Legislative Chair Report for 2014-2015

Following our February NAHU Capitol Conference in Washington DC, I reported to you that the "the ACA is here to stay regardless of the Supreme Court decision, ACA is dramatically changing our industry, we need to influence its implementation to the extent we can, and meanwhile we must adapt our businesses to survive".

The June 25, 2015 Supreme Court decision in King vs. Burwell upheld a key component of the ACA, thereby preserving the Health Insurance Exchanges and nationwide tax subsidies for many participants. There are other challenges to ACA working through the court systems, but none appear likely to radically change the law. As I have said throughout the year, "ACA is here to stay".

One of my primary goals as your Legislative Chair for New Mexico has been to educate our public officials including legislators at the State and Federal levels on how to implement the law in a way which will preserve a viable health insurance system in which our members continue to play key roles for the consumers. I have done that by meeting repeatedly with our Congressional Representatives, Senators, and Governor, State legislators including the Speaker of the NM House, NM Insurance Superintendent, NM Health Insurance Exchange leadership, and key staff members of all these government players. Congresswoman Michelle Lujan Grisham invited me to serve on her Health Care Advisory Committee which I have been doing. She like our other legislators is listening to us and receptive to changes which serve the public's interest.

The "Devil is in the details" of the ACA. Implementation still is being worked out, and we as NAHU members still have the opportunity to influence the "how" of the details. An example of one such success is the appointment of Eva Jean Fomalont, one of NAHU's own key leaders, to serve on the NMHIX Board.

Challenges ahead at the State level include:

  • preserving self-insured plans,

  • assuring a role for brokers & agents in NMHIX,

  • Inclusion of a broker portal for individual marketplace when we have our own individual exchange.

  • creation of dedicated service hotline for certified agents and brokers.

At the national level,we are seeking changes in the law and its implementing regulations to include:

  • elimination of the planned expansion of the small employer marketplace to 1-100 employees in 2016,

  • elimination or significant modification to the "Cadillac tax",

  • restoring the traditional definition of "full time" employment back to 40 hours per week from the ACA standard of 30 hours,

  • changing how group policies are structured and priced,including limits on composite pricing for all employees of small businesses,

  • simplifying employer reporting requirements to allow reporting to be done on a prospective basis,

  • ensuring that consumers have the ability to elect the assistance of health insurance professionals at any time in the coverage process with that decision recorded,

  • Enhancing technologies which will allow agents, brokers and individual consumers better access to the federal marketplace via continued improvements to "healthcare .gov".

This is a challenge bigger than any one person. each of us as NAHU members needs to do our part to get these changes made to preserve a viable health care system in our Nation and our State, one in which we continue to play an essential role. That has been the challenge for the past year and will be for at least the next two years and more.

As Legislative Chairperson for NMAHU, I urge you to make your voice heard at every level of government. This is your future. 


Sherrie Williams

NMAHU Legislative Chair


Why Should Someone Work with an Agent/Broker?

Here are a few reasons! In the United States, most states require anyone who sells, solicits, or negotiates insurance in that state to obtain an insurance Agent/broker license. In order to obtain a broker's license, a person takes pre-licensing courses and must pass an examination. An insurance Agent/broker also must submit an application to the state insurance regulator who will determine whether the insurance Agent/broker has met all the state requirements. Background checks and Finger Printing are completed, to determine whether the applicant is considered trustworthy and competent. A criminal conviction, for example, may result in a state determining that the applicant is untrustworthy or incompetent.

Once licensed, an Agent in New Mexico needs 15 hours of Continuing Education which includes 1 hour of Ethics each year. Medicare products and Exchange products Certification is required each year through CMS, the Federal Government and New Mexico Office of Superintendent of Insurance. These can take from 15 hours up to 40 hours each year. Each Health Insurance Carrier requires that an Agent is appointed, with requires certification for each of their products. Another 4-8 hours per company! Altogether this adds up to 10’s of hours each year!

Look for Agents who belong to National Association of Health Underwriters. (NAHU)

The National Association of Health Underwriters represents more than 100,000 licensed health insurance agents, brokers, general agents, consultants and benefit professionals. NAHU members help millions of consumers by guiding them through the complexities of health insurance purchasing and enrollment, while ensuring they get the best policy at the most affordable price. They seek to understand each personal situation to create recommendations that complement a consumer’s financial and medical security needs. An Agents job does not end with the sale. Good licensed producers help their clients with claims issues, service questions and compliance matters throughout the life of each policy they sell. Members of NAHU agree to abide by NAHU’s Code of Ethics, which requires them to always make health care coverage recommendations with the customer's best interest in mind.

NAHU's Code of Ethics

  • To hold the selling, service and administration of health insurance and related products and services as a professional and public trust and do all in my power to maintain its prestige.
  • To keep paramount the needs of those whom I serve.
  • To respect my clients' trust in me, and to never do anything which would betray their trust or confidence.
  • To give all service possible when service is needed.
  • To present policies factually and accurately, providing all information necessary for the issuance of sound insurance coverage to the public I serve.
  • To use no advertising which I know may be false or misleading.
  • To consider the sale, service and administration of health insurance and related products and services as a career, to know and abide by the laws of any jurisdiction Federal and State in which I practice and seek constantly to increase my knowledge and improve my ability to meet the needs of my clients.
  • To be fair and just to my competitors, and to engage in no practices which may reflect unfavorably on myself or my industry.
  • To treat prospects, clients and companies fairly by submitting applications which reveal all available information pertinent to underwriting a policy.
  • To extend honest and professional conduct to my clients, associates, fellow agents and brokers, and the company or companies whose products I represent.

So WHY chose to have an Agent/Broker help make decisions on their Insurance buying process?

In this world of ever escalating complexity in Health Care Insurance, the Agent/broker is the educated person who can help you through the decisions necessary to make the best choice!