Friday, February 24, 2017
This just in – Grandmothered Policies are now extended to the end of 2018
This is called Transitional Relief. Grandmothered policies were issued with an effective date between April 2010 (right after the passage of the Patient Protection and Affordable Care Act) and December 31, 2013 when the law was completely implemented. Grandmothered policies were underwritten and based on an age ratio of 5:1 or higher.
Healthy and/or young people got a good deal in 2013. If you didn’t, if you were charged extra or if you needed a policy that covered maternity or a pre-existing condition, you purchased a new, compliant policy in 2014. The only people left were the cheapest to insure. And though we haven’t added any new, healthy, people to this pool, the Grandmothered policies are still a better risk than the general population. Grandmothered policies are cheaper!
This rule from CMS will allow each state to decide whether impacted individual policies, group policies, or both may be retained until 2018. Mary Taylor, Lt. Governor and Insurance Commissioner, has been willing to extend Grandmothered policies in the past. There is no reason to believe that she would block this now.
And yes, we did talk with our elected officials about this while in Washington, but I don’t know that we can claim credit for it. This may fall under the area of keeping the waters calm while the storm is brewing on Capitol Hill.
My current policy – Anthem HSA Qualified, $5,500 Deductible - $428.99 per month
2017 policy – Anthem HSA Qualified, $6,500 Deductible - $863.74 per month
If you have a Grandmothered policy you are lucky, again.
Friday, February 17, 2017
It appears that it is common, when someone is on a blind date, to arrange a “Rescue Call”. There is even a commercial on TV that references this. A friend calls you and provides you a reason to cut the date short. I actually saw it in action on Wednesday.
I was in a Congressman’s office. Seven Ohio health insurance brokers were in his office to discuss the Patient Protection and Affordable Care Act (Obamacare) and what we were going to do now. Fifteen minutes into a positive / routine meeting we were interrupted by one of his aides. After one quick knock on the door, the aide poked his head into the room and told the Congressman that he had another meeting. The Congressman waived him off and we all got another fifteen minutes. If this had been a date, we would have just qualified for a second cup of coffee. Welcome to How To Visit Washington DC 2017.
Over a thousand members of the National Association of Health Underwriters (NAHU) gathered this week in Washington to hear from a variety of experts and to talk with our states’ elected representatives. Most of us are there on our own dime. It is that important for us to get the most up to-date information and to make certain that our lawmakers understand how our clients will be impacted, both positively and negatively, by any changes in the way Americans pay for their health care.
The Law of Unintended Consequences.There are a lot of ideas that sound absolutely fantastic on TV but will be irrelevant, or even worse disastrous, in practice. Insurance agents are uniquely positioned to explain the real world impact of these programs.
We were in Washington to deliver one important message for our clients – Market Stabilization. It is already mid-February. Nothing can really be changed for 2017 and the insurers only have eight weeks left to prepare for 2018. Yes, eight weeks. Insurers are currently working to file their plans and rates for 2018 and they, as well as our clients, need to know what the market will look like on both the state and federal levels.
Our key points centered on the individual (non-group) market.
- Allow the tax credits that help so many Americans to afford coverage to remain intact for at least two more years or until a comparable replacement can be put in place.
- Allow tax credits to be used outside of the Marketplace if fewer than two choices are offered in a state.
- Allow any person to purchase a catastrophic-category coverage regardless of age or income status.
- Tighten both the open-enrollment and special-enrollment periods to reduce adverse selection.
- Allow states to be eligible for a new hybrid high risk pool that would serve as a reinsurance mechanism while still providing the same level of coverage for even the highest risk individuals.
- Preserve employer-sponsored health insurance by retaining the employer exclusion.
Armed with individualized packets, we set off to meet our Senators and Members of the House. I had a chance to visit offices in the Senate and the House, Democrats and Republicans. Some of my meetings were with the actual lawmaker. Some were with staff. And though it is always gratifying to have a Congressman make time to speak with a visiting constituent, some of the best meetings can be with a Chief of Staff or a knowledgeable legislative aide, especially one who specializes in public health. I found this year’s meetings productive. The Congressmen and their staffs were totally engaged. They asked good questions. They took notes. I honestly felt that my time and expertise were valued.
