News and Blog

Monday, 20 February 2017
Changes to ObamaCare that make sense

There is so much talk about repealing and replacing the Affordable Care Act (ACA) and the fear this kind of broad sweeping statement makes. Yes, there are major problems and coverage is now unaffordable unless you get substantial subsidies from the Government. It’s important to note that there are some good parts of the ACA, there are many that are not so good, let’s work on those.

I am a longtime member of the National Association of Health Underwriters and these ideas/statements are coming from their March, 2017 magazine. The article featured many different recommendations of changes to make immediately and others to implement them over time. These are a few of what I think are the best ideas.

  • Open enrollment – The first thing is to only have one primary open enrollment period rather than an open enrollment every year. There would also credible life events like marriage, divorce, birth, adoption and job changes to create an open enrollment event. If you do not sign up at open enrolment and later sign up as a “late enrollee” you will now be subject to late enrollment penalties, pre-existing conditions and waiting periods. This creates a real incentive to maintain coverage and preserves guarantee issue. This eliminates an easy way to abuse the system with today’s flexible and unenforced open enrollment rules.
  • Create hybrid high-risk pools – These pools would not issue coverage but insure risks for carriers who are insuring those who have not maintained continuous coverage. Late enrollment penalties would be paid to the pool for ceding risk from the carriers. The advantage is late enrollees would not be turned down for pre-existing conditions with this risk being passed to the pool. Because there is a mandatory waiting period before claims will be covered there is additional stabilization to the market.
  • Allow states to increase competition by offering coverage from carriers domiciled in other states. Coverage offered must reflect the same essential benefits and mandates where the coverage is being offered.
  • Allow states to increase competition by allowing association health plans. Coverage offered must reflect the same essential benefits and mandates where the coverage is being offered.
  • Increase flexibility for HSAs by allowing a limited number of office visits to be covered by co-pays before the deductible each year. This will encourage more people to try an HSA qualified plan letting them see the advantages of an HSA combined with a HDHP as the underlying plan.
  • Remove the metallic limitations of plan designs allowing carriers to offer plans they can better control and that make more sense in their specific market.

These are just a few of the ideas and recommendations to stabilize and improve the individual and small group health insurance market. One thing is for sure, we will see many ideas and proposals coming in the next couple of weeks. Hang on, it will be a bumpy ride but in the end we will all be ok.

Posted on 02/20/2017 11:41 AM by David Moore
Wednesday, 15 February 2017
Humana exits individual markets for 2018 -TN scrambling

Humana just announced they will not offer individual health insurance in 2018. "There isn't enough money in the ACA as it's structured, even with its fees and taxes, to support the population that needs to be served" say Aetna CEO Mark Bertolini. 

This changes hits Tennesseans especially hard with Humana being the only insurer in thee of the states largest communities. In the Knoxville area alone there would be 40,000 Tennesseans losing coverage says Julie McPeak the TN insurance commissioner. 

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Posted on 02/15/2017 3:51 PM by David Moore