-Amy Evans, president, Colibri Insurance Services, Inc.

DPC + HSA

Watching the Primary Care Enhancement Act. HR 365, which is a nonpartisan effort with support to align direct primary care with HSA governance. To me, it's clearly a win-win for all stakeholders.

-Drew Kallestad, EVP, broker and employer engagement, PeakMedPrimary Care

Free-market care

My clients and I are watching all legislation regarding health care financing. However, nothing we have seen so far even remotely addresses the ongoing problem understood by anyone who works in the realm of benefits.

Until an orderly market is created whereby all costs are transparent and which is based upon free market enterprise principles, two trends will continue:

1. The costs of health care will continue to escalate exponentially.

2. The quality and availability of health care will continue to decline.

Creating such a market is simple. However, until such a market is created, we will get no relief.

-Quentin Ledford, benefits analyst, Cambridge Investment Research Advisors, Inc.

DPC powers through

I've been keeping a close eye on HB37, which was signed into law late in March by Gov. Rick Scott. The bill essentially clarifies that DPC membership does not constitute health insurance and is therefore not subject to oversight by the Florida Office of Insurance Regulation. It's no coincidence that this bill attracted a massive lobbying effort to assure it never reached the Governor's desk. Success only came after four attempts.

Claims for self-insured employers who offer this arrangement on a voluntary basis see major reductions in per employee per year costs. Urgent care and emergency room utilization are reduced significantly.

Another benefit of the expansion of DPC is reduced burnout among physicians as well as a new influx of practitioners who can focus on what they do best.

-Curtis Colbert, principal, Simplified Insurance Solutions, Inc.

Small-employer benefits

I have been and will continue to be active in the continual development of the QSEHRA legislation that began with the Cures Act of 2016 and will continue to have the spending limits increased by IRS. For this tool to truly be impactful, we need higher spend limits for small employers and to increase the employer size from 50 to 200. Then there is promise to save the individual health market risk pools and free small employers from the burden and expense of managing health care. The other benefit is that it creates a mechanism for “portable” gig economy workforce benefit communities to form and flourish.

-Joshua Jeffries, principal, Arkin Youngentob Associates LLC

Association health plans

The issue I've been pinged most about lately is the notion of association health plans. Several states and carriers are taking a stand on not allowing small businesses to participate in AHPs; however, if allowed, AHPs will significantly open doors for more potential cost control and flexibility for small employers who have been restricted by small-group regulations for so many years (and who felt they were harmed by ACA). AHPs, though, could potentially hurt our business, if we as an organization do not embrace them, as they could result in lost clients/revenue to those organizations that do embrace it. That being said, the stability and long-term viability of AHPs remains a question for me, given what happened with exchanges. More to come—and I can't wait to see it unfold.

-Beth Robertson, AVP, Corporate Benefits, NFP

Courtroom battles

The legislation around association health plans is foremost in most of our client discussions. We're also watching the pending RBRVS lawsuit. In Martinsville, Virginia, there is a reference-based pricing lawsuit pending that industry insiders are following closely, because it could set a precedent for these types of lawsuits moving forward. In this case, a Virginia hospital has been pursuing an $84,000 balance bill from a former patient for nearly four years and through two separate courts.

-Kimberly Darling, co-founder, WellCard Savings

Commission questions

Georgia's HB 64 legislating that insurance companies do not have to pay commissions during an SEP. We know that CMS is meeting with the insurance industry about agent/broker relations and we hope this trend can be stopped, not further encouraged, by regulation.

-B. Ronnell Nolan, President/CEO, Health Agents for America

Sound familiar?

The feds need to allow direct-primary care subscription fees to be paid out of an HSA account by an employee. Employers can pay these fees for employees but they are not an eligible expense under current HSA rules.

-Suzy K Johnson, president and employee benefit specialists, Employee Benefit Advisors of the Carolinas

Upon further review…

In Massachusetts, like other states, we are behind the eight-ball financially due to the subsidized care pool. Mass Health is projected to cost up to 40 percent of the state budget. Obviously, this is not practical for any state. Thus, Governor Baker instituted the Employer Medical Assistance Contribution Supplement (EMAC).

This EMAC contribution is one that employers have no ability to calculate, plan for, or project into their budget, as there are no reporting requirements on behalf of the state to notify an employer if an employee receives subsidized coverage through Mass Health. Thus, our clients and employers around the state are getting blindsided by penalties for employees receiving coverage through Mass Health. Many of these employees were even offered affordable care as required by the federal mandates, but based on income, qualify for a Mass Health subsidy. Employers can do what is right according the federal guidelines, offer affordable care, and still be penalized. This penalty goes down to employers with more than five employees. It has proven to be a significant burden both financially and administratively on many of our clients.

Yes, there is always an adjustment period, but this has remained a hot topic of conversation. Not directly industry related, but something that has derived from the major changes in health care burdening our state.

-Braden Monaco, Partner & Healthcare Strategist, Blue Horizon Benefits

Doing research

I have been following the association plans and learning more about them! I recently attended the SPBA Meeting in Washington, D.C., where there was a session discussing this topic specifically.

-Vicki Burgess, director of sales, accident & health division, Crum & Forster