** ** ** ** **I was in geek heaven. Cigars. Scotch. Politics. I was with two of my peers and a lobbyist in Shelly’s Backroom doing a deep dive on the current state of affairs. The hours flew by and it was past midnight when I called us an UBER. We walked outside, ignored the parked cab, and looked for Mohammed and his Toyota Camry. A Camry stopped, right in front of us, in the middle of the street. We walked up to the car and tried to get in as the driver frantically waived at us. We had failed to notice that there was a traffic light, here in the middle of the block, and he had been stopped for a red light. He wasn’t an UBER! We stepped back and he sped off.
Another Camry, one with an UBER decal, came up a couple of minutes later. This time we verified that it was an UBER and got in. Sitting shotgun, I noticed that the driver was a little confused. We had only traveled a few blocks before his phone rang. It was Betsy. She wanted to know where the Hell he was. They started arguing. This wasn’t Mohammed and we were in the wrong UBER. In the end I cancelled my order, paid the penalty, and slipped the driver a $10 for a $7 ride. His last ride as an UBER drive might as well include a tip.
Wednesday, February 1, 2017
Robby is the nicest guy I know. No exaggeration. Robby is just a great guy. And right now Robby is losing and winning the health insurance battle.
Robby was referred to me by his employer at the very beginning of the full rollout of the Patient Protection and Affordable Care Act (Obamacare). So I have never asked him any health questions, but I have no reason to believe that he has any medical issues or ongoing prescriptions. He is just a laborer, single and a non-smoker, in his early 50’s, living in Parma. There are thousands of guys just like him throughout Greater Cleveland.
Robby has gone years without health insurance. His employers seldom provided coverage and he couldn’t possibly afford it on his own. The PPACA guaranteed access to coverage AND included a penalty for non-compliance. The penalty was an important factor in his request. It would be unthinkable for Robby to jaywalk, he certainly wasn’t going to do anything penalized by law.
And Robby got a policy. It was a terrible policy with a $6,000 deductible and it cost him $110 a month after his tax credit subsidy of $187, but he was covered and if, G-d forbid, he got really sick or injured he would have easy access to world-class facilities right here in Cleveland. He even got a free routine annual exam, if he ever had a chance to get to a clinic on a day he wasn’t working. So, Robby won. We all did. We had one less uninsured American worried about a major illness and a society less concerned with the inevitable bill for his care.
Robby’s insurance went up $30 a month beginning January 1, 2015. Robby’s victory wasn’t quite so sweet.
The price of insurance was going up. The subsidies were going down even though his income had hardly changed. The invasion of low-cost Medicaid providers into the Exchange severely impacted Robby’s subsidy. If he would allow the Exchange to force him to Metro and Charity hospitals he would pay less. He hung on to the Cleveland Clinic and the price went up to over $250 with his subsidy for 2016.
In 2017 his premium is $325 and his deductible is $6,400. Robby is losing.
I got a call today from Robby. He wants to drop his policy now that he is no longer required to keep it. I let him know that he can drop the policy but that he would still be liable for the penalty. He thought that it was over. I had to break the news to him that the individual mandate, both a Republican idea traceable to the Heritage Foundation in 1989 and Republican strawman, was still the law.
President Trump’s Executive Order gives the Secretary of Health and Human Services and other department heads the ability to reduce the “burden” of complying with Obamacare. Congressman Price’s confirmation for Health and Human Services has been stalled due to what appears to be insider trading. More importantly, the insurance companies are scared to death of adverse selection. Without the individual mandate, the only people who will buy insurance are the sick and the responsible. That could be disastrous.
With no immediate viable replacement, a nice guy like Robby has no place to go. He’s winning. He’s losing. Nothing has really changed.
Monday, January 23, 2017
You may have seen the picture of the new president rushing into his office to sign his first Executive Order. It was Friday, January 20, 2017, after the parades and before the inaugural balls. Chief of Staff Reince Priebus put the paper in front of him, and like a homebuyer whose eyes have glazed over from thirty pages of gobbledygook, President Trump quickly signed the document without a moment’s hesitation. Now if you or I were about to make history, and everything a president does, by definition, is historical, we might have looked at the document, maybe ever READ the document, prior to affixing our name to it.
Since we aren’t on our way to any formal dinners or balls, we have plenty of time to read the Executive Order. Please take a moment. It is only one page.
