Bone Of Contention

 

This blog has sounded the alarm.  There is a concerted effort to dismantle regulations, at least those impacting business activity and business behavior.  And though this is Health Insurance Issues With Dave, we have to take a moment to talk about boneless chicken wings. 

Here is the link to the Court News Ohio article.  The two minute version is that an Ohio man, Michael Berkheimer, revisited a local restaurant in 2017 and ordered his usual, boneless chicken wings.  From the article: 

“Berkheimer followed his normal practice of cutting each boneless wing into two or three pieces. He was eating the third piece of a wing when he felt “a piece of meat [go] down the wrong pipe.” He went to the restroom to try to clear his throat but was unsuccessful. Over the next three days, he spiked a fever and had trouble eating. During a visit to the emergency room, a doctor discovered a thin chicken bone lodged in his esophagus. His medical records indicated it was a “5 cm-long chicken bone,” which is about 1-3/8 inches.” 

The Ohio Supreme Court has ruled that Mr. Berkheimer cannot sue the restaurant or anyone responsible for the production of not-boneless boneless chicken wings.  Our courts have decided that you have no right to assume that a product sold as boneless would actually not have any bones.  This faith in the marketplace to self-correct means that anyone can sell you anything.  No matter what, you should know better.

 I am not implying coordination.  Instead, I see a convergence of a particular mindset / political view with those who would exploit weaknesses in the regulatory system.  Specifically, I am looking at the way legislation pending in the Ohio legislature, H.B. 400 and H.B. 587, would work with the Heritage Foundation’s Project 2025. 

H.B. 400 – Changes the way Medicare Supplements are marketed.  The bill would allow Medicare Beneficiaries under age 65 to purchase Medicare Supplement coverage.  It would also allow these Beneficiaries to change their policies annually.  Since they are under 65 and already declared Medicare eligible due to sickness or injury, there can’t be any underwriting.  Key changes:

·         Sale of Medicare Supplements to <65

·         Change Medicare Supplement policies annually, guaranteed issue with Pre-Ex covered

·         A whole new market that is constantly eligible.

·         Pricing locked in to the age 65 rate

·         Medicare Supplement marketing is state regulated

·         NO MENTION OF MEDICARE PART D (Rx) WHICH HAS FEDERAL MARKETING REGULATIONS.

H.B. 587 – Changes the way Medicare Supplements are marketed within the State of Ohio.  Many of Ohio’s current regulations mirror the federal government’s Medicare Advantage / Medicare Part D (Rx) prohibitions.  This bill removes these consumer safeguards while ignoring the need to help the consumer understand and address all of his/her needs.  Someone purchasing a Medicare Supplement would also need a Medicare Part D (Rx) plan.  And that individual might even be better served with a Medicare Advantage Plan.  Current Federal regulations would prevent the marketing of those plans at that time.  Key changes:

·         “Print solicitations such as…door hangers left at residences or on motor vehicles.”

·         “In-person solicitations of individuals at the individual’s residence or in public or common areas such as parking lots, hallways, lobbies, or sidewalks.”

·         “Telephonic or electronic solicitation such as electronic voicemail messages, text messages, or direct social media messages.”

Please note that H.B. 587 does not address the likelihood that many of those solicited would not qualify for the purchase of a Medicare Supplement policy under the current rules due to their preexisting conditions.  Beneficiaries currently covered by a Medicare Advantage Plan would have to answer health questions and would be subject to decline if they have had the MAPD for over 12 months.  This bill does not address the Beneficiaries’ need for Medicare Part D (Rx) coverage.

 

Project 2025 – The Heritage Foundation’s Mandate for Leadership: The Conservative Promise.  If I may skip the 533 times tax and/or taxpayer are mentioned and the 199 times for abortion, the other key focus of Project 2025 is the privatization and / or move to state (non)regulation of federally regulated programs.  The privatization of Social Security and the move of programs such as Medicare to state regulation are an inherent part of Project 2025.  And this is the final connection:

·         If Medicare was regulated by the State of Ohio, we could lose all of the consumer protections:

A.      Minimum standards for MAPD policies

B.      Age restrictions on Medicare Supplements

C.      Meaningful guaranteed issue vs. underwritten times to purchase coverage

D.     All marketing regulations.  Once anyone on Medicare can routinely change plans, marketing restrictions would be ignored (see current call centers with MAPD) and eventually eliminated.

