Sunday, December 29, 2013

Fiddler On The Roof

In the opening number of the movie Fiddler on the Roof the town Rabbi is asked if there is a prayer for the Tsar:

     Lebisch: Rabbi! May I ask you a question?
     Rabbi: Certainly, Lebisch!
     Lebisch: Is there a proper blessing... for the Tsar?
     Rabbi: A blessing for the Tsar? Of course! May God bless and keep the Tsar... far away from us! 

With the disastrous rollout, rules and regulations being created on the fly and the President’s penchant for modifying deadlines, many of us in the insurance business have decided that we are happiest when Mr. Obama puts all of his time and efforts into immigration reform. 

2013 was the year of the missing hero.  There never seemed to be anyone in charge, anyone willing to be responsible, anyone who actually gave a damn about the American people and was prepared to work on our behalf.  The year started with a last minute deal to fund the government and keep the lights on.  But in an effort to cement the impression that ultimately we are all alone, the U.S. House of Representatives adjourned BEFORE addressing the need for emergency relief for the victims of Hurricane Sandy.  That behavior would repeat itself throughout 2013.  Only bills repealing Obamacare were guaranteed to reach the floor of the House.   

And then the Republicans shut down the government.  This, in of itself, isn’t the end of the world.  Both parties have used this tactic with varying degrees of success over the years.  What was particularly disheartening about this year’s government shutdown was that it was about Obamacare.  The leaders of this fight exhibited as much forethought and preparation for this battle as the White House, the Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid (CMS) had in preparing to implement the law.  This breath taking incompetence, this failure to lead responsibly, on either side, this idea that there will always be someone to clean up the mess has already impacted us in untold ways. 

Insurance agents have a unique perspective on The Patient Protection and Affordable Care Act (PPACA or Obamacare).   Regardless of political affiliation, our first priority is to get our clients insured.  Nothing, not which insurer, not how we are paid, is more important than getting everyone covered.  So we all have PPACA success stories.  I have been able to get the very sick and the working poor health insurance that they would not have had.  Eliminating health questions will allow Americans, some who are without insurance through no fault of their own, to purchase coverage.  Completing the paperwork with someone contemplating surgery or in need of care is life affirming.   

But this comes at a cost.  And those same agents who are celebrating these client victories have also been sounding the alarm about those costs. 

Picture a teeter-totter.  For every cancer patient who will now enjoy a health insurance rate decrease there has to be at least one healthy person seeing a corresponding rate increase.  One of my clients is rabidly anti-Obama.  He actually came to my office in the summer of 2012 to campaign for Mitt Romney.  Before I showed him his new, 2014 rates, I joked that if he saved over $1,000 per month he had to complete the last form in the packet and register as a Democrat.  His savings was closer to $1,100 per month.  Of course he accepted the new policy and the huge savings, but he realizes that his savings is at the expense of others.  And no, he did not change his registration. 

It is equally wrong to deny the gains or losses of the PPACA.  Neither side has exhibited the least bit of intellectual honesty. 

But honesty has been in short supply.  People who can help you have also been scarce. 

The agents knew that we were alone when we encountered the new federal registration system in August.   Part was under one cabinet official with one computer system, while another part was under an entirely different division of the federal government with a different computer system.  We got a full tour of government inefficiency and redundancy.  It was a preview of the issues we would all encounter during the open enrollment.  

The American public faced their own set of challenges.  The PPACA gave us something new.  Not an agent, but with more authority than our better trained secretaries, the PPACA begat the Navigator.  I’ve talked to a couple of navigators.  They knew next to nothing about insurance, networks, or the different policies.  The Navigators aren’t prepared to help the mouse get through the maze to find the cheese.  No, Navigators know just enough to drop the mouse into the maze and wish the mouse (YOU) “Good Luck”. 

But the navigators weren’t the only folks complicating our lives this year.  My friend Greg, who now lives in Florida, sent me an email about his difficulty in finding new coverage.  As NPR reported, there were plenty of people willing to exploit the weakness of this law.   

As Tevya might ask, “A health insurance agent in 2014”?  Between the government that wants to replace us and the insurers that hate to pay us and a public that only appreciates us when they really need us, it sounds a little crazy.  But here in the U.S. we all have our part to play.  Much like a fiddler on the roof, each of us is trying to scratch out a pleasant, simple tune without breaking our necks.  It isn’t easy.  You might ask “Why do we stay up there if it is so dangerous”? Well, we stay because it is what we do. 

And as our health care system changes, our lives, yours and mine, have become as shaky as… as… as a fiddler on the roof!



Monday, December 16, 2013

Buy 11, Get 1 Free!

Some people just know how to shop.  You and I may pay retail, but they always seem to find the best deals.  And if they have to cut a corner or two?  Well, they’ve got great scissors.

We are in the middle of our first open enrollment under the Patient Protection and Affordable Care Act (PPACA or Obamacare).  Applications received by December 23, 2013 will generate new policies as of January 1, 2014.  Preexisting conditions will be covered.  There is no requirement of prior coverage.

Our current policies, operating under the old set of rules, have a 30 day grace period.  It didn’t take long for many of my sharpest clients to realize that paying for December is now optional.  If they get sick or injured in December, they will pay their premiums and file their claims.  If they don’t have a claim in December, they will let the old policy lapse and start anew in January.

Ethical?  Of course not.  Legal?  You bet.  In fact, this is just one more step in our inevitable march off the cliff.  Shorting the insurers and making private major medical health insurance unsustainable are part of the campaign that will lead us to Single Payer.

The Department of Health and Human Services (HHS) isn’t just writing rules and regulations on the fly.  Last week, in a conference call for journalists, Director Kathleen Sebelius and her team revealed a new set of fixes and recommendations.

All of these recommendations are designed to make the transition to the PPACA smoother by bending the rules at the expense of the insurers.

The government now expects the insurers to cheerfully accept the initial payments as late as January 1st.  There is even a push to move that initial due date through the first week or so of January.  And next year’s grace period will be 60 days.   Please don’t expect that same flexibility from the IRS.

Health insurance policies may include lists of Preferred Providers, doctors and hospitals participating in a network, and prescription drug formularies, lists of covered drugs.  HHS is asking the insurers to bend (IGNORE) their own rules during the transition.  Is this push out of concern for sick Americans or an effort to avoid more horror stories on the 6 PM news?

