MLR Rules Still in Play

The Patient Protection and Affordable Care Act requires carriers to spend a specified proportion of the premium dollars they take in on medical care and health quality efforts. That’s the law. As I’ve noted previously, legislation creates a framework. It’s the regulations and day-to-day interpretations of the law that determines its impact. There are lots of opportunity for regulators to soften the edges of the law or sharpen them up.

  • How should the law be applied to small or new carriers who may be subject to extreme fluctuations in their spending ratios that are beyond their control?
  • How should nurses hotlines be treated?
  • Should health quality efforts be considered non-administrative expenses only if they actually improve quality? And if so, what will that do to innovation?
  • How should commissions and other fees received by carriers but passed-through entirely to independent third-parties be treated?
  • At what level should carriers be required to meet the medical loss ratio requirements (i.e., state level? nationally?)

And the list goes on.

The National Association of Insurance Commissioners, working with the Department of Health and Human Services is tasked with resolving these issues. The NAIC provided some meaningful clarity last week when it published draft rules for how carriers were to calculate their medical loss ratios. But there are still many issues that are  far from being settled. The Hill reported that Brian Webb of the NAIC outlined a host of MLR-related regulations the Commissioners are still considering during a presentation he made to the Congressional health Care Caucus.

What’s significant about what Mr. Webb had to say is not just the long list of rules being modified at this late date (the MLR requirements take effect January 1, 2011, so settling on how this provision is to be interpreted is of urgent concern), but his description of how the process of resolving these issues will play out. He indicated that an NAIC panel is expected to adopt the draft regulations on Monday, October 4th. That will no doubt be widely reported. But what will be important for those concerned about the nitty-gritty of the MLR rules to remember is his prediction that the regulations are likely to change before the full NAIC adopts the them in mid-October.

And this vote by the NAIC is unlikely to be the last word. HHS Secretary Kathleen Sebelius has to “certify” the regulations, which gives the Obama Administration an opportunity to tweak elements. Then each state has to adopt its own regulations. And while the NAIC proposal will carry great weight, states will have flexibility to adjust elements of the MLR calculation to suit their own health insurance market — and political — environments.

The Hill also reports that the NAIC will urge Secretary Sebelius to allow, on a state-by-state basis, a transition period phasing in the medical loss ratio targets as it applies to plans sold to individuals and families (non-group plans). Such an exemption would not be automatic and states would need to demonstrate that applying the  80 percent MLR on individual plans in their jurisdiction, as is required by the PPACA, would “destabilize the state’s individual market.” According to Mr. Webb, a similar transition mechanism could be established for the small group market as well.

This ongoing uncertainty will have serious consequences. Carriers will make decisions based on the best guess each makes on where the regulations will wind up (and that best guess will no doubt assume the worst possible outcome). As the regulations get clarified the carriers may seek to adjust some of those decisions creating a ripple effect of change.  All of which means consumers, employer and the brokers who serve them are going to be kept busy adjusting to an evolving marketplace well beyond the effective date of the new health care reform’s medical loss ratio provisions.

15 thoughts on “MLR Rules Still in Play

  1. Well I hate to tell ya ‘I told you so’ but…. I told you so. This evening our Governor – The single biggest fraud of a Republican this planet has ever seen – signed the most anti-insurance industry (and agent) Exchange concepts imaginable into law.

    You’ll note from previous posts that I saw this one coming. There was never any attempt to try and create any sort of politically and conceptually neutral Exchange – this was liberal Democrat all the way. Our Governor who pretended to rail against excess and deficit turned right around and without blinking an eye signed the bills that were placed in front of him. It only gets worse from here: Jerry Brown will be the next Governor and the focus in the state will be how they can create newer and more stealthy taxes to feed the state machine and continue to ignore the gaping sinkhole of $19-$20 billion in red ink we’re drowning in. There will not be any attempt to rectify the glaringly obvious issues with the Exchange as it is currently envisioned. The legislators have done what they set out to do: Used federal Health Reform Legislation to craft a blunt instrument to beat the living heck out of the health insurance industry as it presently exists in this state.

