Posts
Let’s pretend that you own a business, any business. Since we are talking about your imagination, this enterprise could be as small as just you and one employee or it could be as large as G.M. Your pretend business might be a service provider, a manufacturer, or a retail store. You may establish this business in any of the fifty states. It doesn’t matter. The only rule is that your imaginary company must be in a field that is totally foreign to you. So for me, someone who can’t even play an instrument, my fantasy will have me as the leader of a private orchestra. Got it?
I want you to think about your pretend business for a moment. Think about your time, your effort, your sacrifice as I announce that one of your company’s largest expenses is being eliminated. Excited? Did you feel that you are about to be rewarded for your hard work? Have you begun to spend the money?
But this is all an exercise. None of it is real. You can’t know, really know, what you might do in such a situation. Just as I will never be in a band, much less lead an orchestra, the members of the Congressional Budget Office (CBO) have no idea how real businesses function.
In a recently released report, the CBO attempted to predict the possible effects of the Patient Protection and Affordable Care Act (PPACA) on the deficit and the uninsured. It has been widely predicted that employers will dump their company sponsored insurance plans due to the ever-rising costs to comply with the new legislation. That is not new. This COB report unveils a Bad News / Good News scenario that we haven’t seen before.
As reported by Sarah Kliff in The Washington Post, “If employers drop 14 million, currently-insured workers into the exchange, the CBO projects that the federal deficit would actually decrease by $13 billion since those workers could no longer use the current tax deduction for employer-sponsored insurance.” Ms. Kliff’s article quotes the CBO’s numbers and explanation.
The staffers at the Congressional Budget Office imagined a scenario where the owners of businesses would drop the cost of insurance, ignore the government penalty (currently set to be $2,000 per employee per year), and give every employee a raise equivalent to the previous cost of health insurance! If that happened, if all of the employers in the country magnanimously dispersed 100% of the insurance premiums, ignoring personal wants and needs, Social Security tax, unemployment tax, Workman’s Compensation costs, etc…then, and only then, could there be significant deficit reduction from moving millions off employer sponsored group insurance and into the exchanges.
Does this make sense? Sure, if we pretend.
DAVE
www.bcandb.com
Monday, March 19, 2012
Tuesday, March 13, 2012
The Entertainer
I was on a cruise, over a thousand miles south of the Florida coast, when Rush Limbaugh chose to waddle into the fray. Watching CNN as we were dressing for dinner, we thought that we were going to get a break from the stories of the horrific shooting rampage in Chardon when the anchors moved on to other topics. First it was the announcement of the death of Davey Jones. Then it was the death of reason in the ongoing health care debate. El-Rushbo had spoken.
The delivery and payment of health care in this country is already over politicized. We have more than enough emotion and not nearly enough facts. Logic and intellectual honesty are notably absent in most of the discussions. The Republican presidential candidates have studiously avoided anything that even approached a solution. They have all vowed to repeal Obamacare as if that wouldn’t create more problems than it solved. And into this we add Rush.
Where do we begin? Let’s start with a clear statement. Calling Sandra Kay Fluke, a law student four days older than my daughter, a “slut” and a “prostitute” because she vocally supports the President’s health care legislation is abominable. She is a civilian, a private citizen. She isn’t a public figure, someone who willingly subjected herself to this kind of derision or scrutiny. And no, it may not be right to say such things about public figures, but we do. Ms. Fluke should have been off-limits, like the nameless group of men that had testified about women’s birth control the week before.
So the predictable occurred. We put an important national debate on hold while we discussed the relative merits of a radio talk show host. The people that hate him, and Gosh there are plenty who do, got riled up and went after his sponsors. His defenders, a little more reserved than usual, assured us that Rush was just being Rush. There was a certain amount of merit on both sides. There is nothing the political right hates more than to be defeated by the use of the free market. And in all fairness, Limbaugh, ignored in the Republican presidential primary and uninvolved in the national discussion, desperately needed attention. Any attention. Everyone won, even Ms. Fluke. Her brand, her name recognition, is huge. She is assured of a much brighter future thanks to Rush Limbaugh.
What didn’t happen, what was stopped completely, was an intelligent, honest discussion of the issues. So let’s try to kick start the process.
Here are a couple of the stories you might have missed:
Add to this the date March 26, 2012, when the Supreme Court will begin to hear arguments about the Patient Protection and Affordable Care Act, and we have more than enough to keep us busy. In fact, we are much too busy to waste time on an entertainer.
DAVE
www.bcandb.com
The delivery and payment of health care in this country is already over politicized. We have more than enough emotion and not nearly enough facts. Logic and intellectual honesty are notably absent in most of the discussions. The Republican presidential candidates have studiously avoided anything that even approached a solution. They have all vowed to repeal Obamacare as if that wouldn’t create more problems than it solved. And into this we add Rush.
