What’s Happening with Healthcare in D.C. (and Why You Should Care): A Q&A with the NAHU’s Government Expert Marcy Buckner

Mark Rader Industry Insights

Recently, we had the pleasure of talking with Marcy Buckner, vice president of government affairs with the National Association of Health Underwriters (NAHU) about important healthcare-related legislation brewing in Washington D.C. that could directly affect HR professionals in the months ahead. Here are some highlights from our conversation:

Jellyvision:

Hi Marcy, thanks so much for chatting with us. I’m wondering if you could start by talking a bit about what the NAHU is and what you do there.

Marcy Buckner:

Sure! So at the NAHU we’re focused on looking at the overall health insurance market from the individual, small- and large-group perspective. We also work in Medicare and other markets. We try to make sure that we’re working towards increasing access, choice, and affordability for health insurance consumers. I do that by meeting with members of Congress and the administration, speaking with them, and helping them to mold the legislation and policies that they’re working on to help attain those goals.

Jellyvision:

Your role gives you an up-close view into what health care legislation is being considered and what’s coming down the pike. I wonder if you can highlight a few initiatives you’re keeping a close eye on right now.

Marcy Buckner:

You bet. One of the topics is the Cadillac tax—a 40% excise tax on certain employer-sponsored plans. It was set to go into effect in 2018, and they’ve been successful in continuing to have a delay on that. A full repeal of the tax passed the House this summer, and now it’s over in the Senate. At this point I expect that this legislation will be put in an end-of-year tax/budget package. Mitch McConnell has recently expressed that he’s not interested in putting this on the floor during the fall.

If a repeal does happen, HR folks and employers should be excited, because, like I said, it would have been a 40% tax on the majority of health insurance plans that are available through employers. And it really caused employers to take another look at whether they’re going to be offering health insurance benefits to their employees, and I know it would be a really tough decision to have to make if they’re facing a tax that large.

Another big piece that we’re working on that’s getting a lot of attention is surprise billing. This describes when either knowingly or unknowingly people in an emergency are treated by healthcare practitioners that aren’t in their insurance network, and then receive a large bill for the difference of what their insurance doesn’t cover because the practitioners are out-of-network. Both the House and the Senate are looking at different provisions of ways to control that.

From that perspective, employers who self-insure are going to be included in the legislation for the first time. Because self-insured products are overseen on the national level and not the state level, states that have put into place laws around balance billing haven’t been able to touch the self-insure market.

To help protect employers, we’re trying to ensure that, when they’re looking at ways to help solve the problem of balance billing, they don’t go into a system that will actually be very costly for employers that self-insure. One of the options on the table is to go into mandatory arbitration agreements, where they have to go to an arbiter to determine the cost that will eventually be paid toward the balance bill. That would be something that the employer would be responsible for—so we’re working to make sure that doesn’t happen, because that would be a huge financial burden on employers.

Jellyvision:

Where in the process of becoming legislation is this?

Marcy Buckner:

There’s a bill that passed out of the House Energy and Commerce Committee. And there are two bills in the Senate, one that has passed out of the HELP committee and another that will likely get pushed to the end of the year.

Jellyvision:

A follow up to the Cadillac tax piece: Many companies, in anticipation of that passing, changed their strategy in terms of the benefits plans that they were offering, going to high deductible plans and offering less of the Cadillac plans. Knowing that space well, what response do you expect from companies that have already overhauled things thinking this was coming, to then have it go away?

Marcy Buckner:

I think it’ll be mixed. Some companies that went to HDHPs also worked in an HSA that is funded by the employer, so that high deductible is coming out of the pocket of the employees. For those, I think that they may stay with those plans. But for others that have disgruntled employees that do not have an HSA funded by their employer to make up for that high deductible, I think that we may see those plans being adjusted. And you’re right on the mark that there are a lot of companies that changed their plan designs, trying to make sure that they didn’t hit that mark in that threshold to trigger the Cadillac tax that they thought was going to be coming.

Jellyvision:

I’d like to shift into the work that NAHU does in helping consumers figure out the best plans for them, because this is where I think your objectives and Jellyvision’s objectives overlap. How do the NAHU’s benefits consultations with employers and their employees actually work?

