Thursday, February 4, 2016

Time For A Little Firesign Theater


The real name for this post would have been How Can You Be in Two Places at Once When You're Not Anywhere at All. The link to the 1969 Firesign Theater album will let you listen to the album while you continue to read this post. Of course, if you are of a certain age, I’ve already lost you…

How can you be two places at once? How can you appear to advocate for something while you spend all of your time and energies undermining that very same thing? This being Health Insurance Issues With Dave, smart money says that this is probably about health insurance and the companies that sell it.

The major insurers want you to know that they are here for you. Ask them. They’ll tell you. The major insurers litter their public pronouncements and email communications to their agents with words like commitment and partnership. Companies such as Aetna, Cigna, Anthem and UnitedHealth Care want you, the American public, to know that they are committed to their partnership with the American people and are ready to deliver their product through the federal exchange, the state exchanges and whatever platform available to them. You can hear the Battle Hymn of the Republic playing in the background as you read the emails, the fruit of the labors of their overworked PR departments.

And this would be wonderful if it were true. But, of course, it isn’t. There would be a huge uproar if the largest insurers abandoned the exchanges. Terrible publicity. Government officials and the heads of the exchanges would all blast the insurers as bad corporate citizens and incompetents. Plus, drop out of the market and they can’t get back in for five years. So the insurers needed to find a backdoor.

The solution is to stop paying the agents. Anthem, Aetna, Cigna, UnitedHealth Care all hope that by not paying the agents during the Special Enrollment Period we will place our business with those companies who will. Sure that may push all of the clients to one or two companies from February till December, but it won’t be them. And what would happen if all of the companies stop paying the agents, so that none of us can afford to spend the hours of time necessary to match Americans to the appropriate policy and insurer? NOTHING! No one with any authority would ever notice that thousands of Americans were even more unhappy than usual with their health insurance.

The insurers are losing millions of dollars on policies written on the exchanges. The Special Enrollment Periods are being abused. The federal exchange is not enforcing the rules. Fixing the problem is an option. It would take a lot of work and require the building of trust between the exchanges and the insurers. Removing the incentive to do our jobs is easier but terribly cynical. But Congress attempted to repeal the Patient Protection and Affordable Care Act (PPACA or Obamacare) for the 60+ time last week. What is more cynical than that? So who is going to notice one more act of self-serving cynicism?

The insurers will continue to say one thing publicly and do the exact opposite privately. But like Nick Danger, we are lost on the wrong side of the album and you really can’t be two places at once.


Wednesday, January 20, 2016

Running On Empty

Representative Steve King represents Ethanol. I mean Iowa. With an almost unlimited supply of taxpayer supported fake fuel it would seem impossible to imagine Rep. King running out of gas. But he has. Representative King has very little energy. Here, in its entirety, is H.R. 132. This is the bill that Mr. King authored and the Republican Congress passed a couple of weeks ago:


This Act may be cited as the “ObamaCare Repeal Act”.


(a) PATIENT PROTECTION AND AFFORDABLE CARE ACT.-Effective as of the enactment of the
Patient Protection and Affordable Care Act (Public Law 111-148), such Act is repealed, and
The provisions of law amended or repealed by such Act are restored or revived as if such
Act had not been enacted.

Enactment of the Health Care and Education Reconciliation Act of 2010 (Public Law 111-
152), such Act is repealed, and the provisions of law amended or repealed by such Act
are restored as if such Act had not been enacted.

That’s it! That is the entire bill. Rep. King ran out of steam after two paragraphs. He didn’t even have enough energy to think what might happen if, G-d forbid, this silly bill became law.

But what if everything the Republicans said about President Obama were true? What if he really didn’t love this country? What if his real goal was to destroy this country? Signing the above act of political theater and intellectual laziness would be the fastest path to anarchy. Signing the Republican bill would have thrown 20% of the American economy and the healthcare of every American into disarray.

The PPACA is a poorly written law that has both helped and hurt many Americans. Some of you, my readers, now have insurance and access to healthcare. The elimination of underwriting, coverage for preexisting conditions, and tax credit subsidies allowed many of you to buy policies. The increased premiums and poorly designed regulations have knocked some of my clients out of the market. Love or hate the law, we all acknowledge the reality of the law. And since the law exists – rules, regulations and paperwork – the only way forward is to CHANGE the law. Rework the rules. Reengineer the regulations. Modify to a point where the law might not even be recognizable. That is possible and some of the changes might even be desirable.

