The Rescue Call, Market Stability, And How I Failed At UBER

It appears that it is common, when someone is on a blind date, to arrange a “Rescue Call”. There is even a commercial on TV that references this.  A friend calls you and provides you a reason to cut the date short.  I actually saw it in action on Wednesday.

I was in a Congressman’s office. Seven Ohio health insurance brokers were in his office to discuss the Patient Protection and Affordable Care Act (Obamacare) and what we were going to do now.  Fifteen minutes into a positive / routine meeting we were interrupted by one of his aides.  After one quick knock on the door, the aide poked his head into the room and told the Congressman that he had another meeting.  The Congressman waived him off and we all got another fifteen minutes.  If this had been a date, we would have just qualified for a second cup of coffee.  Welcome to How To Visit Washington DC 2017.

Over a thousand members of the National Association of Health Underwriters (NAHU) gathered this week in Washington to hear from a variety of experts and to talk with our states’ elected representatives.  Most of us are there on our own dime.  It is that important for us to get the most up to-date information and to make certain that our lawmakers understand how our clients will be impacted, both positively and negatively, by any changes in the way Americans pay for their health care.

The Law of Unintended Consequences.

There are a lot of ideas that sound absolutely fantastic on TV but will be irrelevant, or even worse disastrous, in practice. Insurance agents are uniquely positioned to explain the real world impact of these programs.

We were in Washington to deliver one important message for our clients – Market Stabilization. It is already mid-February.  Nothing can really be changed for 2017 and the insurers only have eight weeks left to prepare for 2018.  Yes, eight weeks.  Insurers are currently working to file their plans and rates for 2018 and they, as well as our clients, need to know what the market will look like on both the state and federal levels.

Our key points centered on the individual (non-group) market.

  • Allow the tax credits that help so many Americans to afford coverage to remain intact for at least two more years or until a comparable replacement can be put in place.
  • Allow tax credits to be used outside of the Marketplace if fewer than two choices are offered in a state.
  • Allow any person to purchase a catastrophic-category coverage regardless of age or income status.
  • Tighten both the open-enrollment and special-enrollment periods to reduce adverse selection.
  • Allow states to be eligible for a new hybrid high risk pool that would serve as a reinsurance mechanism while still providing the same level of coverage for even the highest risk individuals.
  • Preserve employer-sponsored health insurance by retaining the employer exclusion.

Yes, this is a lot of process and almost nothing that would make a good sound bite. These points and others would help secure the promise of health insurance coverage for the next couple of years.

Armed with individualized packets, we set off to meet our Senators and Members of the House. I had a chance to visit offices in the Senate and the House, Democrats and Republicans.  Some of my meetings were with the actual lawmaker.  Some were with staff.  And though it is always gratifying to have a Congressman make time to speak with a visiting constituent, some of the best meetings can be with a Chief of Staff or a knowledgeable legislative aide, especially one who specializes in public health.  I found this year’s meetings productive.  The Congressmen and their staffs were totally engaged.  They asked good questions.  They took notes.  I honestly felt that my time and expertise were valued.

**  **  **  **  **

I was in geek heaven. Cigars.  Scotch.  Politics.  I was with two of my peers and a lobbyist in Shelly’s Backroom doing a deep dive on the current state of affairs.  The hours flew by and it was past midnight when I called us an UBER.  We walked outside, ignored the parked cab, and looked for Mohammed and his Toyota Camry.  A Camry stopped, right in front of us, in the middle of the street.  We walked up to the car and tried to get in as the driver frantically waived at us.  We had failed to notice that there was a traffic light, here in the middle of the block, and he had been stopped for a red light.  He wasn’t an UBER!  We stepped back and he sped off.

Another Camry, one with an UBER decal, came up a couple of minutes later. This time we verified that it was an UBER and got in.  Sitting shotgun, I noticed that the driver was a little confused.  We had only traveled a few blocks before his phone rang.  It was Betsy.  She wanted to know where the Hell he was.  They started arguing.  This wasn’t Mohammed and we were in the wrong UBER.  In the end I cancelled my order, paid the penalty, and slipped the driver a $10 for a $7 ride.  His last ride as an UBER driver might as well include a tip.

The view from the train beneath the Capitol.

The Ways and Means and Committee needs new furniture!

This is either the office of Rep. Don Young of Alaska or a Betsy DeVos elementary school.


