1990 Pages Hits the Floor of the House

djs · 10-29-2009, 09:00 PM

Hmm, Joe Wilson was right. Undocumented individuals can sign up under this plan as well. They supposedly don't have access to 'affordability' credits, but they can enroll.

Now, since they don't have to, they will only enroll when they need it. Smells like a subsidy to me.

Dan

somarco · 10-29-2009, 09:32 PM

Abortions are in there. Do a word search.

Page 110 reads

(B) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED.—The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the department of Health and Human Services is permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.

agentinsure · 10-30-2009, 12:09 AM

Yeah, almost 2000 pages now, can you belive it? So will you tell us John if you happen to see whether Congress has included themselves, just out of curiousity?

Originally Posted by healthagent

I'm reading it now and taking notes - I'm on page 131. There's some interesting stuff so far. For one, carriers can sell plans in or out of the exchanges. "Separate Excepted Coverage" is permitted....more to come.
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The clause I was looking for - page 191

(g) ROLE FOR ENROLLMENT AGENTS AND BROKERS.—Nothing in this division shall be construed to affect the role of enrollment agents and brokers under State law, including with regard to the enrollment of individuals and employers in qualified health benefits plans including the public health insurance option.
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*Temporary Nat'l High Risk Pool starting Jan 1st 2010 ending with health exchanges are implemented
*Cannot have had coverage for 6 months to be eligible
*Employers cannot "dump" employees onto this plan
*2:1 rate ratio max by age
*No more than 125% of "standard individual rate" to be determined by NAIC
*$1,500 deductible for individual, to be determined for families
*No annual of lifetime max
*OOP no more than $5,000 for individuals and $10K for families
*Each state will manage the program

Individual Market Changes as of Jan 1 2010
*Carrier can only rescind plans after a 3rd party review under the guidance of the Secretary
*Rescissions only allowed when "clear evidence of fraud" is determined by 3rd parter reviewer, not by carrier
*"Price Gouging" review - carrier must submit for rate increases under guidance of the Secretary noting reason for rate increases.

Carrier can offer "Separate Excepted Coverage" which can be sold outside of the exchange and allow them to be priced separately (I cannot find out if they still have to be qualified plans.)

Coverage Sold in the Exchange
*No pre-ex exclusions
*2:1 max rating based on age
*Area rating allowed as specified by the Commissioner
*Individual premiums "uniform" with family premiums
*Dependent age to 27
*Carrier's rates must be approved before allowed into the exchange

Carrier may sell outside of the exchange and may offer additional coverage above what the exchange plans mandate (ie: carriers can sell "Cadillac plans."

Essential Benefits
Hospitalization, outpatient, doctors/care providers, supplies and equipment, drugs, rehab, mental/nervous, wellness, maternity, well baby and durable medical equipment (No cost sharing allowed for wellness)

Agents and brokers are allowed to sell plans in the exchange including the public option. More to come.
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PUBLIC OPTION:

*Only sold in exchange
*Abide by all rules private carriers must follow
*Offer Basic, Enhanced and Premium plans
*Geographically adjust premiums in same manner as private plans
*Rates must fully finance costs
*No bailout provision - cannot get additional Federal funding to pay claims
*2 billion to fund private option
*Medicare docs are in network unless they opt out
*No punishment for docs who opt out
*Annual enrollment period where docs can opt in or out

I dont think we need to worry too much about commissions, after all a small % of a bigger premium is still good for biz, especially mandatory. And heck why would I care if illegals are covered, in fact that too will be good for biz. I think this might be alright for agents who can work on thin margins. But I'm wondering as my own state discoverd some 15 years ago that if you include all pre-conditions than there is a cost. Doesnt it seem like about 9-1 those looking for dental coverage just discovered they need a root canal? That said costs will inevitiably rise either thru premiums, taxes &/or inflation. We'll pay either way, the only diff will be 100,000 more bureucrats on the rolls. This pitch to the public for Free or Affordable Health Care is about as cheesy as a 2% interest rate for a home loan was a couple of years ago, and about as true. But Im sure glad now at they can get rid of that 500 billion in fraud and waste been going on the last 10 years over there at Medicare - seems like that could of started saving that money last month already. Why are the waiting till health care reform passes?

TXINSURANCE · 10-30-2009, 02:16 AM

I have said it before and will say it again - the mandate will not offset the cost of covering all pre ex conditions with no waiting period , richer plans, and community rating.

