You Can Rent Your Own Private Idaho

The Patient Protection and Affordable Care Act (Obamacare) is the law the Republican love to hate. They have spent eight years campaigning on the promise to Repeal and Replace or simply to Repeal the PPACA. The Republican controlled Congress passed over 60 meaningless bills, some just so that newly elected members could have the opportunity to cast a vote. It was only after the 2016 elections, when the R’s retained control of Congress and captured the presidency, that real action seemed unavoidable. We know how that worked out.

The strategy has shifted from repealing the PPACA to simply sabotaging the law. The recent tax law, with the elimination of the financial penalties for failing to own compliant coverage, is instructive in its construction. The Republican controlled Congress determined that it could not repeal Obamacare, nor could they remove the Individual Mandate from the law. They were forced to remove the penalty for not complying with the law. The law still stands.

And that brings us to Idaho

We have been talking about Idaho Governor C. L. “Butch” Otter (real name!) and his decision to create a whole new class of health insurance policies, one that looks suspiciously like the health insurance policies the PPACA eliminated. Governor Butch wanted to return to a time of medical underwriting, limited benefits, and policy caps. You know, the good old days. The details can be found in the blog post Rotten Potatoes. With the help of his insurance commissioner and our friends at Blue Cross of Idaho, Governor Butch was trying to leave the ultimate destruction of the individual health insurance market as his legacy.

Blue Cross of Idaho was prepared to announce plan designs for the new policies within weeks of the announcement that the walls had been breached and that the PPACA was about to fall in Idaho. And that is when the U.S. Department of Health and Human Services decided to do its job. This is the link to the letter to Idaho’s Governor.

The letter, signed by Seema Verma the current Administrator of the Centers for Medicare and Medicaid Services (CMS), echoed the Trump Administration position that the Patient Protection and Affordable Care Act is the worst thing that ever happened to Americans, “However, the PPACA remains the law and we have a duty to enforce and uphold the law”. And since the law is the law, you can cut corners but you can’t stage a blatant frontal attack.

Ms. Verma’s letter noted that the plans that Idaho wanted to create failed to comply with the law on numerous levels and that CMS, her agency, would be required to step in if Idaho chose to ignore the issues. She also detailed the fines that could be levied against any insurer who chose to participate in the Idaho scheme. Her public protection train doesn’t derail until the 4^th page of her letter when she suggests that Idaho should focus on “short-term, limited duration health insurance”. You can’t own your own Private Idaho, but you can rent it.

This blog has discussed the value and problems of short term major medical policies. I normally have between 20 and 25 clients on short term policies. These contracts serve as the safety valve for

• Individuals who accidently missed the enrollment period
• Make too much to qualify for a subsidy but find the premiums too expensive
• Make too little for a subsidy, don’t want to be on Medicaid, and couldn’t afford a regular policy

Short term policies ask a few underwriting questions, are for a limited number of days, and don’t cover preexisting conditions. These plans are not designed to be a permanent health insurance solution. The Idaho plans were. Idaho was trying to syphon off the healthiest risks to policies that would be useful – until they weren’t. As soon as an insured got sick, pregnant, or injured, the plan was to move them to the guaranteed issue, preexisting condition covering, safe haven policies of Obamacare. The healthy and lucky could stay on the special Blue Cross of Idaho policies forever, protected from the responsibility of being part of the general population risk pool.

There are ways to make the PPACA work better. Undermining the law, whether directly or indirectly, will not help us in the long run. Destabilizing the individual insurance market by eliminating the funding for the Cost Sharing Reduction Subsidies, defanging the Individual Mandate, or promoting short term contracts in lieu of comprehensive health insurance, hurt the American consumer. The residents of Idaho, and all of the other states, would be better served with an administration that was less focused on short cuts and work-arounds and more prepared to help the law achieve its stated goals – patient protection and affordable care.

DAVE

www.cunixinsurance.com

Photo – Lost in my Private Idaho – David L Cunix

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(Un)comfortably Numb

There was quite a to-do at the Capitol last week. I happened to be walking by as the body of the late Reverend Billy Graham was being carried up the steps into the Capitol. Thousands of people waited in line over the next few days to pay their respects and celebrate his life.



I was in Washington last week for my annual meeting of the National Association of Health Underwriters and for the opportunity to talk with members of Congress and their legislative aides. The supporters of Reverend Graham seemed to be the only people celebrating anything in Washington DC. Last year’s trip was only a few weeks after the inauguration. The mood in Congress was “What are we going to accomplish FIRST?” This year the mood seemed to be closer to “What the Hell just happened?”