Where do we begin? Let’s start with a clear statement. Calling Sandra Kay Fluke, a law student four days older than my daughter, a “slut” and a “prostitute” because she vocally supports the President’s health care legislation is abominable. She is a civilian, a private citizen. She isn’t a public figure, someone who willingly subjected herself to this kind of derision or scrutiny. And no, it may not be right to say such things about public figures, but we do. Ms. Fluke should have been off-limits, like the nameless group of men that had testified about women’s birth control the week before.
So the predictable occurred. We put an important national debate on hold while we discussed the relative merits of a radio talk show host. The people that hate him, and Gosh there are plenty who do, got riled up and went after his sponsors. His defenders, a little more reserved than usual, assured us that Rush was just being Rush. There was a certain amount of merit on both sides. There is nothing the political right hates more than to be defeated by the use of the free market. And in all fairness, Limbaugh, ignored in the Republican presidential primary and uninvolved in the national discussion, desperately needed attention. Any attention. Everyone won, even Ms. Fluke. Her brand, her name recognition, is huge. She is assured of a much brighter future thanks to Rush Limbaugh.
What didn’t happen, what was stopped completely, was an intelligent, honest discussion of the issues. So let’s try to kick start the process.
Here are a couple of the stories you might have missed:
- We have discussed the Pre-Existing Condition Insurance Plans that the Patient Protection and Affordable Care Act (PPACA) created for the unhealthy uninsureds. The federal government’s actuaries predicted the average cost per enrollee at $13,026. They weren’t even close. The average cost now predicted for each enrollee in 2012 is $28,994! It is that kind of predicting that gives most of us pause as we contemplate the President’s health care program and future liabilities.
- Senator Mitch McConnell (R-KY) has decided that he sees no reason to vote on the repeal of the PPACA until after the November election. It is important to remember that he has never seen a reason to offer an alternative to the President’s plan or a workable way to modify the legislation.
Add to this the date March 26, 2012, when the Supreme Court will begin to hear arguments about the Patient Protection and Affordable Care Act, and we have more than enough to keep us busy. In fact, we are much too busy to waste time on an entertainer.
DAVE
www.bcandb.com
Monday, February 13, 2012
The Guy With The Scalpel? He's My Attorney!
Frank O. had been an agent for over twenty years the day I started with Prudential in October of 1979. My desk was next to his. Fifteen months later I was his manager and my desk was in a private office. I asked to spend a day in the field with Frank, not because he needed me, not even because he wanted me. At best, Frank tolerated me. No, I needed to learn what he was doing and how he had survived for so long as an agent.
The first stop was a longtime client of Frank’s. Climbing up the front steps, I noticed that my employee was walking to the side door. The side door? Frank reminded me that we were not related to the client. We weren’t family. We weren’t their friends. We were service providers and service providers enter via the side door.
It was at that moment that I realized how little I knew about the insurance business.
I was reminded of that humbling experience as I watched President Obama and Health and Human Services Secretary Kathleen Sebelius stumble, again, as they attempted to control the delivery and payment of health care. The biggest difference was that I, at age 26, realized how much I had to learn. Our President and his staff seem surprised that their frequent missteps are so apparent and so unacceptable.
My last post, The Ongoing Religious Battle, addressed the Obama administration’s decision to classify Birth Control Pills, IUD’s, the Morning After Pill, and some forms of Sterilization as preventive Care. The Patient Protection and Affordable Care Act (PPACA) includes a provision that preventive care is FREE. That is the government’s definition of affordable, FREE.
The predicted firestorm erupted. The Vice-President and other committed Catholics in the administration had warned of problems. The White House Chief of Staff resigned. Last Friday the President announced his solution. As long as you don’t care about the moral implications, the money, how insurance works, or intellectual honesty – it was the perfect compromise.
Everything is still free. The insurance company will pay for it.
(Before we go any further, let me assert that I am totally in favor of most forms of birth control and voluntary sterilization. Let me also remind you that this has nothing to do with me, personally. This is about us, all of us.)
It only took a few hours for the double talk of the compromise to become apparent. Senator Roy Blount (R-MO) quickly released a statement via email. It stated, in part:
A little dramatic? Perhaps. I suspect that the Supreme Court will be the final arbiter as to whether this crosses the line. But, Senator Blount was absolutely right when he called out the President for his sleight of hand.
The insurance companies are just going to pay for Birth Control Pills, IUD’s, the Morning After Pill, and certain forms of sterilization? Really? How do they show that on their books? These are claims that are eventually paid by the employer. And of course, large employers, such as hospitals and universities, are often self-insured. The insurance company simply processes the claims and organizes the market.
President Obama decided that insulting observant Catholics and other people of faith wasn’t enough. He decided to insult our intelligence, too. The President declared that insurance companies should pay for Birth Control Pills, IUD’s, the Morning After Pill, and even sterilizations from company coffers because it will save them money. By eating these costs, the insurers won’t be paying for unwanted, unplanned pregnancies. Ignoring the fact that it isn’t the insurer’s money or responsibility, perhaps we should take this to its illogical extreme. If we want to save money and eliminate unwanted and unplanned pregnancies, why don’t we have the insurers hand out chastity belts? Of course that’s silly, but it is no less honest nor illogical as the President’s suggestion.
