The Defense Rests

It is exhausting.  This choice.  This job.  This desire to craft a non-ideological, pragmatic path is taking all of my energy.  Confronted daily by people who either cannot, or will not, see the full picture that is the Patient Protection and Affordable Care Act (PPACA or Obamacare), I find myself calming the fears of its detractors or clarifying the rules to its biggest supporters.  To the right, and the righter than right, I find myself defending the law, or at the very least, the need for change.  Defending the insurers from the left could be a full time job in of itself.

Randy (name changed) called Friday.  He wanted to know when they were going to cancel his group health insurance policy.

Why would Medical Mutual cancel your company’s insurance?

Because my policy doesn’t cover any women or children.

But you don’t have any female employees, right?

Yeah, but they’re gonna cancel me!

OY, Randy, you’ve been watching FOX again.

It took fifteen minutes to reassure Randy.  Now, no one on FOX really said that a small business would lose its health insurance if there weren't any women or children on the policy.  That’s silly.  But the daily barrage of negativity, conspiracy theories, and half-truths take their toll on the viewers.  One day you’re a concerned business owner.  The next you are trying to get one of your employees to get married so that you can retain your group coverage.

It doesn’t get any better on MSNBC.  With neither an ounce of irony nor embarrassment, the outpost of the left gives us Howard Dean, the former governor of Vermont.  I’m sure that an extensive GOOGLE search might find an instance when Gov. Dean knew what he was talking about.  I’m just positive that none of his pronouncements about health insurance or the PPACA have any basis in reality.

For example, Governor Dean was recently discussing the disastrous roll-out and the policy cancellations.  He was on Morning Joe and several other shows.  He opined that all the President had to do was to hire a bunch of unemployed kids, put them in a call center, and have them ring up everyone whose policy had been cancelled.  The kids could enroll everyone into Obamacare!

I doubt that approach would be welcome in Vermont, a state with less than half the population of Greater Cleveland.  I know that wouldn’t fly here.  Who explains the policies to the “kids”?  Vermont may have only one or two insurers and only a few options, but Ohio, California, and any other state that has an actual city or two will have multiple insurers and dozens of choices.  But on one has ever explained insurance, or economics, or city life to Governor Dean.  And there is absolutely no reason to do so now.

40 vs. 5

The PPACA was sold to the American public as a universal win.  Everyone would get better, more comprehensive health insurance for a lower monthly premium.  This blog has repeatedly pointed out that that was not possible.  The airwaves are now filled with the horror stories of cancelled policies and jacked-up premiums.  The right emphasizes every problem, real or imagined.  The left has a new argument – Isn’t it OK to inconvenience five million people so that 40 MILLION AMERICANS can now get access to affordable health care?

What a bunch of hooey.  This wasn’t a Hobson’s choice.  It wasn’t remake our entire system or do nothing to help the uninsured and the under-insured in our country.  We could have accomplished much of that goal by expanding Medicaid.  You don’t score many points by minimizing someone else’s loss.

I have watched my words parsed in the comment sections of Facebook and the AOL Patch.  The attorneys and attorney wanna-be’s who troll for fights can’t tolerate civil discussions.  One guy was convinced that all insurers will cancel their clients at the first sign of a claim.  Another reader is positive that the PPACA is the harbinger of the Apocalypse.  The extremes are so extreme.  The middle is lonely and damn near empty.

For the record:

• Insurers pay claims.  My clients have benefited from their coverage.
• The status quo was not sustainable.
• There is a kernel of truth in everything you see and hear on FOX and MSNBC.  You need more than kernels.  You need a meal.

Take a deep breath.  We will all get through this together.  But for the moment, the defense rests.

DAVE

www.bcandb.com

Where Do They Bury The Survivors?

A plane crashes on the Mexican – United States border. On board were U.S. citizens, Mexicans, Brazilians, and three passengers from Argentina. Where so they bury the survivors?

It is a classic misdirect. A mental sleight of hand. You know the answer. We don’t bury survivors.

Sleight of hand is an art. The best practitioners can shake your hand while they lift your watch and wallet. The trick for us is to watch them at work without becoming a victim.

I recently received an urgent email. A client forwarded Newt Gingrich’s article, “Obamacare’s Marriage Penalty and Divorce Incentive.” Was this true? Is the President anti-marriage?

Newt Gingrich as the defender of the sanctity of marriage? Guard your wallet!

I won’t bore you with the numbers. The federal subsidies are based on the size of the family, the ages of the insured, and are factored on the federal poverty level. A married couple with one child doesn’t need 33% more income when they have a second child. Couples don’t need twice as much income as singles to pay for food and shelter.

Will a few people get divorced to get a bigger health insurance subsidy? Perhaps. Of course, that also means that these people will pay more state and federal income tax. These things have a way of balancing out in the end.

The bottom line is that Newt Gingrich knows that this is irrelevant. Newt would be campaigning against government waste and another inefficient entitlement program if the subsidies were calculated differently. It is just a sleight of hand.

We should, by now, be used to this from our politicians. Sometimes it is a mental misdirect. Sometimes it is a misstatement. And there are other instances when the politician tells the truth, technically, but what he/she said and what we heard are not even closely the same.

Example? My favorite is “If you like your policy, you can keep it. Period”. Balderdash.

