The News Is Good

 

We are getting a better understanding of the American Rescue Plan Act of 2021 and how it will impact your health insurance if you are under age 65 and buying your own policy.  Much of the focus on the recently passed law has been on the stimulus checks and child tax credit.  Today’s post is from an update I sent my clients.  This blog has a national following according to Google Analytics.  Most of you reading this are outside of my service area.  It is not an advertisement.  The information is relevant whether you live Portland, Maine or Portland, Oregon.  I encourage you to talk with your local agent to review your specific options. 

Tax Credit Subsidy – This may be one of the most important changes.  The Patient Protection and Affordable Care Act (Obamacare) included provisions to help Americans pay for their health insurance, the way most of us access and pay for health care.  The 2010 law created Tax Credit Subsidies which were tied to the Federal Poverty Level.  If you, or you and your family, earned less than 400% of the FPL, you could get help.  This was never updated till now.  The new subsidies are going to increase for most of you who have policies on the Exchange.  And the 400% cut-off is going to be eliminated for at least 2021 and 2022.  Instead, the law will extend benefits to all Americans purchasing their own coverage on the Exchange with a goal to limit the cost of insurance to no more than 8.5% of their income.   These changes will impact over 3 million Americans this year.

     Action:

·         If you are currently on the Exchange, you should review you current subsidy.  You may qualify for a higher subsidy which would lower your premium or allow you to switch to a more comprehensive policy.

·         If you are currently on the Exchange and don’t do anything, you will probably get a larger refund when you file your taxes next year.

·         If you are not currently on the Exchange, you and your agent should take a look to see if you would save money.  I can’t guarantee that you will, but it doesn’t hurt to try.

·         THE SYSTEM WILL NOT HAVE THE NEW CALCULATIONS INSTALLED UNTIL EARLY APRIL.  You will be much happier if you wait till at least the middle of April to meet with your agent. I am going to schedule my clients for the end of April and the first two weeks of May.

 COBRA – Some people will qualify for a 100% premium subsidy for COBRA coverage for as much as March 1, 2020 to September 1, 2021.  There are some details to be resolved, but the key is that the employee must have been involuntarily terminated or had his/her hours reduced to zero.  Please contact your former employer’s COBRA administrator if you think that you might qualify. 

Grandmothered Policies – We hold our breath each year waiting for the federal and state governments to approve an extension of Transitional Relief, the right to retain the policies sold and put in place between April 2010 and December 2013.  The Biden administration pushed this through in February and Ohio quickly followed.  This is good news for some of my individual and small group clients.  

Rx Discount Cards – Many of you have asked how to deal with the ridiculous cost of prescription drugs.  This is especially relevant for those of you with high deductible policies that don’t have an Rx copay.  Clever Rx is new option.  The link will let you to sign up for a free discount card.  There is a great app that will allow you to price your medications based on both the dosage and the drug store.  Yes, the drug store matters.  This may help.  There are other Rx plans, too.  Find the one that works with drugstores in your area. 

The American Rescue Plan Act of 2021 is major legislation.  Today’s post is just to make sure that you are aware of a few of the ways it will impact your health insurance options.  Please contact me if you have any questions. 

It is great to be able to deliver good news.  My second shot is scheduled for March 31^st!  New vaccine locations are being announced every day.  Be smart.  Be careful.  

Dave 

www.cunixinsurance.com      

Picture – We Celebrate Good News – David L Cunix

Leadership 2021

Congress has its fair share of villains.  You know their names because once elected they view being on television as important as breathing.  They may not actually do anything you or I might associate with legislating.  Their names are seldom connected to legislation that ever becomes law.  At best, they often seem to delight in their ability to prevent action.  You will see them on the Sunday morning shows bragging about the presidential appointees they have tried to block or the meaningless amendments they have offered in an attempt to clutter the process.  Other Congressmen are merely placeholders.  They carefully embrace anonymity.  Their weekly constituent emails extol the virtues of mom and apple pie and hope like heck that they are never called upon to exhibit leadership or to take a stand on a controversial issue.  For them, reelection is the only goal.

I would rather focus on the heroes.  And yes, Congress does have heroes, individuals who view their election as an opportunity to devise legislation that could help their constituents.  I introduced my readers to Representative Lauren Underwood (D-IL) this past July.  She drafted H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2019 as a freshman Congresswoman.   Her legislation was designed to expand Medicaid services a full year postpartum.  The logic was clear.  “The majority of pregnancy-related deaths happen after the day of delivery, and nearly one quarter of deaths happen more than six weeks postpartum.”  It took a nurse to bring this to Congress’s attention.  And now, the American Rescue Plan Act of 2021 includes her legislation!

