October 2023

 

 

It is October 13, 2023 and I would like to celebrate the boring sameness of health insurance.  It is a joy to enter The Medicare Annual Enrollment Period that begins Sunday.  And the Annual Open Enrollment Period for individuals and families under age 65 who purchase their own insurance will begin on November 1^st.   Agents across the country will be immersed in something we know, love, and will be totally outside of the craziness around us.  It may seem selfish, but the terrorism our friends and relatives in Israel are experiencing and the chaos of the GOP run House of Representatives are taking a toll on even those of us who are only peripherally involved.  Try as I might, I can’t understand the murderous hate of one or the blind incompetence of the other.   At least we will spend our time with human traits we understand – greed and the insatiable desire to get something for nothing.

Our phones are already ringing.  At least once a week the caller asks, “Am I getting all of the benefits I’m entitled to?”  My response is usually, “Ma’am, you are entitled to watch TV without any misleading commercials.”  Something for nothing is big this year.  We have graduated from Free Dental to Free Rides to the Doctor, to Free Bowling Balls and even Free Golf Clubs.  It is as if an entire generation has forgotten the lesson that was pounded into us from a very young age – There is no such thing as a free lunch. 

Sure there is an element of greed with the providers and the insurers.  One of our local hospital systems, famous for its fight-to-the-death negotiation style, is threatening the Medicare Advantage contract of a well-known insurer.  There will be nasty letters to the patients from the hospital suggesting that they find a new insurer and equally shocking letters from the insurer to its client suggesting that they find new doctors.  They will come to terms at the last moment and all will be forgiven.  There is a rhythm to this.  There is seldom any need to panic.

Our Medicare clients, those on Original Medicare with a Part D (Rx) plan and even those on a Medicare Advantage Plan, are happy.   And we, their agents, are happy, too.  Medicare is the best coverage many of our clients have had in decades.  It certainly has been for me.  Medicare Part B will go up $9.80 per month to $174.70.  It is still a great deal.  The prescription coverage has also improved.  Helping our clients to understand and appreciate their coverage is normally a positive experience.  The vast majority of my meetings, in my office over coffee, will be moments of calm for us.

The first policies sold under the Patient Protection and Affordable Care Act (Obamacare) became effective on January 1, 2024.  It has been ten years.  If you polled 5 agents you would get 8 opinions about Obamacare.  We know people who pay more for their coverage due to the law.  We know some who pay less.  But our job is to help people find health insurance, the way most Americans access and pay for health care.  Because of the law we will never again tell the parent of a sick child that we can’t get their family covered.  The healthy and those of you who aren’t agents will never fully appreciate the stress of dealing with pre-existing conditions.  And yes, allowing the sick and injured to participate in our pool of business does have some impact on premiums.  That is the price we pay to include everyone, even YOU should your luck run out next week.  

We are seeing insurers return to the under 65 market.  They have figured out how to make this profitable.  As agents we are forever hopeful, always believing that this next year’s products will be more straightforward and consumer friendly.  We are seeing networks expand.  We are finding an element of flexibility.  The expansion of the Tax Credit Subsidies is making coverage more affordable.

Your agent, wherever you are in the US, will be busy for the next two months.  Try not to be too envious.

Dave

www.cunixinsurance.com

Picture – Blue Skies – David L Cunix

The Pendulum Swings From One Extreme To The Other

August 2023:

Frank, your short term major medical policy will not be an option for you in 2024.  We will need to look at a regular health policy.

           What are those damn insurance companies doing now?

 It isn’t the insurance companies.  They love short term policies.  The applications still ask health questions and the policies don’t cover preexisting conditions. 

            So the Republicans are screwing me?  Is this Kevin McCarthy or MTG?

 No Frank, This is President Biden reversing the excesses of the previous administration. 

            CRAP!

 The pendulum swings from one extreme to the other.  The only guarantee is that we will be smacked on the backside every time the bob passes through the middle.  Our two political parties expend a lot of energy in search of the extremes and each election, be it Congressional or Presidential, impacts health insurance, the way most Americans access and pay for health care.  

New rules from the Biden Administration.

 In the relative quiet of the last two years you would be forgiven if you had forgotten that we are still operating under the Patient Protection and Affordable Care Act (Obamacare) passed in 2010.  We no longer live under the daily threat of our health care system being dismantled without a plan or a care of what would happen to the 50+ MILLION Americans suffering from serious preexisting conditions.  But each administration, Obama, Trump, and now Biden, has had a significant impact on the way the rules are interpreted and administered. 

This blog documented the various ways that the Trump administration attempted to both repeal the law and when that failed, sabotage the basic framework of the PPACA.  The following are some of the rules and regulations President Trump and his team used to destabilize the markets: 

1.      Eliminate the penalties associated with the Individual Mandate

2.      Defunded the Cost Share Reduction

3.      The promotion of short term major medical policies and association plans

4.      Reducing the Open Enrollment Period

5.      Supporting the Texas Lawsuit

And this is just a partial list!