I wasn’t in the room when the President and his advisors crafted that perfect slogan. “If you like your policy, you can keep it. Period.” So clear. So emphatic. So wrong. Did the President and his advisors intentionally mislead the country, or more likely, did we have a room full of people who had no idea what they were talking about?

• Over 80% of Americans get their insurance coverage through work. If you are one of them, you don’t choose your plan, your employer does. It is not up to you.
• Only policies on the books prior to the passage of the law and unchanged since that day, March 23, 2010, are grandfathered.
• How long can the insurers run two separate sets of books? Policies issued prior to March 2010 have one set of rules while new policies have another. Who pays the additional cost to maintain the old contracts and monitor compliance?

This blog has tackled the grandfather issue repeatedly since August 2, 2010’s, Don’t Cry Uncle, Stay Grandfathered. Retroactive rules. Contradictory edicts. Those of us who actually work in the insurance business knew that we would see very few individual or small group policies limp across the finish line on January 1, 2014.

The President is shocked that many Americans are now losing their current policies and being forced into new, more expensive contracts.

There are some awful policies on the market that will disappear on January 1^st. There are some policies that have a $25,000 or $50,000 cap. Those plans were cheap, but they did not really cover a major illness. However, about 11 million Americans are covered by comprehensive policies that will be cancelled in the next twelve months. These plans don’t conform to the new rules.

My policy is scheduled to end a year from now. Why? Because it doesn’t cover me for maternity. If nothing changes in the next twelve months, my premium will more than double next December. Of course I like my policy. And no, I can’t keep it.

The Patient Protection and Affordable Care Act (PPACA) will, eventually, help many Americans. But it would be foolish to dismiss out of hand those people who are angry or upset. You can’t just bury their fears with the survivors.

DAVE

Picture from the Passen Law Group www.passenlaw.com

Crashed

Frank (name changed) is a successful attorney in his early 40’s. He lives in Greater Cleveland. On Friday he completed his health insurance application, hit the submit button, and watched the website crash. This message, in bold red and blue, flashed onto his screen:

Application Wizard

• We apologize but there was an issue with our system when submitting your application. If we were able to process your application, we will send you an email within the next hour and you will not need to do anything else. If you do not receive an email from us within the next hour, then please return to this site and submit the application to us again.

Yes, purchasing a health insurance policy in 2013 can, at times, appear daunting. But Frank wasn’t dealing with the federal exchange. The computer issue had nothing to do with the Patient Protection and Affordable Care Act (PPACA). Frank was submitting an application for a 2013 policy with Anthem Blue Cross.

Alert the media! Contact Rush! Websites crash or are shut down for routine maintenance. No one died and no one got fired.

Anthem’s producer/applicant portal was down for about six hours. Frank’s application has been accepted and by the time you read this, he may have been approved.

The exchange roll out has been a mess. Even insurance agents, professionals long familiar with the complexity of working with insurers, the government, and the public, were surprised at how unprepared the government was for this vast undertaking. We even had advance warning. Agents have had eight years of Medicare Part D (Rx) and Medicare Advantage training, seven to nine wasted hours each August. And this year we were treated to the special training classes and tests to sell on the federally run exchange as detailed in You Put Your Left Foot In. CMM (Centers for Medicare and Medicaid Services), the agency administering the agent authorization process, is still having website issues.

This is a program designed by bureaucrats who know how to make things complicated but may have no idea how to make things work.

What has been lost in this P.R. disaster is just how irrelevant all of this has been. The most important thing to remember is that the new policies don’t start until January 1, 2014. Applications accepted on October 1^st or December 10^th still have the same effective date. Anthem Blue Cross is not going to run out of policies. You don’t need to be the first in line.

Of course, everyone with an ax to grind has jumped into the discussion. Online insurance marketers have “volunteered” to save the day and take over the process. If the federal government would only suspend common sense and a myriad of state and federal laws, an e-marketer could corner the market and restore order. Those offers have landed with a thud.

Equally self-serving have been the Republican members of Congress who have complained about the problems their constituents are having with the roll out. You can’t spend three and a half years actively trying to sabotage a program and then complain when it doesn’t work perfectly. And please, don’t shed tears for the sick and uninsured who are having difficulty enrolling in the now available coverage. There isn’t a Republican plan to cover any of these people.

There is a bi-partisan support to bump back the “Individual Mandate” for another year. Why force people to purchase insurance if the website is difficult to access? I’m surprised that this hasn’t already happened. Everybody wins.

• The Republicans score a moral victory. Being against anything President Obama favors enhances their campaign donations. Winning a meaningless battle shows activity.
• The Democrats show flexibility and are allowed, once again, to play the part of the martyr.
• Big business, the unions, and the insurers see this as one step closer to a Single Payer system. By now you are sick of hearing TV commentators talking about the Young Invincibles, the young, healthy Americans who must be forced into the system for it to work. If healthy people don’t sign up, the system devolves into a Death Spiral and implodes under its own weight.

Delaying, or worse, eliminating the Individual Mandate hastens the conversion to a Single Payer system.

The exchange website and all of its attendant issues aren’t our biggest challenge as a country. It is our lack of intellectual honesty that will be our undoing. Disorganized and unprepared, we are heading for a crash.

DAVE

www.bcandb.com