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Talking healthcare in D.C.: an(other) interview with our President, Greg Seifert

If you’re following us on Facebook, you might’ve seen a recent post from our President Greg Seifert pictured in Sen. Maria Cantwell’s office during his trip to the National Association of Health Underwriters (NAHU)’s annual conference in Washington D.C. We interviewed him after he took part in last year’s conference and people seemed excited to learn about the goings-on, so this year our team member Zoe sat down with him once again to chat about his conversations with policymakers, a bipartisan caucus doing admirable work, his stance on Medicare for All, and more.

Z: Let’s start with the basics: what is the structure of the conference like?

G: The Capitol Conference is the annual fly-in for the National Association of Health Underwriters in Washington D.C. It includes leadership training on Sunday, since a lot of the attendees are officers of local and state chapters; the rest of the conference, the normal legislative things, start Monday. That first morning, a local high school marching band opens the event up on stage decked out in their uniforms – it’s really cool, lots of drums. Our hotel, the Hyatt Regency, is just a couple blocks from the capitol building so it only takes five or ten minutes to get to our meetings, plus it’s right near the train station; very handy.

Z: Any particularly memorable conversations with elected officials, or standout talks?

G: We had some great meetings and speakers all week. We always have a great meeting with Congresswoman Jaime Herrera Beutler, which was the case again this year. Another speaker that stood out for me was a Congressman Josh Gottheimer from New Jersey: he’s one of the leaders of the Problem Solvers Caucus, a bipartisan group of Republicans and Democrats. This is a group where it is quite a process to get in; they interview you, they don’t just let anybody join because there’s a fairly big commitment: you have to agree that the reason you’re there is to actually do things. Many believe Congress hasn’t done anything major in about 50 years and instead have let the courts decide major issues in radical ways, when they could’ve taken a more moderate approach with some bipartisan effort. These guys are saying ‘We’re here to solve problems, we’re not here to just spin our wheels and yak and investigate,’ so the agreement is that if 70% of the group agrees on how to vote on a piece of legislation, then all of them have to vote the same direction. So even if 30% don’t agree, the deal is that if the majority percent is on board for this, we vote as a bloc. And he gave some examples of different things they’d done – they had come out with a proposal for immigration reform, for instance; it’s like, there’s a problem, let’s come up with a reasonable solution that might not please everybody but at least there’s action being taken. They identify issues that they believe are important and that their group thinks are worth taking on, that they believe they can reach consensus on. They spend the time to develop proposals and legislation, and they take positions on existing legislation. He commented that caucus’ members from both sides are taking heat from their own parties.

Here’s the mentality – this will blow you away – if there’s a proposal that makes sense and it comes from one party, the other party won’t support it because they can’t fathom the idea of giving the other party a victory. It’s so political; they know that what’ll happen is the party taking credit will trot it out at the next election cycle and say ‘Look what we did!’, and that in turn makes the opposing party look bad. And while I get that attitude to some extent, that’s the deal you signed up for. You signed up to get stuff done, but both sides are reluctant to give the other a win; even if the legislation makes sense. So these guys craft solutions jointly so that ultimately, if it gets passed, it won’t look like a victory for either side. You can read more about it online – they’re part of a broader group called ‘No Labels.’

A little bit about NAHU: we’re a professional organization, an educational organization, and an political advocacy organization in the healthcare/Medicare reform area, and so in order to do these things we have a PAC, and we’re actually a top 5 healthcare PAC in Washington D.C. We are well-respected (I believe) on both sides of the aisle as experts on healthcare and health insurance.

Z: Yeah – not everyone can be an expert so you need those groups to bring their knowledge to the table and weigh in.

G: Yes, and to give you an example of that, we had a really great meeting with Senator Cantwell and her aide Nico where we discussed some common-ground issues – including a little-known issue with Medicare eligibility: when you come off your employer plan, if it’s creditable coverage, even though you’re past your initial Medicare enrollment, you can sign up for Part B late and you don’t get penalized. Any other time, if you sign up for Part B late and you’re not coming off creditable coverage, then you have a premium penalty of 10% for the rest of your life. But if I go off the Biggs’ plan and onto COBRA continuation, and then I sign up for Part B down the road, I have a penalty – even though it’s the same plan I had at work. And the reason for that is in order to avoid the Part B penalty, you have to be on a plan that’s tied to your active employment (or your spouse’s active employment) – if you leave your job, even if you go on COBRA, you no longer have the active employment connection.

So people can be hit by this penalty, because they don’t know about any of that; in fact there are people that do what I do for a living that don’t know, so how is a regular person who’s been on their employer plan supposed to know how Medicare rules treat a COBRA plan vs. a non-COBRA plan? And the same thing applies if I go onto a retiree plan – you have to be coming right off of active employment.

So we covered all this in our meeting with Senator Cantwell; we talked about the Health Insurance Tax, we talked about our reasons wanting to repeal the Cadillac Tax – which has been pushed off time and time again. I think it’s now been delayed till the end of 2022. We discussed why it doesn’t make sense and how hard employer-paid plans are going to be hit by this. The problem is all legislation in D.C. has two sides: it has the ‘what does it do?’ side and it has the ‘what’s the financial aspect?’ side. Some legislation costs money; for example, components of the ACA such as the premium assistance cost a lot of money – to help people buy health insurance, you’re giving them money, that’s the cost side. Well other aspects of the legislation, like the Health Insurance Tax that we’re paying as part of our premium, are revenue generators to offset the cost. When they score a bill, if it’s going to cost something, they have to have a solution for the revenue side. So while it makes sense to eliminate the Cadillac Tax, the next question is how would we recover that revenue?

