Category Archives: Healthcare

WIPP Works in Washington – August 2018

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Pay No Attention to that Man Behind the Curtain

Ann Sullivan, WIPP Chief Advocate

In the final scene of the Wizard of Oz, the dog Toto pulls back the curtain and Dorothy discovers the man behind the curtain is not the great and powerful Wizard, he’s just a little old man with a megaphone. Sometimes, actions in Washington use the megaphone but there is relatively little “behind the curtain.” That’s how the new rule on Association Health Plans (AHPs), issued by the Department of Labor, feels.

It was with great fanfare that the Administration issued new rules for AHPs. WIPP has supported AHPs since its inception as a necessary tool to allow small businesses to band together to create larger health insurance pools, thus creating more competition and better prices in the small business marketplace. Insurance rules adopted during the Affordable Care Act (aka Obamacare) largely prohibited AHPs from a viable option. Because every insurance plan had to cover 10 “essential health benefits” under the ACA, these plans became mute.

When the Department of Labor announced loosening the regulations to allow AHPs, we applauded. WIPP submitted comments urging better pooling mechanisms, a wider range of health plan options and protections for those with pre-existing conditions. We also urged the Department to include a different “commonality of interest” definition, allowing small businesses to band together beyond a trade, industry, or profession. This would have allowed small business organizations to offer AHP membership to its members, including WIPP.

On June 21, the man behind the curtain showed up. The Department of Labor issued its new AHP rules. By deciding to keep the definition of who can join an AHP to a trade, industry, or profession, business organizations like WIPP, cannot offer an AHP. For example, an accountant in Nevada could join an AHP housed in a national association of accountants, but an organization of women business owners, does not qualify as a trade, industry, or profession, according to the new rules. The AHP can have out-of-state members but must comply with the rules of the state in which it is housed, restricting its ability to be a true “across state lines” option. Important to note is that AHPs are not required to offer the 10 essential benefits, which means education for employers and employees who join AHPs is needed.

News reports suggested that small business associations who have supported AHPs in their policy platforms are not going to take advantage of the new rules. That’s because they can’t—their commonality is business owners, not limited to a specific trade, industry or profession. Giving small business owners more health insurance options continues to be part of our policy platform. As premiums continue to rise, small business exchanges set up by the ACA should not be the only option. The Department of Labor could have done so much more than use their megaphone.

Trump Administration Freezes Billions of Dollars in Payments to Affordable Care Act Risk Adjustment Program

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Over the weekend, the Centers for Medicare & Medicaid Services (CMS) issued a statement saying it was halting billions of dollars of payments to insurers under the Affordable Care Act’s risk adjustment program due to conflicting federal court decisions on the program. This move will likely disrupt the insurance market in the Exchanges and could lead to more premium increases next year.

The purpose of the risk adjustment program, a permanent program, is to reduce the incentive for health insurers to select and cover only healthy individuals in the Exchanges. It shifts money from plans with healthier members to those with larger numbers of sicker members to help mitigate high costs of coverage for less healthy individuals.

America’s Health Insurance Plans (AHIP), the association for insurance carriers, expressed concern and stated, “the decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own. It will create more market uncertainty and increase premiums for many health plans—putting a heavier burden on small businesses and consumers, and reducing coverage options. And costs for taxpayers will rise as the federal government spends more on premium subsidies.”

The CMS has asked for additional guidance from the district judge overseeing the case relating to this program, prior to unfreezing the funds.

Administration Eases Restrictions on Association Health Plans

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Due to a move by the Trump Administration, the Department of Labor released the final version of its Association Health Plan rule, which allows industries and small businesses to band together via bona fide associations to buy insurance as part of a plan to encourage competition in health insurance markets and lower the cost of coverage. AHPs will be an important part of employer options for coverage beginning in 2019.

