Fast Break: Big Beautiful Bill, Big Questions – The State of Individual Marketplace

Matt Cranney

Welcome back to Fast Break, the podcast where we dive into the trends, challenges and opportunities shaping the future of small and growing businesses. I’m your host, Matt Cranney, Executive Vice president of M3 Elevate.

Today, we’re tackling a topic that’s becoming increasingly critical for individuals and organizations alike: the individual health marketplace.

As of 2023, over 16,000,000 Americans were enrolled in health plans through the ACA marketplace, a record high. And nearly 90% of those enrollees receive subsidies to help lower their monthly premiums. These numbers aren’t just impressive. They’re signal a signal that the individual market is no longer a niche solution, but a mainstream option for coverage, especially as workforce dynamics shift and employers explore new models like ICHRAs.

To help us unpack this, I’m joined by a returning Fast Break guest Natalie Damro, client executive at M3 Elevate, who focuses exclusively on the individual health marketplace. Natalie brings deep expertise and a passion for helping individuals find the right coverage in a very complex landscape. Natalie, welcome to Fast Break.

01:16 Natalie Damro

Thanks for having me, Matt.

01:17 Matt Cranney

Natalie, this is a topic that if people are following along and tracking with all of the news right now, I don’t think you can go a single day without seeing whether it’s about the implications of The Big Beautiful Bill, the court reactions to that, the pieces of that that are specifically related to subsidy. There’s so much going on in the individual marketplace and I’m so excited to have you today so that we can dive into all that and try and unpack this for our audience.

I do want to offer disclaimer that because of all of the constantly changing nature of this, both Natalie and I are doing the best that we can today, with the information that we have. But things are changing at a rapid pace, and please continue to stay connected to M3 and to Natalie, and we’ll talk more about how you do that later for all the latest and greatest.

But we didn’t want to go too long without the ability to have at least a conversation, so we can help lead through uncertainty, because I think that is the most valuable role that we can often play.

Before we dive into all of those details Naatlie, let’s go back to the basics. I’m hoping you can share with me and our audience what are the key drivers behind the growth of the individual marketplace and how have you seen it evolve over the last few years?

02:44 Natalie Damro

Yeah, it’s a great question, Matt. You know a few things have driven the growth of the individual marketplace recently. First, I would point out that there’s been, you know, more financial help for people with the expanded subsidies from the Inflation Reduction Act and with those expanded subsidies, this offered more affordable coverage for middle-income families, not just those lower-income families.

There’s also been, you know, a big shift in how plans are designed, how they’re marketed. You know, more carriers have really jumped in, and they’re competitive with their networks and their benefits that they offer. So people do have a lot more of a choice.

Overall, the marketplace has really matured a lot. It’s, you know, more stable and consumer friendly market it’s no longer a last resort option, so it’s more of a legit way for individuals and families to get good coverage.

03:35 Matt Cranney

That’s awesome. Now that’s a I think a really good kind of level set of what is out there. Who are your customers? Right, right now, who do you see turning to that individual marketplace today? I think if you asked me before we started working together and really developing a deep specialization in this area, I would have maybe said like oh it’s some gig workers, you know, early retirees. Or are you seeing sort of a, you hinted at a broader adoption, and I’m curious if you can dive in deeper to that.

04:09 Natalie Damro

You know it is way, way broader than it used to be. You do still have those gig workers, your freelancers, and of course the early retirees who are not yet 65, but now you’re also seeing those middle-income families and people who maybe lost coverage through their employer or they’re rolling off of the Medicaid coverage.

So, you know those bigger subsidies that I touched on before, those are also playing a part in in all of this and how people are really looking for the coverage. Those plan options made it way more affordable and attractive. So it’s not just that fallback option anymore, it’s a real option for all kinds of folks.

04:45 Matt Cranney

When you think about, you know your desk right now and who you’re working with and partnering with, give us a few examples. I mean, obviously no names. Hopefully if you not listen to Fast Break, you’ll hear your name, but where they coming from and \what do they do and like it just illuminated a little bit for us.

05:03 Natalie Damro

A lot of things that I’m seeing in the summer months are teachers who are retiring. They’re maybe just comparing the COBRA or the district plan to what the marketplace offers or I’m seeing jobs that people get and they just don’t offer those group benefits anymore. So they, they do need a different resource or a different avenue, if you will.

