This blog has sounded the alarm.  There is a concerted effort to dismantle regulations, at least those impacting business activity and business behavior.  And though this is Health Insurance Issues With Dave, we have to take a moment to talk about boneless chicken wings.

Here is the link to the Court News Ohio article.  The two minute version is that an Ohio man, Michael Berkheimer, revisited a local restaurant in 2017 and ordered his usual, boneless chicken wings.  From the article:

“Berkheimer followed his normal practice of cutting each boneless wing into two or three pieces. He was eating the third piece of a wing when he felt “a piece of meat [go] down the wrong pipe.” He went to the restroom to try to clear his throat but was unsuccessful. Over the next three days, he spiked a fever and had trouble eating. During a visit to the emergency room, a doctor discovered a thin chicken bone lodged in his esophagus. His medical records indicated it was a “5 cm-long chicken bone,” which is about 1-3/8 inches.”

The Ohio Supreme Court has ruled that Mr. Berkheimer cannot sue the restaurant or anyone responsible for the production of not-boneless boneless chicken wings.  Our courts have decided that you have no right to assume that a product sold as boneless would actually not have any bones.  This faith in the marketplace to self-correct means that anyone can sell you anything.  No matter what, you should know better.

I am not implying coordination.  Instead, I see a convergence of a particular mindset / political view with those who would exploit weaknesses in the regulatory system.  Specifically, I am looking at the way legislation pending in the Ohio legislature, H.B. 400 and H.B. 587, would work with the Heritage Foundation’s Project 2025.

H.B. 400 – Changes the way Medicare Supplements are marketed.  The bill would allow Medicare Beneficiaries under age 65 to purchase Medicare Supplement coverage.  It would also allow these Beneficiaries to change their policies annually.  Since they are under 65 and already declared Medicare eligible due to sickness or injury, there can’t be any underwriting.  Key changes:

• Sale of Medicare Supplements to <65
• Change Medicare Supplement policies annually, guaranteed issue with Pre-Ex covered
• A whole new market that is constantly eligible.
• Pricing locked in to the age 65 rate
• Medicare Supplement marketing is state regulated
• NO MENTION OF MEDICARE PART D (Rx) WHICH HAS FEDERAL MARKETING REGULATIONS.

H.B. 587 – Changes the way Medicare Supplements are marketed within the State of Ohio.  Many of Ohio’s current regulations mirror the federal government’s Medicare Advantage / Medicare Part D (Rx) prohibitions.  This bill removes these consumer safeguards while ignoring the need to help the consumer understand and address all of his/her needs.  Someone purchasing a Medicare Supplement would also need a Medicare Part D (Rx) plan.  And that individual might even be better served with a Medicare Advantage Plan.  Current Federal regulations would prevent the marketing of those plans at that time.  Key changes:

• “Print solicitations such as…door hangers left at residences or on motor vehicles.”
• “In-person solicitations of individuals at the individual’s residence or in public or common areas such as parking lots, hallways, lobbies, or sidewalks.”
• “Telephonic or electronic solicitation such as electronic voicemail messages, text messages, or direct social media messages.”

Please note that H.B. 587 does not address the likelihood that many of those solicited would not qualify for the purchase of a Medicare Supplement policy under the current rules due to their preexisting conditions.  Beneficiaries currently covered by a Medicare Advantage Plan would have to answer health questions and would be subject to decline if they have had the MAPD for over 12 months.  This bill does not address the Beneficiaries’ need for Medicare Part D (Rx) coverage.

Project 2025 – The Heritage Foundation’s Mandate for Leadership: The Conservative Promise.  If I may skip the 533 times tax and/or taxpayer are mentioned and the 199 times for abortion, the other key focus of Project 2025 is the privatization and / or move to state (non)regulation of federally regulated programs.  The privatization of Social Security and the move of programs such as Medicare to state regulation are an inherent part of Project 2025.  And this is the final connection:

• If Medicare was regulated by the State of Ohio, we could lose all of the consumer protections:

1. Minimum standards for MAPD policies
2. Age restrictions on Medicare Supplements
3. Meaningful guaranteed issue vs. underwritten times to purchase coverage
4. All marketing regulations. Once anyone on Medicare can routinely change plans, marketing restrictions would be ignored (see current call centers with MAPD) and eventually eliminated.

