Insurance agents and brokers have a vital role to play in making sure that insurers and other businesses aren't hampered by government health care mandates.

And new mandates seem certain to arise during the current Congress, agreed participants in a panel discussion of health care reform at the Council of Insurance Agents & Brokers in Washington earlier this month.

For example, legislation has already been introduced that would require that health insurers cover mandatory minimum stays for mastectomy patients, pointed out Stuart J. Brahs, vp-federal government relations in the Principal Financial Group's Washington office.

Mr. Brahs also warned that many other mandates have little health care value but that lawmakers get swept into supporting them.

In addition, the president is attempting to expand children's health care coverage, noted Mr. Brahs. He called doing so "a very nice concept" but added that the concept demonstrates a lack of understanding of the working of health plans.

How do you define a child? he asked rhetorically. Fifteen years? Eighteen years? Twenty-five years?

"Simply tell your congressman, 'No new mandates, period,'" advised Mark Isakowitz, director of government affairs for the National Federation of Independent Business.

Mr. Brahs agreed. He said that an agent knows more about the things he or she does on a daily basis than a congressman does. That puts agents in the role of educators who walk people through their concerns about mandates and other health care issues.

"I want to take a couple of conventional wisdoms and throw them out," said Mr. Isakowitz.

The examples of conventional wisdom he wished to demolish were the notion that health care costs have been licked and that attempts to extend the govern See Health on page 44JMandates

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ment's role in health care issues have been beaten back.

Regarding the first piece of convention wisdom, Mr. Isakowitz said that recent a survey of NFIB members showed that the cost of health insurance is their number one concern, even more than tax issues. He said that the recent survey by A. Foster Higgins & Co. Inc., showing that employers' health care costs were rising relatively modestly was flawed in its methodology because it defined small businesses as those with 10 to 500 employees (BI, Jan. 20). NFIB members have an average of 5 employees, and therefore weren't part of the survey, he said.

To remedy the situation, Mr. Isakowitz urged that small businesses be allowed to set up buying groups that would be exempt from mandated benefits. Large businesses with plans governed by the federal Employee Retirement Income Security Act enjoy immunity from state mandates, he said. That allows larger employers to take advantage of the savings available through managed care without having to deal with state curbs on managed care, he said. All employer plans should be regulated the same way, said Mr. Isakowitz.

He then dealt with the second piece of conventional wisdom he wished to demolish, the notion that the government role in health care issues had been beaten back. "We don't want the government to run health care," yet mandates increase the government role, he said. The states alone collectively impose more than 1,000 mandates, he said.

Mr. Isakowitz urged his audience to make their opposition to an expanded government health care role known.

"If you don't like this, don't ask your congressman to oppose this if you are not willing to speak out against this yourself," he warned.

Mr. Brahs had another warning for his audience. "There is a movement undermining employer-provided benefits" on Capitol Hill, he said.

This could be manifested through tax policy as lawmakers examine the tax breaks employers receive for providing health care and other benefits, he said. Many members of Congress have indicated that they believe individuals should be more responsible for their own health care and retirement, through vehicles such as tax-favored medical savings accounts and individual retirement accounts, he pointed out.

"I think members of Congress are saying: 'Hold on here. What are we, the government, getting out of this? Should we continue to provide tax incentives on the same basis?'"

Matthew J. Dolan, a partner in the Washington office of the law firm Baker & Hostetler, moderated the session.