I apologize for the delay in writing.I finished my last Blog in March, just before the birth of our baby boy and that fourth one definitely put a wrench in the routine!
But I’m back to some semblance of normalcy now. There has been a ton of activity in Lansing recently regarding the exchanges.
The Exchange Workgroups Recommendations Released June 17
The work groups wrapped up in March to very little fanfare.MAHU took the quiet time to begin to lobby the legislators regarding the activity we experienced.We have been very successful in communicating our main concern—that the workgroups never gave the question of insurance agents just due.
Each workgroup session began with a series of questions that would be addressed that day.Then the coordinator would take the group through a dialogue based on those questions or topics.Never, ever was the question of the role of the agent or navigator specifically addressed.It was almost assumed by the organizers that the navigator would be the prime distribution arm.We are very disappointed because the recommendations to the law makers reflect that lack of agent inclusion.
In the 53 page document, agents are mentioned a few times.Once, on page 28, agents are mentioned as a group that could be useful in ‘getting the word out.’I might add that we are neatly snugged up between financial advisors (okay) and barbers and beauty shops (really?).
On another page we are listed as a group who would need training on the exchange.Hmm?
And finally, on page 41, agents are not explicitly listed but we are basically implied.Here in the regulatory model language for the law, it is stated:
The Exchange may contract with or enter into a memorandum of understanding with an eligible entity for any of its functions described in this Act. An eligible entity includes, but is not limited to, the [insert name of state Medicaid agency] or an entity that has experience in individual and small group health insurance, benefit administration or other experience relevant to the responsibilities to be assumed by the entity, but a health carrier or an affiliate of a health carrier is not an eligible entity.
I called the consulting firm who wrote the recommendations and asked them if the bolded language included health insurance agents.They told me as long as agents receive compensation from any carrier they would not be eligible to contract with the exchange.
They did graciously remind me we could apply to become navigators.
Remember, a navigator in this law can basically be an unlicensed entity who cannot be paid by any carrier.It must be paid by the Exchange.
Also remember, within PPACA there is specific language regarding agents and the Exchange:
Section 1312, Consumer Choice:
(e) ENROLLMENT THROUGH AGENTS OR BROKERS.—The Secretary shall establish procedures under which a State may allow agents or brokers—
(1) to enroll individuals in any qualified health plans in the individual or small group market as soon as the plan is offered through an Exchange in the State; and
(2) to assist individuals in applying for premium tax credits and cost-sharing reductions for plans soldthrough an Exchange.
(Such procedures may include the establishment of rate schedules for broker commissions paid by health benefits plans offered through an exchange.)
The organizers of the workgroups chose to disregard this language in the meetings and in the recommendations.
Do We Have Your Attention Yet?
These are recommendations only.They are not a signed law.They are not even a proposed bill.
Recently MAHU hosted a ‘Storm the Hill’ event in Lansing.There were about 55 members present to discuss with legislators the need for insurance agents in the exchange.
In addition, just this past Wednesday, June 22, MAHU, along MAIA and MI NAIFA hosted an Exchange 101 for legislators to come learn about the Exchange and what it should be, could be and who it should include.Elaine Coffman, a member from Metro Detroit along with Mike Embry presented and presented powerfully.
This event was organized by House Representative Gail Haines who is the Health Committee Chair.I met Gail at the ‘Storm the Hill’ day and she told me she basically was on board for most of what she was hearing from Chris Priest minus one thing—he thinks he can do it without agents.
Gail is a major ally.She will be asking to write the bill that will become the exchange law.She has asked MAHU to be an essential advisor when attacking this undertaking.
She and her colleagues need to hear from you!They need to hear from your groups.
So What Are You Going to Do?
Wait for the Supreme Court to vote it down?
Look for a new job?
Spend some real time and money to ensure we get written into the law?
What can you do?
Join Health Underwriters now. We are your voice in Lansing.No one else is talking agents first:www.mahu.org.
Donate money to our legislative efforts, specifically adding to the war chest for communicating with the legislators.Events like the ‘Exchange 101’ and ‘Storm the Hill’ take real money and we need it.We have Cusmano Kandler and Reed, our lobbying firm, working hard for us.We can pay them more and extra with donations.
Call your local House Rep and Senator and make an appointment.It is extremely easy.Think of calling on them like you do your clients.Call their office, get an appointment, go down and explain how crucial you are to the system.They have office hours in Lansing and in your District.Don’t wait!
The last thing you can do is mobilize the base.You all know other agents in the industry.It is time to start organizing yourselves again.It is time to attend your local meetings, to share vital information, to bring ideas then step up to enact them.
We will be holding another Storm the Hill.Be sure to get there.This past session, we had 10% of our membership and less than 1% of the agent population of Michigan attend.Pretty disappointing.What reason do any of us have for not descending on Lansing when called upon?
IF NOT NOW, WHEN?
If you have questions or comments, don’t hesitate to contact me or anyone else on the State Board.
March Madness it seems is not a term reserved only for basketball.This has been the month of the Exchange meetings and a ton has been discussed.I apologize that it has been so long since my last post.I have been attending to family affairs as we have a new baby boy in the household.
