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| What is the fundamental issue? |
| Twenty-eight percent of Realtors - more than 350,000 individuals - are uninsured. As part of efforts to address the health insurance needs of members, NAR has advocated for more than six years for reform of the health insurance markets that provide coverage to the self-employed and small employers. Among the legislative approaches that NAR has advocated are small business health options plans (SHOP), small business health plans (SBHPs) and association health plans (AHPs). NAR continues to (1) work on the development of a viable legislative vehicle to address the health insurance problems facing the nation’s self-employed and small employer community and (2) represent the interests of the Realtor community in the larger comprehensive reform debate that is now ongoing. |
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| NAR Policy: |
| NAR supports the passage of health reform measures that will address the access and affordability problems that the self-employed and small employers face when looking for health coverage. Solving the problem of the uninsured must be a top legislative priority for Congress. |
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| Issue Summary: |
For more than six years, NAR has advocated on behalf of a series of small business health reform bills targeted at the problems the self-employed face when seeking health care coverage. During that time, NAR has participated in the legislative drafting of two conceptual approaches to reforming the self-employed/small employer insurance markets - the 109th Congress' Small Business Health Plan (SBHP) legislation and the 110th Congresses' Small Business Health Options Plan (SHOP) bills. While each approach differed in its details, both built on a common core set of principles which include giving the self-employed, like Realtors, the ability to participate in the small group health insurance marketplace. As SHOP participants, the self-employed would have access to guaranteed issue, modified community-rated insurance products available nationwide. By creating a national program, larger pools of participants could be created than is the case under existing state laws. These larger pools would, in turn, enjoy reduced administrative costs and spread risks over a larger number of individuals.
Currently, comprehensive health reform discussions are ongoing. As such it is likely that the type of stand-alone bills advocated for by NAR may be overtaken by a larger, comprehensive reform effort. Many of the concepts being discussed as reform measures are elements that have been at the core of NAR's small business health reform efforts.
As the debate continues and proposals are refined, it is clear that many unanswered questions remain and political hurdles exist. As such, it is difficult at this time to determine if current reform efforts will be successful or if the obstacles will prove insurmountable . |
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| Description of the particular provisions that affect Realtors®: |
Lacking affordable health insurance, many Realtors postpone seeking necessary medical attention and/or face significant financial burdens when they or their dependents need medical care. Without changes, problems with the availability and affordability of health insurance has the potential to undermine the ability of some real estate professionals to continue in their chosen careers.
The needs of the self-employed are particularly acute, as those workers must fend for themselves in the individual insurance market. The plague of uninsured self-employed and other workers will persist unless and until there are corrections to the dysfunctions in both the individual and small-group health insurance markets. Each of these markets are ones in which there is no negotiating, no leverage, no economies of scale and little efficiency.
Since 2003, self-employed individuals have been permitted to deduct from gross income the cost of their health insurance premiums. Regrettably, this provision benefits only those who can actually find and afford the insurance offered in the small group and/or individuals markets. Tax benefits, no matter how thoughtfully crafted and designed cannot provide access to affordable insurance. A deduction is helpful, but only if insurance is available.