 The pendulum swung hard to the right.  As noted in the July 2017 post Begging The Arsonist To Put Out The Fire:

 A key element of the Patient Protection and Affordable Care Act (Obamacare) is the Individual Mandate, the requirement to purchase insurance.  This blog and numerous other published articles have noted that the Individual Mandate traces its roots to the conservative Heritage Foundation over twenty-five years ago.  The logic is simple – If we are going to offer health insurance to all Americans and cover preexisting conditions, we must have everyone participate. 

A concerted effort was made to incentivize the young and healthy to leave the insurance pool.  This was done by removing the penalty for not having comprehensive coverage and by promoting short term major medical plans.  In early 2018 Health and Human Services Secretary Alex Azar changed the definition of short term major medical coverage and allowed these plans to be sold for up to an entire year. These plans were initially designed to bridge the gap between group health plans or, pre-Obamacare, to help those who didn’t qualify for comprehensive coverage.  It is important to note that short term plans:

·         Ask underwriting questions pertaining to health, occupation, and hobbies

·         Are for a limited number of days

·         DO NOT COVER PREEXISTING CONDITIONS

·         Have a limited maximum benefit

 Under the previous administration, the healthiest amongst us were encouraged to enroll in a short term plan until they got sick, injured, or pregnant.  They could then migrate to Obamacare at the Annual Open Enrollment, assuming that they didn’t need comprehensive coverage first.  What could go wrong?

 The pendulum swung through the middle last year on the way to the left.  In the last two years we have seen a Special Enrollment Period that allowed millions of Americans to reassess their plan choices, an expansion of the Tax Credit Subsidy, and the Annual Open Enrollment Period expanded to January 15^th.  The Biden administration is now ready to tackle short term and fixed indemnity policies.

 The Biden administration proposal would limit short term major medical plans to three months and allow only a one month extension.  Though we haven’t seen the details, it is assumed that short terms will no longer offer office visit copays and some of the other benefits that made them look like regular, comprehensive health care plans.  President Biden has cited instances where individuals purchased short term plans and were shocked to learn that their claims weren’t paid.  Short term policies do have a place in the market.  They do a good job of paying for things that are new, big, and different.  There are people who could not or would not pay for full, comprehensive health insurance.  It is a gamble.  It appears that the casino has been closed.    

I’m not looking forward to my call to Frank next month when these rules are finalized.   I expect anger, cursing, and at least one threat to move to Canada.  Frank is politically aware.  He knew that this day would come.  It was as inevitable as a pendulum swinging back the other way.  Me?  I’m just glad that he never had to test the limits of his short term coverage and I’ll remind him that all good(?) things must come to an end. 

Dave 

www.cunixinsurance.com

 Picture – This is where a Foucault Pendulum hung in the Cleveland Museum of Natural History until it was removed during the current construction.  Proof that all good things do, in fact, come to an end.

 

ZOMBIES!

 

You might think that they are dead.  You might even take credit for killing them.  But Zombie Laws survive the best efforts of dedicated legislators, the light of day, or even common sense.  The link is to an example in Georgia, but we in Ohio have our fair share of Zombies.  There is a reason why these poorly thought out regulations, back-door giveaways, or clearly unpopular concepts fail to be passed as standalone legislation and often die in committee.  That would be OK if these Zombies didn’t reappear as an amendment to must pass legislation or snuck into the biannual budget.

Many of us in the insurance industry thought that we had vanquished last year’s House Bill 675 before it could harm Ohio’s senior citizen population.  We just learned that the key provisions have been inserted into House Bill 33, the current Ohio budget bill.   This is the pertinent section:

The superintendent shall not prohibit the following types of solicitation: 57427 57428 (a) Print solicitation such as leaflets, flyers, or door hangers left at residences or on motor vehicles; 57429 57430 (b) In-person solicitations of individuals at the individual's residence or in public or common areas such as parking lots, hallways, lobbies, or sidewalks; 57431 57432 57433 (c) Telephonic or electronic solicitation such as electronic voicemail messages, text messages, or direct social media messages.

Here are two scenes from the not-to-distant future:

1

Four white-haired gentlemen enjoying breakfast at McDonald’s were approached by two individuals, a man and a woman, both in business attire and carrying briefcases.  The man addressed the diners while the woman opened her laptop.

“Good morning gentlemen.  I am agent Rogers and this is agent Moore.  As per Ohio Representative Bill Dean, we are here about Ohio House Bill 33 signed into law by Governor DeWine on May 26, 2023.   This will take just a few moments.  We need your name and the name of your Medicare Supplement company.”

As Bob reached into his pocket to find his insurance card, a young mother rushed over to the table.  “These two aren’t government agents.  They’re insurance agents.  I saw them here last week.”  Rogers, the insurance agent, started to protest that they were allowed to solicit Medicare Supplements at public places and even McDonald’s.  Bob noted that this might be legal, but it certainly isn’t right.

2

The elderly couple pushed their shopping cart through the parking lot.  Just as they opened their trunk, a young man rushed up to their car.  It took a moment or two for the couple to fully grasp the situation.  Finally the woman spoke up.  “Thank G-d you’re just some skeevy insurance agent.  We thought you had a gun.”

