The Not Ready For Primetime Players


It was another one of those meetings.  The regional manager of some insurance company spoke for two hours.  No handouts.  No collateral.  Two hours of power point.  The important stuff was glazed over or skipped entirely.  He returned to the irrelevant again and again.  I was in a room full of agents desperate for the news that this company, or any company, had found a clear path through the Patient Protection and Affordable Care Act (PPACA).  Would this insurer solve our clients’ problems, provide access to the best doctors, and be reasonably priced?

Yes and No.

This particular insurer will be a great answer for a limited number of people in our market.  But it won’t be just the people well served by this insurer and its products who will be carrying that card next year.  For some the coverage and the medical providers will be OK, at best.  And some Ohioans will make a bad decision based on their familiarity with the company’s name or the price on the government’s website.

Unprepared.  Rushed by a timetable that neither the insurers nor the government seem capable of meeting, we emerge from our summer stupor to confront the upcoming open enrollment and renewal season.  In fact, even the insurance company executive noted that this year, 2014, was going to be a bigger mess than last year’s initial debacle.

Insurance agents are people who have figured out how to monetize empathy and problem solving.  The following are some of the pressure points, issues, and concerns that we have as of the end of August 2014.

  1.  We haven’t solved last year’s problems!, which appears to default to Medicaid, is still incorrectly blocking Ohio women from regular, subsidized, health policies.  It has been less than a week since I last encountered this issue.  Women who have recently given birth seem to fight this more frequently.
  2. Speaking of babies… I noted in April the difficulty I was having adding a newborn to an exchange policy.  The problem was solved in May’s Climb Into The Ring.  NO IT WASN’T.  The baby has yet to be added to the policy.  The client is frustrated.  I’m beside myself.  Our senator’s office doesn’t understand why the Centers for Medicare and Medicaid Services (CMS) can’t resolve this and can’t seem to provide any of us with an answer or the courtesy of a returned call.  We’ve all given up hope.  To the shock of my peers. I was forced to write a short term major medical policy for the baby this week.  The child will have coverage if he suffers, G-d forbid, a major accident or illness.  I mailed the application to the insurance company and mailed a check for the $25 I made on the sale to a charity.  I can’t keep that money.  I’m embarrassed that I was forced by the government’s incompetence to write the application.
  3. Perfect Storm… My peers are justifiably concerned about the 24 hour day.  There just isn’t enough time.  Senior citizen (65+) Medicare Open Enrollment is October 15th through December 7th.  A large percentage of our group health policies renew January 1st.  Client meetings will be held during the months of October and November with everything finalized, if we’re lucky, by the first week of December.  AND, all individual PPACA compliant policies renew January 1stThe Open Enrollment Period for individuals and families (under 65) is November 15th through February 15th.  Because of the subsidies and changes, most people should resolve their 2015 coverage prior to December 15th.  30 Days.  The overlap of all of our senior business, most of our group clients, and every single individual policyholder under age 65 converging on our offices in time for Thanksgiving dinner has more than a few of us nervous.
  4. Lack of concern… At least one of our insurers has, effectively, eliminated the reinstatement of lapsed policies.  All of our new individual policies are due on the first of the month.  This particular insurer sends a late notice on the 3rd if payment wasn’t received on time.  Policies not sold on the exchange have a 30 day grace period and only have to be eligible for reinstatement to the 30th day after the first late notice.  Yes, you are seeing that correctly.  If the policy was due September 1st it would be permanently terminated by October 3rd.  Once terminated for non-payment, the individual or family is not eligible for comprehensive major medical coverage until the next Open Enrollment Period in November.  Have they met their clients?  This has already had a big impact on some of my clients.  And this will get worse as the premiums rise.
  5. Subsidies and tax returns… Christmas comes twice a year for some retailers.  There is the traditional excitement of December and there is the joy of March and April, when W-2 wage earners receive their income tax refunds.  That money is immediately plowed back into the economy.  Jewelry!  Clothing!  Appliances!  New and Used Cars!  We have no idea what is going to happen this coming spring as many people will be receiving smaller tax refunds due to adjustments from the subsidies.
  6. Deductibles… As the deductibles for individuals on our new policies rise to $6,000+ and families face out of pocket liabilities well in excess of $10,000, we will soon face a new reality.  How many families can afford both the premiums and the deductibles of the PPACA?  This is not about health.  Never has been.  This entire enterprise is designed to (efficiently?) transfer money to doctors and hospitals.  The current system implodes if they don’t get paid.  Sure, your insurer may cover $88,000 of that $100,000 hospital bill, but what about the $12,000 that you failed to pay?  Will you be forced to provide your MasterCard in the emergency room?  Copy of the deed to the house?  This is going to get ugly.

There’s more, but there is a limit to how stressed any of us should be on Labor Day weekend.  In the end it is about faith.  Our faith in our systems, our government, and our leaders will be tested.  And they will disappoint us, but this will get resolved.  It has to be.  Healthcare is almost 20% of our economy.  And though health is seldom a consideration, there are real impacts from decisions made in Washington and our state capitals.  We just need to remind them every now and then.

The Not Ready For Primetime Players became legends at what they did best.  Who knows?  One day we may look back in appreciation at some of our current politicians and bureaucrats.   It could happen…


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2 Responses to The Not Ready For Primetime Players

  1. David Randolph says:

    Excellent Blog.
    The problems with healthcare .gov. seen to have gotten worse in the past month.
    Notified that an individual client passed on July 29. They have not figured out how to cancel policy yet. Thankfully the carrier stopped the EFT in time but is now sending delinquent notices. Can’t add newborn and unable to cancel a policy due to death. This past week a client that has a MAGI in the 150-200% range was told the only option for his family was Medicaid. He has to apply for Medicaid and be turned down before he is able to complete his enrollment.

    Another client in the 150-200% range was told he did not qualify for a subsidy and we have to submit an appeal. We completed the enrollment because his COBRA ran out Short Term will not work due to pre-x.. Both clients can back up their MAGI.

    The nightmare continues.

  2. […] ← The Not Ready For Primetime Players […]

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