It is important to remember that this mindset is completely convinced that the market will correct any and all excesses.  That faith in market correction ignores the real world consequences of the damage done.

This same thinking can be applied to their efforts to dismantle the Patient Protection and Affordable Care Act in our industry and countless other examples in other industries.

Eliminate all consumer safeguards?  I have a bone to pick with that.

Dave

www.cunixinsurance.com

Picture – Dependably Boneless – David L Cunix

Quick footnote – I hope that some of you, especially those of you who are insurance agents, will click on the links to the legislation.  Both bills are only a few pages.  Also, the Project 2025 link is searchable.

The last thing I tell all of my new Medicare clients is that they will receive their insurance cards, a Welcome Kit, and lots of stuff related to their new coverage.  “They are going to kill a tree in your honor” is how I try to put this into perspective.  And even with that, at least one client calls each month to let me know how much correspondence they are receiving from one of their new insurers.  This, of course, leads us to an important question:

When is junk mail not junk?

This is a serious question.   Overwhelmed by conflicting and confusing correspondence from their insurer, especially the Medicare Part D (Rx) insurance companies, they invariably miss an important letter or billing statement.  AND THEY LAPSE THEIR POLICY!  I have seen clients lapse policies that have a premium of less than $10 per month.  And once it is gone, it is gone.  The policy won’t be reinstated.  The Medicare beneficiary, in most cases, is stuck without prescription drug coverage until the next Annual Enrollment Period.  This is not a money issue.  I have had professionals, a doctor, a financial planner, and business owners lapse their Medicare Part D (Rx) plans.  And though the insurance company is flooding their clients’ mailboxes, there is absolutely no correspondence with the agents.  NONE. The policy is normally terminated before we learn that there is a problem.  My peers and I are trying to change this, but until then, open all of the mail from your insurer.  And call your agent if you receive something that doesn’t make sense.

When is junk mail really junk?

The postcard was green.  Seriously.  The government is not sending you a green postcard about your Medicare benefits.  This client was amused.  The other side of the postcard noted that this was registered to her.  She might qualify for a Medicare plan with $3,500 coverage for routine dental and/or $325 for healthy food options at certain grocery stores.  There was more and a phone number to call.  And, in almost impossibly small and faint print, the legally required disclosures.  All Medicare marketing materials must contain the following verbiage: “We do not offer every plan available in your area.  Currently, we represent 7 organizations which offer 62 products in your area.  Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program (SHIP) to get information on all of your options”.  It is required.

This is just a sales pitch, no better and no worse than the rest of the junk mail we receive almost every day.   And even though the disclosures are really difficult to read, the green postcard and heavy-handed text (Do Not Discard) make this hard to take seriously.  It is the very definition of junk mail.

But the promise of something for nothing is very tempting.

I received a call last week from a wealthy couple.  He owns a successful business and she has been a self-employed consultant for decades.  They called about the FREE GROCERIES.  I asked them if they needed free groceries.  I reminded them that they actually pay the Income-Related Monthly Adjusted Amount (IRMAA), a fee paid by less than 10% of all Medicare beneficiaries.  So, for real, is anyone giving you free groceries or are you being sold something you really don’t want?  Gosh we all love free stuff.  And the television commercials and junk mail stoke that fire.

We are going to get more junk mail, not less.  And there is pending legislation in Columbus to make it easier for unscrupulous marketers to call you and even to come knocking, uninvited, at your door.   Read the mail from your insurer, throw away the junk, and when in doubt, call your agent.

Dave

www.againreally.com

Picture – Wasted Paper / Wasted Time – David L Cunix

We didn’t play golf today.  The weather reports had called for rain.  It didn’t.  We had listened and trusted the forecasters and predictions.  We erred on the side of caution.  We would have gone to the course when we were younger, but we are all old guys now, the youngest of our foursome will be 69 in August.  We could have played.  The ground was wet.  The course was soggy.  There was a chill in the air.  I stayed home, opened the windows, and made a pot of chili.