It is important to note that this was the first Executive Order. So what does it mean?
Option One – If the repeal, replace, demolition, or rebranding of Obamacare succeeds, this Executive Order will be hailed as the important first step President Trump made to keep his promise and to deliver a better program. That is a huge if.
Option Two – This Executive Order opens the door for major changes. Once a Secretary of Health and Human Services (HHS) has been confirmed by the Senate, he (Don’t judge me. All of the nominees are male.) will be able to determine what regulations are burdensome. Here’s a hint – All regulations are a burden to someone. The current nominee is Congressman Tom Price (R-GA). States looking to modify the cost of Medicaid by reducing benefits or access will find Mr. Price supportive. In fact, a quick read of his positions over the years will yield the impression that Mr. Price might happily remove any requirement that the poor and middle class have comprehensive insurance coverage.
And though all of the above might seem like enough of a motivation to sign this Executive Order, I still think that it isn’t enough to be #1. So allow me to offer another explanation.
The Patient Protection and Affordable Care Act (Obamacare) was structured in broad strokes with the details to be fleshed out in the form of regulations. This is not unusual. Major legislation like the Patriot Act are designed this way. The PPACA requires health plans to cover annual routine preventive care visits. These visits are covered at 100%. No deductible. No copays. It was HHS that determined that routine preventive care included a colonoscopy for those of us over 50. This has undoubtedly saved lives. It was also HHS that determined that preventive care included birth control pills, the IUD, and the morning after pill. That made the lives of countless Americans easier. And now that this Executive Order has been signed, it will be HHS that will decide birth control, the IUD, and the morning after pill are no longer part of preventive care.
This change could apply to both individuals and groups. The current court cases dealing with this will be dropped immediately. This will be seen as a victory for those employers who are opposed to these services. And to those who needed these benefits. Well, they aren’t the priority.
Friday, January 20, 2017
Michael Lewis’s recent book, The Undoing Project, details the groundbreaking work of two Israeli psychologists, Daniel Kahneman and Amos Twersky. Their work explored the way we make decisions and how we justify, after the fact, those decisions. Mr. Lewis helps us to understand how these two scientists moved our decision making towards data and away from intuition.
In late 1973 or early 1974, Danny gave a talk, which he would deliver more than once, and which he called “Cognitive Limitations and Public Decision Making.” It was troubling to consider, he began, “an organism equipped with an affective and hormonal system not much different from that of the jungle rat being given the ability to destroy every living thing by pushing a few buttons.” Given the work on human judgement that he and Amos had just finished, he found it further troubling to think that “crucial decisions are made, today as thousands of years ago, in terms of the intuitive guesses and preferences of a few men in positions of authority.” The failure of decision makers to grapple with the inner workings of their own minds, and their desire to indulge their gut feelings, made it “quite likely that the fate of entire societies may be sealed by a series of avoidable mistakes committed by their leaders.”
I can’t think of a more important paragraph to share with you today, January 20, 2017. Health Care, Nuclear Proliferation, Trade – all of these decision will affect us all.
Thursday, January 5, 2017
ALL IN! Crap, all in with a pair of sevens. But he had to do it. It had been so long since he had had a hand, any hand, that he was forced to go all in with a pair of sevens. He had been pushed around long enough. He remembered his last chance, the last time he had been really good hand. Thought he had a winner. The first two cards – King and Queen of Hearts. He bet and his opponent called. Next the Jack and then the ten. Both hearts! He bet big. Call. And then came the ACE! But it was the ace of clubs and all he had was a high straight. He bet and his opponent raised. The warning bells went off in his head as he called. He had a straight, but his opponent had drawn a full house. Now he was all in with a pair of sevens. And his opponent looks like he may call…
It takes a certain amount of courage to put your money on the table and ask to be dealt into the game. Though some may always lose, no one always wins. So you better enjoy the game, revel in the risk, and be prepared to accept the outcome win or lose. And there is one more similarity between poker and politics. You must be prepared to bluff.
In March of 2010 the Democrats went all in. They didn’t have a great hand. This wasn’t the early 90’s when they thought that they had a winner. They didn’t have the National Single Payer plan that they really wanted. They had compromised with their fellow legislators from across the aisle to cobble together a plan that would garner bipartisan support. And they failed. They were all in and they were exposed and alone. On March 23, 2010 the Dems won with a pair of sevens and the Patient Protection and Affordable Care Act (Obamacare) was signed into law.
