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Association Bisnow
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November 12, 2008



With healthcare near the top of the agenda for the 111th Congress, associations representing more than 2 million members are pushing legislation to improve access, reduce premiums and contain year-to-year premium volatility. Groups like the National Association of Realtors, National Federation of Independent Business, National Association of Homebuilders, and Service Employees International Union have been spearheading the campaign. NAR, the largest, is working on behalf of 1.2 M members who are not eligible for employee provided health care plans because most real estate agents are considered independent contractors.


NAR’s Marcia Salkin has spent four years and countless hours crammed in small conference rooms with the legislative staffs of Sens. Dick Durban, Blanche Lincoln, Olympia Snowe, Mike Enzi and Norm Coleman, among others. Last year, she helped refine the text of the “SHOP Act” (S 2795). The Small Business Health Options Program would reduce premiums and volatility by removing health status from the rating equation used by insurance companies. With NAR’s average member aged 48, many are either priced out or simply unable to buy insurance on the individual market if not covered by a spouse or able to get a second job with coverage.


Marcia says the popular idea of expanding the health care plan provided to members of Congress is an attractive one, but it wouldn’t work for most self-employed. She says the Federal government is paying much of the premium as an employer contribution for federal employees, but many self-employed would not be able to afford the expense on their own. Marcia says passing the SHOP Act or any other healthcare plan to help association members will also require that state insurance commissioners (the state level regulators) are on board, and so far their reviews are mixed.

Joe the Plumber Health Care

NFIB, the main association serving America’s small businesses, says 26 M small businesses make up more than half of America’s 46 M uninsured. Michelle Dimarob, NFIB’s manager of legislative affairs in the House has been so busy that she hasn’t even taken home her Cuisinart Immersion blender or other gifts from her wedding in January. Michelle says small businesses on average pay 18% more for health insurance, meaning that when budgets get tight and premiums go up, it is the small businesses that bear the brunt of those premium hikes. For those small businesses that are providing health insurance, the lack of premium predictability cuts directly into their growth potential.


Michelle says it’s “motivating” to be working on behalf of 350,000 NFIB members like Brian Esteppe, who sells meal worms at Bluefin’s Bait & Tackle in Dundalk, Md. Michelle says we are at the point “where economic insecurity meets health care insecurity,” and the federal government will have to act. She says associations affected by these policy discussions need to be at the table promoting the ideas that will be most beneficial and workable to their members. What’s NFIB’s way of figuring out their members’ positions? Quarterly ballots that every member has the right to vote on.

Cardinal Bank
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