HSIS Advocates

While most other health insurance agents were off golfing or vacationing during the slow summer months, I spent my summer meeting with local and national legislators discussing the problems and potential solutions to the Affordable Care Act, which has become anything but affordable! Below were a few of the topics of discussion:

Goal #1 – Consumers want an Agent

We need policy makers to ensure that health insurance consumers will always have the ability and option to work with licensed professionals. We all like having a contact or a go-to person! Health Exchange Navigators, while serving a purpose, in most cases do not have the background or education to assist business owners and individuals with navigating the complicated health insurance system. Licensed agents, on the other hand, have the knowledge and expertise to help their clients select and make the most of health insurance benefits.

Laws & Reforms Related to This Goal: H.R. 815, S 1661

Goal #2 – Affordability

We need to examine what is causing the cost of coverage to skyrocket: new taxes, fees, and more mandated benefit requirements are all causing increased costs to Americans for health insurance.

Residents should have the option to purchase individual insurance coverage using premium subsidies outside the government run exchanges. The current system, which only allows for premium subsidy assistance for California plans purchased through Covered California, unnecessarily limits consumer’s choices and price points.

We need to eliminate new taxes, such as the National Premium Tax that is estimated to add more than $500/year to family health insurance premiums.

Citizens should pay a late-enrollment penalty similar to that used for Medicare if they do not have continuous coverage to discourage folks from gaming the system. As it stands now, although individuals without insurance pay a small penalty, they are allowed to come on during Open Enrollment and pay the exact same premium as those individuals who have carried insurance all along.

Lawmakers need to review essential benefits and other coverage requirements and understand that not everyone needs to have pediatric dental, pediatric vision or maternity coverage.

We should start meaningful conversations about how personal behavior choices are negatively impacting not only our individual health care, but the whole economic health of this country. The law allowed up to 50% higher premiums to be charged for smokers, yet California chose not to implement this surcharge. Making good lifestyle choices should be awarded!

Laws & Reforms Related to This Goal: H.R. 928, S 183

Goal #3 – Reduce the Burden on Business Owners

Small-business owners are feeling the pressure of new measurements and regulations more than other companies. Small business owners are foundation of our nation, yet many are struggling to make ends meet. Having to learn and comply with all the added regulations required by the health care reform law makes it even more difficult to focus on running a successful small business.

I believe the law should change the definition of a full time employee back to the traditional 40 hour work week. Many employers are having difficulty with the 30 hour requirement and counting employees and their hours. Not only is the current system tedious, but it has forced many companies to slash employee hours, which reduces take-home pay.

We need to address the expansion of a small employer marketplace definition as well. Starting in 2016 changes are set to be implemented that will cause significant increases to medium sized business with 51-100 employees. Rates for these employers will be based on each individual employee’s age, rather than an averaged, composite rate. Not only will older employees be impacted by this change, but those with children will now pay premium for each child, rather than the current structure that charges one rate regardless of the number of children. I have seen premium increases as high as 78% as a result of this mandated expansion under the law!

The small business tax credit is still should be allowed for employers purchasing their group health insurance outside the Exchange. In California, the tax credit is currently only available to employers buying insurance through Covered California’s SHOP program. Just as the individual premium subsidy should be available outside the exchange, so should the small business tax credit.

Laws & Reforms Related to This Goal: H.R. 30, S.30, H.R. 2712, H.R. 1624, S. 1099, H.R. 726, S. 379, H.R. 87, H.R. 2050

Change for the Future

Americans have a stake in getting healthcare reform right. The law, as it currently stands, needs some major changes to ensure it serves all citizens, not just those who were previously uninsured. We need to build on the parts of the law that work, and fix the parts that are broken. Any legislator that believes the law, as it currently stands, is the best it can be does not deserve to be re-elected. American citizens deserve a system that provides access to quality care at affordable prices. Until that occurs, I will continue to advocate on behalf of my clients.

Comments are closed.