That is the chance one takes when you listen and rely on experts.  The predictors, the prognosticators don’t all agree.  Our first task is to guess which mavens, if any, we should trust and follow.  This can be a difficult undertaking.  We all possess specialized knowledge.  With over 45 years in the insurance business, I am on firm ground when discussing health insurance, health insurance companies, and even the politics of health insurance law.  That doesn’t mean that I know anything about auto mechanics, lacrosse, or even the weather.  It also doesn’t mean that every other agent, or even any other agent, would agree with me.  That’s OK.

This blog began in 2009 during the run-up to the Patient Protection and Affordable Care Act (Obamacare).  The initial focus was the fear that our politicians would craft a European-like single payer system.  I tried to detail the backroom dealings of Congressmen and Senators from both sides of the aisle.  And because the Democrats were in the center of most of the action, many of the posts focused on their public and private positions.  The politicians, some that I knew personally, were not always happy with me or this blog.  Once the law was passed, the focus moved to the hypocrisy and cynicism of the Republican leadership.   And then it got dangerous.

The question – would the Republicans treat the PPACA the way they had treated abortion in the 1980’s, 1990’s, and 2000’s?  Since Reagan’s election in 1980, abortion was used as a wedge issue, a fundraising vehicle, and a way to keep the base agitated.  There was no real interest in ending access to abortion.  Yes, this was terribly cynical, but it really worked.  The righteous indignation over the new health care law was safe and predictable.  It helped that they could pin this on a president that they really didn’t like, for any number of reasons.  The base went wild and the Republican leadership fanned the flames.  No one would be hurt as long as this was just a game and this was all talk.

The Republicans won the House of Representatives in November 2010, in part based on their campaign against the new health care law.  I predicted a wave of cynicism.  The Republicans jumped into action and introduced H. B. 2, the second bill of the new Congress in 2011. The name of the bill was “Repealing the Job-Killing Health Care Law Act”.  This was not serious legislation.  Most of the next 60+ Obamacare repeal bills introduced over the next 6 years were just for show.  The first change came in July 2014 when conflicting federal court rulings bumped the law up to the Supreme Court.  The coyote caught the roadrunner and now this could be more than just talk.

The Supreme Court under Chief Justice John Roberts would save the Patient Protection and Affordable Care Act THREE times.  The first, in June 2015, came as a huge relief.  It is one thing to rail against the PPACA, it is quite another to repeal the current health care payment system without an alternative.  And we have not had a serious alternative.  This blog detailed the legitimate fears of anyone diagnosed with a preexisting condition as we watched the Texas lawsuit wind its way through the courts.  Would the entire country have Texas level health care?  NO.  The Supreme Court ended the Texas lawsuit on June 17, 2021.  It seems like a long time ago, but it has only been 3 years of peace.

We are about to enter the election season of 2025.  The Republican Study Committee produces the policies, press releases, and talking points for their members and candidates. The candidates might not be talking to reporters if they are in a competitive race, but there is the outline of a Republican plan should they capture the House, Senate, and the presidency.  Health care appears on Page 3 of the 5 page “Fiscal Sanity to Save America” budget proposal.  This is the link.  It is a blast from the past that even includes the widely debunked sentence, “Allow individuals to purchase health insurance across state lines”.   I found on Page 4 the sentence that got my attention, and the motivation for this post, “Allowing medical underwriting to apply downward pressure on all beneficiaries’ premiums and inject stability into insurance markets”.  That is a return to the days of denial, riders, and rate-ups.  Do we really want to return to that?  Read the proposal.  All of it.  This budget proposal touches on the PPACA, Medicare, and Medicaid.  This is really important stuff for all of us.  And for extra credit, I have also included the analysis from the Kaiser Family Foundation site.

