It was a scene that is played out daily in Greater Cleveland. The participants may change, but the message is always the same – The Rules Apply to Everyone But ME.
A physician, we’ll call her Dr. Peg, was discharging a patient from one of our local hospitals (Don’t ask me which one). The subject of insurance came up. The patient laughed and said that he had none. Dr. Peg suggested Healthcare.gov since the patient could now purchase coverage even with his preexisting conditions. He saw no reason to buy insurance. And if there is a penalty, he’ll just pay it.
Not only would the patient not waste any money on insurance, he also knew how much medication he could demand on his way out the door. Dr. Peg looked down in disgust at his paperwork. “Dave”, she later told me, “This guy lives in a nicer neighborhood than me!”
Did the sharpy get his discharge prescriptions? Absolutely. The hospital knew that the medications were cheaper than the malpractice suit.
One of the elements of the Patient Protection and Affordable Care Act (PPACA or Obamacare) is the Individual Mandate, the rule that everyone needs to have insurance. As anyone who has ever been hit by an uninsured motorist can attest, no law and no penalty, no matter how severe, will ever force everyone to be responsible. But that doesn’t mean that we shouldn’t try.
The Individual Mandate was a significant part of the Republican Party’s response to Hilary Clinton’s healthcare plan in the early 1990’s. The Individual Mandate reappeared in 2003 when the Republicans created Medicare Part D (Rx). Failing to enroll in Medicare Part D when first eligible may result in a lifetime penalty.
How much does the penalty (tax) have to be to force someone to be personally responsible? It may be a Risk / Reward issue. The upside of the PPACA has, for me, been the opportunity to easily insure the previously challenged. Sick? Injured? Doesn’t matter. One of my biggest frustrations has been my encounters with people who believe that insurance is for suckers. They think that it is our job, yours and mine, to cover their healthcare costs so that they can spend their money on fun stuff.
It is not our job.
Dr. Peg was really angry. “Obamacare was supposed to cure this”, she told me. And it might. But remember, every time you see a politician, TV ad, or internet spot discouraging young, healthy Americans from acquiring health insurance, we are institutionalizing this ME First / ME Always attitude. We need everyone in the system. And we need them now, before they meet Dr. Peg.
DAVE
www.bcandb.com
Monday, February 24, 2014
Thursday, February 13, 2014
I Fought The Law And The Law Won
I apologize for the wait Sir. Unfortunately, you are not going to like my answer.
That was, of course, an understatement. After three separate attempts to insure a young family through Healthcare.gov, after today’s efforts which had already wasted an hour and a half, after killing another twenty plus minutes on the phone with the national help(less) center – we were told that they I could see that we had not made any mistakes, but that the federal exchange had decided, for no apparent reason, to send the wife to Ohio Medicaid.
We can write subsidized coverage for the twenty-four year old husband and his infant son. But we cannot write a subsidized health insurance policy for his twenty-two year old wife.
The feds have submitted the young woman to the State of Ohio for Medicaid coverage. She will not qualify. We will eventually receive a letter from the State which will allow us to reapply with the feds. When the federal exchange turns her down, again, we will then be allowed to file an appeal. And since the feds have yet to address the appeals’ process, we are doomed to failure.
The good news, and yes, there is good news, is that the family currently has self-paid individual coverage. They will be paying hundreds of dollars per month more than they should, but they will be covered.
I’m really sorry Sir. Do you want to speak to a supervisor?
“No”, I told her. “I have no reason to doubt you. You have laid out our options. Spending more time to hear the same thing is counter-productive. Bouncing up to the supervisor for the purpose of yelling at someone for this mess is really counter-productive. I’m just really disappointed. We expected better than this”.
And that is the truth. We, the American people, deserve better. An experienced agent, I was able to cut through the crap and get to the root of the problem. My clients told me that they would have still been stuck in the application loop. And my clients, unlike many others in their circumstances, would still be uninsured and unprotected.
In a couple of hours on Tuesday, February 11, 2014, I fought the law and the law won.
DAVE
Update – I took a single woman who has worked at the same job for years through Healthcare.gov today. 50 minutes from start to finish. Proof that it can be done. Further reason that we should expect this or better every time we try.
Tuesday, February 4, 2014
So, How Are We Doing? (The Update Post)
Pat Carr, the CEO of UnitedHealthOne, the individual health insurance division of UnitedHealthCare, had a goal. On Tuesday, January 21st, Mr. Carr sent an email to insurance agents in which he shared the news that his company had had a record-breaking December. His goal? He pledged that his company would try to have 90% of those applications through underwriting by February 1st. 90%!
UnitedHealthOne isn’t buried under an avalanche of applicants taking advantage of The Patient Protection and Affordable Care Act (PPACA or Obamacare). No, this deluge of new clients comes from individuals and families attempting to avoid the PPACA for at least another year.
