Medi-Cal advocate Beth Capell smeared the reputation of all health insurance agents by insinuating that agents enroll Medi-Cal eligible children in private plans just for the commissions they derive from those enrollments. Ms. Capell is assuming, incorrectly, that all health agents put money above the best interest of their clients. It’s unclear where Ms. Capell’s animus towards health agents springs from when thousands of agents have assisted tens of thousands of families with enrollment in Covered California and Medi-Cal health plans.
Family fights children’s Medi-Cal enrollment
Ms. Capell’s comments attacking the ethics of health insurance agents were captured in the CaliforniaHealthline story “This Family Says No To Medi-Cal, But A Computer Won’t Listen“, written by David Gorn and published April 7, 2016. The story centered on a Fresno County family’s struggle to get their children out of a Medi-Cal health plan and into private health insurance through Covered California. The family was willing to pay the full premium amount for a private health insurance over the estimated $13 per month under Medi-Cal according to the story. The author, David Gorn, reporting on all the different angles of the story quoted Capell on a proposed fix to the system to allow families to enroll children in private insurance when they were eligible for Medi-Cal.
Beth Capell, spokeswoman for Health Access California, a Sacramento-based consumer advocacy group, said the “fix” Patterson is proposing would create more problems than it could ever solve.
“It’s an attack on Medi-Cal that adds barriers and roadblocks to coverage,” she said.
She explained that the bill would have complicated the enrollment process, created confusion among parents about their choices and possibly created other computer snafus.
She said it wouldn’t help kids but would serve insurance brokers, who stand to make money when more people sign up for unsubsidized coverage instead of Medi-Cal.
Smearing all health insurance agents
Frankly, I’m offended that Ms. Capell would paint all health insurance agents as having low ethical behavior. While I can’t speak for all health insurance agents, it is against my ethics to promote the enrollment into a health plan that would be against the best financial interest of a family. Medi-Cal for kids is a great program and I fully support it. It works for many families, but not all families.
Families don’t need to use an agent
Ms. Capell may be unaware that any parent can enroll their child in a private plan directly with a health plan or health insurance company outside of Covered California. They do not need the assistance of a health insurance agent or broker. Only when the agent assists with the enrollment and is the agent or broker of record are they paid a commission or enrollment fee.
Are there big buck commissions?
Commissions for individual and family plans either directly with an insurance carrier or through Covered California are relatively small compared to other insurance products. The commissions can be as little as $5 a month. Health insurance agents don’t go out trolling for families who want to switch their children to private plans from Medi-Cal. Those families usually approach agents for assistance. If Ms. Capell thinks health agents are all getting rich from this profession, she can go to my blog post “How much do health insurance agents earn?” and read how much I’ve made over the last couple of years as an agent.
Medi-Cal and Covered California clash
There have been many stories written about the nightmare families’ face when trying to navigate through Covered California and Medi-Cal. They are bounced back and forth like ping-pong balls between the two bureaucracies. Medi-Cal readily admits that there are constant and continuous software issues between the multiple programs at Medi-Cal and Covered California (See: County Medi-Cal Eligibility Workers FAQs). What is clear is that Medi-Cal takes precedence over Covered California and many families resent this. Anytime a household member is eligible for Medi-Cal enrollment virtually all changes to the household’s Covered California account must be done through the local county Medi-Cal office, not Covered California.
Covered California online enrollment changes
Covered California recently updated their CalHEERS online enrollment system with additional features for Medi-Cal for pregnant women, former foster care youth enrollment, and new Medi-Cal income eligibility conditions for households for certain Bay Area counties. (See: Covered California updates income reporting and former foster youth enrollment). If the IT and software developers at Covered California can tackle these complicated enrollment features, they certainly should be able to allow families to opt their children out of Medi-Cal.
Opting out of Medi-Cal
Covered California has already created a similar Medi-Cal opt-out adjustment for families in San Mateo, San Francisco, and Santa Clara which have a higher income threshold for Medi-Cal kid’s eligibility. Information from Covered California stated that children in these counties, with household incomes become 266% and 322% of the federal poverty line, will be dis-enrolled from the family’s subsidized health plan. The parent can either enroll their children in private insurance with no subsidy or enroll them in a local county Medi-Cal health plan. (See: Medi-Cal set to snatch Bay Area kids from parent’s plan)
What are the benefits of Medi-Cal?
If a family from one of the affected counties contacted me about enrolling their child in a private plan I would ask them if they had carefully considered the benefits of the Medi-Cal health plans. In addition to saving money, Medi-Cal health plans provide all the minimum essential benefits of a private plan, albeit with a small network of providers. But some families have very valid reasons for wanting a private health plan for their children. The children may be seeing specific providers for certain health challenges and the parents may not want to break the continuity of care their children are receiving.
Is it ethical that government locks consumers into Medi-Cal?
I would turn Ms. Capell’s assumption about unethical behavior on the part of health agents around back to her. Is it ethical for a government bureaucracy to thwart the desire of a parent to enroll their children in a private plan? One of the goals of the Affordable Care Act was to give consumers more choice of health plans for the delivery of their health care. It seems to me that locking people into a health plan they don’t want is contrary to expanding consumer choice.
Let’s not stereotype populations
Regardless of what Ms. Capell may think about health insurance agents in general, my mission is to help educate consumers about their choices for health insurance either through Covered California, off of the Marketplace exchange, and Medi-Cal. Unlike Ms. Capell, I will refrain from arbitrarily assigning negative attributes to any given profession or population of individuals. Big sweeping generalizations only serve to engender bigotry and discrimination.