It is important to remember that this mindset is completely convinced that the market will correct any and all excesses.  That faith in market correction ignores the real world consequences of the damage done. 

This same thinking can be applied to their efforts to dismantle the Patient Protection and Affordable Care Act in our industry and countless other examples in other industries.  

Eliminate all consumer safeguards?  I have a bone to pick with that. 

Dave 

www.cunixinsurance.com

Picture – Dependably Boneless – David L Cunix 

Quick footnote – I hope that some of you, especially those of you who are insurance agents, will click on the links to the legislation.  Both bills are only a few pages.  Also, the Project 2025 link is searchable.

It's All Great As Long As You Don't Pay Attention

Warning – Today’s post deals with the controversial Heritage Foundation Project 2025 Mandate for Leadership: The Conservative Promise.  Here’s a hint, I’m not a fan.  If offering my thoughts and quoting from this document might bother you, skip this issue and come back in another week or so.  Dave

One of last month’s posts on Health Insurance Issues With Dave discussed The Republican Study Committee Fiscal 2025 Budget Proposal and how it would, if given a chance, impact health insurance, the way most Americans access and pay for health care.  Today’s post will take a look at the Heritage Foundation’s Project 2025 Mandate for Leadership: The Conservative Promise.  It is important to note that this blog is my opinion on the major issues affecting health insurance, but the links will take you to the source material.  If you doubt my characterization of Project 2025, read it and then get back to me.

First, a little about the Heritage Foundation.  Many of us in the insurance business first became acquainted with this organization in the late 1980’s and/or early 1990’s.  The Individual Mandate, later to become a flashpoint in the Patient Protection and Affordable Care Act (Obamacare), originated with the Heritage Foundation in 1989.  Conservative Republicans including Orrin Hatch (R-UT), Charles Grassley (R-IA), and Newt Gingrich (R-GA) introduced legislation in 1993 that included the Individual Mandate as a counter to “ClintonCare”.   The concept also played a part in the Republican sponsored Medicare Part D (Rx) legislation ten years later.  As I have often noted for my clients, the first casualty of Obamacare was intellectual honesty.

The history is important because there are those who would edit the records based on whichever way the wind is blowing.  I have seen television interviews of the president of the Heritage Foundation, Kevin Roberts.  I’m certain that he will, by this time next year, either affirm or deny everything he’s said, depending on the results of the election.  But for now we can see and hear him say, “We are in the process of the second American Revolution, which will remain bloodless if the left allows it to be”.

There have been many scholarly papers written about using tax policies for social engineering.  Our government encourages marriage, having children, and owning a home through a variety of tax incentives.  So it is no surprise that the 922 page Project 2025 mentions the word tax or taxpayer a whopping 533 times.  For the record, here are how often a few other key words appear:

• Medicaid                      55 times
• Medicare                      51
• Health Insurance        11
• Obamacare / ACA       17
• Abortion                       199

Medicare first appears on Page 283.  This is an unedited excerpt: 

The first year that Medicare spending was visible on the books was 1967. From that point on through 2020—according to the American Main Street Initiative’s analysis of official federal tallies—Medicare and Medicaid combined cost $17.8 trillion, while our combined federal deficits over that same span were $17.9 trillion. In essence, our deficit problem is a Medicare and Medicaid problem. 

Please review your most recent paycheck.  If you are an employee, you and your employer each paid a 1.45% Medicare Tax.  If you are self-employed you paid the entire 2.9%.  Most Medicare beneficiaries also pay $174.90 per month for Medicare Part B.  The Heritage Foundation is pretending that there is no funding for these programs and is simply fudging the numbers.

On Page 463 we finally get to the meat of the Heritage Foundation’s plan.  First this paragraph:

Increase Medicare beneficiaries’ control of their health care. Patients are best positioned to determine the value of health care services, working with their health care providers. They also benefit from increased choice of doctors, hospitals, and insurance plans. Access to reliable information with respect to physicians, hospitals, and insurers is therefore essential.

This was quickly followed on the next page by:

1. Make Medicare Advantage the default enrollment option.

Where is Alanis Morissette when we need her?

