The national focus on healthcare heated up again late last year as Republican policymakers promised to repeal the reform law at the same time the industry moved forward with plans to evolve its business.
As trade groups and health insurance companies identify which aspects of the Patient Protection and Affordable Care Act to shape, many are focusing on the role of education and simplified messaging to explain what is considered by those in and out of Washington to be an incredibly complex topic.
"The breadth and depth of these regulations are unprecedented," says Robert Zirkelbach, press secretary at America's Health Insurance Plans. "There are 2,000 pages in this legislation that are going to be enacted over the next several years, largely through the regulatory process."
It's an issue also being communicated at the executive level.Improving the law
David Cordani, CEO of Cigna, spoke at the Reuters Health Summit in November, stating that repealing the law, which was signed by President Obama in March 2009, is not in "society's best interest." He noted, however, that there is room to improve it.
Key complaints for business groups include the employer mandate and the 1099 tax reporting requirement, while most health insurers continue to support the individual mandate that will potentially provide them with millions of new customers.
Other issues, such as medical loss ratio (MLR), were settled in 2010. Final regulations say insurers in the large group market, which includes companies such as Aetna and UnitedHealth Group, must spend at least 85% on medical care, although news reports said investors believed the percentage could have been more onerous. Prior to the regulations, there was no requirement for how much insurers were required to spend on premiums.
Nancy Hicks, associate director of the North America healthcare practice at Ketchum, says the insurance industry will continue to seek its role at the table in order to better influence specific regulations.
"When there's any room for interpreting regulations, the industry is going to try to do it in a favorable way, as it did with MLR," she explains. "That first year, the industry knew it had to be at the table if it was going to shape the bill."
Part of shaping the law requires continuing education of lawmakers, media, and other stakeholders, says Zirkelbach. To counter the complexity of the regulatory issues in the law, the trade organization often provides data, reports, and analyses, such as how states have enacted similar reforms and their impact, as educational tools.
"A lot of these issues are extremely technical and complicated, but will have a very real impact," he says.Critics state their case
The US Chamber of Commerce, an outspoken critic of the law, is also focused on providing educational information to stakeholders as part of its effort to advocate for business owners.
Last July, the trade group launched HealthReformImpacts.com, a site that provides news reports, public opinion pieces, polls, analyses, and a share option for people to submit personal stories about how health reform impacts them.
"We've publicly vowed to undertake an effort to raise awareness of the harmful aspects of the law," says Blair Latoff, director of communications at the organization.
"As we educate other businesses and the American people on the harmful aspects," she adds, "we can resort back to those stories."
In particular, the business lobby is focused on removing the employer mandate, which was one of three issues, including the public option and taxes, it fought against during the healthcare reform debates in 2009 and 2010. It has held events, press conferences, and a fly-in to support its efforts advocating against the employer mandate.
Given the scale of the law and its impact on organizations ranging from small businesses to chain restaurants, healthcare is expected to remain central to ongoing policy discussions.
"There's a lot in this law that still needs to be ironed out," suggests Hicks.
Starting in 2014, small businesses with less than 50 employees will be required to offer healthcare coverage or pay a $2,000 fine per employeeIndividuals
Despite the new regulations facing health insurers, the law's individual mandate ensures the industry could gain up to 30 million new customersSmall business
This mandate would require businesses to file 1099 tax forms if they spend more than $600 on vendors or goods in a year