The Supreme Court’s decision to uphold subsidies on the federal exchange resolves a looming uncertainty in the benefits industry; and, many trade groups say, allows them to return their focus to revising key pieces of the health care reform law that remain a challenge to their business and that of their clients.

Key among those aspects of the law that broker and employer lobbying groups say they are seeking to amend or repeal include the Cadillac tax, Affordable Care Act reporting requirements, the medical loss ratio, and new wellness program regulations.

“Since the continuity of subsidies in all exchanges is no longer in question, it is our hope that legislation to make health reform more workable for both individual and business consumers of health insurance will now be able to gain traction and move forward in Congress,” says Janet Trautwein, CEO of the National Association of Health Underwriters.

See also: Employee benefit lobbyists lay out legislative agenda

“In the wake of the Supreme Court decision in King v. Burwell, the National Association of Insurance and Financial Advisors remains committed to pursuing targeted revisions to the Affordable Care Act,” says NAIFA President Juli McNeely.

Cadillac tax, reporting requirements

“The biggest burden is the Cadillac tax,” says Joel Kopperud, vice president of government affairs at the Council of Insurance Agents and Brokers.

If the threshold isn’t changed, Kopperud estimates that 30% of employers will be subjected to the tax when it takes effect in 2018, and 80% within 10 years. Larger companies are already scaling back benefits, he says, and smaller businesses will, too, in the coming years. “It’s hitting companies now,” Kopperud says.

The reporting requirements also need to be streamlined, he says. “The noise from our membership is getting louder and louder and louder about what a headache it is.”

On June 10, Rep. Diane Black (R-Tenn.) introduced the Commonsense Reporting and Verification Act of 2015 on the House floor. The bill, H.R. 2712 would streamline the employer reporting process and strengthen the eligibility verification process for the health care premium tax credit and cost-sharing subsidy.


In addition to the Cadillac tax, medical loss ratio is another pressing matter for brokers, says Wyatt Stewart, director of federal government affairs at the Big “I”. “Those are the two main issues going forward,” he says.

Last week, the Senate revived its effort to separate broker commissions from an MLR formula created by the ACA when Sens. Chris Coons (D-Del.) and Johnny Isakson (R-Ga.) introduced the “Access to Professional Health Insurance Advisors Act.” In February, Reps. Billy Long (R-Mo.) and Kurt Schrader (D-Ore.) introduced an identical bill to the House of Representatives.

McNeely says NAIFA supports both bills.

Senator Bill Cassidy (R-La.) has also introduced legislation that would amend the ACA to grant independent agents and brokers the same access to marketplace enrollment information as is available to navigators and certified assisters.

Stifled access to such information has been a bone of contention for the benefits industry since enrollment under the ACA began.

See also: Senate bill aims to ‘level  the playing field’ for brokers and navigators

“Access to additional info would be extremely helpful to NAIFA members, allowing them to better serve their clients,” says Diane Boyle, NAIFA’s senior vice president–government relations. “Clients have been frustrated when enrollment issues in the marketplace have arisen and their agents have not been able to resolve the issues without getting the client on the line for each of the necessary calls.”

Health Agents for America Inc. President and CEO Ronnell Nolan worked closely with Sen. Cassidy and his health policy expert Robb Walton to create the legislation and says HAFA will now begin a grassroots effort to get the bill passed, including providing members with a sample letter to write to their Senators and a copy of the bill.  

ACA definitions

Industry groups are also supporting efforts in Congress to change the ACA’s definition of a full-time employee and the definition of a small employer.

In May, several adviser and employer groups applauded legislation that aims to maintain the current definition of a small group market as 1-50 employees. The Protecting Affordable Coverage for Employees Act (PACE) would also give states the flexibility to expand the group size if they feel the market conditions in their state necessitate the change.

“It is in the best interest of employers and their employees that states determine the definition of their small group market,” the groups argue letter to the bill’s sponsors, Senators Tim Scott (R-SC), Jeanne Shaheen (D-NH), and Michael Bennet (D-CO).

“The Protecting Affordable Coverage for Employees Act is a bipartisan modification to the ACA that will help NAIFA members continue to serve their small employer clients and avoid plan disruption for employers with 51-100 employees. Without a modification, employers with 51-100 employees will not be able to keep their current health care plans or purchase or renew plans that do not conform to the new regulations,” says McNeely.

Earlier this year, the majority Republican 114th Congress also introduced a bill in the House and the Senate that would change the ACA’s definition of full-time employees to those working an average of 40 hours per week.

“Many employers are concerned that, despite their best efforts to comply, liability [under the employer shared responsibility rule] could be triggered, given the complexity of administering coverage to comply with the law, particularly with respect to employees who work a variable schedule, short-term employees (for example, 4-6 months), temporary, seasonal or similar contingent workers,” says James Klein, president of the American Benefits Council.

See also: Push for 40-hour work week definition heats up

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