    I can’t wait to see how Alan spins this one. Trust me I’m not being a jerk: I am seriously praying Alan DOES have some positive spin to put on this one because if he can’t dress this pig up with some lipstick than it really is as bad as I think it is. Fire away Alan.

    P.S. – Spencer you made some excellent points to which I was intending to respond but to be honest with you I am too depressed.

    • Curt,

      I don’t know any more than you how Alan will interpret the legislation the Governator signed. Believe it or not, we, Fran and I, are affected by CA’s laws as well as Washington’s (equally liberal, if not more so) as we “base” from Palm Springs six months a year (Yup. We’re “Snowbirds”).

      What I really want to say is please, don’t let your frustration get you down. Yes, I smell real trouble coming, but while I can be a cynic (pragmatist?) I’m also an optimist. I believe that by keeping active as we must, to counter the negative (to the consumers and to us) junk being tossed our way, we can effect change. If you would like to discuss some thoughts about how we can take some real actions to effectuate some needed change (thanks for that word, “effectuate”, Ann) please feel free to email me at spencerlehmann101@msn.com. An old saying is “All politics are local”…there are a lot more sayings about politics, but that is one. Much of what Schwarzenegger has just signed into law can be amended, as can much of what Obama has created. Please, don’t give up hope…this is the time to get your energy and your “dander” up, and fight back. As Ann put so well, “We are in this together” and what affects you affects me. Together, we can create change for the better.

  2. “This ongoing uncertainty will have serious consequences. Carriers will make decisions based on the best guess each makes on where the regulations will wind up (and that best guess will no doubt assume the worst possible outcome). As the regulations get clarified the carriers may seek to adjust some of those decisions creating a ripple effect of change. All of which means consumers, employer and the brokers who serve them are going to be kept busy adjusting to an evolving marketplace well beyond the effective date of the new health care reform’s medical loss ratio provisions.”

    Alan,

    Given the events of just the past 24 hours I would like to know if you’re planning to duplicate that Chrystal ball of yours, and if so, can I please buy one?

    Excellent commentary, Alan.

  3. Another Victim of ObamaCare?

    Principal Financial to exit health insurance business, phase out 1,500 jobs

    By The Associated Press, Associated Press
    Last update: September 30, 2010 – 3:02 PM

    Principal Financial Group Inc. will stop selling health insurance. Customers, as policies come up for renewal, will transfer to UnitedHealthcare. The phase-out of all policies is expected to take about three years. Over the three-year transition 1,500 jobs will be phased out. Workers can apply for other open positions in the company. Principal currently has 100 job listings. Link: http://www.startribune.com/local/104093718.html?elr=KArksLckD8EQDUoaEyqyP4O:DW3ckUiD3aPc:_Yyc:aUUsZ.
    __________________________________________

    1,500 jobs will be phased out, plus, not shown, all Brokers and Agents who use the Principal will be out in the cold, regarding the Principal.~~~~~”Workers can apply for other open positions in the company.”~~~~~Principal currently has 100 job listings, meaning that the other 1,400 can go suck eggs.

    Why is it that not one single Democrat who voted for this HCR Bill wants it brought up during their campaigns for reelection? Could it be because the vast majority of Americans didn’t want this done to them? Could it be because the Democrat Sheeple who followed Pelosi, Reid, and their other leaders to the edge of the cliff are doing their best not to fall? Or is the real reason because none of those Democrats has the courage to stick with their convictions, as they did not vote their convictions, fell prey to Pelosi and Reid’s threats to remove any Democrat who didn’t vote for this legislation to be removed from their Committee Chairmanships, and now must face their constituents whom they betrayed?

    The Principal was the large, Cadillac Major Medical company who first left Washington State when HillaryCare was adopted by Washington. I have no doubt that the Principal has other divisions that are far more profitable and has decided that the “getting out was good” to cut any losses they may incur as the result of ObamaCare now being law. Medical Loss Ratio requirements (MLRs) and other mandates being forced down the throats of the companies, Agents, most of whom run small businesses, and the electorate at large certainly wouldn’t have anything to do with their leaving the business, would they? Of course they would, and do.

