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”.