There are only two problems with changing Obamacare as opposed to simply passing the mindless repeal of the law. The first is that the eventual law might still give President Barack Obama credit for getting something accomplished. The other problem is that fixing the Patient Protection and Affordable Care Act would be a lot of work. Real work. And Steve King doesn’t have the energy for that. When it comes to ideas, Rep. King is running on empty.


Sunday, December 27, 2015

Why Do You Have An HSA?

gift wrap

The presents have been opened and some have already been exchanged. Now it is time to take stock of what we actually purchased for ourselves and our families this year. And while we are second-guessing that hoverboard decision, we might also want to make time to understand that new health policy we purchased for next year.

Some of the most popular policies in our market carry the letters HSA in their names. Many of you intentionally purchased this type of policy and intend to take full advantage of the tax advantages. Most people were simply purchasing the cheapest policy available, the one with limited benefits before you reach a high deductible.

To carry the HSA designation, the health policy must have a high-deductible (HDHP). The plan can not have office or Rx copays prior to the deductible being met. The Patient Protection and Affordable Care Act (PPACA or Obamacare) requires the policy to include “first-dollar” coverage for preventive services such as an annual routine physical, medical screening tests (like a colonoscopy), well-baby care, and certain medications. The maximum-out-of-pocket for 2016 is $6,550.

If your policy meets the above criteria, you are allowed to open a Health Savings Account.

It is only cheap insurance unless you open the Health Savings Account. The HSA may be opened through your insurer or at almost any bank. The money that you deposit into the account is tax deductible. You may then use the money, tax free, to pay qualified medical expenses. And the account isn’t use it or lose it. Unused funds roll over to the next year.

2016 Contribution Limits

Individuals      $3,350
Family              $6,750

HSA Catch-up Contributions $1,000

Contributing to your Health Savings Account does not solve all problems. Lots of you are singles purchasing $6,000 deductible policies. Even a maximum contribution to your HSA still leaves thousands of dollars of exposure should you happen to have an accident or unexpected illness. The best of these policies pays 100% of covered charges once the deductible has been met. Some still have coinsurance and only pay 80% or 70% until you have reached your maximum-out-of-pocket.

Whether you intentionally purchased a High Deductible Health Plan with the goal of opening a Health Savings Account or just bought the only insurance you could afford, it is important that you try to make the policy work for you. Either way, lose the hoverboard.


Sunday, December 20, 2015

No Client Left Behind

left behind

The Patient Protection and Affordable Care Act (PPACA or Obamacare) is the insurance equivalent of No Child Left Behind – incredibly frustrating and just as many mindless tests.

We are now through the first phase of this year’s Open Enrollment Period. This would be a good time to catch our breath and review our progress.

This computer stuff is harder than it looks. Our current crop of presidential aspirants constantly discuss shutting off part of the internet or controlling access to certain individuals. They discuss the internet and computers as if they were seasoned mechanics assessing a Chevy. This is year three of the Exchange. On Monday I had to switch to Chrome and enter everything in ALL CAPS to get the site to work. Sure it doesn’t crash as often as it did last year, but if this was my Chevy I would have utilized the Lemon Law to dump it long ago.

The computer issue isn’t limited to the government. A client asked to change her deductible for 2016. This was an off-Exchange policy so we only needed to visit the insurer’s website. The insurer, a big one, will remain nameless. It took over an hour to make an easy change. I would never send a client there which is a problem since the insurers are expecting their websites to carry the load as they cut back on staff.

Saying Goodbye. Some insurers have decided that selling on the Exchange is a losing proposition. Sheer incompetence has overcome others. Many of the Co-ops created under the PPACA have already been shuttered. UnitedHealth Care has announced that they will be pulling out of the Exchange. And then there is HealthSpan…

Cryin’ Won’t Help You. The first full year of the PPACA brought lots of tears. There were tears of joy as the previously uninsured gained coverage and others saved thousands. There were tears of frustration from dealing with and the national call center. And there were tears of anger as some were blocked from coverage for up to a year. Now it is mostly tears of the betrayed.

