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Is the ACA Really Dead?

One year into Donald Trump’s presidency, most would agree that his biggest legislative victory is the recently-passed tax reform legislation. Tax reform was a top priority for the new president, and the bill’s passage helps President Trump fulfill an important campaign promise. Two promises actually:

  1. While running for office, candidate Trump promised to cut taxes, and though many worry that the new tax law benefits corporations and the wealthy much more than it benefits the middle class, the bill does provide at least temporary tax relief to a majority of Americans.
  2. Embedded in the tax bill, though, was a repeal of the unpopular individual mandate. As a candidate, President Trump had promised to get rid of the mandate, and the bill he signed into law on Friday, December 22 makes good on that promise.

To hear President Trump tell it, though, the new law not only repeals the individual mandate but actually kills the ACA altogether.

Millions May Qualify for Special Enrollment

As you know, the Affordable Care Act gives people the opportunity to purchase or change health coverage during the ACA’s individual open enrollment period. And, as you also know, the 2018 open enrollment period was only half as long as last year’s. For 2017 plans, people had three months to sign up; for 2018, they only had six weeks. The open enrollment period officially closed December 15, 2017.

BUT—and this is a big one—millions of people may still be eligible to select an individual health plan for 2018. That’s because the Affordable Care Act gives people who have certain qualifying events an opportunity to purchase health insurance during a 60-day Special Enrollment Period (SEP).

Status of the Individual and Employer Mandates

When the Affordable Care Act was signed into law nearly eight years ago, there was a lot of criticism about a number of different provisions. Some said that the guaranteed issue rule, while noble in its goal to allow anyone who wants health insurance to buy health insurance, would lead to adverse selection and higher insurance rates. Others said that the premium tax credits and expanded Medicaid would blow up the budget. And still others said that the modified adjusted community rating provision would hurt a carrier’s ability to rate based on risk. Even with all that criticism, it could be argued that the two most controversial and unpopular provisions of the massive health care law were the individual and employer mandates. And now, eight years later, those two provisions are both in the news again.


By now you’ve certainly heard the news: CVS has announced plans to purchase Aetna for a record $69 billion, the largest-ever merger in the health insurance industry. CVS currently has roughly 10,000 pharmacies, and, if approved, the deal would allow the pharmacy giant to offer health care services and prescriptions to Aetna’s 22 million members.

Approval isn’t a certainty. As you’ll recall, the proposed mergers between Aetna and Humana and between Anthem and Cigna were both shot down by the Obama Justice Department because of the fear that the mergers would limit competition and reduce consumer choice in a number of markets. We don’t yet know how the Justice Department will respond to the CVS-Aetna deal. It is worth noting that we have a different administration with a very different mentality now, so it’s possible that there won’t be much pushback, especially since this merger isn’t between two carriers but rather between a carrier and a retail pharmacy chain; since it’s a vertical acquisition, it shouldn’t have the effect of limiting competition.

2017 Year-End Wrap Up

As we near the end of another year, it’s time to close the books on 2017 and look ahead to 2018. As we do, it’s helpful to review the big news stories from the last 12 months and determine whether they’ll carry over to the next calendar year or just be interesting moments in history that we can look back on but stop worrying about.

It certainly was an eventful year, one that’s worthy of a series of articles, but we’ll keep it as short as possible. And instead of a timeline of events, we’re separating the big health insurance news stories into two categories: 1) over-and-done-with and 2) ongoing. Hopefully, you’ll find this beneficial as you map out your success strategy for 2018.

What type of coverage do you have?

We know—that’s a weird question, but it is a relevant one. Insurance agents don’t just sell individual and group health insurance policies; most are also covered by one. And that means that many of you are facing the same challenges that your clients have: finding an affordable plan that protects you from financial loss and covers your doctor visits and prescriptions. The trouble is, plans that check off all of these requirements are pretty rare, so you probably have to make some of the same sacrifices as your clients.

Ask yourself these questions.

New People Are Signing Up For Marketplace Coverage

In the insurance industry, we all know that the main reason to purchase health insurance is because we’re unable to predict the future. Unexpected and potentially catastrophic injuries and illnesses do happen, and when they do, people with health insurance tend to fare much better financially than those without.

The Affordable Care Act (ACA) created some additional incentives to purchase health insurance:

  • Plans are guaranteed issue, meaning your clients can’t be turned down.
  • Pre-existing conditions are covered with no exclusions, waiting periods, or surcharges.
  • Premium tax credits help people with incomes up to 400% of the federal poverty level pay their monthly premiums.
  • Cost sharing subsidies reduce the out-of-pocket exposure for those with incomes below 250% of the federal poverty level.
  • Essential Health Benefits ensure that today’s plans meet people’s needs.

Yet, some people dismiss all of these great reasons and choose instead to remain uninsured.

The Medical-Dental Connection

As a general rule, people don’t like health insurance. It’s confusing, the premiums are difficult for many people to afford, and those without serious or chronic conditions may never hit the deductible, reducing their perceived value of the plan.

Most people do, however, like dental insurance. For them, dental coverage gives them the possibility of healthy, attractive teeth, and that can have a big impact on their self-esteem. Just do a quick Google search for “nice teeth self-esteem” and you’ll find a plethora of articles that discuss a connection between a person’s oral health and their general well-being. An article in Mental Health Matters puts it this way: “Our teeth can influence how we look, speak, eat, chew, taste, socialize, and enjoy life. If you have a healthy mouth, you are more likely to have greater self-confidence.”

For these reasons, a lot of people are happy to invest in dental insurance. It’s a tenth of the price of health insurance, provides more first-dollar benefits than most health plans, and can have a big impact on a person’s quality of life. If you’re not offering health insurance to those who ask you about it, you’re missing an opportunity and may be doing a disservice to your clients. Fortunately, AHCP has a number of dental options if you’d like to add them to your portfolio.

One Last Political Update (for now…)

What a crazy summer it’s been for the health insurance industry. Since it appears the “repeal and replace” efforts are done — for now, anyway — we thought we’d provide a quick recap of what happened and, more importantly, what didn’t’ happen. We’d also like to take a look at what happens next. After all, we’re entering the Open Enrollment period for the individual market, and this one promises to be unlike any we’ve seen before.


With all of the news about the CSR (Cost Sharing Reduction) payments, which President Trump halted on October 12, your clients are probably asking you to explain what exactly happened and, more importantly, how it affects them. It’s easy to understand why they might be confused—this is a political issue, so many of the reports on the topic are one-sided arguments from people who may have their own agenda.

Here are a few talking points that will help you explain the issue to your clients.

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