July, 2009 | Employee Health Benefits and Insurance Blog

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What You Need to Know About Health Care Reform: Go On a Diet

 
wellness

You've probably been hearing a lot about how Obama wants to lower the cost of medical care. No one has any idea how he plans on doing that, but one likely plan is by taking advantage of the growing Wellness industry.

Health Care Reform Effects: Insurance Agents

 
reformBecause 1/6 of the total U.S. economy is related to healthcare, there are a lot of people whose livelihood may be affected by U.S. health care reform. It's easy to sit back and wait at a time like this because of all the uncertainty, but I think you should already be preparing your business for what lies ahead (even if you don't know what lies ahead).
In this post I'm going to focus specifically on what insurance agents can do to future-proof their businesses.  It's worth noting that there is a decent chance that U.S. health care reform will pass without having a significant impact on agents.
Let's step through all the different things that might happen, and how you can prepare.

If health care reform requires employers to offer health insurance to their employees...

This wouldn't really impact the existing markets for group or individual insurance.  However, about half of all companies in America aren't offering any benefits right now and so there would be a huge growth opportunity for your business.

The key is that if a company isn't currently offering benefits, they're not going to jump straight to a low deductible group plan.  These companies will only offer whatever bare minimum plan is required by the government.
It's worth noting that I'm pretty biased toward Health Reimbursement Arrangements (HRAs), but I really think that there's no better plan to offer the employers that can't afford top-notch benefits.  HRAs allow the employers to contribute whatever they want, so if they only want to only meet the minimum requirements, they can do so.  HRAs also make it easier on employers that want a high-deductible group plan which will be popular among cash-strapped companies.

So what does this mean for you?  Basically, if you currently only offer insurance products, you might want to look for another product along the lines of an HRA.  Full disclosure: Zane Benefits (the company I work for) has a program to help agents sell HRAs to employers, so this advice is self serving, but I think it's still good advice.

If health care reform requires individuals to purchase their own health insurance...


This is slightly different than employers being required to offer insurance. If every American is required to buy insurance, the individual market will skyrocket and you'll be sorry if you miss out.

If you're not already an individual insurance guru, there are two basic things you need to do to get started.  The first thing is understanding the differences between individual and group insurance so that you can help your clients make the right choice.  It's worth putting in a little bit of research time.

The second thing you need is a better system for organizing your sales leads.  Group agents are often able to make a living by selling to a few large clients which means it's easy to keep track of priorities.  Selling individual insurance can be incredibly lucrative, but you'll be selling to hundreds, or even thousands of clients.  Keeping track of more contacts requires more efficient operations.

The most obvious place to start getting organized is with your software.  Your CRM is your most important friend when it comes to keeping track of all your contacts.  I posted earlier about the best CRM tools for insurance agents, so I'd take a look at that post if you don't already have this stuff figured out.

U.S. health care reform and guaranteed-issue...


There's a reasonable chance that insurance carriers will have to accept all applicants at the same price.  This means both that the price of individual insurance will go way up, and that one of the main problems with individual insurance will be solved.  It's hard to predict the impact of this change, but one thing it will certainly do is make employers more willing to help pay for individual policies rather than group.

Selling individual insurance through an employer is much easier than going around selling it to random people.  While the organizational tools I described above will be important in this case, the real opportunity lies with the employer clients.  You should start looking into other products that you can offer employers like HRAs, HSAs, FSAs, and POP (Premium Only Plan).

You may be thinking that I already made this suggestion, but this is different.  Selling to employers that don't currently offer benefits is all about value.  In this situation, you'll be selling to employers that are already offering expensive group policies so the sale needs to be more about improving benefits and less about cutting costs (although it's easy to do both).

Regardless of U.S. health care reform...


Regardless of what happens, everyone will be confused and looking for someone they can trust.  You can be that person.  Read up on the impact of raising group deductibles, individual insurance, and how new plans like HRAs and HSAs fit in.  Keep reading blogs like this, and I'd even encourage you to start your own blog if you're interested in this stuff.  There's no better way to learn new things than to teach others.

Ambitious agents are in a great position.  The entire insurance industry is notorious for it's inability to accept change, and that means that you can get a huge head start on the rest of the market.  It doesn't matter what changes, as long as something changes.

