NAHU State and Local Legislative Chair Washington Report

President-Elect Obama’s Administration

Key Cabinet Appointments:
Rham Emanuel (D-IL), Chief of Staff
Tom Daschle (D-SD), Health and Human Services Secretary
Peter Orzag, CBO Director

Still Vacant Key Positions and Possible Choices:
CMS Administrator- David Cutler, Harvard Economist; Pearson, AHIP and Harvard
Secretary of Labor- David Bonior, Former Representative; Dick Gephardt, Former Representative; Andrew Stern, President of the Service Employees Union International
Health Policy Advisor- Dr. Dora Hughes; Chris Jennings

Key Health Care Proposals to be considered by the 111th Congress:
Senator Wyden’s Healthy Americans Act

• Senator Wyden’s bill, which would eliminate the employer exclusion, may have lost some steam due to President-Elect Obama’s strong opposition to that financing mechanism articulated on the campaign trail.
• However, a group of Senators recently signed letter to president-elect Obama advocating for the measure. Along with Wyden, the letter was signed by Sens. Lamar Alexander, R-Tenn.; Bob Bennett, RUtah; Maria Cantwell, D-Wash.; Tom Carper, D-Del.;Norm Coleman, R-Minn.; Bob Corker, RTenn.; Mike Crapo, R-Idaho, Judd Gregg, R-N.H.; Daniel K. Inouye, D-Hawaii; Mary L.Landrieu, D-La.; Joseph I. Liebermann, I-Conn.; Bill Nelson, D-Fla.; Arlen Specter, R-Pa. and Debbie Stabenow, D-Mich.
• Includes an individual and employer mandate
  
• All Americans would have to purchase coverage through regional purchasing pools and purchasing pools would contain individual policies that would be guarantee issue and rated on a community or modified community basis.
  
• Government run “health help agencies” would be placed in charge of enrollment, purchasing and claims assistance.
  
• Plan would offer subsidies on a sliding scale for people, up to 400% of the federal poverty level, and would eliminate Medicaid and SCHIP, covering beneficiaries through regional pools.
• Includes a mandatory employer contribution, which is based on a complicated formula, taking into account the number of employees.
  
• Senator Wyden’s bill does have bipartisan support and co-sponsors. Some conservative republicans like that it replaces public programs with “private coverage” and its focus on individual policies rather than employer sponsored.
  
• The elimination of Medicaid and SCHIP, and the required employer contribution, led to the Congressional Budget Office stating that the bill could amount to being budget neutral for the US Treasury.

Senator Kennedy’s Health Reform Proposal

• The Senator and his staff are determined to see health care reform advance through Congress during the time the Senator has left.
• A group of strange bedfellows- consumer groups, insurers, business groups and others including NAHU, have been brought together to hammer our a new health care reform package. Leaders of these organizations are meeting regularly with the Senator’s staff in an attempt to negotiate consensus around the reform.
• Basis for the Kennedy reform will likely center on the 2006 Massachusetts reforms, which included both an individual mandate, an employer mandate and the creation of an exchange.
• On November 18th Senator Kennedy’s office announced the creation of three working groups within his Committee, 1) led by Senator Harkin (D-IA) on prevention and public health; 2) led by Senator Mikulski (D-MD) on improving the quality of care; and 3) led by Senator Clinton (D-NY) on insurance coverage. Still unclear which Senator would lead the third working group if Senator Clinton were to be nominated as Secretary of State in President-elect Obama’s administration.

Senator Baucus’ White Paper

• The very detailed paper advocates for an individual mandate, an employer mandate, subsidies through tax credits to both individuals with incomes up to 400% of the Federal Poverty Level (nearly $85,000 income for family of four) and small businesses, and discusses capping the employer exclusion from both income and payroll taxes based on benefit packages or income or both.
• It calls for a national health insurance exchange to offer both private coverage and a public Medicare-expansion product on a guarantee issue basis with no consideration of preexisting conditions; extension of Section 125 plans, Medicaid and SCHIP eligibility expansions; a Medicare buy-in option for early retirees, and a provision to the formula for Medicare Advantage plan payments.
• While NAHU certainly has concerns about a number of these ideas, the paper also focuses a great deal of attention on medical care cost containment, which NAHU believes is key to any responsible reform proposal.
• Cost containment ideas in the paper include wellness tax incentives, Health IT improvements, investment in comparative effectiveness research, increased transparency, disease management and medical liability reform

AHIP and BCBSA Endorse Individual Mandate w/ Guaranteed Issue Coverage

• AHIP and BCBSA both released statements the week of November 17th in support of an individual health insurance coverage mandate if coverage is also provided to individuals on a guaranteed-issue basis without regard to preexisting medical conditions.
  
