The National Association of Health Underwriters (NAHU) held its 12th annual Capitol Conference on February 2-5 in the shadow of the nation’s capitol. Over 600 health insurance agents and brokers heard some of the nation’s most visible movers and shakers on health insurance-related issues.
Guest speakers included such noted figures as Tommy Thompson, secretary of Health and Human Services (HHS); Congressman Bob Ehrlich (R-Maryland), a candidate for the Maryland governorship; and Tom Scully, administrator for the Center for Medicare and Medicaid Services (CMS).
They were joined by Dennis Smith, CMS director on Medicaid and State Operations; Paul Harrington, senior health policy advisor to Senator James Jeffords (I-Vermont); Mark McClellan, who serves on the Bush administration’s Council of Economic Advisors; and Congressmen Sam Johnson (R-Texas) and Ernie Fletcher (R-Kentucky).
Politics and Health Care
Ehrlich spoke about the relationship between state and federal government policies and outlined several incompatibilities between the two.
“Any attempts at reforming Medicare” the Congressman noted, “are challenged by turf rules. For example, Medicare Part A comes under the jurisdiction of the powerful Ways and Means Committee, while Part B is under the control of the Commerce Committee.” Ehrlich said Medicare reform should include combining Part A and Part B under one jurisdiction, but he expressed doubts anything will happen until one committee is willing to let go of some political power.
Reform is further complicated, Ehrlich said, by the fact that state and federal legislators are really not reforming health care policy; rather, “we are manipulating the tax code.”
Ehrlich also discussed the immediate future for MSA reform, saying “it is pretty much a non-starter due to the political philosophy of the Senate.”
On the single-payer issue emerging in many states, including the major push in Maryland reported in Health Care News, the Congressman was emphatic: “If I am governor, those headlines will not appear in my newspaper.” (See “Md. Single-Payer Proposal Would Cost 117,000 Jobs, Shrink Payroll Tax Receipts by $4.89 Billion,” Health Care News, January 2002.)
“NAHU,” Ehrlich warned, “is not as organized as the single-payer advocates are. The single-payer issue is politically attractive and will get a great deal of support from the media.”
Show Me the Money
Tom Scully proved, once again, to be a straight-shooter and likeable fellow. He immediately jumped the applause meter when he reminded the audience that prior to his CMS assignment, one of his primary jobs was to help kill the Clinton health care plan.
“I am now over here at the old HCFA,” Scully promised, “because my boss Tommy Thompson hired me to shake it up, clean it up, and get it running so the first concern is the beneficiary, not the bureaucracy.”
“Medicare needs to look and act like a modern health insurance policy that offers private options and covers prescription drugs outside of hospital care,” Scully said. “People don’t give a damn how they get the money, they just want health care.”
Scully outlined some of his key goals for CMS:
- Teach beneficiaries more about health care choices and how to stay healthy;
- Reduce paperwork burdens for health care providers;
- Standardize claims processing and streamline forms; and
- Close the upper payment limit loophole that siphons off money for other health care needs.
One of many problems Scully is whittling away at is the Medicare computer system. The $150 million spent on the upgrade crashed. “We are holding our computer system together with bailing wire,” he confessed.
Insuring the Uninsured
In addition to the political “star-power” speakers, NAHU staff members themselves delivered fact-filled presentations on a variety of issues representing the main focus of the association: insuring the uninsured.
Kevin Corcoran, NAHU executive vice president, said NAHU continues to advocate a health care system that maximizes choice and promotes a robust and competitive market. He noted the group has been very active in finding creative, free-market solutions and has opposed heavy-handed government mandates.
“We are,” Corcoran said, “also very concerned with any initiatives that add to the already rising cost of health insurance policies, pricing people out of coverage.” Commenting specifically on so-called “patients’ bill of rights” proposals, Corcoran noted, “The most important right is the right to affordable health insurance.”
The three-day meeting was organized into topic sessions and breakout workshops conducted by NAHU staff members. NAHU members were given time in the afternoon to visit their Congressmen and lobby on behalf of NAHU issues.
