PIA Against 'Navigators' Aspect Of House Health Reform Plan

Regarding the "navigators" issue, PIA officials said a provision of the bill allows the Small Business Administration to design a health care insurance program for small business.

The provision, titled "Assistance for Small Employers," is in essence a "navigators" program that drafters of health care reform legislation promised would not be in the bill, said Mike Becker, PIA national director of federal affairs.

Mr. Becker did note that PIA is "heartened" that the House bill does allow insurance agents and brokers under state law to participate in providing coverage to individuals and employers in qualified health plans offered through insurance exchanges.

But, he said, PIA is concerned about the SBA mandate, which gives the SBA authority to set up, in essence, a "navigators" program requiring the SBA to provide educational activities to small businesses.

SBA officials would also be allowed to distribute information and provide "enrollment and plan selection assistance for employers" for health plans available under the Health Insurance Exchange created under the legislation, he said.

"In short, the SBA would be required to perform the functions of an insurance agency or brokerage for small groups of under 100," Mr. Becker said. "Professional, independent insurance agents and brokers already perform all of the services for consumers that the bill would require the SBA to provide."

In addition, independent, private-sector insurance agents and brokers are better equipped to offer their clients objective assistance in "navigating" the choices offered through Health Insurance Exchanges, he contended.

"In contrast, a government-funded agency or third-party contractor could employ unlicensed individuals with no expertise in health insurance to perform functions that currently require state licensing," he charged.

In its view of the legislation, James Klein, president of the ABC, said the House bill jeopardizes employer-sponsored coverage that now serves more than 160 million Americans."

He said ABC members have consistently supported a balanced, bipartisan approach to health care reform "that recognizes the value of employer plan sponsorship."

"We hope that, as reform legislation advances toward enactment, lawmakers will incorporate several of the provisions first developed by the Senate Finance Committee, which help avoid many of the destabilizing provisions embodied in the House bill," Mr. Klein said.

"We look forward to working with Congress to achieve reform that employers, employees and all stakeholders can embrace," he added.

In commenting on the bill, PIA officials did note that the provisions in the House bill that would repeal health insurers' and medical malpractice insurers' exemption from antitrust enforcement under McCarran-Ferguson does include an amendment added during the markup of the antitrust repeal language by the House Judiciary Committee.

The amendment retains the McCarran-Ferguson Act exemption for compiling and disseminating historical loss data.

But PIA officials said the provision is "unnecessary" and "adds nothing to the bill."

Mr. Becker said, "In fact, the bill states that its exemption to McCarran-Ferguson is to guarantee against "price-fixing, market allocation or monopolization…"–all of which are already illegal under state law and have never been permitted under McCarran-Ferguson."