February 4, 2020

Morning Joe broke for a commercial moments after I had turned on the television.  The first ad was from You Know Who, one of the largest marketers of insurance in this country.  They don’t like to admit that they sell insurance.  They prefer to advertise that they endorse certain products.  Yeah. Yeah.  In this day and age of 10 second and 20 second spots, this one full minute Medicare Supplement advertisement felt like a documentary.  As soon as that commercial ended, a new ad, from a different company began.  This one featured a former football star, 40+ years past his glory, pitching all of the free stuff that came with some unnamed Medicare Advantage policy.  The 30 second commercial for Tylenol was a welcomed relief.

I turned 65 today.  That stack of junk mail pictured above is a small fraction of the solicitations I’ve received in the last year.  One company, You Know Who, has been sending stuff to both my home and office.  As an official old person, I find that the television shows that I watch seem to be sponsored by medications, investment companies, and Medicare products.  The newspaper, yes I still get the Plain Dealer delivered, has envelopes inserted for Medicare products.  I sometimes watch football just to be a part of a different demographic.

I had a doctor’s appointment this morning.  My first on Medicare.  I presented my Medicare Card and my Medicare Supplement Card.  I won’t mention the company since I don’t want this to be seen as a recommendation of a particular insurer.  My previous coverage was a Grandmothered $5,500 deductible HSA qualified policy with Anthem Blue Cross.  My January premium was over $800.  My new Medicare premium for a Plan G contract is around $125 per month and my deductible for Part B services is $198!  The doctor’s staff gladly accepted my Medicare Card.  I now have the best, most comprehensive insurance I’ve had in almost 30 years.  And I am covered in all fifty states.

There are people who misuse the word Medicare and apply it to a very different type of coverage, to a policy that covers 100% of everything.  That isn’t Medicare.  That is a fantasy.   Medicare, with its deductibles and copayments, was designed to pay approximately 75% to 80% of a beneficiary’s medical bills.  But just as some long to make Medicare even more comprehensive, there are others trying to weaken it.  As noted in a recent post, the Association of American Physicians and Surgeons is still fighting the existence of Medicare fifty-five years after its creation.  And Mitch McConnell has targeted both Social Security and Medicare for cuts after the next election.  The impact this could have on those reliant on these programs is beyond comprehension.  Some might caution that we should first wait to see the results before we raise our concerns.  But those are the very same people who would have repealed the Patient Protection and Affordable Care Act without any replacement.

My health insurance, the way I will access and pay for care, changed last Saturday.  I am now on Medicare.  But my concern, and the concern of other insurance agents around this country, is unchanged.  We are here to make this system work.  And as our system changes, to make that new one work, too.  About 1,000 of us will be in Washington at the end of this month to meet with members of this administration, the House, and the Senate.  Now is the time to let us know your thoughts and your concerns so that we can share them with the people who write the rules.  That, too, is part of our job.

DAVE

www.cunixinsurance.com

Picture – Junk Mail – David L Cunix

 

 

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The New Normal 2020

Senator George McGovern told Senator Sherrod Brown a story about a time, in 1980, that he was standing in line at a Sioux Falls supermarket.  “…he saw two women standing in front of him paying for their groceries with food stamps, the program no one in Washington had done more to expand then McGovern.  Not having noticed that their senior senator was standing nearby, they were discussing the upcoming Senate race between McGovern and his Republican challenger, James Abnor.  With all of the major problems in our economy, one woman said as she handed the clerk the food stamps, ‘I can’t vote for McGovern.  He’s for too many of those giveaway programs!” (From Desk 88 by Senator Sherrod Brown)

Today is the new normal.  The past is just the past.  The women in line were oblivious to the irony.  They weren’t the recipients of government largesse or even a helping hand.  Apparently they no longer remembered struggling to feed their families.  Their food stamps were THEIR food stamps, as normal for them as their homes or their family pets.  But please don’t spend my money on someone else.  That would be a giveaway.