Do you know the ratio of healthy persons you would need to offset just one million dollar claim? It's probobaly staggering.

They should have just subsidized poor and expanded a national risk pool.

Most people will have higher costs once sticker
Shock kicks in. But maybe that is the goal.

Winter · 10-30-2009, 07:02 AM

Originally Posted by agentinsure

I dont think we need to worry too much about commissions, after all a small % of a bigger premium is still good for biz, especially mandatory.?

Sigh.

Well, we certainly have had this discussion a few hundred times so people have to do their own thinking. Also, to help you with your argument, if you mix in guaranteed issue you will basically just be skipping from house to house all day long picking up complete applications even though the premiums are smaller.

Is that what you are hearing from the agents in the states that have guaranteed issue now?

healthagent · 10-30-2009, 08:03 AM

Commissions will be intact - at what level? No one knows.

CHUMPS FROM OXFORD · 10-30-2009, 09:14 AM

My grading scale (A, of course being the best case scenario for us) First year and renewal...

A- 15 and 7
B- 12 and 5
C- 7 and 5
D- 5 and 3
F- 3.5 and 2

I have a feeling we're looking at c+.

Winter · 10-30-2009, 09:28 AM

Originally Posted by CHUMPS FROM OXFORD

My grading scale (A, of course being the best case scenario for us) First year and renewal...

A- 15 and 7
B- 12 and 5
C- 7 and 5
D- 5 and 3
F- 3.5 and 2

I have a feeling we're looking at c+.

Whatever it is for the first couple years, it will be less after that. Carriers are going to try to get market share coming out of the shoot and if they need to do that through agents for a short while, they will, all while figuring out how to take them out of the cost structure.

To your comment about the C+, it is true that they have no need to totally eliminate the agents so I would concur somewhat. After all, if they get the commission down to a pittance then any business that agents bring in is just "found money" that they would not have otherwise had.

It is actually a double-whammy though. It is not just the reduction in commission, it is the change in the sales channel where the agents will be largely/increasingly bypassed all while they are trying to get the smaller commissions. Yes, I know the rap about how carriers have always tried to eliminate agents and they always end out needing them, etc. First or all, I am in a state where that has already been done for individual policies so it is not that far-fetched to me. Second, of all, I am just saying that it is a gamechanger in the market and no one is arguing that agents will disappear so no need to go down that rathole.

healthagent · 10-30-2009, 09:39 AM

It becomes a bit like selling med supps - there is not "bad" plan to keep people away from. We'd be walking them through the difference between the basic, premium, etc...plans.

I don't see any shortage of auto agents at around 10% comp? What's the average policy - around $150/mo?

CHUMPS FROM OXFORD · 10-30-2009, 09:47 AM

I'm not crazy about the "Exchange" concept. Right now..customers come to us by visiting our websites and we offer advice and have them apply online through a link we generated.

Under the new concept, hopefully, we will still be able to create a link that allows them to apply etc...

Our quote engines might become dinosaurs. Hope not though.

djs · 10-30-2009, 10:19 AM

Originally Posted by CHUMPS FROM OXFORD

My grading scale (A, of course being the best case scenario for us) First year and renewal...

A- 15 and 7
B- 12 and 5
C- 7 and 5
D- 5 and 3
F- 3.5 and 2

I have a feeling we're looking at c+.

I think you graded this on desired outcomes, not likely outcomes. I would start thinking a different way.

I assume carriers will be free to do whatever they want for agents, similar to now. Of course, for now, their hands are tied because if they don't pay the same as everyone else, they don't get the business.

I think the public option will come in with a flat rate per app, similar to most other government health plans (hopefully with a better payout though). This will probably be along the lines of Kaiser IFP, here is a check for $100, go away.

Carriers will be tempted to try the same thing. It will be interesting to see if they succeed. They may also try to base this on what they do in group, since group is frequently similar to what is proposed as required moving forward (as close as you get for now), which will be 7%-8%, new and renewal.

Now, keep in mind that the good thing about this is carriers should not be able to 'roll' their book every few years to try to get people to go through underwriting again, allowing them to raise premiums on those who can't change plans.

Based on the changes, health insurance sales will become very transactional. I'm hoping they adopt more of a P&C type model, where it is 10% new and renewal for IFP, but the agent has a bigger role in supporting the client. This would be my A+ scenerio.

