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August 04, 2016 at 08:39 AM
Health Agents for America is meeting this week in New Orleans as the individual commercial health insurance market looks as if it’s falling apart.
UnitedHealth Group is pulling out of the individual health market in most states. Executives at Aetna, Cigna and Humana who once bragged about their infant exchange operations’ enrollment growth are now apologizing for the cash they are pumping into “premium deficiency reserves.’ The reserves are funds set up to help insurers cope with the fact that they set premiums for 2016 too low, have no legal right to increase the premiums, and expect to pile up huge losses until the end of the year.
Related: 3 ways Aetna just shook the ACA’s foundations
Even executives at Anthem, a company with a dominant position in some states’ exchange programs, say they are thinking hard about what Anthem should do about the individual health market in 2017.
The members of Baton Rouge, Louisiana-based HAFA (pronounced “Hoffa”) are all independent producers who sell individual commercial health insurance, small-group commercial health insurance, or both. They are struggling to figure out what exactly they will be able to sell, and where, in the coming year, and whether any of the issuers of the products that are available will pay sales commissions. Some fear a single carrier will have many of the counties they serve all to itself, with no real competition but uninsurance.
HAFA is just four years old. It is much smaller than the biggest agent groups and has registered only about 140 participants for the New Orleans meeting. But HAFA has tried to empower its members to speak up, and many members are desperate to talk to reporters about how problems with the Affordable Care Act and ACA implementation are affecting them, and what they think agents and others should do about the problems.
Related: Health agents head to New Orleans
For a look at some of what HAFA members and meeting speakers said in interviews Wednesday, before the meeting officially began, read on:
(Photo: Allison Bell/LHP)
1. B. Ronnell Nolan
B. Ronnell Nolan, the founder and president of HAFA, was a service representative at an insurer for 16 years. She later got into lobbying with the Louisiana Association of Health Underwriters and the Medical Tourism Association. She now runs her own Baton Rouge-based government affairs firm. She started HAFA in 2012, with the goal of members surviving the effects of the Affordable Care Act.
Right now, Nolan said, one problem is that neither the Republicans nor the Democrats in Washington show much interest in making the compromises needed to keep the individual health market stable in 2017.
“No one wants to move to the middle of the aisle till we have a president,” Nolan said.
Similarly, she said, insurers, the groups representing doctors and other organizations seem to be quieter than she might expect, possibly because of uncertainty about the outcome of the elections.
Related: 4 tales from the ACA agent misery files
(Photo: Allison Bell/LHP)
2. Kristin Kahle
Kristin Kahle, the chief executive officer of NavigateHCR, a San Diego-based compliance company, has a doctorate in business from Argosy University. She believes she has the first doctorate granted based on a dissertation about the ACA.
Earlier this year, her company helped 4,000 employers send out 800,000 1095-C ACA coverage notices to current and former employees.
Her firm also helps with general ACA, Employee Benefits Security Administration and Health Insurance Portability and Accountability Act compliance.
Asked about the kinds of issues relatively simple, well-organized, plain vanilla employers are facing, Kahle said, “There are no vanilla clients. They all have issues.”
Many employers have not even put together the summary plan description required by older benefits requirements, let alone started sending out the required ACA notices, Kahle said. Kahle said, based on the kinds of calls her firm has received, that she believes that many employers either sent their 1095-C’s out very late or did not comply with the notice requirements at all.
When her firm has tried to put clients through Health Insurance Portability and Accountabillity Act health information privacy and data security tests, “nobody’s passed the test,” she said.
Some law firms and accounting firms hire Kahle’s firm to help with ACA and HIPAA compliance, and Kahle’s firm also advises the human resources and benefits departments at some law firms and accounting firms.
“They’re not any better” than the other clients, she said. “They just don’t understand it.”
Even if a few lawyers at a firm do understand the require ACA and HIPAA requirements, the “poor HR manager who wears 15 different hats” probably doesn’t, she said.
Related: PPACA employer mandate may start two-step fights
(Photo: Allison Bell/LHP)
3. Wes Fischer
Wes Fischer is the president of Fischer Services, a Kissimmee, Florida-based field marketing organization that distributes Medicare Advantage and Affordable Care Act individual health products through a network of about 500 agents.
He likes how the ACA exchange system and ban on use of personal health status information in underwriting has helped reduce the state’s uninsured rate to 15 percent, from 2013. But he said there’s no sign yet that Florida’s individual health market is stabilizing.
“It’s not stabilizing,” he said. “It’s re-inventing itself.”
A new ACA exchange health carrier with a clinic network it owns is coming into Dade and Broward counties, and Long Beach, California-based Molina Healthcare is entering some other counties. But Fischer believes that, in 2017, Jacksonville, Florida-based Blue Cross Blue Shield of Florida may have a monopoly in 44 of the 67 counties he serves.
Fischer said agents and brokers need to do a better job of explaining to insurers, regulators and public health managers how live-human agents can help with applying application rules, handling service issues, getting consumers to pay their premium bills and other activities that can improve a plans financial performance and enrollee satisfaction scores.
Fischer said agents and brokers need to think about the stability of the insurers as well as the stability of their own sales commissions.