Welcome to the PPACA, where much of what you’ve been told on TV is not quite true.
There were seven editions of Health Insurance Issues With Dave posted in the last quarter of 2013. At the same time I sent an additional seven separate PPACA updates to my clients. These updates have been more insurer specific and action oriented. Today’s post will merge these two communications, at least for this week.
- UnitedHealthOne – Mr. Carr’s email is an indication of a new attitude of transparency. His company does not have an exchange policy in Ohio. Their emphasis is on Short Term Policies (more of that later) and off-exchange contracts.
- Medical Mutual of Ohio recently sent an apology to its agents. The Cleveland-based insurer admitted that it has had significant service issues through the conversion and that it hopes to be back to normal soon. Based on today’s experiences, soon can’t come soon enough.
- Anthem Blue Cross is overwhelmed. The clients and I have been underwhelmed.
- The insurers and their websites were as unprepared for October 1st and the PPACA roll-out as the federal government. The timing, a national insurance revolution in the middle of the annual Medicare Open Enrollment and the time of the year that American businesses reevaluate their group health policies, over-taxed our system. This could not have been worse.
- As reported in the Washington Post, over 20,000 Americans have filed appeals with the government over mistakes made by Healthcare.gov. Overcharges, denial of benefits, and being sent to the wrong policies are just some of the problems cited. But the biggest problem is that the federal government has no way to correct the problems.
- The upheaval we are witnessing overshadows the Medicare Part D (Rx) rollout of eight years ago. This mess is closer to the disaster of Y2K. And like Y2K, we will get through this, too.
- There is no reason to go to Healthcare.gov unless you will qualify for a subsidy.
- For those who will qualify for a subsidy, Healthcare.gov is working better. I say that even though I spent close to three hours on the site yesterday attempting to help two clients. We were not successful, and will be trying again later this week.
- Applying for a subsidized policy through the insurers’ websites may still prove to be the easiest path.
- The Medicaid Expansion will help millions of Americans access affordable care.
- Will there be a tax / penalty for not purchasing a PPACA qualified policy in 2014? A lot of people are guessing, NO. Short Term Policies, once thought to be the victims of the new health care law, are having a revival. These are G-d forbid policies. They only cover accidents and illnesses that are new, big, and different. And, they are very cheap.
- Many healthy Ohioans, even ones who may qualify for a subsidy, are finding that their old policies are cheaper. If you don’t need maternity, why would you change?
- Unhealthy individuals and small employers who have been charged extra because of unhealthy employees are buying the new policies and saving a bundle. For now. $700 per month. $900 per month. $1,100 per month. It is incredible. Of course, if the only people rushing to purchase insurance are the people most likely to use it, the system will crash. Politicians may shade the truth, but numbers don’t lie.
We are all in this together.
Sunday, December 29, 2013
Fiddler On The Roof
In the opening number of the movie Fiddler on the Roof the town Rabbi is asked if there is a prayer for the Tsar:
Lebisch: Rabbi! May I ask you a question?
Rabbi: Certainly, Lebisch!
Lebisch: Is there a proper blessing... for the Tsar?
Rabbi: A blessing for the Tsar? Of course! May God bless and keep the Tsar... far away from us!
With the disastrous rollout, rules and regulations being created on the fly and the President’s penchant for modifying deadlines, many of us in the insurance business have decided that we are happiest when Mr. Obama puts all of his time and efforts into immigration reform.
2013 was the year of the missing hero. There never seemed to be anyone in charge, anyone willing to be responsible, anyone who actually gave a damn about the American people and was prepared to work on our behalf. The year started with a last minute deal to fund the government and keep the lights on. But in an effort to cement the impression that ultimately we are all alone, the U.S. House of Representatives adjourned BEFORE addressing the need for emergency relief for the victims of Hurricane Sandy. That behavior would repeat itself throughout 2013. Only bills repealing Obamacare were guaranteed to reach the floor of the House.
And then the Republicans shut down the government. This, in of itself, isn’t the end of the world. Both parties have used this tactic with varying degrees of success over the years. What was particularly disheartening about this year’s government shutdown was that it was about Obamacare. The leaders of this fight exhibited as much forethought and preparation for this battle as the White House, the Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid (CMS) had in preparing to implement the law. This breath taking incompetence, this failure to lead responsibly, on either side, this idea that there will always be someone to clean up the mess has already impacted us in untold ways.
Insurance agents have a unique perspective on The Patient Protection and Affordable Care Act (PPACA or Obamacare). Regardless of political affiliation, our first priority is to get our clients insured. Nothing, not which insurer, not how we are paid, is more important than getting everyone covered. So we all have PPACA success stories. I have been able to get the very sick and the working poor health insurance that they would not have had. Eliminating health questions will allow Americans, some who are without insurance through no fault of their own, to purchase coverage. Completing the paperwork with someone contemplating surgery or in need of care is life affirming.
