CapCon 2011

Day 3 of Cap Con 2011 began with another 3 hour “mega” general session. We had more congressional representatives who spoke with us and I can say that I am even more convinced that we have support for agents and brokers, as a part of the delivery process for healthcare reform, on the Hill.
Rob Andrews, a NJ Representative started things off and was a good speaker. He was very honest with us and noted that he does not believe PPACA will be repealed. He noted there were 4 major points he wanted to make today;
1. That he believes that agents and brokers should be a part of the delivery system.
2. That our services do not add cost as much as value, and as such, our fees and commissions should be counted in MLR.
3. The small business tax credit needed to be “cleaned up”. He noted that, currently, spouses and children of business owners are not counted and need to be. He did make appoint that resonated with me. He noted that this encourages small business owners to not think about hiring family, but looking to others when thinking about expanding. I could see how some small business owners could find this troublesome.
4. (This was his most emphatic point) That patient responsibility needs to be better addressed in PPACA. Rep Andrews believes that this is the number one drive of rising healthcare costs.
He left us with an interesting statement. He wondered how countries such as Egypt and Tunisia are faring as they struggle to keep people from fleeing their countries, while we here have to deal with the problem of too many people trying to get in. He stated this is still the number 1 economy, healthcare system and place for education in the world. We still have much going for us and we should remember that.
Next up was Richard Popper, a Deputy Director at HHS who is charged with the formation and promulgation of high risk pools to insure those with pre-existing conditions who cannot obtain coverage. Again, our speaker was honest with us and went to the edge on a few answers in the interest of honesty. I really like it when people take the tough questions and respond with answers that may not win them popularity contests, but know that the answers need to be said. Richard educated us on the formation of Pre-existing Condition Insurance Plans (PCIP’s) and noted that about 27 states opted to create their own PCIP’s while the other 23 are using a federal PCIP. If you want to see which states are doing what, go to www.pcip.gov. Two interesting items to note were, of the 27 states that opted for their own PCIP, 25 are paying some form of compensation to agents and brokers for helping guide folks through the system. I believe New York is one of the 2 that do not compensate agents and brokers for helping folks connect to the PCIP. The second item was his response when he was asked if the federal PCIP was subject to the same MLR that other carriers are and he answered (honestly) no. The crowd was visibly upset and he did go on to state that most high risk pools run with MLR’s in excess of 160% and that MLR was not really necessary. I thought if it was not, why wouldn’t they obligate themselves just to show that the government is willing to play by the same rules it dictates. Interesting.
Next up was the first of two senators who spoke with us. I was interested to hear what they had to say since the House clearly is not happy with PPACA but the senate is still pushing forward with it. Mike Enzi from Wyoming was the first up. Next up was Mark Begich. I put these two presenters together because they each did not say much. My guess is that they know there is no senate support for PPACA repeal and to go out and take a stand against it may not help them, so I think they both played it safe. Both did express their concern, but were not specific about solutions. Sen. Begich did say, quite frankly, that he felt the Senate failed on cost-containment and admitted they have to work on that. I guess you can say I got the answer to my “where’s the savings?” question.
The last speaker was a good one. Karen Harnet (again, I may have the last name wrong or misspelled it as she was not on the list) is the Counsel for the National Federation of Independent Business (NFIB) and she is heading up the NFIB’s fight to rule the individual mandate unconstitutional. She was very good at giving us the legal update on where this is without losing us in the technicalities. Generally speaking, the thrust of the argument is that, while Congress is charged with regulating commerce, it cannot compel individuals to engage in it. The NFIB (along with 26 states) feel that Congress overstepped their bounds. There was some discussion of district circuits and upcoming decisions, but what struck me is that 26 states are more than half our country. There are those who believe that the individual mandate is the lynch pin for the entire PPACA and if that is ruled unconstitutional, the entire bill is in jeopardy. What I took that to mean is that, over half our nation believes that this law is not good (at best) and even want to undo everything that has happened since last march and start all over again (at worst). I have always felt reform was needed, and am nervous about going back to square one in this economy. I also think there are several aspects of the act that do not make sense and are actually counterproductive to healthcare reform, so I am not sure whether to wish for repeal or not.
Anyway, I am done with my legislative meetings so that is it for now. I have asked all those from our state that had meetings to send me a briefing about their meetings so I can share them with you. I’ll post more on the blog as soon as I hear back. I want to thank all those who participated and shared their information with me. A special Thanks to Mickey Lyons, Jeanette Jones and Maureen Pelose for making more than their fair share of meetings. It is good to have folks like this in our association.
Feel free to post your comments and feedback.
All the best to all of us.
Pete

