Health insurance and other insurance are regulated by the government at federal and state levels. The Affordable Care Act (ACA), provides most high level rules about health insurance including; guaranteed issue plans, no waiting periods for pre-existing conditions, plan design requirements, policy provisions, and mandated benefits. The Employee Retirement Income Security Act (ERISA) is also a law about market rules, and employee rights. We have studied the health insurance markets for over two decades, and are prepared to help you understand the rules and requirements. We have legislative representatives in Washington DC, Oregon, and Washington State. They monitor legislative activities for us and help us communicate insurance consumer needs to lawmakers. We have met with lawmakers in Salem over the years, and continue to monitor the state legislative activities as they related to health insurance, and other insurance, and administrative programs for those who we help in Oregon and Washington.
- H.R. 6074 Coronavirus Preparedness & Response Supplemental Appropriations Act On March 6th, the President signed into law the Coronavirus Preparedness and Response Supplemental Appropriations Act. The bill provides $6.5 billion to the Department of Health and Human Services, $1.2 billion to the State Department and USAID for international efforts, and $20 million to the Small Business Administration.
- H.R. 6201: Families First Coronavirus Response Act On March 18th, The President signed into law Families First Coronavirus Response Act. The bill requires private health plans and government programs such as Medicare to waive cost sharing for COVID-19 diagnostic tests and related office visits. The bill also designates $1 billion for COVID-19 diagnostic testing and services for uninsured individuals. Other provisions include nutrition assistance, unemployment insurance, and limited family and medical leave and paid sick leave benefits, in addition to tax credits to assist businesses with related costs.
- H.R. 748: Coronavirus Aid, Response, And Economic Security (CARES) Act On March 27th, the president signed into law the $2.2 trillion emergency relief package—the Coronavirus Aid Relief and Economic Security (CARES) Act. The bill is the largest relief bill in American history and will provide financial support to individuals, businesses, states, and key government agencies. The bill extends $1,200 to most American adults, and $500 for most children. It would create a $500-billion lending program for businesses, cities, and states. In addition, it will offer small businesses access to a $367-million employee retention fund if they keep employees on their payroll. Laid-off or furloughed workers will receive an additional $600 per week to their state’s unemployment insurance. Finally, groups on the front lines received significant support: hospitals and providers were given $130 billion, the CDC $3.4 billion, and community health centers $1.3 billion.
- Single Payer: Proposals are currently being considered to implement a single-payer system in the United States, to include Medicare-for-All, Medicare-buy-in, Medicaid-buy-in, public option, and others.
- Employer Exclusion: Congress is considering healthcare reform proposals that would eliminate or place a cap on the employer-tax exclusion for health insurance.
- Cadillac/Excise Tax: UPDATE! On Thursday, December 19, 2019, the House and Senate passed the fiscal year 2020 spending bill and companion tax extenders measure, which included a permanent repeal of the Cadillac Tax effective January 1, 2020.
- Health Insurance Tax: UPDATE! On Thursday, December 19, 2019, the House and Senate passed the fiscal year 2020 spending bill and companion tax extenders measure, which included a permanent repeal of the Health Insurance Tax (HIT) effective January 1, 2021.
- Surprise Billing: Surprise medical billing, or “balance billing” of out-of-network medical care, is one of the most pressing health and affordability challenges facing patients and their families, with millions of Americans receiving unexpected and unaffordable medical bills every year. These bills often include exorbitant charges that are far greater than in-network rates and can cost consumers thousands or even tens of thousands of dollars.
Medicare Loss Ratio: The medical loss ratio (MLR) requirements contained in the ACA are having a devastating financial impact on the country’s approximately half-million licensed professional health insurance agents and brokers, as well as on all of their employees and their millions of employer and individual clients. While we agree with the goal of providing consumers with more value for health care dollars spent, the MLR requirements significantly and negatively impact access to health insurance agents and brokers, at the very time more Americans need the expert advice of a health insurance agent or broker to navigate the complicated plan selection process.
- Employer Reporting: The requirements for employers to report health plan information to the federal government are confusing and extremely complicated.
- Full Time Status: Under the ACA, employers with 50 or more full time equivalent employees must provide employees who work an average of 30 hours or more a week with health coverage or face a financial penalty.
- COBRA Coverage: Seniors who are enrolled in COBRA coverage but are eligible for Medicare face financial penalties for not enrolling within the mandated time-frame. However, seniors who are enrolled in similar employer-sponsored plans are not penalized as their coverage is considered creditable for Medicare.
- Observation Status: Many Medicare beneficiaries are classified as being on “observation,” which can result in significantly higher claims and prevent Medicare coverage from being applied for nursing home care for patients who do not have a three-day inpatient hospital stay.
- Small Business Tax Credit: The Small Business Tax Credit was included as part of the ACA to encourage small employers to provide health insurance to their employees. Unfortunately, many employers have been unable to claim the credit due to the current eligibility qualifications.
- HSA Reforms: Health Savings Accounts (HSAs) offer individuals and families the ability to save and pay for medical expenses with tax-free benefits in the form of contributions, interest-earned, and withdrawals for qualified expenses. Employers and individuals have increasingly been turning to HSAs; however, reforms are needed to ensure that these accounts remain a valuable tool for the foreseeable future.
- Medicare Legislative Issues: NAHU believes that increasing Medicare beneficiaries’ access to a wide range of health plan choices that meet the demographic and economic circumstances of today’s seniors and improving the professional agent/broker’s ability to service their Medicare clients will truly benefit the Medicare program and all Medicare beneficiaries. Americans have come to depend on Medicare as a core financial and health security element in their later years. NAHU looks forward to working with policymakers to ensure that all Americans have access to an efficient and dynamic Medicare marketplace serviced by licensed professional health insurance agents and broker.