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The Nice Guy Finished Last / First

Robby is the nicest guy I know. No exaggeration.  Robby is just a great guy.  And right now Robby is losing and winning the health insurance battle.

Robby was referred to me by his employer at the very beginning of the full rollout of the Patient Protection and Affordable Care Act (Obamacare).  So I have never asked him any health questions, but I have no reason to believe that he has any medical issues or ongoing prescriptions.  He is just a laborer, single and a non-smoker, in his early 50’s, living in Parma.  There are thousands of guys just like him throughout Greater Cleveland.

Robby has gone years without health insurance. His employers seldom provided coverage and he couldn’t possibly afford it on his own.  The PPACA guaranteed access to coverage AND included a penalty for non-compliance.  The penalty was an important factor in his request.  It would be unthinkable for Robby to jaywalk, he certainly wasn’t going to do anything penalized by law.

And Robby got a policy. It was a terrible policy with a $6,000 deductible and it cost him $110 a month after his tax credit subsidy of $187, but he was covered and if, G-d forbid, he got really sick or injured he would have easy access to world-class facilities right here in Cleveland.  He even got a free routine annual exam, if he ever had a chance to get to a clinic on a day he wasn’t working.  So, Robby won.  We all did.  We had one less uninsured American worried about a major illness and a society less concerned with the inevitable bill for his care.

Robby’s insurance went up $30 a month beginning January 1, 2015. Robby’s victory wasn’t quite so sweet.

The price of insurance was going up. The subsidies were going down even though his income had hardly changed.  The invasion of low-cost Medicaid providers into the Exchange severely impacted Robby’s subsidy.  If he would allow the Exchange to force him to Metro and Charity hospitals he would pay less.  He hung on to the Cleveland Clinic and the price went up to over $250 with his subsidy for 2016.

In 2017 his premium is $325 and his deductible is $6,400. Robby is losing.

I got a call today from Robby. He wants to drop his policy now that he is no longer required to keep it.  I let him know that he can drop the policy but that he would still be liable for the penalty.  He thought that it was over.  I had to break the news to him that the individual mandate, both a Republican idea traceable to the Heritage Foundation in 1989 and Republican strawman, was still the law.

President Trump’s Executive Order gives the Secretary of Health and Human Services and other department heads the ability to reduce the “burden” of complying with Obamacare.  Congressman Price’s confirmation for Health and Human Services has been stalled due to what appears to be insider trading.  More importantly, the insurance companies are scared to death of adverse selection.  Without the individual mandate, the only people who will buy insurance are the sick and the responsible.  That could be disastrous.

With no immediate viable replacement, a nice guy like Robby has no place to go. He’s winning.  He’s losing.  Nothing has really changed.

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The Number One Priority

You may have seen the picture of the new president rushing into his office to sign his first Executive Order.  It was Friday, January 20, 2017, after the parades and before the inaugural balls.  Chief of Staff Reince Priebus put the paper in front of him, and like a homebuyer whose eyes have glazed over from thirty pages of gobbledygook, President Trump quickly signed the document without a moment’s hesitation.  Now if you or I were about to make history, and everything a president does, by definition, is historical, we might have looked at the document, maybe ever READ the document, prior to affixing our name to it.

Since we aren’t on our way to any formal dinners or balls, we have plenty of time to read the Executive Order.  Please take a moment.  It is only one page.

It is important to note that this was the first Executive Order. So what does it mean?

Option One – If the repeal, replace, demolition, or rebranding of Obamacare succeeds, this Executive Order will be hailed as the important first step President Trump made to keep his promise and to deliver a better program.  That is a huge if.

Option Two – This Executive Order opens the door for major changes. Once a Secretary of Health and Human Services (HHS) has been confirmed by the Senate, he (Don’t judge me.  All of the nominees are male.) will be able to determine what regulations are burdensome.  Here’s a hint – All regulations are a burden to someone.  The current nominee is Congressman Tom Price (R-GA).  States looking to modify the cost of Medicaid by reducing benefits or access will find Mr. Price supportive.  In fact, a quick read of his positions over the years will yield the impression that Mr. Price might happily remove any requirement that the poor and middle class have comprehensive insurance coverage.

And though all of the above might seem like enough of a motivation to sign this Executive Order, I still think that it isn’t enough to be #1.  So allow me to offer another explanation.

