It was just another boring week in Washington DC. Nothing going on. True, the president’s former attorney and fixer, Michael Cohen, was staying at the same hotel as we were. We happened upon the hearings while we were walking through the halls of Congress. The president was in Vietnam to meet with the leader of North Korea. Congress was debating a bill of disapproval over Trump’s emergency order. And we were there, about 800 of us, to talk to our representatives about health insurance, the way most Americans access and pay for health care. We may have been the least controversial people in the entire city.
I don’t wish to minimize our efforts or effectiveness, but we seemed to have been the Fords next to the Lamborghini display at the auto show. Some members of Congress and their staffs took extra time with us, savoring the half hour or so of normalcy. Other offices were just so overwhelmed that we found ourselves meeting in stairwells and hallways. No matter what, our elected representatives and their staffs were professional, prepared, and serious. They are aware that they have been entrusted with a great deal of responsibility. My annual trips to Washington restore my faith in our system of government.
These trips tend to be broken into two parts. The first involves speakers, usually thought leaders, members of Congress and the administration, promoting their vision for improving the health care system. The rest of the week is spent on Capitol Hill meeting with our elected officials. Somewhere in between all of this I try to squeeze in conversations with agents and company reps from around the country and a cigar at Shelley’s Back Room, a cigar lounge frequented by foreign diplomats, lobbyists, and politicians.
One has to admit that the current administration has tested my faith. We were pleased to have Alex M. Azar II, the Secretary of Health and Human Services (HHS), speak to our group on Wednesday. This is a big deal. We had already heard from John O’Brien who specializes in drug pricing for the administration and Brian Blase, a special assistant to the president for economic policy. The Secretary, as the others before him, felt compelled to highlight the economy and the jobs’ numbers. And of course, we were told that President Trump cared deeply about protecting coverage for preexisting conditions. We were all too polite to note that this administration chose not to defend this provision in the Texas lawsuit. We were also told that President Trump was concerned about Surprise Billing, a real issue for many of our clients. The message was familiar. It was the way it was delivered, the constant name-checking of their boss, that made it so odd. At one point I closed my eyes and substituted “Dear Leader” in each sentence for Trump. It worked surprisingly well.
It has been eight years since the passage of the Patient Protection and Affordable Care Act (Obamacare). Some Democrats want to scrap the legislation and move to some form of single payer coverage. More, possibly most, Dems would like to change and improve the law. And the Republicans? It depends. After eight years of empty promises and weak options (Do you remember the American Health Care Act?) bomb throwers like Jim Jordon (R-OH) now have comments like this on their government websites: “First and foremost, we need to get health care reform done right, not done fast. Passing another thousand-page bill without amendments or debate will do nothing to help the economy, create jobs, or reform health care.” That may be translated to “Other topics are more fun. I’ve moved on”. But Senator Lamar Alexander and other Republicans are working, mostly around the edges, to improve the PPACA. Our time was best spent with those representatives concerned about stabilizing the markets and making the system work.
I met with Tina Chhabra, a former pharmacist, in Senator Sherrod Brown’s (D-OH) office. I also talked with Catherine Wilson who works for Congressman David Joyce (R-OH) and Joe Herrbach from Congresswoman Marcia Fudge’s (D-OH) staff. Congressman Joyce was in a hearing. This is the first time he was unable to meet with us.
Much like last year and the year before last, our focus was on stabilizing the market. In a world dominated by sound bites and tweets, someone has to remind our elected officials of the real world implications of their legislation. Here are a few of the areas we discussed with our members of Congress:
- COBRA as Medicare Credible Coverage – This is one of those down in the weeds issues that had no champions, only victims. COBRA doesn’t count as credible coverage. Senior who retain their COBRA coverage instead of enrolling in Medicare when they become eligible, are considered to be “late enrollees”, subject to a waiting period, and will pay a penalty for the rest of their lives! It is normally just a mistake. Retirees over 65 may not have access to good, free information. We can correct this. H.R. 5104 died in committee last year. We hope to see it reintroduced soon. This is the link to the previous bill – Medicare Enrollment Protection Act.
- Transitional Relief – It seems to fall upon us to remind our friends in Washington about the importance of Transitional Relief / Grandmothered health policies. These policies were written and issued in 2010 after the PPACA was passed until the end of 2013 when the law was fully implemented. Many of us are dependent on our ability to retain these policies and wait nervously for the annual announcement. There aren’t any policies sold in Ohio that can match the network access of the Anthem, Medical Mutual, and Golden Rule Grandmothered contracts. Every Congressman and legislative aide quickly grasped the importance of granting transitional relief for these policies. Some even thought that this should be simply granted permanent status. As with so many other issues, this would disappear without our constant vigilance.
- Retain the employer tax exclusion – More than 178 million Americans get their health insurance at work. There were some proposals being floated to either cap the maximum amount of premium the employer could deduct or eliminate the deduction completely. Talk about destabilizing the market! There seemed to be little interest in overturning our markets in the offices I visited.
We had more time in some offices than others. Some of our representatives are more interested in how consumers could use the Tax Credit Subsidy outside of the Marketplace if there were fewer than two choices available in a particular county. Others are more focused on delaying or repealing the so-called Cadillac Tax. I would be happy to have a more in depth discussion of the issues over coffee (or cigars!) at your leisure. It isn’t nearly as boring as it might seem.
Picture – A Quiet Spot – David L Cunix