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Small‑business owners press Congress to protect self‑insurance, telehealth and direct primary care options
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Summary
Small‑business witnesses told a House subcommittee that rising premiums and limited marketplace options are forcing employers to pursue self‑insurance, level‑funded plans, telehealth and direct primary care; they urged passage of bills to protect stop‑loss insurance and permanently preserve pandemic-era telehealth expansions.
Marcy Strauss, a benefits consultant testifying for the National Federation of Independent Businesses, and other witnesses described a range of employer-driven innovations—self‑insurance with stop‑loss (reinsurance), level‑funded plans, direct primary care (DPC), reference‑based pricing and telehealth—that they said helped small employers control costs and maintain benefits.
Strauss said small employers in Iowa face sharply higher premiums: "In Polk County where I live, family premiums for small group plans have gone up 85% in just eight years," she said. She described employers who saved more than 40% by switching to plans that pair direct primary care or reference‑based pricing with stop‑loss protection.
Why it matters: witnesses argued that small employers pay substantially more than large employers for comparable coverage and that expanding access to self‑insurance tools and innovative plan designs can preserve employer coverage in communities that rely on small firms for jobs.
Testimony highlights: Strauss described level‑funded plans and stop‑loss as risk‑management tools that let small groups lower deductibles and out‑of‑pocket costs while protecting against catastrophic expenses. She urged Congress to pass the Self Insurance Protection Act to prohibit states from regulating stop‑loss in ways that would make it inaccessible.
Witnesses also urged permanent telehealth coverage for workers and supported Chairman Wahlberg’s Telehealth Benefit Expansion for Workers Act, saying telehealth improved access to behavioral health in rural areas and reduced costs during the COVID‑19 pandemic. Strauss and others noted tax treatment challenges for DPC subscriptions under HSAs and called for fixes so employers can pair DPC with tax‑advantaged accounts.
What was not decided: the hearing did not produce votes or committee actions; lawmakers asked for additional materials and placed statements into the record.
Ending: Small‑business advocates urged lawmakers to preserve tools that let employers tailor benefits and to remove regulatory barriers that, they say, limit small employers’ ability to offer affordable coverage.