The Patient Protection and Affordable Care Act (Obamacare) was structured in broad strokes with the details to be fleshed out in the form of regulations.  This is not unusual.  Major legislation like the Patriot Act are designed this way.  The PPACA requires health plans to cover annual routine preventive care visits.  These visits are covered at 100%.  No deductible.  No copays.  It was HHS that determined that routine preventive care included a colonoscopy for those of us over 50.  This has undoubtedly saved lives.  It was also HHS that determined that preventive care included birth control pills, the IUD, and the morning after pill.  That made the lives of countless Americans easier.  And now that this Executive Order has been signed, it will be HHS that will decide birth control, the IUD, and the morning after pill are no longer part of preventive care.

This change could apply to both individuals and groups. The current court cases dealing with this will be dropped immediately.  This will be seen as a victory for those employers who are opposed to these services.  And to those who needed these benefits.  Well, they aren’t the priority.


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Michael Lewis’s recent book, The Undoing Project, details the groundbreaking work of two Israeli psychologists, Daniel Kahneman and Amos Twersky.  Their work explored the way we make decisions and how we justify, after the fact, those decisions.  Mr. Lewis helps us to understand how these two scientists moved our decision making towards data and away from intuition.

In late 1973 or early 1974, Danny gave a talk, which he would deliver more than once, and which he called “Cognitive Limitations and Public Decision Making.” It was troubling to consider, he began, “an organism equipped with an affective and hormonal system not much different from that of the jungle rat being given the ability to destroy every living thing by pushing a few buttons.”  Given the work on human judgement that he and Amos had just finished, he found it further troubling to think that “crucial decisions are made, today as thousands of years ago, in terms of the intuitive guesses and preferences of a few men in positions of authority.”  The failure of decision makers to grapple with the inner workings of their own minds, and their desire to indulge their gut feelings, made it “quite likely that the fate of entire societies may be sealed by a series of avoidable mistakes committed by their leaders.”

I can’t think of a more important paragraph to share with you today, January 20, 2017. Health Care, Nuclear Proliferation, Trade – all of these decision will affect us all.


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Pair Of Sevens

ALL IN! Crap, all in with a pair of sevens.  But he had to do it.  It had been so long since he had had a hand, any hand, that he was forced to go all in with a pair of sevens.  He had been pushed around long enough.  He remembered his last chance, the last time he had had a really good hand.  Thought he had a winner.  The first two cards – King and Queen of Hearts.  He bet and his opponent called.  Next the Jack and then the ten.  Both hearts!  He bet big.  Call.  And then came the ACE!  But it was the ace of clubs and all he had was a high straight.  He bet and his opponent raised.  The warning bells went off in his head as he called.  He had a straight, but his opponent had drawn a full house.  Now he was all in with a pair of sevens.  And his opponent looks like he may call…

It takes a certain amount of courage to put your money on the table and ask to be dealt into the game. Though some may always lose, no one always wins.  So you better enjoy the game, revel in the risk, and be prepared to accept the outcome win or lose.  And there is one more similarity between poker and politics.  You must be prepared to bluff.

In March of 2010 the Democrats went all in. They didn’t have a great hand.  This wasn’t the early 90’s when they thought that they had a winner.  They didn’t have the National Single Payer plan that they really wanted.  They had compromised with their fellow legislators from across the aisle to cobble together a plan that would garner bipartisan support.  And they failed.  They were all in and they were exposed and alone.  On March 23, 2010 the Dems won with a pair of sevens and the Patient Protection and Affordable Care Act (Obamacare) was signed into law.

March 23rd wasn’t the end of the game, just the biggest tournament to date.  The Republicans have been very busy since that loss.  They had no respect for the gambler, President Obamacare, and hated to have been bested by such a weak hand.  It took almost seven years, but here they are, back at the table.  The Republicans had spent almost every waking hour since the defeat preparing for this day.  A poker player needs a bankroll.  The Republicans needed votes – a solid majority in the House of Representatives, the Senate, and a Republican in the White House.  And on Friday, January 20, 2017 it will all come together.

For almost seven years the Republicans have told everyone who would listen that they were the better choice. “Bet on me”, they said to the American public.  Their focus, the game, scheduled for 1/20/2017 was impressive.  We all knew that if they were given the chance they would repeal and replace Obamacare.  They just needed their bankroll.  And now they’ve got it.  There is only one problem.