The Association Health Plan (AHP) rule broadens the definition of an employer under ERISA, the Employee Retirement Income Security Act, to allow more groups to form association health plans across state lines, similar to large employers. Key provisions in the final AHP rule include:

  • Expansion of definition of those that can form an Association Health Plan (AHP) – An association that represents a single trade, specific industry or profession can now establish an AHP that provides coverage to their members across the entire country, like a large employer plan. General business organizations and workers, or business owners in unrelated professions can band together to obtain coverage through an association health plan, but they must be in the same geographic region. While this allows for a breadth of types of AHPs – national, statewide or local – by restricting criteria of commonality to establish AHPs across state lines, many existing national associations will be unable to set up AHPs and provide access to affordable insurance options to their members.
  • Association Health Plans (AHPs) can bypass certain requirements of the Affordable Care Act (ACA) – AHPs do not have to meet ACA essential health benefits requirements, thus they do not have to cover all the benefits that are currently required in the health insurance plans presently sold in the state exchanges. While this will allow AHPs more flexibility in customizing plan options, and likely result in lower premium costs, it is important for business owners and workers to note that these plans will likely offer less comprehensive coverage.
  • Association health plans cannot restrict membership based on health status or charge sicker individuals higher premiums – An AHP will operate like a large employer plan and includes nondiscrimination rules ensuring the association cannot deny coverage to anyone that meets their membership requirements and wants to purchase coverage. AHPs can adjust premium costs of members based on age, which is similar to age rating rules in current ACA health exchanges.

WIPP has supported the implementation of AHPs as an effective mechanism for small businesses to pool together to obtain affordable health insurance. WIPP submitted comments to the Department of Labor on the proposed Association Health Plan rule, highlighting that WIPP believes that a successful healthcare market should encompass three core principles: an effective pooling mechanism, a wide array of health plan options, and a protection in place for those with pre-existing conditions.

In addition, WIPP recommended including an additional criterion for commonality of interest to allow employers to band together for the purpose of establishing an AHP through a membership organization or association that is comprised of members regardless of whether they are in the same trade, industry, line of business or profession, and regardless of whether they are located in the same area. Unfortunately, as highlighted above, the Department of Labor did not agree with this more expansive view, leaving national business organizations like WIPP unable to set up an AHP across state lines.

The Department of Labor shared a fact sheet on the new rule that noted important dates for associations or business owners interested in AHPs:

  • All associations (new or existing) may establish a fully-insured AHP on September 1, 2018.
  • Existing associations that sponsored an AHP on or before the date the Final Rule was published may establish a self-funded AHP on January 1, 2019.
  • All other associations (new or existing) may establish a self-funded AHP on April 1, 2019.

Although the Affordable Care Act envisioned state exchanges rather than AHPs, WIPP believes there is room for both. Though the Obamacare Exchanges initially gave small businesses more coverage options, many plans have dropped coverage, leaving the small business market with fewer coverage options and premium costs have risen year over year. The expansion of AHPs would provide more cost-effective coverage options for small businesses and the self-employed.

March Policy Update

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Policy Upate Graphic.pngSCOTUS Punts on DACA (For Now)

Last week, the Supreme Court sent the Trump Administration’s appeal on the President’s order to cancel DACA back to the 9th Circuit Court of Appeals, leaving the program’s March 5 expiration moot. Dreamers will remain protected from deportation until the Court of Appeals renders a decision, which could take months.

Breaking the Bank: WIPP Weighs in on Access to Capital

The Senate continues working through amendments to bipartisan lending legislation today that would lighten regulations imposed on small and mid-sized banks through Dodd-Frank. WIPP has advocated for ending the “one-size-fits-all” approach by calling on Congress to enact legislation to address the regulatory relief needed for smaller lending institutions, thus freeing up capital for small businesses.

Read the Economic Growth, Regulatory Relief, and Consumer Protection Act here. Read WIPP’s Breaking the Bank platform here.

WIPP Urges Expansion of Association Health Plans

In January, the Department of Labor issued a proposed rule that would expand participation in Association Health Plans for small businesses and the self-employed. WIPP urged the department to implement a program that maximizes the number of businesses that can participate in the plans, so that women business owners can provide more choices for affordable health insurance.

Read WIPP’s comments here.

NLRB Reverses Joint Employer Standard

Obama’s legal standard for determining whether joint employers could be held liable for an intertwined business’s workplace issues is back due to a conflict of interest of a board member who did not recuse himself from the case. NLRB granted the parties in the original case the ability to appeal and could rehear the case later this year.