It is time to remind you that none of this is about contraception, women’s rights, or even preventive care. It is about creating an environment where private insurance becomes unaffordable and only a government solution will work. Whether that is by accident or on purpose is for you to decide. But if you have someone restructuring the delivery and payment of health care in this country who doesn’t understand the basics of the market and insurance, you might as well have your attorney remove your appendix.
DAVE
www.bcandb.com
The first stop was a longtime client of Frank’s. Climbing up the front steps, I noticed that my employee was walking to the side door. The side door? Frank reminded me that we were not related to the client. We weren’t family. We weren’t their friends. We were service providers and service providers enter via the side door.
It was at that moment that I realized how little I knew about the insurance business.
I was reminded of that humbling experience as I watched President Obama and Health and Human Services Secretary Kathleen Sebelius stumble, again, as they attempted to control the delivery and payment of health care. The biggest difference was that I, at age 26, realized how much I had to learn. Our President and his staff seem surprised that their frequent missteps are so apparent and so unacceptable.
My last post, The Ongoing Religious Battle, addressed the Obama administration’s decision to classify Birth Control Pills, IUD’s, the Morning After Pill, and some forms of Sterilization as preventive Care. The Patient Protection and Affordable Care Act (PPACA) includes a provision that preventive care is FREE. That is the government’s definition of affordable, FREE.
The predicted firestorm erupted. The Vice-President and other committed Catholics in the administration had warned of problems. The White House Chief of Staff resigned. Last Friday the President announced his solution. As long as you don’t care about the moral implications, the money, how insurance works, or intellectual honesty – it was the perfect compromise.
Everything is still free. The insurance company will pay for it.
(Before we go any further, let me assert that I am totally in favor of most forms of birth control and voluntary sterilization. Let me also remind you that this has nothing to do with me, personally. This is about us, all of us.)
It only took a few hours for the double talk of the compromise to become apparent. Senator Roy Blount (R-MO) quickly released a statement via email. It stated, in part:
It’s clear that President Obama does not understand that it isn’t about the cost – it’s about who controls the religious views of faith-based institutions. President Obama believes that he should have that control. Our Constitution states otherwise.
Just because you can come up with an accounting gimmick and pretend like religious institutions do not have to pay for the mandate, does not mean that you’ve satisfied the fundamental constitutional freedoms all Americans are guaranteed.
A little dramatic? Perhaps. I suspect that the Supreme Court will be the final arbiter as to whether this crosses the line. But, Senator Blount was absolutely right when he called out the President for his sleight of hand.
The insurance companies are just going to pay for Birth Control Pills, IUD’s, the Morning After Pill, and certain forms of sterilization? Really? How do they show that on their books? These are claims that are eventually paid by the employer. And of course, large employers, such as hospitals and universities, are often self-insured. The insurance company simply processes the claims and organizes the market.
President Obama decided that insulting observant Catholics and other people of faith wasn’t enough. He decided to insult our intelligence, too. The President declared that insurance companies should pay for Birth Control Pills, IUD’s, the Morning After Pill, and even sterilizations from company coffers because it will save them money. By eating these costs, the insurers won’t be paying for unwanted, unplanned pregnancies. Ignoring the fact that it isn’t the insurer’s money or responsibility, perhaps we should take this to its illogical extreme. If we want to save money and eliminate unwanted and unplanned pregnancies, why don’t we have the insurers hand out chastity belts? Of course that’s silly, but it is no less honest nor illogical as the President’s suggestion.
It is time to remind you that none of this is about contraception, women’s rights, or even preventive care. It is about creating an environment where private insurance becomes unaffordable and only a government solution will work. Whether that is by accident or on purpose is for you to decide. But if you have someone restructuring the delivery and payment of health care in this country who doesn’t understand the basics of the market and insurance, you might as well have your attorney remove your appendix.
DAVE
www.bcandb.com
Wednesday, February 1, 2012
The Ongoing Religious Battle
Can you force your employees to live YOUR creed? More importantly, can you make it unpleasant and expensive for your employees to break your personal religion’s rules? The answer, as it is so often, is Yes and No.
Preventive Care is a key benefit of the Patient Protection and Affordable Care Act (PPACA). Katherine Sebelius, Secretary of Health and Human Services, recently decided that Birth Control Pills, IUD’s, and the Morning After Pill are all FDA approved forms of contraception and as valid a part of preventive care for women as mammograms and Pap tests.
The PPACA therefore forces employers to not only cover Birth Control Pills, IUD’s, and the Morning After Pill, but it also eliminates the copays for these items. They are free to the insured employee. This shifts the cost for these items to the insurance which in turn shifts the cost to the employer.
