The Self-Insurance Protection Act, which passed with a 400-16 vote, could limit state insurance regulators from overseeing these health plans by excluding medical stop-loss policies. The legislation would amend the Employee Retirement Income Security Act, the Public Health Service Act and the Internal Revenue Code to clarify that federal regulators cannot redefine stop-loss insurance as traditional health insurance. Its a preemptive play to prevent regulatory overreach in our view, says Mike Ferguson, CEO of Self-Insurance Institute of America, a trade group for companies in the self-insurance marketplace. We feel its important to go ahead and get this clarified now. The bill was developed after the Obama administration began looking into regulatory action to prevent small and mid-sized self-insured employers from trying to skirt certain ACA requirements, says Ferguson. [Image credit: Bloomberg] The administration, he says, saw stop-loss carriers as health insurers because they were bearing the risk. Thus, self-insured employers could be considered fully insured entities and be brought under the ACA umbrella, which would subject to the medical loss ratio and the Cadillac tax , under an aggressive interpretation of the statute. Without protections, stop-loss carriers would stop offering those policies, leaving employers in the lurch if they get hit with catastrophic claims. They dont want to be conflated with health insurers, says Ferguson. Proponents are also hopeful that the legislation will help employers in their ongoing struggle to slow the growth of health benefit costs. By protecting access to self-insurance, we can help ensure employers have the tools they need to control healthcare costs for working families, Rep. Phil Roe (R-Tenn.), who introduced the bill, said in a statement.
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