The answer is obvious.  This has never been about sick people.  This has always been about money and politics.  The doctors, hospitals, and drug companies want our money.  The politicians want our money and our votes.  Health is hardly a consideration.

So whether they want to or not, the insurers are having a sale.  I’m going to pay my December premium.  I’m just that way.  Buy you?  You may choose to pay for eleven and get one free.

Monday, November 25, 2013

The Defense Rests

It is exhausting.  This choice.  This job.  This desire to craft a non-ideological, pragmatic path is taking all of my energy.  Confronted daily by people who either cannot, or will not, see the full picture that is the Patient Protection and Affordable Care Act (PPACA or Obamacare), I find myself calming the fears of its detractors or clarifying the rules to its biggest supporters.  To the right, and the righter than right, I find myself defending the law, or at the very least, the need for change.  Defending the insurers from the left could be a full time job in of itself.

Randy (name changed) called Friday.  He wanted to know when they were going to cancel his group health insurance policy.

Why would Medical Mutual cancel your company’s insurance?

Because my policy doesn’t cover any women or children.

But you don’t have any female employees, right?

Yeah, but they’re gonna cancel me!

OY, Randy, you’ve been watching FOX again.

It took fifteen minutes to reassure Randy.  Now, no one on FOX really said that a small business would lose its health insurance if there weren't any women or children on the policy.  That’s silly.  But the daily barrage of negativity, conspiracy theories, and half-truths take their toll on the viewers.  One day you’re a concerned business owner.  The next you are trying to get one of your employees to get married so that you can retain your group coverage.

It doesn’t get any better on MSNBC.  With neither an ounce of irony nor embarrassment, the outpost of the left gives us Howard Dean, the former governor of Vermont.  I’m sure that an extensive GOOGLE search might find an instance when Gov. Dean knew what he was talking about.  I’m just positive that none of his pronouncements about health insurance or the PPACA have any basis in reality.

For example, Governor Dean was recently discussing the disastrous roll-out and the policy cancellations.  He was on Morning Joe and several other shows.  He opined that all the President had to do was to hire a bunch of unemployed kids, put them in a call center, and have them ring up everyone whose policy had been cancelled.  The kids could enroll everyone into Obamacare!

I doubt that approach would be welcome in Vermont, a state with less than half the population of Greater Cleveland.  I know that wouldn’t fly here.  Who explains the policies to the “kids”?  Vermont may have only one or two insurers and only a few options, but Ohio, California, and any other state that has an actual city or two will have multiple insurers and dozens of choices.  But on one has ever explained insurance, or economics, or city life to Governor Dean.  And there is absolutely no reason to do so now.

40 vs. 5

The PPACA was sold to the American public as a universal win.  Everyone would get better, more comprehensive health insurance for a lower monthly premium.  This blog has repeatedly pointed out that that was not possible.  The airwaves are now filled with the horror stories of cancelled policies and jacked-up premiums.  The right emphasizes every problem, real or imagined.  The left has a new argument – Isn’t it OK to inconvenience five million people so that 40 MILLION AMERICANS can now get access to affordable health care?

What a bunch of hooey.  This wasn’t a Hobson’s choice.  It wasn’t remake our entire system or do nothing to help the uninsured and the under-insured in our country.  We could have accomplished much of that goal by expanding Medicaid.  You don’t score many points by minimizing someone else’s loss.

I have watched my words parsed in the comment sections of Facebook and the AOL Patch.  The attorneys and attorney wanna-be’s who troll for fights can’t tolerate civil discussions.  One guy was convinced that all insurers will cancel their clients at the first sign of a claim.  Another reader is positive that the PPACA is the harbinger of the Apocalypse.  The extremes are so extreme.  The middle is lonely and damn near empty.

For the record:
  • Insurers pay claims.  My clients have benefited from their coverage.
  • The status quo was not sustainable.
  • There is a kernel of truth in everything you see and hear on FOX and MSNBC.  You need more than kernels.  You need a meal.
Take a deep breath.  We will all get through this together.  But for the moment, the defense rests.


Tuesday, November 12, 2013

Where Do They Bury The Survivors?

A plane crashes on the Mexican – United States border. On board were U.S. citizens, Mexicans, Brazilians, and three passengers from Argentina. Where so they bury the survivors?

It is a classic misdirect. A mental sleight of hand. You know the answer. We don’t bury survivors.

Sleight of hand is an art. The best practitioners can shake your hand while they lift your watch and wallet. The trick for us is to watch them at work without becoming a victim.

I recently received an urgent email. A client forwarded Newt Gingrich’s article, “Obamacare’s Marriage Penalty and Divorce Incentive.” Was this true? Is the President anti-marriage?

Newt Gingrich as the defender of the sanctity of marriage? Guard your wallet!

I won’t bore you with the numbers. The federal subsidies are based on the size of the family, the ages of the insured, and are factored on the federal poverty level. A married couple with one child doesn’t need 33% more income when they have a second child. Couples don’t need twice as much income as singles to pay for food and shelter.

Will a few people get divorced to get a bigger health insurance subsidy? Perhaps. Of course, that also means that these people will pay more state and federal income tax. These things have a way of balancing out in the end.

The bottom line is that Newt Gingrich knows that this is irrelevant. Newt would be campaigning against government waste and another inefficient entitlement program if the subsidies were calculated differently. It is just a sleight of hand.

We should, by now, be used to this from our politicians. Sometimes it is a mental misdirect. Sometimes it is a misstatement. And there are other instances when the politician tells the truth, technically, but what he/she said and what we heard are not even closely the same.

Example? My favorite is “If you like your policy, you can keep it. Period”. Balderdash.

I wasn’t in the room when the President and his advisors crafted that perfect slogan. “If you like your policy, you can keep it. Period.” So clear. So emphatic. So wrong. Did the President and his advisors intentionally mislead the country, or more likely, did we have a room full of people who had no idea what they were talking about?
  • Over 80% of Americans get their insurance coverage through work. If you are one of them, you don’t choose your plan, your employer does. It is not up to you.
  • Only policies on the books prior to the passage of the law and unchanged since that day, March 23, 2010, are grandfathered.
  • How long can the insurers run two separate sets of books? Policies issued prior to March 2010 have one set of rules while new policies have another. Who pays the additional cost to maintain the old contracts and monitor compliance?
This blog has tackled the grandfather issue repeatedly since August 2, 2010’s, Don’t Cry Uncle, Stay Grandfathered. Retroactive rules. Contradictory edicts. Those of us who actually work in the insurance business knew that we would see very few individual or small group policies limp across the finish line on January 1, 2014.