    We have heard about McDonald’s and the Principal in just the last 24 hours. Neither of these companies needs bad press, but clearly feel that they have no option. Who will be next?

  4. “McDonald’s Corp. has warned federal regulators that it could drop its health insurance plan for nearly 30,000 hourly restaurant workers unless regulators waive a new requirement of the U.S. health overhaul.

    The move is one of the clearest indications that new rules may disrupt workers’ health plans as the law ripples through the real world.

    Trade groups representing restaurants and retailers say low-wage employers might halt their coverage if the government doesn’t loosen a requirement for “mini-med” plans, which offer limited benefits to some 1.4 million Americans.

    The requirement concerns the percentage of premiums that must be spent on benefits.” http://online.wsj.com/article/SB10001424052748703431604575522413101063070.html?mod=rss_whats_news_us

    The Law of Unintended Consequences? This is the first truly “big hit”. There are bound to be hundreds of thousands, if not millions more who will suffer as the result of the poorly researched, poorly drafted, and highly unpopular HCR Bill Obama & Company (which includes the Democrat controlled Congress) jammed down the throats of so many unwilling Americans.

    How many will now end up Uninsured?

    How many Agents/Brokers will be put out of work?

    How will Congress and the country’s Leader (?) make things right?

    Would it have been that tough to do this right, take more time and do the research, and first, before anything else, have tackled, at least begun to work on the Economy and Jobs?

    Obviously, the answer is NO, a resounding NO, it not only wouldn’t have been that hard, and it would have been the right and moral thing to do.

    There will be those on this blog, perhaps even including Alan, who will disagree with me (many usually do). However, when, not if but when changes, amendments calling for drastic changes to the now made Law, HCR Bill are “dropped” in Congress, and all the rules change again, who is it that should be held accountable for the billions of dollars lost in promulgating these changes, who should be held accountable for the many thousands of jobs and careers lost, and who will be responsible for once again educating the electorate on the “New”, “New”, now even “Newer” Health Care Legislation? The Agents/Brokers will be responsible, and they will be paid about one quarter of what they should be paid by those who will look to us and say, “help?”.

    Okay all, a one sentence quiz: How many Democrats who voted for ObamaCare are tooting their horns as they campaign for reelection, about their passing this historic HCR Legislation? How about, not one. Not one single Congress-critter who voted for this abomination that has been wrought on the American Public is bringing it up as they campaign.

    Says a lot about our Congressional Delegations who voted for this legislation not having the courage of their convictions.

    • Love ya Spencer! Please note my link and comments below – the push back is starting to pick up steam and you can start seeing that the Emperor has no clothes…

      I actually think Alan already addressed your comment about “…taking the time to do it right…” – he referenced the ‘fact’ that the Prez felt he had a very narrow window of opportunity (based on congressional numbers) and wanted legislation in hand – no matter how bad it was/is – Here again: I think the admin is either purposely brilliant or accidentally brilliant: This is playing out where left leaning states are going to use Fed Health Reform to crucify the Industry. That will mean support and MONEY will continue to flow into Democratic coffers from ‘satisfied’ democrats. I now can clearly see that I will live in a day and age where the lines between the two parties will be clearly drawn and that there will be a dwindling number of ‘swing states’ or swing voters. There will be Republican states and there will be Democratic states and never the twain shall meet. As my previous post noted the democratic legislators in CA are using the template provided by FEDERAL Health Reform to nail the CA insurance industry whereas in Republican states you’ll see a kinder gentler application of Federal law to help the consumer without decimating the broker community.
      I seriously doubt this is what our Founding Fathers had in mind and thus there you have the Tea Party movement in a nutshell: A group of people fed up with legislators going WAY beyond the scope of what elected officials SHOULD be doing.

      • “Love ya Spencer!…I actually think Alan already addressed your comment about “…taking the time to do it right…” – he referenced the ‘fact’ that the Prez felt he had a very narrow window of opportunity (based on congressional numbers) and wanted legislation in hand – no matter how bad it was/is –…the democratic legislators in CA are using the template provided by FEDERAL Health Reform to nail the CA insurance industry whereas in Republican states you’ll see a kinder gentler application of Federal law to help the consumer without decimating the broker community.”