You don’t have to like the Patient Protection and Affordable Care Act or the proposals from the other side of the aisle to be concerned about this proposed budget.  And we know that you can no longer count on this just being all talk.  For every reader who may chime in that I am being hyperbolic, there is another already concerned about her/his access to health care should these plans be implemented.   Senator John McCain is no longer with us.   It is up to us to save ourselves.

The rains started at 12:30.  Had we played, we would have been on the 15^th hole, the furthest spot from the Pineridge clubhouse and shelter.  We were lucky.  Sometimes the predictions are right.

Dave

Picture – Soon To Be Lost In The Woods – David L Cunix

www.cunixinsurance.com

Fear.  Damn, I had forgotten the sound of fear.  I had enjoyed the relative calm of the last 3 years.  But fear was returning to the insurance business.  Worse, that fear wasn’t unwarranted.

The exact wording may vary, but the clients’ questions tend to track in one of these directions:

• “I have Cancer/a Heart Condition/MS/Other pre-existing condition. Am I going to lose my health insurance?
• “Will they let me keep my health insurance, but charge so much that I will have to drop it?”
• “Am I going to lose my Medicare Supplement?”
• “Are they going to move Social Security to 69 or 70?”

You know these questions and a half a dozen more.  You may have asked them yourself.  The former president/presumptive Republican nominee is still campaigning to repeal the Patient Protection and Affordable Care Act (Obamacare).  Trump is still complaining, seven years later, about Senator John McCain saving the country.  What would happen if Donald Trump was the president and the Republicans regained the majority in both the House and Senate?  John McCain is gone.  Would you trust your health care to Ted Cruz and J D Vance?

It would be wrong to pooh-pooh the worries of the 50 year old cancer survivor.  That person, and the 54 million other non-elderly Americans with pre-existing conditions, have legitimate concerns.  Most elected Republicans are happy to complain about the prices and deductibles, but no longer want to engage in discussions about repealing and replacing Obamacare.  Without a viable replacement, they having decided to substitute whining for action.  But there is a vocal minority within the current House majority, the ones who disposed of one Speaker of the House and are constantly threatening the current placeholder, who are still trying to impose their concept of “political purity” on their caucus and the rest of us.  Thankfully they have been too fixated on Hunter Biden to have had the time to dismantle our health care system.  Given another term and a different president, who knows?

Some of my clients, and yes, many of my clients are well-read and up on current events, are focused on the Supreme Court.  The Roberts Court saved the Patient Protection and Affordable Care Act several times.  Will Texas strike again?  Will this new majority, one no longer concerned with precedent or judicial restraint, protect us again?  That hardly seems like a safe bet.  There will be more challenges to birth control, Medicaid, Medicare, and other health related issues in the next few years.  We can only guess, with Susan Collins like accuracy, how this court will rule.

There is a move to raise the Social Security age to 69.  It is reasonable to believe that the same 175 members of the Republican Study Committee would also want to both privatize Medicare and to move the starting point past the current age 65.  I don’t know of any of my elderly clients that would want the current Republican members of the US House of Representatives to tinker with their health care or retirement.  And if they are paying attention, the 25 year olds are just as concerned.  Addressing the funding and structure of our social safety net may make sense, but it is time to ask for all of the details.

It is April 2024.  We have seven months until the election.  There will be television ads filled with half-truths and complete lies.  Our letter carriers will be forced to deliver actual junk mail.  And you will receive unsolicited phone calls and texts almost daily.  Heck, I get texts from Laura Trump and Don Jr.  Don’t let fear get the best of you.

Dave

www.cunixinsurance.com

Picture – A Moment Of Calm – David L Cunix

I have friends who enjoy the challenge of a good jigsaw puzzle.  They might spend entire weekends tackling a bucolic scene of 2,000 or more pieces.  Not me.  I am still haunted by the puzzle frustrations of my childhood.  No matter how careful I was, there would always be a piece missing!  That missing piece, perhaps in the lower right corner, wasn’t relevant until it was everything, the very definition of whether or not I had completed the puzzle.