The President is shocked that many Americans are now losing their current policies and being forced into new, more expensive contracts.

There are some awful policies on the market that will disappear on January 1st. There are some policies that have a $25,000 or $50,000 cap. Those plans were cheap, but they did not really cover a major illness. However, about 11 million Americans are covered by comprehensive policies that will be cancelled in the next twelve months. These plans don’t conform to the new rules.

My policy is scheduled to end a year from now. Why? Because it doesn’t cover me for maternity. If nothing changes in the next twelve months, my premium will more than double next December. Of course I like my policy. And no, I can’t keep it.

The Patient Protection and Affordable Care Act (PPACA) will, eventually, help many Americans. But it would be foolish to dismiss out of hand those people who are angry or upset. You can’t just bury their fears with the survivors.


Picture from the Passen Law Group

Sunday, November 3, 2013


Frank (name changed) is a successful attorney in his early 40’s. He lives in Greater Cleveland. On Friday he completed his health insurance application, hit the submit button, and watched the website crash. This message, in bold red and blue, flashed onto his screen:
Application Wizard
  • We apologize but there was an issue with our system when submitting your application. If we were able to process your application, we will send you an email within the next hour and you will not need to do anything else. If you do not receive an email from us within the next hour, then please return to this site and submit the application to us again.
Yes, purchasing a health insurance policy in 2013 can, at times, appear daunting. But Frank wasn’t dealing with the federal exchange. The computer issue had nothing to do with the Patient Protection and Affordable Care Act (PPACA). Frank was submitting an application for a 2013 policy with Anthem Blue Cross.

Alert the media! Contact Rush! Websites crash or are shut down for routine maintenance. No one died and no one got fired.

Anthem’s producer/applicant portal was down for about six hours. Frank’s application has been accepted and by the time you read this, he may have been approved.

The exchange roll out has been a mess. Even insurance agents, professionals long familiar with the complexity of working with insurers, the government, and the public, were surprised at how unprepared the government was for this vast undertaking. We even had advance warning. Agents have had eight years of Medicare Part D (Rx) and Medicare Advantage training, seven to nine wasted hours each August. And this year we were treated to the special training classes and tests to sell on the federally run exchange as detailed in You Put Your Left Foot In. CMM (Centers for Medicare and Medicaid Services), the agency administering the agent authorization process, is still having website issues.

This is a program designed by bureaucrats who know how to make things complicated but may have no idea how to make things work.

What has been lost in this P.R. disaster is just how irrelevant all of this has been. The most important thing to remember is that the new policies don’t start until January 1, 2014. Applications accepted on October 1st or December 10th still have the same effective date. Anthem Blue Cross is not going to run out of policies. You don’t need to be the first in line.

Of course, everyone with an ax to grind has jumped into the discussion. Online insurance marketers have “volunteered” to save the day and take over the process. If the federal government would only suspend common sense and a myriad of state and federal laws, an e-marketer could corner the market and restore order. Those offers have landed with a thud.

Equally self-serving have been the Republican members of Congress who have complained about the problems their constituents are having with the roll out. You can’t spend three and a half years actively trying to sabotage a program and then complain when it doesn’t work perfectly. And please, don’t shed tears for the sick and uninsured who are having difficulty enrolling in the now available coverage. There isn’t a Republican plan to cover any of these people.

There is a bi-partisan support to bump back the “Individual Mandate” for another year. Why force people to purchase insurance if the website is difficult to access? I’m surprised that this hasn’t already happened. Everybody wins.
  • The Republicans score a moral victory. Being against anything President Obama favors enhances their campaign donations. Winning a meaningless battle shows activity.
  • The Democrats show flexibility and are allowed, once again, to play the part of the martyr.
  • Big business, the unions, and the insurers see this as one step closer to a Single Payer system. By now you are sick of hearing TV commentators talking about the Young Invincibles, the young, healthy Americans who must be forced into the system for it to work. If healthy people don’t sign up, the system devolves into a Death Spiral and implodes under its own weight.
Delaying, or worse, eliminating the Individual Mandate hastens the conversion to a Single Payer system.

The exchange website and all of its attendant issues aren’t our biggest challenge as a country. It is our lack of intellectual honesty that will be our undoing. Disorganized and unprepared, we are heading for a crash.


Sunday, October 20, 2013

The New Normal

Under the old rules, the underwriting rules we’ve lived by for decades, health insurance premiums were determined by risk.  Healthy people paid less than those that weren’t.  We asked questions such as:

Do you smoke?
What is your height and weight?
What medications do you take and why?

The new rules under the Patient Protection and Affordable Care Act (PPACA) eliminate underwriting.  The new rules have us charging everyone the same premium regardless of health.  The only questions now are:

Do you smoke? (old habits die hard)
How old are you?
Where do you live?

How is that working?

Angie (name changed) is a 55 year old owner of a successful home-based business here in Greater Cleveland.  She purchases her own health insurance.  Angie is not a preferred risk.  Her $4,000 deductible HSA (Health Savings Account) policy was not rated Tier 1.  Nor Tier 2.  Tier 3.  Tier 4.  She wasn’t rated Tier 5.  Nor Tier 6.  Tier 7.  Tier 8.  Not even Tier 9.  Angie, a few years post-surgery, was issued, after intense negotiations, at TIER 10.  Her current premium is $482 per month.
How much will her premium be under the new system, a system that doesn’t ask health questions and doesn’t factor in previous illnesses?