The current COVID relief package includes several other provisions to help Americans acquire health insurance, the way most of us access and pay for health care.

Tax Credit Subsidy

The Patient Protection and Affordable Care Act (Obamacare) was designed to help people purchase their health insurance.  The initial plan was to provide a tax subsidy starting with individuals earning 150% of the federal poverty rate that decreased in value until it ended with an income equivalent to 400%.  This has never been updated until now.  For the next two years the subsidy at the lower income levels has been increased and, and this is really important, it doesn’t cut off at 400%.  Many of my clients have had difficulty paying for insurance because they make just a little too much to qualify for a subsidy.  This is going to allow them to purchase a regular policy instead of short term major medical.

COBRA

The COBRA regulation allows a former employee to retain the health insurance coverage he/she had from the previous employer.  The former employee must pay the full premium plus a fee of up to 2%.  The American Rescue Plan Act of 2021 will help laid off employees by paying the premiums through September.  This will allow some people to retain their coverage who might not have otherwise.

There are other provisions in the new law related to Medicaid and subsidy relief.  Much of the focus of the new COVID relief package will be on the stimulus checks coming to American families by the end of this month and the enhanced unemployment checks.  Others will focus on the fact that no Republicans voted for the bill, even after some of their amendments were included.  My focus is on health insurance and our elected representatives who are trying to make things better.  That’s leadership.

DAVE

www.cunixinsurance.com

Picture – Visiting The People’s House – David L Cunix

 

Virtually In Washington

 

The answer, of course, was NO.  A friend knows that I normally spend the last week of February each year in Washington DC and called to ask if I was packed and ready.  Nope.  We aren’t holding our annual meeting this year in person.  This year we are strictly virtual.  I am underwhelmed. 

Our organization, The National Association of Health Underwriters, has done an excellent job in lining up relevant and interesting speakers.  We will meet, via Zoom, with our elected representatives and their legislative aides, and we will have a full agenda.  But it won’t be the same.  Worse, after January 6^th, it may never be the same again. 

One of the speakers will be Kurt Schrader (D-OR) who is leading the bipartisan fight for greater transparency in prescription drug pricing.  This is the opportunity to hear from the Congressmen who don’t spend every Sunday morning on the talk shows.  Last year we got to hear from the impressive Lauren Underwood (D-IL) and now retired Greg Walden (R-OR).  Good ideas aren’t limited to either party.  The Congressional speakers provide insight to the thinking and efforts that go into the process that creates legislation. 

The most important part of this annual conference is still our meetings on Capitol Hill.  I look forward each year to my conversations with Senator Brown’s (D-OH) legislative aide, Abby Duggan.  She is knowledgeable and well-prepared.  I have also had the pleasure of meeting with a number of the men and women Ohio sends to the House of Representatives.  They welcome our visits because we bring focus to the issues that directly affect their constituents, our clients.  Insurance agents champion an end to Surprise Billing, resolution to Medicare’s hospital observation debacle, and transparency in prescription drug pricing not because it will aid us financially (no impact) but because our clients need our help.  We are in the position to report the real life impact of these issues.  

Will this year’s visit make as much of an impression as 700 to 1000 of us paying our own way to Washington?  I don’t know.  But I know that we aren’t going to give up.  A client was kept in a hospital last month under observation status and charged $87 for maintenance medication that would have been covered had he been admitted.  It could have just as easily been $1,000.  Who is fighting for him if not us? 

I won’t be wandering around the Halls of Congress next week and I won’t be popping into the Smithsonian during down time or hanging out at Shelly’s Back Room in the evening.  My goal is to still make the time meaningful.  Next year in Washington. 

Dave 

www.cunixinsurance.com

 Picture – A Tangible Link – David L Cunix

Positive Change

 

 

Here is a question: Should the government make your life easier of harder?  If you answer harder, you aren’t going to like this post. 

Last spring, as businesses closed and our lives were turned upside down, consumer advocates and the insurance industry found themselves on the same side of an issue.  We needed an Open Enrollment.  With jobs, incomes, and medical concerns changing, Americans needed an opportunity to reevaluate their health insurance options.  The previous administration refused to help. 