So, if you own a factory and you are opposed to these forms of birth control, you will soon be paying for your employees’ pills. Fair? Most of us will say Yes. We don’t want our employers to dictate moral positions to us.
But what if we aren’t talking about a factory? What if we are discussing a church or a church funded organization? Is there a difference? According to the Obama administration, the answer is No. Every employee has a right to preventive care and preventive care includes birth control. The Supreme Court may disagree.
We are constantly trying to define property rights in this country. Ron Paul takes the Libertarian position that the government doesn’t have the right to force you to conform to other people’s wishes. If you don’t want to serve African-Americans in your restaurant, the market should push you to reconsider, not the law. That is one extreme. The other extreme has the government involved in many of the day to day decisions of businesses. This involvement manifests itself in smoking bans in bars, the elimination of trans fats in restaurants, and forcing businesses to not only provide health insurance, but to determine the very nature of the coverage. This is where we are again.
Where is the line? Can the Catholic Church, which is adamantly opposed to most contraceptives, limit access to its priests, nuns, and church employees? Can the Church limit access to the employees, Catholic and non-Catholic, of its schools? What about Catholic hospitals that may employ hundreds of non-Catholics? How much influence is the employer granted?
The Supreme Court, in a 9 – 0 decision, recently ruled that the First Amendment “gives special solicitude to the rights of religious organizations” in how they treat their employees. This decision was reached in response to a lawsuit brought by a teacher who had been terminated by her employer, a Lutheran school. Chief Justice Roberts challenged “government interference with an internal church decision that affects faith and the mission of the church itself”.
Will the Patient Protection and Affordable Care Act allow you to provide access to birth control for all of your full-time employees? Yes. Will you as an employer pay for it? Yes. Will you be forced to provide access if you don’t want to? If you are a business the answer is still Yes. If you are a church or a religious based institution, the jury is still out.
DAVE
www.bcandb.com
Preventive Care is a key benefit of the Patient Protection and Affordable Care Act (PPACA). Katherine Sebelius, Secretary of Health and Human Services, recently decided that Birth Control Pills, IUD’s, and the Morning After Pill are all FDA approved forms of contraception and as valid a part of preventive care for women as mammograms and Pap tests.
The PPACA therefore forces employers to not only cover Birth Control Pills, IUD’s, and the Morning After Pill, but it also eliminates the copays for these items. They are free to the insured employee. This shifts the cost for these items to the insurance which in turn shifts the cost to the employer.
So, if you own a factory and you are opposed to these forms of birth control, you will soon be paying for your employees’ pills. Fair? Most of us will say Yes. We don’t want our employers to dictate moral positions to us.
But what if we aren’t talking about a factory? What if we are discussing a church or a church funded organization? Is there a difference? According to the Obama administration, the answer is No. Every employee has a right to preventive care and preventive care includes birth control. The Supreme Court may disagree.
We are constantly trying to define property rights in this country. Ron Paul takes the Libertarian position that the government doesn’t have the right to force you to conform to other people’s wishes. If you don’t want to serve African-Americans in your restaurant, the market should push you to reconsider, not the law. That is one extreme. The other extreme has the government involved in many of the day to day decisions of businesses. This involvement manifests itself in smoking bans in bars, the elimination of trans fats in restaurants, and forcing businesses to not only provide health insurance, but to determine the very nature of the coverage. This is where we are again.
Where is the line? Can the Catholic Church, which is adamantly opposed to most contraceptives, limit access to its priests, nuns, and church employees? Can the Church limit access to the employees, Catholic and non-Catholic, of its schools? What about Catholic hospitals that may employ hundreds of non-Catholics? How much influence is the employer granted?
The Supreme Court, in a 9 – 0 decision, recently ruled that the First Amendment “gives special solicitude to the rights of religious organizations” in how they treat their employees. This decision was reached in response to a lawsuit brought by a teacher who had been terminated by her employer, a Lutheran school. Chief Justice Roberts challenged “government interference with an internal church decision that affects faith and the mission of the church itself”.
Will the Patient Protection and Affordable Care Act allow you to provide access to birth control for all of your full-time employees? Yes. Will you as an employer pay for it? Yes. Will you be forced to provide access if you don’t want to? If you are a business the answer is still Yes. If you are a church or a religious based institution, the jury is still out.
DAVE
www.bcandb.com
Monday, January 16, 2012
The Great Great Contest
The new president of the Ohio Jaycees, back in the early 1980’s, was a good old boy from the southern part of our state. We’ll call him Bubba. I was a state level officer and had been very involved in the other guy’s campaign.
Bubba was a nice enough guy who was incapable of stringing four words together without saying the word “great”. No other superlative, just “great”.
The Ohio Jaycees were holding a state-wide meeting and Bubba was going to give a fifteen minute presentation. I created the Great Great Contest. I divided an oversized sheet of cardboard into a thousand numbered squares and allowed the guys to predict how many times Bubba would say “Great”. Each block cost $1. Half would go to the winner. Half to charity. You could hear the crowd counting throughout Bubba’s speech.