There have been several meetings since my last post. Here is a review from our various participants:
The Governance Work Group met again on February 18, February 28 and on March 10.Here are the topics discussed and their outcomes:
Should Michigan employ one exchange for both individual and small group? The answer was a resounding yes. One website, one organization split into two.
Should there be two separate risk pools for individual and small group? This was contentious. All the insurance people definitively said ‘yes, that these two types of purchasers buy insurance for different reasons and for the health of the small group pool, they should be split.’ The non-insurance people believed that more people means a bigger, healthier pool. The vote was grid locked and no consensus was reached.
Should the exchange be a private entity or a governmental body or a mix between the two?It was voted that the exchange would operate as an independent public authority.
Finally, we voted on the make up board of trustees who will govern over the exchange. The work group reached no consensus on this vote until the final meeting on March 10.Here’s how the governance board will be constructed:
13 members to be made up of:
5 buyers
5 sellers
3 experts
3 state people
1 – insurance commissioner - ex officio/nonvoting
The Governor’s office will have the responsibility of appointing the board and it may end up having to consult the Senate.The Board will hire an executive director of the Exchange.The Board will hold open meetings in accordance with the Freedom of Information act.
The Technology Work Group met on Thursday, February 24 and March 10.Here is the report from Karl Albrecht:
Meeting 1:We had our first Technology Workgroup meeting today. It was interesting and frustrating. A good number of special interest, community and specific issue contingencies were there. I knew a few folks there including the NAIFA person fairly well.
Right off the bat we started with how to market the exchange. This devolved into a conversation and talking points as follows:
Typically you have a product and you market that product to create demand. Legislation creates the demand so why would the State spend resources creating elaborate marketing efforts that has been decreed by Washington? Secondly why is Technology discussing marketing channels and methods?
The debate went on for a bit about making recommendations as to methods of marketing and leaving it to another group as to what to do. I haven't checked to see if the formal notes have been posted but a vote was taken and we moved on.
A lot of talk was over a "call center". It was pressed that the call center required under the law is for technical assistance not education and facilitating. Agents could do this in a dispersed call center versus an expensive brick and mortar state run call center. There seemed to be real hesitation by all in the room, except OFIR folks, at having a call center run by the State. This was left mostly open but there may be a very good opportunity here to work with the various advocacy groups to support agents. Why? Agents are paid to perform a job. In the past most of the constituents of these groups could not easily obtain coverage and making a living was impossible for an agent. They may volunteer but they have to feed their families. NOW it's possible that these at risk and underserved populations can have the SAME professional advisors that others have enjoyed for years! I think it's possible to get some support as they can see what could be provided locally and statewide. OFIR indicated that they should be point on the Navigators and Brokers as "they license" agents. Good tone about the need to ensure those providing support are known by the state and approved by the state....AGENTS!
The second item we discussed revolved around State systems needing interoperability with the exchange. After each group in attendance was listed as very important (groups on aging, county and some community groups) the questions was raised (yes I raised it) "NONE of these are state systems they're all other types of groups and do they even need interoperability or simply the ability to refer them over easily?" So the decision was made to make it "any" group needing interoperability. We added agents/brokers to the list. Then noted that the list was a good one of "in's" but the purpose is to get coverage. Where are the insurers interoperability? We were running out of time and things got a bit sketchy as this made little sense. So the facilitator indicated that "we aren't ready for them" and I understand we'll address this in the future.
One really interesting point of this whole discussion is this. The mission of so many of these advocacy groups is helping their constituents get coverage. With an exchange they may now ALL be obsolete and redundant. Some eyes got really wide at that thought.
Meeting 2:
The Tech meeting was interesting and a bit troubling.
This group is comprised of many special needs, at risk and or specific disease interest groups. The focus of our first meeting was on what State technical systems might the exchange need in order to validate and/or enroll new members. This meeting continued this discussion and a brief overview was given of many of the state systems and what they do.
Long and short of it- It seems that every interest views the role of the exchange as one to cover their constituents and/or anyone with health conditions or having difficulty gaining coverage. While it’s true that this is PART of the objective of the exchange there was zero focus, and little interest, in the other 80% of potential enrollees, the average Michigan citizen, without significant health problems looking to acquire coverage. Although this has to change the path right now is one where, from a carrier’s perspective, participating in the exchange is not a real attractive thought. Insurers are viewed simply as a money tree. As far as understanding the “balance” needed (it needs to at least roughly make business sense) there seems to be a real disconnect here.
I do believe there’s an opportunity that perhaps we’ve overlooked. Agents have never focused on any of the special risk populations as, running a business, Agents need to focus on areas where they can make a living and/or the hurdles are not too high. This has meant that these groups have been denied the services of professional agents. I can imagine a scenario where these groups would embrace agents as, should the exchange allow commissions, their constituents could now receive the professional attention and value the rest of the market has had.
Keep in mind that I also believe some of these groups feel either threatened (the exchange takes away their purpose) or anticipate a further windfall. The windfall is attempting to fill the role of the “navigator” and generating revenue. The Insurance Bureau seems unlikely to support anyone but Agents being compensated but that’s just my inference from their comments. They feel it’s important to regulate the distributors and I’m sure we all agree with that stance.