You know another thing I’ve been seeing, I guess would be a small company that just started up, and they only have one or two employees or it’s family owned and they only have themselves, so they also need the coverage option because they don’t have enough employees for a group coverage plan.

05:43 Matt Cranney

That’s awesome. And actually that leads us really well into the next question that I had for you and that is from that employer perspective, I’m thinking how does the individual marketplace intersect with strategies like ICHRAs? I know, we’ve had a conversation on Fast Break before about ICHRAs and the emergence there, and it’s continuing to be an emerging market, but from an employer perspective, what do you think leaders of organizations should be thinking about?

06:11 Natalie Damro

Yeah, ICHRAs really lean on the fact that the individual market has come a long way. I think employers can, you know, hand their employees a sum of money and they can go out and pick a plan that’s best suited for their needs or their families needs, instead of picking between maybe one or two options that they offer that might not even scratch the surface for them.

So it just creates that flexibility for the employees and it can save money for the employer. So something you know, leaders should be thinking about is maybe how much support that they’re giving their employees.

It’s really important to, you know, partner with the right folks to provide that support, the education, things that they can expect when they’re implementing the ICHRA. And really the ICHRA does work best when the allowance that the employer is offering to the employee is fair and that their employees feel supported and not left on their own.

07:01 Matt Cranney

I think it’s a call, Natalie, for employers who are listening to us today to really maybe do their homework, connect with experts, like you, maybe like their small group benefits connection to understand all of the things that are out there. Is it a traditional group health plan that would serve them best? Is it an individual health marketplace option for, you know, for very small organizations? Is it an ICHRA versus the days of hey, we don’t do anything and then we just move to a group plan when we grow or we get bigger.

True talent these days as people are, we talk all the time here about how benefits can be and should be, how you recruit and retain and develop your employees. And in an increasingly AI driven world, and we’ve had a recent conversation on Fast break about that too. The most human company is going to win. I really believe that.

With that, and so, if you’re listening today and you feel like it’s been a minute since you engaged on this topic or this conversation in terms of, just maybe not even making a change, maybe not even offering it, but just doing homework to understand all the different options that are available. And then your point, Natalie, which I think is really important, what do your employees want and how can you make them feel supported so that it’s not just regardless of what you choose, a solution that employees feel like they have to navigate on their own. Is that fair?

08:34 Natalie Damro

Yeah, absolutely. You nailed it.

08:36 Matt Cranney

It’s no secret that choosing a plan can be overwhelming. I’ve lived in the states now for 21 years and I still feel every time open enrollment comes around and our group plan, I still feel a little bit overwhelmed cause I came from the UK where we had National Health, so it wasn’t something I was used to doing. And so I always appreciate the resources that M3 makes available to be able to guide people through that.

So what are some of the maybe misconceptions or challenges that individuals face when they’re shopping for coverage, either with you or in the marketplace direct.

09:10 Natalie Damro

It’s no secret that shopping for insurance can feel like learning a new language. A big misconception is that people think that the cheapest premium is automatically the best deal, and then you find out, you know, a couple months later that that lowest price comes with a big, large deductible that you’re never going to meet, or your favorite doctor is no longer in your network. I would just pay attention to that.

Plus you know, there’s so much information to sift through. There’s acronyms, there’s metal tiers, bronze, silver, gold. Figuring out what actually fits your needs. Many people don’t realize that there’s subsidies that they could potentially take advantage of that can make a better plan, maybe a little bit more affordable for them, or that there’s even help available to walk them through all of those acronyms, metal tiers and those plans.

So that’s exactly what we do here. At M3, we sit down and we have those conversations and we try to help you move through all the all the noise.

10:06 Matt Cranney

The piece that comes to mind Natalie sometimes my Britishness doesn’t come out very often. Most people think I’m actually from Boston with my accent now. But I feel like at times it comes out in large grocery stores or department stores where there’s so much choice here, like in the UK, it’s not that way. And it’s sort of that image of, you know, I have in my mind of me walking around. And you know, a big grocery store trying to find something very specific and not knowing which aisle to look in or not, which shelf to look at it, it can kind of feel that way too, maybe with the marketplace where it’s, hey, I know I’m in the right place. I know there’s things here that I need, but how do I get what I need? How do I make sure I’m making the right choice? And for me, I know personally nothing that I struggle with is I don’t like to make the wrong choice. Right? I wanna make the best choice for me and my family.