Bubba isn’t running for President, but I think about him every time I watch the Republican hopefuls debate. Which candidate will be the first to say that he will “Repeal Obamacare”? It is a race. I half expect Mitt Romney to be mouthing the words as the cameras focus on him during the introduction.
There are two more debates this week. Get out a sheet a paper and keep score. Who gets to be the first to promise to “Repeal Obamacare”? Who says it the most? How many times are Obamacare, and its orphaned cousin, Romneycare, decried in each debate? You may need a large piece of paper.
Now grab a post-it note to score how many times any of these candidates propose an alternative. My prediction – ZERO.
This blog has been clear. The Patient Protection and Affordable Care Act (PPACA) is a terrible overreach and a badly written bill. The numbers don’t add up. The stated goal, the motivation for this whole endeavor, was to cover the uninsured. The PPACA has not solved that problem. But, what does repealing it accomplish?
The PPACA is almost two years old. Businesses and insurance companies have spent millions of dollars to comply with the ever-changing regulations. President Obama was clear, prior to the bill’s passage, that “if you like your current health insurance plan, you can keep it”. That didn’t happen. The cost to maintain a separate series of “grandfathered” contracts compliant with the contradictory regulations emanating from Katherine Sebelius’s Health and Human Services was beyond reason. One by one, the insurers eliminated all of their old contracts. If you repeal the PPACA, do you have to go through the expense of changing the majority of the group and individual health policies in our country?
The PPACA made preventive care a mandatory benefit. Does that stay or go?
The PPACA allows children to stay on their parents’ insurance until age 26. How many pregnant 24 year olds would lose coverage if you suddenly repealed the PPACA?
Would the repeal of the Patient Protection and Affordable Care Act eliminate the health policies that were created for the chronically uninsured?
You get the idea. The PPACA may be a mess, but it, just like the problems it purported to fix, exists. Repealing the Presidents’ health care plan without having a well-crafted replacement might be worse than retaining it.
This blog has consistently doubted the Republican’s sincerity about repealing the PPACA. I view it as a safe fundraising ploy. It would take way too much effort to create a viable alternative. There is no risk to denigrating legislation disliked by over half of our populace. Creating an alternative would expose them to the same type of scrutiny and probably the same results. Even modifying the law was more effort than the Republican House could muster.
Bubba said “Great” 123 times. The winner received $140. Bubba isn’t running for President, but I am convinced that he was one of Michele Bachmann’s speechwriters.
DAVE
www.bcandb.com
Bubba was a nice enough guy who was incapable of stringing four words together without saying the word “great”. No other superlative, just “great”.
The Ohio Jaycees were holding a state-wide meeting and Bubba was going to give a fifteen minute presentation. I created the Great Great Contest. I divided an oversized sheet of cardboard into a thousand numbered squares and allowed the guys to predict how many times Bubba would say “Great”. Each block cost $1. Half would go to the winner. Half to charity. You could hear the crowd counting throughout Bubba’s speech.
Bubba isn’t running for President, but I think about him every time I watch the Republican hopefuls debate. Which candidate will be the first to say that he will “Repeal Obamacare”? It is a race. I half expect Mitt Romney to be mouthing the words as the cameras focus on him during the introduction.
There are two more debates this week. Get out a sheet a paper and keep score. Who gets to be the first to promise to “Repeal Obamacare”? Who says it the most? How many times are Obamacare, and its orphaned cousin, Romneycare, decried in each debate? You may need a large piece of paper.
Now grab a post-it note to score how many times any of these candidates propose an alternative. My prediction – ZERO.
This blog has been clear. The Patient Protection and Affordable Care Act (PPACA) is a terrible overreach and a badly written bill. The numbers don’t add up. The stated goal, the motivation for this whole endeavor, was to cover the uninsured. The PPACA has not solved that problem. But, what does repealing it accomplish?
The PPACA is almost two years old. Businesses and insurance companies have spent millions of dollars to comply with the ever-changing regulations. President Obama was clear, prior to the bill’s passage, that “if you like your current health insurance plan, you can keep it”. That didn’t happen. The cost to maintain a separate series of “grandfathered” contracts compliant with the contradictory regulations emanating from Katherine Sebelius’s Health and Human Services was beyond reason. One by one, the insurers eliminated all of their old contracts. If you repeal the PPACA, do you have to go through the expense of changing the majority of the group and individual health policies in our country?
The PPACA made preventive care a mandatory benefit. Does that stay or go?
The PPACA allows children to stay on their parents’ insurance until age 26. How many pregnant 24 year olds would lose coverage if you suddenly repealed the PPACA?
Would the repeal of the Patient Protection and Affordable Care Act eliminate the health policies that were created for the chronically uninsured?
You get the idea. The PPACA may be a mess, but it, just like the problems it purported to fix, exists. Repealing the Presidents’ health care plan without having a well-crafted replacement might be worse than retaining it.
