I’ve just returned from our annual trip to Washington DC with my partner, Mike.  As legislative co-chairs for the local chapter of the National Association of Health Underwriters (NAHU), we meet with other members of the industry and coordinate talking points to share with our respective congressional leaders as part of a NAHU event called Capitol Conference. This year, nearly 1000 professionals attended, as there are many issues that deserve our lawmakers’ attention.

I do not expect you to fully engage with many of our talking points-unless of course, you are a professional in the health care arena. Despite the granularity of the information, there are a few topics that you can/should discuss with peers at dinner parties, book clubs or other social engagements.

As stated by the chief legislative aid of one of our democratic representatives from the Chicago area, “Sometimes the more radical legislators work too hard for an outcome for which they don’t understand the negative repercussions that we all end up having to live with.” This comment was articulated as the discussion of single payer healthcare or “Medicare for all” was circulating around DC.

I will share a general list of talking points with you later; however, one issue worth addressing in greater detail is the Cadillac Tax. The following infographic gives a summary of the initial intent of the new tax and the ensuing unintended consequences if it is implemented (it’s currently delayed and congress is contemplating a permanent repeal). The Cadillac tax was just one of over 17 taxes initially proposed by the Affordable Care Act (ACA).

Following is a summary of the general talking points that we discussed.  While there is much detail behind each bullet point, you can get an idea of the scope of work that needs to get done to keep us on the road to improvement.

Market Stabilizers to Reduce Cost and Improve Individual and Employer Market Risk Pools

• Individual Market
  • Allow tax credits to be used outside of the Marketplace if fewer than two choices are offered in a state.
  • Reduce the 90-day grace period for non-payment of premium for individuals receiving tax credits to the same 30-day grace period for other covered individuals.
  • Allow states to be eligible for funding for new hybrid high-risk pools/reinsurance. The new pools would not issue coverage but would be available as a reinsurance mechanism to insure risk above certain levels for high-risk individuals who enroll after going longer than 60 days without coverage.
• Individual and Employer-Based Market
  • Repeal the Health Insurance Tax and Excise/Cadillac Tax (H.R. 748).
  • Increase flexibility for HSAs.  For example, once other market stabilizers are in place, allow contributions equal the out-of-pocket maximum and a limited number of office visits to be covered before deductible each year.  Other important changes could also be included but should be considered after other market-stabilization mechanisms are in place.
• Employer-Based Market
  • Preserve the employer tax exclusion. The employer-sponsored health insurance system provides private-sector, market-based coverage for more than 175 million Americans, including those covered by unions.  Eliminating the exclusion would be detrimental to the stability of the employer-based market and would negatively affect middle-class Americans.
  • Allow states to be eligible for funding for small group reinsurance, which would operate similarly to the individual risk pools, allowing for premium stabilization in the small group market. 
• Surprise Billing/Balance Billing
  • Prohibit health care providers from balance billing patients in cases of emergency, involuntary care, or instances where the patient had no choice in choosing their provider.
  • Require notice to be furnished to patients informing them of their providers’ network status and possible options for seeking care from a different provider.
  • Prohibit arbitrary and excessive bills in these situations by setting reimbursement criteria based on market rates determined by reasonable, contracted amounts paid by private health plans to similar providers in a geographic area or percentage of Medicare.
• Concerns Regarding Medicare for All
  • Medicare for all would not allow consumers to maintain their current coverage.
  • Medicare for all would be prohibitively expensive.  Estimates are around $32 trillion, an average annual tax increase of $24,000 per household.
  • Medicare for all would reduce the standards of quality and access Americans currently enjoy in their health care.
• Medicare
  • Allow COBRA coverage to count as credible coverage for Medicare beneficiaries just as employer-sponsored coverage does. This will allow beneficiaries to have access to Part B on a timely basis without penalties for late entry into the program.
  • Modify Medicare Advantage marketing rules to suspend the scope of appointment requirements for agents and brokers, allowing better counseling for beneficiaries. Request other changes to the current rules to facilitate communication between CMS and NAHU on issues pertaining to or affecting agents/brokers.
  • Many Medicare beneficiaries are classified as being on “observation,” which can result in significantly higher claims and prevent Medicare coverage from being applied for nursing home care for patients who do not have a three-day inpatient hospital stay. Our proposal would allow observation stays to be counted toward the three-day mandatory inpatient stay for Medicare coverage of a skilled nursing facility.

One positive aspect of this year’s talking points is that they propose logical solutions to current problems.  They do not attempt to repeal the spirit of existing legislation, but work to remove the unintended negative consequences that occur with comprehensive legislation.  While we continue to volunteer time on behalf of our customers to encourage improvement, it’s time for the uninformed consumer to understand the issues and speak up for common sense legislation.