UHC and Obamacare; More of Your Money

My Answer to a customer who asked,

“This caught my eye over the weekend. Does this change our decision matrix at all?”

This customer is in the middle of making decisions today for their employees. I wrote the  email that follows to help them understand what this article is really about. The customer can move ahead as planned but should know more changes are coming for Obamacare. More importantly I explain how this article is an example of how the government and insurers do not care about your health.

If that’s important to you read on.


 

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The article includes this CEO quote,

“We cannot sustain these losses,” Chief Executive Officer Stephen Hemsley told analysts on a conference call. “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself.”

Source: http://www.bloomberg.com/news/articles/2015-11-19/unitedhealth-may-pull-out-of-obamacare-marketplace-stock-slides


 

My email to my business customer asking about how this UHC article may affect their present decisions for their employees.

Short answer to your question about UHC:

No, what they’re deciding makes no difference for your decision today. Your decision today will only be good until they make more changes and they do that everyday. What you decide today could change tomorrow, that’s not a joke, that’s real.

Long answer to your question about UHC:

Still, the answer is no, this won’t affect you in the short term and you can’t plan long term.

I’ve been using the words, “shifting sands” for 5 years now. The Obamacare law is 5 years old, March 23rd, 2010. Shifting sands means continuous course corrections by all system stake holders that affects more than $2-3 Trillion of the American economy. This means, today UHC is saying they’re out. But, what it actually means is they’re lobbying for more money. What we have going on here is “lobbying for position.” In the halls of congress, the industry exerts leverage in order to get more money from the government. Welcome to modern politics.

Our elected officials didn’t read the law; they had no idea what they approved and now it’s obvious. People like me have been calling attention to the cost problem for 5 years or more (my blog: https://www.donwatza.com/category/benstaff-inc/white-paper-research/) but the American public won’t listen to someone like me over articles like this. The evidence and problem is documented in my white paper posts.

Sad, but true, I can confidently say, I’ve never seen a bigger mess. Before Obamacare, Healthcare needed a fix because the insurance industry wouldn’t police itself. But, this isn’t a fix and national healthcare won’t fix it any better either (watch my video on, “US healthcare system in crisis”).

My guess about UHC? UHC and the feds will make up; the feds will give UHC more money (this will drag on over the next few months) and in order to give them money they have to make the fix look like they didn’t. In the end, just more rules, overhead, confusion and frustration; and cost.

Summary: The government is making massive changes everyday while the plane is flying. Thoughtless unread regulations created this mess and their fix is a daily stream of thousands of new patches, regulations, paperwork and confusion. I’ve been living in the trenches for 5 years trying to help employers understand and navigate. The reality and size of this law is starting to impact small employers like you.

 There has been NO improvement in health or cost because your health doesn’t matter to them (any of them). What are we going to get if we keep doing what we’ve been doing? Do you expect a different result?

My frustration is clear, we’re in an awful mess and no one cares. There’s a different voice that’s needed; here’s my hope (https://www.donwatza.com/about-2/owners-health-initiative/).

Peace,

Don

Read Don’s Huffington Post Article for Owners

PS

P.S. I will add below related articles;

“Insurers say Obamacare changes needed soon to protect companies from losses” USA Today, 11-24-2015.

“New research out this week from Commonwealth Fund shows far fewer people think their insurance premiums and deductibles — from employer-provided or exchange plans — are affordable than the government does when it defines affordability. About 40% of 2,700 people surveyed said they delay care and prescription refills when they were sick because of high deductibles, Commonwealth found.”

http://www6.lexisnexis.com/publisher/EndUser?Action=UserDisplayFullDocument&orgId=2778&topicId=100025082&docId=l:2487319212

Hard Working Americans Trust Their Leaders

Do You Think Leaders are Making the Same Decisions You’d Make?

Link: http://www.pacificresearch.org/home/article-detail/?tx_ttnews%5Btt_news%5D=6814&cHash=b34e1ec79d3e473aab5f27222d25d467
Ordinary Consumers Are Paying For ObamaCare’s ‘Savings’

Obamacare is not “affordable” because it wasn’t intended to lower costs, only increase them (see video why). Obamacare created a way to give an insurance card to 16 million Americans. The lie was that it would save money.

As a medical economist, a veteran of rating and pricing, of more than 28 years, it’s time to consider real reforms before we leave more decisions to poor leadership. The direction we’re headed will guarantee us a healthcare system that looks like our struggling cities and schools.

Ordinary Consumers Are Paying For ObamaCare’s ‘Savings’

“ObamaCare may cost the feds less than anticipated, but it’s extracting far more from consumers’ wallets than they bargained for.  …

Meanwhile, overall health-care spending has increased drastically under ObamaCare.”

