One minute, four stern faces look into the flashing camera as they all channel the broker provisions in a reform bill. The next minute, bunny ears go up behind a head and everyone sniggers. Someone quips, "I'm not smiling if he's not!"

"You guys have known each other for a while. I can tell," says the photographer. "Do you all work together?"

They respond in unison: "We do now."

It was only a few months ago that the chief lobbyists from the top organizations representing broker interests in Washington, D.C., saw each other just occasionally. Now, these leaders of the Association of Health Insurance Advisors, Council of Insurance Agents & Brokers, Independent Insurance Agents & Brokers of America and National Association of Health Underwriters get together every single Friday to plot their strategy on health care reform.

As policymakers readied their bills for committee markup, EBA sat down for a candid talk with the lobbying heavyweights from your industry's top trade associations.

Time is running out

To use a well-worn sports analogy, the game is heading into the third quarter and it's time to make a play, says Janet Trautwein, executive vice president and chief executive officer of NAHU. "We are about to have two very serious bills coming out of the Senate, which will pretty much make or break what happens. Those will be voted on over the summer" along with House bills, she says. "So we have to move quickly. We have to be serious about it now."

Don't expect the third and fourth quarters to be regulation time either, adds Charles Symington, senior vice president of government affairs for the Big "I". He thinks they'll be the equivalent of one minute each. "That's why it's so critical that the four groups that are represented here today are working together. Because it's going to be getting information by firehose and we're not going to have that much time to digest it ... and how it will impact our membership," he says. "When you have the four major producer trade organizations working closely I think that will say a lot."

Although he's not convinced Congress will be able to follow the aggressive schedule they've set for themselves, Joel Wood, senior vice president of government affairs for CIAB, says "none of us want any of our members to wake up that morning after [a bill is passed] and say, 'Where were you?'"

That doesn't mean they see themselves as the only ones accountable. The organizations are counting on their members across the country to take action as well. "We're gearing them up," says Diane Boyle, executive vice president of AHIA, the health and employee benefits division of the National Association of Insurance and Financial Advisors.

This is a critical time for brokers and advisers, says Trautwein. "[T]his is make it or break it time," she says. "They're in the health insurance business. This is what they do, and if it doesn't go well, it will impact them severely - and their clients."

While there's been some talk of a wait-and-see attitude in the broker community, the lobbyists all say they haven't had to motivate their members to act. With 21 years in the industry, "I have never seen spontaneous uprising of concern, anxiety, anguish and, honestly, anger about where a lot of the options are [like that which is] coming from our members right now," says Wood. "Now, it's our job to try to channel that in the most constructive possible way and I think we're doing all of the things that we need to be doing on that."

Symington echoes the sentiment. For the 300,000 members of The Big "I", health insurance sales represent approximately 14% of their book of business. "In this tight economy, 14% can mean the difference between being in the black or being in the red ... Our members are motivated. They're self motivated," he says. "Now, we have to harness that, we have to focus them on the right things, but we're doing that."

Capitalizing on the urgency of the moment, all four groups are uniting for a first-ever "Fly-in" July 15 when several hundred producers will descend on the Capitol to meet with their senators and congressmen. "It's pretty interesting ..." says Wood. "We haven't done anything like this. Ever."

Meanwhile, Boyle, Symington, Trautwein and Wood are on the Hill themselves almost every day. An average day on the Hill for Trautwein starts with a 7 a.m. meeting and ends when the last one wraps up around 8 p.m. "We do things like we're submitting testimony, we're testifying in hearings," she says. "It's just non-stop things that all of us are doing all of the time where there's always testimony to be submitted, there are comments to be made, there are coalitions to manage, there's groups to make sure that somebody just doesn't jump off the ledge - because there's always someone upset about something."

Wood gives Trautwein credit for covering a good chunk of the health care-related interests. She testified before the Senate Health, Education, Labor and Pensions Committee March 24 on insurance market reform and the House Education and Labor Committee April 23 on insurance cost reduction, then again June 11 on the HELP Committee's reform bill. "Janet is much to be personally credited for having been on the inside of all of those working group, behind-the-scenes staff negotiations, roundtable discussions early on," he says. She's been "on the firing lines since day one and deeply engaged in all of that."

Trautwein takes the praise in stride. "I think it's because that's what our members do. We're 100% about health issues and so I can devote all that time to do it ..." she says. "We're really tunnel-vision focused on all of these issues that have to do with that. It's just a matter of being up here for a long time and you build relationships. It's a lot actually like what our members do. They build relationships with their clients. We build relationships on the Hill. The Hill staff are our clients in a weird sort of way."

Priorities

It's statements like the one expressed by White House health reform czar Nancy-Ann DeParle in April that an advantage to a public plan would be that it "doesn't have the need to have brokers out selling" that keep Wood's head in the game. "It is about debunking that perception that is coming from the White House right now," he says.

Making a government-run public plan option "radioactive," as Wood puts it, is the top priority of the four organizations. "That's what brings us all together," he says as affirmations of "right" and "yeah" come from the other lobbyists.

Wood doesn't buy the oft-repeated promise from supporters that it won't have an unfair advantage over private plans. He points to the student loan program, now almost entirely federally run, as an example of a similar promise broken. "This whole notion that a government-run plan is necessary to keep private plans honest is offensive and that's what's motivating our members," he adds.

Although stopping the public plan "is hugely important," the devil is in the details, and there are numerous ones to be set straight before legislation passes, says Trautwein. For example, policymakers have talked of the term "small group" meaning as many as 250 employees, as opposed to the HIPAA definition capping it at 50. "Just those small changes that someone may make in a bill and not understand what they're doing are the very things that we have to pay attention to, and we are paying attention to, so that they don't unintentionally do something that could just blowup the market," says Trautwein.

