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.