This blog has consistently doubted the Republican’s sincerity about repealing the PPACA. I view it as a safe fundraising ploy. It would take way too much effort to create a viable alternative. There is no risk to denigrating legislation disliked by over half of our populace. Creating an alternative would expose them to the same type of scrutiny and probably the same results. Even modifying the law was more effort than the Republican House could muster.
Bubba said “Great” 123 times. The winner received $140. Bubba isn’t running for President, but I am convinced that he was one of Michele Bachmann’s speechwriters.
DAVE
www.bcandb.com
Friday, December 30, 2011
Clear As Mud
When is selling not selling? Where is the line between helping your customer and primarily helping yourself? Determining that becomes harder each day.
One of my clients needed to talk. She had received a disturbing phone call at her home and wanted to know if she had handled it correctly and if I knew the back story. Mary (not her real name) was contacted by a national pharmacy. We’ll call the pharmacy chain Mega Rx. Mary was advised that her insurer would no longer cover medications for her and her family from their local Mega Rx. Since they knew that Mary would hate to loose access to Mega Rx, they would be happy to connect her to someone who could help her find an insurance policy that would allow her to retain them. All she had to do was stay on the line. Mary thanked them but said that she already had an agent and hung up.
Think about this for a second. The national drug store chain had fought and lost a battle with a national insurer. They were mining their records for anyone who had that insurer and had had a prescription filled in the last year or so. And if Mary was gullible and not paying attention, she might have somehow been talked into different insurance that would have definitely covered Mega Rx, but might not have covered her doctor, or given her and her family the same level of coverage.
The appointment to change individual health insurance policies usually takes an hour in my office and involves a lot more than whether or not Mega Rx is in the network. This silliness is taking place under our current set of rules. The states and the federal government are still writing the new rules. Some people don’t think we really need licensed agents. Why not let anyone sell insurance?
I just spent twenty minutes completing my application to renew my license to sell life and health insurance. I had to prove that I had completed 21 hours of continuing education and 3 additional hours of ethics training in the last two years. I actually had a total of 42. That does not include the 7 to 9 hours per year for Medicare products or the mandatory additional training for long term care coverage. I then attested that I haven’t been convicted of any crimes, haven’t had my insurance license suspended or revoked, and that I don’t owe back child support. This is true. You can not sell insurance in the State of Ohio if you owe back child support. I paid my $5 and I should get an approval notice some time next week.
All states have seen a value in licensing insurance agents. It is obvious that one value of the requirements is to weed out the part-timers. The public is better served by committed professionals who are willing to take the time and effort to stay current. And though insurance agents (me included) will never be confused with rocket scientist, we do serve an important function in the market as we help the insured public acquire coverage and navigate the process to get the most from their contracts. The insurers long ago (begrudgingly) accepted our value.
This brings us to the Patient Protection and Affordable Care Act (PPACA). The authors of this legislation did not believe that the public is capable of calling an insurance agent or company or shopping online to purchase health insurance. Since finding health insurance was so difficult, insurance exchanges, a marketplace, would be created in each state. As you can see from the Obama administration’s website, the exchanges, an additional layer of bureaucracy, is going to save you money. And how will you get to the exchange and who is going to help you choose the right type of policy for you? That would be the Navigators.
The PPACA is pretty sure that almost anyone that can fog a mirror is capable of doing my job. Any employee of trade association or union can walk you through the process. In fact, the PPACA spends more time on the notion that the Navigators can not be compensated by the insurers than it does on training or qualifications.
A well publicized letter from David M. Casey, Senior Vice President of MAXIMUS, a company that specializes in Medicaid enrollment, details the Patient Protection and Affordable Care Act’s aversion to professional insurance agents.
John Doak, the Oklahoma Insurance Commissioner, is succinct in his judgment. He has consistently challenged the federal government’s intrusion into insurance regulation and health insurance. He has asked what kind of training the Navigators will have in insurance products, health information privacy regulations (HIPAA), or ethics. And of course we already knew the answer, none.
The other question is “Who will be paying the Navigators”? You have two choices. Either the Navigators eventually become employees of an endlessly growing government program, or they are employees of organizations who have something to gain by you and I being steered into one policy versus another. And that brings us back to Mega Rx. The major pharmacy chains are currently exploring ways to have employees become Navigators under the future exchange program. Will they be impartial? Will they be looking out for your best interest? Will the sun rise from the west tomorrow morning?
This is too easy and way too transparent a case of conflict of interest. What if a major insurer is donating money to your local trade group? The employee of that trade group would work to navigate people to that company’s policy. There is a lot of money involved. This won’t be subtle. And it won’t be easily traced.
So when you get that phone call from the drug store, or the doctor’s office, or the Chamber of Commerce, and you will one day, ask yourself why. Slow the process down and try to determine who is getting paid and for what.
In the interest of creating transparency and simplicity, we have failed at both.
