Several members of Congress from both political parties expressed support for the role of the agent and broker post-health care reform to a crowd of more than 700 at February's National Association of Health Underwriters annual Capitol Conference in Washington, D.C. - including calls for the medical loss ratio provision of the Patient Protection and Affordable Care Act to be altered.



Sen. Mike Enzi (R-Wyo.) acknowledged that agents are among "the most negatively impacted" by PPACA and reassured the audience that Rep. Mike Rogers (R-Mich.) would soon bring a bill to the House floor that would alter the MLR calculation. Rogers, who also spoke, did not directly address such a bill, but said, "We're going to work on trying to fix this medical loss ratio."

Rogers stuck to his word March 17 when he and co-sponsor Rep. John Barrow (D-Ga.) introduced the "Access to Professional Health Insurance Advisors Act of 2011."

On March 3, the NAIC put out its own draft legislation that would remove broker compensation from the medical loss ratio calculation. The bill is reportedly "nearly identical" to the Rogers-Barrow bill, said Jessica Waltman, NAHU's SVP for government affairs.

During a question-and-answer session at the Capitol conference, Susan Voss, Iowa insurance commissioner and National Association of Insurance Commissioners president, was asked why the NAIC did not stand behind agents when making its original MLR recommendations to the Department of Health and Human Services last fall when it kept brokers on the administrative side of the MLR. Voss insisted that the NAIC tried, but could not get HHS to agree on a broker waiver. However, she stressed that the NAIC will "continue to lobby to keep agents in the process," adding that HHS "can't make this work without the agents - they can't."

Freshman Representative Andy Harris (R-Md.), a practicing anesthesiologist, called brokers a "vital part of the road to true economic recovery" and restated the promise to address the MLR calculations: "We'll do things like attempt to exclude your fees from the MLR," he said.

Rogers went on to say that the health insurance agent is the one hope that businesses have to save costs, and that PPACA as it stands now punishes them for reaching out to the agent. He called PPACA's impact on the NAHU members at the gathering "an example of an unconscionable consequence" of the legislation.



Joel Ario, director of the Office of Insurance Exchanges at HHS' Office of Consumer Information and Insurance Oversight, praised the ability of agents to understand both the consumer and business perspective of the health insurance market and emphasized that there is nothing in PPACA that directly addresses the agent's role in the upcoming state exchanges.

While it's possible that the federal government will weigh in on the agent's role, Ario expects the issue to be left up to state discretion.

"On the small business side there's almost unanimity," said Ario. "I rarely come across a person who doesn't say, 'You know what, if the small businesses exchanges are going to work the agents have to be part of the process.'

"It makes sense to work closely with the agents," Ario added.

Rogers urged brokers not to give up and emphasized the importance of making the connection to their community about how they're being impacted by PPACA.

According to NAHU, 72% of the 2,386 agents who responded to their request for information on PPACA's impact report that they have already seen a loss in income due to the new MLR requirements. Additionally, 26% expect to reduce client services as a result of the economic challenges of PPACA and a full 50% are pulling out of servicing entire product areas.

"You can't give up," Rogers said. "This is your chance to stand up and be heard."

After his opening remarks, OCIIO's Ario was asked how PPACA's navigators compare to the existing role of agents. "A lot of the descriptions of the navigators fit very much what agents do," said Ario. "Assisting the consumers, helping to find choices in the marketplace, helping to enroll in those choices in the marketplace, helping them solve problems they have in the marketplace."

Ario added that "everybody agrees there's a baseline of similarity between what a navigator would do and what an insurance agent would do," but that he's heard from some that agents "don't reach some of the hard-to-reach populations."

Without further defining the populations he was referring to - and over a growing murmur of displeasure from the audience - Ario said it's an area where "agents haven't done everything they could do," and that navigators could fill that gap.



While Democrats Rep. Rob Andrews (N.J.) and Sen. Mark Begich (Alaska) acknowledged their ongoing support for PPACA, both addressed changes that they believe should be made to the law.

Andrews said he wants to work on four specific areas. First is a role for the agent and broker in the sale of insurance. "Some see your role as cost-added," he said; "I see your role as value-added." Second, adjusting the MLR to move brokers to the medical side. Third, including family members in calculating the small business tax credit. And fourth, fully utilizing patient responsibility and wellness initiatives in an effort to contain costs.

Begich said areas that need fixing include increased cost containment, reimbursement rates, allowing importation of prescription drugs, and meeting the increased demand for health care by creating more jobs in the field. Addressing broker and agent participation in the state exchanges, Begich said, "We want to make sure they're part of the process."

There were several questions for Voss relating to the NAIC's decision last fall not to recommend that brokers be removed from the administrative side of medical loss ratio calculations. Instead, the NAIC and HHS developed a broker task force. One audience member asked Voss if HHS is taking the task force seriously. She responded with a belief that HHS has "had an epiphany" and a change in leadership has made the department both more state-friendly and more friendly to the agent community. "My guess is they really want to find a way to make it work," she said.

To that account, the task force met with the agent community a few days after the Capitol Conference to discuss the MLR issue and the role of agents and brokers in the exchange system. "It was a productive meeting," said NAHU's Waltman.

NAHU and other agency groups reiterated their request that HHS remove agents and brokers from the MLR calculation entirely, according to Waltman, but since HHS has indicated that they don't believe they have the statutory authority to do so, they also discussed the possibility of putting a stay on the implementation of the MLR until the issue can be addressed.

One of the last to speak at the conference was Karen Harned, executive director of the National Federation of Independent Business' Small Business Legal Center, who updated the audience on the status of NFIB's joint lawsuit with 26 states that questions the constitutionality of PPACA's individual mandate. Harned expressed optimism that the case - in which a Florida judge ruled in favor of the plaintiffs - will make it to the Supreme Court in time for their October session and be ruled on next year.



In afternoon meetings on Capitol Hill with members of Congress and/or their staff, agents experienced a more positive reception than in years past, say NAHU members.

"A number of our members commented to me that both Republicans and Democrats really wanted to hear their perspective this year - maybe even more than ever - about not just the impact of health care reform on them specifically as agents and brokers, but also on their clients and the economic impact the law is having," said NAHU's Waltman.

"I feel like the receptivity to our messaging on Capitol Hill was much greater this year than it was in the last two," said Mark Gaunya, principal at Borislow Insurance in Massachusetts. "There were people on the Hill who wanted to listen to what we had to say, who were concerned about the amount of work that was put on our plates by virtue of the Patient Protection and Affordable Care Act, that was put on the backs of employers and consumers as a result of this law."

Gaunya met with Sen. Scott Brown (R-Mass.) who asked Gaunya what he'd like Congress to focus on moving forward. Gaunya emphasized his belief in the importance of transparency and Brown felt he may be able to sponsor some legislation on ERISA plans that would make the contracts between providers and health plans transparent to the public.

Because of the large amount of turnover that happened in the last election, Dave Petno of Ohio's Accelerated Benefits said many of his fellow agents and brokers spent a good amount of time educating new members and staff on the inner workings of health care and how PPACA will affect the business community. Petno was excited by the level of energy coming from new Republican members of Congress.

"I came back encouraged that there are people fighting to protect our industry and to protect private health care and they're fighting hard at it," Petno said. "That's exciting."

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