And that brings us to the Patient Protection and Affordable Care Act (Obamacare).  Today is the new normal.  The past is just the past.  Cancer survivors come into my office during the annual open enrollment period (November 1st – December 15th) to purchase or change health insurance policies without the fear that their preexisting conditions will inhibit the transaction.  Those clients come from across the political spectrum, from the far right to the equally far left.  What they share, aside from preexisting conditions that would have made the purchase of insurance coverage nearly impossible in 2009, is little understanding or appreciation of how Obamacare has opened the door for them.  Today is the new normal.

The expansion of Medicaid under the PPACA is also part of the new normal.  Some of my most virulent anti-Obama / anti-Obamacare clients have taken advantage of this free health care.  And thank G-d for it.  Bringing Medicaid to the working poor, people making up to 138% of the federal poverty level, opens the door for routine care and necessary medication to individuals and families who might not have been able to afford such care.  And, importantly, that door is the front door.  Obamacare removed the stigma attached to Medicare.

In January 2020, Americans expect to have their preexisting conditions covered.  They expect their children to be covered until they are 26 years old by a parent’s policy.  And if their 27 year old can’t get a job, possibly Medicaid.  American women expect maternity to be covered and men concern themselves with how to combat prostate cancer not whether or not their surgeries or radiation will be paid.

The American public has been lulled into complacency.  The benefits of Obamacare have been disconnected from the law.  It is as if Obamacare could be ruled unconstitutional and eliminated, but we get to keep all of the good stuff.  Mitch McConnell was recently asked about his support of the Texas lawsuit to undo the PPACA’s protection for preexisting conditions.  He said, “There’s nobody in the Senate that I’m familiar with who’s not in favor of coverage for preexisting conditions”.

A reader recently complained that this blog was too political.  Really?  Those were politicians who negotiated, argued, and crafted the compromises ten years ago that created the Patient Protection and Affordable Care Act.  There have been politicians trying to destroy the law for the last ten years while other politicians have fought hard to save it.  It is all about politics and it is my job to chronicle the fight.  What it is not about is YOUR health.  The debate is about how medical providers are compensated.  Who pays and how much?  What was once about hospitals and doctors now encompasses hospitals, doctors, pharmaceutical companies, medical testing equipment, therapists, and countless others attached to the business of health.  Every one of them has an army of lobbyists in Washington and every state capitol.  Hell yes this is political.

The new normal in 2020 isn’t perfect.  Our premiums are too high.  Prescription drug pricing is out of control.  There is plenty of room for improvement.  But denying the safety net of Obamacare is a lot like complaining about government giveaways while paying for one’s groceries with food stamps.

Dave

www.cunixinsurance.com

Picture – All Was Perfect In The Turtles’ World – David L Cunix

Bonus – Happy Together

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In Other Breaking News

The President was bragging.  The car radio, tuned to CNN, was playing President Trump’s press conference.  Among his other claims of success, real or imagined, was his victory, yesterday, in the Supreme Court.  He quickly corrected himself and changed it to the Appeals Court.  He was talking about the Court of Appeals for the Fifth Circuit declaring the Individual Mandate provision of the Patient Protection and Affordable Care Act (Obamacare) unconstitutional.  Mr. Trump was elated.  He claimed that it was the Individual Mandate that made health insurance expensive.

Read the decision.

Most of the people I know in this industry, from across the political spectrum, realize that the Individual Mandate could lower premiums by expanding the available pool of clients to include the youngest and healthiest amongst us.  Since its origin from within the Heritage Foundation through the introduction of Clintoncare, Romneycare, and the creation of Medicare Part D (Rx) it has been widely accepted that plans that accept everyone (guaranteed issue) and that cover the most unhealthy (preexisting conditions) must be structured to incentivize participation by the entire eligible population.  The Individual Mandate only became a Republican strawman when the PPACA neared passage in 2010.

This blog has discussed the Texas lawsuit, the effort by 18 states and the Trump administration to declare the PPACA unconstitutional, in numerous posts.  We continue to cover it because the lawsuit’s success could eliminate coverage for nearly 54 million Americans with preexisting conditions and disrupt the way every one of us accesses and pays for health care.  Yes, all of us.  The elimination of Obamacare, its rules, its regulations, its heart, will impact individuals, employees covered by group health insurance, Medicare beneficiaries, and entire industries.   Over and above health, and that should be enough, we are also discussing about 20% of our economy.  But, I digress.  Mr. Trump is elated.

