WASHINGTON BUREAU — The National Association of Health Underwriters (NAHU) has responded to President Obama's State of the Union address by repeating earlier calls for changes in the Affordable Care Act.
Obama said Tuesday during the speech that he welcomes proposals for improving the act – the legislative package that includes Patient Protection and Affordable Care Act (PPACA) – but does not want to re-fight the battles of the past two years.
NAHU Chief Executive Janet Trautwein has welcomed some parts of Obama's 
speech, such as an expression of willingness to consider medical malpractice reform, but she showed no sign that she or NAHU will be retreating from efforts to change the bill. She says a provision that will require employers with more than 50 employees to provide health coverage starting in 2014 or pay a penalty has to go, and she also is continuing to oppose the current version of a minimum medical loss ratio (MLR) mandate.
"We are pleased to see the strong commitment from the president to reform medical liability laws," Trautwein says in a statement.
But the employer coverage mandate is a "job-killer at a time when unemployment is still sky-high," Trautwein says. "If companies can't afford to give their workers insurance the government deems acceptable, they simply can't afford to make new hires. Republicans and Democrats alike want to revive the economy, and killing the employer mandate would be an easy way to help."
The minimum MLR provision will require the percentage of premium revenue spent on health care and tightly defined quality improvement efforts to be 85% at large plans and 80% for individual and small group coverage. Producer groups say the MLR provision is already giving health insurers a reason to cut producer commissions.
Producers argue that commissions should be excluded from MLR calculations, because customers pay the commissions and carriers collect the commissions as a convenience to the customers.
The MLR formula being imposed by the U.S. Department of Health and Human Services will "invalidate many administrative expenses that undeniably improve patient care," Trautwein says.
Fraud and abuse prevention programs "will fall on the wrong side of the MLR divide and will likely be eliminated, which
makes no sense," Trautwein says. "Efforts to reduce fraud ensure that insurance dollars go to those who need them most – the truly sick. Limiting those efforts will drive up premiums for everyone."
Trautweins warns that the MLR rules could also diminish consumer and employer access to insurance agents and brokers.
"Millions of individuals and small businesses depend on licensed agents and brokers to help them navigate the health care marketplace and find health plans that suit their needs and budgets," Trautwein says. "Without agents' expert advice, many individuals and businesses will end up spending more for insurance policies than they otherwise would."
Groups such as Health Care for America Now, Washington, that support the Affordable Care Act are seeking to frame continuing debate about the act as a battle between "millions and millions of people" and health insurers.
"The president made clear that we are not going to give our health care back to the insurance companies, and he challenged Republicans to look forward instead of fighting the battles of the past," HCAN Executive Director Ethan Rome says in a statement. "Instead of trying to destroy a law that's working, Congress should spend its time revitalizing the economy, putting people back to work and rebuilding the middle class."
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