• AHIP’s proposal expands on its existing guaranteed-access plan, released last year, which encourages states to guarantee-issue coverage in combination with a broadly funded pool to cover uninsurable risks.
• In 2006 NAHU’s Board of Trustees and Legislative Council approved a white paper on the issue of individual mandates, in which we state that we need to approach the idea of an individual mandate with caution. While the concept of an individual mandate does attempt to creatively address the problem of the uninsured, NAHU feels this solution raises practical and philosophical concerns, such as viable enforcement, cost, and possible greater government intrusion into the private health insurance market.
• NAHU also has a current internal working group on individual market reforms and is working actively to release our blueprint to address the needs of consumers purchasing individual insurance in the near-term future. NAHU will continue to work with AHIP, BCBSA, Members of Congress, state legislators, the administration, and others to find sensible solutions to the uninsured crisis.

DOI Update

By Len Barend
Legislative Chair

A workshop was held on August 14, 2008 in Carson City with a video feed to the DOI office in Las Vegas. The main purpose of the workshop was to review several items prior to the DOI meeting scheduled for the following week.


Of particular interest was the commission item on the agenda. The purpose of the new regulation was to change commissions to be calculated by a % of premium or a flat rate per application. Many of the CCAHU membership felt this was an easy out for the DOI instead of enforcing the current regulations. (There are three insurance carriers that are not in compliance with current regulations by paying commissions on the base rate of the premium rather then the entire premium amount.)


Jim Wadhams, our lobbyist was contacted and our options were discussed. Jim suggested that this was an unnecessary and undesirable regulation of commissions without statutory predicates. He then wrote a letter to the commissioner suggesting that the regulation should be removed. He also requested that the non-compliance issues be dealt with under existing regulations and the proposal be withdrawn.


Jim's suggestions were adopted by the commissioner and the proposed regulation was withdrawn and the DOI will be sending letters to those insurance carriers out of compliance.
This is an example of why brokers should be members of the association because without our presence this regulation could have been adopted and our income severely impacted.

Democrats Set Convention Agenda For Healthcare

By Len Barend
Legislative Chair

Democratic National Convention's official platform calls for universal healthcare coverage.In continuing coverage from the Aug. 11 edition of NAHU Newswire, Modern Healthcare (8/15, DoBias) reported that "[t]he agenda-setting committee for the Democratic National Convention released its official platform for the party convention, calling for universal healthcare coverage but stopping short of making it a mandate." Furthermore, "[t]he committee...calls on the medical establishment to more quickly adopt health information technology, primarily 'privacy-protected' electronic medical records and calls for financial incentives to help them do so." Sen. Barack Obama (D-Ill.) "has said that he would sign a comprehensive healthcare plan into law by the end of his first term, if elected."

2008 Capitol Conference Report by Ken LaRovere

This year’s Capital Conference was truly a remarkable experience. We had the opportunity to listen to a variety of speakers who discussed a multitude of topics. We were given definitions of various health plan proposals and points of view of politicians and proposals for change. Breakout sessions covered topics of interest. I participated in a session that addressed dealing with the media. I learned that it isn’t enough to state a position, but how necessary it is to make sure that the person you are discussing a topic with not only hears what is being said, but fully understands what points of view are being communicated. It is your obligation to make sure the media understands your position. If they don’t understand, the real possibility of being misquoted exists and incorrect information will be at risk of being disseminated. Carriers often have media departments that address media inquiries, where a carrier representative can refer media inquiries to that department. Agents and brokers don’t have the luxury of having media departments; they must be well informed and be prepared to address questions when asked.

The legislative visits were pre-arranged and were on time. Topics discussed included:
¨ SCHIP
¨ Trade Adjustment Assistance Act Reauthorization/Health Care Tax Credit
¨ Mental Health Parity
¨ The Federal Tax Code and the Tax Exclusion for Employer-Paid Health Insurance Premiums
¨ Access to Health Insurance Coverage
¨ Universal Health Coverage Initiatives
¨ Making Long-term Care Insurance Available through Section 125 Cafeteria Plans
¨ Promoting Greater Access to H.S.A.s
¨ Health information Technology
¨ Wellness

The hot topics were: Health Information Technology, Long-term Care and Access to Health Care. It appeared that SCHIP was a back burner issue.

This trip, I was extremely impressed with seeing first hand, legislators asking questions and truly viewing our members as a resource. Congressman Porter had several questions that could not immediately be answered. Larry Harrison took notes, after leaving Congressman Porter’s office, Larry and I met one of the NAHU staff members, the staffer wrote down the questions, he promised to research the answers and respond promptly to Larry, who in turn will respond to Congressman Porter. This interaction impressed me. This is an example of the value NAHU has for all of us. Credible and timely responses to our questions and concerns. Cap Conference is very important for all of our futures. Getting correct and accurate information in the hands of our legislators is so important.

Cap Conference is an opportunity for legislators to hear our members talk with one voice that is accurate and well informed.