1990 Pages Hits the Floor of the House

[djs]

Hmm, Joe Wilson was right. Undocumented individuals can sign up under this plan as well. They supposedly don't have access to 'affordability' credits, but they can enroll.

Now, since they don't have to, they will only enroll when they need it. Smells like a subsidy to me.

Dan

 

[somarco]

Abortions are in there. Do a word search.

Page 110 reads

(B) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED.—The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the department of Health and Human Services is permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.

 

[agentinsure]

Yeah, almost 2000 pages now, can you belive it? So will you tell us John if you happen to see whether Congress has included themselves, just out of curiousity?

I'm reading it now and taking notes - I'm on page 131. There's some interesting stuff so far. For one, carriers can sell plans in or out of the exchanges. "Separate Excepted Coverage" is permitted....more to come.
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The clause I was looking for - page 191


(g) ROLE FOR ENROLLMENT AGENTS AND BROKERS.—Nothing in this division shall be construed to affect the role of enrollment agents and brokers under State law, including with regard to the enrollment of individuals and employers in qualified health benefits plans including the public health insurance option.
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*Temporary Nat'l High Risk Pool starting Jan 1st 2010 ending with health exchanges are implemented
*Cannot have had coverage for 6 months to be eligible
*Employers cannot "dump" employees onto this plan
*2:1 rate ratio max by age
*No more than 125% of "standard individual rate" to be determined by NAIC
*$1,500 deductible for individual, to be determined for families
*No annual of lifetime max
*OOP no more than $5,000 for individuals and $10K for families
*Each state will manage the program

Individual Market Changes as of Jan 1 2010
*Carrier can only rescind plans after a 3rd party review under the guidance of the Secretary
*Rescissions only allowed when "clear evidence of fraud" is determined by 3rd parter reviewer, not by carrier
*"Price Gouging" review - carrier must submit for rate increases under guidance of the Secretary noting reason for rate increases.

Carrier can offer "Separate Excepted Coverage" which can be sold outside of the exchange and allow them to be priced separately (I cannot find out if they still have to be qualified plans.)

Coverage Sold in the Exchange
*No pre-ex exclusions
*2:1 max rating based on age
*Area rating allowed as specified by the Commissioner
*Individual premiums "uniform" with family premiums
*Dependent age to 27
*Carrier's rates must be approved before allowed into the exchange

Carrier may sell outside of the exchange and may offer additional coverage above what the exchange plans mandate (ie: carriers can sell "Cadillac plans."

Essential Benefits
Hospitalization, outpatient, doctors/care providers, supplies and equipment, drugs, rehab, mental/nervous, wellness, maternity, well baby and durable medical equipment (No cost sharing allowed for wellness)

Agents and brokers are allowed to sell plans in the exchange including the public option. More to come.
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PUBLIC OPTION:

*Only sold in exchange
*Abide by all rules private carriers must follow
*Offer Basic, Enhanced and Premium plans
*Geographically adjust premiums in same manner as private plans
*Rates must fully finance costs
*No bailout provision - cannot get additional Federal funding to pay claims
*2 billion to fund private option
*Medicare docs are in network unless they opt out
*No punishment for docs who opt out
*Annual enrollment period where docs can opt in or out

I dont think we need to worry too much about commissions, after all a small % of a bigger premium is still good for biz, especially mandatory. And heck why would I care if illegals are covered, in fact that too will be good for biz. I think this might be alright for agents who can work on thin margins. But I'm wondering as my own state discoverd some 15 years ago that if you include all pre-conditions than there is a cost. Doesnt it seem like about 9-1 those looking for dental coverage just discovered they need a root canal? That said costs will inevitiably rise either thru premiums, taxes &/or inflation. We'll pay either way, the only diff will be 100,000 more bureucrats on the rolls. This pitch to the public for Free or Affordable Health Care is about as cheesy as a 2% interest rate for a home loan was a couple of years ago, and about as true. But Im sure glad now at they can get rid of that 500 billion in fraud and waste been going on the last 10 years over there at Medicare - seems like that could of started saving that money last month already. Why are the waiting till health care reform passes?

 

[TXINSURANCE]

I have said it before and will say it again - the mandate will not offset the cost of covering all pre ex conditions with no waiting period , richer plans, and community rating.

Do you know the ratio of healthy persons you would need to offset just one million dollar claim? It's probobaly staggering.

They should have just subsidized poor and expanded a national risk pool.

Most people will have higher costs once sticker
shock kicks in. But maybe that is the goal.

 

[Winter_123]

I dont think we need to worry too much about commissions, after all a small % of a bigger premium is still good for biz, especially mandatory.?

Sigh.

Well, we certainly have had this discussion a few hundred times so people have to do their own thinking. Also, to help you with your argument, if you mix in guaranteed issue you will basically just be skipping from house to house all day long picking up complete applications even though the premiums are smaller.

Is that what you are hearing from the agents in the states that have guaranteed issue now?

 

[Crabcake Johnny]

Commissions will be intact - at what level? No one knows.

 

[CHUMPS FROM OXFORD]

My grading scale (A, of course being the best case scenario for us) First year and renewal...

A- 15 and 7
B- 12 and 5
C- 7 and 5
D- 5 and 3
F- 3.5 and 2

I have a feeling we're looking at c+.

 

[Winter_123]

My grading scale (A, of course being the best case scenario for us) First year and renewal...

A- 15 and 7
B- 12 and 5
C- 7 and 5
D- 5 and 3
F- 3.5 and 2

I have a feeling we're looking at c+.

Whatever it is for the first couple years, it will be less after that. Carriers are going to try to get market share coming out of the shoot and if they need to do that through agents for a short while, they will, all while figuring out how to take them out of the cost structure.

To your comment about the C+, it is true that they have no need to totally eliminate the agents so I would concur somewhat. After all, if they get the commission down to a pittance then any business that agents bring in is just "found money" that they would not have otherwise had.

It is actually a double-whammy though. It is not just the reduction in commission, it is the change in the sales channel where the agents will be largely/increasingly bypassed all while they are trying to get the smaller commissions. Yes, I know the rap about how carriers have always tried to eliminate agents and they always end out needing them, etc. First or all, I am in a state where that has already been done for individual policies so it is not that far-fetched to me. Second, of all, I am just saying that it is a gamechanger in the market and no one is arguing that agents will disappear so no need to go down that rathole.

 

[Crabcake Johnny]

It becomes a bit like selling med supps - there is not "bad" plan to keep people away from. We'd be walking them through the difference between the basic, premium, etc...plans.

I don't see any shortage of auto agents at around 10% comp? What's the average policy - around $150/mo?

 

[CHUMPS FROM OXFORD]

I'm not crazy about the "Exchange" concept. Right now..customers come to us by visiting our websites and we offer advice and have them apply online through a link we generated.

Under the new concept, hopefully, we will still be able to create a link that allows them to apply etc...

Our quote engines might become dinosaurs. Hope not though.