Read the NLRB’s press release here.

Proposed Rule Issued to Expand AHPs

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Healthcare.jpgIn October, the Trump Administration issued an Executive Order directing the Department of Labor to expand access to Association Health Plans (AHPs).
On January 5, a proposed rule was published that would expand participation in AHPs for small employers and the self-employed. Specifically, the proposed rule would:
  • Treat AHPs as large employers (flexibility on pricing and products)
  • Relax the requirement that associations must exist for a reason other than offering health plans
  • Relax definition of “commonality of interest” as:
  • 1) Being in the same trade, industry or profession; or
  • 2) Being in the same principal place of business within the same state or common metropolitan area (even if the metro area extends across state lines) to make it easier for employers to group together
The proposed rule would also adopt non-discrimination protections that bar all health group plans from conditioning eligibility, benefits or premiums on health status.
The deadline to submit comments to the Employee Benefits Security Administration within the Department of Labor is March 6. Comments can be submitted here.

2018 will be a big year for WIPP. Please join us!

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January Letter From WIPP President Jane Campbell

Happy New Year!

Washington was hit by a deep freeze at the beginning of January, causing a bit of a slow start for Congress. But national politics has already resumed its’ torrid pace.

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WIPP President Jane Campbell

Don’t worry, Women Impacting Public Policy, with cool heads and thoughtful deliberation, will continue to advance and advocate for meaningful public policy that has a positive impact on women business owners. 

We are off to a great start. This week, we held an informative and well-attended policy briefing to help our members understand the intricacies and impacts of new developments, like the tax law, in Washington. This will be a new monthly series where members can ask WIPP’s Chief Advocate Ann Sullivan and me questions about the rapidly shifting policy landscape.

On top of our policy work, we are planning a new series of ChallengeHER events across the country to deliver the information and connections women need to succeed in government contracting. We are also busy lining up an informative slate of GiveMe5 webinars to provide members with government contracting knowledge delivered by experts in the field. From taking the first steps into contracting to learning what to do once you’ve landed a big government contract, these webinars are an indispensable resource!

As you can see, WIPP is on track to accomplish many amazing things this year. But it’s your voice and membership that makes us powerful in Washington. And it’s more important than ever that women entrepreneurs make their voices heard. After all, if we are not at the table, we will only get the scraps.

WIPP is a nonpartisan organization that brings women from all walks of life and both sides of the aisle together to speak with one voice about what women in business need to succeed. Please consider joining us today.

Jane Campbell
WIPP President

News You Need to Know: December 2017

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Emily Murphy

Longtime WIPP friend Emily Murphy, right, was sworn in as GSA administrator this week. She’s pictured here with WIPP Chief Advocate Ann Sullivan at the ceremony.

Longtime WIPP Friend Emily Murphy Sworn in as GSA Administrator

Longtime WIPP friend Emily Murphy, was sworn in as the 41st administrator of the General Services Administration (GSA) this week. Murphy’s Senate confirmation was strongly bipartisan, with leaders on both sides of the aisle praising her experience, qualifications and commitment to public service. The Senate’s unanimous consent decision came after Murphy’s confirmation hearing before the U.S. Senate Committee on Homeland Security and Governmental Affairs, where she discussed her key priorities and vision for advancing the agency. Murphy will lead a workforce of 11,600 full-time employees and oversee approximately $54 billion in annual contracts.

“I look forward to working with our partners in industry, customer agencies, and Congress so that GSA can continue to fulfill its mission of providing the best value in real estate, acquisition, and technology services to government and the American people,” Murphy said last month.

Deadline to Apply for 2018 Health Coverage Friday

The final deadline to apply for 2018 health coverage at HealthCare.gov is this Friday, Dec. 15. Visit www.HealthCare.gov now to apply. You can also find a host of nonpartisan information about health coverage costs, requirements and options on the Kaiser Family Foundation website.