DAVE
www.bcandb.com
One of my clients needed to talk. She had received a disturbing phone call at her home and wanted to know if she had handled it correctly and if I knew the back story. Mary (not her real name) was contacted by a national pharmacy. We’ll call the pharmacy chain Mega Rx. Mary was advised that her insurer would no longer cover medications for her and her family from their local Mega Rx. Since they knew that Mary would hate to loose access to Mega Rx, they would be happy to connect her to someone who could help her find an insurance policy that would allow her to retain them. All she had to do was stay on the line. Mary thanked them but said that she already had an agent and hung up.
Think about this for a second. The national drug store chain had fought and lost a battle with a national insurer. They were mining their records for anyone who had that insurer and had had a prescription filled in the last year or so. And if Mary was gullible and not paying attention, she might have somehow been talked into different insurance that would have definitely covered Mega Rx, but might not have covered her doctor, or given her and her family the same level of coverage.
The appointment to change individual health insurance policies usually takes an hour in my office and involves a lot more than whether or not Mega Rx is in the network. This silliness is taking place under our current set of rules. The states and the federal government are still writing the new rules. Some people don’t think we really need licensed agents. Why not let anyone sell insurance?
I just spent twenty minutes completing my application to renew my license to sell life and health insurance. I had to prove that I had completed 21 hours of continuing education and 3 additional hours of ethics training in the last two years. I actually had a total of 42. That does not include the 7 to 9 hours per year for Medicare products or the mandatory additional training for long term care coverage. I then attested that I haven’t been convicted of any crimes, haven’t had my insurance license suspended or revoked, and that I don’t owe back child support. This is true. You can not sell insurance in the State of Ohio if you owe back child support. I paid my $5 and I should get an approval notice some time next week.
All states have seen a value in licensing insurance agents. It is obvious that one value of the requirements is to weed out the part-timers. The public is better served by committed professionals who are willing to take the time and effort to stay current. And though insurance agents (me included) will never be confused with rocket scientist, we do serve an important function in the market as we help the insured public acquire coverage and navigate the process to get the most from their contracts. The insurers long ago (begrudgingly) accepted our value.
This brings us to the Patient Protection and Affordable Care Act (PPACA). The authors of this legislation did not believe that the public is capable of calling an insurance agent or company or shopping online to purchase health insurance. Since finding health insurance was so difficult, insurance exchanges, a marketplace, would be created in each state. As you can see from the Obama administration’s website, the exchanges, an additional layer of bureaucracy, is going to save you money. And how will you get to the exchange and who is going to help you choose the right type of policy for you? That would be the Navigators.
The PPACA is pretty sure that almost anyone that can fog a mirror is capable of doing my job. Any employee of trade association or union can walk you through the process. In fact, the PPACA spends more time on the notion that the Navigators can not be compensated by the insurers than it does on training or qualifications.
A well publicized letter from David M. Casey, Senior Vice President of MAXIMUS, a company that specializes in Medicaid enrollment, details the Patient Protection and Affordable Care Act’s aversion to professional insurance agents.
John Doak, the Oklahoma Insurance Commissioner, is succinct in his judgment. He has consistently challenged the federal government’s intrusion into insurance regulation and health insurance. He has asked what kind of training the Navigators will have in insurance products, health information privacy regulations (HIPAA), or ethics. And of course we already knew the answer, none.
The other question is “Who will be paying the Navigators”? You have two choices. Either the Navigators eventually become employees of an endlessly growing government program, or they are employees of organizations who have something to gain by you and I being steered into one policy versus another. And that brings us back to Mega Rx. The major pharmacy chains are currently exploring ways to have employees become Navigators under the future exchange program. Will they be impartial? Will they be looking out for your best interest? Will the sun rise from the west tomorrow morning?
This is too easy and way too transparent a case of conflict of interest. What if a major insurer is donating money to your local trade group? The employee of that trade group would work to navigate people to that company’s policy. There is a lot of money involved. This won’t be subtle. And it won’t be easily traced.
So when you get that phone call from the drug store, or the doctor’s office, or the Chamber of Commerce, and you will one day, ask yourself why. Slow the process down and try to determine who is getting paid and for what.
In the interest of creating transparency and simplicity, we have failed at both.
DAVE
www.bcandb.com
Thursday, December 15, 2011
The Day After The House Burned Down
This is a post about someone with cancer. I have not met Ms. Ward, nor do I think that I ever will, but I wish her a successful recovery. This post may take issue with some of her choices and many of her conclusions. These differences should not be interpreted as personal. They are not. Too many of our discussions have devolved into the personal as they abandon fact and reason. This blog champions a polite discussion of the facts.
Spike Dolomite Ward has cancer. Ms. Ward is a forty-nine year old married mother of two. She lives in California. This past Sunday’s Plain Dealer included an article she wrote that initially appeared in the Los Angeles Times. Ms. Ward explained why she hasn’t had health insurance for over two years. Trust her, it is not her fault.
