As the Senate’s discussion of health care reform proceeds in fits and starts, one question that continues to be asked is: Where will health insurance agents and brokers fit in as the Affordable Care Act is dismantled?
“We see (the Senate health care proposals) still maintain that role for the agent and broker and the health care community,” said Marcy Buckner, vice president of government affairs for the National Association of Health Underwriters (NAHU).
Stabilizing the individual health insurance marketplace and preserving the role of the agent and broker are NAHU’s main concerns as the health care reform debate slogs on.
One issue in the most recent set of health care reform proposals that Buckner said is disappointing to agents is that the repeal of the medical loss ratio (MLR) is not included the bills that are being debated in the Senate. The inclusion of agent commissions in the MLR has been cited as the reason health insurance carriers have slashed commissions to agents since the ACA went into effect.
“Unfortunately, we did see that the repeal of the medical loss ratio did not meet the Byrd Rule, so that is out,” Buckner said. “We were hoping to use that to relieve the agents and brokers of the MLR that has burdened them on their commissions– and burdened consumers on their ability to access agents and brokers.”
Despite that disappointment, Buckner said, NAHU hasn’t seen anything in the proposed legislation that would “impede the ability of agents and brokers to be active enrollers in the market.”
Preserving the agent’s role in health care reform means little if the individual insurance marketplace isn’t shored up, Buckner said.
“We do worry about the stabilization of the market with the provisions in the Senate bills,” she said. “We are worried if there isn’t some kind of reinsurance mechanism that’s put in place for the individual market with the Senate bill, we think the market will be hit hard with premium increases for 2018 and 2019 because of the uncertainty.”
“There is a possibility that something could pass without including a provision for some type of reinsurance. Could we have a standalone bill for reinsurance that could get 60 votes in the Senate? That is up for question,” Buckner said.
“Thinking of ways we can get both Democrats and Republicans on board with the reinsurance issue is already part of our strategy,” she continued. “If we don’t see a reinsurance mechanism put in place, another thought is to try to get legislation introduced to ease the burdens of the qualification process for 1332 waivers to allow the states to apply to be able to do some of these reinsurance pools in an easier fashion.”
The years 2018 and 2019 are expected to be especially uncertain for the health insurance marketplace as carriers try to set premiums without knowing who will be required to obtain coverage and what types of coverage must be offered. After 2019, Buckner said, the market is expected to settle down.
“We have been thinking about 2018 and 2019 for a while,” she said. “Last summer, NAHU started having conversations about 2018 and 2019 with the current administration and agency staff, and then with the pre-transition teams of both presidential candidates and eventually with the Trump transition team. We’re looking at the overall stability of the market but also narrowing down on 2018 and 2019.”
“Another piece that we believe will be really important for 2018 and 2019 will be to continue the cost sharing reduction payments and having some certainty on that,” she added.
Will navigators continue to compete with health insurance agents to enroll consumers in coverage? A draft House appropriations bill for the Department of Health and Human Services (HHS) would defund the health insurance navigators program.
“In the version of the health care bill that was passed in the House, there was a lot of focus on agents and brokers being the front-facing enrollment folks for this market,” Buckner said. “I think it’s also up to whether this administration will fund the navigators through the navigator grants and that’s something that’s maybe less likely because it was done through the Obama administration - and it’s politically charged.”
NAHU has been urging its members to contact their senators and congressmen while they are back in their home districts over the August recess to voice their concerns over the health care bill.
Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].
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