Friday, February 24, 2017

Lucky, Again

This just in – Grandmothered Policies are now extended to the end of 2018

This is called Transitional Relief. Grandmothered policies were issued with an effective date between April 2010 (right after the passage of the Patient Protection and Affordable Care Act) and December 31, 2013 when the law was completely implemented. Grandmothered policies were underwritten and based on an age ratio of 5:1 or higher.

Healthy and/or young people got a good deal in 2013. If you didn’t, if you were charged extra or if you needed a policy that covered maternity or a pre-existing condition, you purchased a new, compliant policy in 2014. The only people left were the cheapest to insure. And though we haven’t added any new, healthy, people to this pool, the Grandmothered policies are still a better risk than the general population. Grandmothered policies are cheaper!

This rule from CMS will allow each state to decide whether impacted individual policies, group policies, or both may be retained until 2018. Mary Taylor, Lt. Governor and Insurance Commissioner, has been willing to extend Grandmothered policies in the past. There is no reason to believe that she would block this now.

And yes, we did talk with our elected officials about this while in Washington, but I don’t know that we can claim credit for it. This may fall under the area of keeping the waters calm while the storm is brewing on Capitol Hill.

Quick Example:

My current policy – Anthem HSA Qualified, $5,500 Deductible - $428.99 per month

2017 policy – Anthem HSA Qualified, $6,500 Deductible - $863.74 per month

If you have a Grandmothered policy you are lucky, again.


Friday, February 17, 2017

The Rescue Call, Market Stability, And How I Failed At UBER

It appears that it is common, when someone is on a blind date, to arrange a “Rescue Call”. There is even a commercial on TV that references this. A friend calls you and provides you a reason to cut the date short. I actually saw it in action on Wednesday.

I was in a Congressman’s office. Seven Ohio health insurance brokers were in his office to discuss the Patient Protection and Affordable Care Act (Obamacare) and what we were going to do now. Fifteen minutes into a positive / routine meeting we were interrupted by one of his aides. After one quick knock on the door, the aide poked his head into the room and told the Congressman that he had another meeting. The Congressman waived him off and we all got another fifteen minutes. If this had been a date, we would have just qualified for a second cup of coffee. Welcome to How To Visit Washington DC 2017.

Over a thousand members of the National Association of Health Underwriters (NAHU) gathered this week in Washington to hear from a variety of experts and to talk with our states’ elected representatives. Most of us are there on our own dime. It is that important for us to get the most up to-date information and to make certain that our lawmakers understand how our clients will be impacted, both positively and negatively, by any changes in the way Americans pay for their health care.

The Law of Unintended Consequences.

There are a lot of ideas that sound absolutely fantastic on TV but will be irrelevant, or even worse disastrous, in practice. Insurance agents are uniquely positioned to explain the real world impact of these programs.

We were in Washington to deliver one important message for our clients – Market Stabilization. It is already mid-February. Nothing can really be changed for 2017 and the insurers only have eight weeks left to prepare for 2018. Yes, eight weeks. Insurers are currently working to file their plans and rates for 2018 and they, as well as our clients, need to know what the market will look like on both the state and federal levels.

Our key points centered on the individual (non-group) market.
  • Allow the tax credits that help so many Americans to afford coverage to remain intact for at least two more years or until a comparable replacement can be put in place.
  • Allow tax credits to be used outside of the Marketplace if fewer than two choices are offered in a state.
  • Allow any person to purchase a catastrophic-category coverage regardless of age or income status.
  • Tighten both the open-enrollment and special-enrollment periods to reduce adverse selection.
  • Allow states to be eligible for a new hybrid high risk pool that would serve as a reinsurance mechanism while still providing the same level of coverage for even the highest risk individuals.
  • Preserve employer-sponsored health insurance by retaining the employer exclusion.
Yes, this is a lot of process and almost nothing that would make a good sound bite. These points and others would help secure the promise of health insurance coverage for the next couple of years.