        Curt, love ya back! 🙂 You make some excellent points in your post, specifically your comment about Republican states using an application of the Federal Law that won’t decimate Agent’s/Brokers (paraphrasing). Just a couple of comments:

        Regardless of a state being Red or Blue, the law must be applied evenly and equally (at least in a perfect world). I like what you said because you’re not pushing for “Repeal” which I think is unlikely and unnecessary. We need reform, though I think primarily Insurance Reform. That being said, this law needs some very serious “Amending”, in order to make it a reasonable law that will give the consumers the relief they need without putting the Agent/Broker Community out of business, or causing our community serious harm.

        I do think that we will need to do all that we can to “unseat” those Democrat Legislators who voted this legislation in, as they have already displayed their arrogance toward and being out of touch with the desires of their constituents. You have several in California (Pelosi, Boxer, Waxman, you probably know more), as we do in Washington (Patty Murray, Maria Cantewell, and Jim McDermott to name a few of the more well known) and we as a country will do well without them (Waxman has been a thorn in my side since the Omnibus Reconciliation Act of 1993, OBRA ’93 and “The Waxman Amendment”, which ruined the Public/Private Partnerships for Long Term Care for all states except CA, IL, CT, and NY). I agree that the Republicans will do far more to help the consumers and the Agents in dramatically amending ObamaCare.

        Maybe, with the Republicans controlling at least one House of Congress, we can tackle, seriously tackle, Jobs and the Economy, too. Now there’s a thought.

        BTW, to any who may be wondering, I am not a Republican. I am a “John Avlon independent”. I’m Socially liberal, and Fiscally Conservative. Thanks to the actions and lack of by the Congressional Democrats, I’m more Fiscally Conservative now than I was 19 months ago.

        • Health Plans Face Scrutiny Amid McDonald’s Move

          * SEPTEMBER 30, 2010, 8:29 P.M. ET

          “The Obama administration said Thursday that its top health official will “exercise her discretion” in enforcing a new health-law requirement, a move that could prevent McDonald’s Corp. and other employers from disrupting their health-care policies for hourly workers…McDonald’s is among the retailers and restaurant chains that offer a “mini-med” limited benefit. Most of these plans don’t meet a 2011 requirement that they spend 80% to 85% of premiums on medical benefits instead of overhead expenses…McDonald’s last week sent a top official at the Department of Health and Human Services a memo saying “it would be economically prohibitive for our carrier to continue offering” its “mini-med” limited benefit plan unless it got an exemption from the requirement…On Thursday, administration officials indicated they are hopeful that HHS Secretary Kathleen Sebelius will be able to allow certain waivers to the requirement, but that it was too early to confirm they will. She must wait for guidance from state insurance commissioners, and the administration doesn’t expect to release the agency’s final guidance until December. The agency said the law gives Ms. Sebelius discretion to apply the requirement.

          “We fully intend to exercise her discretion under the new law to address the special circumstances of mini-med plans in the medical loss ratio calculations,” said Jay Angoff, a director at the Department of Health and Human Services. “We intend to address these and other special circumstances in forthcoming regulations.” Link: http://online.wsj.com/article/SB10001424052748704789404575524502131067836.html?mod=WSJ_hps_MIDDLETopStories
          _____________________________________

          Well Curt, pardon me! I was wrong! I always thought (silly man) that the law is supposed to be applied equally.

          According to the Obama Administration, it isn’t. After all, Barack Obama, that genu-wine campaigner, who promised us “Transparency in Government”, then cut back-room deals with Unions, the NEA, Big Pharma (can’t get drugs legally from Canada, and this is the reason why), Ben Nelson, Blanche Lincoln, the AMA, and anyone else who wanted to “smoke a Cuban, shoot some scotch, and meet behind closed opaque doors” (My words, not a quote) has now announced that He will allow any kind of deal to be cut if the entity threatening to screw up his facade in front of the nation, especially just a few weeks before the mid-term elections, He’ll get ‘er done!

