Saturday, February 28, 2015

Shopping At Garage Sales In Alternate Universes

Senate cufflinks

February 2015 – Washington DC

There are only two groups of tourists to our nation’s capital in the dead of winter, 8th graders with their teachers and chaperones and constituent visitors otherwise known as unpaid lobbyists. It has been a long time since I had an 8th grader, so you know why I was wandering around the halls of Congress last week.

The National Association of Health Underwriters (NAHU) is the health insurance agents’ trade group. NAHU holds a conference annually in Washington and I was here to listen to regulators, members of the Administration, and members of Congress address hundreds of agents from around the country. I have to admit that I was impressed that not only did the new CEO of the Federal Marketplace ( come to talk with us, he even answered questions and promised to follow-up on specific issues.

And that was why we were in Washington. At the risk of sounding almost altruistic, our main mission was to make the Patient Protection and Affordable Care Act (PPACA) work better for our clients. Each of us has more than a few stories of clients who have benefited by the new law. But, we can also cite plenty of examples of families and businesses who are no longer adequately insured due to correctable problems with the law and its administration. Things have gotten better. Last year was a disaster. But I still spent almost 5 hours online and on the phone February 15th to enroll one family. There is plenty of room for improvement.

Improvement requires the assistance of Congress.

I had appointments with members of both the House and the Senate in their offices. These are always a crap shoot. Sometimes you get to meet with the elected official. Sometimes it is the legislative aide. Some are prepped and ready. And some are meeting with you out of courtesy. There are only so many minutes in the day, only so many constituent visits our elected officials and staff can attend. The halls were filled with Disabled American Veterans, a well coifed group of broadcasters, and a contingent of the blind. The realtors and countless other groups, some with identifying name tags and some just with nice suits that were last worn at a relative’s wedding, preceded or quickly followed us into every office. And each group came with a perfectly reasonable request, one of remarkable fairness that couldn’t help but move our country forward.

Our big get was a bi-partisan letter, authored by Congressmen John C Carney, Jr. (D-DE) and Daniel Benishek (R-MI), to Secretary Sylvia Burwell of the Department of Health and Human Services. The key provision was the request to “create a dedicated customer service hotline for certified agents and brokers, navigators, marketplace assistors and state health officials to ensure that problems with enrollment are addressed quickly and effectively.” In other words, we want to be able to call someone who has been trained to understand the issues and empowered to fix a problem once discovered.

One legislative aide finally asked me what else we wanted.

There are members of Congress, in both parties, who are dedicated to constituent service and have instructed their staffs to solve problems. This blog has noted the help I have received from Senator Sherrod Brown’s (D-OH) office. Other Democrats have little to no interest in problems. They only want to hear success stories. And some Republicans are collecting tales of woe.

I was in a Republican’s office (Don’t ask who!). I was just one of seven in our delegation and I can’t even tell you why I had been included. But I was there and my main job appeared to be to nod my head authoritatively. I can do that. His constituents brought a couple of important examples where the law of unintended consequences had caused significant harm to individuals and small businesses in his district. He welcomed their report and arranged for his staffer to collect more. It was at this point that I realized that he had no interest in solving any of these problems, just amassing a collection, a weapon for future debates and campaigns.

This was not the time to express my outrage. (Cue up Mr. Cunix goes to Washington.)

I pushed my thumbnail hard into my index finger and looked around the room. I saw awards and tchotchkes, the kind that you might find in most offices, and I was beginning to worry that I wasn’t going to be sufficiently distracted. And then I focused on a picture on the wall right behind the Congressman. There were eight Republican Presidents playing poker! Really. Teddy Roosevelt was glancing with admiration at Richard Nixon. Reagan had a Bush on either side of him and Ike was standing in the background. Abraham Lincoln had his back to us. I don’t know if Abe Lincoln would play poker with Ronald Reagan or Richard Nixon if he had chance to come back to the living, but I do know that he would always sit with his back against the wall. The name of the picture is Grand ‘Ol Gang.

Lincoln Memorial

My favorite Lincoln

The picture summed up everything I needed to say about this Congressman. Republican first. Not problem solver. Not legislator. But he is not alone. There is a Congressman representing a district only a few hundred miles away with the corresponding picture of Democratic Presidents. True Blues has Lyndon Johnson leaning over Harry Truman to talk with Woodrow Wilson. JFK appears to be watching Jimmy Carter play poker with FDR and Bill Clinton. And the picture’s owner is just as partisan, just as dedicated to his career.