Source: Pacific Research Institute, quoting Investors’ Business Daily, April 7th, 2015, Author Sally C. Pipes. It can be found at this link: Pacific Research Institu…r ObamaCare’s ‘Savings’ 4-7-15  and from the original web source at:
http://www.pacificresearch.org/home/article-detail/?tx_ttnews%5Btt_news%5D=6814&cHash=b34e1ec79d3e473aab5f27222d25d467

When Obamacare was conceived it threatened the existence of many players in the “healthcare system.” These players gathered together to stop Obamacare from becoming law. To get the law passed and accepted by the healthcare system stakeholders, Obamacare authors provided access to all these parties to participate in Obamacare in a way that helped their position. Maybe you’d call this “bellying up to the bar.” They were afforded the opportunity to lobby their position and were offered incentives to accept Obamcare, or at a minimum not fight it. All the Stake holders got something except the American public. They were not represented and as a result they are now paying the tab in these higher rates.

Are you suspect of that this is true? If you want proof, read the law and you will find revenue that is earmarked for every stakeholder in the system who “bellied up to the bar.” If you unravel what was signed into law five years ago you will find only a token measure or two that helps Americans. And, at that, they’re only there because they made good sound bites for the public.

It’s amazing that with the intellect of so many, that so little was done.

Making the systematic changes that will make healthcare more affordable are not pie-in-the-sky ideas but ideas that will work. They will require hard work, if you want to help out, call me.

A Real Life Story of Accepting ACA Changes for a Small Business; Part II

Part II – a Small Business Looking to Do Better

The story starts with a business who engaged us for our Decoder because they asked the simple question, “we know it’s different than it use to be, and we perceive we could do better but we don’t know how to make the right decision.” In the first post, a couple days ago, you learned about the background a little bit. Feel free to review that post below.

Today, we’ll begin to cover details about who is being covered and who is not. It’s very common to have employers who cover individuals that should not be covered. Would you be surprised to know that employers have been known to cover deceased employees, or family members? When we visit with employers we never expect problems but we’re never surprised to find them either.

Job One, Research

Our first job is to research the details about all those covered and all those who are, or were, working for a company. We ask for lists that would show us this information. For instance, tax statements that provide lists of employees and payroll reports that show hours worked plus HR rosters of employees and former employees and other data. The research starts almost immediately and it usually entails asking questions about documentation that’s available that an insurance company would ask to prove the status of an employee or dependent. Identifying problems can be as easy as doing this research.

Our research immediately draws our attention to questions about a former board president who is still covered. In asking questions, it’s obvious there is no current relationship with the former executive. They had been involved and were made promises by the company. As we discuss this with current ownership, no one wants to address the issue with the board or the former executive. We helped solve the problem by including a proper commentary about the liability to both parties for covering someone who should not be covered.

But the former executive had an agreement?

Insurance companies can audit large claims any time, that’s in the small print. If they audit a claim on a former executive, like in our story, and they discover this person is covered it would be bad for both the employer and former employee. Coverage for groups means employees of the group must be covered and individuals who are not employees can not be covered. This is why it’s called group coverage.

So what actually would happen?

If an audit were to occur by the insurance company they would deny the claim of the former employee stating they’re not an employee of the company and not eligible for “group” coverage.  This is bad because the former employee and covered individual could use promises by the government to impose upon the employer the need to pay the claim. To keep the story simple, I’ve eliminated all the details and possibilities for how this could happen. The point is, there’s a chance the employer would be stuck paying the claims of the employee without insurance coverage. This is bad for everyone.

When we arrived the former employee had been on the plan more than 10 years. Why this had been left to linger is anyone’s guess.

What was the outcome?

The employer and former employee understood the risk to both employer and former employee. We introduced an agent who could help with individual coverage. We directed them to seek individual coverage immediately. This was completed within a week. As a note about how this worked, ACA makes transition from group to individual possible because it eliminated pre-existing conditions and medical underwriting. In the old days, these two rules made doing what we did much more difficult.

This small adjustment to the rules gave us the understanding to help the employer. Because the Decoder puts all of these facts in writing, it made it much easier for the employer to make the change with confidence. They just had to see it in writing and be able to show the former employee as well. This is the purpose of the Decoder.

If you enjoyed the story, or learned something from it, please let me know in the comment below. Do you have your own insurance story?

All insurance is not Created Equal.

A Health Policy Buyers Dilemma

If you’ve had an insurance policy, and we all do, you may not have ever had a claim. The serious claim that is often large, like ten’s of thousands of dollars large is something many people never experience. This causes a purchase dilemma for most people. They must choose a policy without knowing if, at claim time, it will pay as hoped. They may not be entirely sure what to expect even after the sale. It’s popular for a buyer to accept a recommendation from a sales agent because they have to trust that person to match their needs.

Question One

Here’s the rub, many agents are wonderful, terrific people who want to take good care of their customer. There are some, as in any industry, who are going to recommend what’s in their best interest over their clients interest. Unfortunately, it isn’t quite so black and white. In our work with clients and the Decoder we frequently find opportunities for customers and make adjustments to the original recommendations. We’re making a living on finding these opportunities. We can’t say exactly why it is this way but it’s clear there are always opportunities to do better. In case you’re curious, these adjustments along the way pay for the Decoder within a month or two for most groups.