We are about to see how Paul Ryan plays a bluff. He’s got the votes.  But he doesn’t have the cards.  There is no viable Republican alternative.   Even Republican governors want/need to retain the expansion of Medicaid built into the law.  Nobody wants to reinstate medical underwriting, exclude preexisting conditions, or kick kids off their parents’ policies.  Everyone wants cake and ice cream for dessert, but no one wants to be forced to eat the liver and onions entrée.

The players are about to be seated. We’ve already taken a peek at the Republicans’ hand.  Wonder what the Dem’s have?  Wonder how they’ll play their cards?  More importantly, who is going to tell all of them that this isn’t just a game?


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Fighting For Care


Irritated. My right eye was irritated.  So was I.  My eye had been bothering me for a couple of days.  I didn’t know if it was allergies, a sty, or an infection.   I had been determined to rely on eye drops and to just tough it out, but that was before I had needed a warm compress in the middle of the night.  Time to get medical attention.

As previously noted, I was a touch irritated. Before I could deal with my issues I had to solve a client’s problem with UnitedHealth One.  I was on hold for 52 minutes!  My phone has a timer.  Staffing cuts reflect the company’s losses over the last few years.  Once that was completed I could focus on me.

I contacted the Cleveland Clinic facility in Beachwood. It only took 30 seconds for me to clearly state that I didn’t need to see my doctor, or any doctor.  I would be perfectly happy with a nurse practitioner as long as I got to come in today.  I had also detailed my eye problems.  If I was having a heart attack or bleeding to death the scheduling tech would have been able to send me to the E/R and hang up.  No, she had to talk to me.

I have been a Cleveland Clinic patient for years. The clerk had all of my information on her screen.  Still, she needed to verify ALL of the information from my Anthem card, front and back.  I said that I’ve had this policy for over three years.  Nothing has changed.  It didn’t matter.  She plowed on.  Next, where do I work?  What is my job title?  At the eight minute mark, remember my phone has a timer, I noted that we had spent more time confirming how the Cleveland Clinic would be paid than my health problem.  She persisted.

Ten minutes into the call I asked her again who was going to see me. She said, “We don’t have any openings today”.  “Then why did you waste my time”?  She began to offer appointments for the following week, but I had had enough and hung up.

I hear it all of the time. Every negative encounter with the medical industry is blamed on Obamacare (the Patient Protection and Affordable Care Act).  Sometimes the complainer is correct, but not always.  Failure can be traced to a number of sources.

The staff cuts and financial losses at UnitedHealth One are due, in part, to some really awful decisions. And UH1 cut their marketing and service staff when the going got tough.  They succeeded in making it harder to do business with them.  UnitedHealth One will get better.  This is just a bump in the road.

And the Cleveland Clinic’s failure can’t be blamed on Obamacare. This insatiable push for more money, more donors, and more buildings occasionally leaves the patient as nothing more than a necessary evil.  We are in the way. Soon we will be diagnosing and treating our own ailments and simply sending tribute payments to the Cleveland Clinic.

Two websites and a phone call later I had an appointment at a Minute Clinic in a CVS. These clinics are somehow affiliated with the Cleveland Clinic.  The nurse checked my vitals, noted my agitation, and gave me a prescription for some eye drops.

So what was it? Allergies?  Sty?  Infections?  I’m still not sure.  I took an antihistamine and have religiously put in the eye drops as prescribed.  I’m sure I’ll be OK in another day or so.


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A Tragedy of Shakespearean Proportions

Dana Milbank, opinion writer for the Washington Post, was featured on some of the news shows yesterday to discuss Trump voters who desperately rely on Obamacare (The Patient Protection and Affordable Care Act).  His article appeared Tuesday and was creating quite a buzz.  I, for one, enjoyed 20 minutes of TV that didn’t feature Putin or the words “Conflict of Interest”.  Still, this is a serious issue, and we will treat it with a little more respect than Mr. Milbank.

There are and always will be Americans who vote against their personal interest. This is a link to a Forbes article on the issue.  But as this article and many like it point out, it is not necessarily that simple.  Poor people in Kentucky didn’t decide on Election Day to screw themselves.  The previously uninsured didn’t vote for Donald Trump because he vowed to repeal Obamacare.  Interviewing them now, a month after the election and a month before anything has changed is unfair to them.  It is bad enough to be poor.  We don’t need to make them look stupid.

I have a number of clients who have benefited from the PPACA who still voted for Trump. Let’s take a quick look at some of the possible reasons for their choice.