CapCon 2011

What a busy day. Today began promptly at 8 AM with a general session that lasted three and half hours. Today's general session was like the Cap Con’s of old, where representatives and industry experts had a chance to communicate their positions and support of our industry.
The first up was Mike Rogers, a congressman from Michigan. Congressman Rogers serves on the health subcommittee of the energy and commerce committee of the House of Representatives. His first point was to applaud us, stating that the First Amendment of the Constitution gives the people the right to petition the government, and he says, we should be here to exercise that very right. I found that interesting. He then lightened the mood with a couple of jokes; one by noting that health care reform (as promised by the president) said we could keep our own health plan if we liked it. He also noted that health care reform was going to lower premiums. He jokingly asked, “How's that working out for you”. Rep. Rogers, who owns a small business in Michigan, made a great point that emphasized the point I made in yesterday's blog. He noted that most small business owners are working six days a week and to eliminate agents and brokers as a part of the healthcare guidance process shifts the burden to those small business owners who are already devoting their time to their business and that is not good. I think his statement supports that we are a part of healthcare and a very important resource to small business. He also answered the question that I've been asking many throughout this conference; what's in the healthcare reform bill that deals with cost-containment? His response was-he has not seen anything. Rep. Rogers clearly is in support of agents and brokers.
Next up was Joel Aria (sp? My apologies if I have misspelled his last name). Joel is the Director of Exchanges for the Department of Health and Human Services and also was a previous insurance Commissioner for the state of Pennsylvania. He, to, suggested that agents seem to know the business of health insurance. Joel was an interesting speaker in that he made some statements that drew some applause, but also some boos from the audience. In particular, with reference to exchanges, Joel said he compared the role of the navigator in insurance exchanges to insurance agents and explained that the term navigator was created because it seemed that there were some “harder populations” that needed to be insured that agents and brokers typically did not serve. I actually agree with Joel on this point as I do not see many agents and brokers dealing with the individual market, sub standard market or state subsidized market, and there may be a need to have folks to deal with these individuals and groups. I think as an association we may want to expand our roles and work at providing commissions on products to these populations in order to ensure our role in the exchanges.
Next up was Susan Voss. Susan is the current insurance Commissioner for the state of Iowa and Chair of the National Alliance of Insurance Commissioners. When Susan was introduced only two people in the entire audience (about 700) stood up and applauded. She made a short joke of it, but I'll tell you, when she left, everyone stood and applauded. Susan's presentation was probably the most inspirational and the most supportive of our position as agents and brokers. She talked about how PPACA is not addressing cost, we all agree with that. She also mentioned that the NAIC is mentioned 21 times in PPACA. She assured us that the NAIC is not only important to this legislation but that they are dedicated to keeping agents and brokers involved. She was also very honest with us in answering the questions about MLR. She informed us that the NAIC supported agents but, as an association, was split 30/30/30 on MLR. She felt that in order to further discussions with HHS the NAIC needed to present a more united position. She was honest enough to share with us that the decision was to support MLR in order to have positive discussions with HHS. She did mention that the HHS is moving in a direction that is recognizing the role of the agent in the sales and explanation and service process of healthcare. I think the most resounding comment she made was when she stated that in her role as an Insurance Commissioner, consumers call her to complain, but it is the agents that educate her. She reiterated her support of what we do and what role we play in the process.
The next presenter was Dr. Andy Harris, a freshman congressman from Maryland. He did mention that he felt these times were interesting, exciting and frightening. I thought those were good descriptions. I've been attending Cap Con for some time and I've seen many representatives present in front of us. There is much talk of the “freshman class” in the house this year. I here there's more of them than ever before. I'd never really experienced a freshman presentation per se, but could tell the difference between experience representatives, who seem to engage us more, and freshman representatives, who read more from a script and quote more “campaign like” speech such as referring to America as a beacon of freedom or conversations about overcoming personal adversity to reach the house. Dr. Harris was informative but you could tell he was somewhat scripted.
The last presenter was Representative Kevin McCarthy from California who is majority whip in the House. You could tell Rep. McCarthy had some experience. He was not scripted, told more jokes, and never looked down to referred was notes. Again, he was supportive of our position and gave me the belief that the role of the agent and broker is being represented, communicated and supported on Capitol Hill.
From the end of the general session it was off to a quick lunch and then up to the Hill for my lobbying appointments. My first appointment was with Becky Cornell, Legislative Assistant for my representative, Paul Tonko. I've met Becky before and, while I know representative Tonko supports single-payer, the purpose of my meeting was to asked the question about cost and explain the value and role that I, as an agent and broker, bringing to my clients with respect to health care. Becky responded positively and told me that she has never heard representative Tonko not support the agent broker community. He also told me she would mention to him the stories that I shared with her and felt that representative Tonko would be supportive of agents and brokers moving forward. From there I went to my next congressional meeting with freshman representative Chris Gibson. I was joined by fellow NAHU members Mickey Lyons, Brian Bodner and Sher Sparano. The four of us met with Nick Czajka, a legislative staffer for Representative Gibson. The office was busy and Nick was very attentive, but was not up to speed on many aspects of PPACA. We shared with him our stories, our support of agents and brokers and the role of NAHU in healthcare reform. At the end of our meeting Nick thanked us and did tell us that he had learned a lot and was grateful for our meeting. I got the feeling was truthful. Representative Gibson will be speaking to our local Northeastern New York chapter in March.
Next, I joined Mickey Lyons in his meeting with another freshman representative, Tom Reed. Our contact for our meeting was out for the day, however, his office was accommodating and we met with Carlton Jackson, Operations Manager for Representative Reed. We were fortunate enough to briefly meet Rep. Reed as he passed through the office and took a moment to come over and introduced himself to us and shake our hands. I've been up here a lot, and have a representative take a moment to introduce themselves to us, that meant something. Carlton, like Nick at Representative Gibson's office, was very welcoming and seemed interested in hearing our position and our stories. He too noted that Representative Reed supports agents and brokers, but was not able to commit to a whole lot. I can understand that.
I had dinner with Todd Bellistri, a Metro New York NAHU member and fellow small agency principal. We talked about best practices, our struggles with dealing with carriers, competition and clients.
All in all, I have to say that today gave me greater belief that we, as agents and brokers, are winning the fight for our right to survive. We’ve got a lot of support up here on the Hill, but we need to continue to deliver the message of our value to those who either do not understand this or feel we add to the cost (unnecessarily) to the system.
That's all for now, I've got a get some sleep.
Until tomorrow…