Think about all those people that made millions off of the tech bubble ten years ago.  The only reason many of them were successful was because they were the first ones to enter the market.

I know that the idea of dramatically changing your existing business isn't very appealing, but if you don't take advantage of this tremendous opening in the market, someone else will.  If you're not moving forward, you're moving backward.
















Health Reimbursement Arrangement (HRA) Rules in Illinois

 
illinois hras

Upon hearing the claims by the Colorado Department of Insurance (see Tyler's earlier post), a Health Reimbursement Arrangement (HRA) distributor in Illinois contacted the Illinois Department of Insurance (DOI) to understand their stance on HRAs.  Specifically, the insurance agent (i.e. the HRA distributor) explained to a representative at Illinois Department of Insurance that an Illinois employer (with less than 50 employees) wanted to exercise his federal right to establish an HRA to reimburse employees' individual health insurance policies.

Cavalcade of Risk #83 is up

 
Cavalcade riskWe got a mention in this weeks calvalcade of risk.  Head on over there to see some great posts about risk including an entire section specifically devoted to healthcare.  While I'm linking to other sites, here are a couple more things you might be interesting in:

Alan Katz summarizes what the final reform might look like.  There's still a lot of guesswork obviously, but it never hurts to dream about what might be.

Here's a fun and informative look at when and why individuals can change their employer health plans by Humana (via InsureBlog). 

That's all for now.  Enjoy!







Answering some old questions (sort of)

 
health care reform quesitonsA while back I set out to try to verify three things I've heard about the new reform proposal. Well, this post is kind of a cop-out.  Since my original post, it's become clear that the bill I was researching has no chance of actually being passed into law.  

With that in mind, I have still paid attention to the same issues, but it's not really important what that ancient bill from a couple of weeks ago says.  To avoid completely backing out of my goal to investigate the three questions, I'm going to re-address them using pure speculation based on what I've been hearing.  If you follow healthcare reform closely, speculation should be nothing new for you.

So here are the questions:

I've heard people say that there is some super obscure language that basically makes private insurance illegal. I have a hard time believing these claims, so I want to check it out.
While it seems like there was a weird line in the bill that might have been interpreted this way, it was clearly not the intention of whoever wrote that.  Private insurance will absolutely exist in some way, although it might exist in a world of heavy regulation and competition with a government plan.

People are saying that in order for insurance to satisfy the minimum requirements, it would need to cover maternity, preventative care, and doctor visits. I defended this requirement earlier, but I might be eating my words if this is true.
I checked and the bill really did say something to this effect, but it was vague enough that it shouldn't matter.  For example, an insurance plan might cover maternity with a $10,000 deductible and still qualify.  Either way, this issue is on hold until both sides figure out if insurance will be required at all.

I'm still not sure if private carriers will be able to use medical underwriting. That's a pretty important thing to know.

This is the most interesting of the three questions.  It seems like there actually is a pretty good chance that medical underwriting will be a thing of the past, but that's far from settled.  I'll write a post on what this might mean, but if carriers must accept all applicants and charge them all the same amount, that could have a very dramatic effect on how the market responds to this reform.













Why Individual Health Insurance Threatens the Group Market

 
ind health ins

There are a lot of people that are afraid individual insurance.  Most of these people have some vested interest in the group market and they dislike individual insurance because of how it can so easily destroy the existing system.  Keep in mind, most people agree that the existing system needs destroying, so this isn't necessarily a bad thing.

A follow-up on this morning's post

 
followup colorado health benefits

I guess my post from this morning misled a couple of people, so I just want to clarify some things.

First, the DOI has no authority over employers.  Companies that offer HRAs are doing absolutely nothing to break any laws.  If you are an employer offering an HRA or an employee using an HRA to help pay for individual insurance, what you're doing is absolutely legal.  Even the most radical states (like Colorado) aren't suggesting employees or employers are in the wrong.

The main targets of small group laws are the insurance carriers themselves.  The state is basically trying to block insurance carriers from selling policies to individuals who will be reimbursed by an HRA.

The insurance companies are big enough to handle this on their end.  Everyone knows that the states are acting well outside of their authority, but it's up to the carriers to decide whether or not to sell these individual policies.

