With the failure of the American Health Care Act—the House Republicans’ first attempt at repealing and replacing Obamacare—there will be more pressure on federal regulators like HHS Secretary Tom Price to “do something” to increase competition, expand plan options, and keep prices under control.
The Affordable Care Act delegated much of the responsibility for implementing the health reform legislation to government agencies like Health and Human Services, the Department of Labor, and the IRS. For the first three or four years after the ACA was signed into law, we eagerly awaited proposed and final rules on everything from the individual mandate and premium tax credits to market reforms and the employer shared responsibility requirement. Once we knew the rules, we could properly advise our clients and recommend solutions to help them comply with and, in some cases, get around the regulations.
To help combat the rising costs of health care we’re seeing a lot of new consumer tools emerge and growing in popularity. Services and tools such as telemedicine, healthcare pricing tools, and prescription discount cards. Some are offered on a stand-alone basis; others are incorporated into the health plans you’re already selling. Because these services are growing in popularity, we thought it was time for a quick update. In this post, we’ll get you up to speed on telehealth.
While there are variations among different telehealth providers, what these services do is give members the ability to visit with a doctor by phone or video conference and receive advice and some prescriptions, if medically necessary. The telehealth company works with a number of family doctors who take the calls and review the members’ symptoms, as long as the symptoms described are minor, the doctors are able to diagnose over the phone. Some of these physicians have their own practices and take calls between seeing patients; others work for the telehealth companies.
The American Health Care Act had only a 17% approval rating before being pulled without a vote on Friday, March 24. The legislation would have made a number of positive changes for Health Savings Accounts, but the good news for HSA fans is that Republican lawmakers have another shot at expanding these popular tax-advantaged accounts.
On February 15, the Health Savings Act of 2017 was introduced by Senators Orrin Hatch (R-UT) Representative Erik Paulsen (R-MN). This bill would make many of the same changes that were proposed in the American Health Care Act plus a whole lot more.
As we approach the end of tax season, there’s a lot of confusion about the tax filing requirements under the Affordable Care Act’s individual mandate, largely because Americans have received mixed messages about what the rules actually are.
On day one of his administration, for example, President Trump signed an executive order instructing federal regulators to take steps to ease the financial burdens of Obamacare, and the IRS responded by saying that the agency would not automatically reject 2016 tax returns that fail to answer the question about whether the individual or family had minimum essential coverage. We’ve also heard Republican lawmakers on cable news stations saying that they will soon be repealing Obamacare and eliminating the individual mandate. In the American Health Care Act, they tried to do just that: the AHCA would have reduced the ACA’s individual shared responsibility penalties to $0 beginning January 1, 2016.
On Friday, March 24, President Donald Trump and Speaker Paul Ryan made the decision to pull the American Health Care Act—the reconciliation bill that was designed to repeal sections of the Affordable Care Act—after it became obvious they didn’t have the votes to send the proposed legislation to the United States Senate. The House Freedom Caucus, a group of about three dozen highly conservative Republican lawmakers, is being blamed for the bill’s failure as the majority of its members refused to support the legislation. Their argument was that they had promised their constituents they would repeal and replace Obamacare but the Ryan plan stopped short of accomplishing that goal; instead, they referred to the bill as “Obamacare-lite” since many of the law’s provisions would remain.
Before deciding to walk away from the deal, President Trump visited with Freedom Caucus members, made some concessions, and then met with more moderate Republican lawmakers who were unhappy with the changes. In the end, it was clear that the party wasn’t united behind the bill, so instead of putting lawmakers on record with a vote for or against the unpopular proposal, President Trump agreed with Paul Ryan that it was better to withdraw the bill.
This is a question you may not have given any thought to. Insurance professionals tend to operate in a vacuum—sure, you see and talk with clients and prospects every day of the week, but unless you’re involved with an agent association, you may not interact with your colleagues or competitors very often, or encounter someone new to the industry. So why are we asking you how you would advise an agent who’s just getting their feet wet? That’ll become clear in a moment, but like many of us, you’re probably scratching your head trying to figure out what you would say to a new agent who asks for your advice. Maybe you’re thinking that you would tell them to RUN; after all, with all the turmoil in the industry, it may not be the ideal time to be entering the health insurance sales force. Or maybe your advice would be to take a path different from the one you chose.
A lot of the agents we work with at AHCP sell both individual and Medicare products. While they may have originally focused their attention on one of these two market segments, they realized somewhere along the way that there’s a lot of overlap in the way the products are sold. Agents who are successful selling individual health plans, for instance, catch on pretty quickly when they make the decision to sell Medicare Advantage and Part D plans, and vice versa.
To illustrate, let’s compare subsidized Marketplace plans with Medicare Advantage plans. For both products, there’s an annual open enrollment period when people can sign up or make changes to their coverage and then special enrollment opportunities throughout the year for those who qualify. There’s also a government-run web portal where agents can compare the available options before making a recommendation to their clients. With one exception for Medicare Advantage plans, both products are guaranteed issue and members are not required to answer medical questions. And finally, in both cases the government pays a portion of the premium, meaning that that the net cost to the member is a lot less.
Humana’s been making a lot of news lately. On January 23, a federal judge blocked the proposed $37 billion merger between Humana and Aetna. On February 14, the companies announced that they wouldn’t appeal the ruling and that that they were walking away from the deal they’d been working on for the last year-and-a-half. Then, later that same day, Humana made news once again when it announced that it would not be participating in the Obamacare exchanges in 2018. While the company will presumably continue to offer plans outside the Marketplace, it won’t be selling individual health plans eligible for a government subsidy through the federal or state exchanges.
On its own, this isn’t that big of deal. Humana had already pulled out of the Marketplace in a number of states. But now that the company has made the decision on a nationwide basis, it certainly makes you wonder whether this will be the first of multiple Marketplace exits by major insurance carriers.
In July of 2015, just weeks apart, four of the top five insurance companies in the nation announced that they would be merging with one of their big competitors: Aetna made an offer to acquire Humana for $37 billion and, in an even bigger deal, Anthem offered to purchase rival Cigna for $48 billion. Now, just a year-and-a-half later, following two adverse court decisions, both of those deals are dead.
You don’t have a job. Hopefully you know that by now. People with jobs simply trade time for money and may be doing something they don’t particularly like to help them achieve some larger goal. Students working their way through college have jobs.
You, on the other hand, have a career. Your goals, we hope, are more long-term in nature, and you actually plan to be doing the same thing five years from now. Insurance, you see, is a profession, and you’re an insurance professional. With that being the case, it’s worth asking the question – what steps can you take to look more professional? Here are a few ideas.