The Regulatory Work Group has met twice.Cathy Cooper’s recap is below:
My workgroup met last Friday and we went through the model legislation, section by section, making recommendations and striking language. We skipped the sections that were dependent on decisions from some of your workgroups and stopped right before diving in to the Navigator section. I spoke to Gary on Friday after the meeting because I was concerned about the makeup of the group--heavy with providers of healthcare, unions, and consumer groups, weak with people who are familiar with the purchase of healthcare--and I was feeling that the ability to get consensus among that group when asking to add navigators that need to be licensed insurance agents, was slim. I felt that we need the insurance carriers, like BCBSM, to talk about the value of agents in front of this group to help shift consensus in our favor. However, even if this does not happen, Gary said we can propose other legislation that would have that language in it, so this is not the end. Scott Hummel from MAIA was there in Val's place and he is working with us to call some other carriers on our workgroup. Also, I did post the Iowa legislation in our workspace so that should help with the discussion next week. If you have any questions, let me know. Thanks!
The Business Operations work group has met twice as well. Here are comments from Elaine Coffman.
Role of the Exchange
The first was focused around the role and staffing of the exchange. The discussion around the role of the exchange focused around the pros and cons of three possible roles: Market Organizer/Distribution Channel, Selective Contracting Agent, or Active Purchaser.
As a Market Organizer/Distribution Channel, the exchange’s role would be to effectively bring exchange products to the end consumer, requiring exchange products meet the minimum requirements of PPACA (which are quite extensive) as well as all OFIR requirements.
As a Selective Contractor, the exchange would effectively add another layer of requirements to PPACA and OFIR to “select” or “limit” plans based on various criteria (quality, adherence to state health policy initiatives, size, meeting outcome metrics etc). Under this model, the exchange could also set a maximum number of carriers and plans, limiting the choices to consumers so that the purchase process wouldn’t be as overwhelming.
As an Active Purchaser, the exchange would actually have plans bid for their role on the exchange, negotiating price on behalf of its members.
The group voted with a clear majority that the Michigan Exchange should serve as a Market Organizer/Distribution Channel, allowing market forces to determine plan offerings and exchange winners. Individual purchasers will have more choice, which has positives and negatives, but should hopefully limit extra overhead costs at the exchange and internally at the carriers by not expanding to an RFP or additional requirements beyond the law. It should also promote creativity among the plans competing for membership.
The second question involved input of the staffing of the exchange. Instead of formally recommending an organizational structure, the group focused on the principles that should guide the exchange structure versus giving titles and positions to the exchange staffing positions. Flexibility, modifications, and a customer service focus were important. Formal titles and bureaucratic structure was less preferable than a flatter, more flexible organization. We also discussed what components of the exchanges functions could be outsourced. The output was several documents on the functions of the exchange with input that many functions could be outsourced, especially in the early years as staffing is more volatile and as companies may pop up with specific expertise (i.e., certification that plans meet PPACA requirements will be the same across the country, so maybe this is outsource…don’t know yet).
Adverse Selection
The second meeting was a discussion about adverse selection. An actuary from Mercer, who HMA has hired through the State contract, was at the meeting and provided good insight and education on this topic to the non-insurance people in the room.
The discussion was complex and the group was tasked to answer the following questions:
Should Michigan require insurers that offer insurance products outside the Exchange to participate in the exchange?
Should the state require carriers to offer all levels of coverage both in and outside the exchange?
Should Michigan adjust the regulation that all insurance plans comply with the standards established for Exchange Qualified Health Plans?
If Michigan opens its Health Insurance Exchange to large groups in 2017, should Michigan purchase coverage for State employees through the Exchange?
There was good discussion on each item, but no consensus (majority vote) on any of them. The first 2 questions were asked separately for the individual market and the small group market. More people voted “NO” on the first 3 than yes, but not enough for a majority. The 4th question has a majority vote as “I’m not sure” as the group didn’t feel this was the forum or time to make such a decision. We will not discuss this any further to try to reach a majority, but the conversation and final votes will be documented in the final report.
Note that this conversation focused on answering these questions relative to what was good for the exchange, which may not necessarily be the same thing as what is good for the market as a whole, or for Michigan businesses. There was no discussion of the adverse risk created by individuals coming in and out of the market, the adverse risk of employers choosing to self fund and avoid the new insurance market rules, or the impact some of these decisions may have on pushing employers to drop their plans altogether. Nor was there a discussion regarding the adverse risk created by the exchange subsidies, where healthier people will likely take lower cost plans. We did talk about the “risk adjustment” process created by PPACA whereby all plans/carriers in and outside the exchange will have their enrollment evaluated based demographics and health status. Plans with a better mix will make payments to plans that have a worse mix. This will be a complex process and won’t likely make up for all the risk selection that may occur in the market.
In Summary
It seems the best we’ve gotten out of these workgroups is that we’ve been present with very strong people who have added positively to the dialogue.All of us are frustrated with the process somewhat but we have all seen it as positive overall.
The work groups come to a close over the next few weeks and I’ll give another update.
Already, Gary Reed is working the legislators in the House and Senate as the real work will be done there.We had great movement in the fact that Gail Hanes, a Republican House member, asked MAHU to do a presentation on the Exchanges to the entire House.We’ll work that angle hard and try to position ourselves as a resource.
More to come!