The Department of Health and Human Services (HHS), the part of this administration in charge of implementing our system had nothing to say about this latest court decision.  Here is the link to the department’s press releases of the last week.  If the Texas lawsuit succeeded, the nation would turn to HHS for a solution.  How would we cover preexisting conditions?  How would our system react?   As is so often in this administration, creating havoc is everyone’s job.  Solving problems is no one’s.

One of the parties in the lawsuit is the Association of American Physicians and Surgeons.  They aren’t just upset with Obamacare.  The AAPS is still fighting the creation of Medicare!   OY.

Though many legal scholars have derided the underlying legal argument at the heart of the Texas lawsuit, one would be foolish to rely on logic at a time like this.  Senator Lamar Alexander (R-TN), was quoted in a Kaiser Health News article as saying, “I am not aware of a single senator who said they were voting to repeal Obamacare when they voted to eliminate the individual mandate penalty”.  Yes, he was only trying to irreversibly damage the law.  He didn’t mean to kill it!  There are members of this administration that believe that dismantling the law would only impact residents in the 18 states pushing the lawsuit.  As noted recently, H B 390 was just introduced in the Ohio House to address these issues.  It is, at best, a start.

We just completed our annual Open Enrollment Period for individuals under age 65 and the Annual Enrollment Period for Medicare beneficiaries.  In truth, I’m exhausted.  But even more tiring is this struggle to make sure that Americans, at least the ones I impact, have health insurance, the way most of us access and pay for health care.  Yesterday’s breaking news was that the federal government and a group of states are working hard to destroy our health care system without any idea what would happen if, G-d forbid, they succeeded.

Oh yeah, there was another major news story yesterday, but this is an insurance blog!

DAVE

www.cunixinsurance.com

Picture – Broken! – David L Cunix

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Still Waiting For A Real Solution

You are in the hospital preparing yourself, mentally, for surgery when a doctor enters pre-op.  He introduces himself as Doctor Jones, the anesthesiologist.  He has been asked to participate in today’s procedure.  He is NOT in your network.  This is no time to spring a surprise on you.  You are prepped and ready.  Dr. Jones is prepared.  He has a form for you to sign and he reads the first paragraph that includes these key points:

  1. The individual provider informs the covered person that the individual provider is not in the person’s health benefit plan provider network.
  2. The individual provider provides the covered person a good faith estimate of the cost of the health care services. This estimate shall contain a disclaimer that the covered person is not required to obtain the services at that location or from that individual provider.
  3. The covered person affirmatively consents to receive the health care services.

Here’s the question – Do you sign his form or do you put on your clothes and go home?                                                                                             

Those three points are directly taken from the current Surprise Billing legislation Ohio S B 198.  Until this loophole is removed, Ohioans will still be victimized by Surprise Billing.

DAVE

www.cunixinsurance.com

Picture – You Had A Choice – David L Cunix

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First Aid

How big a Band-Aid do you need if you are attacked with a machete?  Today’s volunteer paramedics are Ohio House of Representatives Randi Clites (D-75) and Jeffrey Crossman (D-15).  Their bandage is the recently introduced 89 page House Bill 390.  The machete is Texas v. U.S., the lawsuit targeting the Patient Protection and Affordable Care Act (Obamacare).  They may need a bigger Band-Aid.

In an effort to save you time, here is the link to the Detailed Analysis provided by the Ohio Legislative Service Commission.  This is the Summary from the same site:

  • Repeals outright suspended provisions that allowed health insurers to pass on the cost of reinsurance to certain high risk individuals.
  • Codifies in state law the federal Patient Protection and Affordable Care Act’s (ACA’s) limitations on premium charges.
  • Codifies in state law the ACA’s ban of annual and lifetime limits.
  • Codifies in state law the ACA’s ban on preexisting condition exclusions.
  • Codifies in state law the ACA’s provisions requiring health plans to offer certain essential health benefits.
  • Codifies in state law the ACA’s cost sharing limitations.
  • Codifies in state law the ACA’s requirement that a health plan provide benefits that are actuarially equivalent to 60% of the full actuarial value of the benefits provided.