CapCon 2011

As I mentioned yesterday, it’s a different world for healthcare reform and this year's Cap Con began to reflect that. Last year's general sessions were chock-full of Representatives talking about their stance on healthcare reform, their opinions on how reform should be and what should go in the bill. This morning’s general session included three senior legislative staffers giving their opinions on healthcare reform and how we should conduct ourselves in our legislative meetings. To be honest, their advice and presentations were pretty much familiar. There were two interesting things to note in this general session. One of the presenters John Williams noted that the average age of a congressional staffer 25 years old. This puts the average congressional staffer in the category of “young invincible” with respect to healthcare. What's interesting here is most people know that although there Congressman or Congresswoman does actually cast the “vote” and certainly are aware of the issues. But we need to be aware that congressional representatives and senators rely on staff to make them aware of situations and advise them on certain issues. It is interesting to me that healthcare reform and the future of healthcare is being assisted by and advised by those who have little familiarity with healthcare utilization.
The second interesting thing about this session was during the Q&A session. John Williams was asked how he selected his health insurance plan as a congressional employee. This question was met with the rowdy laugh and applause from the audience. He noted that he read a “booklet” put together by the human resources department that standardizes the offerings available to him and he chose a plan based upon what he thought was the best choice for himself and his family. What I found interesting here was that John has access to (what I would say is) a pretty well-heeled human resources department who probably put together a nice explanation of what benefits are available to him and how they stack up to other options. What it made me wonder was how does the small employer provide their employees with benefit communications? I believe herein lies the value of the agent. I believe the value of an agent to the employer can be different from large employers to small employers. I think large employers rely on an agent or broker to be a good negotiator. Think small employers rely on an agent or broker to be a good communicator. For small employers, it is usually the agent or broker who is holding the enrollment meetings for employees and explaining coverage so that they can make their choices. Can we really expect busy people to read more about such complex issues in order to save 3-5%? I think they would gladly pay it to have someone to help them.
After the general session we had our regional meeting with our VP, Norm Michael's. Norm noted that our region had the highest Cap Con attendance that we've ever seen. Mickey Lyons, a previous New York State AHU president, noted that New York State had more congressional meetings scheduled than we ever had as well. It was good to hear that during these very tumultuous times agents and brokers are stepping up taking an active role in their industry. Our members here are not just striving to preserve their role but trying to preserve all agents and brokers roles. Our region is divided up into several states Norm invited each state to give a legislative update on what each state has been doing with respect to healthcare reform and share some of the challenges that they have had over the past year. The folks from Massachusetts had the most to say. I would've expected that. One particular note that I found interesting was that in Massachusetts they set MLR at 88%. The question I posed to the representatives from Massachusetts was that, in light of the exchange program the Massachusetts and an 88% MLR, how are agents in Massachusetts surviving? The answer was we are resilient. There you have it; we are resilient. I believe agents and brokers bring a value to healthcare system. Massachusetts brokers would have gone away if employers did not value them. We may need to change the way we do business and our brothers and sisters in Massachusetts are leading the way.
In the afternoon I attended the first of a two part session on exchanges. The format of these one-hour sessions was one half hour of presentation and one half hour of Q&A posed to a panel. The presentation part was extremely helpful as NAHU staff and others gave tips on what they thought exchanges would be and what we as agents can do to prepare for them. Now keep in mind that exchanges probably make the broker community more nervous than any other aspect of the PPACA, but exchanges will not be of effective until 2014 so there is much to be considered and there are many different forms that exchanges could take between now and then. The best advice that was given to the membership was that we is agents should familiarize ourselves with as many existing exchanges as there are. As you know, each state looking to form exchanges will most likely look to existing ones when creating and developing their own. Massachusetts, as you know, is probably the most well known exchange. However the state of Utah has also created an exchange program and Wisconsin has begun a prototype. The advice of the panelist were that NAHU members should visit these websites familiarize themselves with the navigation tools on the sites. The Massachusetts exchange can be found at www.mahealthconnector.org and the Utah exchange can be found www.exchange.utah.gov. Take a look when you get some time. The second half of the session was a Q&A for the panelist and I have to say I could sense the frustration of the broker community in the questions that came.
The second part of the exchange breakout session was not as exciting since the formation of exchanges is speculative at this point. The panelist did a great job at laying out the options and the members ask questions however, many answers were “we’re not sure”, “we don't know” or “we’ll have to wait and see”. One particular member posed the question that Massachusetts, which is really the oldest exchange example, has not fared well and what is NAHU doing to hold that as an example of not how to do things. That question was met with a round of applause from the audience. The panelist did their best to answer it, but again where not sure. Each state makes its own decision as to how to structure and manage and regulate their exchange.
The last session I attended was the final general session of the day. The format of the general session was a town hall meeting to discuss member questions and concerns prior to their Capitol Hill visits. After a brief presentation of the panel, the floor was opened up to questions from the over 700 NAHU participants. Janet Trautwien was surprised (as I was) that the line at the microphone was not as long as we might have expected. I think that speaks volumes. We spent a lot of energy and a lot of resources getting to know PPACA, fighting against certain aspects of that act and understanding the ramifications after it was passed. We also spent a lot of time communicating with our clients over the past year and we might be a little tired. But we can't give up. I Believe customers and clients in the public are starting to see all of the different aspects of this act and that, as a combined piece of legislation, there is much to be desired.
Now is when we will be needed to advise those who are charged with implementing this facets of the law and I believe they will be grateful for our help and assistance and we can prove our value to them like we do to our clients every day. Take a break if you must, but come right back and help because we need to do more.
BTW- I did ask three different conference participants about how this act was going to lower health-care premiums. Every single one of them shook their head had no answer for me. I don't know if I'm going to get a different answer on the Hill tomorrow but you bet I’ll asked that question.
Talk with you all tomorrow.