The Biden administration did not waste any time.  Last week, less than 10 days in, President Biden announced a three month Open Enrollment beginning February 15^th. 

·         Can you change policies within your current insurer? YES!

·         Can you change insurance companies? YES!

·         Can you apply / change your tax credit subsidy? YES!

·         Will preexisting conditions be covered? YES!

·         Will the Browns make it to the Super Bowl next year? Possibly!

Since we just had our Open Enrollment from November 1^st to December 15^th, I don’t think that we will see millions and millions of Americans take advantage of this opportunity, but it will help some people and it will hurt no one.  I know a half a dozen families that will benefit from this chance to make a change.  And, this action sends an important signal.  The government is now committed to making the purchase of health insurance, the way Americans access and pay for health care, easier. 

Joe Biden has been the president for less than two weeks.  We will all like and vehemently dislike his decisions, his Executive Orders, and the legislation he chooses to champion.  That is normal.  But if his focus remains on helping Americans, we may see a net positive from his efforts. 

DAVE 

www.cunixinsurance.com

Picture – Time For A Change – David L Cunix

Running The Omnibus Off The Cliff

Even by Congressional standards, the Omnibus legislation passed by Congress last week was massive.  The Consolidated Appropriations Act of 2021 is 5593 pages.  It includes the long-awaited COVID relief, the continued funding of the federal government, and the other spending priorities of both our Congress and our President.

Some of our friends on social media are learning about Omnibus legislation for the first time.  Their shocked ignorance is being fueled by people who know better but are enjoying the opportunity to take advantage of the newly “aware”.  For those who need a concise definition, this is from thefreedictionary.com:

Omnibus: [Latin, For all; containing two or more independent matters.] A term frequently used in reference to a legislative bill comprised of two or more general subjects that is designed to compel    the executive to approve provisions that he or she would otherwise reject but that he or she signs into law to prevent the defeat of the entire bill.

Major spending bills are passed on a bipartisan basis.  Spending priorities are not a Democrat vs. Republican issue.  There are regional concerns, geopolitical considerations, and a host of interests who have found a way to be heard.  Well-crafted legislation is remembered by each legislator for the victories scored.  Those same legislators ignore or forget where they have given ground.

I couldn’t wait to read the bill.  OK, not all of the bill.  I have a life.  My interests lie in Pages 4096 to 4463, “The No Surprises Act”.  I knew this was going to be good when a Senator, someone who had absolutely nothing to do with the drafting of this legislation, sent me an email.  His alert was filled with weasel words that made it look like he was responsible for the legislation.  He wrote that he was continuing “to work to ensure that health care opportunities are available to all Ohioans”.  Everyone was taking credit.

So how good is the legislation?  Pretty darn good.  The key element is that the patient is no longer a direct victim of Surprise Billing.  The insurance companies will deal with the non-network providers and hedge funds.  Protection for both Emergency and non-Emergency Care is included.  Even Air Ambulances are included in The No Surprises Act.  There is some haziness on the definition of Informed Consent, which must be addressed during the rulemaking.  All in all, this legislation could be an important benefit for the health care consumer.

It may also be irrelevant.

The Consolidated Appropriations Act of 2021 is in limbo.  Donald Trump has announced that he won’t sign it.  The stated reason is neither real nor relevant.   At this moment you may reduce his constant tweets and his bizarre video to “I didn’t really lose and I want more attention”.  As of right now, Sunday afternoon, he hasn’t signed the bill and he hasn’t vetoed it.  If he signs the bill, millions of Americans get COVID relief, our government is funded, and we’ve gone a long way towards ending Surprise Billing.  If he vetoes the bill, Congress has the opportunity to override his veto or face the voters if they fail.  But there is another option, a Pocket Veto.

From the US Senate website:

Pocket Veto - The Constitution grants the president 10 days to review a measure passed by the Congress. If the president has not signed the bill after 10 days, it becomes law without his signature. However, if Congress adjourns during the 10-day period, the bill does not become law

Congress cannot override a Pocket Veto.  If Trump continues this temper tantrum and neither signs nor vetoes the bill, it will be up to the next Congress to start all over.  The COVID relief needed by countless Americans will have to wait.  The funding of our military, our seniors on Social Security, and every other government function will be put on hold until Congress can pass new, emergency legislation.  And that legislation, thrown together by necessity, will have to be redrafted at that time.  The No Surprises Act may appear again someday as a separate piece of legislation or again a part of some larger bill.  It is unlikely that it will be included in the emergency continuing resolution Congress passes to keep the government open while we wait for the next administration.