The only potential collateral damage seems to be insurance agents in the state of Colorado.  While the DOI has no authority over employers, agents can have their insurance licenses taken away.

That said, Zane Benefits works with many agents in Colorado and none of them have had their licenses revoked by the DOI, althought the DOI is trying to intimidate and bully some of them.  We're doing everything we can to put this ridiculous issue to rest, but unfortunately there is still some lingering risk for agents (not for long hopefully).

So to summarize, if you're an employer or an individual, there is absolutely nothing to worry about.  If you're an insurance agent, it's my personal opinion that this isn't a major problem, but the DOI could potentially make your life a little more difficult than it needs to be. 













Other people are upset with Colorado too!

 
Colorado Health UpsetEarlier this month, I mentioned that the state of Colorado is doing basically everything they can to prevent small employers from providing the same health benefits that large employers can provide (and which are allowed by federal law).

Yesterday, Coloradoan.com posted an article outing the Colorado DOI (Department of Insurance) for the same shady tactics.  The article does a great job of highlighting how ridiculous it is for a state to ban a health plan that is specifically allowed in IRS code.

The article highlights one company in particularly, EnergyLogic, who's HRA is at risk because of the states policies.  An employee of the company is quoted as saying:
"What are they trying to do? That's what I don't understand. Who is it helping? It's not helping us.

This is exactly the point we all need to remember.  The government's job is to serve us.  There's absolutely no way for the state government to justify this policy.  The DOI's argument is that they're trying to protect individuals that would be denied coverage on the individual market, but I don't understand how denying everyone insurance helps protect the few people with preexisting conditions.

One thing that the article doesn't focus on is that the exact same HRA plan which is being complicated by the DOI would be perfectly fine if EnergyLogic had over 50 employees.  It just doesn't make any sense.  If the state wants to protect individuals with preexisting conditions (which they aren't doing in the first place), why would they only want to offer this protection employees at small companies?

I hate to sound paranoid, but the only beneficiaries of this policy are group insurance agents and carriers.  We at Zane Benefits are trying to get a straight answer from the Colorado state government, but they aren't exactly eager to explain themselves (for obvious reasons).

If you live in Colorado, you should consider contacting some of your local legislators and asking them to put pressure on the DOI to fix this blatantly discriminitory practice.  If you want to get involved, shoot us an email.











Employers pass the costs on

 
employers pass on health costs
I just read this post from InsureBlog about how the reform discussion is missing a basic understanding of how economics work.  The point they make is obvious, but it's not one I've seen mentioned elsewhere (including on this blog).
The argument they make is that penalizing employers with an 8% fine for not providing health insurance isn't exactly punishing employers.  In their words:
...these "fines" will be passed along to employees (in the form of lower wages) and consumers (in the form of higher costs).
The obvious counter-argument is that by this logic, the same is true if employees have to pay for health insurance.  Those costs are also ultimately coming from consumers.  You could argue that all money ultimately comes from the same place so it doesn't matter who pays for health insurance.

The reason it matters is because humans are irrational and our behavior might be different based on who is directly paying for something.  If an individual has to open up his or her wallet to pay for health insurance, they're likely to feel more involved in the process and be more responsible medical consumers as a result.

With employers paying, healthcare seems "free" even though it never is.  As I've mentioned before, I consider this the main reason the system is broken right now.

Additionally, by creating complex rules that disguise where the money is coming from, the chances of companies and individuals making poor decisions increases.  If you just hold individuals responsible for buying their own insurance, purchasing insurance is relatively straightforward.  If you require individuals to have insurance (or pay a 2% fine) and employers to provide insurance (with an 8% fine) and add the complicated tax plans on top of that, some people are bound to get confused and make mistakes.

I overuse this quote, but it's very fitting here: "Simple rules lead to complex behavior.  Complex rules lead to stupid behavior"




You are still allowed to pay for things

 
pay here for health care

Somehow we've developed a culture in America where everyone thinks that it's taboo to pay directly for certain things.  Healthcare in particular has this strange fog of mystery surrounding it which causes people completely dissassociate the service with the price.

An overview of FSAs (Flexible Spending Accounts)

 
fsa flexible spending account

I'm working on a post about FSAs, but I realized that some people might not be clear on how FSAs work, so I'm going to spend this post going over the FSA basics.