Armed with individualized packets, we set off to meet our Senators and Members of the House. I had a chance to visit offices in the Senate and the House, Democrats and Republicans. Some of my meetings were with the actual lawmaker. Some were with staff. And though it is always gratifying to have a Congressman make time to speak with a visiting constituent, some of the best meetings can be with a Chief of Staff or a knowledgeable legislative aide, especially one who specializes in public health. I found this year’s meetings productive. The Congressmen and their staffs were totally engaged. They asked good questions. They took notes. I honestly felt that my time and expertise were valued.

** ** ** ** **

I was in geek heaven. Cigars. Scotch. Politics. I was with two of my peers and a lobbyist in Shelly’s Backroom doing a deep dive on the current state of affairs. The hours flew by and it was past midnight when I called us an UBER. We walked outside, ignored the parked cab, and looked for Mohammed and his Toyota Camry. A Camry stopped, right in front of us, in the middle of the street. We walked up to the car and tried to get in as the driver frantically waived at us. We had failed to notice that there was a traffic light, here in the middle of the block, and he had been stopped for a red light. He wasn’t an UBER! We stepped back and he sped off.

Another Camry, one with an UBER decal, came up a couple of minutes later. This time we verified that it was an UBER and got in. Sitting shotgun, I noticed that the driver was a little confused. We had only traveled a few blocks before his phone rang. It was Betsy. She wanted to know where the Hell he was. They started arguing. This wasn’t Mohammed and we were in the wrong UBER. In the end I cancelled my order, paid the penalty, and slipped the driver a $10 for a $7 ride. His last ride as an UBER drive might as well include a tip.

This is either the office of Rep. Don Young of Alaska or a Betsy DeVos elementary school.

The view from the train beneath the Capitol.


Wednesday, February 1, 2017

The Nice Guy Finished Last / First

Robby is the nicest guy I know. No exaggeration. Robby is just a great guy. And right now Robby is losing and winning the health insurance battle.

Robby was referred to me by his employer at the very beginning of the full rollout of the Patient Protection and Affordable Care Act (Obamacare). So I have never asked him any health questions, but I have no reason to believe that he has any medical issues or ongoing prescriptions. He is just a laborer, single and a non-smoker, in his early 50’s, living in Parma. There are thousands of guys just like him throughout Greater Cleveland.

Robby has gone years without health insurance. His employers seldom provided coverage and he couldn’t possibly afford it on his own. The PPACA guaranteed access to coverage AND included a penalty for non-compliance. The penalty was an important factor in his request. It would be unthinkable for Robby to jaywalk, he certainly wasn’t going to do anything penalized by law.

And Robby got a policy. It was a terrible policy with a $6,000 deductible and it cost him $110 a month after his tax credit subsidy of $187, but he was covered and if, G-d forbid, he got really sick or injured he would have easy access to world-class facilities right here in Cleveland. He even got a free routine annual exam, if he ever had a chance to get to a clinic on a day he wasn’t working. So, Robby won. We all did. We had one less uninsured American worried about a major illness and a society less concerned with the inevitable bill for his care.

Robby’s insurance went up $30 a month beginning January 1, 2015. Robby’s victory wasn’t quite so sweet.

The price of insurance was going up. The subsidies were going down even though his income had hardly changed. The invasion of low-cost Medicaid providers into the Exchange severely impacted Robby’s subsidy. If he would allow the Exchange to force him to Metro and Charity hospitals he would pay less. He hung on to the Cleveland Clinic and the price went up to over $250 with his subsidy for 2016.

In 2017 his premium is $325 and his deductible is $6,400. Robby is losing.

I got a call today from Robby. He wants to drop his policy now that he is no longer required to keep it. I let him know that he can drop the policy but that he would still be liable for the penalty. He thought that it was over. I had to break the news to him that the individual mandate, both a Republican idea traceable to the Heritage Foundation in 1989 and Republican strawman, was still the law.

President Trump’s Executive Order gives the Secretary of Health and Human Services and other department heads the ability to reduce the “burden” of complying with Obamacare. Congressman Price’s confirmation for Health and Human Services has been stalled due to what appears to be insider trading. More importantly, the insurance companies are scared to death of adverse selection. Without the individual mandate, the only people who will buy insurance are the sick and the responsible. That could be disastrous.

With no immediate viable replacement, a nice guy like Robby has no place to go. He’s winning. He’s losing. Nothing has really changed.