It Didn’t Matter – There are many people who feel that Obamacare will be repealed loudly and retained quietly.  We may end up with Trumpcare, a modification that fixes some issues while creating new problems.  The Republicans declare victory and the Democrats cede the next 5 years of glitches and complications to the other side.

The Bright Side – I have at least one client predicting a major economic recovery that will result in more jobs with benefits.  If they score better gigs, they won’t need individual coverage and all of this will cease to be relevant to THEM.

A Better Way – There must be a better option and their team’s got it.  No matter how many times they have been let down by politicians of both parties in the past, this could be the time they get it right.

There Are Other Issues – Health Insurance is really important to me, but I doubt that there are many single issue Health Insurance voters.  Abortion, Pro-Life or Pro-Choice, seems to drive people to the polls.  Immigration and jobs, too.  People were riled up and voted AGAINST Obamacare, often without understanding its positive impact on them personally, but I think that they saw it as part of a whole, a failure of Washington to properly serve and protect them.

Regardless of why or who voted for Donald Trump, the election is over and about 40% of us have spoken. Donald Trump will be the next president and he has a Republican controlled Congress.  He has nominated Tom Price (R-GA) to be the next Secretary of the Department of Health and Human Services.  Mr. Price is famously anti-Obama and anti-Obamacare.  His solutions are radically different and concerning.  Will the Price plan or something like it be implemented?  No one knows at this point.

Congress will be very active in January and February. It will be important for all of us to watch them closely and share our thoughts with our elected officials.  I don’t think that we will see any major changes in 2017, but that is my guess.  I will be in Washington in February, in part to discuss my clients’ needs and how the actions of Congress can help or hurt my people.

Until then, if you need a liver transplant like Mr. Mills of Whitley County, Kentucky, I strongly suggest that you get this scheduled soon. The press may paint you as a victim of your own folly for being in this mess, but if you put it off too long this really could be a tragedy of Shakespearean proportions.


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Reality What a Concept

Editor’s Note: All articles, blogs, and news reports about Obamacare (The Patient Protection and Affordable Care Act) must, per the edict from the incoming president, begin by stating that Obamacare is a terrible burden on the American public and that it needs to be repealed immediately.  If you have benefited by the law because of the subsidies, preexisting conditions, or access to care, please have the good sense to keep that to yourself.  You wouldn’t want the most powerful man in the world to tweet about you at 3 AM.

The election was about a month ago. Each day brings new proclamations and trial balloons. The Congress beat at Health Insurance Issues With Dave has been working overtime to monitor all of the pronouncements coming from our elected officials.  Today’s post will serve as an update.

Republicans in both the House and Senate are eager to repeal Obamacare. The repeal may even be HB 1, the first bill of the new legislative session.  It will be a great moral victory.  The newspapers, Facebook, and TV news will talk about it that night.  The details are more important.  Some in Congress want to have the replacement bill be introduced as soon as the celebration and back-slapping dies down.  Others believe that the replacement package is still 1, 2, EVEN 3 years away.  This is known as Repeal and Delay.

There are advantages and disadvantages to both strategies.

On June 22, 2016, Speaker of the House Paul Ryan released his health care plan, A Better Way.  His proposal begins with the repeal of Obamacare.  “…This law cannot be fixed…We need a clean start in order to pursue the patient-centered reforms the American people deserve”.  That has been the Republican line of attack since the bill was passed in March 2010.  No compromise.  No tweaking.  No amendments.  The Republicans have bludgeoned the Democrats with Obamacare to the point that even those Americans who have benefited the most from the new law might not understand or appreciate it.

If Obamacare is repealed and immediately replaced we, the American people, would be able to quickly identify winners and losers, the before and after of the Republican’s actions.  The insurance companies and the medical providers would also know their places in the new market.  Unfortunately, that is not going to happen.  There is no Republican alternative plan.  There never was one.  Speaker Ryan’s recent interviews confirm that.  Reality: What a Concept.

So we are looking at Repeal and Delay. The concept is simple.  As detailed by the Urban Institute, the partial repeal of Obamacare could be done through the process of reconciliation. The Senate Democrats could not stop this since reconciliation only needs a simple majority in the Senate.  Congress would starve Obamacare by cutting off the funding for Medicaid, tax credit subsidies, and eliminate the individual and employer mandates.  Doing that immediately would be the equivalent of dropping a bomb in Times Square.  But it could be phased in over a three year period.