Let’s move over to health insurance.  A few pages later, on page 468, we get to individual health insurance.  Over the next few pages they will cover the importance of concierge medicine, pricing negotiations on a case by case basis, and the elimination of the safeguards built into Obamacare (guaranteed issue, preexisting conditions covered, no policy maximum benefits, etc.)  I am posting some of the actual paragraphs for you to read.

AFFORDABLE CARE ACT AND PRIVATE HEALTH INSURANCE 

Remove barriers to direct primary care. Direct primary care (DPC) is an innovative health care delivery model in which doctors contract directly with patients for their care on a subscription basis regardless of how or where the care is provided. The DPC model is improving patient access, driving higher quality and lower cost, and strengthening the doctor– patient relationship. DPC has faced many challenges from government policymakers, including overly exuberant attempts at regulation and misclassification. Changes should clarify that DPC’s fixed fee for care does not constitute insurance in the context of health savings accounts. 

Facilitate the development of shared savings and reference pricing plan options. Under traditional insurance, patients who choose lower cost care do not benefit financially from that choice. Barriers to rewarding patients for cost-saving decisions should be removed. CMS should ensure that shared savings and reference pricing models that reward consumers are permitted. 

Separate the subsidized ACA exchange market from the non-subsidized insurance market. The Affordable Care Act has made insurance more expensive and less competitive, and the ACA subsidy scheme simply masks these impacts.  To make health insurance coverage more affordable for those who are without government subsidies, CMS should develop a plan to separate the non-subsidized insurance market from the subsidized market, giving the non-subsidized market regulatory relief from the costly ACA regulatory mandates.

Strengthen hospital price transparency. In 2020, CMS completed its rule to require hospitals to post the prices of common hospital procedures. Future updates of these rules should focus on including quality measures. Combined with the shared savings models and other consumer tools, these efforts could deliver considerable savings for consumers.

Center for Consumer Information and Insurance Oversight (CCHO).

CMS also plays an outsized role in overseeing the Obamacare exchanges, including managing Healthcare.gov, through the Center for Consumer Information and Insurance Oversight (CCIIO). While Obamacare limits plan options, CCIIO has been overly prescriptive in dictating what benefits and types of health plans may participate in the exchanges, thereby actually stifling market innovation and driving up costs.

Congress should build on the Trump Administration’s efforts to expand choices for small businesses and workers, both in and out of the exchanges, by codifying an expansion of association health plans, short-term health plans, and health reimbursement arrangements (including individual coverage HRAs). CCIIO should also work with the Treasury Department and the Office of Management and Budget (OMB) to give consumers more flexibility with their health care dollars through expanded access to health savings account.

The Heritage Foundation is not a big fan of Group Health Insurance:

Wages vs. Benefits.

The current tax code has a strong bias that incentivizes businesses to offer employees more generous benefits and lower wages. This limits the freedom of workers and their families to spend their compensation as they see fit—and it can trap workers in their current jobs due to the jobs’ benefit packages. Wage income is taxed under the individual income tax and under the payroll tax. However, most forms of non-wage benefits are wholly exempt from both of these taxes. To reduce this tax bias against wages (as opposed to employee benefits), the next Administration should set a meaningful cap (no higher than $12,000 per year per full-time equivalent employee—and preferably lower) on untaxed benefits that employers can claim as deductions. Employee benefit expenses other than tax-deferred retirement account contributions should count toward the limitation, whether offered to specific employees or whether the costs relate to a shared benefit like building gym facilities for employees. Tax-deferred retirement contributions by employers should not count toward this limitation insofar as they are fully taxable upon distribution. Only a percentage of Health Savings Accounts (HSA) contributions (which are not taxed upon withdrawal) should count toward the limitation.  The limitation on benefit deductions should not be indexed to increase with inflation.  Employers should also be denied deductions for health insurance and other benefits provided to employee dependents if the dependents are aged 23 or older. 

My focus is on health insurance.  There is more, a lot more, focused on removing guardrails with the understanding that there is no reason to worry about excesses because the market will self-correct.  But this is health care, not just 20% of the economy but whether or not you get to see a doctor and receive medical attention when you need it.

This is getting long so I will spare you the numerous abortion, LGBTQ+ (12), or gender (111) references.  I had to include the one section that proves that self-described Conservatives have rhythm:

Expand inclusion of fertility awareness–based methods and supplies to family planning in the women’s preventive services mandate.

