As Rep. Tom Price (R-Ga.) on Tuesday faced his second confirmation hearing to become Secretary of the Department of Health and Human Services, lobbyists for advisers and self-insured employers continued work behind the scenes to shape the health plan that will replace the Affordable Care Act.
Joel Wood, senior vice president of government affairs for The Council of Insurance Agents & Brokers, says his organization’s lobbying strategy is “extremely simple.”
CIAB is seeking “the preservation and enhancement of the employer-sponsored insurance group and health insurance marketplace,” Wood says. Adding, “That has a million moving pieces and lots of potential implications and intended consequences — and potential unintended consequences — depending on which replacement plan you're looking at.”
Everything is up for debate at this point, even Trump-supported ACA cornerstone items, such as coverage for pre-existing conditions and coverage for 26-year-olds on their parents’ health plans.
“We want to see substantial modification to the ACA and we have some wonderful opportunities [to do so] on whatever the replace policy is going to be,” says Wood.
A deliberate approach
When it comes to lobbying the committees in Congress charged with developing the ACA’s replacement — primarily the Ways & Means Committee in the House and the Finance Committee in the Senate — James Klein, president of the American Benefits Council, favors a stable, deliberate approach to repealing the ACA and introducing an alternative.
“We want this to be done carefully, and hopefully on a bipartisan basis. The type of legislation that is always the most sound and the most enduring is that which is enacted on a bipartisan basis,” he says.
Wyatt Stewart, senior director of federal government affairs for the Independent Insurance Agents & Brokers of America, says his firm is primarily focused on the repeal of the Cadillac tax. For the last two years, the Big ‘I’ has been a member of a healthcare-related coalition dedicated to repealing the ACA’s Cadillac tax called Alliance to Fight the 40.
“We were successful in getting that tax pushed back for two years at the end of last year. So that now doesn't go into effect until 2020. We're still working on getting that [fully] repealed and we're hopeful will happen,” says Stewart.
The Big ‘I’ is also working on preserving employer-sponsored healthcare, specifically avoiding a cap on the employer tax exclusion. Stewart is concerned because this particular issue has been in a number of ACA replacement plans that have been presented by Republicans, including Paul Ryan’s “A Better Way Plan.”
“We would not like a cap. We would like it as-is,” says Stewart.
A new plan
No matter what the replacement plan, Stewart and the Big ‘I’ are pushing to make sure the important role agents and brokers play is recognized. Especially in terms of addressing the medical loss ratio, which, under the ACA, mandates that insurers spend at least 80% of premiums on claims payments and healthcare quality improvements and no more than 20% on non-claims costs such as administrative costs, advertising — and commissions.
With commissions in the administrative category under ACA regulations, it “really made it difficult for insurance agents to organize their industry,” says Stewart. He adds, “It was our position that we would like to make sure that does not continue in any sort of replacement plan.”
Members of the House Ways & Means committee and the Senate Finance Committee have been “receptive” so far, he says. “They're definitely open to discussion, absolutely.”
However, when asked what Trumpcare would ultimately look like, the lobbyists declined to hazard a guess. “I do believe we're going to see a substantially different environment. Now, how do you reconcile the president's statement that there will be health insurance for all and that we will continue to have the market reform and no one is going to lose their benefits?” Stewart asks. “That’s the million-dollar question.”
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