Want to make a difference in health policy issues? Then remember these three key pieces of advice from Karen Timberlake and her colleagues at Michael Best Strategies:
- Keep following health policy issues to keep your employee benefit plan in compliance, now and in the future.
- Have faith in your ability to make a difference, based on the power of employer stories to inform and influence lawmakers.
- Know the effective ways to take action.
Timberlake, a principal at Michael Best Strategies (MBS), shared her advice at the Alliance Learning Circle on Health Policy at The Monona Terrace on March 21, where she also offered an overview of health policy issues to watch in Wisconsin and Illinois. The Alliance retains MBS to monitor and advise the cooperative and its members on health policy issues.
Wisconsin Faces Budget Fight
Wisconsin Gov. Tony Evers, a Democrat, will hammer out a biennial budget with a Republican-dominated legislature. Timberlake noted the two groups currently seem to “agree on the time of day and the day of the week and little else.”
A major issue will be Gov. Evers’ desire to expand Medicaid to cover an additional 82,000 adults, which many Republicans oppose. The expansion would bring in additional federal dollars to:
- Pay more to hospitals and dentists.
- Pursue women’s health initiatives.
- Increase payment for mental health services.
- Increase payment for long-term care and direct care workers.
Meanwhile, legislators are advancing bills with some apparent impact on employer health plans. Timberlake singled out bills addressing four issues that are currently being monitored by The Alliance:
- Coverage for people with pre-existing medical problems: Assembly Bill (AB) 1 would help people with medical problems get access to insurance coverage if the Affordable Care Act (ACA) is overturned.
- Step therapy exemptions: AB 24 would let patients bypass insurance rules that require them to try less expensive drugs before taking more expensive options.
- Direct primary care (DPC): AB 26/Senate Bill (SB) 28 defines direct primary care and establishes requirements for “valid” DPC arrangements.
- Pharmacy benefit managers (PBMs): SB 100 establishes new rules for PBMs by requiring more transparency of costs and rebates and preventing PBMS from limiting pharmacists‘ ability to inform patients of lower cost options.
“These fall in the category of things that change fast, so it’s important for employers to be part of the dialogue,” Timberlake said.
Illinois Seeks Revenue
Much of Illinois’ legislative activity is focused on finding revenue to cover a $3.2 billion deficit. Gov. J.B. Pritzker is a Democrat and Illinois’ legislature has a Democratic majority in both houses.
Two proposals to increase revenue could have an impact on health care.
- A proposed tax on e-cigarettes — matching the rate of the tax on traditional cigarettes — is projected to generate $10 million. Meanwhile, the tax on traditional cigarettes will be increased by 32 cents per pack to generate an additional $55 million to fund the Medicaid program.
- A new Managed Care Organization (MCO) assessment would create a 1 percent tax on health care claims that would be paid by both Medicaid MCOs and commercial insurers. The proposed tax would apply to third-party administrators (TPAs) that serve self-funded employers.
Two developments in the Illinois legislature are being monitored for their impact on employers.
- The House Prescription Drug Affordability Committee is focused on prescription drug prices. How it will impact employers is still evolving.
- House Bill 465 was filed by House Leader Greg Harris and aims to:
- Define and regulate PBMs.
- Require pharmacists to alert customers when a less expensive product is available to fill a prescription.
- Protect consumers using the emergency room from having their insurance coverage rejected.
- Prohibit insurers from adopting “copay accumulator programs” that prevent manufacturers’ copay cards from applying to an enrollee’s deductible.
Your Voice Matters
As proposed legislation and regulation moves through the federal and state lawmaking process, employers can contact their legislators or participate in other Alliance activities aimed at alerting policymakers to the potential impact of their actions.
Timberlake noted that employers can sway lawmakers and regulators by sharing the impact of proposed legislation on their organization and their employees.
“Constituent stories are the most influential approach to persuading the legislature to act,” Timberlake said. Policymakers are generalists, so they appreciate input that shows the impact of proposed legislation.
“We have to help them see the world as you see it,” Timberlake said. “We have to help them tap into your expertise.”
She urged employers to respond when The Alliance seeks their input on legislation, which could include a willingness to testify at legislative hearings.
“Employers can be incredibly persuasive,” Timberlake said.
What The Alliance and Its Members Have Done in the Last 18 Months to Reach Lawmakers
- Requested members to contact their legislators about the need to repeal the Cadillac Tax.
- Signed on to “open letters” from organizations such as the American Benefits Council to educate Congress about health benefit issues.
- Commented on pending regulation at the state and federal level.
- Testified to the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee.