California broker to NAHU: Fight ‘abysmal state of affairs’

A former president of the California Association of Health Underwriters (CAHU) is asking colleagues to do more to save their part of the U.S. health insurance market.

Jeff Miles, who is attending the National Association of Health Underwriters (NAHU) annual convention in New Orleans this week, says health agents and brokers should be working with antitrust lawyers to make sure they are taking advantage of every legal opportunity to defend major medical producers’ turf.

PPACA now requires health insurers to spend at least 80 percent of individual and small-group revenue, and 85 percent of large-group revenue, on health care and quality improvement efforts, or else compensate the insureds by paying rebates.

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Some have suggested that health insurers may be suffering more than they let on from the effects of PPACA on claims, but Miles said in an interview that he believes health insurer stock prices show that the big, publicly traded health insurers are doing well, and that those insurers are using the PPACA minimum medical loss ratio (MLR) rules to shift producer compensation money into their profit margins, not to hold down costs for the insureds.

“They’re saying, ‘We’re going to keep that money now, and you can go get paid by your client directly,’” Miles said. “That’s an abysmal state of affairs. The consumer is going to suffer.”

The intervention of an experienced, knowledgeable, committed broker has been critical to resolving health insurance customer service problems, in part because, traditionally, insurers have made a point of courting brokers by offering them extra access to staff members with the ability to resolve the problems, Miles said.

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One carrier recently sent its agents an email about a shift to a pure fee-for-service model in the small-group market. The carrier seems to have backed away from that approach, at least for now, but Miles said producers need to find ways to talk about that kind of thing, not let antitrust concerns shut down communication.