A top Republican and a top Democrat in the U.S. Senate have put a long health insurance agent and broker compensation disclosure provision in a major new health care finance system change bill.
Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash.,Alexander, included the provision in their new Lower Health Care Costs Act of 2019 bill draft.
Alexander — the chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee — and Sen. Patty Murray, D-Wash., the highest-ranking Democrat on the Senate HELP Committee, have been trying for years to come up with a bipartisan effort to shore up the current Affordable Care Act (ACA) system.
Alexander and Murray have sometimes won significant bipartisan support for their ACA fixer packages, but efforts to pass the packages failed, in part because of some Republican House members’ opposition to the idea of doing anything to that might extend the life of the ACA framework.
The current version of the Alexander-Murray bill draft has five main “titles,” or sections. The five main titles relate to improving health care transparency, improving the exchange of health information ending surprise medical bills, reducing prescription drug prices, and improving the U.S. public health system.
The health insurance producer compensation disclosure provision is part of the health care transparency title.
The Alexander-Murray Health Care Transparency Title
The proposed producer comp disclosure provision is one of a number of provisions in the health care transparency title.
Some of the other transparency provisions would:
- Ban what Congress sees as anticompetitive terms in insurance contracts.
- Ban price information confidentiality clauses.
- Set new accuracy rules for health plan provider directories.
- Require that health plan enrollees know what their own portion of medical bills will be, through a cost-sharing information access requirement.
The producer comp disclosure provision, described in Section 308 in the bill draft, would require “disclosure of direct and indirect compensation for brokers and consultants to employer-sponsored health plans and enrollees in plans on the individual market.”
Section 308 takes up about 15 pages in the 165-page draft PDF file.
The section would apply to a producer or entity expecting to earn more than $1,000 in direct or indirect compensation for selling or administering health coverage.
The revenue total used for the applicability threshold would apply to compensation for services such as benefits consulting, benefits administration, recordkeeping and providing stop-loss insurance as well as for selling coverage.
An affected individual or entity, or “covered service provider,” could report compensation as a monetary amount, a formula, a per-enrollee charge, or using ”any other reasonable method,” according to the draft text.
A covered service provider in the group health market would have to give a group health plan fiduciary compensation reports, listing the services provided and the sources of the compensation, when coverage was purchased or renewed, or when compensation arrangements changed.