WORKING WITH CONGRESS A Primer on Being an Effective Citizen Lobbyist

1. WORKING WITH CONGRESS A Primer on Being an Effective Citizen Lobbyist Presented by Janet Trautwein, Peter Stein, John Greene and Adam Brackemyre National Association of Health Underwriters

2. Why are We “Lobbying”? • NAHU members are a valuable resource to the policymaking process • We are all joined in a growing trade association because we care about our industry and its future • We have distinctive knowledge and understanding of the realities of health care markets • We must interface and build relationships with elected officials so that they make policy decisions that are based on how we make health care work on a daily basis

3. What to Expect in a Meeting • Health care staff people who advise Member of Congress on health and health insurance issues can be new to the subject matter • Capitol Hill staff in personal offices often cover a wide variety of issues for their Member • It is up to us to help Members and staff understand how health care delivery works in the real world, and how different policy ideas might affect the populations that we serve

4. What to Expect in a Meeting • Likely to meet with staff, and perhaps not Member of Congress / Senator – this is positive • Meetings usually last no more than 25-30 minutes • Members of Congress have very crowded and busy schedules, but they rely on staff to be their eyes and ears on their policy portfolio. So get to know and develop a working relationship with key people on their staff. • If Member is able to meet with you, it is not uncommon for him/her to be late or to have the meeting interrupted • Always keep in mind that since this is your livelihood, you probably know a lot more about health insurance than the staff or Member – help them learn more

5. The Approach: Quick Prep Items for your Meetings • In whatever team of colleagues you are joined for your visits, it is helpful coordinate among yourselves topics to be covered and assign main spokespeople • Try to determine how knowledgeable of health care the staff or Member of Congress is – know committee assignments, sponsorship / cosponsorship of measures, votes on major bills of interest

6. What to Expect on a Visit • Since both your and their time is valuable, be prepared to state a clear and concise objective in discussing our issues • Explain why the issue is important to you personally (wear various hats: as producer, parent, as club member) and try to link the importance to the elected official’s district / state (“All Politics is Local”) • If you don’t know an answer – that’s OK! Make a note and get back to them

7. Election Results • Changes to Congress • Factors to Consider: • Historic number of new legislators • Tremendous turn-over in staff and committees • Need to off-set repeal changes with other spending cuts • House actions will be tempered by tight Democratic majority in the Senate and President Obama • GOP will need to balance delivering on promises now and goals for 2012 • Changes to States • New Governors • Potential change for 20 + state insurance commissioners • Historic number of new state legislators

8. Current MLR requirements are significantly and negatively impacting access to health insurance producers • -This is loss of a vital consumer service • MLR is forcing insurers to eliminate key business areas that reduce costs like claims management, fraud prevention and disease-management and to pull out of some markets • -This means consumers may pay more or be unable to afford coverage • Many agents are seeing a net reduction of their business incomes of 30-50% or more. • -This means fewer will be able to stay in business and many will have to begin reducing services to clients and cutting jobs • NAHU supports exempting pass-through fees collected for independent agents/brokers from the MLR calculation MLR

9. Role of Agents, Brokers and Consultants • We support the continued involvement of professionally licensed benefit specialists before, during and most importantly, after the purchase of coverage, regardless of the place of purchase. • We oppose the exclusion or limitations on the use of licensed benefit specialists in any setting including state or federal exchanges created as a result of PPACA.

10. Employer Issues • PPACA will limit the ability of many employers to afford to offer coverage to their employees and is contributing to our nation’s current economic uncertainty and limited job growth. • Erosion of the employer-based system of health insurance will make health coverage more expensive for millions of Americans.

11. Employer Issues • We support repealing the PPACA employer mandate provisions or at minimum, the affordability provisions. • We support increasing the maximum waiting period to at least 120 days, auto enrollment consistent with waiting period, and preserving ERISA • We oppose the current 105(h) non-discrimination requirements as they apply to small employer groups.

12. We support: • A national open enrollment period with late enrollment penalties for child-only plans. • Loosening restrictions on the requirements for grandfathered plans. • Annual enrollment periods with late enrollment penalties. • A transition period for the shift to new rating structure and expanded age rating bands • Eliminating the deductible cap on small employer health plans. • Raising the FSA limit to $5000 in 2013 and tying future annual increases to the medical inflation rate • Eliminating the ban on reimbursing OTC drugs through FSA, HRA, and HSA funds Market Reforms

13. Making Coverage Affordable • We support: • Allowing federal premium subsidies to be used to purchase coverage both inside and outside of the exchange • Improvements to the small business tax credit program • Same tax benefits for individual health consumers as the self-employed but not at the expensive of removing the tax-exclusion for employer sponsored benefits

14. Containing Health Care Costs • We support: • Expanding access to wellness programs and wellness discounts • Medical liability reform • Provider quality and cost transparency • Federal initiatives to encourage provider use of best-practice guidelines and evidence-based medicine • Payment mechanisms designed to reduce the cost of care

15. Senior Issues • We support: • Congressional action to restore funding cuts from PPACA on Medicare Advantage • Restoring the Open Enrollment Period for Medicare beneficiaries • Repeal of the Class Act, an under-funded government-run long-term care benefit program to be replaced with incentives to purchase long term care insurance