Michigan Association
of Health Underwriters
Exchange Blog—February 16, 2011
From NAHU Exchange Liason: Dominic Siciliano
Happy Valentine’s Day!
As I write this today, we have several people working on our behalf in Washington in the Capitol Conference. It sounds like they are having a great time, hearing some dynamic speakers, but most importantly doing some important work representing us with our legislators.
Back in here in Michigan, MAHU has been doing yeoman’s work in Lansing as it pertains to the Exchanges. It was a whirlwind a few weeks ago as news starting to trickle out about who was appointed to the Exchange Work Groups. We were pleased to hear that MAHU had five members appointed to the work groups. They are as follows:
NAHU Exchange Liason, Dominic Siciliano, Governance Work Group
Incoming President, Cathy Cooper, Regulatory
Region 3 Vice President, Mike Embry, Business Operations
Former MAHU and MDAHU President, Karl Albrecht, Technology
MDAHU Member, Elaine Coffman, Business Operations
Legislative Chair, Pat Pennefather, Designated Hitter When Necessary
In addition to MAHU, insurance agencies have strong partners represented as well.
SBAM: Rob Fowler; Scott Lyon; Jeff Thomas; Don Vroon (Grotenhuis)
MBPA: Jennifer Kluge, MBPA has representation in four work groups
Michigan Dental Association: Craig Start, agent
MAIA: Scott Hummel MAIA Lobbyist; Ryan Root, West Michigan agent; Valerie Kramer, Metro Detroit agent and MAHU Board Member
NAIFA: NAIFA is represented in four work groups and represented among others by Chuck May, health agent from Kalamazoo; Carolyn Miller, health agent from Mt. Pleasant;
Our lobbyist, Gary Reed, is meeting each Monday with the lobbyists from both MAIA and NAIFA to ensure we are all working on the same page. We have been in constant contact with SBAM and the MBPA and we believe we are all moving in the right direction. MBPA has officially written memos to both OFIR and the Michigan Department of Community Health that their association believes the only way for exchanges to work is to utilize the services of independent, licensed agents.
A Run Down of the Meetings So Far
The first work group, Governance, met on Wednesday, February 9. There were about 30 people represented as voting members of the workgroup. These people represent different consumer groups and State-based agencies of size and shape. Some groups of note besides the ones I mentioned above were the MMA; MSMS: many Community Health organizations; HAP; MESSA and BCBSM.
It was interesting to hear the conversation because much of it centered around Medicaid. That makes sense because State-based organizations are so focused on that subject. I was encouraged though the group and the proctor, Public Sector Consultants, were open to listening to my point of view and that of SBAM and other business associations that bring the perspective of the small business.
I was encouraged by the meeting as I believe we got some very good things accomplished. I was also encouraged because I believe we can be a positive educating force and we can help shape the conversation. I was nervous heading into the work groups that this would not be the case.
Here is a review of what we covered and decided:
We voted that Michigan would adopt its own State-based exchange and one centrally located exchange. The question on the table was whether we should join other states or let the Federal Government run it for us.
We voted on whether the exchange should be a state-run, quasi state, non-profit run organization or a full non-profit organization. We were not able to come to consensus on this issue but we did vote that it will definitely not be a full state run organization. We may come back to this discussion but right now the group is okay with it being a quasi-state entity or a full not-for-profit governed by a board of trustees.
Determined the core functions of the exchange. The keys that we were able to add input to were consumer protection and knowledge of current private insurance markets. The biggest single factor we can rely on for including agents in the exchange is consumer protection. We continue to give anecdotes of the dangers of leaving consumers out to purchase health insurance as a commodity. Imagine showing your clients a spreadsheet of plans and asking them to choose one without your input. How would they determine the network, the nuances, the merits of the health plans before them?
In addition we were able to remind the group that the exchange will be extremely adversely selected if agents are not compelled to show it to their clients. I believe we were successful laying down these two ideas.
The Business Operations Meeting met Friday, February 11 and Elaine Coffman and Pat Pennefather were able to attend. Below is an account of what they learned from Elaine Coffman:
The Business Ops meeting was interesting. We took votes on two issues, confirming by more than a two thirds majority that there should be a market for individuals to purchase coverage both in and outside the Exchange (18 of 26 in favor, three undecided, and five opposed) and there should be a market for small employers to purchase coverage both in and outside the exchange (19 in favor, three undecided, and four opposed).
I'm going by memory on the votes, but I'm sure about the "in favor count" and total count of 26. I'm not sure if we have only 26 people on the work group, or if there were 4 people not in attendance, but depending on the make up of those additional four it could put our 18-19 count that seem to have similar views on many issues under the two third’s majority in future votes, requiring more support from the undecided on future issues.
The other issue that we discussed but didn't vote on was about the "certification" requirements for carriers to be allowed to offer products in the exchange. I thought the facilitators did an excellent job of facilitating the process, but it is a little concerning that there is some pre-disposition on some of the issues. When we originally began the discussion, the term being used was how plans would be "selected,” implying that the exchange itself would function as a purchaser and gatekeeper. Note the document given to the group on this was called "Selected Implementation Issues for Health Insurance Exchanges Under ACA" that focused on the certification requirements versus another document called "Questions Regarding State of Michigan "Best Practices" in Procurement/Health Plan Selection.” The second document was what they used to kick off the conversation.