The ACA requires coverage of and prevents insurance plans from imposing any cost-sharing requirements on women who obtain preventive care and screenings as defined by HRSA. In 2016, HHS included “instruction in fertility awareness-based methods” as part of this requirement. However, in December 2021, HHS removed that language from its list without using the notice-and-comment process or giving any rationale, both of which are mandated by the Administrative Procedures Act. In August 2022, a federal court blocked this attempt to eliminate health insurance coverage for fertility awareness–based methods of family planning from requirements that cover at least 58 million women, and the judge made his ruling permanent in December 2022. HRSA should promulgate regulations consistent with this order. HHS should more thoroughly ensure that fertility awareness–based methods of family planning are part of women’s preventive services under the ACA. FABMs often involve costs for materials and supplies, and HHS should make clear that coverage of those items is also required. FABMs are highly effective and allow women to make family planning choices in a manner that meets their needs and reflects their values.

A lot has been said about Project 2025.  Some on the left have taken these plans to their illogical extreme.  Many on the right are already running away from Project 2025 (unless they win).  There wasn’t a Republican Party platform in 2020.  The recently released 2024 draft is oddly silent on almost everything other than the border.  If we are going to assess the Republican plans for governing this country in general and health care in particular, we must look at the work of the Republican Study Committee and the Heritage Foundation.  Those links will take you to THEIR WORDS and THEIR GOALS.  I am only here to get you started.

We are all in this together.

Dave

www.cunixinsurance.com

Picture – The Gorge – David L Cunix

They Killed A Tree In Your Honor

 

The last thing I tell all of my new Medicare clients is that they will receive their insurance cards, a Welcome Kit, and lots of stuff related to their new coverage.  “They are going to kill a tree in your honor” is how I try to put this into perspective.  And even with that, at least one client calls each month to let me know how much correspondence they are receiving from one of their new insurers.  This, of course, leads us to an important question:

When is junk not junk?

               

This is a serious question.   Overwhelmed by conflicting and confusing correspondence from their insurer, especially the Medicare Part D (Rx) insurance companies, they invariably miss an important letter or billing statement.  AND THEY LAPSE THEIR POLICY!  I have seen clients lapse policies that have a premium of less than $10 per month.  And once it is gone, it is gone.  The policy won’t be reinstated.  The Medicare beneficiary, in most cases, is stuck without prescription drug coverage until the next Annual Enrollment Period.  This is not a money issue.  I have had professionals, a doctor, a financial planner, and business owners lapse their Medicare Part D (Rx) plans.  And though the insurance company is flooding their clients’ mailboxes, there is absolutely no correspondence with the agents.  NONE. The policy is normally terminated before we learn that there is a problem.  My peers and I are trying to change this, but until then, open all of the mail from your insurer.  And call your agent if you receive something that doesn’t make sense.

 

When is junk mail really junk?

The postcard was green.  Seriously.  The government is not sending you a green postcard about your Medicare benefits.  This client was amused.  The other side of the postcard noted that this was registered to her.  She might qualify for a Medicare plan with $3,500 coverage for routine dental and/or $325 for healthy food options at certain grocery stores.  There was more and a phone number to call.  And, in almost impossibly small and faint print, the legally required disclosures.  All Medicare marketing materials must contain the following verbiage: “We do not offer every plan available in your area.  Currently, we represent 7 organizations which offer 62 products in your area.  Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program (SHIP) to get information on all of your options”.  It is required. 

This is just a sales pitch, no better and no worse than the rest of the junk mail we receive almost every day.   And even though the disclosures are really difficult to read, the green postcard and heavy-handed text (Do Not Discard) make this hard to take seriously.  It is the very definition of junk mail. 

But the promise of something for nothing is very tempting. 

I received a call last week from a wealthy couple.  He owns a successful business and she has been a self-employed consultant for decades.  They called about the FREE GROCERIES.  I asked them if they needed free groceries.  I reminded them that they actually pay the Income-Related Monthly Adjusted Amount (IRMAA), a fee paid by less than 10% of all Medicare beneficiaries.  So, for real, is anyone giving you free groceries or are you being sold something you really don’t want?  Gosh we all love free stuff.  And the television commercials and junk mail stoke that fire. 