Library of Congress

Library of Congress

Walking the halls of the utilitarian office buildings of the House of Representatives or the majestic buildings of the Senate, the Capitol, or the Library of Congress I began to wish that our elected officials simply aspired to be worthy of these buildings and the ideals that built them. But these Congressmen and Congresswomen are no different than the men and women we revere from 50, 100, or even 150 years ago. They had moments of greatness and reprehensible pettiness. They lead and they followed. Some of the giants of the Senate were not necessarily thought to have been giants in their own time. Our grandchildren may one day be taught that George W. Bush and Jimmy Carter were great visionaries. I doubt it, but it could happen.

And with that I joined a couple of my peers in one more meeting with a legislative aide. She (the staffer) was fully up to speed on the issues and actually kept the broadcasters waiting. And there were no poker pictures on the wall.


Tuesday, February 10, 2015

Freeze Tag


Today’s edition of Health Insurance Issues With Dave may provide relief and cause panic. Many of you will be relieved to know that the title is not a Frozen reference. This is a Disney-free zone. And way too many of you will become panic-stricken as I remind you that the Open Enrollment Period ends February 15th.

If you are under 65 and are not covered by the government or an employer sponsored group health insurance policy, you will have until Sunday night to either change your existing coverage or to purchase a policy. A great national game of Freeze Tag begins at 12:01 AM Monday morning. You are where you are until the government tags you again on November 15th.

Are you ready? Are you in the right place? FREEZE


Sunday, February 1, 2015






We’ll return to Health Insurance Issues With Dave after this quick ethics test:

You are standing at the corner of Mayfield Road and SOM Center at 2 AM. The light is red and the crosswalk sign is against you. There isn’t a car in sight.

1. Do you cross the street?

  • Yes
  • No
Three people cross the street, two not even bothering to come to the corner. A police car drives by and doesn’t stop to even warn the scofflaws.

2. Do you cross the street now?
  • Yes
  • No
The above is brought to you courtesy of the U.S. Government and your friends at the Internal Revenue Service. Would you like to rethink your answers?

The Individual Mandate is a core element of the Patient Protection and Affordable Care Act (PPACA). The requirement of universal participation is an important component of any serious proposal that would extend coverage, without underwriting, to everyone. It is an unfortunate part of human nature that many people would opt out of coverage until 5 minutes AFTER they suffered a major accident or experienced chest pains.

It is only under the threat of penalty that some people feel compelled to act responsibly.

Americans were required to have health insurance in 2014. And not just any insurance. Compliant, approved insurance. The penalty free options for someone under 65 in 2014 were:
  • Employer provided group health policy
  • Individual policy purchased on the Exchange with an effective date of January 1, 2014 or later
  • Individual PPACA compliant policy purchased off the Exchange with an effective date of January 1, 2014
  • Individual policy purchased prior to March 2010 – Grandfathered
  • Individual policy purchased with an effective date between March 2010 and December 31, 2013 – Grandmothered
  • Medicaid, Medicare, or Veterans Administration provided
  • Granted a Hardship Waiver from the government
The Grandmothered policies are the special contracts that fall under the “If you like your coverage you can keep it” compromises of 2013 and the spring of 2014. We are good for another year on most of them.

Those are acceptable options. If you have one of these you don’t have to pay the Shared Responsibility Fee that I just mentioned in the blog and client update last week. Are you in compliance?

Line 61 on Form 1040 is of little help. Health care: Individual responsibility (see instructions) Full-year coverage (___). Unless you purchased a policy on the Exchange, the government has no idea whether or not you had a compliant policy. We just learned this past week that the insurers will not be providing Form 1095B confirming compliant coverage in 2014. As UnitedHealth Care stated in an update to agents:
“The IRS has indicated that taxpayers will not need specific documentation to “check the box” in good faith and avoid the shared responsibility payment.”

The IRS has to trust us to voluntarily confess non-compliance.

This is not a big surprise. As I noted several months ago, the forms needed to verify compliant coverage have yet to be created. Too complicated. Too many moving parts.

Did you have any health insurance in 2014? Did you save money and purchase short term coverage for the year? Time for that ethics test. Will you turn yourself in when the possibility of detection is almost nil?

Instead of simply waiting a year to impose the Individual Mandate, the Obama Administration has chosen to collect from the intensely honest or the poorly advised. And in the end that is the real ethics test. And the government failed.