In their comments they indicated that the State has directed HRA to interview Mi Dept of Corrections, Medicaid, SCHIP, and the State Employee and Retiree benefit system to help in the recommendations. There will likely be a separate deliverable from these interviews that will be a part of the recommendations and could skew the "certification" versus the "selection" role of the exchange. This may be a big deal.
Some in the group clarified that the exchange should be certifying plans, not selecting plans as they did in Medicare Advantage. Kirk Roy of BCBSM gave the group parameters that he felt would cover the basics for certification and my guess is that his suggestion will get a favorable vote next meeting. In essence, it says that if a plan meets OFIR's requirements, meets HHS's plan requirements, agrees to provide the reporting/data elements required by the exchange, and makes a commitment to be operational to sell business within the exchange by appropriate deadlines, then any plan should be allowed to sell their products in the exchange.
In another instance of pre-disposition of the facilitators, there is a document called " The Exchange As Exclusive Distribution Channel for Individuals and Small Group Health Insurance Products: Advantages and Disadvantages". Out of four disadvantages, one of them is "Impacts on Insurance Producers and Other Distributers of Health Coverage: exclusive provision of health coverage through a Health Insurance Exchange would significantly diminish the ability of insurance producers and other sources for health coverage (like trade associations or chambers of commerce) to provide assistance to small businesses seeking health coverage. Many smaller firms have long-standing relationships with producers and many very will want to continue to utilize these sources to purchase health coverage."
Several in the room questioned why this was on the document, as it is our understanding that producers are able to sell through the exchanges. The facilitators did assume that the role would be diminished and were not sure of the role of brokers when question. Pat set them straight that brokers/agents are specifically allowed by ACA to sell products in the exchanges, which again, they didn't seem clear on. There was confusion about the role of navigators, which I think are paid by the exchange, versus role of agents/brokers. We will have this clarified by our next meeting. This didn't affect the vote, but we want to work on modifying documents so that this is not assumed in future documents or references to the exchange structure.
The next work group is Governance again and it meets Friday, February 18. For a complete listing of the work group schedule, click: Exchange Blogs here.
More to come in a week!
Michigan Association
of Health Underwriters
Exchange Blog—February 2011
From NAHU Exchange Liason: Dominic Siciliano
Happy New Year!
I am writing all of you in earnest to begin this New Year. I have heard from a handful of you who are frustrated and disappointed and brimming to get the word out to get something done. You have heard very little lately in terms of news out of Lansing about where we are with both the MLR waiver in Michigan as well as the Exchanges.
First the Minimum Loss Ratios—
Even though this is the Exchange Blog, it is important to reference the work we’re doing on the Minimum Loss Ratio issue.
One thing agents continue to ask me is,
‘What are other agents saying or thinking about this?’
This varies. Some of you are indifferent; most of you are gravely concerned.
In one of my recent blogs, I included a memo from Jamie Mills who outlined Aetna’s new commission policy and her concern this might begin a trend (December Blog attached). Jamie has followed up on that memo. I am excited and proud to report that Jamie has donated $5,000 to help the legislative battle in MAHU. She wants the money to go to funding a ‘Storm the Hill’ day in Lansing where all the members of MAHU descend on the CapitolBuilding and educate our lawmakers about our industry and our importance within it. MAHU has planned this day for May 25th, 2011.
Jamie has been attending national brokerage seminars where she is networking with other insurance agents from other states. She has heard the effect of MLR on agents in other states, maybe in states with more for-profit carrier dominance.
These minimum loss ratios are a real threat to the insurance agent distribution system. So, that being said—here is what MAHU is doing. We know the single best thing Michigan can do is to ask for a temporary waiver for the provisions of the MLR to be pushed back. MAHU met with Commissioner Ken Ross the week before Christmas. He asked at that time for data to support our concerns which we did that same week. Following the New Year we followed up with the commissioner’s office as to what they were going to do. The response was that Commissioner Ross is slated to hold his post until 2/12 and he was not inclined to ask for the waiver as he feels like that should be a decision for the new commissioner. They also told us that the information we received was good but they were going back to the carriers for more data.
Refusing to let that be our final answer, we took our conversation to the House and Senate as well as to Governor Snyder’s office. The key players in the House and Senate are:
Senate Health Policy Chairman, Senator Jim Marleau
Senate Insurance Committee Chairman, Senator Joe Hune.
House Insurance Chairman, Representative Peter Lund
House Health Policy Committee Chairman, Representative Gail Haines
We spoke with Peter Lund as well as the Governor’s Chief of Staff Dennis Muchmore. Both men indicated the best idea was to have Peter Lund send a memo to Ken Ross urging him to apply for the waiver. We have sent that memo to Peter Lund and await his response. MAHU has meetings with all four legislators above on February 9 to discuss both the MLR and the Exchanges.
As for the Exchanges. . .
Delay, delay, delay. That was the tone in Lansing as all the new folks got acclimated. As I reported last month, the administrator was appointed to organize and gather data for the work groups. Finally, late Tuesday, January 25th, we did receive the work group schedule (attached).