Burdensome Regulations

The SBA Office of Advocacy is asking for input on burdensome regulations as part of the office’s Regulatory Reform Efforts. You may fill out the form at www.sba.gov/advocacy. You don’t have to an expert to comment. The office is seeking to engage small business owners on their everyday pain points with respect to federal com

Letter from WIPP President Jane Campbell: December 2017

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Winter is here and the weather is chilly, but things are boiling over in Washington. Congress is running full-tilt to try to complete a herculean amount of work before year’s end. In this newsletter, we cover developments in taxes, the National Defense Authorization Act, the deadline to sign up for health coverage and a looming deadline to appropriate  funds for the 2018 budget.

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WIPP President Jane Campbel

We saw record support in 2017 from business organizations, with more than 575 organizations nationwide supporting small businesses on Small Business Saturday—an 18 percent increase over previous years.

WIPP, in conjunction with American Express, founded the Small Business Saturday Coalition in 2011. This year, 7,200 events and activities celebrating Small Business Saturday were held nationwide, engaging more than 2.2 million small businesses.

Every year, WIPP is proud to work with public officials at all levels of government and hundreds of organizations and thousands of small businesses to encourage all Americans to “shop small” at local businesses and “dine small” at local bars and restaurants.

As you do your last-minute shopping, consider going to a small business to get it done.

Happy Holidays!

SBA Administrator McMahon makes first appearance before a Congressional committee

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By Jennifer White, WIPP Government Relations

Small Business Administration Administrator Linda McMahon talked about her plans for the agency during her first official hearing with the House Small Business Committee on April 5. From the start, Administrator McMahon made clear that her goal is to raise the profile of the agency, in hopes of renewing the spirit of entrepreneurship in America.

“Becoming administrator has been a lot like assuming the position of CEO – trying to evaluate employees and practices and figuring out what’s working and what’s not. My first town hall address was to let folks know that I want this to be the best SBA that’s ever been,” said McMahon.

Throughout the hearing, committee members showed interest in working with the administrator and addressed hard-hitting topics for WIPP – including access to capital, healthcare, tax reform, and regulations. Below are highlights:

  • Access to capital
    • In response to inquiries on improving access to capital for women, McMahon said one of her main focuses would be to ensure that more women apply for loans. McMahon plans on providing counseling to women entrepreneurs creating a business plan. She also said she believes SBA can work to increase the number of women in lending positions when asked about the lack of Small Business Investment Company (SBIC) investments to women-owned firms. SBICs are licensed by the SBA to supply small businesses with both equity and debt financing. Increasing women in lending positions is a point highlighted in the WIPP Economic Blueprint.
  • Healthcare
    • The administrator supports the creation of association plans across state lines offered to small businesses, which WIPP supports. McMahon, referring to HR 1101, which recently passed the House, believes this change to the healthcare market would reduce premiums for small business owners.
  • Tax reform
    • Administrator McMahon wants small businesses to receive similar tax treatment as large businesses, another position WIPP outlines in its Economic Blueprint.
  • Regulations
    • The administrator supports reforming regulations to reduce the burden and costs placed on small businesses. She believes the first step is to look at what regulations are really necessary and go from there. WIPP cites the need for reliable policies and regulations in the Economic Blueprint, as well.

Only two months into her position, the administrator is in the early stages of making the progress she wants to. But, between her enthusiasm for the positions outlined here and the committee’s readiness to work with the administration, it is certain there will be lots to watch for in the coming year.

To watch the full hearing and read Administrator McMahon’s written testimony, click here.

March Madness: A Policy Version—The Elite Eight

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By Ann Sullivan, WIPP Chief Advocate

For many years, my son Matt and I watched March Madness together (that was until he moved to Los Angeles). Not only are many of the games squeakers, I love the upsets and Cinderella teams that emerge during the tournament. Half of the fun is filling out the brackets and guessing which teams will move forward.

So, in honor of March madness, we bring you March policy madness. We have created a policy bracket of the issues we expect will make it past the first round of Congressional action. Just for fun.

WIPP Works Bracket March 2017.png 

Here’s an explanation of the Policy Brackets:

Upper Left: Healthcare vs. Border Wall

President Trump’s Executive Actions have identified both repeal of Obamacare and the potential construction of a border wall. Congressional attention is focused on repealing and or replacing the Affordable Care Act.

