Turning Advocacy into Action: NABIP's Legislative Priorities

Speaker A: For benefits professionals, legislation isn't something that happens someplace else. A bill introduced in a statehouse or a rule that appears with little warning can change how we serve clients, how markets operate, and what consumers pay. This year, NABIP's legislative council has a three part advance model legislation. Use the association's voice to protect the profession and consumers and respond rapidly when state and local issues emerge. What does that strategy look like in practice? And where do individual members fit in? Let's get briefed.

Speaker B: This is the Benefits Brief, the official podcast of the National Association Professionals. Your fast track to what you need to know to stay sharp, informed and ready to deliver for your clients. And now, here's your host, former NABIP president and award winning podcaster, David Saltman.

Speaker A: And our guest today is Chris Vanderwaal. Chris is chairman of NABIP's legislative council. He's also an attorney, a certified employee benefits specialist, and serves as Director of Compliance and innovation with OneDigital and Kistler Tiffany Benefits General Agency. Chris, welcome to the Benefits Brief.

Speaker C: Hey David, great to see you again.

Speaker A: Um, always a pleasure. You've described three prongs for success. I alluded to them in the cold open, um, for the council before we unpack them. What are they generically speaking and why these three now?

Speaker C: So I like the rule of three. It makes it easier to keep people focused and understand what happens. So three priorities feels right. And we've got a mission. As an association, our job isn't just to get together at a diner and have a coffee and a breakfast once a month. Our job is to advocate. And our job is to advocate for our members, for our markets, for our customers, uh, and really for America as a whole. So our three priorities for this year are to one, get our model legislation introduced, two, use our voice for our profession and consumers, and three, respond quickly to state and local issues. And what that means is our membership has a wealth of experience, intelligence and information that might be missing from other critical stakeholders in society. When we look at our local legislators, our federal legislators, our, they often lack an understanding of how our industry really works on the ground. And that hampers them in coming up with ways to offer real solutions. I think we all agree that the healthcare delivery and finance mechanism could be better than it is today. And so it's important that we bring our knowledge to the table and help people understand what some of those solutions could be in line with NABIP's values and our Bill of Rights to make sure that we're advocating for good changes to the market that will serve everybody.

Speaker A: So let's dive into the first prong, which is getting NABIP's model legislation introduced. What is model legislation and why is it such an important tool for our association?

Speaker C: So model legislation generally is writing a law. It's figuring out a problem that you could solve if you could change a law, and if you could do that, how would you change it? So you write it down, you get together as a group and you figure out what, what's the problem we're trying to fix and how can we fix it? Uh, you don't necessarily have to come up with a brand new idea. There's great solutions out there. The United States has often been referred to as 50 independent laboratories of democracy. And so you can look to one state and say, hey, maybe there's something good happening there and maybe we can combine it with another state's idea. We've done that in Namib, in our working groups. We've done it three times now, uh, once for the Prescription Drug working group, and twice in the employer working group where we've looked around and said, this is a good idea, that's a good idea. Let's figure out how we can combine it. And what we do is we put together essentially a template that people in the other states that don't have these ideas passed and implemented could pick up and take into their state legislators and say, we think this is a good idea and it's a starting point, it's a model for it. And there's other associations that do this very effectively. Uh, there's the national association of Insurance Commissioners puts together model legislation all the time that insurance commissioners use for property and casualty, excess and surplus lines and employee benefits. There's the National Council of Insurance Legislators that do the same thing outside of insurance. There's all sorts of advocacy groups that put together bills that say, this is a problem we want to solve and here's how we think we can do it. And so after a number of years of really playing defense, really great, we had some conversations in some of the working groups to say, let's go on the offense. We have good ideas too. How can we do that? And so we've put together a handful of model bills, uh, as really just a starting point for consumer oriented market corrections that will help provide access to affordable, quality, accessible care.

Speaker A: So the bills that we're talking about are the Credit act, the Alara Act, E L A, R A, and the Prescription Drug Pricing Transparency Model Act. Can you give us those in a synopsis and in plain English that we mere mortals can understand.