Janet Trautwein, NAHU’s director of federal policy analysis, laid out the focus of the conference, citing educational programs on insuring the uninsurable, defined contributions, high-risk insurance pools, private-sector planning for long-term care needs, genetic discrimination, and a “Prognosis for Domestic Health Policy.”
As soon as Trautwein completed her conference duties, she was testifying at a hearing of the House Small Business Committee. Access to affordable health insurance is a key issue for NAHU at both the state and federal level. Trautwein explained to the committee that “access is a moot point if you can’t afford to purchase a health insurance policy.”
Jessica Waltman, NAHU manager of health policy, provided members with a detailed update on state legislative activity, warning that state budgets awash in red ink will severely affect the uninsured rate.
Waltman explained how the Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative represents “one spoke in the wheel” that includes tax credits, MSAs, and high-risk pools as ways to address the uninsured population.
HIFA is a newly developed Medicaid and State Children’s Health Insurance Program (SCHIP) section 1115 waiver approach. She pointed out that many states have not been successful in enrolling kids in SCHIP plans. In most cases, those states have had to return to the federal government their unspent SCHIP block grant money.
The HIFA initiative is a way to use currently available public funds in an effort to reach the non-Medicaid uninsured population by using the private individual and employer-based insurance market.
Kristin Fitzgerald, a staffer for the House Education and Workforce Committee, moderated a break-out session on a sleeper issue with grave ramifications, genetic discrimination. According to Fitzgerald, several groups from across the political spectrum want to prevent companies and insurers from using genetic testing. Republicans want to allow it, but only with modifications from current practice. The issue is now before the Senate’s Health, Education, Labor and Pensions Committee.
Susan Rash, associate chair for employee benefits on NAHU’s Legislative Council, moderated the defined contribution session. Representatives of defined contribution leaders Lumenos and Vivius made presentations that helped explain the defined contribution concept and the many ways it can be implemented.
And the Oscar Goes To …
NAHU awarded its highest honor, the Spirit of Independence Award, to Secretary Thompson.
In an inspiring acceptance speech, Thompson made crystal clear his dedication to providing better access and affordable health insurance for all Americans. Mentioning tax credits as one way to achieve that goal, he stressed the importance of making sure the would be available monthly, when insurance premiums are due, rather than in a lump sum at the end of a tax year.
Thompson, in his closing remarks, made a solemn promise to make health care for all American citizens one of his top priorities during his tenure at HHS.
Bynum Tuttle, president of NAHU and an active insurance broker, offered closure to the Capitol Conference, saying “Our specific tasks in the coming years will take on many faces, but our purpose won’t change. We’re here to promote the best access there is to health care for all Americans. And we know you can’t have the best access to care if you can’t pay for it. We’re here to be sure affordable private health insurance coverage remains available for everyone so they have the ability to pay for the health care they need.”
Tuttle also made a case for flexibility. “We know,” he said, “as time passes, situations change, and the strategy we use to achieve our goals must also change. But as we look at each issue we face, we’ll look at it with the goal of making a difference to those we serve. We’ll continue to bring fresh new insight and share the reality of the real world with lawmakers, regulators, and others who may not have our experience in serving consumers and whose primary exposure may be just here in Washington.”
Tuttle said his top priority for NAHU was to bring affordable private health insurance coverage to more people. He expressed confidence 2002 will be the year a refundable tax credit is signed into law. And he pledged to mobilize NAHU members in an effort to make sure the funds already available to states through the new HIFA waivers are used to provide the greatest number of people with private health coverage.
The meeting was concluded Tuesday evening with a by-invitation-only Congressional Reception at the Rayburn House Office Building.
NAHU represents over 17,000 professional health insurance agents and brokers who collectively provide health insurance protection for millions of Americans. Their expertise and daily experiences in the field have given NAHU members a level of credibility rarely seen on Capitol Hill. As one New Hampshire legislator is quoted as saying during a public hearing, “We are not going to make any decisions until we hear from health underwriters.”