J.P. Wieske (Photo: House Energy) J.P. Wieske (Photo: House Energy)

Congress should try to make health insurance market rules friendlier to insurance agents and brokers, because agents and brokers are more effective at getting people covered than navigators are, according to J.P. Wieske.

Wieske, the vice president of state affairs at the Council for Affordable Health Coverage (CAHC), made that case last week at a hearing on health care costs organized by the House Energy and Commerce health subcommittee.

Wieske has been affiliated with groups that promote a market-based approach to health finance system change for years. He was deputy commissioner of insurance in Wisconsin under Wisconsin’s former Gov. Scott Walker, who is a Republican.

Democrats now control the U.S. House. In addition to promoting other CAHC priorities, such as offering states flexible reinsurance programs, Wieske told House Democrats, and their Republican colleagues, about the value agents and brokers offer consumers in the individual major medical market.

The ACA requires ACA exchange program managers to set up navigator programs, or programs that offer consumers help with understanding how to use the ACA exchange system.

In Wisconsin, navigators had a “limited value” in getting people covered, Wieske said at the hearing, which was streamed live on the web.

“I think it’s been much more effective to use agents,” Wieske said.

(Related: ACA Individual Health Market Can Stabilize, Officials Say)

In Wisconsin, navigators tend to be clustered in urban areas, and they tend to work with consumers mostly when the consumers are signing up for ACA exchange plan coverage, Wieske said.

Rural communities are much more likely to have insurance agents than to have ACA navigators, and agents are more likely to have an ongoing relationship with their clients, Wieske said.

Not All the Navigators’ Fault

The U.S. Department of Health and Human Services (HHS) provides ACA exchange services in Wisconsin through HealthCare.gov. HHS has been funding HealthCare.gov’s Wisconsin navigators through grants.

A Republican lawmaker at the House hearing, Rep. Larry Bucshon, R-Ind., asked Wieske about reports showing that the government spends about $2,700 on navigator funding for each navigator client enrolled in ACA exchange plan coverage.

Wieske did not take the opportunity to criticize navigators for that high ratio, or to agree with Bucshon that HHS should claw grant money back from navigator agencies that fail to meet enrollment targets.

“I think the funds, to be honest, are spent at the time they’re granted,” Wieske said. “The awards come very, very late. It’s very difficult for the navigators to be able to plan ahead, based on when they’ve received those grants. They’re almost required to spend [the money] the day they get it.”

Policy Changes

Wieske said states could help agents and brokers by easing the current ACA minimum medical loss ratio regulations, which keep producer compensation in the loss ratio formulas.

He said Congress could help even more by making health insurance rules more flexible, to help states restore the individual major medical market to profitability.

The fundamental problem is that medical loss ratios in the individual major medical market have been too high, and insurers have been forced to slash spending, Wieske said.

“Largely, they’ve cut it out of agents,” Wieske said.

Also at the Hearing

Wieske testified at the House hearing alongside two heads of state-based Affordable Care Act (ACA) public exchange programs: Peter Lee, the executive director of Covered California, and Audrey Gasteier, a policymaker at the Massachusetts Health Connector.

  • Lee said an exchange program has to spend heavily on advertising and other forms of outreach, because about 40% of the enrollees flow in and out each year, and because, even with heavy marketing, many consumers are still unaware of how the ACA public exchange system works.
  • Gasteier said Massachusetts has held its average monthly premiums to the lowest level in the nation — $385 before subsidies — by offering strong in-person help and adding state subsidy money to beef up the federal subsidies.

Resources

Links to House Energy health cost hearing resources, including a video recording of the hearing, are available here.x

— Read Health Policy Shaper: Congress Can Get Things Done, on ThinkAdvisor.

— Connect with ThinkAdvisor Life/Health on LinkedIn and Twitter.