Legislation like this can be a tough slog to read.  It is a step by step process of affirming and / or amending sections of the Revised Code.  There are plenty of opportunities for both missteps and mischief in this type of bill.  Barb Gerken, the Chairperson of the Ohio Association of Health Underwriters’ Legislative Committee, immediately noticed that full-time employment had accidentally reverted to 25 hours per week.  That and other questions about Rx copayments were the first issues she noticed.  A careful reading will find other problems large and small.  Though there are lots of cosponsors, Democrats and Republicans, the final bill, if passed, will undergo significant changes before it might ever land on the governor’s desk.

House Bill 390 is an important first step.  The TV talk shows have featured numerous legal scholars who have derided the merits of the Texas lawsuit.  But the elected leaders of the State of Texas seemed determined to drag the rest of our country down to their level of health care insecurity.  Even if this lawsuit fails, there will be another.  A poker player only needs a “chip and a chair”.  Texas only needs an attorney and a lack of conscience.  We must applaud the efforts of Representatives Crossman and Clites.  In her testimony before the Ohio House Insurance Committee, Representative Clites cited her personal experience as the mother of a child who has endured major medical conditions.  It is estimated that nearly two million Ohioans suffer from a pre-existing condition that would threaten our ability to purchase health insurance.  We share her concern.  The question is whether the Insurance Committee’s Chairman, Representative Thomas E. Brinkman, Jr. (R-27), also shares our concern.

Eighteen states and the Trump White House are swinging a machete at our health care system.  It will take legislation, not Band-Aids, to protect us.  HB 390 is the first legislative step to help Ohioans retain access to health insurance, the way most of us access and pay for health care.  I’m looking forward to other serious proposals.  I just hope to see some soon.  That machete is too close for comfort.

DAVE

Picture – It’s A Start – David L Cunix

www.cunixinsurance.com 

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I Got My Card!

It is no secret that I will turn 65 in February. My daily mail, the phone calls, and the pop-ups on Facebook are proof that my 65th birthday is eagerly anticipated by a whole host of marketers. And yet, we are all celebrating the same thing, my transition to Medicare.

Countless clients have nervously approached their enrollment into Medicare as if they were buying a house or, worse, unboxing a new cellphone. They thought that it would be confusing and difficult. I have been suggesting the same two options for years. One option is to simply go online to www.medicare.gov. The other option was to go to the local Social Security office. Our local Social Security office (Beachwood, Ohio) has a great reputation for both efficient and respectful service. It was recently my turn to enroll in Medicare Part A and Part B.

Though it was tempting to just go to the Social Security office, I decided that I should try to enroll in Medicare online. The process begins up to three months before your birth month. On Friday, November 1st, I took the first step. The entire process, including registering on the Social Security website, took 20 minutes. It was easy, so easy I was actually worried that perhaps I had screwed up.

I received confirmation that the process had begun within days by both email and snail mail. On November 16th I received an oversized envelope in the mail. My card? I tore open the envelope to find the Extra Help forms. This program is designed to help financially challenged senior citizens pay the monthly premiums, annual deductibles, and co-payments for their Medicare prescription drug program. Thankfully, I don’t need Extra Help. But if I did, this form would have been a breeze to complete.

My Medicare Card came in yesterday’s mail! It took less than three weeks. There is no reason to be nervous. The process is not hard. Sometime in the next month I will apply for my Medicare Supplement and Medicare Part D (Rx). This couldn’t have been easier.

I started to pay in to Social Security and Medicare in 1970 at the age of 15. I never doubted that Medicare would be waiting for me to turn 65. Never. All of that faith has paid off.

Dave

www.cunixinsurance.com

Picture – The Newest Medicare Beneficiary – David L Cunix

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The Important News Was On Page 22

 

The front page of today’s Plain Dealer featured stories about algae, UAW workers second guessing their recent strike, and lead safety rules for child care centers.  Other stories were teased at the very top and bottom of the page.  But the news that will impact millions of Americans and a significant number of Greater Clevelanders was buried on Page 22.  Did you find it?  We now know the important Medicare changes for 2020.