Speaker C: Yeah, yeah. So, uh, these are all amalgamations of great ideas elsewhere. So the credit act is based on a law that's, uh, in force in Texas and Tennessee. And what it does is it gives people credit, which is part of the pun. It stands for consumer recognition of eligible direct insurance transactions. But it gives people credit for making good consumer choices. It's also been called the cash pay bill. Uh, and if you think about two scenarios in particular, where the quality of the care is not likely to change no matter where you get it, but the price can vary wildly. You've got imaging and prescription drugs. The prescription drug is going to be the same just about everywhere you get it. The pill will be the pill will be the pill. What you pay for it will vary wildly based on where you pick it up and what it's run through. If we set that aside and we think about all the channels that are available now for people to buy prescription drugs, you can go to, uh, Goodrx Mark Cuban Cost plus drugs. You can go to your local grocery store for generics and they will sell you generic drugs for almost pennies, uh, because they want you in there to buy other stuff. There are avenues to go get cost effective drugs for your generics where you're looking at pennies at the grocery store. Most people probably wouldn't file a claim. But if we think about the blockbuster drugs that have cost so much money, things like Humira Stelara, we're talking about seven or eight thousand dollars a month. And for people that are on high deductible health plans, what that really means is in January they either have to come up with five or six thousand dollars or they don't get their medication. Alternatively, they could buy a generic for a few hundred dollars, um, or they could go buy it direct with a, with a Goodrx coupon code. And we are not affiliated with any of those brands or anything. I'm just using those because people know them in the market. But if you go buy a drug for $1,000, that would be $8,000 on your plan. You don't get credit for that $1,000 in 48 states on a fully insured plan. Our bill would say that if you pay $1,000 and your network price was going to be $8,000, you should get $1,000 credit towards your cost sharing because we should want people to go and find more affordable care. It also works for imaging. There are only a couple of manufacturers of MRI machines in the world. So the Picture you get of your knee, if your knee hurts is probably the same picture regardless of where you go or how much you pay for it. Imaging is very shoppable. There are companies uh, out there that buy up excess machine capacity and they basically buy appointments at imaging centers and resell those. There's other companies that go and negotiate, set up their own imaging. And there's also the reality that if you call an imaging center you offer to pay cash, they are very happy to have you because they don't have to fight prior authorizations or anything like that. They will sell you an MRI for a couple hundred dollars through your insurance. It could be a couple thousand or more. So we want to encourage people to go do those good consumer behaviors. But right now they're penalized on their plans. So we want them to be able to have that access. Um, so that's the Credit Act. The ILARA act is employer level access, uh, for claims. We want claims data to be provided to employers. Texas actually has this and has had it on the book now for almost 20 years where employers in the small group market can still can go to their insurer and can ask for claims data. We said that's a great idea. This is a big invoice every month that employers pay. They don't know what they're buying or if they're getting a good deal. They should know that. And so we took some of the language from Texas and then we looked to 32 BJ that has uh, really led a lot of forward looking health care financing and delivery policy. And they put out a, uh, administrator, a plan first administrator contract. And in there what they meant to do with that was if you're a big employer like 32 BJ, you've got a couple hundred thousand members on your plan, you have leverage. Uh, most employers don't have that kind of leverage. Most employers you get what you get and you probably get upset but there's not much you can do about it. But 32 BJ in their uh, plan first contract said we want the following data in the following format, will you provide it? And so we said that's a great thing to do because a lot of the data transparency rules that we've got, um, if you look at RXDC or gag clause attestation, the federal efforts at transparency have been challenging because the data format wasn't really specified and the affirmative right wasn't really there. They said you can't put a gag clause in your contract. But they didn't say you have to give the Contract over. Uh, so we wanted to get ahead of that by saying, yes, you have an affirmative right to your claims, and this is the way that data needs to be presented. So that way there's no wiggle room to squirm there. Uh, the final one is about prescription drug transparency, and this is actually navip's, uh, first legislative victory in terms of getting language drafted in a committee turned into law. We actually got this done, uh, so we can do this. We have done this, and we will do this again. For the prescription drug transparency bill, we looked to Florida and New Jersey that had been really on the forefront of identifying all the various stakeholders in the supply chain for prescription drugs. PBMs, GPOS, PSAOs, rebate aggregators. There's a whole lot of operation on top of the transmission of a drug from the manufacturer to the patient. And all those layers each add a cost. That's fine if they're all adding a commensurate value to it, but there's no way to know if they're adding enough value to justify the cost unless you know what the costs are. So we said we would think that it would be beneficial to everybody if they had to report certain claims data, certain cost data, and that every stakeholder involved had to do so, not just one. Because if you clamp down on one side of a balloon, the other side just grows. If you say PBMS can't have any more fees, that money will move to GPOs and PSAOs immediately. So those are our three bills. And a part of that bill was, uh, actually taken out and put right into law in Virginia in 2025, unanimously voted on by both houses of their state government and then signed into law by their governor.