I was recently in Washington DC as part of the National Association of Benefits and Insurance Professionals (NABIP) annual Capitol Conference.  As I have detailed in previous years, 500+ health insurance agents and industry employees gather in our nation’s capital to hear from the heads of the regulatory departments (think CMS), Congressmen, Senators, and thought leaders on the issues impacting us and our clients.  And, we then get the opportunity to meet with our elected representatives or their legislative aides in their offices.

I love wondering around the Halls of Congress.

Most of our attendees are very familiar with legislation pending in either the House or the Senate.  Some even know the players, who is championing a particular bill, or may be in opposition.  There is an entire process to the meetings in the Congressional offices.  The meetings are scheduled in advance.  Our talking points, the key issues we would like to discuss, are provided to their offices along with a list of which of our members will be attending.  And yes, we even include our attendees’ addresses so that the Congressman or staff will know if they will be meeting with a constituent.  Our meetings are an opportunity to put a face and a story to the issues and to explain the real-world consequences of their actions or inactions.

Due to the limitations of this Congress, our talking points were reduced to one page (front and back!), much less than previous years.  We limited our focus to pending legislation.   But we did have something else to discuss – the brand new NABIP American Healthcare Consumer Bill of Rights.  The key, at least in my opinion, begins with the idea that we are Consumers, not patients.  As consumers we are purchasing goods and services.  Our expectations are different when we identify as consumers.  Our focus isn’t simply about outcomes, but we should know that we have the right to access healthcare, that we will be respected, that the process will be transparent, and that we will be a part of the decision making process.  Does this fix all/any of our system’s flaws? No.  This is just another step in the right direction.  And if it helps my clients to better understand their place in the process, an active participant not just an end-user, then we will have accomplished something.

I led two delegations to Congressional offices this year.  We met with one staffer who, though relatively new in this particular office, had been on the Hill for almost a decade.  And we met with a bright young woman early in her career.  In both instances our members were able to help the Congressional staffer to see the individuals and small businesses impacted by the laws and regulations they helped to shape.  That is what seems to be missing, the human factor.  We are the last piece of the puzzle.  Insurance is the way most Americans access and pay for health care.  And insurance agents are the way the product is most effectively delivered.  We are also in the position to help regulators and Congress to course correct when the best of intentions lead in the wrong direction.

And that is why I’ll be in Columbus a few times this year and already look forward to next year’s Capitol Conference.

Dave

www.cunixinsurance.com

Picture – At The Top, Cannon Office Building 2024 – David L Cunix

Friday, December 29th, the last business day of 2023, was a very good day to be an insurance agent.  At least it was in my office.

I started the day with three important scheduled appointments, three disasters.  One of the problems was caused, in part, by the client trying to fix things on his own.  The other two were related to the failure of Ohio Medicaid to communicate effectively.  It doesn’t matter if you are talking about children or senior citizens, sudden changes in your health coverage with little to no warning can be terribly disruptive.  I needed to get everyone properly covered on the 29^th or they would be stuck in limbo for all of January. Each of these appointments could have lasted for hours and similar cases had.  But on Friday all three were successfully resolved by 1:30 in the afternoon.

Communication failures led to two more client contacts later that afternoon.  In these cases I was able to reassure the clients that everything was fine.  The client and/or their child have access to the doctors and facilities important to them.  The clients might be able to talk to someone at the state, or the insurance company, but they can always get a response from their agent, me or any of my peers.

This blog has readers across the country. My peers, my friends who are agents, in Phoenix, Atlanta, or Portland (Maine and Oregon) encounter interesting and possibly even more complicated issues every day.  This is the gig.  Our job is to solve the problems of our clients – individuals, families, small and large businesses – as they attempt to acquire and maintain effective health insurance. The insurance companies may have call centers and someone will eventually answer the phone at the state’s office, but your insurance agent is the one you know you can call.

I am already booked for Washington DC for the end of February and I hope to be in Columbus a couple of times in 2024.  There is a good chance I will see your agent in Washington and that he/she will also be spending time meeting with your state legislature this year.  Let us know what is on your mind and how we can help.