  • Medicare Part B Premium – $144.60, an increase of $9.10 per month
  • Medicare Part A Deductible – $1,408
  • Medicare Part B Deductible – $198, an increase of $13

The Associated Press article by Ricardo Alonso-Zaldivar cited a statement from the Centers for Medicare and Medicaid Services (CMS) blaming these premium and deductible increases on “drugs administered in doctors’ offices.  Those medications are covered under the Part B outpatient benefit and include many cancer drugs”.

There was no mention of government funding, or that Medicare is unable to negotiate drug pricing, or any of the other issues contributing to the rising costs of health care.  Perhaps those are being held in reserve for the 2021 increases.

And when those increases are announced this time next year, don’t be surprised if they won’t be found in a Sunday paper on Page 22.

DAVE

www.CunixInsurance.com

Picture – Ready For The Birdcage – David L Cunix

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Open Enrollment 2019

The leaves are changing.  It’s Open Enrollment Season, or as the Trump Administration calls it, “Weekend at Bernie’s”.

Medicare Open Enrollment is from October 15th to December 7th.  The compressed under age 65 Open Enrollment is now November 1st to December 15th.  Yes they overlap.  Plus, most of our group policies renew on January 1st.  Your local insurance office is very busy.

Please allow me to share a couple of thoughts.

Medicare Beneficiaries are always early for their appointments.  On October 15th, the first day of Open Enrollment, I had two clients waiting to talk with me at 1:50 for their 2 PM appointments.  One was 10 minutes early.  The other was 24 hours early.  She was scheduled for the 16th.  That might have been shocking had we not had an unexpected visit from our friend Bob (name changed) that morning at 11 AM.  His appointment?  December 2nd.  Six weeks early!  A new record.

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It is almost election season.  Sometime over the next few months you will hear a friend say, “If (fill in the blank) wins, I’m booking the first plane to Canada!”  People from both sides say that, but we all know that they aren’t going anywhere.  We have an insurance version of that.  Every agent has heard, “If I get sick, I’m just going to get on a plane and go back to (insert country of origin here) where it won’t cost me anything!”  Seriously, they aren’t going to go back to England, Italy, or Russia the moment they feel chest pains.  These people are in the USA by choice, and they really have no interest in being anyplace else.  The insurance agent nods knowingly and then gets back to finding the client the right policy.

*     *     *     *     *     *     *

Open Enrollment can be very stressful for both the agents and the clients.  The Patient Protection and Affordable Care Act (Obamacare) policies change every year.  The prices usually go up.  The networks expand and contract. The deductibles and copayments are tweaked annually to comply with the ever-changing regulations.  We are in this together.  We need your focus and attention, if only for 45 minutes to an hour.  Some of our clients need to go through the Exchange to qualify for a Tax Credit Subsidy before they can pick the right policy.

This is blog has a national following and according to Google Analytics, most of you reading this are outside of my service area.  So this isn’t about me, it is about You and Your agent, whether she is in Portland, Maine or Portland, Oregon.  You and your agent are on the same team.  Your agent, very often a small business person purchasing his/her own coverage, is there to help you get health insurance, the way most Americans access and pay for health care.

We celebrate Open Enrollment.  There may not be cake.  There definitely will be coffee.

DAVE

www.cunixinsurance.com

Picture – Knoxville In The Fall – David L Cunix

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They Suffer Least Who Suffer What They Choose

The song is American Gothic.  The artist, David Ackles.  I remember where I was when I first heard an odd song about an unsuccessful farmer and his less-than-faithful spouse.  The payoff was the last line, “They suffer least who suffer what they choose”.  I was only eighteen, but surely I had heard something like this before though I could not recall when.  We must accept some responsibility for what we have and what we lack.  This should not be confused with blaming the victim for circumstances beyond his/her control.  It simply means that we may be part of both the problem and the solution.  Or, we may actually be OK with the status quo.

