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D.C. Dysfunction: Let’s Talk Immigration and Health Care

D.C. Dysfunction: Let’s Talk Immigration and Health Care. Illinois Chamber Day April 11, 2018. Immigration: Why is Reform Needed?. Does the current system… Promote the rule of law? Promote economic competitiveness and growth? Meet our workforce needs?

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D.C. Dysfunction: Let’s Talk Immigration and Health Care

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  1. D.C. Dysfunction: Let’s Talk Immigration and Health Care Illinois Chamber Day April 11, 2018

  2. Immigration: Why is Reform Needed? • Does the current system… • Promote the rule of law? • Promote economic competitiveness and growth? • Meet our workforce needs? • Adequately provide security from external threats? • Uphold and promote American values?

  3. Why is Reform Needed? • Current System is Dysfunctional • 6% of all green cards go specifically to workers • 10-year wait for a green card for talented workers • Annual H-1B and H-2B visa allotment cap woefully inadequate • 70% of Ag workforce is unauthorized • 11 million people here and we don’t know who they are

  4. Critical Components of Reform • Legal immigration reform • More employment-based green cards to create U.S. jobs here by attracting the brightest and hardest-working • Greater job opportunities here for American workers • Workable guest worker programs to meet our workforce needs • Promotes job and economic growth AND reduces the pressure of illegal migration

  5. Critical Components of Reform • A workable employment verification system (E-Verify) • Preemption of state and local laws will provide clarity and consistency that employers need • Turning off the “jobs magnet” by discouraging immigrants from coming and/or staying here illegally • Addressing the Undocumented – DACA

  6. Congressional Progress

  7. A Few Immigration Victories H-2B cap relief in the past few years H-4 work authorization STEM OPT But…large scale reform remains elusive

  8. Recent DACA History 2012 – Obama established DACA through EO 2017 – Trump announces DACA wind-down (Sept. 5)

  9. Recent DACA History (cont.) – 2018 Jan. 9 – bipartisan/bicameral meeting at the WH with Trump the dealmaker; work on 4 pillars: DACA, border security, family migration, diversity visa Jan. 9 – federal judge in SF issues order that DACA program continue Jan. 17 – Trump rejects the Graham/Durbin proposal

  10. Recent DACA History (cont.) – 2018 • Jan. 25 – WH announces its framework • 1.8 million Dreamers protected • $25 billion for border security + legal enforcement changes • eliminates diversity visa • eliminates extended family migration • Feb. 15 – Senate defeats four immigration measures • March – omni spending bill does not include DACA or other large immigration provisions

  11. What Now? • House – Goodlatte bill we oppose • Dramatic cuts to legal immigration • WH and immigration activists appear willing to wait until November/Supreme Court rules

  12. H-2B – Facts About the Program Annual cap of 66,000 (woefully inadequate) Seasonal, non-Ag guest worker program Fill only after unsuccessful in hiring American workers Many worker protections (wages, etc.) Each visa helps support 4.64 American jobs on average Inability to fill positions hurts businesses, year-round jobs associated with the businesses, and communities

  13. H-2B – Current Situation 2/3rds will not get their positions filled for April 1 Spending bill provides Trump administration discretion to raise the cap if needed Contact your Senators and Representatives and have them weigh in with DHS and DOL – WE NEED CAP RELIEF NOW

  14. Immigration Regulatory Issues H-1B third party placement Stopped premium processing New pilot program for Canadian L-1s Social media submission for visas Public charge leaked document Ended power of attorney for visa filings

  15. Impact of These Regulatory Actions

  16. How Did Health Care Become So Partisan? March 2010 – ACA signed into law without GOP support; Dems own health care reform “Obamacare” Nov 2010 – GOP takes House majority; GOP major election gains with promise to repeal Obamacare 2011 – Washington health care gridlock begins 2016 – GOP wins control of White House and Congress vowing to “repeal and replace” Obamacare

  17. GOP Health Care Challenge “It’s an unbelievably complex subject. Nobody knew health care could be so complicated.” -- President Trump, Feb. 27, 2017

  18. Health Care 2017: What Happened? • Repeal and replace failed in the Senate • President Trump stopped insurer CSR payments • Tax reform repeals the Obamacare individual mandate • Big ACA tax delay wins in January 2018 spending bill • 2 year delay of Cadillac tax (till 2022) and medical device tax • 1 year delay of health insurer tax (in 2019)

  19. ACA Repeal and Replace in Context About 2/3rds of Americans pre-retirement receive their health insurance through their employer (approx. 178 million) ACA individual market exchanges consumes so much attention but directly impacts less than 10% of population

  20. Legislative Priorities • Opioids • 44,000 deaths in 2016 • $44 billion in lost productivity • HSA Improvements Act (H.R. 5138) • Updates HSAs to make them more workable and effective • Individual market stabilization package • Reinsurance and other mechanisms to offset elimination of CSRs and individual mandate

  21. Regulatory Issues • Short-term, limited duration insurance plans • Employer mandate notices • One employer received a $22 million bill • Litigation? • Please let us know if you’ve received anything

  22. Regulatory Issues – Association Health Plans (AHPs) • Proposed Rule • Geography as sole commonality • Health coverage can be sole purpose of creating AHP • Self-employed eligible to participate • Continues to allow industry as commonality

  23. Association Health Plans (AHPs) • Proposed Rule Limits • Must be working owners of an association (Alumni Association current structure wouldn’t qualify) • Can only be formed amongst corporate or employer members • Result – U.S. Chamber can’t offer plans…but National Restaurant Association or Illinois CoC could

  24. Association Health Plans (AHPs) • Interested in possibly offering an AHP? • Speak with a health insurer about what fully insured products could be offered • Speak with a benefits manager about possibly self-insuring

  25. Threats to Employer-Sponsored Insurance (ESI) Single payer • House – Conyers Medicare for All • 2009-10: 1/3rd of House Dems cosponsored • 2017-18: almost 2/3rds of House Dems cosponsoring • Becoming a litmus test for Democrats with national aspirations

  26. Single Payer • Senate – Bernie Sanders Medicare for All bill • 16 cosponsors (1/3rd of Senate Democrats) this year • Cosponsors in 2013-14??? • 0

  27. Threats to ESI – Capping the “Exclusion” Exclusion – employees don’t pay taxes on their employer-provided benefits Why cap it? “Costs” a lot of money – about $250 billion annually Some argue it raises health care utilization and costs Not fair to those without employer-sponsored insurance

  28. Threats to ESI – Capping the Exclusion But… Foundation of our employer-sponsored system (ESI) 178 million Americans receive health insurance through employers Highest satisfaction, best value, most innovation in health care Tax hikefor those with ESI

  29. Contact Info: Jeff Lungren at 202-463-5607, jlungren@uschamber.com

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