As you can read, the schedule and pace of the work groups is very aggressive. There are five topics and they meet a minimum of four times each. We have learned that we can only send one to each set of meetings and that person must commit to being at every meeting. MAHU’s Executive Committee has met and in conjunction with the three legislative chairs, we have selected the following folks to represent MAHU:
Incoming President, Cathy Cooper
Region 3 Vice President, Mike Embry
NAHU Exchange Liason, Dominic Siciliano
Former MAHU and MDAHU President, Karl Albrecht
MDAHU Member, Elaine Coffman
We believe we have selected five people who have been through the legislative wars before and who bring a unique set of skill set to each work group. Still, there is no guarantee we will be selected. We know our friends in the industry, SBAM, MBPA, Detroit Regional Chamber, NAIFA, MAIA were all represented in the fact finding meeting on February 1. We will stay in contact with these folks as aids should they be selected to some committees we miss out on.
We will communicate continually as these work groups get underway via email. We will also post everything to the MAHU website (mahu.org) We know that the work groups are simply the first stage and this conversation will move into committees at the House and Senate level where we are sure to see more work group meetings. Still, our involvement is paramount as we work to begin to shape the discussion.
Curious about our talking points, please see my recent Exchange Blogs here. However, the best outline of our talking points is attached.
There is reason for hope as that we will be successful in this work. States such as Iowa and Utah have bills that have passed or in the process of passing that state any insurance purchased in the exchange must be through a licensed agent and the commissions must be at a certain threshold
What can you do to help:
Many of you have already emailed me that you’d like to volunteer for a certain meeting. Although we have already solidified these positions, there is still so much you can do. I have been working and connecting with a group of MAHU members who have stepped up and asked to help in the Exchange process.
Karen Kilpatrick, Julie Balgooyen and Susan Emery are three members from three corners of the State who came together to create a survey that we sent out to all of you.
We asked you the details of your business: how many you employ, the services you perform daily, etc. About 400 of you responded and the data is powerful. We will utilize this data in the work groups to outline why there will be no need to create new brick and mortar to distribute product in the Exchange.
In addition to these three folks, Laura Miller and Anthony Fracchia wrote a great memo we will be sending to all the Chambers and Associations asking for their support as we wok through the Exchanges. Still other members, Craig Start, Joe Biermacher, Kurt Buursma and many others have offered to utilize their contacts either with Representatives in Lansing or with the Public Sector Consultants working through the Exchange to help the cause.
These work groups will be only the first run. This debate will travel to the House and the Senate at which point we’ll need everyone to pepper their representatives and explain the value of the agent in this system. But you don’t have to wait for that moment. Do it now. Write a letter, make a call. Lay the ground work for our conversation.
A month has passed since my last Blog and we’ve taken some good action but the work is going to begin very soon.We just learned yesterday that Health Management Associates out of Lansing won the bid.This is the company who will organize and run the five work groups who will convene to discuss the exchange and how it should look in Michigan.We know very little about this company right now but we are working hard to figure them out and to create an inroad.To be clear, this is not the company who will run the exchange but who will organize, run and report the data from the work groups.
Their website is http://www.healthmanagement.com/default.asp.They are a nation-wide consulting firm that is made up of former State Department of Community Health and Medicaid officials.Upon first blush, this may seem scary but by all initial accounts, they look like they do a ton of research work and they are extremely knowledgeable and politically neutral.I’ve included an attachment that outlines some of their previous work.It includes a link to a speech one of their members gave to the National Governors Association concerning Exchanges.It is by and by on the right track to what we will be working for.All of us feel like we will have a schedule for these work groups set around January 1.
MAHU’s Plan of Attack:
Each of the four Legislative Chairs from our four locals along with State Legislative Chair Pat Pennefather and I met Tuesday the 30th to discuss our plan.Our objective here was to create MAHU’s talking points for the Exchange Workgroups.Our initial topics included:
·Do we pursue language in the exchange that dictates agents much be used or language that leaves it up to the carriers to decide?
oLanguage surrounding commissions
oTalking points for the value of an agent
§Healthy folks entering pool
§Service
§Local business
·Small Market versus Individual
·MI Exchange versus Regional versus National
·Non-profit entity versus State Run
·Utah Model versus Mass Model
We landed on two strategies that all could agree on.First, we decided to create a five bullet talking point white paper about why agents are essential to the system.I have begun this white paper and a rough draft is attached to this memo.Also attached are two white papers that other states have used in their work groups.The first is “Americans Deserve Access to Agents and Brokers in Health Care Reform” and the second is “Unhealthy Exchange Pool Risks Results from Wrong Assumptions of Consumer Behavior.”Both of these papers are very powerful in outlining why agents are necessary in the system.My white paper is entitled “Michigan Citizens Deserve Access to Agents and Brokers in Health Care Reform” and it outlines our five bullets we hammered out as to what we bring to the system.This paper is not finished.It is a work in progress but you can see what points we will be presenting in the work groups.
Having that base created, we now have to come to consensus on what type of exchange we would like to see created.I was on the NAHU Exchange Liason conference call last week and it sounds like NAHU will be issuing model language for this.We in MAHU have been impressed by Utah’s exchange.Troy Duimstra, West Michigan Leg Chair, attended the AHIP Conference in Chicago and has access to the two Health Underwriters in Utah who helped put it together.Troy has brokered a conference call with these guys and we are going to see what we would take from this system to recommend in the work groups.Essential questions to ask in that meeting:
How did the role of agents change once the exchange was introduced?