HSA Qualified Policy                                        Premium

  $3,000 deductible                                           $518.41

  $6,000 deductible                                           $369.63

Those numbers are real.  Tier 10 is the new normal.
The new 2014 policies would provide Angie coverage for maternity, though at 55 she’s willing to accept that risk.  Her current policy, issued in 2013, already has preventive care and an unlimited maximum benefit.
Much to the chagrin of some of the bureaucrats in Washington and the advocates around the country, the insurance companies, billion dollar corporations, understood who will be applying for health insurance in the next few months.  The doors are being thrown open (well, the exchanges will work eventually) and these are the first applicants:

Our currently insured who have been highly rated
High risk clients covered by  state mandated guaranteed issue contracts
Very unhealthy Americans who can't afford those guaranteed issue policies
These people need affordable health insurance.  More importantly, they need access to health care, but the PPACA does not necessarily meet that need.  Many of the very people this law was meant to serve were surprised when I told them the price.  Some were expecting free.  Almost everyone thought for sure that the premium would be less.
The insurers have no interest in losing their existing clients. For some reason the people pushing the PPACA, the government and the advocates, thought that the insurance companies would dump their entire book of business into the new insurance pools.  Sure this might allow the new clients to pay less initially, right up until all of the young and/or healthy dropped their coverage.  Then what?
Local insurers – Medical Mutual of Ohio, Anthem Blue Cross, UnitedHealth One, etc… - are offering their existing clients an opportunity to renew their policies as of December 1, 2013.  Sign a form and you get to keep your current policy until next December.  What happens in December 2014?  G-d only knows.
This is survival.  The insurers are stocking the pond.  In an effort to attract more 2013 business, major insurers have adjusted their underwriting.  Anthem blue Cross has suddenly decided that maybe smoking isn’t that bad.  Other companies have made similar short term changes.
Are you paying attention?  If you are going to qualify for a major subsidy, if you are suffering from a serious, expensive to treat illness, or if you have had a debilitating accident, you may be significantly better off thanks to the PPACA.  But if none of the above apply to you, then there is still a little time left to get in under the old system, to play by the old rules, to pay premiums based on your risk.
You have a small window before you become a part of the new normal.


Sunday, October 6, 2013

Plotting Your Escape From The PPACA

William was damned near ecstatic. My client had a right to be. William is a 57 year old self-employed Republican pragmatist. He is also very unhealthy. There are no imminent threats. He just suffers from the kinds of things that causes health insurance companies to run away. William’s current health insurance, a $5,000 deductible HSA qualified contract, is $1,055 per month. On January 1, 2014 his premium plummets to $404.

William is now a huge fan of the Patient Protection and Affordable Care Act (PPACA). And if you, like Bill, are paying a lot of money for your health insurance due to your significant health problems, then the new law may save you a lot of money, too. Today’s blog is not for you.

Today’s blog is for those Americans who are reasonably healthy, do not need maternity coverage, and have an income above 400% of the federal poverty level. This is also a post for those people who will not qualify for a federal subsidy for a number of other reasons. The following will actually be relevant for a lot more people than you might think.
Today’s blog post includes numbers. Lots and lots of numbers. Stay with me. This is your money.

The exchanges opened October 1st. There have been, predictably, significant computer issues that will be resolved in time. Some of our insurers are still trying to get their policies and applications approved. I have been advising my clients to ignore the new system until November 1st.

I finally received Medical Mutual of Ohio’s 2014 rates. We don’t have applications, just rates. Here is how the PPACA affects a healthy 58 year old who happens to be fond of a good cigar (ME!).

Current Policy - $5,000 deductible HSA qualified contract - $310 per month

New 2014 Policy - $6,000 deductible HSA qualified contract - $633 per month

If you will bear with me, I will give you a more complete look at some real numbers. The following is a Medical Mutual of Ohio policy, $6,000 HSA qualified contract, for a non-smoker. The 2013 rates assume the insured is healthy. We no longer care in 2014 as we begin to utilize community rating.

                     2013                                                                        2014
            Male          Female                                                  Male and Female
22     $ 55.21         $ 75.43                                                        $166.75
42        92.68          135.67                                                          219.62
62      244.92          254.09                                                          476.20

Community rating is great if you are the sickest guy on your street.
All of these policies, new in 2013 and new for 2014, cover preventive care at 100%. The 2014 policies also cover maternity the same as any other medical condition. But if you don’t have a serious pre-existing condition and you don’t need maternity, you don’t need one of the new 2014 policies.

How do you escape the PPACA if it isn’t going to help you? Get coverage now! A policy purchased now, effective now, eludes the PPACA till the end of 2014. What will we do a year from now? I don’t know, but I would rather save $3,600 over the next year and see what develops.

The Department of Health and Human Services (HHS) has been forced to create this on the fly. Let’s give them an extra year to get this right. If you allow yourself to be victimized by the PPACA, it is your own damn fault.


Friday, September 27, 2013

Why Are You Afraid?

This is a blog. You, Dear Readers, are viewing this online either on the blog’s home site or on the AOL Patch System. You are comfortable online and this is probably only one of several blogs that you read on a regular basis. We know how to research issues. We know how to find the information we need to help us form our opinions or to confirm our long held beliefs.

Our comfort with the internet allows us to laugh at the television reports that paint an issue in strictly solid black or solid white. We can, if we wish, quickly go online and find the shades of gray.

But what if you don’t have internet access? What if you not only don’t have a computer, but you really don’t know how to use one? Then you are at the mercy of your news sources – TV, the newspaper, the radio, and your friends. And many of your news sources like to keep you nervous. Scared to death. Many, but not all.

Monica Robbins is the Senior Health Correspondent at WKYC, Channel 3. Ms. Robbins has been covering health issues in the Greater Cleveland market for over ten years. She and her station have worked diligently to demystify the Patient Protection and Affordable Care Act (PPACA) from its inception. The WKYC website and her on air reports have attempted to answer viewers’ questions in a straight-forward, non-political fashion.

In an effort to build on a mission of providing information instead of fear, Monica Robbins invited the local chapter of the National Association of Health Underwriters (NAHU) to spend three hours last night fielding viewers’ questions. Channel 3 set up a phone bank, brought in snacks and sandwiches, and promoted our availability online, during Dr. Phil, and on the evening news broadcast.

We received nearly 300 phone calls!

There was a common thread that ran through the vast majority of the calls that I received, FEAR. The people who called were afraid of “Obamacare”. How was the new law going to affect them? Would they lose their coverage? Will they be able to afford their new policies?