Are there a couple of things that you know when you know, if I had called you and said Natalie I need help in the marketplace is there like one or two guiding principles that you give people like you know do you say like hey, take a deep breath.  What are a couple of those things that you share with people?

11:13 Natalie Damro

Yeah. I mean, I think it’s really easy to get overwhelmed, especially if you’re not used to what you’re looking at or you’re not familiar with it. I focus mainly on, hey, where do you live? Because it’s going to be different, you know, if you live in Milwaukee versus if you live in Green Bay, the prices are going to be different. The networks are going to be different and it’s really important to focus on where you live.

Also, your doctors that are in the network because not every plan has all the doctors in the network. So we want to really make sure that you know you’re enrolled into the plan that has your doctors in the network, your medications are covered. And you have all the information to really make that choice.

11:51 Matt Cranney

It feels like before you go to the store, have your grocery list right, have kind of like what time you want to get there. Have all those things. So before even engaging with someone like you, have the list of the doctors that you need. Have a list of your medications. Have a list of what’s important to you around to your point the geography and the surrounding health systems, and where you would like to receive care.

Because I’m sure if somebody shows up with that level of preparedness, it becomes much easier for a guide like you to be able to point me in the right direction.

Natalie, we’ve come to the part of our conversation that I think, you know, we can disclaim with the heck out of this, right. Neither you and I are our political lobbyists. We don’t read the tea leaves of what’s going on in Washington, DC. But we do know that right now it’s an area of and we referenced it at the start, incredible uncertainty.

I think as you and I and the team were planning for our upcoming open enrollment season sort of in the wake of The Big Beautiful Bill, and some things in it, we were able to say, OK, we can see what’s in it. We can see how this is going to shake up, then obviously challenges to that through the court system that have led to a period of is it going to be that way or is it not?  

And so even for people listening to our episode today, and maybe they saw the title and they’re like, Oh yeah, I need to listen to that. It doesn’t seem like we go one day right now without seeing news stories and the impact of Big Beautiful Bill on the individual health space and the response from every angle: carriers, legal.

It’s a big, broad question, Natalie and we will navigate this together. But I’m hoping you can give guidance to our audience on how best to navigate the uncertainty, I mean we don’t know yet which way it’s going to go, but if I need coverage tomorrow, right or today, what’s the advice and guidance that that you would give from that?

13:52 Natalie Damro

You’re right, it does feel like every day there’s a new headline or a new update, and it can be overwhelming to kind of keep track of what really matters. So I think my best advice is don’t try and sort through all of it alone. Really. Start with the basics. What does this mean for you and your coverage today and what do you need to plan for in the future?

Focus on really what’s in your control and then, you know, lean on us as your trusted resource.

And that’s exactly why we’re here at M3. We keep up with all those moving parts for you and you know, we’re happy to talk through all the changes with you, explain maybe how they might affect your situation now or in the future. And you know, give you a clear path forward. If you’re feeling stuck in that uncertainty, you know, reach out to us and we can definitely help you through it.

14:39 Matt Cranney

Natalie, if we have people that are listening today what are the two or three big areas right now that are causing the uncertainty, I  know you and I you know, have talked about subsidies, and you know whether there will be or won’t be. Can you give us maybe just maybe some of the big headlines that are causing the uncertainty?

14:55 Natalie Damro

You know, subsidies is the main and big question of will they or won’t they have them. And if they do have them, at what capacity?

I think another one is now they have to provide documentation that they lost coverage or do they have to or don’t they have to. It’s kind of flipped back and forth.

There is also another one where they will have to pay a penalty if they let their plan auto renew, and they don’t actively go in and make that change with somebody or on their own. So just some things to kind of pay attention to and we’ll kind of learn that as we go and keep everybody updated.

15:32 Matt Cranney

Really helpful and obviously incredibly meaningful: subsidies, fines, documentation. These are the things again that add to you know an already complex space, right. You talked earlier about acronyms and tears named after metals and all those things and now we have this to deal with as well.

I think the two key messages that I would bring out, one: if you need help, we’re here, Natalie’s here and M3 is here. Second, stay connected to M3 from a resources perspective as well as we gain more clarity around different pieces here, we are big believers in not just we’re having our conversation today and you’ll never see or hear more about it again. Obviously, you’ve heard Natalie has been her repeat guest on Fast Break, and if we need to, we’ll do another episode. We’ll write pieces on our website. There will be lots of information that we want to put out there so that you can help continue to be guided.