March 23rd wasn’t the end of the game, just the biggest tournament to date. The Republicans have been very busy since that loss. They had no respect for the gambler, President Obamacare, and hated to have been bested by such a weak hand. It took almost seven years, but here they are, back at the table. The Republicans had spent almost every waking hour since the defeat preparing for this day. A poker player needs a bankroll. The Republicans needed votes – a solid majority in the House of Representatives, the Senate, and a Republican in the White House. And on Friday, January 20, 2017 it will all come together.
For almost seven years the Republicans have told everyone who would listen that they were the better choice. “Bet on me”, they said to the American public. Their focus, the game, scheduled for 1/20/2017 was impressive. We all knew that if they were given the chance they would repeal and replace Obamacare. They just needed their bankroll. And now they’ve got it. There is only one problem.
We are about to see how Paul Ryan plays a bluff. He’s got the votes. But he doesn’t have the cards. There is no viable Republican alternative. Even Republican governors want/need to retain the expansion of Medicaid built into the law. Nobody wants to reinstate medical underwriting, exclude preexisting conditions, or kick kids off their parents’ policies. Everyone wants cake and ice cream for dessert, but no one wants to be forced to eat the liver and onions entrée.
The players are about to be seated. We’ve already taken a peek at the Republicans’ hand. Wonder what the Dem’s have? Wonder how they’ll play their cards? More importantly, who is going to tell all of them that this isn’t just a game?
Sunday, January 1, 2017
Irritated. My right eye was irritated. So was I. My eye had been bothering me for a couple of days. I didn’t know if it was allergies, a sty, or an infection. I had been determined to rely on eye drops and to just tough it out, but that was before I had needed a warm compress in the middle of the night. Time to get medical attention.
As previously noted, I was a touch irritated. Before I could deal with my issues I had to solve a client’s problem with UnitedHealth One. I was on hold for 52 minutes! My phone has a timer. Staffing cuts reflect the company’s losses over the last few years. Once that was completed I could focus on me.
I contacted the Cleveland Clinic facility in Beachwood. It only took 30 seconds for me to clearly state that I didn’t need to see my doctor, or any doctor. I would be perfectly happy with a nurse practitioner as long as I got to come in today. I had also detailed my eye problems. If I was having a heart attack or bleeding to death the scheduling tech would have been able to send me to the E/R and hang up. No, she had to talk to me.
I have been a Cleveland Clinic patient for years. The clerk had all of my information on her screen. Still, she needed to verify ALL of the information from my Anthem card, front and back. I said that I’ve had this policy for over three years. Nothing has changed. It didn’t matter. She plowed on. Next, where do I work? What is my job title? At the eight minute mark, remember my phone has a timer, I noted that we had spent more time confirming how the Cleveland Clinic would be paid than my health problem. She persisted.
Ten minutes into the call I asked her again who was going to see me. She said, “We don’t have any openings today”. “Then why did you waste my time”? She began to offer appointments for the following week, but I had had enough and hung up.
I hear it all of the time. Every negative encounter with the medical industry is blamed on Obamacare (the Patient Protection and Affordable Care Act). Sometimes the complainer is correct, but not always. Failure can be traced to a number of sources.
The staff cuts and financial losses at UnitedHealth One are due, in part, to some really awful decisions. And UH1 cut their marketing and service staff when the going got tough. They succeeded in making it harder to do business with them. UnitedHealth One will get better. This is just a bump in the road.
And the Cleveland Clinic’s failure can’t be blamed on Obamacare. This insatiable push for more money, more donors, and more buildings occasionally leaves the patient as nothing more than a necessary evil. We are in the way. Soon we will be diagnosing and treating our own ailments and simply sending tribute payments to the Cleveland Clinic.
Two websites and a phone call later I had an appointment at a Minute Clinic in a CVS. These clinics are somehow affiliated with the Cleveland Clinic. The nurse checked my vitals, noted my agitation, and gave me a prescription for some eye drops.
So what was it? Allergies? Sty? Infections? I’m still not sure. I took an antihistamine and have religiously put in the eye drops as prescribed. I’m sure I’ll be OK in another day or so.