Face to face, tell your neighbor they are not worthy of affordable health insurance.
Can you look your neighbor in the eyes and tell them they are not worthy of affordable health insurance? As a health insurance agent in California I must do this on a regular basis. The worst part of my job is telling people that the insurance company has determined that they are an unacceptable risk and they have been declined for a health insurance policy.
These are hard working women and men, mothers and fathers, who trying to protect their families by getting health insurance. They get up every day and go to work. But because of a condition they born with, an accident or illness from years ago or chronic disease they are managing, the insurance companies have determine they fall outside the parameters of a “good risk”.
It was the continual denial of coverage from health insurers that pushed me from a passive supporter into ardent advocate for the Patient Protection and Affordable Care Act also known as Healthcare Reform (HCR). One of the reasons I chose the health insurance profession was the component of helping people protect their health and family. I quickly realized that the health insurance system had morphed into an industry that had become risk averse to anyone that may represent the potential for excessive medical expenses.
My support of HCR has not been warmly received by my fellow agents. Just like me, most insurance agents are small government proponents that bristle at bureaucratic intrusion in the private sector. The real salt in the wound for agents was the implementation of the Medical Loss Ratio (MLR) provision of HCR. The MLR has meant that insurance companies slashed agent commission in half on many types of policies. This severe change to the compensation structure has put the viability of many agencies and independents like me in doubt.
Recently I was contacted by a husband and wife that were agents in southern California. They had the very real concern that their agency of over twenty years would fade away under the new health insurance exchanges and the reduced commission structure. We all agreed that the era of the health insurance agent, as we know it, was ending. Just has the horseless carriage replaced the buggy maker; HCR may cause the extinction of the health insurance agent.
That is not to say that there will not be other opportunities for agents that are willing to adapt and diversify. Unfortunately, for large general insurance agencies with a brood of agents under their wings, diversification means up sell and cross sell. To replace the income lost from standard health insurance policies we are seeing a greater emphasis on questionable products like accident and illness indemnity plans and association discount health cards.
While the plans and cards are legitimate, they offer more value to the agent than the plan member or card holder. Agents are encouraged to move the client into a stratospherically high deductible and then take part of the difference, or savings, over the cost of a low deductible plan to buy a cancer policy or discount dental plan card. When you look at the monthly premiums and their utilization of these specialty plans, the average person would be better off spending their money on a lower deductible health insurance plan.
We only have to look at the words and actions of the large health insurance companies to forecast the future. Unlike so many of my colleagues, health insurers are not screaming about the constitutionality of the individual mandate included in HCR. On the contrary, they asked for the mandate and got it. They knew that if they had to offer a health insurance swim suit for everyone, guarantee issue, then everyone had to be made to get into the health insurance pool. Only if everyone is made to get in the pool will the carriers be able to spread the costs.
Health insurance companies are already planning for the future of HCR and testing out strategies. We are seeing health insurers open up retail locations at your local strip mall. Large retailers and pharmacies are looking into selling health insurance policies right in their stores. (Are health insurance agents going extinct?) Several insurers have announced the formation of group plan Accountable Care Organizations as outlined in the HCR legislation.
A central theme of HCR, and a tenant that health insurance companies have not balked at, is “An ounce of prevention is worth a pound of cure”. All new health insurance plans issued after September 23, 2010 must include preventive office visits at no charge. There are a variety of preventive visits that are covered from immunizations to mammography to colonoscopies. (List of preventive no charge office visits)
Constantly I have opponents of HCR badger me with quips of, “There is no free lunch” or “Someone is paying for the visit”. They are correct. But when you look at it from the perspective of the health insurance company or government program, it is a whole lot cheaper to detect and treat cancer early than finding it in stage 4.
As a child our family never had health insurance. By the grace of God no one was ever stricken with a major illness or accident. By the time my parents reached 65 Medicare was a life saver for them. I am certain that if my parents would have had access to affordable health insurance during their working years with preventive office visits they would have been able to avoid some of their chronic illnesses later in life. My father’s chronic illness cost the state of California over $250,000 in Medi-Cal expenses. As a society, would we rather cover an $80 preventive office visit or the cost of 5 years spent in a skilled nursing facility at tax payer expense?
As we slowly emerge from recession there has been a growing acknowledgement that small business is the engine for employment and growth. There is no sector of our economy that is in more dire need of HCR than the small businesses I have dealt with. Often times it is the cabinent maker, contractor or other small business that can’t get health affordable health insurance. They are only one accident away from losing their business to the expenses associated with doctors, hospital, labs, imaging, and prescription medicines.
The PPACA is not perfect legislation. We have already seen some parts removed or modified, such as the 1099 requirement that was viewed as excessively onerous to small business. I am sure there will be other changes in the future. But the central fact remains that a healthy America is a productive American. I can’t continue to support a system that denies productive Americans affordable health insurance to protect themselves and their families. I look forward to the day when no one has to look into the eyes of their neighbor and tell them they are not worthy.