Speaker A: That's awesome. Um, now, back in the day, when I was a, uh, denizen of boards and committees and whatnot, we talked a lot about grassroots, but we don't hear a lot about that anymore. And you and I know a model bill doesn't move on its own. How do regional vice presidents, chapter presidents, legislative chairs, and rank and file members turned into an actual state introduction?

Speaker C: So states are small, the state government is very local, and you might know more people involved in state government than you think, especially if you're in our industry. What we're looking for is, uh, initially, we want to know where we think we can make this work. So we're asking our team, internally, RVP's regional legislative chairs, to make affirmative contact with all the states and find out, um, what they think is viable, where they Think they can go, uh, but the most important thing is to think about who your members are and who the members know. At any given kids soccer game, you've got parents sitting in bleachers. Those parents are our members, they're our customers. And in many cases they're our state legislators too. Those people are in our communities. They live with us, they work with us, their kids play with ours. Those relationships really matter because that brings the human element in. We aren't talking about these laws in the abstract. This is real dollars for real companies, for real employees, for real families that we're trying to help them save while delivering good healthcare. So that's a conversation you can have with people you know on a human level. And those are the relationships that will move needle for us. We want you to think about who do you know in your state. If you have a lobbyist for your state association, they're going to know as well who the right avenues are for you, who the members of your legislative body are going to be that'll be interested, work with them. There's a reason we've hired them and it's not just so they can send us a daily email of what's happening in our state. They're your lobbyists. We want to be able to leverage that. And they'll tell you how to proceed. They'll know where the figurative bodies are buried. Uh, they're going to know who's got a stake where, who's going to be resistant. They're going to give you that heads up. And like we talked about in the very beginning, this is model legislation. It's a starting point. It's not the finishing point. So it will be. We expect it to be tailored to your community. It'll be your market, your state. One of the Bill of Rights for NABIP is states rights. It's our last one. Um, but that doesn't mean it's the least important. It means that all of that filters through, that we want this to be something you can have a good conversation to guide your state on. So think about your local legislators, who you might know, who you see at soccer practice, who you have dinner with, who you see at Rotary or Chamber of Commerce. Those are the people that can make this move and make a real meaningful impact for people.

Speaker A: Your second prong is using nabip's voice for the profession and consumers. What does that mean beyond lobbying for a specific bill?