Dave

www.cunixinsurance.com

Picture – Oh, And I got A New Car, Too – David L Cunix

It is October 13, 2023 and I would like to celebrate the boring sameness of health insurance.  It is a joy to enter The Medicare Annual Enrollment Period that begins Sunday.  And the Annual Open Enrollment Period for individuals and families under age 65 who purchase their own insurance will begin on November 1^st.   Agents across the country will be immersed in something we know, love, and will be totally outside of the craziness around us.  It may seem selfish, but the terrorism our friends and relatives in Israel are experiencing and the chaos of the GOP run House of Representatives are taking a toll on even those of us who are only peripherally involved.  Try as I might, I can’t understand the murderous hate of one or the blind incompetence of the other.   At least we will spend our time with human traits we understand – greed and the insatiable desire to get something for nothing.

Our phones are already ringing.  At least once a week the caller asks, “Am I getting all of the benefits I’m entitled to?”  My response is usually, “Ma’am, you are entitled to watch TV without any misleading commercials.”  Something for nothing is big this year.  We have graduated from Free Dental to Free Rides to the Doctor, to Free Bowling Balls and even Free Golf Clubs.  It is as if an entire generation has forgotten the lesson that was pounded into us from a very young age – There is no such thing as a free lunch.

Sure there is an element of greed with the providers and the insurers.  One of our local hospital systems, famous for its fight-to-the-death negotiation style, is threatening the Medicare Advantage contract of a well-known insurer.  There will be nasty letters to the patients from the hospital suggesting that they find a new insurer and equally shocking letters from the insurer to its client suggesting that they find new doctors.  They will come to terms at the last moment and all will be forgiven.  There is a rhythm to this.  There is seldom any need to panic.

Our Medicare clients, those on Original Medicare with a Part D (Rx) plan and even those on a Medicare Advantage Plan, are happy.   And we, their agents, are happy, too.  Medicare is the best coverage many of our clients have had in decades.  It certainly has been for me.  Medicare Part B will go up $9.80 per month to $174.70.  It is still a great deal.  The prescription coverage has also improved.  Helping our clients to understand and appreciate their coverage is normally a positive experience.  The vast majority of my meetings, in my office over coffee, will be moments of calm for us.

The first policies sold under the Patient Protection and Affordable Care Act (Obamacare) became effective on January 1, 2024.  It has been ten years.  If you polled 5 agents you would get 8 opinions about Obamacare.  We know people who pay more for their coverage due to the law.  We know some who pay less.  But our job is to help people find health insurance, the way most Americans access and pay for health care.  Because of the law we will never again tell the parent of a sick child that we can’t get their family covered.  The healthy and those of you who aren’t agents will never fully appreciate the stress of dealing with pre-existing conditions.  And yes, allowing the sick and injured to participate in our pool of business does have some impact on premiums.  That is the price we pay to include everyone, even YOU should your luck run out next week.

We are seeing insurers return to the under 65 market.  They have figured out how to make this profitable.  As agents we are forever hopeful, always believing that this next year’s products will be more straightforward and consumer friendly.  We are seeing networks expand.  We are finding an element of flexibility.  The expansion of the Tax Credit Subsidies is making coverage more affordable.

Your agent, wherever you are in the US, will be busy for the next two months.  Try not to be too envious.

Dave

www.cunixinsurance.com

Picture – Blue Skies – David L Cunix

August 2023:

Frank, your short term major medical policy will not be an option for you in 2024.  We will need to look at a regular health policy.

What are those damn insurance companies doing now?

It isn’t the insurance companies.  They love short term policies.  The applications still ask health questions and the policies don’t cover preexisting conditions.

So the Republicans are screwing me?  Is this Kevin McCarthy or MTG?

No Frank, This is President Biden reversing the excesses of the previous administration.

CRAP!

The pendulum swings from one extreme to the other.  The only guarantee is that we will be smacked on the backside every time the bob passes through the middle.  Our two political parties expend a lot of energy in search of the extremes and each election, be it Congressional or Presidential, impacts health insurance, the way most Americans access and pay for health care.

New rules from the Biden Administration.

