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7 views on the ACA upheaval, from New Orleans

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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:

B. Ronnell Nolan

(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

Kristin Kahle

(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

Wes Fischer

(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.

“If [insurers] are going to lose money, they’re not going to stay in business,” Fischer said. “Our job is to help fix the problem.”

Related: Managed Medicaid plans whip commercial plans 

Mike Huval

(Photo: Allison Bell/LHP)

4. Mike Huval

Mike Huval is a state representative who represents the area around Breaux Bridge, Louisiana, in the Louisiana House. He is also a second-generation insurance agent.

He said his colleagues seem to be learning about how the ACA exchange system works by responding to pleas from constituents for help. 

Consumers are starting to understand that the government says they should call the ACA exchange system to get health coverage, and Huval sai he sees some noticing that the out-of-pocket cost of the coverage is more than they can afford.

He does not see much awareness among his about insurers’ frustration with the state of the individual health market.

“I don’t think they realize there’s a crisis,” he said. 

Related: State lawmakers deliberate on telemedicine policy

Angie Surra

(Photo: Allison Bell/LHP)

5. Angie Surra

Angie Surra, a HAFA vice chairman, spent more than 19 years working as an insurance consultant at an insurance agency in central Pennsylvania. She now works as an independent health insurance agent and an Affordable Care Act compliance specialist. 

She said she joined HAFA in the first place because of a dearth of accurate, detailed information about how the ACA exchange system and the ACA rules that affect the commercial health insurance market really work.

“There’s no education,” Surra said. “There’s no assistance for agents.”

Even when materials are billed as being for agents, in most cases, “they’re not,” Surra said. “They’re not getting into the nuts and bolts of it like HAFA.”

Surra said one example is a bulletin HAFA sent out advising agents who were having trouble with the main enrollment site, because of high traffic, to switch to the much more stable Spanish-language version of the site.

She said agents and brokers around the country need to join HAFA or a similar group and get to work explaining how the ACA system really works to public officials of all kinds at the federal, state and local level.

Even among state representatives, “the level of ignorance is surprising,” Surra said.

Related: Jan. 1 ACA coverage: Some producers seek glitch extension

Charles Giardina

(Photo: Allison Bell/LHP)

6. Charles Giardina

Charles Giardina, a New Orleans-based agent who has been active in agent groups for decades and has been serving as the HAFA meeting chairman for three years, said colleagues have to come out to defend the value of what agents do.

“Consumers are starving for advice,” he said. “Not an 800 number. Not an identity theft opportunity waiting to occur on a website or on an 800 number.” 

Related: ACA agency head defends outreach

Sylvie di Giusto

(Photo: Allison Bell/LHP)

7. Sylvie di Giusto

Sylvie di Giusto, an image consultant who co-owns Studio for Image Professionals, a New York City-based executive image improvement education firm, is at the meeting to give a presentation on a meat-and-potatoes topic: making a great first impression and maximizing the benefits from that great first impression.

Health insurance agents may feel as if their core market is terrible right now, but “all the markets I speak to are terrible,” di Giusto said. “When they call me, they are already in pain.”

She contends that the best response is to go back to basics and make a great first impression. The main change in that area is that professionals must make a great impression with their e-mail, their social media feeds and other components of their digital footprint as well as with their bodies, she said.

For consumers looking for professionals to help with their money, their lives or their children, trust is specially important, and the focus on trust must by a top concern for health insurance agents and brokers, she said.

She said she will ask health agents and brokers, “Where do I see trust in you?”

Producers must embody trust in their behavior, not just in their words, di Giusto said.


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