Z: Anything you wish had gone differently?

G: Well the conversations aren’t always great. We’ve had conversations with leaders that were not fun at all. The ACA is still this football that’s being tossed back and forth, it’s highly political; it’s like you don’t want to touch it because if you’re talking to one party, they think it’s great (for the most part), and if you’re talking to the other party, they think it’s garbage, while the reality is generally somewhere in between. For the meetings, if you’re perceived to take a position in the wrong direction, conversation basically shuts down.

But we had several productive meetings with our elected representatives; those meetings are pretty much Tuesday afternoon and all-day Wednesday. We always have some first-timers and we had some this year – it’s a really fun experience for them.

One of our Washington State reps, Congresswoman DelBene of the 1st District spoke in one of the morning sessions… she got booed twice, I think, after she hinted that she was in favor of Medicare For All. Even after that less than friendly reception we had a nice one-on-one meeting after she spoke – one of our members who was a first-timer, Molly, lives in her district and she and I went off to the side with the Congresswoman and she was very gracious.

To return to Medicare for All for a moment: as an organization we believe that Medicare for All would mean bad healthcare for all and would really mean Medicare for none, because it would destroy Medicare as we know it and the seniors who have it currently would end up with something very different. When they do these polls you might’ve seen in the news, people are saying ‘70% of people are in favor of Medicare for All’ – well to me those polls are simplifying the issue, asking ‘Do you think people should have health insurance?’ and of course the answer is ‘Well yes!’ ‘Do you think they should have affordable health insurance?’ ‘Well yes.’ ‘Well if Medicare for all did that then wouldn’t that be great?’ ‘Yes!’ However there should then be follow-up questions like ‘Would you still support if it means you’re going to lose your personal health insurance?’ ‘Well, no.’ ‘Would you still support it if it meant the seniors who have Medicare now would be losing it?’ ‘Well no.’ ‘Would you still support it if it meant your payroll tax would go through the roof?’ ‘Well no.’ So what happens is that 70% number drops to more like 40% if you clarify what you’re really asking and the consequences of Medicare for All. Thus we’re not a fan of any of the single-payor proposals; we believe that the quality of healthcare would dive significantly in our country if we had that. Here’s a video made by a coalition of which NAHU is a part that explains it really well.

Z: Tell me more about yours and NAHU’s stance on this issue.

G: What I’ve maintained for a long time is that if someone believes everybody should be insured and that it should be through the government, I’d then ask whether you feel it’s fair for the doctors to get paid at Medicare reimbursement levels, generally perceived to be less than it cost to provide the care. Many people say that isn’t fair, and I then ask what makes them think that the government would want to put a plan in place that would pay more than Medicare? You’ve got Medicaid, which pays less than Medicare; you’ve got Medicare which pays at Medicare levels…

And this is being negotiated in our own backyard: in Olympia this year there’s a bill for a public option plan in the individual market, because individual coverage is so expensive. They’re trying to find a solution to provide richer coverage that costs less. So the logic was ‘we need a plan that costs less, we need to pay less for claims, at Medicare levels or close to it.’ Here’s the problem: you have a public option plan that’s got Medicare reimbursement levels, and then you have market-based plans paying claims at negotiated commercial levels, which are 30-40% more. So the same claims would be 30-40% more costly, meaning they have to price their product 30-40% higher than the public option plan. So then what’s going to happen to the commercial market, to consumer choice? It’s going to go away.

The other consequence is that small employers, who I’ve worked with for years, are going to look at this and think ‘Well gosh, my employees can get coverage for their dependents for 40% less than I’m paying by going to this public option plan, so why should I offer an employer-paid plan? It’s not helping them and it’s costing me an arm and a leg.’ So what they’re going to do is take advantage of a new Health Reimbursement Arrangement, HRA law, that says employers can use HRAs to give employees money to buy individual coverage – they take the money that they’re spending now (or even less), and say ‘Okay, we’re going to give you what we’re paying now in cash, and you go out and pick your coverage with pre-tax dollars.’ So it would probably also destroy the small group market in the state of Washington. It sounds great – it would cost less, and I love the idea of people being able to afford health insurance, because they can’t right now.

One opinion is to look at premium subsidies, at some other way of reducing cost; and part of the proposed legislation is a study of what they could do with premium subsidies at the state level. So there’s things in the bill that make sense and it’s clear that these lawmakers get the idea that it’s claims that drive premium – not commissions, not CEO salaries, claims. It’s just that the destruction of the commercial individual market and the small group market is a big price to pay to come up with this plan.

Z: Tell me about some non-conference-related memories of the trip.

L: Vietnam Women’s Memorial, designed by Glenna Goodacre; R: The Three Soldiers, designed by Frederick Hart

G: Well of course we checked out the monuments; my wife Karen joined me on Wednesday… we were supposed to bring our grandsons but they got snowed in in Bend – they had 2½ feet of snow on the ground for like, a week. We went to the changing of the guard and I’d never been there when one of the guards was a woman, that was cool to see. Plus we always visit the Kennedy Eternal Flame at Arlington – that’s very sobering. I always enjoy reading the text of one of John Kennedy’s speeches – the one where he said ‘Ask not what your country can do for you’ – that’s engraved on the cement behind the memorial; very impactful. And finally I took some time to appreciate the statues at either end of the Vietnam Veterans Memorial, one of three soldiers gazing out over the wall and one of three nurses assisting a wounded soldier. It’s just this portrait of war that’s extremely moving and well-rendered.

If you want to get in touch with Greg, you can find his contact information on our Team page!