I had to explain to a young family why they couldn’t have reasonable coverage. They own a small business and live in a Cleveland suburb. In 2015 they had qualified for a heavily subsidized Silver Level Medical Mutual policy based on their income in the mid 40’s. In 2016 they will get $355. That is only 35% of the cheapest Anthem Silver policy, the least expensive unfettered access to University Hospital. The cheapest Medical Mutual Silver policy is a touch more. It would cost them $669.99 per month. They can’t afford that. The subsidy is designed to give them access to the second lowest Silver Level policy. That would be an awful contract from CareSource. (Yes, their office is directly above mine.) For $366.65 per month this family can go to Akron General, MetroHealth, and LakeWest. There is nothing inherently bad about any of these facilities, but would you sacrifice 10% of your income for insurance that bars you from University Hospital and The Cleveland Clinic? I wouldn’t.

Deductibles. Fewer good choices and skyrocketing premiums have forced people to increase their deductibles. $4,000 and $6,000 deductibles are common. What is not common are the savings accounts necessary to withstand the hit of an unexpected illness or accident. How long will it be before doctors and hospitals ask for a credit card with your insurance card? The answer is SOON.

We have more people covered. We have more people covered badly. We have an insurance bubble, no less serious than the housing bubble of eight years ago. We are all along for the ride. And no client will be left behind.



Monday, November 2, 2015

How Many 4th Graders Support Donald Trump?


We interrupt this blog for Breaking News.

We have the results from the latest poll. We asked the students of Mr. Miller’s 4th grade class, here in East Podunk, Ohio, who they would vote for if the election was held today. And this is shocking! These student voters are equally divided – 33% for Donald Trump, 33% for Hillary Clinton, 33% for BeyoncĂ©, and 1% for John Kasich. This is the first poll we’ve taken that has shown Kasich ahead of Jeb Bush.

4th graders. Could the report be accurate? Yes. Could it be 100% true? Sure. Does it mean anything? Absolutely Not.

Saturday’s Plain Dealer had a front page article – In 3rd year, NE Ohio insurance costs drop 6.3%. For most of you, that number is as real as BeyoncĂ©’s electability.

All of the new individual policies, purchased on or off the government’s Exchange, renew on January 1st each year. Like my fellow agents, I have been reviewing the records of several hundred clients since the information was released a little over a week ago. One client at a time.

I have yet to see even one rate decrease.

How can that be? Where are these rate decreases? My Anthem PPO clients, people who wanted a clear path into University Hospital, did not see their premiums shrink. And Medical Mutual of Ohio, the E Ticket into the Cleveland Clinic, had rate increases of up to 27%. How could the Plain Dealer be both 100% accurate and 100% irrelevant?

The answer lies at the heart of the Patient Protection and Affordable Care Act (PPACA or Obamacare). The focus has never been on health or health care reform. The point of the law is to reorganize how medical providers get paid. And, herding lower income people into lower cost providers is more efficient than allowing them to ring up big bills at expensive facilities that are eventually written off.

I went on to today and looked at the least expensive policies for me, a 60 year old living in Cuyahoga County. Please remember that rates are gender neutral and that there are no health questions.

The lease expensive policy, $434 per month, is from Ambetter Insurance. The deductible is $6,800. This policy sends you to Metro Health and St. Vincent’s. More importantly, the Cleveland Clinic and University Hospital are not in their network. Never heard of Ambetter? Don’t want them? Too bad. They have lots of options on the Exchange close to this price point. None get you into U.H. or the Clinic.

The next insurer is CareSource at $444 per month with a $6,650 deductible. CareSource’s Medicaid policy has a great network, but if you are paying all or part of your premium you are again looking at a policy that fails to include University Hospital or the Cleveland Clinic.

Molina’s least expensive policy comes in at $468. Still no University Hospital of Cleveland Clinic.

Aetna has introduced a full portfolio of innovative group policies that provide great access to all of our major hospitals. Their least expensive individual policy at $520 per month does not. The deductible is $6,450. The doors to U.H. and C.C.F. are closed.

HealthSpan, an HMO, has a $4,500 deductible policy at $566 per month. This is the least expensive policy on the Exchange that grants access to University Hospital.

The new Anthem HMO policy is also $566. This policy has Anthem’s smallest network. Neither University Hospital nor the Cleveland Clinic are included.

HUMANA has a $6,450 deductible policy at $567 per month. University Hospital is in their network.

Medical Mutual of Ohio’s workhorse policy, the $6,000 deductible 100% plan, is $569 per month. This plan utilizes the old SuperMed Plus Network. It includes the Cleveland Clinic and the suburban facilities of University Hospital. This is not an HMO and it does not require a referral to see a specialist.

$569! It takes eight different insurers and over a dozen policy options to get to a policy that provides easy access to the majority of doctors and hospitals in Greater Cleveland. The price for access isn’t decreasing. It is increasing.

Are the rates decreasing on the Exchange? Sure. We are getting more and more offerings from the Ambetters, Molinas, and CareSources. But if we flood the market with Yugos, does it mean that the price of cars is going down?

The Plain Dealer reported that the price of insurance has decreased. Perhaps a more complete article would have noted the influx of limited access carriers. Would you really pay $434 - $566 per month to go to Charity Hospital? Do you really care how many 4th graders support Donald Trump?




Monday, October 12, 2015

A Glimmer Of Hope

Glimmer of Hope

The news can be so depressing. Bad news 24/7. It is hard to believe, based on what is reported on FOX, MSNBC, or even CNN, that anything is getting done in Washington. And that is why I am particularly happy to devote today’s blog post to some good news.

President Obama signed into law H.R. 1624 last week. Yes, there are laws, bipartisan laws, getting through Congress. The Protecting Affordable Coverage for Employees (PACE) Act is legislation that will allow states to define the size of small groups for health insurance purposes.

The Patient Protection and Affordable Care Act (PPACA) changed the size of small groups from 2-50 to 2-100 as of January 1, 2016. The new regulations, especially community ratings, have the potential of eliminating group health coverage for hundreds of thousands of employees and their families. The PACE Act fixes the problem.

Many of my readers and clients wondered why I went to Washington in February. “Why waste your time and money?” they asked. PACE was one of the major issues on our agenda. Our elected representatives paid attention to me and my peers because they understood that we were there in Washington for our clients, not ourselves. We were able to impress upon them that fixing this and other issues didn’t mean that they agreed or disagreed with Obamacare. This was just constituent service.

This bill was sponsored by Representatives Brett Guthrie (R-KY-2) and Tony Cardenas (D-CA-29) in the House and Senators Tim Scott (R-SC) and Jeanne Shaheen (D-NH) once it got to the Senate. The President quietly signed the PACE Act into law Wednesday evening. The House, the Senate, and the President stripped the politics out of this and simply worked together to get something done. This is proof that our leaders are still capable of working in our best interest.

Our other big issue is “Grandmothered” policies. These are the policies that were issued with an effective date between April 2010 and December 31, 2013. I have mentioned that my personal health policy would be twice as much under the new law. Twice as much, over $600 per month.

The good news is the “Grandmothered” policies are still around for another year. The renewals are coming in and the rates are still terrific. Agents and our trade groups are committed to fighting for our clients and the option to retain these older, more affordable policies. And just like PACE, we know that the key to success is getting Congress to understand the scope of the problem.

The PACE Act may be the feel good story of 2015.


Friday, October 2, 2015

I'm Rich! I'm Rich!


The check came in the mail earlier this week. My check. Made out to me personally. And I couldn’t be happier. One of the most touted provisions of the Patient Protection and Affordable Care Act (PPACA) is the MLR, Medical Loss Ratio. This check was my rebate.

The PPACA requires an insurer to issue a rebate to each client if it does not spend at least 80 percent of the premiums it receives on health care services. Allowable services include actual medical claims, activities to improve patient safety, and efforts to improve health care quality. The other 20% may be used for administrative costs, salaries, advertising and agents.

Last year my insurer, Anthem Blue Cross Blue Shield spent only 79.70% of a total of $340,647,389 of premium dollars on health care. They had to issue rebates since they fell .30% short. My check, my share of this windfall was $7.90.

I think I’ll go to Vegas.



Photo credit - Jeff Bogart