A third of my calls were from people on Medicare. Aside from the improvements in the Medicare Part D (Rx) benefits, Medicare is pretty much untouched by the PPACA. But my 11th caller was a nervous 68 year old. His buddy told him that the premium for his Medicare Supplement was going to be four times higher next year due to Obamacare. Some friend. There was the 66 year old who was concerned about her vitamin D prescription. And there was the woman in her mid-fifties, still recovering from the surgeries to remove brain tumors, who had been told that the new policies would not cover liver transplants for anyone over 60. There is nothing in the law that prohibits liver transplants for 61 year olds, and she doesn’t need a transplant, but she has heard the reports and she is worried.

There wasn’t a single call, not one, from someone who will be hurt by the new law. My fifth call was a grandmother inquiring about coverage for her 22 year old granddaughter. The young woman is an uninsured college student. I had several calls from people who had lost their jobs, could not afford to exercise their COBRA option, and were now uninsured. Most had dependent children. The PPACA doesn't benefit everyone. What law could? But the concern and fear fueling these calls was a direct result of negative, often fact-less, political messaging.

Two of my calls came from people who were paying a lot of money for their or their spouse’s employer sponsored group health insurance plans. I couldn’t promise that the new health plans would be cheaper. I could reassure them that they will have choices and the opportunity to shop for alternate coverage.

Many of our callers just needed a safe website that could answer their questions. This one, created by the Ohio Association of Health Underwriters, even has a subsidy calculator. I patiently repeated the actual web address for them as they wrote it down before heading to the public library to access the internet.

We were supposed to start at 5 PM, but the phones started to ring before that. After an hour I turned to Ms. Robbins and Ingrid Martin, our Board Member who had helped to organize this, and asked when we were going to do this again. They had already agreed to the need. They appreciated our mutual commitment to helping Greater Clevelanders in making this transition. I’m sure we will be back again in a few weeks.

I, of course, am looking forward to doing this again. A veteran of numerous charity telethons, I love answering the phone on TV. That and we were too busy to meet Russ Mitchell when he came down to say hello. He and I share a real appreciation of Gino Vannelli.


Sunday, September 22, 2013

A (Lack of) Progress Report

The car was careening down the hill. The driver, desperate to stop, never touched the brake pedal. Instead, he grabbed the emergency parking lever with both hands and violently pulled it towards himself. It snapped off! The car picked up speed. The driver opened the door and abandoned the car. He got up. Dusted himself off. And as he watched the out-of-control vehicle continue down the hill he declared that whatever happens, happens. It was not his problem since he was no longer driving the car.

The Patient Protection and Affordable Car Act (PPACA) was signed into law March 23, 2010. We have seen plenty of changes in how we pay for our health care delivery system over the last 3 ½ years. But the biggest changes are scheduled for October 1, 2013.

Are we ready?

If you are a regular reader of this blog, you know the answer – Not Quite.

Let’s start with the policies. As of right now, the cupboard is empty. Anthem, Medical Mutual of Ohio, etc… are waiting for final approval. Even if the policies are all approved on Monday, September 23rd, how do they all get loaded into the various computer quoting systems in eight days? Brochures? Ads? Supporting documentation? Is it realistic to believe that everything can be up and running in a week?

The new online insurance shopping portal, the Exchange, is another area of concern. Once policies are loaded into the computers, how will we access them? The insurers and agents are still wading through a convoluted system that is being created on the fly. We are spending big bucks to create websites that will allow individuals to go to one site, plug in their information to determine their personal premium subsidies, and then apply for coverage. Those connections are not in place.

The government is also not ready. The software created to determine how much premium subsidy someone would receive is still not functioning at 100%. Brian Cook of the Centers for Medicare and Medicaid Services (CMS) states that they have been rigorously testing the software for a year. OK, but it is still failing. Many people will base their choice of coverage on the net price of the policies. If the subsidy calculations are wrong, we have the potential for real problems. Can this be resolved in the next week? That may be possible.

Those are some of the challenges we face to implement the President’s health care law. Are these insurmountable? Not really.

First and foremost, the October 1 date is not a drop-dead deadline. If everything was working, Americans could begin to purchase policies on October 1st that would become effective on January 1, 2014. It doesn’t matter whether the policy is purchased on October 1st or December 7th, the policy is still not going to start until January. If the exchanges aren’t ready until November 1st, we can still have people covered January 1st.

The PPACA is a poorly written bill that attempted to do too much in too little time. I have talked to our elected representatives, staffers, and Health and Human Services (HHS) employees. They are not evil. They mean well, but they may be in over their heads.

And that brings us to Senator Ted Cruz. Mr. Cruz spends an inordinate amount of time talking about defunding “Obamacare”. Let’s be clear – we are not repealing nor defunding the PPACA. Mr. Cruz’s entire cynical campaign is a tactless fundraiser and a desperate cry for attention. Shockingly, even political commentators on FOX are now calling him out as a huckster.

The insurance industry has spent millions upon millions of dollars to comply with this law. The states have spent as much if not more. Every business, even ones with only one employee, has had to complete forms and make decisions about health insurance. Most of the policies for sale today will no longer be available in a few months.

Repeal the PPACA? Will all of the money, the time, and the effort of the last 3 ½ years be for naught? Which of the regulations stay on the books? Which disappear? Who will tell the sick that their insurance will cease on December 31st?

The people leading the charge to repeal the PPACA or worse, to simply defund it, will only serve to make a muddled mess worse. They understand that the Patient Protection and Affordable Care Act could have been slowed or stopped by gently applying the brakes sometime over the last 3 years. But they never touched the brakes. Now the PPACA can’t be stopped.

The legislators who never tried to constructively modify the PPACA would like you to believe that they bear no responsibility for any of the problems. They jumped out of the car.

We’re at the bottom of the hill.


Sunday, September 15, 2013

Zen And The Art Of Insurance Selling

Gary may be a federal employee. He might be the employee of a federal contractor. I can’t say. We were having our third conversation as he tried to solve the ongoing problems with the CMS Enterprise Portal, a multi-purpose site that I needed to access so that I could be registered to work on the new exchanges. During our second conversation my screen had said that I was locked out of the site while his said that I had an open door. Sadly, mine was right. We were about to try again.

Gary, before we start, I have to tell you a quick story. A buddy of mine called right after we got off the phone yesterday. He was having difficulty getting in to the Portal. I got him on to Chrome and walked him right through the process. No crashes! No hassles! He is registered.