And maybe the third point I would add to is if you need help today, help can be given today. Don’t feel like you have to wait to engage or connect with us. We are here now.

16:45 Natalie Damro

Reach out anytime that you need help navigating through it. It’s not. It’s not easy and it’s nice to feel supported and that we have a resource to make those decisions, so absolutely reach out if you need help.

16:59 Matt Cranney

OK, Natalie, before we wrap up our conversation today, let’s maybe the one piece of advice that you give to someone exploring the individual marketplace people who are navigating it for the first time and maybe a piece of advice with people who are coming back.

17:17 Natalie Damro

Starting off, focusing on your needs first, not just that plan that it looks the cheap. Just think about the coverage that you’ll actually use for your medications. Your favorite doctor that you see, and your expected care that you know you’re going to have. And then from there you know you can compare plans based on those needs. It might take a little bit of extra time and leg work up front, but it really is helpful when you go to actually pick the plan because it will work for you and your needs, and it’s not one that will just save you a couple dollars in the end.

You know, with that uncertainty and the increase of premiums, there is a lot of things to really take into consideration. You know, like we need to know your income and we need to know where you live and all of those different factors. So I think it’s just important to have the whole picture before you really pick the plan.

18:02 Matt Cranney

Natalie, I think before we move on to our next section of our conversation, I just want to say thank you. Thanks not just for being a guest today on Fast Break, but thanks for doing what you do for our clients.

I know I speak firsthand when I tell you we are so proud to have Natalie on our team the way that she guides and cares for people in this marketplace makes us all proud to be your colleague. So Natalie, thank you for that. I know it’s going to be incredibly busy coming up here. A lot of people are going to need help and guidance as we head into open enrollment in the end of the year.

18:40 Natalie Damro

Absolutely. Thank you.

18:42 Matt Cranney

All right, everybody, it’s time for our fastest break questions. And because this is Natalie’s, I think third time on Fast Break, we’ve had to stretch and come up with some new rapid fire questions. So now it’s going to be kind of a either or right set of questions and I’ll fire. You just give me a response and we’ll go to the next one, OK.

19:01 Natalie Damro

Sounds good.

19:02 Matt Cranney

OK, sweet or salty snacks for you?

19:03 Natalie Damro

Sweet.

19:05 Matt Cranney

Coffee or tea?

19:06 Natalie Damro

Neither.

19:06 Matt Cranney

I love that answer beach vacation, or mountain getaway?

19:09 Natalie Damro

Definitely the beach.

19:10 Matt Cranney

Early bird or night owl?

19:12 Natalie Damro

early bird

19:14 Matt Cranney

Books or podcast?

19:15 Natalie Damro

Podcast.

19:16 Matt Cranney

City life or country living?

19:18 Natalie Damro

I would say somewhere in between.

19:20 Matt Cranney

Text or call?

19:21 Natalie Damro

Text.

19:21 Matt Cranney

OK, that’s super helpful for me to know I’m gonna start texting more because I’m a big caller. It’s probably frustrating the heck out of you. Summer or winter?

19:29 Natalie Damro

I’m definitely not made for these cold winters in Wisconsin, so summer for sure.

19:33 Matt Cranney

OK, Natalie, before we close, we know the big theme of our conversation is reach out. Educate yourself, get help.  We’re here. So if we have people in our audience, whether they’re individuals whose coverage is changing, individuals whose life phase is changing, small businesses that are thinking about what options they have, and they’ve listened today and they would love to connect with you. Can you share with our audience where they can find out more about you, and the best way to get connected.

20:04  Natalie Damro

Yeah, they can head over to our M3 insurance website at M3Ins.com, and they can check out the solutions tab. From there you’ll fine a page dedicated specifically to individual health and that’s filled with articles, resources, everything that you need to help you understand what your options are.

And of course my contact information is right there too. So if you wanted to connect or you have any questions, you can reach out to me anytime.

20:28 Matt Cranney

Everybody stay tuned. Things are changing quickly in this space and we will be your side and your advocates in your resources through it. So Natalie, thank you so much for joining us today on Fast Break and sharing your insights around all of the things in the world of individual health in an absolutely crazy time. We really appreciate it.

20:50 Natalie Damro

Thanks for having me.

This has been Fast Break brought to you by M3 Elevate. I’m Matt Cranney, thank you for joining me. Do you want more tips to grow protect your business? Subscribe now and catch all of our episodes and we’ll see you next time.