Advocating in DC with NAHU
WAHU members visiting Senator Cantwell's office.
This article was originally published on LinkedIn
Last week was a whirlwind of new experiences as I joined the National Association of Health Underwriters (NAHU) at the Capitol Conference. NAHU is a professional association for health insurance agents, brokers, general agents and consultants. We are a dedicated group of benefits specialists across the nation who advocate on behalf of our clients – all consumers of healthcare and we represented an array of experience: Medicare, individual buyers, small business, large group and self-funded clients. My work on The Checkup with Zach Snyder, the Government Affairs Director at Regence BlueShield led me to ask him: “What can I DO? I’m tired of delivering bad news to my clients about new mandates and taxes and saying it’s too late to do anything.” His response as an educator and lover of democracy was a catalyst. He told me to get involved because that is the only way democracy works. To NAHU I went.
We zeroed in on about five key areas. I’m providing extra details below for issues that impact large and small group employers:
Surprise Billing:
The bill would prohibit healthcare providers from balance billing patients in cases of emergency, involuntary care, or instances where the patient had no choice. There are several versions floating around with a couple of committees wanting to weigh in and all have bipartisan support. Where there is division, it’s between how parties believe the provider/insurer disputes should be resolved. NAHU is lobbying for a process that would tie out of network reimbursements to market-based rates varying by geography and the specialty or complication of procedure or care. I think of this as the Healthcare Bluebook model where a fair and reasonable price is established using in-network provider fees and that’s the amount out of network providers would receive. The other route is arbitration which would likely require a new government committee and it would cost more – administratively and likely in provider fees. Numbers from the CBO support the first solution as being the most cost effective. Surprisingly, more republicans are leaning toward arbitration or a hybrid due at least in part to some lobbying from provider groups (backed by private equity) that are using words like “government-based rates” or “benchmark”. There was a lot of emphasis last week about using third party data that outlines fair and reasonable prices – not a government established rate. This bill will likely make it to the floor in May and be relatively quiet leading up to a vote. There is confidence something will pass and when it does, it will also supersede state rules (like Washington) that put the cart out there first.
Market Stabilizers to Reduce Cost and Improve Individual and Employer Market Risk Pools:
Preserve the employer tax exclusion. The employer sponsored sector provides coverage for more than 175 million Americans. Eliminating or capping the exclusion would be detrimental to middle class Americans and could lead to employers dropping coverage. The bill to remove the exclusion didn’t seem to have much support as we made rounds with our state representatives and heard from senators in general sessions.
Employer Reporting (S.2366 and HR 4070) establish a new voluntary reporting system, reduce the number of individuals and amount of information that would need to be reported. The bill would eliminate the requirement to collect dependent social security numbers and ease reporting provisions. Needless to say, I think every Applicable Large Employer (ALE) would love this.
Medicare for All: As stated by James Slotnick of SunLife, “It’s really easy to have a campaign platform for Medicare for All. Entirely different to legislate it.” We heard varying versions of that last week. We also heard there is no way any bill would be introduced this year.
Public Option – this is for Washington since this was legislation passed last year. It’s hard to imagine many providers will willingly contract to take 145% of Medicare rates for primary care or 165% for Specialty. Like many areas around the country, we have access issues in Washington State. I had a couple of great conversations with legislative assistants about digital health tools and what the future could hold. One message I really wanted our representatives to hear is that having health insurance is great but that doesn’t guarantee access to care and we need that too.
MEDICARE: These have a lot of support and make a lot of sense as people work later in life. Namely:
Allow COBRA coverage to count as creditable coverage for Medicare beneficiaries just as employer sponsored coverage does. This would allow beneficiary to have access to Part B on a timely basis with lifetime penalties for late enrollment. HR 2564
HR 3796 would allow Medicare beneficiaries to contribute money to their HSA while they are still working.
2020 is going to be an interesting year with elections and such an emphasis on healthcare. During the month of March, I will be recording a video session with the experts of SunLife who spend time in DC on healthcare topics and are in the trenches with family leave and those national conversations. Their insight and perspectives will arm you with information to help mold strategies for the future and perhaps give you ideas for action steps to start soon. Email me if you’d like a link to this video as soon as it’s available. The team at Propel and I will be working to keep you updated along the way with the hope that perhaps it will inspire you to pick up the phone or send an email to your representatives and share how these bills will impact you, your business and your employees. Let’s do our part to make democracy work.