In the relative quiet of the last two years you would be forgiven if you had forgotten that we are still operating under the Patient Protection and Affordable Care Act (Obamacare) passed in 2010.  We no longer live under the daily threat of our health care system being dismantled without a plan or a care of what would happen to the 50+ MILLION Americans suffering from serious preexisting conditions.  But each administration, Obama, Trump, and now Biden, has had a significant impact on the way the rules are interpreted and administered.

This blog documented the various ways that the Trump administration attempted to both repeal the law and when that failed, sabotage the basic framework of the PPACA.  The following are some of the rules and regulations President Trump and his team used to destabilize the markets:

1. Eliminate the penalties associated with the Individual Mandate
2. Defunded the Cost Share Reduction
3. The promotion of short term major medical policies and association plans
4. Reducing the Open Enrollment Period
5. Supporting the Texas Lawsuit

And this is just a partial list!

The pendulum swung hard to the right.  As noted in the July 2017 post Begging The Arsonist To Put Out The Fire:

A key element of the Patient Protection and Affordable Care Act (Obamacare) is the Individual Mandate, the requirement to purchase insurance.  This blog and numerous other published articles have noted that the Individual Mandate traces its roots to the conservative Heritage Foundation over twenty-five years ago.  The logic is simple – If we are going to offer health insurance to all Americans and cover preexisting conditions, we must have everyone participate.

 A concerted effort was made to incentivize the young and healthy to leave the insurance pool.  This was done by removing the penalty for not having comprehensive coverage and by promoting short term major medical plans.  In early 2018 Health and Human Services Secretary Alex Azar changed the definition of short term major medical coverage and allowed these plans to be sold for up to an entire year. These plans were initially designed to bridge the gap between group health plans or, pre-Obamacare, to help those who didn’t qualify for comprehensive coverage.  It is important to note that short term plans:

• Ask underwriting questions pertaining to health, occupation, and hobbies
• Are for a limited number of days
• DO NOT COVER PREEXISTING CONDITIONS
• Have a limited maximum benefit

Under the previous administration, the healthiest amongst us were encouraged to enroll in a short term plan until they got sick, injured, or pregnant.  They could then migrate to Obamacare at the Annual Open Enrollment, assuming that they didn’t need comprehensive coverage first.  What could go wrong?

The pendulum swung through the middle last year on the way to the left.  In the last two years we have seen a Special Enrollment Period that allowed millions of Americans to reassess their plan choices, an expansion of the Tax Credit Subsidy, and the Annual Open Enrollment Period expanded to January 15^th.  The Biden administration is now ready to tackle short term and fixed indemnity policies.

The Biden administration proposal would limit short term major medical plans to three months and allow only a one month extension.  Though we haven’t seen the details, it is assumed that short terms will no longer offer office visit copays and some of the other benefits that made them look like regular, comprehensive health care plans.  President Biden has cited instances where individuals purchased short term plans and were shocked to learn that their claims weren’t paid.  Short term policies do have a place in the market.  They do a good job of paying for things that are new, big, and different.  There are people who could not or would not pay for full, comprehensive health insurance.  It is a gamble.  It appears that the casino has been closed.

I’m not looking forward to my call to Frank next month when these rules are finalized.   I expect anger, cursing, and at least one threat to move to Canada.  Frank is politically aware.  He knew that this day would come.  It was as inevitable as a pendulum swinging back the other way.  Me?  I’m just glad that he never had to test the limits of his short term coverage and I’ll remind him that all good(?) things must come to an end.

Dave

www.cunixinsurance.com

Picture – This is where a Foucault Pendulum hung in the Cleveland Museum of Natural History until it was removed during the current construction.  Proof that all good things do, in fact, come to an end.

You might think that they are dead.  You might even take credit for killing them.  But Zombie Laws survive the best efforts of dedicated legislators, the light of day, or even common sense.  The link is to an example in Georgia, but we in Ohio have our fair share of Zombies.  There is a reason why these poorly thought out regulations, back-door giveaways, or clearly unpopular concepts fail to be passed as standalone legislation and often die in committee.  That would be OK if these Zombies didn’t reappear as an amendment to must pass legislation or snuck into the biannual budget.

