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

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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.

See also: Agents ponder health comp cut response

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.

See also: Health agents work to move beyond plan sales

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.

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Right now, Miles said, he feels as if he tried to talk at a NAHU forum about any issue relating to an individual carrier, such as Assurant’s withdrawal from the major medical market, or the data breach at Anthem, NAHU would cut that discussion short, identifying it as a possible violation of antitrust rules.

Jeff Miles

Miles said he would also like to see NAHU be more open to the media.

Fifteen years ago, NAHU let reporters observe almost all convention events that were open to regular attendees, including state political action committee organizational meetings.

This year, NAHU has limited reporters to covering part of the opening general session, some of the educational workshops offered on Monday, and the exhibit hall.

The NAHU town hall meeting being held today is off limits to reporters. The NAHU House of Delegates meeting scheduled for Wednesday is set to be off limits to reporters.

Even the keynote address Terry Bradshaw gave during the opening general session was off limits to reporters.

“I find that shocking,” Miles said.

Miles said he is now becoming more active in another group, Health Agents for America (HAFA), because he thinks it’s more transparent, and because he thinks it’s making more progress with representing producers’ views in Washington.

See also: How the PPACA exchange program still infuriates agents

NAHU has had success in Washington with making the case that customers are really the ones who pay brokers’ commissions, and that commissions should therefore be excluded from MLR calculations. Miles said he believes that strategy has backfired, by giving insurers cover for forcing producers to negotiate their own compensation arrangements with the customers.