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On the Third Hand: Childish

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We have a system that encourages me as both a reporter and a blogger, which may or may not be a great idea, journalism-wise, but is how the world works.

I want to try to be non-partisan in my coverage, and usually avoid taking sides on controversies that get readers riled up. Not so much because I worship objectivity for the sake of objectivity, but just because:

  • I’m a reporter, not an expert. Who am I to judge?
  • To me, it seems boring to read articles by reporters who have a predictable ax to grind. 
  • I actually change my mind a lot, anyway.

And, let’s face it, I’ve covered the war between brokers and consumer groups over the Patient Protection and Affordable Care Act (PPACA) exchange navigator, in-person assister, licensed producer, certified application counselor, Web-broker entity, matchmaker, bookie, Snow White witch magic mirror and Millennium Falcon HIX data smuggler programs as hard news.

(And maybe I made up the last four categories of intermediaries, but maybe I saw them in a Federal Register filing.)

In the future, I will try to behave. I will try to write about these programs in a dry, even-handed manner with lots of “he saids,” “she saids,” and “they saids.”

But, today, after reading this fine article about the broker-consumer group navigator conflict by Nicholas Kusnetz, on the Center for Public Integrity website, my reaction is: Argh.

Just argh.

Maybe the whole point of PPACA is to increase my blood pressure.

Stages of this strange war between the brokers and the consumer groups:

  • Early 1900s: Employers, policymakers and others create modern health insurance, in the face of predictions by actuaries (which were well-reported at the time in National Underwriter, one of the publications that feed into and that health insurance plans would always face moral hazard, underwriting and pricing problems.
  • 1940s to 1990s: Insurers, brokers, doctors, hospitals, and patients keep gaming one another in ever-escalating ways until they drive one another nuts.
  • 1940s to now: Insurance brokers sometimes got people mad over the years by selling people some lousy products (in addition to selling many good products).
  • 1940s to now: The consumer groups – which call themselves consumer advocacy groups, but, let’s face it, have never been hired or elected to represent consumers by any genuinely representative group of consumers — worked over the years to get state insurance regulators to heap complicated licensing and continuing education requirements on agents and brokers.
  • 2008 to 2010: The consumer groups threw their own ability to claim objectivity about PPACA programs out the window, by putting their full faith and credit behind getting PPACA approved.
  • 2009 to 2010: The consumer groups got supporters of Congress to include a gratuitously nasty ban on broker participation in the navigator program, and a gratuitously nasty ban on health insurer participation in the COP-OP plan program.
  • 2010: The PPACA navigator provision just provided a teeny weeny bit of money for navigators, or ombudsmen, to explain PPACA. Except, maybe, in Vermont, where the state lawmakers seem to be trying to shut out brokers, the navigator program has no direct effect whatsoever on brokers’ ability to act as brokers or, really, to help uninsured people figure out how to use the PPACA exchange system. Even with commission cuts, brokers probably will still usually get more money for selling exchange coverage than navigators will get for explaining the exchange system.
  • 2010 to now: The brokers mostly have seemed to support Republican members’ of Congress efforts to starve and block PPACA implementation at every turn, giving the impression that brokers want the PPACA gravy but won’t do anything to keep the PPACA gravy train on the tracks.
  • 2010 to now: While the Obama administration has been implementing PPACA, the consumer groups have sat on their hands humming folk songs while regulators interpreted the law and implemented the law in ways that would have had the groups screaming bloody murder if health insurers had tried to pull the same understandable, financially necessary but despicable stunts. When, for example, the Obama administration suddenly pulled the Pre-existing Condition Insurance Plan (PCIP) funding rug out from under states that tried to run good, state-based PCIP programs, the groups just smiled and went about their business.
  • 2010 to now: The brokers have reacted to the consumer groups’ hostility and the consumer groups’ lack of attention to their own shortcomings and conflicts of interest by trying to get state lawmakers to subject the consumer groups’ darlings, the navigators, to the same kinds of licensing requirements that the consumer groups have heaped on the brokers.
  • 2010 to now: The consumer groups have whined about the expense involved with the navigators having to deal with the costs and red tape that the consumer groups have heaped on the brokers.

So, now, we come to the Center for Public Integrity article, with the headline “Obamacare’s hidden battle: insurance agents push state regulation of guides to new marketplaces.”

Oh, those horrible insurance agents. Wanting poor people with complicated personal, financial and probably legal problems to get advice from folks with serious training. How evil and corrupt that is! Not.

On the one hand, OK: Qualified brokers are not generally providing much, if any, serious help to uninsured people now. There are a lot of street people who will probably eventually qualify for Medicaid, Social Security Disability Insurance (SSDI) and veterans’ benefits who are panhandling on the blocks around my office as I write this.

If any of you broker readers are so eager to help those folks sign up for coverage, why are you letting a matter of a nominal $50 navigator enrollment fee stand between you and talking to the lady who panhandles on the bench in front of Carlo’s Bakery? Maybe if you get her into Medicaid quickly, so a doctor can keep her diabetes from eliminating her remaining eyesight, you could get Carlo’s to give you a free Italian cookie.

On the other hand: If you’re one of my beloved consumer group readers (and I love you, too): Why have you (or, at least, some of your colleagues) been so intent on picking fights with folks who know a lot about the nuts and bolts of how health insurance works and who could be powerful allies in the fight to get uninsured people insured? 

On the third hand: CVS and Walgreens are a lot more evident in the blocks around my office than either health insurance brokers or consumer groups. While you folks bicker when you could be helping the lady by Carlo’s Bakery get Medicaid, or the old veteran across from the real estate building get SSDI and veterans’ benefits, the drug stores are actually starting to put up their health insurance marketplace information….

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