          Now we know that the law is only what Obama says it is. Pardon my disgust. I’m glad for the 30,000 McDonald’s employees, and those who have similar coverage at Disney Worldwide Services, Home Depot, Blockbuster, Staples, and many others who would lose their limited health care plans, but OMG! Are we already living in a Socialist Dictatorship? Is this not playing really fast and loose with the law? “Some of you gotta follow the MLR Rules and some of you don’t. We’ll decide that behind closed doors, too, just as soon as we ascertain how big you are and how much damage you could cause if we don’t let you off the hook.”

          In my opinion, it will be virtually impossible for anyone to be able to “draw the outline”, the schematics of ObamaCare, because Obama is going to change the rules whenever he thinks it politically necessary.

          I will admit (Oh, this is so hard) that I voted for Obama. I just couldn’t vote for Sarah the Palin. I really thought Obama was going to give America real change. I guess that he is, from a democracy, a representative form of government, to a socialist state. What have we voters done? We must change this in November 2010, and again in 2012. I would never in a million years thought that anyone could make Sarah the Palin look good.

          MLRs? Why? This Administration, and this Congress, challenge AZ because they passed a good Immigration Reform law, and they did it based on the fallacious argument that no state has the right to pass a law whether or not the Feds intend to address the issue. Now it is clear that no state had better mess with MLRs because that, too, is only under the purview of the Feds. What next? A National Religion?

  5. I’m sure this is a little off subject for a post about MLR, but… Health Net of AZ just sent us an e-mail announcing that they will no longer take apps that include any child, even on the parent’s app, until the Open Enrollment solution is established. I thought I misunderstood, but I just verified it with my Health Net rep. No children. When the Open Enrollment comes (probably 1/1/2011), it will just be no child-only apps, but for now it’s no children at all. This applies to the regular individual market only, not group or HIPAA, not in-force business, and not newborns or newly adopted children added to in-force policies that already include children. I hope this doesn’t begin the “domino effect” where no carrier wants to be a sitting duck for a segment of business that the other carriers aren’t taking… It’s getting messy!

    • Isn’t it great to see this kind of push back from the insurance carriers? It of course highlights just how badly this legislation was written to begin with amplifies the need to have people who don’t have a political agenda to fashion health reform.

      I am of course being (almost) totally facetious about the push back comment because here’s where this is all leading: These two sides are playing chicken with the brokers in between the two oncoming trains. The carriers bail on the child-only market exposing the federal legislators for the incompetent boobs they are and then the state legislators use actions like the one Ann referred to as their cue to fashion even more brutal anti-insurance industry legislation in the form of really left leaning Exchanges. I believe there is already legislation afoot in CA that would bar a carrier from the individual market for 5 years if they leave a niche like the child only market as certain carriers have already done out here.

      I suspect some of you folks are old enough to get this reference: I feel like the Doctor who – at the end of Bridge on The River Kwai – wandered the scene and – surveying the damage – muttered “Madness….madness….”

      • Curt, an excellent post.

        In 1993 HillaryCare took hold (was passed into law) in Washington State. And the then WA State Legislature put ground glass in it. We had passed a HCR bill that made Washington a “Magnet State”. No pre-x, period. Not even for 90 days. Not for 60 days. The carriers then in the Individual Market, pulled out. Our then ultra liberal governor, Mike Lowery, flew to WA DC to have his photo op with Bill and Hillary Clinton. The next two years went by with not one Individual plan offered for sale to the public. In 1995 we passed “The Health Care Reform Improvement Plan” (as Chair of Representative Phil Dyer’s campaigns for his three terms, he served as Chair to the House Health Care Committee) I was privileged to write the Long Term Care insurance portion of the legislation. That Legislation was blunt; all Long Term Care Agents were to be put out of work by 1997, and all other Health Agents by 1999. We reversed and amended that wretched, anti-Consumer, anti-Agent abomination, and the public, who had been greatly harmed by that politically aggrandizing mistake, applauded the changes we made.