The key element, the point that requires ten paragraphs to justify, is that she has been saved by President Obama and the Patient Protection and Affordable Care Act (PPACA). How you ask? Will the President be administering the Chemo? No, but close. As we have discussed before, the PPACA included the creation of guaranteed issue policies that cover pre-existing conditions for people who have been uninsured for over six months.
I completely understand the need to purchase homeowners insurance now that my house has burned to the ground.
Please read Ms. Ward’s article. It is entirely possible that the laws in California are very different from those here in Ohio. It is also possible that there is a touch of exaggeration and hyperbole in those first ten paragraphs. Don’t get lost in the details. They aren’t relevant. This post is about the uninsured and the individual mandate.
We are, or at least should be, responsible for our choices. Ms. Ward is not alone. There are millions of uninsured Americans. The poor have Medicaid, a program that should have received a lot more attention in the last two years. It is the working poor that are falling through our system’s cracks. There is also a large segment of the population who simply choose to spend the money on other stuff. I refuse to speculate as to Ms. Ward and her family’s status.
Ms. Ward is correct. Her life choices, her insurance choices, her and her husband’s job choices could have had devastating consequences. Instead, someone else, you, will pay the bills. Any solution that includes guaranteed issue and the complete coverage of preexisting conditions must include a mandate that requires everyone to have insurance.
The individual mandate has been both championed and disparaged by everyone from Newt Gingrich to Barack Obama. One day they embrace it. The next day they flee from the concept. As an agent, as someone in the system for thirty-three years, I am convinced that requiring people to participate is the only way a guaranteed issue plan would work. This is not limited to private insurance programs. A government plan is just as dependent on universal participation. That is why Medicare Part B and Part D penalize late enrollees.
All of the candidates expressed their hatred of the individual mandate at last week’s Republican debate. I understand. They are running for president. But the time has come to stop telling us that you hate “Obamacare” and to instead offer a realistic alternative. Better yet, there are lots of serious people waiting to hear any viable option that doesn’t include an individual mandate.
Whether or not an alternative is ever proposed and passed, we wish a full and speedy recovery to Ms. Ward. And we wonder how in the world we can afford all of the other Spike Dolomite Wards we are going to be supporting.
Spike Dolomite Ward has cancer. Ms. Ward is a forty-nine year old married mother of two. She lives in California. This past Sunday’s Plain Dealer included an article she wrote that initially appeared in the Los Angeles Times. Ms. Ward explained why she hasn’t had health insurance for over two years. Trust her, it is not her fault.
The key element, the point that requires ten paragraphs to justify, is that she has been saved by President Obama and the Patient Protection and Affordable Care Act (PPACA). How you ask? Will the President be administering the Chemo? No, but close. As we have discussed before, the PPACA included the creation of guaranteed issue policies that cover pre-existing conditions for people who have been uninsured for over six months.
- Significant medical condition like cancer? Check.
- About to have lots of expensive treatments? Check.
- Uninsured for over six months? Check.
- Insurance now seems like a really, really good idea? CHECK.
I completely understand the need to purchase homeowners insurance now that my house has burned to the ground.
Please read Ms. Ward’s article. It is entirely possible that the laws in California are very different from those here in Ohio. It is also possible that there is a touch of exaggeration and hyperbole in those first ten paragraphs. Don’t get lost in the details. They aren’t relevant. This post is about the uninsured and the individual mandate.
We are, or at least should be, responsible for our choices. Ms. Ward is not alone. There are millions of uninsured Americans. The poor have Medicaid, a program that should have received a lot more attention in the last two years. It is the working poor that are falling through our system’s cracks. There is also a large segment of the population who simply choose to spend the money on other stuff. I refuse to speculate as to Ms. Ward and her family’s status.
Ms. Ward is correct. Her life choices, her insurance choices, her and her husband’s job choices could have had devastating consequences. Instead, someone else, you, will pay the bills. Any solution that includes guaranteed issue and the complete coverage of preexisting conditions must include a mandate that requires everyone to have insurance.
The individual mandate has been both championed and disparaged by everyone from Newt Gingrich to Barack Obama. One day they embrace it. The next day they flee from the concept. As an agent, as someone in the system for thirty-three years, I am convinced that requiring people to participate is the only way a guaranteed issue plan would work. This is not limited to private insurance programs. A government plan is just as dependent on universal participation. That is why Medicare Part B and Part D penalize late enrollees.
All of the candidates expressed their hatred of the individual mandate at last week’s Republican debate. I understand. They are running for president. But the time has come to stop telling us that you hate “Obamacare” and to instead offer a realistic alternative. Better yet, there are lots of serious people waiting to hear any viable option that doesn’t include an individual mandate.
Whether or not an alternative is ever proposed and passed, we wish a full and speedy recovery to Ms. Ward. And we wonder how in the world we can afford all of the other Spike Dolomite Wards we are going to be supporting.
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