One, I wanted to share a success story. Two, I want to put this into perspective. I’m an insurance agent. I’ve been doing this for 35 years. This stuff is just a bump in the road. It is going to work. And when it does, I will be back to doing what I do – solve problems for individuals and businesses. This is what you do. I can only imagine how frustrated YOU are with these system issues.

Thank you Dave. We are trying.

Did you forget that the guy at the other end of the phone is just another human being? At what point did we decide that anyone who disagrees with us or doesn’t do what we want them to do is Evil, or Incompetent, or Destroying America?

The Patient Protection and Affordable Care Act (PPACA) is 3 ½ year old. The law instituted some useful, meaningful changes, some expensive, problematic changes, and some non-starters. But the most visible, most significant provisions of the law are about to go into effect at the beginning of next month. Spoiler Alert – this is going to be a rocky start.

I can’t really explain why, perhaps it is my partner Jeff and his incessant talk of Yoga, but I have achieved a certain peace with the PPACA and the upcoming upheaval it may bring. And because of the calm that I must be projecting, I have fielded lots of calls from not just my individual and employer clients, but also from my fellow agents. Most of the people I talk to are either hopeful or apprehensive. Of course, I do get the occasional calls from the angry people who watch too much TV.

My clients, businesses and individuals, want to know how the law will affect them. Will they get to keep their doctor? Are the prices going up or down? Will they be OK? Isn’t that what we all want to know? Are we going to be OK? The answer is YES.

You, Mr. or Ms. Reader, might pay more or less for your health insurance coverage. We don’t know the answer to that today. But you will have access to coverage and to care. And the vast majority of us will adjust, because we always do. Freaking out about it now accomplishes nothing. When and if the time comes for you to shop for coverage, you may need to muster all of the skill you recently used to compare cell phone plans or car deals to determine the best program for you. If you are lucky you will be able to utilize the help of a trusted advisor to help explain your choices.

People in Cleveland may be forced to choose between the Cleveland Clinic and University Hospital systems. How many Americans wish that they had such a tough decision? I suspect that the pharmacies will be lining up with specific insurers. The nearest drug store in your plan may be three blocks from your home instead of two. We will survive.

This blog has contended for over three years that we are moving away from employer sponsored group health insurance to buy it yourself plans. Nothing has changed in that assessment. Your needs aren’t necessarily the same as your co-workers. You may do a better job of meeting your needs. Or not.

Many of my peers are more than a little conflicted. We all know individuals who have been unable to acquire affordable health insurance in the past due to an illness or injury that renders them difficult to insure. Whether or not the problem was self-inflicted isn’t really relevant at this point. We want to help them to be insured and the new law may solve some problems. We are also worried about the clients, individuals and businesses, which may take massive rate increases. And we are worried about ourselves. We are being squeezed by both the insurers and the government. Both would love to eliminate our jobs, but must reluctantly admit to our need in the marketplace.

The last calls are like the one I received Thursday from a man in his early 50’s. I don’t know why he is on Social Security Disability. It is none of my business. I insure his children. He called to complain about Obamacare. He spent almost ten minutes of my time complaining about a litany of villains – President Obama, Nancy Pelosi, weak Republicans, all Democrats, etc… His rant was as tiresome as it was inaccurate. He even ventured into the Takers and Job Creators territory. I tried my best to peel him off the ceiling, got bored, and gave up. There is nothing I could say that would solve his problems.

There are going to be significant computer issues with the new exchanges. Even registering to be an agent was a challenge. And the PPACA has real flaws. Some of those issues could have been resolved, in a bi-partisan fashion, over the last three years. But they weren’t. So we will muddle through and the problems, like a dented fender, will be eventually repaired. But nothing good will come from losing your temper or screaming. Working for solutions is the only way to accomplish solutions.

Or as Jeff might say, “Close your eyes and take a deep breath”.


Tuesday, August 27, 2013

Plumber? Attorney? Government Flack!

I have a quick question for the business owners in the audience – How’s it going? Been busy? Terrific. I hate to bother you, but the U.S. Government has another job for you. You are going to help steer Americans to the new Health Insurance Exchanges. And by the way, the gig starts today.

The legislators and staff who gave us The Patient Protection and Affordable Care Act (PPACA) may not have known anything about health insurance, but they were experts in the federal bureaucracy. The PPACA’s home address may be the Department of Health and Human Services (HHS), but the Internal Revenue Service, the Department of Labor and other federal agencies are involved with the implementation. The law has metastasized and can now be found throughout the government, which makes the raw meat mantra of defunding “Obamacare” that much more cynical.

So Mr. or Ms. Business Owner, how are YOU involved? This next section is from the Department of Labor’s website. It is safer to print this exactly as it appears rather than to paraphrase the governmentese and miss something.

Background On The Notice to Inform Employees of Coverage Options Under the FLSA

Section 18B of the FLSA, as added by section 1512 of the Affordable Care Act, generally provides that, in accordance with regulations promulgated by the Secretary of Labor, an applicable employer must provide each employee at the time of hiring (or with respect to current employees, not later than March 1, 2013), a written notice:
  1. Informing the employee of the existence of the Marketplace (referred to in the statute as the Exchange) including a description of the services provided by the Marketplace, and the manner in which the employee may contact the Marketplace to request assistance;
  2. If the employer plan's share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs, that the employee may be eligible for a premium tax credit under section 36B of the Internal Revenue Code (the Code) if the employee purchases a qualified health plan through the Marketplace; and
  3. If the employee purchases a qualified health plan through the Marketplace, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for Federal income tax purposes.
On January 24, 2013, the Department of Labor (the Department) issued guidance stating the Department’s conclusion that the notice requirement under FLSA section 18B will not take effect on March 1, 2013 for several reasons.(2) The Department explained that this notice should be coordinated with HHS's educational efforts and Internal Revenue Service (IRS) guidance on minimum value. The guidance also stated the Department’s commitment to a smooth implementation process including providing employers with sufficient time to comply and select an applicability date that ensures that employees receive the information at a meaningful time. The guidance further stated that the Department expects the timing for distribution of notices will be the late summer or fall of 2013, which will coordinate with the open enrollment period for the Marketplace.