The comprehensive health reform discussions now ongoing will obviously have an impact on Realtors and indeed all Americans. Many of the proposals being discussed as possible reform measures are elements that have been at the core of NAR's small business health reform efforts and will benefit the self-employed and small employers. Guaranteed issue requirements would mean that an insurer could not turn an individual or business down for coverage. Creating a uniform federal set of underwriting and rating rules for health insurance would enable the creation of larger risk pools which should result in lower premiums for those who are in ill health and limit premium volatility over time. Eliminating pre-existing condition exclusions would mean that those who need coverage for an existing health problem would not find themselves unable to obtain coverage for that ailment. Other proposals have not been part of NAR's previous efforts, i.e. eliminating annual and lifetime coverage caps, requiring that all Americans have health insurance coverage, requiring employers to offer coverage to employees and/or contribute to the cost of providing coverage to those employees, creation of a 'public option' plan, etc. Obviously, a requirement that all have insurance coverage or that a broker/owner with employees offer coverage will also have an impact on NAR's members. |
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| Proponents of NAR policy will say: |
| The current health insurance delivery system is broken and is not meeting the needs of the small business community, especially the self-employed. The self-employed and the owners and employees of small businesses are widely recognized as the largest source of new American jobs and much of the technological innovation from which our economy has benefited. Without change, problems with the availability and affordability of health coverage will increasingly threaten what has been a major source of job growth and innovation in this nation. |
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| Opponents of NAR policy will say: |
| Solving the problems of the uninsured is a large scale systemic problem that cannot be addressed by focusing on the needs of just one component of the uninsured population. Therefore, any reform efforts must be a part of a larger scale national health care reform effort. |
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| What's needed? |
| In order to ensure that the health insurance needs of the self-employed are considered, either as a sand-alone measure or as part of any health care reform debate, broader and increased awareness of the problems that the self-employed have finding health insurance must be created. NAR has continued to stress the importance of addressing the problems that plague the self-employed and the need to broaden the discussion of solutions to the nation's health insurance problems beyond the traditional focus on the employer-provided insurance market. |
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| Legislative/Regulatory Status/Outlook: |
| Efforts to craft health reform legislation have consumed the health and tax-writing committees of both the House and Senate throughout the summer and into the fall. As of October came to an end, both House and Senate leaderships were working to meld the three versions of HR 3200, the America's Affordable Health Choices Act of 2009, approved in the House and two Senate bills – S. 1679, the Affordable Health Choices Act, and S. 1796, America's Healthy Future Act of 2009 - into one House and one Senate bill, respectively.
Early reports indicated that the House would begin floor consideration of its bill during the first week of November. Senate Majority Leader Reid (D-NV) had announced plans to begin floor debate once the Congressional Budget Office had been able to score the bill he had been working with the chairmen of the Senate Finance and the Senate Health, Education, Labor and Pensions Committees to merge. However, the outlook for that timeline was called into question by the Leader’s decision to include in the bill sent to CBO a public plan to which many moderate Democrats and all Republicans objected.
While each of the five bills approved between July and October differ in their details, all share a common underlying framework. Each includes a new health insurance marketplace (i.e. an exchange), a requirement that all individuals purchase health insurance (i.e. an individual mandate), a parallel requirement for employers to provide some level of support for their employees’ health insurance coverage (i.e. an employer mandate), tax credits for individuals who purchase their own coverage and employers who provide employee health benefits, as well as very significant changes to the way in which private insurers could underwriting and price health insurance policies for both individuals and employer groups.
The self-employed and small employers, such as Realtors and realty firms, would benefit from the significant underwriting and rating reforms in each bill. These reforms require insurers to treat individuals very much the same as they have always treated participants in group plans. These include requiring insurers to accept all applicants and renew all policies, banning the use of pre-existing conditions for pricing purposes and significantly limiting how much an individual could be charged based on their age or their family structure than is currently the case under existing state insurance regulations. While each of the measures include provisions that would ‘pay-for’ the new spending, none of those provisions include any changes to the mortgage interest deduction.
Given the fluid nature of the bills' provisions, NAR has not taken a formal position on any of the health reform bills. NAR has though communicated with each of the policy committees, leadership and individual offices on the impact of the various components of each bill on the Realtor population. Copies of NAR's letters and statement, along with more information on the health reform debate, are available at www.realtor.org/healthreform.
Update: On October 29, 2009, the House released the bill that would be considered on the House floor as early as the following week. NAR staff are currently reviewing the bill's provisions. |
 | House bill introduced by: |
| Kind (D-WI) Gerlach (R-PA) |
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| House bill number: |
| HR 2360 |
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| House committee of jurisdiction: |
| Committee on Energy and Commerce |
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| House subcommittee of jurisdiction: |
| Health |
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| Senate bill introduced by: |
| Durbin (D-IL) Snowe (R-ME) Lincoln (D-AR) |
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| Senate bill number: |
| S. 979 |
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| Senate committee of jurisdiction: |
| Finance |
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| Senate subcommittee of jurisdiction: |
| Health |
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Related information: |
| NAR's Page on Health Reform |
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 Link to Thomas
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