And that brings us to Texas.  WalletHub, a personal finance website, accessed health insurance data from the U.S. Census Bureau to compare the rates of uninsured in our country.  There is a lot of information here and worth a couple minutes of your time.  The graphs show the percent of uninsured by race and income, children vs. adults, and the change since the passage of the Patient Protection and Affordable Care Act (Obamacare). This is the link to the comparison by state.  This is the link to the comparison by city.  To the surprise of no one, Texas came in last.  It wasn’t even close.

The adult uninsured rate for Texas in 2018 was 20.23%, 1 in 5 of every adult in the state.  The next closest was Oklahoma at 16.31%.  The rate for children was a shocking 11.15%.  These rates are an improvement over pre-Obamacare rates.  For comparison sake, Ohio ranks 18th with adults at 6.97% and children at 4.82%.  Not great, but not Texas.

In case you were wondering, Cleveland came in at 258th with an adult uninsured rate of 8.99%.  Dallas is 539th with an uninsured rate of 27.03% for adults and 16.96% for children!  There are Texas cities, like Laredo and Brownsville, with even higher numbers.

The Texas / Trump lawsuit is working its way through the courts.  Invalidating the PPACA without any replacement, transition, or clue would disrupt our system and eliminate the protections afforded so many of us by the law.  It is estimated that 27% of Americans under age 65, 53.8 million, have preexisting conditions that would impact whether or not they could purchase health insurance if we went back to asking health questions and underwriting.

Health insurance is the way most of us access and pay for health care.  It is one thing for the residents of Texas to accept a 20% uninsured rate.  It is quite another if we let them impose that on the rest of us.  It is incumbent upon us to act.  They suffer least who suffer what they choose.

Dave

www.cunixinsurance.com

Picture –My Team, My Pain, My Choice – David L Cunix

Quick Update:  This is from NPR.

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Hedge Fund Maneuvers In The Dark

There always has to be someone at the bottom.  There really is a group that is less trusted than insurance companies, less popular than Congress.   The winners of the “who is our least favorite / least trusted” are the owners and operators of Hedge Funds.   With the exception of Mitt Romney extolling the virtues of Bain Capital, many Americans only contact with a hedge fund or private equity company was when their local factory jobs were eliminated.  Disliking hedge funds isn’t limited to just Democrats or just Republicans.  There are very few truly bipartisan issues in Washington and our local statehouses.   Surprise Medical Billing may be just such an issue and we have some hedge funds to thank for this.

My last post, Step Away From The Wallet, discussed the misleading ads from a group called “Physicians for Fair Coverage”.  The ads, part of a $17 million dollar ad buy, have peaked the interest of the Chairman, Frank Pallone Jr. (D-N.J.) and Ranking Member, Greg Walden (R-OR) of the House Energy and Commerce Committee.  They are initiating an investigation into the three private equity companies that own major physician staffing agencies.

According to The Hill, the two Congressmen are pleased that this issue is totally bipartisan and even has the support of the White House.  Together they have focused their efforts to get more information from KKR, the Blackstone Group, and Welsh, Carson, Anderson & Stowe who own the staffing companies.  Surprise medical billing, especially problematic when the patient has carefully accessed non-emergency care in a network facility only to be seen by a non-network doctor, can result in thousands of dollars of unexpected costs.  It is a gaping hole in our system, the kind that seems perfect for a hedge fund to exploit.

The state legislatures are also looking at this issue.  Some states, like California, are more focused on consumer protection.  Other states may be more interested in maintaining the Status Quo.  Ohio is beginning to look at Surprise Billing.  Ohio SB 198, also bipartisan, had its first hearing this week.  It needs a lot of work and will look a whole lot different (hopefully) if it ever becomes law.  I will link a revised version when it becomes available.

The key today is that transparency in medical billing is an ongoing struggle.  Health insurance is the way most Americans access and pay for health care.  Health insurance companies help to organize the market.  They prove their value every time a patient is balance billed by a doctor employee of a hedge fund.   

DAVE

www.cunixinsurance.com   

Bonus – Orchestral Manoeuvres In The Dark – If You Leave

Picture – Not Another Hedge – David L Cunix

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