Coming Revolution in Health Insurance

[Paradigm]

Base on my conversations with AHIP carriers here are my conclusion within 12-18 months.

1) Guaranteed Issue

2) Coverage Mandate with scaled subsidies

3) No rateup for conditions

4) Scaling back of underwriting in favor of automation with eventual elimination of all underwriting other than sex and age classification

5) Jet issue on all policies

6) No single payer

7) No competing government plan

8) No government run health insurance online kiosk

9) Additional carrier certification will probably be needed and possibly a federal license instead of just a state.

10) Paid enrollment fee and renewal fee like Medicare
Advantage. ex: 400.00 1st year 200.00 renewal regardless of case size.

*The carriers with not accept GI unless there is a coverage mandate under any circumstances.*

*There is a rush to do this relatively quickly since Kennedy is dying and Obama needs to show some success for all the rhetoric and spending the government has been doing*

*Implementation of mandate will be initially difficult but will have to have teeth in it to force people to get coverage*

 

[myinsurebiz]

Good!

So long as the client can't switch plans every 6 months . . .

Tom

 

[Paradigm]

Good!

So long as the client can't switch plans every 6 months . . .

Tom

There wont be the need to as all plans will have to meet government minimum coverage standards.

 

[Winter_123]

Base on my conversations with AHIP carriers here are my conclusion within 12-18 months.

1) Guaranteed Issue

2) Coverage Mandate with scaled subsidies

3) No rateup for conditions

4) Scaling back of underwriting in favor of automation with eventual elimination of all underwriting other than sex and age classification

5) Jet issue on all policies

6) No single payer

7) No competing government plan

8) No government run health insurance online kiosk

9) Additional carrier certification will probably be needed and possibly a federal license instead of just a state.

10) Paid enrollment fee and renewal fee like Medicare
Advantage. ex: 400.00 1st year 200.00 renewal regardless of case size.

*The carriers with not accept GI unless there is a coverage mandate under any circumstances.*

*There is a rush to do this relatively quickly since Kennedy is dying and Obama needs to show some success for all the rhetoric and spending the government has been doing*

*Implementation of mandate will be initially difficult but will have to have teeth in it to force people to get coverage*

I believe all of that is basically correct except I do not see the mandatory coverage in the first round. I think it is coming but is further out than 18 months by another year or two. Instead the government will provide incentives both through subsidy and tax credits to move people into creditable plans. AHIP will fuss but they will basically conclude that this is 90% of the pie and since their hands will be full for the first couple years they will live with the mandatory being phased in. Basically it becomes a discussion that is not unlike the difference between what Hillary proposed and what Barry proposed. It is like layers on an onion.
- - - - - - - - - - - - - - - - - -

Good!

So long as the client can't switch plans every 6 months . . .

Tom

If they do want to switch they could just do it online anyway. The same way that they signed up for their first plan. Or call that 800 number. This whole shabang is about United Health and a couple others just reducing it all to television ads. Might be a short gold rush in the beginning for some agents but within a couple years it will all be down to 800 numbers and online. After all, with guaranteed issue and standardized plans, how much do you need an agent- and even if you can rattle off ten reasons why they should go though an agent that doesnt mean the consumer will do that.

 

[medx]

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[somarco]

I could be wrong, but it seems to me there is a market for Med supp's which are guaranteed issue, but not in all cases. There are agents selling Med supp's and making a living from it.

If ALL plans are GI, with or without the mandate, expect a revolt that will eclipse the tea parties that occurred yesterday. If you think health insurance is expensive now, just wait until carriers are compelled to accept everyone.

Most states have risk pools which are GI and run parallel to underwritten plans. I see no reason why that type of arrangement can't continue to operate in the future.

This crap about carriers excluding 47 million Americans is just that . . . crap. Fact is, only a small percentage of the population is uninsurable . . . somewhere in the 4 - 6% range. The uninsured are roughly 17% of the population so why aren't the other 11% insured?

Most of them choose to opt out of coverage. Many are young invincibles. Roughly 25% or so of the uninsured are illegal aliens. Another 15% are children, many of them eligible for SCHIP or similar programs.