Healthcare wins this round.

Upper Left: Regulatory Reform vs. FY2018 Appropriations

Congress is hungry to take back policy-making power from the Executive Branch and has found a sweet spot—rolling back regulations—a move President Trump agrees with. He has already signed legislation repealing a Department of Interior rule and is expected to sign more repeals in the coming months.

On the other hand, appropriations is a long and cumbersome process. To get started, on Fiscal Year 2018 appropriations, President Trump needs to share a budget outline with Congress expected next month, and both the House and Senate Appropriations Committees will need to pass all 11 appropriations bills by the end of September. This is a process that has not occurred in over 20 years.

Regulatory reform wins this round.

Lower Left: Trade vs. Supreme Court Nominee

President Trump has indicated that reforming trade policy is a high priority.  But revamping global trade deals into bilateral negotiations will prove to be complicated. The Supreme Court vacancy, on the other hand, has been top of mind. Some Senate Democrats have privately conceded that they expect Neil Gorsuch to be confirmed, taking the place of Antonin Scalia.

The bracket goes to Supreme Court nominee Neil Gorsuch.

Lower Left: Debt Ceiling v. Government Shutdown

Toward the end of the summer, the Treasury Department will have exhausted all “extraordinary measures” to continue paying the government’s bills. Once again, Congress will need to raise the debt ceiling. This close-to-annual exercise used to be non-controversial. But not anymore. This is an opportunity for Congress to discuss fiscal policy.

Another opportunity to discuss fiscal policy is the expiration of the Continuing Resolution on April 28th. In the past, government shutdowns have been threatened/executed, putting continued funding of the government at risk. Given that both Houses of Congress and the president are from the same party, it doesn’t seem likely that shutting down the government is an option. That being said, crazier things have happened in Washington.

Due to timing, debt ceiling wins by a single foul shot.

Upper Right: Taxes vs. Immigration

Tax reform, a priority of both the president and the Congress, is long overdue. In fact, comprehensive tax reform has not been successful since 1986. But don’t look for action overnight. Congressional Republicans are suggesting it will be undertaken sometime this fall.

On the other hand, immigration is even more contentious and bipartisan reform plans were last successful in 1996 under President Clinton. Since then, although there have been many efforts, reform has been elusive.

Tax wins this round.

Upper Right: Defense Spending vs. Infrastructure

Appropriators are currently preparing a special supplemental funding bill for the Defense Department and President Trump announced he would like to add $54 billion to the defense budget. The infrastructure bill hasn’t gained as much traction as the rhetoric about its importance.

Defense spending wins this round.

Lower right: FY17 Omnibus Appropriations vs. NDAA

The National Defense Authorization Act has a 55-year history of being signed into law each year. It is considered in Congress a “must pass” bill. Omnibus appropriations that combine multiple appropriations into a single bill have a spotty record at best. While Omnibus appropriations passed in Fiscal Year 2016, it is still unclear how the rest of FY17 will be funded. Because no one is quite sure, we declare NDAA the winner.

NDAA wins this round.

Lower right: Spending Cuts vs. Elimination of a Federal Agency

President Trump made a campaign promise to significantly decrease agency spending and is expected to propose major cuts in the FY2018 budget. Although eliminating agencies is possible, it is easier to starve an agency than eliminate it altogether.

Spending cuts win this round.

The Elite Eight issues that we predict will prevail to the next round in Washington are:

  • Regulatory Reform
  • Healthcare
  • Supreme Court Appointment
  • Debt Ceiling
  • Tax
  • Defense spending
  • NDAA
  • Spending Cuts

In Washington policy circles, representing women-owned businesses is often like rooting for the underdog. Women across the country who have joined our voice often end up winning the policy fight even though they are dismissed in the “first round.” But collectively, we can end up being the winners who bring home the victory. Not just for us, but for those who have come before us and those that are coming behind us.

Which issues do you think will score over the coming month? Tweet at us @WIPPWeDecide #DCelite8 with your predictions for the Final Policy Four.