We will revisit The No Surprises Act when/if it becomes law.  We have more important issues right now, like an Omnibus going over the cliff.

Dave

www.cunixinsruance.com

Picture – No Surprises Act – David L Cunix

Who Is Selling Your Name?

 

 

 I received a surprising call last week.  A Cleveland Clinic nurse called me to discuss Medicare options for her and her husband.  This was surprising because the Cleveland Clinic provides excellent coverage for its employees.  She told me that she had received a solicitation from an online health insurer that referenced her employer and MyChart.  She was directed to a website and Medicare Advantage products.  What really shocked her was that one of the featured products, one of the ones you see pushed on TV, didn’t include her Cleveland Clinic doctors!  This is what really confused her.  I would have been shocked had I not received the same solicitation, also from the same online seller, noting that they had received my name from University Hospital’s Follow My Health.  I assured her that her best possible action was to tear the solicitation into tiny pieces and throw it away. 

We are used to the annual bombardment of advertisements during the Annual Open Enrollment period.  The phone calls.  The emails.  And the endless parade of washed-up athletes pushing high pressure call centers.  I am amazed by the money involved in one minute and even two minute television commercials.  The cost to send unsolicited packets to our homes every week is staggering.   And yes, we have even come to accept the violation of our privacy.  Yet this solicitation, one that appeared to come from our very health care providers, seems to cross every line. 

It is not this particular online insurance sales organization.  They are no worse, nor no better, than any other boiler room operation.   They are all selling the same products.  Hell, any of us could sell the same stuff (many of us choose not to).  No, the issue is that our health care provider sold our names and allowed their name to be attached to the solicitation.  Does your doctor really want you to switch to the Medicare Advantage sold by Night Life of Nevada?  Does University Hospital really want you to change your coverage to a policy that sends you to a different hospital?  

The nurse was sharp enough to realize that her doctors and her husband’s doctors might not be covered if she chose the wrong plan.  Any agent can tell you stories about clients who came to them after they had been talked into the wrong policy, one that had lots of FREE stuff, but not the access they needed. 

It is time to ask “Who is selling my name and information?”  And it is time to stop them.

Dave 

www.cunixinsurance.com

 Picture – My Letter – David L Cunix

 

 

What's At Stake

 

Today, November 1, 2020, is the first day of Open Enrollment for individuals and families who are under age 65 and purchase their own health insurance.  Over the last two weeks I’ve sent emails or hand-written notes to my clients about their policy renewals.  I spent today in my office contacting the last several dozen of them.  One by one I review each of my client’s 2021 policy options.  Some have premiums increasing as much as 8%.  Some premiums are actually decreasing.  Most of my clients will see a small bump of 3% - 5%.  More interesting than the numbers are the stories, the people who own those policies and who depend on them to provide access and payment for health care. 

I got a call in the last days of Open Enrollment last year from one of my regular readers.  She had a friend who needed me.  Her friend, Linda (name changed for obvious reasons), was in the middle of a health emergency.  She had been diagnosed with a potentially life-ending condition that required immediate attention.  Her medical care was guaranteed to cost at least $100,000, probably more, needed to begin as soon as possible, and she didn’t have any health insurance.  My reader wanted to know if I would help. 

Why didn’t Linda have health insurance?  I asked her.  Her answer was that she had been healthy and had better ways to spend the money than on insurance.  Since she didn’t have to have insurance, she didn’t.  We all know lots of Linda’s.  But The Patient Protection and Affordable Care Act (Obamacare) has a true Open Enrollment.  We don’t ask any health questions.  You don’t have to have prior coverage.  Preexisting conditions are covered.  If given a choice, no insurer would take Linda.  They didn’t have a choice.  I got Linda health insurance. 

I thought about this as I processed Linda’s renewal.  And that is what is at stake.  Linda got the same access to the world class health care that every other insured greater Clevelander enjoys.  The system would work better if everyone, healthy and unhealthy, participated.  It is difficult to create a health care payment system based on the sick and the responsible.  

We need everyone. 

DAVE 

www.cunixinsurance.com

 Picture – Tools Of The Trade – David L Cunix