Why three years? For one, Paul Ryan, Mitch McConnell and the entire Republican team want to take a victory lap for killing Obamacare even before it is really gone.  The real impact of their actions wouldn’t hit until after the 2018 election, just the press releases.  The other reason is that they need several years to come up with a viable option that can be phased in properly.  Mr. Ryan doesn’t want to take health insurance away from 20 million Americans.  That is not his goal.  Plus, some of them vote!  And, if they can buy three years they have enough time to find a Democrat or two to sign on to their final legislation which will provide the illusion of bipartisanship.    The Democrats tried the same thing in 2009 and 2010. But in the end Senator Chuck Grassley and Senator Olympia Snowe still walked away from the negotiations.

The insurance companies, already losing money in the individual market, and the medical providers aren’t real excited. Eliminating Medicaid expansion will force millions of Americans out of the health care system.  No routine care.  No access to maintenance prescriptions for diabetes, high blood pressure, and other common easily treated illnesses.  The E/R waiting rooms will again be filled with people seeking care for minor ailments better treated in a doctor’s office.  Would the Republican controlled Congress reinstate reimbursements for charity care?  Who knows?

The insurance side is worse. The law would still require insurers to cover anyone who applied, regardless of preexisting conditions.  But healthy people would not be required to retain coverage.  Only the unhealthy and the responsible would seek coverage.  Insurers would be foolish to offer coverage under those circumstances.  Major insurers, now publicly owned, would be forced to leave markets or face the ire of their shareholders.

Other alternatives? Darned if I know.  You can’t have health insurance if there isn’t an insurance company to sell it.  I am scheduled to go to Washington in February to meet with our members of Congress.  I have no idea what I’m going to find when I get there.

Oh, and did I mention that Speaker Ryan would like to change Medicare?


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The Post-Election Update


Wednesday was a terrible day in the office. I was a mess.  I had been awake most of the night, my worries as dark as the bedroom.  Clients called.  Clients texted.  Everyone, all through the day, wanted to know how this election would affect them.  I was too busy to write this update.  And I was too concerned about the possible impact to prepare a full report.  A friend came in around 5:30.  He asked me how I was doing.  I told him.  I probably did ten minutes on where we were and how worried I was about my clients.  He was very patient.   Then he asked me, again, how I am.  I had completely forgotten that my friend David is totally apolitical.  He was asking about my health!

We’ve had a couple of days to watch the president-elect articulate his vision and the current Congressional leaders voice theirs. They are not the same.  The future of health insurance will be determined by both the new president and Congress.  And the courts may also play a part in our future.

This blog is Health Insurance Issues With Dave. It is not my interest nor place to discuss any part of the election that does not deal with health insurance.  And health insurance is our method of compensating   medical providers for their products and services.  Health insurance is regulated on both the state and federal level, which means that decisions are influenced by finances and the public good.  Finances are in black and white.  The public good is open to discussion.

The president-elect campaigned on the promise to Repeal and Replace Obamacare (The Patient and Protection and Affordable Care Act).  The Republicans who control Congress have promised this for years.  On Tuesday the coyote caught the roadrunner.

First, Mr. Trump. As discussed in March, there wasn’t a detailed Trump alternative.  We had no idea, prior to the election, what his priorities were or how he would accomplish them.  Our closest peek into his thinking came at his Gettysburg speech in late October when he spoke of selling insurance across state lines and of increasing access to Health Savings Accounts, both Republican ideas.  This week he expressed his view that the Repeal and Replace would take place simultaneously and that two key provisions of Obamacare – coverage for pre-existing conditions and the ability of children to retain their parents coverage till age 26 – would be continued.

Congress has a different view. Some in Congress have PRIVATELY admitted that Obamacare couldn’t be repealed.  Amended?  Sure.  Changed?  You bet.  But the idea of repealing the law and blowing up our system, and 20% of our economy, and then eventually replacing the law would be a disaster.  Passing repeal bills was safe and easy.  There was no danger as long as a Democrat was in the White House to veto the law.

We have had a chance to review the various alternatives. Over the las few years I have covered plans from Governor Scott Walker, Speaker of the House Paul Ryan, and Senator Orrin Hatch.  Some have been exercises in ideology and others are closer to marketing projects, the rebranding of Obamacare to a Republican name.  You will hear a lot more about this in the coming months.

