Now that the calendar has turned on 2017, all eyes in Washington, D.C. are turned to the Affordable Care Act.
What stays, what goes, and what will the new healthcare landscape look like?
This time, insurance agents and brokers will be represented at the table, said Ronnell Nolan, President and CEO of Health Agents For America.
“Our motto for 2017 is taking our industry back,” she said. “I describe it as the door being open and it’s our opportunity to walk through the door and sit at the table.”
Republican lawmakers and Trump's team have pledged for weeks to undo Obama's signature health care law and replace it with something better.
However, it remains unclear what that replacement program might look like, how it would work, or whether Trump has even begun crafting it yet.
HAFA is among the groups fighting for influence now that Republicans are in position to make changes to the ACA.
There are many changes that can be made to improve the business of selling health insurance, Nolan said. For example, HAFA supports reforming the Essential Health Benefits clause.
The ACA requires non-grand fathered health plans in the individual and small group markets to cover essential health benefits in 10 benefit categories, which include things like ambulatory patient services and prescription drugs.
But the EHB list also includes “maternity and newborn care,” things a 65-year-old couple has no need for, Nolan explained.
“That is something that has increased rates unnecessarily,” she said. “The private market needs to create plans that the people want to purchase.”
Eliminate the MLR
The National Association of Health Underwriters (NAHU) is also targeting one ACA issue it has had in its sights for years: the Medical Loss Ratio.
Under the ACA’s medical loss ratio, health payers are required to spend a minimum of 80 percent of their premium revenue on paying claims and boosting quality while the rest can be spent on administrative fees, marketing and profits.
Health insurance companies have claimed they have trouble meeting the calculations of the MLR due to treating fraud prevention and recovery differently.
Previously, NAHU has supported a tweak to the MLR removing agent and broker commissions from the administrative pool of dollars. With momentum for changes to the ACA at an apex, NAHU is now asking legislators for full repeal of the MLR, Buckner said.
Eliminating pricing pressures brought on by mandates such as the EHB and the MLR could boost agent commissions.
“We do think that with the medical loss ratio provisions implemented on the carriers, it has resulted in higher premiums,” Buckner explained. “So if those restrictions can be taken off the carriers, it could help ease some of the burdens that carriers are feeling on the premium side.”
In addition to those reforms, HAFA has a checklist of healthcare goals that includes:
• Eliminate healthcare “navigators.” Created by the PPACA, these government counselors duplicated the work meant to be done by agents, Nolan said. “We’d love to see those defunded.”
• Reform pre-existing conditions clause. A popular aspect of the ACA is the guarantee of coverage for people with pre-existing health problems. While a good concept, Nolan said, “there has to be something to tweak the market so people aren’t getting on when they’re sick and getting off when they’re well.”
• Expand the 3-1 ratio. The 3-1 ratio stipulates that premium rates must not vary by more than 3-1 for like individuals of different age who are 21 years and older. For example, if a 21-year-old woman is charged a $200 monthly premium, then a 65-year-old woman cannot be charged more than $600.
The ratio needs to be expanded “to maybe 5-1,” Nolan said.
• Drop plan to permit insurance sales across state lines. This was one of Trump’s campaign themes to make health insurance more affordable. But it doesn’t work, Nolan said.
“We can’t figure out how anybody on Capitol Hill thinks that is going to save anyone money,” she said.
HAFA produced a white paper it plans to take to Capitol Hill to make sure agents’ voices are heard as health care reform is being crafted, Nolan said.
The good news, she added, is it seems Republicans “are not going to tell insurance companies how to run their businesses.”
InsuranceNewsNet Senior Editor John Hilton has covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected]
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