        I am convinced that the same will be the case when we amend ObamaCare until it no longer looks like the first major step into a Socialist governing mode that it does today. Will we be able to repeal the whole mess? Probably not. It will be very possible to amend it until it is in a format with which Americans can live, including the Agent/Broker Community. I continually read comments that we must learn to change with this legislation, we must adapt. As with Lemmings who follow the leaders over the cliff, we should simply go to our deaths, leaving smiles plastered on the faces of those who did this to America, and not fight back. I do not agree. We can effect change. Our willingness to do so will be first witnessed this November. It will take shoe-leather, money, phone calls, and a lot of sacrifice of “Play time” but we can change this ludicrous legislation, and create a Health Care Funding and Benefit reform that will be in the best interests of the electorate.

        Just rolling over and saying, in effect, “Oh well, we lost.” is defeatist, is being willing to accept that the future of this country will be the implementation of a Socialist form of governance, and in my opinion, is not acceptable.

        Now is the time to “Push back”, and hard. I repeat, can anyone name a single Democrat who is running for reelection who has mentioned how wonderful they performed in passing HCR into Law? I haven’t been able to find a single one, not one. Apparently, all of those Sheeple are now too ashamed of what they have done to want HCR even mentioned.

        Repeating myself, not a single Democrat who voted for this mess has the courage of their convictions to voice their pride in what they did to this country.

        • I agree. This legislation is a mess and it can be reformed, and might even be reformed to the extent that it looks similar to a repeal.

          I only disagree with the viewpoint that those saying, “adapt” meant to “simply go to our deaths, leaving smiles plastered on the faces of those who did this to America, and not fight back”, as you said. They meant an agent can’t continue “business as usual” and survive in the new situation. This is true if we reform the reform law or not. Our industry is changing whether it’s ObamaCare, or state-by-state reforms, or even just the growth of technology.

          You’re right, Spencer, we need to fight hard to effectuate change of this miscarriage, and we need to have our voices heard to guide that change in a proper direction. This is a “redo”, and we have a one-time shot at helping them “redo” it correctly.

          I didn’t know you were from WA state. Curt is correct by saying that the liberal left-leaning states will suffer more than the conservative right states, especially in areas where the states have control (like exchanges). AZ formerly was red, but for 10+ years we’ve voted more blue. Recently, AZ reverted to its wild west roots. In AZ, support of our governor SPIKED when she thumbed her nose at the Whitehouse over immigration. AZ is one of the few states that did all 3 legal efforts to fight ObamaCare – they joined the lawsuit, they passed a resolution, they put it on the ballot. I am willing to see that my viewpoint on the effect to agent/brokers is tainted by the expected result in my locality. I certainly empathize with those of you in other states.

          I also understand that those who produce mostly individual/family insurance suffer more than producers of group insurance. And I understand that those accustomed to commissions of 20% first year & 5% renewal suffer more than those accustomed to 10% level (or less). Those of us that do mostly group insurance are accustomed to 4-6% level. How badly you suffer somewhat depends on where you’re coming from. But it also means that many of us suffered these blows previously, as group commissions were 10% level before HIPAA laws.

          We are all in this together. What affects you, as my fellow agent, affects me. It’s clear from your comment above that you’re willing to change bad legislation, and you know how to do it. We are with you.

        • Ann,

          I didn’t mean to imply that by saying “Adapt” those uttering those words meant to just “roll over” and accept the results, though I would have liked to read something more positive than just “Adapt”.

          A young person in our field may have time to “adapt”, or at least to make changes that will allow them to continue in their chosen career. That said, many of our colleagues, those in their 50s and 60s and some older than that will not have the time, energy, or ability to “adapt”. I started in the Health Care field and Disability Income when I was 21 (1969). In 1974 Long Term Care insurance was first introduced and I fell in love with the concept, the product, and the challenge of marketing this new product. In 1978 my partner and I opened the doors to our new firm, specializing in LTCi and Medicare Supplements. We helped develop and market the first True Group LTCi coverage in 1980/1981. We were compensated with very low level commissions as True Group in WA then had a loss ratio requirement of 80%, and not a lot was left for the agents. We made it work, and were fortunate to become successful (we put together many groups; Retirement Centers, Credit Unions, School Districts, and also marketed Individual coverage), both in our careers and in being a part of the National Association of Health Underwriters (NAHU). I was the WAHU (don’t laugh now) State President in 1989/1990, and served on the NAHU Board as Chairman of HITC (The Health Insurance Training Council) during that same period. I also served under Alan when he was Chair of the Leg Council for NAHU (he then went on to become a Gordon Memorial Winner, “Person of the year” and President of NAHU).