Dan

healthagent · 10-30-2009, 10:20 AM

Don't worry - read the report on how many people signed up in Mass. on the Connector website - then you'll see there's nothing to worry about.

Winter · 10-30-2009, 10:23 AM

Originally Posted by healthagent

It becomes a bit like selling med supps - there is not "bad" plan to keep people away from. We'd be walking them through the difference between the basic, premium, etc...plans.

I don't see any shortage of auto agents at around 10% comp? What's the average policy - around $150/mo?

Yup. In fact that is the point. People keep mixing in the "agents going away" thing when what is repeatedly being said is that it is a gamechanger. That does not mean it goes away. It meansit's a gamechanger. The med supp analogy is one that I have used many times. And the auto policies could be another. Those agents who can build a business based on stacking up a lot of small coins consistently will do well. Those who can't won't.

Lest we get lost along the way in regard to what peoples thoughts and views are, when the reforms come, I am planning on getting in bigtime or at least as a piece of the mix. Things are so bad and agents are so shut-out now it can only get better. I dont say that to be fece-ish. Only because I believe it is true. It will be a step up from where we are now in my state but it will be a considerable step down from the old way of doing business in some other states. Our mileage obviously varies from state to state.

healthagent · 10-30-2009, 10:37 AM

Agents will not go away. The only way health insurance agents go away is with universal health care.

CHUMPS FROM OXFORD · 10-30-2009, 10:58 AM

"I think you graded this on desired outcomes, not likely outcomes"

Actually...I did base those numbers on likely outcomes. Keep in mind that the "A" option is not necessarily the most likely of the five choices...just the best for us. I still say the most likely is the "C" type option.

But I would be very happy with a 10/10 setup. Flat fees could be a disaster since turnover would be lower.

Winter · 10-30-2009, 11:59 AM

Originally Posted by healthagent

The only way health insurance agents go away is with universal health care.

We don't know that either. Even if we had medicare-for-all what would that mean? Supplements for all too? Don't know.

Or as in Canada, their critical illness business is booming to fill in the blanks there.

Don't know.

djs · 10-30-2009, 12:10 PM

Originally Posted by CHUMPS FROM OXFORD

But I would be very happy with a 10/10 setup. Flat fees could be a disaster since turnover would be lower.

I'd like the 10/10 setup, though I think it comes with more work on the agents side. Very similar to P&C, you'll have to process payments, deal with sweeps through trust accounts, actually issue policies, deal with clients claims, etc.

Since I'm a P&C agent primarily, I have the resources in place already to deal with this. No big deal. Good health agents do everything but deal with the cash, a change, but not as big a deal as one might think. Health agents who like to write the business and run would see a significant change in this scenerio.

The only way the 10/10 deal works (perhaps 12/7), is if the carriers can push administrative overhead work out to the agents. Since underwriting will change significantly, this likely will be done primarily by the agent, again, similar to how P&C works for personal lines stuff.

Yes, you could actually be printing the policy right in your office, id cards and all.

I might be dreaming a bit, but to me it is a very likely scenerio. We'll see how the comp plays out.

Dan

TXINSURANCE · 10-30-2009, 12:29 PM

The only way the 10/10 deal works (perhaps 12/7), is if the carriers can push administrative overhead work out to the agents. Since underwriting will change significantly, this likely will be done primarily by the agent, again, similar to how P&C works for personal lines stuff.

It's nice to dream.

Maybe in the short term, not long term.

Long term I see a $50 spiff in your future!

JMO Fan · 10-30-2009, 05:01 PM

CBO estimates the cost at just over $1 trillion. That's half a billion per page. What a waste of paper.

djs · 10-30-2009, 07:28 PM

Originally Posted by TXINSURANCE

It's nice to dream.

Maybe in the short term, not long term.

Long term I see a $50 spiff in your future!

I think all exchange products will be a flat rate. Can't see much of a way around that. $50 won't get anyone to pay the marketing costs to get people to enroll for the carriers though. Kaiser pays me $100 for an IFP per person, and I chuckle when I cash those checks. Ironically, since it takes so long to get them, I've long since forgotten they are coming, and then I think of it as 'free' money.

10/10 is a dream. I don't think it's unrealistic, but it requires some work shifting from carriers to agents, not unlike P&C carriers do. Of course, it would mean signing more government forms to have access to the secret medical records (not sure why you would need this actually), similar to how I access peoples MVR's now.

Dan