Marcy Buckner:

It’ll vary depending on the client and the market that they’re in, whether it’s individual, small, large, or Medicare. But most of the time it’s in person, and the benefits consultant and our agent will speak with the decision maker—sometimes it’s HR, sometimes it’s a COO or CEO; it depends on what the organizational structure is. They’ll look at the client’s plan design and ask things like: Are you going to hit the Cadillac tax threshold? Are you in compliance with things like employer reporting? Are you offering what meets minimum essential coverage? Are you offering coverage that’s considered affordable to your employees? Are you going to trigger the employer mandate? It’s going through all of those sorts of things.

And then oftentimes, our consultants will spend time and make themselves available to employees to come in and ask questions about their specific plan, too. The thought of changing their primary care physician or something like that is very daunting to consumers. So our folks will make sure that, if there are any plan changes, or if they’re going to a different carrier, things that the consumer has become comfortable with—their doctor, their treatment plans, the prescriptions that they’re on—are going to be covered. Or if they’ve had a change in health or need a new type of care, we’ll make sure it’s something that is going to be acceptable in their community.

Jellyvision:

Pivoting more into our world here…as you know, there’s been this influx of benefits communication software solutions the last decade or so that accomplish what these personal one-on-one consultations do, but in an interactive, digital way. I’m interested in your take on this new wave of HR technology, and how benefits education fits in this bigger picture of making sure employees are getting the care that they need.

Marcy Buckner:

I think it really is about education for the employees, and with some of the newer technologies that are coming out, it makes it a lot easier for employees to be a bit more proactive and get that information in a useful, understandable way. If they aren’t working with someone who will sit down and really discuss things with them, and they’re just left with a plan benefit design, then they’re going to be lost. They’re not going to understand what they have, and they’re not going to utilize their plan.

But with some of the newer technologies where it does really focus a lot on education of health insurance and how it works, we’re seeing and hearing from groups that are using it that employees are really taking advantage of the plans that they have, but doing it in ways where they’re going and getting their preventive care, which is helping to reduce health costs. They’re getting treatment when they need it initially, and not waiting so long that they’re then having to have more extensive and expensive treatment.

Jellyvision:

Great to hear! Speaking of better behaviors, I’d love to hear how NAHU is trying to make employees better healthcare consumers, especially those that have these high deductible plans where there’s a shopping-around element that could be helpful to them. What do you do in that area?

Marcy Buckner:

With that, it’s about trying to make sure that we have resources available for our agents and brokers to help educate their clients. But then in other ways, from an advocacy standpoint, I work with members of Congress and the administration, IRS and Treasury specifically, on some of the employer reporting requirements and some of the electronic disclosure forms that are required at open enrollment, and look at the wording of those disclosure forms, some of which aren’t electronic.

Jellyvision:

So…issues related to transparency.

Marcy Buckner:

Right. Basically, we’re trying to increase the amount of information that employers are able to share with their employees on their phone and through the computer instead of having to sign off that they’ve received things in writing.

One of the other pieces we’re floating around on the Hill is looking at drug transparency, specifically. There are some bills that we’re supporting that would require pharmaceutical companies to disclose any reason if their prescription drug increases in cost over a certain threshold—I think it’s 10,000 for a certain drug class and 25,000 for another. So if the cost increases a certain amount, they have to disclose why that’s happening.

There’s also legislation that’s been introduced that requires more reporting on drug patenting and trying to make sure that drug manufacturers aren’t able to take a drug that has a patent that’s expiring and change one very, very slight thing in that drug and have it re-patented, and then possibly being able to sell it for even more for a certain number of years where they hold the exclusive patent, to try to maintain health insurance costs.

And of course there’s also transparency when it comes to sharing the actual cost of care: being able to look up and see what a knee replacement or colonoscopy would be by different providers, and being able to see that actual cost difference to help consumers determine where they want their health cost dollars spent. That’s also something we support.

Jellyvision:

Well, Marcy – thanks so much for sharing all this with us. Really appreciate it.

Marcy:

My pleasure!