By Dawn McFarland
I don’t know if you all feel this way, but I feel like the whole first quarter of 2023 flew past. It’s interesting to observe the changes in our environments in our post-COVID world. Our industry has adapted over and over again, and we are not done. I have come to understand, as so many of my mentors have explained, that healthcare has always needed — and will always need — advocacy. And the integrity of the independent agent is on the line. I feel like there are a lot of new and young people joining this industry that would love to help advocate.
We need ambassadors encouraging participation in the associations that advocate for the real-life experiences of people using and paying for healthcare – our clients.
Before I summarize the current events post CAHIP Bill Review, I want to make a plea.
If you are reading this article and not yet a member of the National Association of Benefits and Insurance Professionals (NABIP), join at www.nabip.org. And if you need a reason to do so, you join the California Agents & Health Insurance Professionals (CAHIP, the state chapter of NABIP) in Sacramento from May 8-10th for our annual Capitol Summit (go to www.cahu.org for agenda and registration link).
This event is where hundreds of us go to the state capitol and meet with our legislators to discuss how healthcare financing and access to care affects their constituents. Our stories matter when we are explaining the help we provide, to counter the stories the legislators hear of bad actors in our industry.
CMS final rule
This leads me to the latest CMS Final Rule released the first week in April. As most of you are likely aware, about this time last year CMS released a final rule that lumped independent agents with the definition of third-party marketing organizations (TPMOs). It also required new disclaimers and client call recording for agents that serve Medicare beneficiaries. This rule was a result of 40,000 complaints in 2021, a drastic increase from 21,000 in 2016.
In response NABIP and other organizations worked on many levels to get answers and clarification from CMS because its new rules did not stop the bad actors. I know my clients are still receiving text messages urging them to hurry to meet a deadline threatening loss of coverage. On the flip side, I feel like the commercials have toned down significantly. It has been a while since I’ve heard the “let’s check your zip code” commercial.
There was an agent petition started by those that serve Medicare beneficiaries, an Operation Shout from NABIP, and even a piece of legislation (introduced too late in the session) to remove agents from the definition of TPMO. This year NABIP is continuing the effort and is actively working to get a new piece of related legislation introduced.
Now we have the new 2024 Final Rule, which includes things like reinstating the 48-hour scope of appointment (SOA) for all appointments except walk-ins, rules limiting what you can do with marketing versus education meetings, list every carrier you are certified with and mention SHIP counselors, (HICAP in California), in the disclaimer.
The good news is that CMS has backed off the call recordings for all calls, instead applying the new rule only to calls associated with the marketing and enrollment of a plan.
Visit www.nabip.org to see all the activity and CMS communications NABIP has worked on. Many of us just returned from Washington D.C., lobbying this issue and others on behalf of you and your clients. If you would like to see the full list of NABIP of federal priorities 2023 visit www.nabip.org.
CAHIP’s annual bill review session
CAHIP’s annual bill review session — where the local chapter legislative chairs and chapter presidents take a full day to review and discuss the many pieces of California legislation regarding healthcare financing and healthcare access — just took place in March 2023. It was a massively successful day.
Our entire industry benefits from this legislative work, but only a fraction of licensed California health agents are members. This association is truly for you. It is made of volunteers that do what you do. These volunteers go through all introduced legislation each season and work with policy makers to avoid unintended consequences and things that can harm Californians.
February 17 was the 2023 deadline to introduce any legislation this session in California. There were 2,600 bills introduced, a high number even by California standards! CAHIP is actively watching a list of about 137 bills related to healthcare, paired down to about a dozen bills on our priority list (available to CAHIP Members at www.cahu.org). Many are proposals to address social determinants of health and access to care. We consider the costs versus the benefits of each piece of legislation, to determine whether to support, oppose, and/or consider alternatives.
Some interesting statistics about the 2600+ newly introduced bills: v1,046 (40%) of them were nearly blank, commonly referred to as “spot bills” or “intent bills..” As spot bills are amended and filled in with substance, we will continue to flag key bills of interest.
The top urgent priorities for CAHIP are California’s SB 770 and AB 1048, both regarding movement toward a single payer healthcare system in California. While the price tag continues to rise and the California budget is questionable at best, it seems preposterous. However, without advocacy and voices to share concerns with policy makers, those policymakers will only hear one side of the story. (Another plea to join us in Sacramento! With 31 new legislators in state seats who have not heard our concerns in the last two single payer fights, we need industry professionals from up and down the coast to join us.)
We are also watching the Long-Term Care (LTC) Task Force and the Office of Healthcare Affordability as measures to control the cost of healthcare and LTC continue to rise.
The CAHIP member newsletter for April has a rundown of California legislation. Feel free to read the article at www.cahip.org. You will learn about all these things and more if you attend CAHIP’s Capitol Summit in May.
Hey, we should make a drinking game out of how many times I mention Capitol Summit in this article, LOL.
Onward we go, doing our best to help California consumers understand how to access their healthcare in the most affordable ways, working for a future with real healthcare instead of sick-care. Hope to see you in the trenches!
Dawn McFarland is VP of legislation for CAHU (now known as CAHIP), president of M&M Benefits Solutions in Los Angeles and the vice chair for the Leadership & Development Committee for
NAHU (now NABIP).