FAQ: Can I have an HRA and an HSA at the same time?

 
Simultaneous

Everyday I talk to employers, agents, or other financial professionals who
ask me questions about Health Savings Accounts (HSAs), and how they function with Health Reimbursement Arrangements (HRAs) and insurance plans.  See Tyler's earlier post "The difference between HRAs and HSAs" for appropriate background.

A common question I receive is "Can an employee have an HRA and HSA at the same time?"  The answer is:  "Absolutely,  yes. And they should!" (See US Treasury FAQ 8).

To be eligible for a Health Savings Account (See US Treasury FAQ 1), an individual must:




Should we focus on speed or quality?

 
speed vs quality health care

The healthcare discussions are getting way too meta.  Rather than arguing about how we can fix the system, politicians and journalists are arguing about if the real argument is being done in haste.

How a visit to a quack doctor almost cost me $32,242 on my health insurance

 
quack doctor health insurance

Yesterday we posted about how medical care can be harmful to you even if you're not the one paying for it. Here's an example of how this happened to me. 

Health care can cost you even if you're not the one paying

 
true cost of health care

One of the major problems with how health insurance works right now is that many people have policies that effectively pay for everything.  Because of this, there's no reason for individuals to put any thought into what type of care they actually need.

Ten Questions Every American Should Know the Answer To

 
health reform questions answers

In her WSJ article today, "Ten Questions on the Health-Care Overhaul", Janet Adamy says it best:

You can't solve a problem that you haven't defined

 
health care problem

I studied engineering in college.  Like most engineers, I believe that the most important step in problem solving is making sure that the problem is well defined.  Most of the confusion and disagreement surrounding healthcare seems to be caused by a lack of a real problem definition.

The government's role in Medical I.T.

 
medical it

Medical I.T. is one of the main phrases tossed around when politicians talk about innovation and cost savings.  There's no question that improving the way doctors and hospitals store and share information could have a huge impact, but I wonder if the private sector won't be the driving force behind this change.

It's hard to know who's telling the truth

 
health care reform truth

There are a lot of reports coming out about the new health reform bill.  A lot of very negative things are being said that, if true, are very troublesome.

5 tools that every insurance agent should have

 
health insurance tools

Have you been wishing that we'd talk about something other than healthcare reform on this blog?  Well, you're in luck.  I develop software at Zane Benefits and I feel like indulging myself by going all-out nerd for this one post.  I want to talk about how Insurance Agents (and most other sales people) can use improved operations and technology to make business run smoother.

Thoughts on the new healthcare reform bill

 
healthcare reform ugly

In case you haven't heard, the House of Representatives has released a healthcare reform plan.  Here are some quick thoughts about it. 

Small Group Laws are hurting small employers

 
small group laws

Traditionally, employer-sponsored health insurance has come in the form of group plans.  For various reasons, employers are starting to switch to plans that let them help the employees pay for their own individual insurance.

The difference between HRAs and HSAs

 
HRA vs. HSA

There are a lot of acronyms used when discussing non-traditional health benefits options. Two of the most popular and promising options are HSAs (Health Savings Accounts) and HRAs (Health Reimbursement Arrangements).  Even though they both have the same basic idea, there are a few key differences.  If you have an HSA/HRA or you are considering offering one to your employees, consider the following:

Clearing up some confusion about individual insurance

 
health insurance confusion

If there's one thing you'll get plenty of on this blog, it's talk about individual insurance.  We're big fans and it's no secret.  It's hard to know where to start the discussion though, so I'll just start with something that came up recently.

Getting the money to the right people

 
free health insurance

I want to follow up on something that I mentioned when summarizing Obama's speech from last week.  If there's one thing that everyone can agree on, it's that a country as rich as America should be able to come up with a system where everyone can get basic healthcare.

Recapping Obama's Townhall on Healthcare

 
health care reform

Last week, President Obama hosted a town hall discussion about the future of health care inAmerica.  I'm going to go over what we can take away from his comments.

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Disclaimer: The information provided on this website is general in nature and does not apply to any specific U.S. state except where noted. Health insurance regulations differ in each state. See a licensed agent for detailed information on your state. Zane Benefits, Inc. does not sell health insurance.