The first priority of the industry in 2010 will be prevailing on Congress to enact final health care reform legislation that makes health insurance more affordable than current versions of the legislation.
Another key priority, industry officials say, is ensuring a role in the final bill for agents to sell insurance in all markets.
Congressional staffers and investment analysts say Senate passage of healthcare reform legislation in an historic Christmas Eve vote sets the stage for tough negotiations between the House and Senate on differing bills.
But the priority of congressional Democrats and the Obama administration is to complete work on such legislation by late January, if possible, these officials say.
Diane Boyle, vice president of government relations at the National Association of Insurance and Financial Advisors, says she believes legislation will be enacted. "We have improved the Senate bill, but much work remains to be done to address affordability in any final legislation."
One concern is that both the House and Senate bills contain the Community Living Assistance Services and Supports Act, or CLASS Act, a long-term care entitlement program about which the industry has deep concerns. "It is a new government entitlement and it does not serve reform goals," Boyle says.
Karen Ignagni, president and CEO of America's Health Insurance Plans, agrees that affordability remains a key issue.
"Specific provisions in the current bills "will increase, rather than decrease, health care costs; reduce coverage options; and disrupt existing coverage for families, seniors and small businesses-particularly between now and when the legislation is fully implemented in 2014."
AHIP members, she says, "support legislative changes that would provide guaranteed access to all Americans, with no pre-existing condition limitations and no health-status-based premiums. These reforms are essential to giving all Americans greater peace of mind and health security."
Janet Trautwein, CEO of the National Association of Health Underwriters, says the Senate bill specifically ensures the role of licensed health insurance agents in state exchanges. However, Trautwein adds, "we would like to see these provisions expanded and clarified to ensure that all policies provided through the exchanges be available for purchase through an agent or broker.
"Our nation's agent and broker community could do a great deal to enroll currently uninsured Americans who would be eligible for purchasing assistance under this new measure," she says.
John Greene, NAHU vice president of congressional affairs, adds that while there have been some improvements in the Senate bill, "the road to acceptability is long.
"Employers, especially small businesses are already scaling back hiring plans and finding ways to avoid higher taxes," he says.
A new amendment in the Senate bill that would require employers to provide certain employees with a voucher "will move more employees off their employer plan and into the exchange, where the subsidies are very rich," he says.
He also contends that "demand for the subsidies will grow and attempts will be made to move even more into the exchange for the subsidy creating more demand for taxpayer dollars."
Another key concern is that the medical loss ratio (MLR) requirements during the transition period to 2014 "will shrink the carrier market before we even get to the exchange, thereby limiting choice in the exchange," Greene says.
"Not all costs under MLR are bad," he adds. "Disease management, wellness programs, claim adjudication and fraud and abuse detection are among the expenses under MLR."
The final Senate bill does not contain a public option, one of the industry's primary concerns.
According to officials at the Council of Insurance Agents and Brokers, the public option in the Senate bill has been replaced by a program requiring the federal Office of Personnel Management to oversee private individual and small-group plans that would be offered in state exchanges.
"This is designed to assure that each exchange has at least two private market options for each market sector," CIAB officials say.
"While we are still analyzing this provision, our first instinct is to think of this as a federal certification for private insurers (who may band together under this proposal) to offer qualified plans nationwide," the CIAB says in a note to members.
Boyle says inclusion of the CLASS Act in both bills remains a big concern.
"The benefit level is substandard to the private insurance market, but it creates a false sense of security for Americans that their long term care needs will be met through this program.
"We have a population that now believes Social Security provides for LTC needs, and that is simply not true," she says. "This remains a major issue for NAIFA."
She says indexing Flexible Spending Accounts for inflation is a major improvement in the Senate bill. "Ideally, we would have liked to have seen the cap raised, but to the extent they wouldn't raise the cap, we at least were able to ensure that the FSA arrangements are indexed to inflation."
Another concern eased in the Senate bill is that for the most part, "there is no tax on employer-provided health insurance."
Another improvement in the Senate bill is that it delays the tax on health insurers from 2010 to 2011, and the highest taxes will be in the out years, she says. "But, it did a impose a tax on those who earn over $250,000," Boyle adds.
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