Over the course of four days I spoke with people from all across the political spectrum. To be clear, the federal employees (Congressmen, aides, and security personnel), the insurance agents, and the political professionals are all patriots who love our country and are trying to do what they think is best. That seems to be the first thing lost in these debates and smear campaigns. One may question whether self-interest sometimes clouds one’s judgement. We are all human. But constantly questioning someone’s patriotism gets us nowhere.

Why Bother – There were fewer people participating this year. I could be wrong, but I felt like our annual meeting of hundreds of insurance professionals from around the country was down 10% to 15%. This is understandable since most of us are paying own way and all of the instability of the last year has taken a toll on us. Still, the huge ballroom at the Hyatt is normally SRO. What really got my attention were the empty halls of Congress. Our appointments are usually shoehorned in right after one group and just before another. That was not the case this year. One Congressman might still be meeting with us had he not had to leave, well over 30 minutes into our meeting, to cast a vote. The smaller numbers of groups meeting with members of Congress speaks to the general questions of how or why anything is getting done while this administration is in the White House.

News – A Columbus area friend is running for the Ohio House of Representatives. He held a fundraiser at the Dubliner, a famous Irish pub a few blocks from the hotel. I mentioned to a woman from Middleburg Heights that the Dubliner has served as the Washington home for Morning Joe. She made a face and made clear her disdain for all things MSNBC. I thought of my westside friend while in the office of one of our Ohio Republican Congressmen. His reception area had FOX News on the wall-mounted TV. His inner office was running MSNBC. With this administration, where the position du jour may be blurted out on live TV or a tweet, you have to be open to receiving your news from all possible sources.

Why Bother 2 – We record both small victories and minor setbacks each year. This year will be no different, but I have reason to be hopeful. For one, both the Congressmen and their aides had the time to conduct meaningful policy discussions. For another, the silliness and intellectual dishonesty of Repeal and Replace may have finally been laid to rest. Here are a couple of things that we discussed last week:

• COBRA as Medicare Credible Coverage – This is one of those down in the weeds issues that had no champions, only victims. COBRA doesn’t count as credible coverage. Senior who retain their COBRA coverage instead of enrolling in Medicare when they become eligible, are considered to be “late enrollees”, subject to a waiting period, and will pay a penalty for the rest of their lives! It is normally just a mistake. Retirees over 65 may not have access to good, free information. We can correct this. I am happy to announce that our efforts have been rewarded with the introduction this past week of H.R. 5104 - Medicare Enrollment Protection Act.
• Transitional Relief – With all of the confusion at Health and Human Services (HHS), it is not surprising that the Grandmothered health policies have fallen through the cracks. These policies were written and issued in 2010 after the Patient Protection and Affordable Care Act (Obamacare) was passed until the end of 2013 when the law was fully implemented. Many of us are dependent on our ability to retain these policies and wait nervously for the annual announcement. There aren’t any policies sold in Ohio that can match the network access of the Anthem, Medical Mutual, and Golden Rule Grandmothered contracts. Every Congressman and legislative aide quickly grasped the importance of granting transitional relief for these policies. Some even thought that this should be simply granted permanent status. As with so many other issues, this would disappear without our constant vigilance.
• Retain the employer tax exclusion – More than 175 million Americans get their health insurance at work. There were some proposals being floated to either cap the maximum amount of premium the employer could deduct or eliminate the deduction completely. Talk about destabilizing the market! There seemed to be little interest in overturning our markets in the offices I visited.

Politics in the Real World – The topic of Congressional Hearings came up during a conversation with a Republican Congressman. He brought it up, not me. He mentioned the lack of hearings as part of the overall failure of last year’s efforts to repeal Obamacare. He noted that “We’ve done nothing to bring the cost of health care down”. He had a real grasp of some of the nuts and bolts of the health care funding debate and expressed his regrets with the lack of tangible results. In many ways it mirrored the conversation I had with the Senior Legislative Assistant of a local Democratic member of Congress. I have met this particular aide several times and knew her to be a straight shooter. We discussed the anticipated November 2018 wave election. She expressed a sincere desire to not replicate the mistakes of this past year, to be inclusive, and to get things done. One party having significant majorities in the Senate, House, as well as the Presidency has been a shock to the system. The question is whether the ideologues will win out and the politics of Washington will careen wildly from one extreme to another or if the pragmatists from both sides of the aisle can regain control of the House and the Senate and return order, decorum, and respect to our institutions.

I was standing in a Senator’s office when President Trump announced on live TV an entirely new gun control policy. The staff didn’t even bother to look up knowing full well that he would reverse himself tomorrow. I get that. We’re all (un)comfortably numb.

DAVE

www.cunixinsurance.com



Picture – There Had To Be A Moon Involved – David L Cunix

Picture – The Reverend Billy Graham – David L Cunix

Picture – Fighting The Crowd In The Hart – David L Cunix