December 8, 2010 

Office of Health Plan Standards and Compliance Assistance 

Employee Benefits Security Administration 

U.S. Department of Labor 

200 Constitution Avenue, N.W., Room N-5653 

Washington, DC 20210 

Attention: RIN 1210-AB42 

RE: Amendment to the Interim Final Rules for Group Health Plans and Health 

 Insurance Coverage Relating to Status as a Grandfathered Health Plan 

 Under the Patient Protection and Affordable Care Act

Dear Sir/Madam: 

The National Association of Wholesaler-Distributors (NAW) appreciates the opportunity to 

submit comments in connection with the rulemaking referenced above undertaken by the 

Departments of Health and Human Services, Labor, and Treasury. NAW, the “national voice of 

wholesale distribution”, is a Washington, DC-based trade association comprised of direct 

member companies and a federation of national, regional, state and local line-of-trade 

associations which together include approximately 40,000 enterprises with 150,000 place of 

business located in every state in the United States. 

In my August 6, 2010 letter offering NAW’s comments on the initial Interim Final Rule (IFR) I 

wrote: 

“...what is set forth in the instant rulemaking regarding ‘grandfathering’ of health plans in 

existence on March 23, 2010 will substantially limit, to the point of practically removing, the 

tools employers, including wholesaler-distributors, have routinely used to partially mitigate 

large increases in health premiums and related costs, enabling them to continue ... offering 

health coverage benefits to their workers.”

The ability of insured plans to seek alternatives to their current issuer is one of these tools taken 

by the IFR. By allowing “a group health plan to change health insurance coverage (that is, to 

allow a group health plan to enter into a new policy, certificate, or contract of insurance) without 

ceasing to be a grandfathered health plan,” this Amendment properly restores this important 

marketplace tool. Regrettably, its restoration is prospective only; i.e., for only those changes to 

group health insurance coverage that are effective on or after November 15, 2010. We urge that 

this Amendment be applied to all group health plans in existence as of March 23, 2010 (the date 

of enactment of the Patient Protection and Affordable Care Act (PPACA)). 

-moreNATIONAL ASSOCIATION OF WHOLESALER-DISTRIBUTORS

1325 G Street N.W., Suite 1000, Washington, DC 20005  202-872-0885  FAX: 202-785-0586  www.naw.org 
December 8, 2010 

Page 2 of 2 

NAW’s August 6 comments also indicated: 

“... this interim final rule is so overreaching as to severely discount the value and purpose of 

‘grandfathered’ status. The result, we fear, will be an unending yet unsustainable upward spiral 

in employer health care costs ...”

Consequently, NAW called upon the departments “to radically re-shape this ‘grandfathering’ 

regulation to more closely adhere to the President’s assurances regarding existing health plans”; 

i.e., to allow people to keep their existing plans if they wish to do so. This Amendment, while a 

partial step in the right direction, clearly falls short of our admonition in this regard. The 

preamble to this Amendment acknowledges as much: 

“The Departments expect that this amendment will result in a small (emphasis added) increase 

in the number of plans retaining their grandfathered status ...” 

Finally, NAW continues to believe the underlying IFR vastly exceeds anything that can be 

reasonably inferred by Section 1251 of the PPACA. NAW stands by the August 16, 2010 

comments of the Small Business Coalition for Affordable Health Care in which we joined, that 

among other things observed: 

“ ... neither PPACA Section 1251 nor any other provisions of the Act authorize or even 

contemplates post-enactment loss of grandfathered health plan status by a group health plan or 

employer-sponsored health insurance coverage that satisfied the requirements of Section 1251 

on the date of enactment ... PPACA Section 1251(e) defines the term ‘grandfathered health plan’ 

with respect to criteria that must be satisfied as of March 23, 2010, and Section 1251 ... does not 

mention or even allude to any (emphasis in original) possibility of loss of grandfathered health 

plan status, much less of ‘ceas(ing) to be a grandfathered health plan’”.

Thank you for your consideration of NAW’s views. 

Respectfully submitted, 

Jade C. West 

Senior Vice President-Government Relations