Who set the compensation for products within the exchange and who pays it?
Who is responsible for assessing the risk in the exchange for all carriers involved?
Who created the framework technology behind the exchange?
What has worked, not worked, what would they like to see improved in their model?
How did they ‘sell’ it to the government officials?
I did some studying on my own and some hard core listening on the NAHU Exchange Call last week and I discovered something about Utah that was an ‘ah hah’ moment.The Utah Exchange was designed as a place not only individuals could go to join a large pool but also individuals within small groups could go to do the same.The Exchange allows small employers to offer a true cafeteria of benefits and carriers where each individual within the group can take the employer contribution and purchase the health plan brand and product that most suits his/her individual needs.This is a pretty progressive idea as it puts the onus completely back on the employee and puts him/her in the driver’s seat.It is a big leap from our small business system in most of the country where employers select maybe one or two options from the same carrier and there you go.Employees are subject to the increases from the carrier and from the decisions of their employer whether they get to keep the benefits or carrier they enjoy.The folks in Utah believe our current system is flawed because employees using the benefits do not truly choose their own plans.It’s that consumerism thing once again but through the structure of the employer.
What You Can Do:
Volunteer.Below I have outlined several tasks that we need completing.We had 31 members already volunteer to lend their services and time to the work groups.Once we have the schedules, we will call on them but we need everyone’s help with the items here:
1.We are interested in forming a coalition with other Insurance Agent groups.We’ve reached out to NAIFA and they are on board.If you have contacts within the MAIA or other type of Agent Associations, could you please reach out to them and ask them if they will allow us to say they endorse our work in the Exchanges?If you secure that commitment, could you please just ask them to email or mail me their commitment in a memo?Please don’t just send me contact information.I am swamped and I am looking to members to make the connection and ask the question and report back the response.
2.On that note, the same goes for Chambers and Associations.We need their official endorsement and we would like to reach out to them to see if they would like to form a coalition.We have the list of Chamber/Association contacts.We need a few members to run the process of reaching out and asking for their support.
3.Please ask your carriers if they would be willing to publish an official endorsement of the work we are doing in Lansing.Put pressure on your carrier partners to recognize publicly the work you do for their clients and the value you bring to the system.
4.I need someone for a special project.We are trying to do a survey of the insurance agencies in the State to see how many people they employ.I know this one might be a long shot, but one of our bullets in our “Michigan Deserves Agents” piece is a section about how insurance agencies are strong employers.This project would involve sending a survey to all the agents in the state and asking them to respond with how many people they employ, if they offer benefits, etc.These would be powerful numbers to present in Lansing.
5.Donate money.We will need funding to pay for our members to drive back and forth to Lansing several times in 2011.We may need funds for meals, for materials, printing and even maybe for lobbying events.We need to build a ‘war chest’ for this effort.
6.Bring non-member agents into the fold.Your dues go to the State Budget, the majority of which goes straight to our lobbying efforts.We have grown considerably this year in MAHU but we need more members.
7.Volunteer at an Agent Forum or a “Storm the Hill” Lansing Event.You will see in the first part of 2011, MAHU will be holding special events for MAHU members and non-members as well to come learn about the work we are doing legislatively.These will be informative, fund raising and membership drive events.We will need help organizing and running these as we would like to hold them in areas where there are no locals and where agents have had little contact with MAHU.
If you are interested in helping in any of these capacities, please let me know with an email to:dsiciliano@e-agentalliance.com.
The Next Time You Hear From Me:
I will be reporting to you about the work group formulations and we will be on our way to shaping these things in the right way for the people of Michigan.
Thanks to all of you and please let me know if you have questions, comments or if you would like to join the fight!
Michigan Association of Health Underwriters
Michigan Exchange Blog—December 13, 2010
October 4, 2010
From NAHU Exchange Liaison:Dominic Siciliano
Happy Holidays!
A month has passed since my last Blog and we’ve taken some good action but the work is going to begin very soon.We just learned yesterday that Health Management Associates out of Lansing won the bid.This is the company who will administer the five work groups who will convene to discuss the exchange and how it should look in Michigan.We know very little about this company right now but we are working hard to figure them out and to create an inroad.
Their website is http://www.healthmanagement.com/default.asp.They are a nation-wide consulting firm that is made up of former State Department of Community Health and Medicaid officials.Upon first blush, this may seem scary but by all initial accounts, they look like they do a ton of research work and they are extremely knowledgeable and politically neutral.I’ve included an attachment that outlines some of their previous work.It includes a link to a speech one of their members gave to the National Governors Association concerning Exchanges.It is by and by on the right track to what we will be working for.All of us feel like we will have a schedule for these work groups set around January 1.