Many of us in the insurance industry thought that we had vanquished last year’s House Bill 675 before it could harm Ohio’s senior citizen population.  We just learned that the key provisions have been inserted into House Bill 33, the current Ohio budget bill.   This is the pertinent section:

The superintendent shall not prohibit the following types of solicitation: 57427 57428 (a) Print solicitation such as leaflets, flyers, or door hangers left at residences or on motor vehicles; 57429 57430 (b) In-person solicitations of individuals at the individual’s residence or in public or common areas such as parking lots, hallways, lobbies, or sidewalks; 57431 57432 57433 (c) Telephonic or electronic solicitation such as electronic voicemail messages, text messages, or direct social media messages.

Here are two scenes from the not-too-distant future:

1

Four white-haired gentlemen enjoying breakfast at McDonald’s were approached by two individuals, a man and a woman, both in business attire and carrying briefcases.  The man addressed the diners while the woman opened her laptop.

“Good morning gentlemen.  I am agent Rogers and this is agent Moore.  As per Ohio Representative Bill Dean, we are here about Ohio House Bill 33 signed into law by Governor DeWine on May 26, 2023.   This will take just a few moments.  We need your name and the name of your Medicare Supplement company.”

As Bob reached into his pocket to find his insurance card, a young mother rushed over to the table.  “These two aren’t government agents.  They’re insurance agents.  I saw them here last week.”  Rogers, the insurance agent, started to protest that they were allowed to solicit Medicare Supplements at public places and even McDonald’s.  Bob noted that this might be legal, but it certainly isn’t right.

2

The elderly couple pushed their shopping cart through the parking lot.  Just as they opened their trunk, a young man rushed up to their car.  It took a moment or two for the couple to fully grasp the situation.  Finally the woman spoke up.  “Thank G-d you’re just some skeevy insurance agent.  We thought you had a gun.”

This could be our future if the Ohio budget includes this Zombie legislation.  Ohio Representative Bill Dean (R-71)  was the bill’s sponsor.  I plan to provide a copy of his testimony to every client who complains to me about insurance telephone solicitors bothering them at their homes or at dinner.  Some of you might think that I am exaggerating the risk.  Is the State of Ohio encouraging insurance agents to accost us?  This is from Representative Dean’s Sponsor’s testimony last year:

“The current rule, Ohio Administrative Code 3901-8-09, prohibits virtually all agent-generated communications with potential clients unless it’s through direct mail or if the potential supplemental insurance client is already a business client. Here are a few examples of how restrictive the current prohibitions are:

• An agent calling fellow members of a 65+ group at his or her church about purchasing supplemental insurance; 
• An agent sending a Facebook message about interest in purchasing insurance to someone they graduated from high school with 50 years ago; 
• An agent approaching a group of seniors enjoying their coffee at McDonald’s and asking them if they’re interested in chatting about supplemental insurance.

Unless the agent has an existing business relationship with these potential customers, all of these interactions violate the current rule in place.”    

Representative Dean wants to change that.  He failed last year and now his Zombie may be a part of our next state budget.

As I noted last year, I’m 68.  I get all of the solicitations from out-of-state call centers.  Most of them are illegal but somehow beyond the reach of the Ohio Department of Insurance.  It is annoying to have my cellphone ring at 7 AM on a Saturday morning.  We (seniors) may not have to answer the phone, but we do have to see who is calling us.  It could be important.  It might be a sick friend or family member.  We need less people hounding us, not more.  We don’t need someone knocking on our door, approaching us in a restaurant, or tracking us down in a parking lot.  Representative Dean thinks that Ohio’s seniors are being deprived of important purchasing opportunities.  He is wrong.  Here is his email – www.ohiohouse.gov/bill-dean.  Drop him a line, unsolicited, and let him know what you think of his annoying law that won’t die, his Zombie. 

Dave

www.cunixinsurance.com

Picture – It’s  A Trap – David L Cunix and A.F.