          That was then, this is now. What I mean by that is that when the bottom dropped out of our economy a couple of years ago many who I know took massive hits, in their 401Ks, SEP IRAs, and other retirement vehicles and, considering their ages, will find it very difficult to “start over”. Sure, we (My wife and I) got hit, too, for a lot (we owned a lot of WAMU, and Lehman Bros…NO, no relation, huh uh, they even dropped the second “N” when they immigrated to America…do not know them! 🙂 We were lucky…we had invested in a lot of real estate, primarily apartments, so while we were hit there, too, as all real estate has been, we do just fine. Sadly, several of my personal friends have no retirement to which they can look forward; they can’t even “cut down” on the time they work each week.

          As this “runaway train” gathers momentum I am seeing more and more of my colleagues being hurt; commissions dramatically cut, carriers leaving the business, demographically isolated parts of the business ceasing to be (I.e. Children’s coverage), and if we don’t make changes, and now, when the Exchanges are fully in place, what role will the Agent Community really have? We don’t really know that, but given what we have witnessed thus far, I doubt the role will be a very good one. It seems very odd to me that at precisely the time that we are seeing the Socialized Systems throughout the world failing, we are moving quickly to adopt just such a system.

          I really appreciate your comments, have been enjoying reading them, and especially like your comment that what affects me, as a fellow agent, affects you. Every day that I read even more about those in the agent/Broker Community being harmed by this legislation, I hurt. And I want to do something, which is why I am deeply involved in helping to run the campaign of the fellow we hope will unseat Senator Patty Murray, a very liberal Democrat from Washington. I continue to make myself available to those Health Underwriter groups that want to hear from an old guy who tells them to “get off your butts and get to work on political campaigns, local, state, and federal, if you hope to see things change.”

          Ann, you seem like quite a gal (that’s a compliment). I am proud that we are colleagues. Keep posting, and keep punching, Ann. It will make a difference.

  6. If the federal government can’t write up a decent piece of legislation how in the world can we expect the morons in Sacramento to?!

    http://www.nationalreview.com/articles/print/248105

    The answer is – of course – they can’t and health reform in the state will be just as screwed up as everything else in California. The sad fact is that so many of our state legislators are simply out of their depth: They are simply incapable of understanding the important issues of our time.

  7. . And while the NAIC proposal will carry great weight, states will have flexibility to adjust elements of the MLR calculation to suit their own health insurance market — and political — environments.

    Man – I guess there’s two things you don’t want to see made: Sausage and CA state law. What is so outrageous about all this is that you can almost wrap your brain around a piece of legislation from the federal level which is screwy (Affordable Care Act) but what is so outrageous is that this piece of federal legislation opens the door to state (California) lawmakers who will use it as a blunt instrument on an industry.

    How is it possible that we have law being made on a federal level that just opens up a process where states have the option – the incentive! – to take a piece of federal legislation and handcraft something that works well for the people on JUST one end of the political spectrum? As I have said time again and as Alan has chastised me: This federal piece of legislation will land squarely on the backs of health insurance professionals in states that lean left. If I were an agent in a right leaning state I wouldn’t give Health Reform a second thought.

    On a somewhat related note I see where the federally funded high risk pool is up and running here in CA and lo and behold what should pop up on agents’ quote engines? The plan offerings from PCIP – for which the agent will get $50 if they help someone with the app. (Not gonna be able to cross sell someone anything who’s in PCIP; so $50 bucks it is!). Isn’t it nice that the agent community serves a function when it’s convenient for the state and federal government but we’ll be useless in 2014 when an unlicensed ‘helper’ will be able to do our jobs?

    Oh you gotta’ love it.

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