We are going to get more junk mail, not less.  And there is pending legislation in Columbus to make it easier for unscrupulous marketers to call you and even to come knocking, uninvited, at your door.   Read the mail from your insurer, throw away the junk, and when in doubt, call your agent.

 Dave 

www.againreally.com

 Picture – Wasted Paper / Wasted Time – David L Cunix

Golf

 

We didn’t play golf today.  The weather reports had called for rain.  It didn’t.  We had listened and trusted the forecasters and predictions.  We erred on the side of caution.  We would have gone to the course when we were younger, but we are all old guys now, the youngest of our foursome will be 69 in August.  We could have played.  The ground was wet.  The course was soggy.  There was a chill in the air.  I stayed home, opened the windows, and made a pot of chili. 

That is the chance one takes when you listen and rely on experts.  The predictors, the prognosticators don’t all agree.  Our first task is to guess which mavens, if any, we should trust and follow.  This can be a difficult undertaking.  We all possess specialized knowledge.  With over 45 years in the insurance business, I am on firm ground when discussing health insurance, health insurance companies, and even the politics of health insurance law.  That doesn’t mean that I know anything about auto mechanics, lacrosse, or even the weather.  It also doesn’t mean that every other agent, or even any other agent, would agree with me.  That’s OK.

This blog began in 2009 during the run-up to the Patient Protection and Affordable Care Act (Obamacare).  The initial focus was the fear that our politicians would craft a European-like single payer system.  I tried to detail the backroom dealings of Congressmen and Senators from both sides of the aisle.  And because the Democrats were in the center of most of the action, many of the posts focused on their public and private positions.  The politicians, some that I knew personally, were not always happy with me or this blog.  Once the law was passed, the focus moved to the hypocrisy and cynicism of the Republican leadership.   And then it got dangerous.

The question – would the Republicans treat the PPACA the way they had treated abortion in the 1980’s, 1990’s, and 2000’s?  Since Reagan’s election in 1980, abortion was used as a wedge issue, a fundraising vehicle, and a way to keep the base agitated.  There was no real interest in ending access to abortion.  Yes, this was terribly cynical, but it really worked.  The righteous indignation over the new health care law was safe and predictable.  It helped that they could pin this on a president that they really didn’t like, for any number of reasons.  The base went wild and the Republican leadership fanned the flames.  No one would be hurt as long as this was just a game and this was all talk.

The Republicans won the House of Representatives in November 2010, in part based on their campaign against the new health care law.  I predicted a wave of cynicism.  The Republicans jumped into action and introduced H. B. 2, the second bill of the new Congress in 2011. The name of the bill was “Repealing the Job-Killing Health Care Law Act”.  This was not serious legislation.  Most of the next 60+ Obamacare repeal bills introduced over the next 6 years were just for show.  The first change came in July 2014 when conflicting federal court rulings bumped the law up to the Supreme Court.  The coyote caught the roadrunner and now this could be more than just talk. 

The Supreme Court under Chief Justice John Roberts would save the Patient Protection and Affordable Care Act THREE times.  The first, in June 2015, came as a huge relief.  It is one thing to rail against the PPACA, it is quite another to repeal the current health care payment system without an alternative.  And we have not had a serious alternative.  This blog detailed the legitimate fears of anyone diagnosed with a preexisting condition as we watched the Texas lawsuit wind its way through the courts.  Would the entire country have Texas level health care?  NO.  The Supreme Court ended the Texas lawsuit on June 17, 2021.  It seems like a long time ago, but it has only been 3 years of peace.

We are about to enter the election season of 2025.  The Republican Study Committee produces the policies, press releases, and talking points for their members and candidates. The candidates might not be talking to reporters if they are in a competitive race, but there is the outline of a Republican plan should they capture the House, Senate, and the presidency.  Health care appears on Page 3 of the 5 page “Fiscal Sanity to Save America” budget proposal.  This is the link.  It is a blast from the past that even includes the widely debunked sentence, “Allow individuals to purchase health insurance across state lines”.   I found on Page 4 the sentence that got my attention, and the motivation for this post, “Allowing medical underwriting to apply downward pressure on all beneficiaries’ premiums and inject stability into insurance markets”.  That is a return to the days of denial, riders, and rate-ups.  Do we really want to return to that?  Read the proposal.  All of it.  This budget proposal touches on the PPACA, Medicare, and Medicaid.  This is really important stuff for all of us.  And for extra credit, I have also included the analysis from the Kaiser Family Foundation site. 