Speaker C: So there's a ton of activity right now in D.C. in particular. Um, we've got an election coming up inside a couple months. And both parties are looking to figure out what they can do to make an impact regardless of how the election shakes out. And so those come by way of RFIs, or requests for information. We've got a couple of those that we're working on. And then there's also proposed rules. So the federal government is very active. They're trying to figure out how things work, and they're trying to figure out how to make things better. Uh, those laws we just talked about, we looked at state activity because we think we can move things at the state level faster than the federal level, but that doesn't mean we're not active on the federal level. Uh, some of these RFIs are things like the Senate's asking for information about how drug pricing works, and the Finance Committee in the Senate is also asking for health coverage reform to look at things like public option, prior authorization, enrollment, ensure accountability. These are things that our members know like the back of their hand. This is muscle memory. We know how this really works. But when you get into dc, if you're looking living in a policy world, you're not actually exposed to a lot of this stuff, so you don't know how it works other than maybe from an academic perspective. And that academic perspective is useful, but you need to know how things actually operate on the ground. So, for example, uh, September 21st, there's a. Is a comment deadline for the DOL proposed rule on ERISA, Electronic Disclosure Safe harbors. They've updated it. We haven't had an updated Safe harbor since 2002. And the DOL says, okay, it's time to update that. We didn't have iPhones. We didn't have, uh, itunes. We didn't have a whole lot of stuff back then. Maybe we should update it. So they put out this proposed rule and they said, this is what we think we should do for health plans, but it won't apply to life and disability plans. Well, our practical experience on the ground, we know that employers treat their benefits almost always like one bundle. If they are doing ERISA compliance at all, they've got one wrap document that includes all of it. So why should we have separate rules for the same benefits program? And that's the type of feedback they need. They need to know with prescription drugs that for small employers, you can't carve out your PBM with any of the major carriers, even if you use their TPAs. They don't understand that intuitively because they aren't in the market. Our people are in the market. We know how this works. So we put together responses to these requests for information, uh, or proposed rules with our experts. And how does that work? Well, um, if you've never heard any of this stuff, it's probably because you're not on one of our working groups. We would love for you to apply. That application comes out every May. Uh, but we look to our working groups who are members, who've raised their hand and said, I have an expertise in this area. I want to be engaged, and this is the group I want to work with. And so we say, hey, this is going to impact the individual working group or the prescription drug working group, or the state public option working group, or Medicare or employer or mental health. And sometimes they affect all of them. And we parcel out parts of the RFI to make sure we're getting expertise from those people specifically so we can bring it back together and we can make sure that our voice gets heard when the, uh, powers that be, whether they be regulators or legislators, are going to start making decisions. And that insight is critical. It's been important throughout the years to have big impacts. Right now, we're in 2026, but for the efforts of our members throughout the years and members and associations like ours, we'd be paying the Cadillac tax right now. That was because we continue to lobby on that. And lobbying comes in the form of not just our Hill visits at Capitol conference, not just our August recess visits, but also making sure they understand the impact of certain policy changes. And that's what we mean. But when we say we want to use our voice.

Speaker A: You mentioned August recess. What should members be doing now with senators and representatives in their district now that. Now that they are back at home for a few more weeks.

Speaker C: Yeah. So Congress is home. They're all home. And they're looking to see constituents. Everybody in the House of Representatives is up for election in November, and a third of the Senate is as well. So they are home. And this is one of the more impactful August because it's before the federal election cycle. So we want our members to go and make those in district meetings at the end of February, we go down to D.C. i say down. Some come east, some come north. Um, but we go to D.C. in February, we go to the Hill. That's important. We also have this opportunity in August to go see them where we live and where we work. And so we can go see them. Maybe it's not our town, but in our congressional district, they have an office somewhere. Sometimes they have several. We can schedule appointments with them. We might Just meet with their staffers, but we can talk to them about who NAVIP is so they have context, the role we provide, that we help guide people through this complex system of healthcare finance and delivery to get them affordable access to care. Um, and then we can talk about some of the things we want them to do. We want them to support certain bills that we think will help members, will help our customers, will help us. So we're asking them to co sponsor a number of bills that are in the August Talking Points. We're looking at things like the Patients Deserve Price Tags act, the Lower Cost More Transparency act, the Choice Arrangement act, the PLAN act, the Medicare Enrollment Protection act, the Independent Brokers Time Act. Uh, we're looking for specific asks for them to get on and as a sponsor to look into this. How does that look? They're not going to commit to it in the meeting with you, but the legislative aide that you'll meet with will take it back and say, is this a bill that aligns with our office? And then recommend that their member either sign on or not? Hopefully they do. Hopefully they're on board. The more sponsors, the better it is. These are not partisan bills. These are bills that are kitchen table bills. And everybody that you talk to in Congress wins. If they can go back and tell the campaign story, we help lower the cost of health care, that's their win. Our job is to help bring them the options to do that. Regardless of which side of the aisle they're on, they sit on the same table then.

