On the insurance side of health care changes, insurance agents report confusion with changes, frustration in getting certified and an opportunity to insure people who previously were turned away.
Beginning with the new year, the Affordable Care Act requires all U.S. citizens and legal residents to obtain health insurance. States were able to create their own options and Minnesota created MNsure (MNsure.org).
MNsure provides a marketplace to shop for health insurance plans, see side-by-side comparisons, look at potential costs, enroll for a plan, see hospital and clinic quality ratings — and to check qualifications for tax credits, financial assistant or a low-cost or free plan.
■ MNsure reports:
• Minnesotans who have affordable coverage through an employer or are covered by Medicare will continue with their current coverage and won’t use MNsure. For others, enrollment with MNsure started in October with health plan coverage beginning Jan. 1, 2014.
• Small businesses with 2-50 employees may participate in MNsure if they offer coverage to all full-time employees. Businesses with fewer than 25 employees and employees at certain income levels that purchase through MNsure may be eligible for tax credits to help pay for coverage.
Representatives from the insurance industry said companies are toiling over how to price plans on the health-care exchange now that risk factors and pre-existing conditions are not used to determine if an individual is a good risk or a poor one, work previously done by underwriters.
Dave Racer, an author and speaker has written eight books on health care reform, lives in St. Paul and regularly gives talks for insurance agents. Racer said the primary problem with MNsure has been an inability to communicate with insurance agents on issues like training and he pointed to difficulties in setting up accounts.
Racer said there has been frustration with moving targets. Required training for agent certification changed from a expectation of 100 hours to 20 hours, before falling finally to three online hours. Insurance agents said the testing for certification is so general any well-informed person on the issues could manage it.
Racer said a large number of agents want to be certified to offer services through MNsure but haven’t been able to complete the process, citing website issues.
The winners in the health care change, Racer said, are people who have high risk and high health care costs already.
“I think the offerings and the small business side are going to be a lot less attractive than MNsure thought they were going to be,” Racer said. “There are a lot of choices out there in the marketplace. The government marketplace has a lot fewer choices.”
Racer said the private marketplace already offered numerous options, including health exchanges. And Racer said the Massachusetts exchange, now seven years old, continues to be 85 percent subsidized. While turning away people for pre-existing conditions doesn’t sound inviting, Racer said the alternative drives up the cost for everyone.
Chris Klein of Klein Insurance and Financial Services in Eagle Bend, responded as soon as MNsure released information on training in June. He has six agents in his office either certified on in the process. He was still looking for clear direction from MNsure on how to technically enroll people.
Klein said in all fairness he’s sure MNsure is swamped and things may be clarified in the coming weeks. But he expressed frustration with the process.
“We have a lot of people who are already interested and several already who would like to enroll,” Klein said.
He said there has been greater interest from people than he expected.
“I think it will be helpful,” Klein said. “It’s exciting to me. In the past I would say 50 percent of people who applied for individual health insurance couldn’t get it. They were denied. We are going to be able to help a lot more people get what they need now.
“From a business perspective those insurance professionals who embrace the change and take the time to learn about it will be able to help a lot more people and will benefit business as well.”
The downside, Klein said, is that people who already have insurance are likely to see an increase in premium costs and for many that may be substantial as the risk pool is spread out among everyone, including the healthy.
Klein said in some cases people will have premium increases but they will also have more services with their plan, such as mental health and chemical dependency, so the coverage has greater value.
Even while the idea of the online marketplace was to simplify things, Klein said it’s still complicated and people want help to navigate it. That, he said, is what agents who’ve made a career in this industry are able to provide.
There are an estimated more than 48 million uninsured Americans.
Dave Bergin, benefits consultant with Fiducia Benefits Group in Brainerd, regularly speaks to businesses about health care options.
“My big take is the struggle we have in this country — health care itself is very expensive,” Bergin said. “This isn’t health care reform. This is insurance reform.”
With income guidelines, individuals earning up to $45,960 could qualify for a tax credit through MNsure that could lower a monthly premium and families of four may earn up to $94,200. Additional savings may reduce health care costs for individuals earning up to $28,725 or families of four earning up to $58,875.
“This is going to be a viable option for a lot of companies to offer something they weren’t offering before,” Bergin said. “There is a lot of confusion. This is going to make it more affordable for some people because there is a government subsidy. The downside with that subsidy is I don’t see that as sustainable. I really think this is a march toward national health care.”
Insurance, Bergin said, is there to protect people from unforeseen issues. He pointed to a large percentage of health care claims related to personal choices — smoking, drinking, overeating and lack of exercise. In August, the Centers for Disease Control (CDC) reported one in three American adults and almost one in five youths are obese. The CDC reported four modifiable health risk behaviors — “lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption — are responsible for much of the illness, suffering, and early death related to chronic diseases.”
Bergin questioned the requirement to have dental coverage on children from birth. He wasn’t alone in questioning the 2 percent tax on medical devices.
“In the end, something needed to be done,” Bergin said. “Is this the answer? That’s something that remains to be seen. I just don’t like it when government takes over.”
For those who don’t buy health insurance before the March 31, 2014, deadline, they won’t have another enrollment period until Oct. 15, 2014, unless they experience a life change — lose a job, have a child or a change in martial status.
Minnesota was already a state at the forefront of providing health care for those who were denied coverage on the private market. Klein said Minnesota was the exception to the rule in providing such a safety net.