Let’s quickly hit a couple of the major talking points.

Selling Insurance Across State Lines – I have tackled this a number of times.  This is a link to the Kaiser Foundation’s explanation.

Covering Pre-existing Conditions – Everybody loves this, but it doesn’t work unless we have everyone participating.  Given the opportunity, lots of healthy people would choose to save their money until they needed coverage.  Health insurance is really expensive if only the unhealthy buy it.  That means that any law, Obamacare or its replacement, needs to have some form of mandated participation.

Subsidies – The current Tax Credit Subsidy is complicated.  There is a lot of room for improvement.  Some of the Republican plans will give you a tax credit in 2018 for what you paid in 2017 on insurance.  That only works if you can afford the premium in 2017.  That eliminates millions of Americans.

Health Savings Accounts – Another great idea if you’ve got disposable income and could us a tax break.  Otherwise, no big deal.

Preventive Care – This is really important, especially for children.  There is an upfront cost, but long term savings.  How preventive care is defined may be changed under the new administration.  This has been very contentious.

This has been a very long post and I truly appreciate your patience. There are no simple answers for complex questions.  I am very concerned about what the next year holds for us.

I leave you with a thought about a Ferris Wheel. The ride stops when you get to the top.  The view is incredible.  You are filled with joy.  The ride begins to move again and eventually you are at the bottom and forced to leave.  The world, even our little world of health insurance, is never as euphoric or bleak as it might seem.  We will get through this together.



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October 16, 2016

I got to the office in the middle of the second quarter of the Browns’ game. I left a 7:30.  It was time.  I had spotted a unicorn.

Open enrollment for Medicare Part D (Rx) and Medicare Advantage products technically began yesterday. It will officially start at 9 AM tomorrow morning in my office.  Most of my Medicare visitors will be coming to confirm that they don’t need to do anything.  No changes, just a cup of coffee and some conversation.

My real challenge is the open enrollment for individuals under age 65. Most of my clients received their renewal packet on Saturday, October 1st.  They began calling my office that day.  Unfortunately, we, the agents that service these insureds, never got our copy.  We were told that the packets were in the mail.  We were also told that we could download, one 8 page renewal at a time, from the insurer’s website.  Hundreds and hundreds of renewals.  I gave up and started to pull and print these a few days ago.

And today I am in my office to work on these renewals.

I am not complaining. I am not telling you about this process because I am some kind of insurance martyr.  I love this gig and I’m not the only guy working on a Sunday.  Successful agents throughout this country are evaluating their clients’ 2017 health insurance options.

One by one I review each renewal. Should the client stay with his/her current insurer or move?  Would a higher deductible save enough money to be worth the additional exposure?  Is this the year we should try for a tax credit subsidy?  And then, once I know what I would like for them to do, I send them an email or a hand-written note.

This process isn’t fast and it can’t be delegated. The insureds are counting on the agent’s experience and expertise.  The health insurance premium may be someone’s second or third largest monthly bill.  My goal is to have all of these processed before November 1st.  My fellow agents are working just as hard.


I had predicted a tough year. I expected increases of 15% – 20%.  Policies that have Rx and office visit copays are coming in around 17%.  My HSA policies seem to be averaging a few percent less.  The highest HSA deductible plans, now $6,400, were renewed at the best rates.  Those policies may work for some people, but not for everyone.  Analyzing the options, not simply choosing the cheapest, gives us a better claims experience should you ever get sick or injured.

One of the clients that contacted me on the 1st was particularly concerned about his increase.  He and his family got hammered.  25%!  It took some time this afternoon to figure out why.  What happened?  I determined that his son was the main reason for the price jump.  He turned 21 this year and will now be rated as an adult, not a child.  Just to be sure, I went to the insurer’s website and ran a quote as if he was only 20.  I don’t know if this family will be any happier about their new rate, but at least they will understand why.

A unicorn is a mythical creature.  They supposedly exist, but no one has ever seen one.  My insurers said that the renewal rates were the best that they could offer.  Heck, some people might even see a rate reduction as the deductible on the HSA qualified policy drifts from $6,000 to $6,400.  It was about 7 PM when I found a renewal with a 7% decrease.  A decrease!  I rerated the family just to be sure.  I sent the client an email, packed up my stuff, and locked up.

Once you spot a unicorn, it must be time to go home.


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