Question Two

There is a second question to be asked. If you’re not worried about your agent’s recommendations and are confident in them, the question is determining their level of confidence in understanding where the opportunities exist for your business. Healthcare is changing daily, we call it “shifting sands,” the speed of change literally keeps me up at night and this is what we do.

Chances are, what your agent knows, comes almost exclusively from insurance carriers and vendors. If you look objectively, you have to say that makes complete sense. After all, selling insurance to business is what they do for their lively hood. You shouldn’t expect something different. Plus, the speed of change makes sorting out all the carrier and vendor and marketplace options really difficult. Is your agent really up on all the options that might fit you, and can they explain those options in a coherent financial manner your CPA would understand?

Assess Two Qualities About Your Agent

I’m probably stating the obvious but it’s important to know where your allegiance lies. In the first case, the agent who you can trust must be screened by you. It’s very likely, you have confidence in your ability to screen out the better agents. You will have confidence then in choosing or keeping your agent.

Let’s assume in the first case that you’ve used a good process to hire an agent. What about the second case, where you are less prepared to assess how up to speed agent is with ACA, reform, plan regulations, policies and myriad of new options? Fact is, it’s highly unlikely that your abilities in this second part are as adequate.

Sales Process Does Not Work in a Buyers Favor

Insurance has the reputation it has because it’s earned it, and because what insurance provides almost seems like selling air. It is complicated and the sales process does not work in a buyers favor. What is common is that most people don’t experience serious claims that test their trust in a policy and agent, and as a result learn too late that they have a problem.

Insurance is complicated and healthcare is among the most complicated. You should almost expect problems if you’re not introducing an outsiders opinion about the decision you’re making for your policy. I’ve built BenStaff to do just that for you. I had to separate myself from the traditions of insurance and stepped out intentionally to offer an alternative. To protect and work with owners to solve the equation for the optimum outcome has been a real struggle and also opportunity. I have no part in traditional insurance and as a result can give you the benefit of insider information without making a living at selling you a product. I work with agents all the time and am happy to work with a customer’s agent. BenStaff does not participate in commissions, fees or overrides or other bonus’ traditionally part of the sales process.

Many businesses feel forced to reduce the decision to who they trust. While this can be good, it exposes your small and large business to the risk that who they choose to trust may not be the right person or not sufficiently knowledgable to tackle the new day.

An Obamacare Article Written for CPA’s is Right On

“Choosing the right plan requires the knowledge to make the right choice.” I couldn’t have said it better.

Screen Shot 2015-03-06 at 6.08.54 AMDuring the Goldman Sachs 10,000 Small Businesses classes and work I learned just how difficult it is for an owner to hear my message. It’s because when I say the word insurance, the label “insurance dude” is applied. That’s fine, except with it usually comes the connotation that I’m going to sell them insurance. It’s a logical conclusion but it would be wrong. Why?

If what I was doing was popular people wouldn’t get to that conclusion, instead they might ask, “are you selling a product or are you providing independent advice?”

The quote I found while reading an article makes my case why I’ve left the “agent/broker/consultant” world to help America do better (watch my video).

So, I’m reading an article written for CPA’s on the topic, PPACA – Obamacare. It’s a 4 page article making recommendations to CPA’s on how to advise their clients on these complicated topics: insurance markets, metal levels, pricing and benefits, government sponsored exchanges, SHOP, private exchanges, self funding, pay-or-play, employer reporting, limited networks and finally underwriting.

“numerous strategies are available to businesses as they try to make the best health insurance choices for themselves and their employees in this new regulatory environment. Choosing the right plan requires the knowledge to make the right choice.”

“Health Care Reform Essentials”, Journal of Accountancy, July 2014; Dietrich, Marks.

This statement could be the description of BenStaff’s Decoder work.

Two critique’s I have about this, first, what a great list of all the new options in healthcare, it demonstrates what I’ve been saying now since March of 2010. The very reason I built BenStaff and BenStaff’s team built the Decoder. On one hand it’s as easy as the article states. But, to optimize the right balance between taking risk (self funding) and low cost and access (limited networks) the question is, who is better suited to advise on these matters?

My team is independent, we don’t sell insurance, and we have much deeper knowledge of benefits especially healthcare. Having former underwriters we know risk and pricing in groups and individual markets, our actuarial team provides expertise to the Decoder, our CEBS specialists cover the plan in operation requirements of the DOL, HHS, CMS and the IRS. And, we encourage a businesses advisors to offer their best thinking so don’t miss something. A small businesses CPA, CFO, HR executives, attorney’s or other advisors are welcome to contribute. No one person has all the answers but we believe we’re as close to that as possible.

Our structure gives us dominance and reach into every market and option available. Overall, our Decoder is the answer to the question posed to owners and CPA’s at the end of the article, beautiful;

“Choosing the right plan requires the knowledge to make the right choice.”

I couldn’t agree more.