Monday, February 13, 2012

The Guy With The Scalpel? He's My Attorney!

Frank O. had been an agent for over twenty years the day I started with Prudential in October of 1979. My desk was next to his. Fifteen months later I was his manager and my desk was in a private office. I asked to spend a day in the field with Frank, not because he needed me, not even because he wanted me. At best, Frank tolerated me. No, I needed to learn what he was doing and how he had survived for so long as an agent.

The first stop was a longtime client of Frank’s. Climbing up the front steps, I noticed that my employee was walking to the side door. The side door? Frank reminded me that we were not related to the client. We weren’t family. We weren’t their friends. We were service providers and service providers enter via the side door.

It was at that moment that I realized how little I knew about the insurance business.

I was reminded of that humbling experience as I watched President Obama and Health and Human Services Secretary Kathleen Sebelius stumble, again, as they attempted to control the delivery and payment of health care. The biggest difference was that I, at age 26, realized how much I had to learn. Our President and his staff seem surprised that their frequent missteps are so apparent and so unacceptable.

My last post, The Ongoing Religious Battle, addressed the Obama administration’s decision to classify Birth Control Pills, IUD’s, the Morning After Pill, and some forms of Sterilization as preventive Care. The Patient Protection and Affordable Care Act (PPACA) includes a provision that preventive care is FREE. That is the government’s definition of affordable, FREE.

The predicted firestorm erupted. The Vice-President and other committed Catholics in the administration had warned of problems. The White House Chief of Staff resigned. Last Friday the President announced his solution. As long as you don’t care about the moral implications, the money, how insurance works, or intellectual honesty – it was the perfect compromise.

Everything is still free. The insurance company will pay for it.

(Before we go any further, let me assert that I am totally in favor of most forms of birth control and voluntary sterilization. Let me also remind you that this has nothing to do with me, personally. This is about us, all of us.)

It only took a few hours for the double talk of the compromise to become apparent. Senator Roy Blount (R-MO) quickly released a statement via email. It stated, in part:

It’s clear that President Obama does not understand that it isn’t about the cost – it’s about who controls the religious views of faith-based institutions. President Obama believes that he should have that control. Our Constitution states otherwise.
Just because you can come up with an accounting gimmick and pretend like religious institutions do not have to pay for the mandate, does not mean that you’ve satisfied the fundamental constitutional freedoms all Americans are guaranteed.

A little dramatic? Perhaps. I suspect that the Supreme Court will be the final arbiter as to whether this crosses the line. But, Senator Blount was absolutely right when he called out the President for his sleight of hand.

The insurance companies are just going to pay for Birth Control Pills, IUD’s, the Morning After Pill, and certain forms of sterilization? Really? How do they show that on their books? These are claims that are eventually paid by the employer. And of course, large employers, such as hospitals and universities, are often self-insured. The insurance company simply processes the claims and organizes the market.

President Obama decided that insulting observant Catholics and other people of faith wasn’t enough. He decided to insult our intelligence, too. The President declared that insurance companies should pay for Birth Control Pills, IUD’s, the Morning After Pill, and even sterilizations from company coffers because it will save them money. By eating these costs, the insurers won’t be paying for unwanted, unplanned pregnancies. Ignoring the fact that it isn’t the insurer’s money or responsibility, perhaps we should take this to its illogical extreme. If we want to save money and eliminate unwanted and unplanned pregnancies, why don’t we have the insurers hand out chastity belts? Of course that’s silly, but it is no less honest nor illogical as the President’s suggestion.

It is time to remind you that none of this is about contraception, women’s rights, or even preventive care. It is about creating an environment where private insurance becomes unaffordable and only a government solution will work. Whether that is by accident or on purpose is for you to decide. But if you have someone restructuring the delivery and payment of health care in this country who doesn’t understand the basics of the market and insurance, you might as well have your attorney remove your appendix.


Wednesday, February 1, 2012

The Ongoing Religious Battle

Can you force your employees to live YOUR creed? More importantly, can you make it unpleasant and expensive for your employees to break your personal religion’s rules? The answer, as it is so often, is Yes and No.

Preventive Care is a key benefit of the Patient Protection and Affordable Care Act (PPACA). Katherine Sebelius, Secretary of Health and Human Services, recently decided that Birth Control Pills, IUD’s, and the Morning After Pill are all FDA approved forms of contraception and as valid a part of preventive care for women as mammograms and Pap tests.

The PPACA therefore forces employers to not only cover Birth Control Pills, IUD’s, and the Morning After Pill, but it also eliminates the copays for these items. They are free to the insured employee. This shifts the cost for these items to the insurance which in turn shifts the cost to the employer.

So, if you own a factory and you are opposed to these forms of birth control, you will soon be paying for your employees’ pills. Fair? Most of us will say Yes. We don’t want our employers to dictate moral positions to us.

But what if we aren’t talking about a factory? What if we are discussing a church or a church funded organization? Is there a difference? According to the Obama administration, the answer is No. Every employee has a right to preventive care and preventive care includes birth control. The Supreme Court may disagree.

We are constantly trying to define property rights in this country. Ron Paul takes the Libertarian position that the government doesn’t have the right to force you to conform to other people’s wishes. If you don’t want to serve African-Americans in your restaurant, the market should push you to reconsider, not the law. That is one extreme. The other extreme has the government involved in many of the day to day decisions of businesses. This involvement manifests itself in smoking bans in bars, the elimination of trans fats in restaurants, and forcing businesses to not only provide health insurance, but to determine the very nature of the coverage. This is where we are again.

Where is the line? Can the Catholic Church, which is adamantly opposed to most contraceptives, limit access to its priests, nuns, and church employees? Can the Church limit access to the employees, Catholic and non-Catholic, of its schools? What about Catholic hospitals that may employ hundreds of non-Catholics? How much influence is the employer granted?

The Supreme Court, in a 9 – 0 decision, recently ruled that the First Amendment “gives special solicitude to the rights of religious organizations” in how they treat their employees. This decision was reached in response to a lawsuit brought by a teacher who had been terminated by her employer, a Lutheran school. Chief Justice Roberts challenged “government interference with an internal church decision that affects faith and the mission of the church itself”.

Will the Patient Protection and Affordable Care Act allow you to provide access to birth control for all of your full-time employees? Yes. Will you as an employer pay for it? Yes. Will you be forced to provide access if you don’t want to? If you are a business the answer is still Yes. If you are a church or a religious based institution, the jury is still out.