PHOENIX — The Self-Insurance Institute of America Inc. is mobilizing for battle as self-insured group health insurance comes under attack from lawmakers at the state and federal levels.

In addition to some states' regulatory crackdowns on the use of stop-loss coverage by self-funded employers, there are potential threats at the federal level to employers' use of self-funding, SIIA President and CEO Mike Ferguson said.

“The regulation of stop-loss insurance is a hot issue both at the state and federal levels. We may see some regulation at the federal level to make it more difficult for small and midsize employers to access stop-loss. So this very much remains a tier 1 issue for us,” Mr. Ferguson said.

The issue also affects SIIA members “involved in the stop-loss captive marketplace. Rest assured that we have this as a primary focus for SIIA now and in the foreseeable future,” he said.

More assessments on self-insured employers and their business partners is another issue, he said during SIIA's 24th annual National Educational Conference & Expo last week that attracted more than 1,700 self-insured employers and their providers to Phoenix.

“We saw a little bit of this earlier this year when the state of Connecticut tried to impose an assessment on the self-insurance marketplace” to subsidize a state program designed to implement value-based health care payment rules, Mr. Ferguson said.

“We think that is going to be a hot issue to watch in 2015,” he said, adding that SIIA also plans on seeking U.S. Supreme Court review of a federal appellate court decision upholding a Michigan law that imposes a 1% tax on paid health care claims.

While SIIA works to preserve self-insured employers' pre-emption from state benefit mandates under the Employee Retirement Income Security Act pre-emption provision, the Patient Protection and Affordable Care Act and other federal legislation and regulations continue to erode this protection, Mr. Ferguson said.

“The threats to ERISA pre-emption take many different forms, from taxes and assessments to regulatory schemes,” he said.

SIIA also is keeping a close eye on the debate over whether to reauthorize the federal terrorism backstop, which reinsures some captives that self-insure terrorism risk, he said.

“If that law expires, the option to use captive insurance for terrorism exposures goes away,” Mr. Ferguson said. “In the waning days of this congressional session, we expect this to go down to the wire, and we're engaged on that.”

Though SIIA has a federal lobbyist, that alone “just doesn't cut it these days,” he said. “In order to be an effective advocacy organization, we have to have what I call an "advocacy toolbox,' which includes multiple tools that you use in different ways in order to get where you want to go,” he said. To this end, “SIIA has been building its toolbox to make it larger and more effective over time.”

In addition to its federal lobbyist in Washington, SIIA has added an in-house state lobbyist and put another on retainer in New York, Mr. Ferguson said. SIIA also urges its members — especially employers — to join the fight as part of a grass-roots lobbying campaign.

In many cases, “when you put a constituent in front of a member of Congress and have them talk eyeball-to-eyeball about the issues that are affecting them,” it can have a greater effect than professional lobbying efforts, Mr. Ferguson said. “Employers need to get more involved by meeting with their elected officials to explain the role of self-insurance and why it's so important.” SIIA also has joined forces with nine other insurance industry and employer groups to form the Self-Insurance Defense Coalition, he said.

In addition to SIIA, the other members of this coalition are the U.S. Chamber of Commerce, the National Association of Manufacturers, the Council of Insurance Agents and Brokers, the National Association of Wholesaler-Distributors, the National Retail Federation, the National Association of Health Underwriters, the National Franchisee Association, the National Electrical Contractors Association and Heating, Air-Conditioning & Refrigeration Distributors International. The group will coordinate lobbying, litigation and media relations of the national trade associations on self-insurance issues at the federal and state levels, Mr. Ferguson said.