Thursday, June 27, 2013

The Tar Pits Are Calling

Giant Eagle. Ask a small child where hot dogs come from and he will answer the name of the last place he rode around in a shopping cart. This is the beginning of a conversation about farms, animals, and possibly soy beans.

The H.R. Department. Ask a government bureaucrat or one of our elected officials where a health insurance policy comes from and they might tell you that all of that paperwork originated with Marge in H.R. And this is the beginning of a conversation about how many of us get our health insurance, from agents servicing individuals, small businesses, and the self-employed.

This blog, Health Insurance Issues With Dave, has been published for over 4 years. The original posts were more personal and had less graphs and links. But this now appears in three formats and has readers around the country, so there is usually less of me and more of a straightforward presentation. At the risk of shocking or irritating a few of my readers, today’s post will be more personal, more like the originals.

Let me be clear – I am very concerned. I’m concerned about the country and how we manage the self-inflicted mess we are about to encounter and I am concerned about me.

Now before our friends on the right get excited and our friends on the left, agitated, we need to state that there is plenty of blame to go around. Neither side has listened to the other. For good or ill, the Patient Protection and Affordable Care Act (PPACA) is the law of the land. One side has done everything it can to undermine the legislation without any concern for the impact their actions might have on their constituents. The other side lacks the fire power to execute this massive transition and is too stubborn to pull back to get this right.

Stubborn – Incompetent – Unconcerned About the Collateral Damage

Too be honest, it is easier to pick on the Democrats, the Department of Health and Human Services, and the President because they are doing something. It may be Grade C work, but if you are comparing them to Mitch McConnell and John Boehner, then C beats incomplete any day of the week. In fact, when it comes to the health care debate, the Republican leadership is simply AWOL.

Last week’s post dealt with the federal government’s invitation only webinar. The facilitator was asked for some specifics about the “Metal Plans”. She quickly pooh poohed the question. From the start, the PPACA has presumed that there would only be a couple of plan options. Since it is pretty obvious that none of the people who wrote the law have ever actually shopped for insurance, they had no idea what they were creating. They envisioned a system so simple that even an untrained navigator could help the computer illiterate enroll in coverage.

I have been given an advance peek at one company’s plans for the new exchange. To comply with the law, these policies are far more complicated and limiting than the current plans. Provider networks are shrinking. Simple deductible / 100% plans are disappearing. Determining the right policy for an individual or family may take more time, not less, in the future.

To counter this reality, Secretary of Health and Human Services Kathleen Sebelius excitedly announced this week the creation of a new website and telephone call center. The number is 1.800.318.2596. The website is Sure the Government Accountability Office (GAO) has found that the federal government and many of the states are “behind schedule”. Sure we have less than 100 days till the exchanges are supposed to be up and running. But we have a website and a call center all prepared to tell us how wonderful everything is going to be.

I went to the website. It is information light and propaganda heavy. At one point I found this nugget on the small business page: Insurers can no longer charge more for women. Of course we know that in the small business market, women are charged more than men at some ages and less than men at other ages. In other words, the rates reflect the risk. If the government was interested in presenting facts instead of simply selling, the page would note that rates will now be gender neutral. I would tell you more about the site, but they still have work to do on it. My computer froze while on the site and I had to reboot to get back to work.

I’m worried about us because these people are in over their heads. They’ve got the pitch memorized but they don’t understand the product. And they don’t know enough to care.

And I’m worried about me. I have been doing this since 1979. The things I know and the work I am capable of doing, is no longer valued and may not be compensated. I have about 500 clients. Most of them have employees. They are all impacted by these changes. Some will save money. Some of my clients are about to take a hit. Each needs a personal strategy. Each needs time, my time. And the truth is that none of my peers knows, today, how much time we will be able to spend with our clients.

Tuesday I talked with an agent who is abandoning the individual market. Too much time. Too much effort. Too little money after the last round of commission cuts. He wants to spend all of his time working with businesses with 50 or more employees. He is a fifteen year veteran of this business. His clients will notice his absence. He can’t be replaced by a volunteer from the local union hall. And neither can I.

On October 1, 2013 we will not enter the gates of insurance heaven nor fall into a dark abyss. No, it will be something in between, mediocre, messy, but just close enough to warrant, at least initially, a C.

And I will fight on for me and for my clients. But I would have to be deaf or in denial if I said that I didn’t hear the tar pits calling.   DAVE

Friday, June 21, 2013

Watch Where You Step

I admit that I was a bit confused. The key employee of a local not-for-profit was about to give us the “30 Thousand Foot View” on a particular issue. My confusion? I had always thought that it was easier to find bullshit in a cow pasture. Our guy proved me wrong.

I was reminded of our captain of the shovel brigade Wednesday afternoon when I had the opportunity to take part in a special government sponsored online seminar on the Patient Protection and Affordable Care Act (PPACA). The facilitator promised a High Level Overview of the new law. What we got was a cheerleader who attempted to substitute PowerPoint for back flips and the ubiquitous can-can line. If one-sided hyperbole is your favorite way to spend an hour, you would have been in heaven.

Though this briefing was by invitation, only, there were no requests to keep the contents secret. Reporters were supposedly on the line. We were even provided a link to the presentation. I would include it, but It Doesn’t Work!

I knew we were in for an informative webinar when the first slides told us why we had to have the PPACA. “Insurance companies could take advantage of you and turn away 129 million Americans with preexisting conditions”. We learned that the law was built on everything that worked in our system and fixed everything that didn’t. I turned away for a moment, but I’m sure that one of the bullet points was that the President and the PPACA guaranteed that the sun would forever rise in the east and set in the west.

The twenty-eight page presentation covered little substantive ground. The slides extolled the virtues of the yet to be created exchanges and the new heroes of healthcare, the Navigators. Our facilitator mentioned a new class of participants, Certified Application Counselors, but her screen presentation failed to note or define them.

For someone who has spent almost 34 years in the business, it was an hour of total frustration. How do you unlearn what you know to be true? Can you pretend that up is down or that black is white?

I didn’t have time to dwell on the seminar. Dinner Wednesday night was to be downtown with friends. Flipping through the stations as I was driving on I 90 into town, I happened on to Neil Cavuto on FOX. He was interviewing Dr. Ben Carson, a noted pediatric surgeon from Johns Hopkins and a FOX favorite.

Dr. Carson is a really, really smart guy. And if I was looking for a surgeon to separate conjoined twins, he would be at the top of my list. But his political rants aren’t in that same class. I’ve included the link. While his voice went high and shaky, his argument sunk to the level of your average FOX talking head. The segment ended with Cavuto and Carson delivering what they hoped to be the fatal dagger to the heart of the PPACA – IRS involvement.


There is no reason to expect more than this from FOX, but we need more from someone. We are months from the real start of the PPACA, the opening of the exchanges, and the wholesale upheaval of our current payment system. Businesses have already spent millions of dollars in an effort to be in compliance with regulations that are still being drafted and changed. Neither one-sided cheerleading sessions nor silly rants will help us efficiently pay for the medical services of over 300 million Americans.

There is still time to modify the Patient Protection and Affordable Care Act to make it more effective. All we need is a Congress more interested in fixing problems than scoring political points. We don’t need more grandstanding. We need action. But I’m not holding my breath. I am, however, watching where I step.   DAVE