Maintaining a role for the broker comes hand in hand with whatever legislation is produced, says Boyle, particularly if some form of an insurance exchange - which is supported by both Democrats and Republicans - is enacted. A toll-free number or Web site created to help with comparing plan options won't cut it when the majority of people aren't familiar with the complicated terms that professionals throw around on a day-to-day basis, says Boyle. "The level of expertise, training and continuing education requirements that our guys go through now, you can't substitute that with somebody who's answering a phone call," she says.

Rounding out the top three priorities is ensuring that the private market system is here to stay, says Trautwein, that whatever is enacted "is not something that will harm the private market in such a way that at the end of the day we'll say, 'Oh well, the private market changes didn't work, so now we have no choice but to go to a single-payer system.'"

Where do we go from here

Speculating on the future, "if there was such a thing as a sure bet in the bill, this would be it: the creation of an insurance marketplace, or 'exchange,'" reports Politico. That's fine with Trautwein. "The exchange only makes a broker's role more important," she says.

People will still need coverage outside of the exchange. Someone will need to help determine if people are eligible for subsidies and where they can get them, how group size matters and how it's defined from one place to another. The list goes on. "It goes back to this issue of there's more to a broker's role than signing a piece of paper or having someone say, 'Check here.' There's a lot more to it," says Trautwein. "There's a lot of needs analysis done and claims assistance that can't be done through a toll-free number or a call center or by checking a box on a Web site."

These are the services that - in the small marketplace in particular where companies don't have an internal HR department - are needed most from brokers, says Symington. That won't change. "Whatever we see coming out of this reform bill, it's still going to be a very complicated marketplace," he says. "There's still going to be a very important role for the independent agent and broker."

However, if every American has the opportunity to opt-out of a system that has been negotiated by a broker, that could eventually destroy the system, says Wood. For example, if a healthy 25 year old drops out of an employer's 100-person group that has several diabetics and cancer patients, "that's where that group blows up," he says. "And that is where you do get to that situation, which we really don't see among the clients of our member firms today, of the employer just saying, 'We want out of here.' That will be the result of it."

As for insurance carriers still needing brokers in an exchange-run system, the lobbyists say that's a sure bet. "I think for the most part the carriers understand that there's going to be a distribution system," says Wood. "I mean you look at, there are major HMOs that we all know the name of that tried to go it on their own that are now essentially broker based."

Of course, "if they could get rid of us and be successful, they would," jokes Boyle. "But the reality is they can't, and I think they do recognize that."

But what if things don't go as planned?

Symington's not ready to think that way. "We're so focused on the fight right now. Sure, you have backup plans so to speak but we're not willing to give an inch at this point," he says. "We're focused on the fight at hand, and then it sounds like the decision will be made very quickly ... and then we'll have to pivot. But at this point we're just happy to work with the other groups."

While she agrees with Symington, Trautwein still has one eye on plan B. She points out that most every version of legislation that's been hinted at so far requires a role for the states. NAHU has "a pretty big state operation, and we figure that we'll have another shot at some of these things, to fine tune them so that they'll work better on a state basis," she says. "... [B]ut, we have definitely not given up on this. I think we have many champions on the Hill that understand the role of brokers, and before we're done we're going to make sure that they all understand what the role is that's really played."

It's not just about preventing certain reforms, either. "We're not opposed to health care reform," says Boyle. "One of the things that we've talked about at the table a whole lot is what are you fighting against, but we're actually fighting for something. So we're going to try to make sure that whatever is ultimately introduced and passed is something that we can embrace and it's going to be good for our members."

For as long as Wood can recall, in every annual CIAB membership survey asking where members see their business growing and what they think are the most valuable services they provide, more than 85% of respondents have said employee benefits. He ticks off a list of supported reform initiatives: guaranteed issue requirements, health IT, subsidies for uninsured, underinsured, small businesses and individuals, individual mandates. "We're open to so many things that could make a positive difference," says Wood. "...[E]very one of the surveys that I've seen shows that tens of millions of Americans who secure their insurance through their employer, brokered by our member firms, are very happy and satisfied with the coverage that they have, and we feel that that's at risk. So, is there a plan B? Sure. We'll survive. Our members are going to be around. They're going to be doing something. There will be distribution and they will figure out a way to thrive."

Joel Wood

Organization Council of Insurance Agents & Brokers

Title SVP, Government Affairs

Membership size - 270 member firms, all large brokerages with significant employee benefit consultancies

Average time spent on the Hill -At least 30 hours a week physically, but the interaction is constant

Favorite activity outside of work - I play around (sometimes foolishly, sometimes not) investing in restaurants

Last book you read The Forgotten Man: A New History of the Great Depression

Can't miss TV show - Top Chef

Person (dead or alive) you'd most like to meet - Otis Redding

Janet Trautwein

Organization National Association of Health Underwriters

Title CEO

Membership size - We represent about 100,000 agents, brokers and consultants

Average time spent on the Hill - Per week? That's embarrassing ... 30-40 hours

Favorite activity outside of work - Travel in Europe

Last book you read -The Forgotten Man: A New History of the Great Depression

Can't miss TV show- 24

Person (dead or alive) you'd most like to meet - DiegoVelázquez (Spanish painter, 17th century)

Diane Boyle

Organization National Association of Insurance and Financial Advisors (NAIFA)

Title EVP, AHIA - NAIFA Health & Employee Benefits

Membership size - NAIFA comprises more than 700 state and local associations representing the interests of approximately 200,000 agents and their associates nationwide

Average time spent on the Hill - 80%

Favorite activity outside of work - Do people have activities outside of work?

Last book you read - Llama, Llama Mad at Mama

Can't miss TV show - None

Person (dead or alive) you'd most like to meet - I haven't prioritized a list. I like meeting whoever crosses my path.