they’re 26 and some other pieces, so we really feel like there are just some continuing things that need to be fixed. There were a lot of unintended consequences that happened with the ACA. Also that happened because some of the Supreme Court cases altered the makeup of the ACA. Obviously with Medicaid expansion not going through in all of the states, that was not intended in the drafting of the law, so it did hinder some of the success in what we saw.
There are things that we would like to get rid of as well, so we just want to make sure that there’s a thoughtful process when going through and doing this piecemeal and putting something together that will be better for everyone.
EBA: Are you looking at Trump’s talk of potential tax reform and maybe getting into the tax exemption for employer-sponsored benefits?
Buckner: We are looking into the tax side. On that we are opposed to the HIT tax and the Cadillac tax. We are for preserving the employer tax exclusion for employees to be able to exclude the contributions of their employer from their income, so it does make us a little nervous when we start talking about the employer exclusion and whether that will be preserved. But, we believe it is a great instigator to get folks into the employer-sponsored market, which we believe right now is a very healthy, stable market. So we will be watching his plans on the tax side as well.
EBA: He’s referenced being in favor of HSAs and strengthening HSAs, do you all have a stance on them?
Buckner: We haven’t discussed it too much because we haven’t had as many details from the campaign as to what exactly they mean by this, what the cap would be and things like that. Is it something like providing HSAs in place of some of these other things in the ACA, whether it would be providing enough funds for people to actually be able to be in the best plan for their needs? We just need a little more information about that.
EBA: What have you been hearing from members as they react to the new president?
Buckner: Their questions are more about the when and the now. They are obviously right in the middle of open enrollment; open enrollment began Nov. 1 in the exchanges, so they are working with consumers right now who hear that Trump has been elected and he wants to repeal the ACA so their clients are asking them, ‘If I enroll in this plan for 2017, will it be there?’ And our answer to that right now is, ‘Yes.’ Because we do not believe that the ship can be turned so quickly for them to not fulfill their plan year with the carrier for 2017.
We are getting questions, but most of them are just asking about what they can expect for 2017. They want to feel confident when they’re helping their clients that they’re selling them a product that’s going to be there, and right now we’re saying, ‘Yes, it will be there.’ But there are possible changes that can be made where we’ll see the outcome of that for 2018 and 2019.
EBA: Have you had a chance to get together with the other broker organizations yet?
Buckner: [We] met before the election but we haven’t had a powwow yet. We’re planning on putting together a transition packet for the Trump administration that addresses where we see there are opportunities for them to take action to better the marketplace and also to really expand on what we have received from his camp as far as healthcare goes. We definitely foresee putting together some stakeholder groups to work on that because obviously none of us can do it alone and we are looking forward to working with other groups as we tackle the changes ahead.
EBA: Do you see this as an opportunity to shoot for the stars with a new administration, a new congressional makeup, to see how far you can get with your wish list items?
Buckner: Yes, to some extent. Because we have things that we want to do away with completely that are part of the ACA, like the Cadillac tax. We’re also not happy with the composite rating numbers, so we’d like to change that. These are the pieces where when we start to see what types of things the administration wants to change we do see it as an opportunity to share our expertise to try to see if we can provide those suggestions as part of the solution while also making sure that the changes that are made don’t have unintended consequences that could possibly hurt the market any further.
EBA: Anything else you’d say to advisers about where NAHU is headed?
Buckner: We just really believe that it is an opportunity for change and we’re going to do our best to make sure we maintain the stability of the individual and employer market, both the public and private markets. We also know that in a time of change there is one thing that is for certain and that is that health insurance agents, brokers and consultants are going to be a trusted source for their clients moving through this transition. There is absolutely a niche for them in the market and their purpose and need is going to be proven in this time.