You don’t have to like the Patient Protection and Affordable Care Act or the proposals from the other side of the aisle to be concerned about this proposed budget.  And we know that you can no longer count on this just being all talk.  For every reader who may chime in that I am being hyperbolic, there is another already concerned about her/his access to health care should these plans be implemented.   Senator John McCain is no longer with us.   It is up to us to save ourselves.

The rains started at 12:30.  Had we played, we would have been on the 15^th hole, the furthest spot from the Pineridge clubhouse and shelter.  We were lucky.  Sometimes the predictions are right.

Dave

Picture – Soon To Be Lost In The Woods – David L Cunix

www.cunixinsurance.com

 

 

Clouds On The Horizon

 

 Fear.  Damn, I had forgotten the sound of fear.  I had enjoyed the relative calm of the last 3 years.  But fear was returning to the insurance business.  Worse, that fear wasn’t unwarranted. 

The exact wording may vary, but the clients’ questions tend to track in one of these directions:

•  “I have Cancer/a Heart Condition/MS/Other pre-existing condition.  Am I going to lose my health insurance? 
•  “Will they let me keep my health insurance, but charge so much that I will have to drop it?”
•  “Am I going to lose my Medicare Supplement?”
•  “Are they going to move Social Security to 69 or 70?” 

You know these questions and a half a dozen more.  You may have asked them yourself.  The former president/presumptive Republican nominee is still campaigning to repeal the Patient Protection and Affordable Care Act (Obamacare).  Trump is still complaining, seven years later, about Senator John McCain saving the country.  What would happen if Donald Trump was the president and the Republicans regained the majority in both the House and Senate?  John McCain is gone.  Would you trust your health care to Ted Cruz and J D Vance?  

It would be wrong to pooh-pooh the worries of the 50 year old cancer survivor.  That person, and the 54 million other non-elderly Americans with pre-existing conditions, have legitimate concerns.  Most elected Republicans are happy to complain about the prices and deductibles, but no longer want to engage in discussions about repealing and replacing Obamacare.  Without a viable replacement, they having decided to substitute whining for action.  But there is a vocal minority within the current House majority, the ones who disposed of one Speaker of the House and are constantly threatening the current placeholder, who are still trying to impose their concept of “political purity” on their caucus and the rest of us.  Thankfully they have been too fixated on Hunter Biden to have had the time to dismantle our health care system.  Given another term and a different president, who knows? 

Some of my clients, and yes, many of my clients are well-read and up on current events, are focused on the Supreme Court.  The Roberts Court saved the Patient Protection and Affordable Care Act several times.  Will Texas strike again?  Will this new majority, one no longer concerned with precedent or judicial restraint, protect us again?  That hardly seems like a safe bet.  There will be more challenges to birth control, Medicaid, Medicare, and other health related issues in the next few years.  We can only guess, with Susan Collins like accuracy, how this court will rule. 

There is a move to raise the Social Security age to 69.  It is reasonable to believe that the same 175 members of the Republican Study Committee would also want to both privatize Medicare and to move the starting point past the current age 65.  I don’t know of any of my elderly clients that would want the current Republican members of the US House of Representatives to tinker with their health care or retirement.  And if they are paying attention, the 25 year olds are just as concerned.  Addressing the funding and structure of our social safety net may make sense, but it is time to ask for all of the details.  

It is April 2024.  We have seven months until the election.  There will be television ads filled with half-truths and complete lies.  Our letter carriers will be forced to deliver actual junk mail.  And you will receive unsolicited phone calls and texts almost daily.  Heck, I get texts from Laura Trump and Don Jr.  Don’t let fear get the best of you.  

Dave 

www.cunixinsurance.com

 Picture – A Moment Of Calm – David L Cunix

Piece Of The Puzzle

 

 

 I have friends who enjoy the challenge of a good jigsaw puzzle.  They might spend entire weekends tackling a bucolic scene of 2,000 or more pieces.  Not me.  I am still haunted by the puzzle frustrations of my childhood.  No matter how careful I was, there would always be a piece missing!  That missing piece, perhaps in the lower right corner, wasn’t relevant until it was everything, the very definition of whether or not I had completed the puzzle. 