 

This could be our future if the Ohio budget includes this Zombie legislation.  Ohio Representative Bill Dean (R-71)  was the bill’s sponsor.  I plan to provide a copy of his testimony to every client who complains to me about insurance telephone solicitors bothering them at their homes or at dinner.  Some of you might think that I am exaggerating the risk.  Is the State of Ohio encouraging insurance agents to accost us?  This is from Representative Dean’s Sponsor’s testimony last year:

“The current rule, Ohio Administrative Code 3901-8-09, prohibits virtually all agent-generated communications with potential clients unless it’s through direct mail or if the potential supplemental insurance client is already a business client. Here are a few examples of how restrictive the current prohibitions are:

• An agent calling fellow members of a 65+ group at his or her church about purchasing supplemental insurance; 
• An agent sending a Facebook message about interest in purchasing insurance to someone they graduated from high school with 50 years ago; 
• An agent approaching a group of seniors enjoying their coffee at McDonald’s and asking them if they’re interested in chatting about supplemental insurance.

Unless the agent has an existing business relationship with these potential customers, all of these interactions violate the current rule in place.”    

Representative Dean wants to change that.  He failed last year and now his Zombie may be a part of our next state budget.

As I noted last year, I’m 68.  I get all of the solicitations from out-of-state call centers.  Most of them are illegal but somehow beyond the reach of the Ohio Department of Insurance.  It is annoying to have my cellphone ring at 7 AM on a Saturday morning.  We (seniors) may not have to answer the phone, but we do have to see who is calling us.  It could be important.  It might be a sick friend or family member.  We need less people hounding us, not more.  We don’t need someone knocking on our door, approaching us in a restaurant, or tracking us down in a parking lot.  Representative Dean thinks that Ohio’s seniors are being deprived of important purchasing opportunities.  He is wrong.  Here is his email - www.ohiohouse.gov/bill-dean.  Drop him a line, unsolicited, and let him know what you think of his annoying law that won’t die, his Zombie. 

Dave

www.cunixinsurance.com

Picture – It’s  A Trap – David L Cunix and A.F.

Mr. Cunix Goes To Washington

You either believe or you don’t.  Mark me down as one who believes.  I believe in the fundamental promise of the United States, that all men are created equal (even when we fail miserably at that ideal), that we can govern ourselves (even when we elect less than competent leaders), and that we can structure a system to benefit most, if not all, of us.  And for that reason I work on legislative issues on both the federal and state level.  And that is why over 500 members of the National Association of Benefit and Insurance Professionals (NABIP) were in Washington DC last week.

This was our first completely in-person meeting since February 2020, the onset of COVID.  I wondered if citizens would again have full access to the House and Senate buildings post January 6, 2021.  I am happy to report that yes, I was able to wander around the halls of Congress.  I find the hours I spend in these buildings in serious discussions with our elected officials and/or their staffs, seeing the delegations of veterans, business representatives, and school children from around the country, or even just a casual encounter with a senator to be democracy affirming.

Our meetings with our elected representatives and their staffs are designed to reinforce our main message that health insurance is the way most Americans access and pay for health care.  We remind them that according to the 2020 US Census, 54.4% of the United States population is covered by employer sponsored group health insurance.  We want to make group insurance work smoothly and effectively.  With 10,000 Americans turning 65 every single day, our other main focus is to make Medicare work for our clients, their constituents.  We can get into the various bills and specifics, but the basics, access and payment for care, have remained the same for years.

Our timing was less than optimal this year as the Democratic members of the House of Representatives were on a three day policy retreat last week.  I was disappointed that we were unable to meet with Shontel Brown (D-OH) who represents much of Greater Cleveland.  I was fortunate to be included in a meeting with Troy Balderson (R-OH) of South Central Ohio.  Mr. Balderson and his legislative assistant, Megan Porter, were fully engaged in our conversation and well-versed on our issues.

There wasn't anyone waiting to talk to this Congressman.

I also led a delegation to Senator Sherrod Brown’s office.  Senator Brown (D-OH) was meeting with several Cuyahoga County mayors so our group met with Francis Goins, a legislative aide who graduated from Shaker Heights.  Mr. Goins extended our meeting to 45 minutes.  He took notes and asked great questions.  Senator Brown has worked to resolve the Observation Trap and has sponsored legislation in previous sessions.  We are hoping the Senator will reintroduce legislation specifically addressing this issue.

Mr. Smith Goes To Washington premiered in 1939, a time when a Senate filibuster actually took effort and it was shocking to see a film that depicted both the American ideal and the reality of political corruption.  In 2023 the corruption is understood and the ideal is sometimes forgotten or ignored.  My annual participation in our organization’s Capitol Conference is confirmation that we can still achieve our ideals.

Dave

www.cunixinsurance.com

Pictures:

Mr. Cunix Goes To Washington – David L Cunix

The Loneliest Place in DC – David L Cunix

Winter in DC – David L Cunix