The MSM is fanning the flames on the uninsurables and frankly that is a red herring.

Even if the idiots at AHIP are ready to roll over, I don't think the country is really ready for another mortgage fiasco. If you like the current economic woes caused by government forced mortgages then you will love what they do with the health care system.

 

[Justin Bilyj]

edit

 

[Winter_123]

From a NAHU update

Discussion About Government-Run Public Plan Option Heats UpAs Congress and the Administration prepare for the introduction of comprehensive health care reform legislation later this spring, one of the central items for discussion in Washington is the possibility of a government-run public health plan option to be offered as an alternative to, or in competition with, private-market health plan offerings.

Discussion on this topic was further fueled this week when White House Office for Health Reform Director Nancy-Ann DeParle said, "A public plan could be designed to address concerns about the federal government overreaching in its role."

One compromise, she suggested, "might be that the public plan pays hospitals and doctors rates similar to what private insurers pay. That would address fears that government would use its muscle to pay rock-bottom prices for medical services, allowing the public plan to charge discounted premiums" with which private insurers could not compete. Moreover, DeParle added, "Even if the government plan paid private-market rates to doctors and hospitals, it could still cut costs. A government plan wouldn't have to turn a profit, and could also save on administrative expenses."

DeParle said her definition is "something that’s sponsored by the government and therefore has very low, almost non-existent administrative costs compared to the others, it doesn’t have the need to have brokers out selling, it wouldn’t have the need to have a lot of costs and profits the way private plans do." (emphasis added)

The release of a Lewin Group study on the likely competitive impact of a government-run private plan on private health insurers The Cost and Coverage Impacts of a Public Plan: Alternative Design Options was also the subject of much discussion.

Lewin projects that if the public plan used Medicare or Medicaid rates for reimbursement, premiums charged could be up to 30% lower and 32 million people would leave private insurance for the public plan. If such a government-run public plan were opened up to large employers (in addition to individuals and small business as proposed by President Obama and others), then 119 million people are expected to leave private insurance for the public plan. That’s about 70% of all people with private coverage. The shift would be far more muted if the public plan paid similar rates to providers as private plans. Under this scenario, premiums would be nine percent lower (due to the government’s shifting of other administrative costs), and private insurers would lose six to eight percent of its membership.

NAHU opposes the creation of a government-run public health plan option. Please review the grassroots action we’d like our membership to take on this issue in the story below.

 

[Guest]

We need a revolution alright, first we start off by charging this and the last administration with Treason, Round them all up on prime time, and go down the line putting a bullet in each head. Man that would be great!!

This is sickening. You disgrace us all, each an every one of us. If I owned this board you would be banned for life. This goes way beyond the issue of "free speech."

 

[somarco]

if the public plan used Medicare or Medicaid rates for reimbursement, premiums charged could be up to 30% lower

Maybe, but that is only temporary.

Personally, I would challenge the 30% figure. There are nominal savings on admin . . . maybe 5 - 8% at best. Medicare reimbursements are around 88% of carrier rates and Medicaid about 10% lower than Medicaid.

Absent addressing health care inflation, which none of the proposals do, any savings would be lost in 2 years.

And what about the lack of PCP's? No one talks about that. PCP"s are already on the low end of the income scale and in short supply. If everyone is reimbursed at Medicare/Medicaid levels there will be even fewer and demand for services will outstrip supply.

This is already happening in Massachusetts where the wait to see a PCP for a "newly insured" can be 4 - 6 months.

I also don't buy the "we don't need brokers" argument. FWIW, most carriers market direct already and guess what? The acquisition cost of marketing direct exceeds the cost of marketing through brokers. So if you eliminate brokers admin costs will go even higher and there will be fewer players.

Blue is the only carrier that can market direct with any success. The other carriers pick up business but not at the same clip as Blue. Here in GA roughly 60% of their individual business comes from brokers. Other carriers like GR and H1 get less than 8% of business direct with the remainder coming from brokers.

The public perception that brokers add a layer of expense and no value is (mostly) our own fault. Too many peddlers, not enough real agents.