I was recently in Washington DC as part of the National Association of Benefits and Insurance Professionals (NABIP) annual Capitol Conference.  As I have detailed in previous years, 500+ health insurance agents and industry employees gather in our nation’s capital to hear from the heads of the regulatory departments (think CMS), Congressmen, Senators, and thought leaders on the issues impacting us and our clients.  And, we then get the opportunity to meet with our elected representatives or their legislative aides in their offices. 

I love wondering around the Halls of Congress

Most of our attendees are very familiar with legislation pending in either the House or the Senate.  Some even know the players, who is championing a particular bill, or may be in opposition.  There is an entire process to the meetings in the Congressional offices.  The meetings are scheduled in advance.  Our talking points, the key issues we would like to discuss, are provided to their offices along with a list of which of our members will be attending.  And yes, we even include our attendees’ addresses so that the Congressman or staff will know if they will be meeting with a constituent.  Our meetings are an opportunity to put a face and a story to the issues and to explain the real-world consequences of their actions or inactions. 

Due to the limitations of this Congress, our talking points were reduced to one page (front and back!), much less than previous years.  We limited our focus to pending legislation.   But we did have something else to discuss – the brand new NABIP American Healthcare Consumer Bill of Rights.  The key, at least in my opinion, begins with the idea that we are Consumers, not patients.  As consumers we are purchasing goods and services.  Our expectations are different when we identify as consumers.  Our focus isn’t simply about outcomes, but we should know that we have the right to access healthcare, that we will be respected, that the process will be transparent, and that we will be a part of the decision making process.  Does this fix all/any of our system’s flaws? No.  This is just another step in the right direction.  And if it helps my clients to better understand their place in the process, an active participant not just an end-user, then we will have accomplished something. 

I led two delegations to Congressional offices this year.  We met with one staffer who, though relatively new in this particular office, had been on the Hill for almost a decade.  And we met with a bright young woman early in her career.  In both instances our members were able to help the Congressional staffer to see the individuals and small businesses impacted by the laws and regulations they helped to shape.  That is what seems to be missing, the human factor.  We are the last piece of the puzzle.  Insurance is the way most Americans access and pay for health care.  And insurance agents are the way the product is most effectively delivered.  We are also in the position to help regulators and Congress to course correct when the best of intentions lead in the wrong direction. 

And that is why I’ll be in Columbus a few times this year and already look forward to next year’s Capitol Conference. 

Dave 

www.cunixinsurance.com

Picture – At The Top, Cannon Office Building 2024 – David L Cunix

Raison D'etre

 

Friday, December 29th, the last business day of 2023, was a very good day to be an insurance agent.  At least it was in my office.  

I started the day with three important scheduled appointments, three disasters.  One of the problems was caused, in part, by the client trying to fix things on his own.  The other two were related to the failure of Ohio Medicaid to communicate effectively.  It doesn’t matter if you are talking about children or senior citizens, sudden changes in your health coverage with little to no warning can be terribly disruptive.  I needed to get everyone properly covered on the 29^th or they would be stuck in limbo for all of January. Each of these appointments could have lasted for hours and similar cases had.  But on Friday all three were successfully resolved by 1:30 in the afternoon.    

Communication failures led to two more client contacts later that afternoon.  In these cases I was able to reassure the clients that everything was fine.  The client and/or their child have access to the doctors and facilities important to them.  The clients might be able to talk to someone at the state, or the insurance company, but they can always get a response from their agent, me or any of my peers. 

This blog has readers across the country. My peers, my friends who are agents, in Phoenix, Atlanta, or Portland (Maine and Oregon) encounter interesting and possibly even more complicated issues every day.  This is the gig.  Our job is to solve the problems of our clients - individuals, families, small and large businesses - as they attempt to acquire and maintain effective health insurance. The insurance companies may have call centers and someone will eventually answer the phone at the state’s office, but your insurance agent is the one you know you can call. 

I am already booked for Washington DC for the end of February and I hope to be in Columbus a couple of times in 2024.  There is a good chance I will see your agent in Washington and that he/she will also be spending time meeting with your state legislature this year.  Let us know what is on your mind and how we can help. 

Dave 

www.cunixinsurance.com

Picture – Oh, And I got A New Car, Too – David L Cunix