CapCon 2011

Hello,

Well it's Sunday afternoon and I'm in Washington DC at the Hyatt Regency, home of this year's Capitol Conference. In coordinating and preparing for my meetings, I have been thinking about what points I will make to the legislators I’ll be speaking with. Last year, the message was all about the various aspects of the proposed healthcare reform legislation. Since the legislation had not yet passed, the message was one of education so that the representatives would know what was in the bill that was good and what was in that was not. I believe NAHU made great strides to prevent a healthcare reform bill that could have been much worse (if you can imagine). This year we're in a post healthcare reform world and that world is still very uncertain. Many aspects of the Patient Protection and Affordable Care act have yet to reveal their effects on health insurance or their impact. I am very interested to hear what other agents and brokers are planning for in their meetings.

As a health care agent and broker I have three concerns. One; that my clients and customers get the kind of health insurance they need. Two; that my clients and customers are able to afford the premiums for the health insurance they need. Three; that I am able to earn a living helping my clients make decisions about items one and two. I truly feel that my clients are better off with me than without me. In order for me to stay around, I need to earn revenue. I am not ashamed to admit that I collect commissions for the work I do.

I'll be honest I’m not convinced that some of the coverage enhancements that took effect this past year were all bad. I like the fact that I don't worry that one of my clients will call panicked because an employee was just diagnosed with MS and is going to chew through their prescription plan maximum in about a week and a half. I also like the fact that I don't have to worry about a pre-existing condition exclusion, that I'm not able to remove from a policy (even at an extra cost), constantly burdening a small company’s human resources department in case they forget to provide a HIPAA certificate, or worse, forget to explain to a new employee, who has had a lapse of coverage for more than 63 days, that certain claims could be denied.

What I don't like is the cost. I think no one does. That’s what I want to find out while I’m here. How, exactly, are rates and premiums supposed to come down if coverage gets better, and some are challenging that not everyone has to participate? That is the question I’ll be asking everyone here. I’ll let you know what they all say.

So, there you go. I think this year’s Cap Con message from me will be- How can we make this more affordable and how do I ensure my future (and yours) in the health insurance industry.

Stay tuned…