The Department is issuing this temporary guidance and model notice in advance of the expected timeframe announced in the guidance because, since the issuance of the guidance, the Department has received several requests from employers for a model notice on an earlier timeframe so that they may be able to inform their employees now about the upcoming coverage options through the Marketplace. Therefore, employers are permitted to use the model notice and/or rely on this temporary guidance prior to the applicability date stated below(3) to inform their employees earlier.

OK. How about in English?

Employers must provide a notice to each employee about the new Exchanges. There is no clear exemption for small businesses. Some parts of the health care laws apply to businesses with over 50 employees. There are rules for businesses with 20 employees. This regulation applies to businesses with as few as ONE employee.

The Department of Labor has, thankfully, created a pair of model documents. This link takes you to the form to use if you provide health insurance for any of your employees. This link is to the form for those employers who don’t.

Both forms advise the employee that he/she may save money by purchasing health insurance on the Exchange. Both direct the employee to the government’s website (the home of the internet’s largest collection of pictures of happy people). Both forms ask who at this business may be contacted to confirm information should the employee choose to apply for coverage on the Exchange. And if the employer provides coverage, there is a third page that asks the business to voluntarily provide additional information. Don’t volunteer.

What are the penalties for failing to comply? I have no idea. I gave up looking for that. I am preparing the forms for my clients. Some businesses are sending out blank forms. That would not appear to comply with the law.

How does a small business that doesn’t offer health insurance, and thus doesn’t have an agent, know to provide this form to its employees? You’re reading it. Click on the link and access the form. And how many of your people will sign up for coverage through the new Exchanges? We’ll set sales goals next week.


Visit the website -

Sunday, August 18, 2013

You Put Your Left Foot In

It was Chicken Cordon Bleu prepared by a lifelong vegetarian. It was a doctoral thesis that had been assigned to an illiterate. It was how I spent four hours and ten minutes Saturday evening. It was the federal government’s online classes for agents and brokers. People who have never purchased nor sold a health policy created these three courses:
  • Affordable Care Act and Marketplace Basics
  • Individual Marketplace Course
  • SHOP Marketplace Course
I read. I passed the quizzes. I aced the tests. I am now qualified to sell policies that are still waiting for approval on a platform that has yet to be created. Welcome to health insurance August 2013.

The Patient Protection and Affordable Care Act (PPACA) mandates that individual health policies will be available through Exchanges. Because you can never find an insurance agent when you need one, Exchanges were to be created by every state as a way for Americans to efficiently shop for health insurance. If a state balked at the potential cost or hassle (or at, G-d forbid, appearing to in any way help implement “Obamacare”) the federal government was empowered to create its own Exchange or a state / federal hybrid. Ohio has opted for the hybrid.

The PPACA mandates Exchanges, but in a widely misunderstood and disliked law, the concept of Exchanges ranks near the bottom of consumer and employer acceptance. So the marketers at the U.S. Department of Health and Human Services (HHS) have given us a new term – Marketplace.

What is a Marketplace? Think Exchange.

Today I learned how we in Ohio, which once had hundreds of choices for small group health insurance, will now have more choices even if the actual number of options is way less. Go ahead and re-read that sentence as many times as necessary until it makes sense. I also learned that there are only nine easy steps for a small employer (2-50 employees) to purchase health insurance coverage for his/her employees through the SHOP Exchange.

The individual Exchange is one way someone can purchase personal health insurance coverage. Why bother with the Exchange? $$$$ Individuals and families earning between 100% to 400% of the federal poverty level will qualify for subsidies. You have to go through the Exchange to qualify for the subsidy. Well over 50% of all applicants will get some premium assistance.

You can almost hear the border collies herding everyone to the pens.

We have been promised a single, streamlined form that could be completed by an individual, done over the phone with a government employee, or prepared online. The online version sounds like it will be the easiest option. The insurance shopper will be able to do this alone, with a qualified agent, with the yet to be fully defined Navigator, or with a volunteer.

The form will ask:
  • Your name
  • Your date of birth
  • Your address
  • Your citizenship / residency status
  • Your marital status
  • Do you smoke
  • Are you incarcerated
  • Your Social Security Number
  • Your income
  • Do you have access to a qualified, affordable health plan at work
Are you eligible for government provided health care
And of course, if they are covering any of your family they will need all of the above for them. The form has yet to be released. There may be more questions on the actual form.

The government will verify your answers through the appropriate agencies and determine your eligibility. Once you are advised of the amount of your subsidy, you may begin to shop for insurance.

A large portion of today’s classes dealt with how to safeguard the PII, Personally Identifiable Information. We have been protecting our clients personal information for years. My office is safe. My records are private. The government should do so well. What has yet to be determined is how the Navigators and volunteer organizations will protect the taxpayer information that will be routinely collected.

Four hours of this silly dance. I suspect that I’ve got another hour with the feds next week. The State of Ohio will have its own class sometime in September. If this is a war of attrition, they’ve picked a fight with the wrong guys. Thirty-five years in the business, I’m ready for the marathon. But I am frustrated with the Hokey-Pokey.


Saturday, August 10, 2013

How Do You Spell "Knife"?

There was a time when children would ask a parent or a teacher how to spell a particular word. The adult would inevitably send us to the dictionary. This would often prove to be a lesson in self-reliance, problem solving, and phonetics. But English being English, a dictionary search could also be a frustrating waste of time.

Senator Sherrod Brown invited me to a seminar. The invitation stated that he was bringing the U.S. Department of Health and Human Services to Cleveland on August 8, 2013 to answer questions about the Marketplaces or Exchanges. I emailed my RSVP within minutes of receiving the invitation.

We have all seen a young cheerleader whoop it up after her side’s quarterback has thrown an interception, totally unaware of the gravity of the situation. Well, in the last few weeks I have been on two phone conference / webinars with the Centers for Medicare and Medicaid Services (CMS). As previously noted, the government employees hosting the meetings were woefully unprepared. Cheerleading permeated each seminar. After a basic slide show presentation high on platitudes but almost bereft of facts, questions were thrown to the hosts, who, like the Browns’ receivers, quickly dropped them. These meetings were frustrating wastes of time.

I was counting on Senator Brown to host an informative meeting. Based on the email address, I could tell that this invitation was sent to his supporters, people who had worked on the campaigns and maybe even donated to his campaigns in the past. This was going to be a friendly crowd.