MAHU’s Plan of Attack:
Each of the four Legislative Chairs from our four locals along with State Legislative Chair Pat Pennefather and I met Tuesday the 30th to discuss our plan.Our objective here was to create MAHU’s talking points for the Exchange Workgroups.Our initial topics included:
·Do we pursue language in the exchange that dictates agents much be used or language that leaves it up to the carriers to decide?
oLanguage surrounding commissions
oTalking points for the value of an agent
§Healthy folks entering pool
§Service
§Local business
·Small Market versus Individual
·MI Exchange versus Regional versus National
·Non-profit entity versus State Run
·Utah Model versus Mass Model
We landed on two strategies that all could agree on.First, we decided to create a five bullet talking point white paper about why agents are essential to the system.I have begun this white paper and a rough draft is attached to this memo.Also attached are two white papers that other states have used in their work groups.The first is “Americans Deserve Access to Agents and Brokers in Health Care Reform” and the second is “Unhealthy Exchange Pool Risks Results from Wrong Assumptions of Consumer Behavior.”Both of these papers are very powerful in outlining why agents are necessary in the system.My white paper is entitled “Michigan Citizens Deserve Access to Agents and Brokers in Health Care Reform” and it outlines our five bullets we hammered out as to what we bring to the system.This paper is not finished.It is a work in progress but you can see what points we will be presenting in the work groups.
Having that base created, we now have to come to consensus on what type of exchange we would like to see created.I was on the NAHU Exchange Liason conference call last week and it sounds like NAHU will be issuing model language for this.We in MAHU have been impressed by Utah’s exchange.Troy Duimstra, West Michigan Leg Chair, attended the AHIP Conference in Chicago and has access to the two Health Underwriters in Utah who helped put it together.Troy has brokered a conference call with these guys and we are going to see what we would take from this system to recommend in the work groups.Essential questions to ask in that meeting:
How did the role of agents change once the exchange was introduced?
Who set the compensation for products within the exchange and who pays it?
Who is responsible for assessing the risk in the exchange for all carriers involved?
Who created the framework technology behind the exchange?
What has worked, not worked, what would they like to see improved in their model?
How did they ‘sell’ it to the government officials?
I did some studying on my own and some hard core listening on the NAHU Exchange Call last week and I discovered something about Utah that was an ‘ah hah’ moment.The Utah Exchange was designed as a place not only individuals could go to join a large pool but also individuals within small groups could go to do the same.The Exchange allows small employers to offer a true cafeteria of benefits and carriers where each individual within the group can take the employer contribution and purchase the health plan brand and product that most suits his/her individual needs.This is a pretty progressive idea as it puts the onus completely back on the employee and puts him/her in the driver’s seat.It is a big leap from our small business system in most of the country where employers select maybe one or two options from the same carrier and there you go.Employees are subject to the increases from the carrier and from the decisions of their employer whether they get to keep the benefits or carrier they enjoy.The folks in Utah believe our current system is flawed because employees using the benefits do not truly choose their own plans.It’s that consumerism thing once again but through the structure of the employer.
What You Can Do:
Volunteer.Below I have outlined several tasks that we need completing.We had 31 members already volunteer to lend their services and time to the work groups.Once we have the schedules, we will call on them but we need everyone’s help with the items here:
1.We are interested in forming a coalition with other Insurance Agent groups.We’ve reached out to NAIFA and they are on board.If you have contacts within the MAIA or other type of Agent Associations, could you please reach out to them and ask them if they will allow us to say they endorse our work in the Exchanges?If you secure that commitment, could you please just ask them to email or mail me their commitment in a memo?Please don’t just send me contact information.I am swamped and I am looking to members to make the connection and ask the question and report back the response.
2.On that note, the same goes for Chambers and Associations.We need their official endorsement and we would like to reach out to them to see if they would like to form a coalition.We have the list of Chamber/Association contacts.We need a few members to run the process of reaching out and asking for their support.
3.Please ask your carriers if they would be willing to publish an official endorsement of the work we are doing in Lansing.Put pressure on your carrier partners to recognize publicly the work you do for their clients and the value you bring to the system.
4.I need someone for a special project.We are trying to do a survey of the insurance agencies in the State to see how many people they employ.I know this one might be a long shot, but one of our bullets in our “Michigan Deserves Agents” piece is a section about how insurance agencies are strong employers.This project would involve sending a survey to all the agents in the state and asking them to respond with how many people they employ, if they offer benefits, etc.These would be powerful numbers to present in Lansing.
5.Donate money.We will need funding to pay for our members to drive back and forth to Lansing several times in 2011.We may need funds for meals, for materials, printing and even maybe for lobbying events.We need to build a ‘war chest’ for this effort.
6.Bring non-member agents into the fold.Your dues go to the State Budget, the majority of which goes straight to our lobbying efforts.We have grown considerably this year in MAHU but we need more members.
7.Volunteer at an Agent Forum or a “Storm the Hill” Lansing Event.You will see in the first part of 2011, MAHU will be holding special events for MAHU members and non-members as well to come learn about the work we are doing legislatively.These will be informative, fund raising and membership drive events.We will need help organizing and running these as we would like to hold them in areas where there are no locals and where agents have had little contact with MAHU.
If you are interested in helping in any of these capacities, please let me know with an email to:dsiciliano@e-agentalliance.com.
The Next Time You Hear From Me:
I will be reporting to you about the work group formulations and we will be on our way to shaping these things in the right way for the people of Michigan.
Thanks to all of you and please let me know if you have questions, comments or if you would like to join the fight!
