Private sector could ease health care problems


by Mitchell Schnurman

Source: Dallas Morning News

Obamacare could use some help from private enterprise, and legions are ready to step up. If only the president would embrace them.

Brokers and insurance companies, which were often demonized in the run-up to health reform, could become valuable allies in turning around the debacle now. They have a profit motive, a once-in-a-generation chance to expand the business, and a history of enrolling people in insurance.

They also don't carry the same political baggage.

"My customers call about insurance, and they say, 'I don't want Obamacare, and I don't want to call the government,'" said Mike Bilbrey, a broker in Fort Worth since 1972.

President Barack Obama has often said he's open to ideas to improve the health law. Here's an easy one: While waiting for HealthCare.gov to get fixed, tell people to "Try your broker." Or even suggest that they call insurers directly.

These private players share the same goal - getting more people covered - and have many folks on the case. (One example: 228 members of the Texas Association of Health Underwriters are certified to sell plans on the federal exchange.)

Ultimately, HealthCare.gov has to be fixed because it's the only way to get the federal subsidies Obamacare provides. But until then, people can make a lot of progress finding the right plan.

In the debate over the health law, brokers were often targeted as "middlemen," and many believed they were being squeezed out. Limits on overhead sliced commissions for agents. And the federal government awarded grants to "navigators" to assist buyers; that's a role that brokers have always played, and brokers already have training and certification.

The law's architects saw them as expenses, soon to be made obsolete by new technology.

"With the federal website, they thought brokers wouldn't be necessary, but they were wrong," said Tom Baker, an insurance expert at the University of Pennsylvania Law School.

He believes the White House will shift course and that brokers have a chance to add real value because health insurance remains a complicated product. Several brokers expect HealthCare.gov to add a link soon so that shoppers can find a local agent to help with the process.

A few years ago, brokers nationwide boosted sales of federally sponsored policies for people with pre-existing conditions. Initially, the government offered no commissions and had trouble enticing enrollees. After bringing brokers on board, enrollment climbed.

In Texas, brokers also signed up close to 2,000 people for a low-income children's health plan, broker Carolyn Goodwin of Dallas said.

Shopping around

The attention on health care has boosted business for Bilbrey. He asks about health history, explains the trade-off on deductibles and premiums, and reviews the options in North Texas. For some, doctor and hospital networks are paramount.

He emails price quotes, recommends a plan and sometimes helps with the application.

Many customers buy individual insurance outside the federal exchange because their income is too high to qualify for a subsidy. Others must formally apply for the subsidy, and that's when they go to HealthCare.gov. Bilbrey said 15 clients have applied for a subsidy, and all are awaiting approval.

"Some people are panicky, but there's plenty of time," said Bilbrey, co-owner of Creative Insurance Concepts.

There's no extra charge for using a broker because the insurer pays the commission. The price is the same whether they buy through a broker, insurer or HealthCare.gov.

Understanding and analyzing the plans can be difficult. Bilbrey said many clients take two to three weeks to mull the choices. In Massachusetts, the pioneer in health exchanges, an executive said there were 18 website visits for every purchase in the early days; that shows people do a lot of shopping before they're ready to buy.

Turning to brokers

Many sources can speed the process. Several online brokers agreed to help the government with enrollment. In a recent letter to Obama, eHealth offered to handle sign-ups on all federal exchanges.

Some providers, such as Blue Cross and Blue Shield of Texas, have detailed websites that are ideal for window shopping. They deduct estimated subsidies from the monthly premium, alleviating some sticker shock. They also have toll-free numbers for talking with a representative.

While insurers offer their plans only, Dallas shoppers can also go to Cigna and Aetna to see other offers in the individual market. Or ask a broker to compare plans.

HealthCare.gov has improved, too, with easier shopping options.

Brokers are probably getting about $150 in commissions, estimated Devon Herrick, a senior fellow at the National Center for Policy Analysis in Dallas. That's labor-intensive for the return, so many prefer to meet with large groups or company owners who have many potential customers.

Many brokers still resent the caps on overhead and federal grants to navigators, who had to be trained for a similar mission.

"The administration made enemies of brokers," Herrick said.

It needs them as frenemies now.