The seminar was scheduled for 5:30 – 7:00 PM at The City Club. That lack of awareness should have been a tip-off. His staff didn’t know that the Browns were playing their first preseason game that night or that the Indians were hosting a Dollar Dog Night game against the Detroit Tigers. Both a few blocks away.

By the way, it shouldn’t be necessary to note this, but the Patient Protection and Affordable Care Act (PPACA) lives at the U.S. Department of Health and Human Services (HHS). Senator Brown bringing in HHS should be the equivalent of having a Supreme Court Justice explain the Constitution.

Wrong Again

Arriving at 5 PM, I knew I had wasted my time the moment I walked into the empty room. Instead of the Senator and an advance team, I saw a couple of staffers and Sherrod on a screen in the front of the room. All they had to do is hit play and we would be treated to a quick canned intro from the Senator. If this presentation wasn’t going to be good enough for him to show, I already knew that I had blown $20 on parking.

The room was eventually filled with leaders of various not-for-profits, Democratic activists, and the terminally confused. There were only three insurance agents in the room. The vibe was positive right up until the presentation started.

Our young presenter was from Chicago. We knew this because she mentioned it, and her need to catch a plane, frequently. Being from out of state was a double liability for her. She was not prepared to discuss the new regulations and she was often wrong about the Ohio health insurance marketplace. Worse, the audience quickly sensed her numerous shortcomings.

Ms. Chicago may have left her pom poms at home, but she was a determined, if not talented, cheerleader. She begged the audience to remember Begged is not an exaggeration. She told us that the government’s website is the answer to every question you could possibly have about health care and the solution to ANY problem you may ever encounter.

I was sitting next to the executive director of one of the dread disease foundations. My tablemate, a young woman in her early thirties, quickly grew frustrated with our presenter’s mistakes, inability to answer the most basic of questions, and repetition of the website address.

If someone representing the U.S. Department of Health and Human Services can’t answer a basic question, who can? I asked a question about the Personal Responsibility Fee, which is the new Orwellian way to say the Individual Mandate. I won’t bore you with the question. She couldn’t answer it. Worse, she said that the answer would have to come from the Internal Revenue Service. THAT IS WRONG. The IRS may have a hand in administering the PPACA, but HHS is writing the rules.

But we still have the website. Good luck finding the answer to your questions there. And we still have dictionaries. The huge Webster’s Encyclopedic Unabridged Dictionary of the English Language sitting on my bookshelf may have almost every word in the English language, but it is still a challenge to find the correct spelling of some words. Sometimes it’s darn near impossible. Don’t believe me? Have your child look up "knife".


Friday, August 2, 2013

Everybody's Happy!

A billion here, a billion there, and pretty soon you're talking real money.
Senator Everett McKinley Dirksen (1896-1969)

The new rates are out!  The new rates are out!  The Cleveland Plain Dealer reported today (won’t be able to say that much longer) that we finally have the new individual rates under the Patient Protection and Affordable Care Act (PPACA).  These are the prices that Ohioans will pay if they purchase coverage through the new exchanges.  And everyone is thrilled.  Positively giddy.

Mary Taylor, Lt. Governor and Insurance Commissioner, announced that our rates will be going up an average of 41%.  The Ohio Department of Insurance is projected our average adult premium will be $332.58 per month.  The Democrats were happy since they were worried that the number was going to be higher.  The Republicans were celebrating another opportunity to complain about escalating costs.  And average Ohioans, numb from way too many political ads last November and the recent budget shenanigans, chose to focus on the streaking Cleveland Indians.

Of course, loving the numbers wasn’t really good enough for either side.  Thankfully there are plenty of chances to evangelize their message and fight with the other side.  And everyone has a dog in this fight.

Approximately 80 – 90 percent of the people purchasing policies on the public exchange will qualify for a subsidy from the federal government.  As we have discussed previously, the federal government will help you pay your health insurance premium if you earn between 100% - 400% of the federal poverty rate.  That means if you earn less than $45,960 as a single or $94,200 as a family of four, you may qualify for assistance if your employer doesn’t provide adequate group health insurance.

The left is happily furious that Ms. Taylor reported the real number, $332.58, and not what someone might pay if he/she qualifies for a subsidy.  The Plain Dealer article notes that a 30 year old making $30,000 per year would have a premium of $285 per month, but that the federal government would cover $76 of that monthly fee.  Our hypothetical 30 year old would really have a premium of $209 per month.

At the risk of appearing to take sides – BALONEY!

1. The premium really is $285.  Some of it will be paid by the insured and the rest will be paid, in real dollars, to the insurance company.
2. That $76 is actually $912 in year one.
3. President Obama postponed the employer mandate, the tax that was scheduled to cover the cost of subsidizing the individual policies.
4. The uninsured 30 year old that was in my office yesterday was thrilled to acquire a health policy for $92.39 per month.  She would not have purchased a $209 policy.  And yes, coincidentally, she is a hairdresser making $30,000 a year.

The good news is that if my 30 year old hairdresser is forced to purchase a policy through the exchange next year, she will be acquiring maternity coverage at no additional cost.  She doesn’t think that she needs it, but it couldn’t hurt.  My healthy thirty year old male clients are looking at larger price bumps without a meaningful increase in benefits.

The Patient Protection and Affordable Care Act was supposed to be revenue neutral.  Sure there were costs associated with implementing the bill, but there were sources of revenue, too.  The first to disappear was the CLASS ACT, a program that was to pay for long term care eventually but front-load some early money for the PPACA.  That program ended almost two years ago.  The real money stream was to come from the employer mandate.

The nonpartisan Congressional Budget Office has estimated that delaying the employer mandate will cost us $12,000,000,000.  The Washington Post also reports that the CBO estimates that as many as 1 million fewer people will be insured due to the delay.

While the left denied the existence of mathematics, the right pretended that everyone in our country has access to comprehensive health care.  Blinders on and fully aware that their actions are equivalent to doing nothing, the Republicans of the U.S. House of Representatives voted today for the 40th time to repeal all or most of Obamacare (PPACA).  Then they went home for the summer recess.  This vote was so irrelevant that the major new outlets ignored it.

But back to Ohio.  Our rates are going up, but it could have been worse.  If you are unhealthy, pregnant, or earning less than 400% of the federal poverty level, the policies may prove to be a good deal.  And if you’re not, well the Indians are 60 – 48.