But this comes at a cost. And those same agents who are celebrating these client victories have also been sounding the alarm about those costs.
Picture a teeter-totter. For every cancer patient who will now enjoy a health insurance rate decrease there has to be at least one healthy person seeing a corresponding rate increase. One of my clients is rabidly anti-Obama. He actually came to my office in the summer of 2012 to campaign for Mitt Romney. Before I showed him his new, 2014 rates, I joked that if he saved over $1,000 per month he had to complete the last form in the packet and register as a Democrat. His savings was closer to $1,100 per month. Of course he accepted the new policy and the huge savings, but he realizes that his savings is at the expense of others. And no, he did not change his registration.
It is equally wrong to deny the gains or losses of the PPACA. Neither side has exhibited the least bit of intellectual honesty.
But honesty has been in short supply. People who can help you have also been scarce.
The agents knew that we were alone when we encountered the new federal registration system in August. Part was under one cabinet official with one computer system, while another part was under an entirely different division of the federal government with a different computer system. We got a full tour of government inefficiency and redundancy. It was a preview of the issues we would all encounter during the open enrollment.
The American public faced their own set of challenges. The PPACA gave us something new. Not an agent, but with more authority than our better trained secretaries, the PPACA begat the Navigator. I’ve talked to a couple of navigators. They knew next to nothing about insurance, networks, or the different policies. The Navigators aren’t prepared to help the mouse get through the maze to find the cheese. No, Navigators know just enough to drop the mouse into the maze and wish the mouse (YOU) “Good Luck”.
But the navigators weren’t the only folks complicating our lives this year. My friend Greg, who now lives in Florida, sent me an email about his difficulty in finding new coverage. As NPR reported, there were plenty of people willing to exploit the weakness of this law.
As Tevya might ask, “A health insurance agent in 2014”? Between the government that wants to replace us and the insurers that hate to pay us and a public that only appreciates us when they really need us, it sounds a little crazy. But here in the U.S. we all have our part to play. Much like a fiddler on the roof, each of us is trying to scratch out a pleasant, simple tune without breaking our necks. It isn’t easy. You might ask “Why do we stay up there if it is so dangerous”? Well, we stay because it is what we do.
And as our health care system changes, our lives, yours and mine, have become as shaky as… as… as a fiddler on the roof!
DAVE
Monday, December 16, 2013
Buy 11, Get 1 Free!
Some people just know how to shop. You and I may pay retail, but they always seem to find the best deals. And if they have to cut a corner or two? Well, they’ve got great scissors.
We are in the middle of our first open enrollment under the Patient Protection and Affordable Care Act (PPACA or Obamacare). Applications received by December 23, 2013 will generate new policies as of January 1, 2014. Preexisting conditions will be covered. There is no requirement of prior coverage.
Our current policies, operating under the old set of rules, have a 30 day grace period. It didn’t take long for many of my sharpest clients to realize that paying for December is now optional. If they get sick or injured in December, they will pay their premiums and file their claims. If they don’t have a claim in December, they will let the old policy lapse and start anew in January.
Ethical? Of course not. Legal? You bet. In fact, this is just one more step in our inevitable march off the cliff. Shorting the insurers and making private major medical health insurance unsustainable are part of the campaign that will lead us to Single Payer.
The Department of Health and Human Services (HHS) isn’t just writing rules and regulations on the fly. Last week, in a conference call for journalists, Director Kathleen Sebelius and her team revealed a new set of fixes and recommendations.
All of these recommendations are designed to make the transition to the PPACA smoother by bending the rules at the expense of the insurers.
The government now expects the insurers to cheerfully accept the initial payments as late as January 1st. There is even a push to move that initial due date through the first week or so of January. And next year’s grace period will be 60 days. Please don’t expect that same flexibility from the IRS.
Health insurance policies may include lists of Preferred Providers, doctors and hospitals participating in a network, and prescription drug formularies, lists of covered drugs. HHS is asking the insurers to bend (IGNORE) their own rules during the transition. Is this push out of concern for sick Americans or an effort to avoid more horror stories on the 6 PM news?
The answer is obvious. This has never been about sick people. This has always been about money and politics. The doctors, hospitals, and drug companies want our money. The politicians want our money and our votes. Health is hardly a consideration.
So whether they want to or not, the insurers are having a sale. I’m going to pay my December premium. I’m just that way. Buy you? You may choose to pay for eleven and get one free.
DAVE
Monday, November 25, 2013
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.
DAVE
www.bcandb.com
Tuesday, November 12, 2013
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?
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 1st. 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
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