Speaker A: The third prong that we talked about early on is response to state and local issues that seem to bubble up. How's that different from the planned work around model legislation and federal policy? And how can members be helpful?

Speaker C: So as much as we love to move in a slow, deliberate, calculated manner, sometimes things happen quickly. Uh, for instance, we had our annual convention in Atlantic City at the end of June, end of July. In that same timeframe, we were in Atlantic City for a few days. About 100 miles away in Trenton, a, uh, bill rocketed through with no hearings and became law that requires employers with employees on Medicaid to pay a fee. That's the type of thing that we need to prepare for and be ready to react rapidly when there's an opportunity for hearings, when there's an opportunity to submit testimony. We need to know if states and local chapters need help with that. Uh, and the way to do that, communicate through your either regional ledge Chair, your regional VP, or copy legislative.org on, um, that same email. So we can mobilize people. We have a cadence of monthly meetings, but sometimes things happen faster than that and we need to get through there. Make sure you're telling those regional edge chairs and VPs about it so we can make sure we work on it deliberately if it's a slower process. But if there's a hearing next week and we don't have a meeting, and you know that, reach out direct to legislative.org we want to be there to help you. We have a lot of existing collateral that we can use and help you prepare a response and testimony. Uh, we can help you if you have a position as a chapter, if you've drafted something, send it over. We can help you review it and vet it, make sure that we're getting on all the impact because we want to make sure that we get that message conveyed across. Our value to the market is not very broadly understood, even though it's felt in every transaction, every consumer in the market, every person on Medicare, every person on employer service, employer coverage, everybody on individual coverage knows the value or has felt the value of a qualified person navigating through the system or not. Their experience is directly related to the competency of the person who helped set up their program. And we need the legislators to know what the market already feels.

Speaker A: For the advisor who's listening, who believes that advocacy really matters, but who maybe has some limited time, what's the single most useful thing they can do to like, uh, let's say this month.

Speaker C: So the most useful thing you can do in August would be if you. Limited time is limited time. But an easy thing you could do is to go to nabip.org, sign in, download, uh, the August talking points and email it off to your legislator. You can do that in a couple of minutes. We'll have a link in the show notes to the talking points too. So you can go download that there. Um, but please, at a minimum, that's about two minutes time, download the show notes, look up your congressman's email and send it off and say, hey, I'm a benefits professional in your district, I represent x number of employees and employers in your district, and we would like you to help us make sure that healthcare remains affordable and accessible, uh, to all Americans. Here's some ideas that would help with that as we wrap up.

Speaker A: Chris, if we haven't covered it already, what's one legislative council priority or one request for members that you don't want us to leave out? What would we end on here?

Speaker C: So I guess, uh, the national staff would, um, would be raising their hands if I didn't say, whatever you do, if you send that email off to your legislator, if you do have an in district meeting, make sure you let the national staff know that's done through votervoice.net that link will be in the show notes as well. What that does, if you just send. It doesn't have to be an essay. It doesn't need to be a paper. If you just tell us. I ran into my congressman at a baseball game and we talked for two minutes. Um, that helps. So that when the national staff is meeting with them in between our February and August visits, they say, oh, yeah, you, uh, ran into David Saltzman at a baseball game. He's one of our members. He said the following great thing about your conversation. It really helps us advance our relationships with them if we know what everybody's doing. So any engagement you have with a state or local legislator, get into votervoice.net and let us know what it is so that we can make sure that we're capturing all the good work you're doing.

Speaker A: Chris, thanks so much for joining us and for helping all of our members understand better how they can turn advocacy into action. I'm David Saltzman, and until next time

Speaker B: you've been briefed, stay ahead with the benefits brief. Subscribe on Apple Podcasts or Spotify or catch every episode in your Member exclusive Washington Update each Friday. To learn more about how NABIP helps you succeed or or to become a member, visit nabip.org that's nabip.org.