During the recent National Association of Health Underwriters Capitol Conference in Washington, state associations from across the country moved into the halls of Capitol Hill to ensure legislators understand the critical need to keep employer-sponsored benefits stable as they develop new healthcare reform legislation.
Most of the meetings revolved around keeping the tax-favored benefit status of employer-provided healthcare and stabilizing the individual market. EBA spoke with representatives from seven states for details on the discussions and how those who influence and make policy responded.
The California delegation met with Reps. Juan Vargas (D) and Scott Peters (D) in person, and staffers from the offices of Reps. Duncan Hunter (R), Susan Davis (D) and Darrell Issa (R).
“At each meeting we discussed market stability, tax credits for counties across California that have two or less insurance companies, tightening open enrollment in the exchange from 90 days to 30 days, penalties for not getting insurance during open enrollment, HSA plans and catastrophic plans for all ages,” says Craig Gussin, president and CEO of Auerbach & Gussin Insurance and Financial Services, Inc. in San Diego.
The meetings also discussed allowing employers to continue offering group health insurance and have the employees pay their portion with pretax dollars, the HIT tax, Cadillac tax and removing agents from the MLR.
The Missouri delegation split into three teams, meeting with aids from the offices of Sen. Claire McCaskill (D) and Rep. Lacy Clay (D), as well as Reps. Blaine Luetkemeyer (R) and Billy Long (R).
“Because of the instability in the individual market, it is also critical that the employer market be supported. A critical element to this is maintaining the employer exclusion,” says Emily Black Bremer, partner at brokerage Bremer Conley LLC in St. Louis, on what the delegation discussed. “We shared with our legislators the types of costs employers are seeing and the cutbacks they have already had to make regarding benefits and premium contributions."
In their meetings, the Missouri delegation was “reassured to hear from the Republican offices that we met with that they seemed to understand the issues and wanted to make sure that the process of making changes would be done right and not rushed,” Black Bremer says. “We were also pleased to hear from McCaskill’s office that the need for transparency in the system was something that she could relate to personally.
“We hope that she will work with us to continue to improve a system that is too costly for so many,” Black Bremer adds. “The problems we face are not Democrat problems or Republican problems; they are all of our problems. … It is time for both parties to work together for the common good of this country. Our healthcare is depending on it.”
The Texas delegation met with staffers form the officers of Sen. Ted Cruz (R) and John Cornyn (R).
The main issue discussed was “what immediate steps need to be taken to stabilize the individual market,” says Jessica Watts, vice president at Frost Insurance in Austin. “This is crucial not only for individual coverage but to ensure continued stability in the employer-sponsored group market.”
“With two or fewer carriers offering policies in over 70% of counties nationwide, even if individuals qualify for advanced premium tax credits to reduce premium costs, the subsidized cost does not matter if there are no choices or policies sold in their service area,” she adds.
Another issue discussed was the new hybrid risk pool. “Since the Texas Legislature meets every other year and they are in session right now, ensuring that the Texas Department of Insurance will be able to react quickly if the federal government funds a hybrid risk pool concept is a very timely issue,” Watts says. “In the Biennial report to the 85th Legislature, [the Texas Department of Insurance] recommended deactivating the existing Texas Health Reinsurance System for small groups.”
The Texas delegation on Capitol Hill wanted to be sure their representatives were aware of this recommendation.
The delegation also expressed support for preserving the employer exclusion. “The employer-sponsored health insurance system provides private-sector, market-based coverage for more than 175 million Americans,” Watts says. “Eliminating the exclusion or placing a cap on the amount of health insurance an employer can provide tax-free to its employees would be detrimental to the stability of the employer-based market.”
Dave Mordo, NAHU’s legislative council chair, met with Rep. Frank Pallone (D), ranking member of the Energy & Commerce Committee.
“We spoke about the threat of capping or eliminating the employer exclusion, which would potentially hurt the 177 million people covered under employer-sponsored insurance and amount to a tax on the middle class,” Mordo, director of compliance and broker education at Slattery GA in Holmdel, a division of Arthur J. Gallagher & Co., says.
Pallone indicated he would not be in favor of capping the employer exclusion, Mordo says. “The Congressman was, as always, very open to our ideas and will work to make sure people are covered and that the coverage is affordable,” he adds.
The Ohio delegation met with Sen. Rob Portman’s (R) legislative assistant for healthcare. In the meeting, the delegation discussed “the immediate need to stabilize the individual insurance market by keeping advanced premium tax credits and cost sharing tax credits for the 2018 plan year,” says Lee Nathans of Call Insurance Agency in Columbus. “We also discussed allowing the APTC [Advance Premium Tax Credit] to be used to purchase coverage outside for the federal marketplace.”
The staff member was “engaged and interested” in the meeting with 10 Ohio Association of Health Underwriters. “I felt that our suggestions aligned with Sen. Portman's positions and that he is sensitive to the concerns of many Ohioans about losing their current coverage, while at the same time, the need to strengthen and stabilize insurance markets nationwide,” Nathans says.
The Indiana delegation had two meetings with healthcare staffers from Rep. Susan Brooks’ (R) and Rep. Andre Carson’s (D) offices.
In the meeting with Carson’s staff, “we discussed the importance of the preservation of the employer exclusion, as [ending] it would eliminate most advantages of employer-sponsored coverage and [have a] negative impact on the middle class,” says Susan Rider of Gregory & Appel Insurance in Indianapolis. “We also provided real examples from clients in his district on how the ACA has negatively impacted their business, but positively impacted employee’s engagement with the resources their employer is offering to help them change unhealthy behavior through wellness initiatives.”
In the meeting with Brooks’ staff, the delegation also discussed market stabilization and the importance of maintaining coverage for dependents age 26 and younger, as well as pre-existing condition coverage, Rider explains. The staff member “asked for data from Indiana insurance carriers in regards to their impact — positive or negative,” Rider adds. “Rep. Brooks is interested in helping insure the individual market is stabilized and that competition remains."
The Delaware delegation met with two staffers in Sen. Christopher Coon’s (D) office. The staffers “understood our concerns and desire to offer solutions to help with the stabilization of the individual market,” says Nicholas Moriello, director of business development at brokerage Savoy Associates in Newark. “They offered to help support bills that would help to move forward this cause.”
Moriello also met with a staffer in Sen. Thomas Carper’s (D) office, “who also understood and supported our efforts,” Moriello recalls. The staffer “offered to consider support to bills that would further the cause to stabilize the individual market as well and to help prevent consumers from losing coverage and/or tax credits and subsidies that they might be receiving currently.”
In his final meeting, Moriello met with a staffer from Rep. Lisa Blunt Rochester’s (D) office. Although a brief meeting, Moriello says the staffer “appeared to understand our issues and concerns, but was taking more of an approach of waiting to see what the Republicans in the House do with regard to the Affordable Care Act.”