Editor’s Note: Ken Crerar, president of The Council of Insurance Agents & Brokers, with tongue firmly planted in cheek, expresses his opinion on health care reform proposals. For the latest on The Council of Insurance Agents & Brokers’ health care reform efforts, visit www.ciab.com
I don’t question the need for healthcare reform to make vital care more affordable and accessible to all Americans. But as I look at some of the proposals being debated in Congress, I can’t help but ask myself: What are you thinking?
Don’t get me wrong—some of the proposed measures would go a long way toward addressing the cost and access problems with our current system. These include federal subsidies for low-income individuals, waiving of pre-existing conditions, costs transparency, portability, wellness programs, standardized medical records, continuation of FSA and HSA tax incentives as well as state-based health insurance exchanges for the unemployed and those not part of a group program.
I’m humble enough to admit that you may know something I don’t. Maybe eliminating the middleman is a good idea, and will save consumers scads of money. But why undermine one of the most efficient parts of our system—the highly experienced insurance brokers and agents who daily navigate the complexity of the healthcare system for millions of Americans and businesses?
One proposal calls for allowing association and union members to become so-called peer “navigators” who help consumers in their organizations get through the maze of health care insurance options. I can see it now: A teamster hopping down from his 18-wheeler, leaning on the hood and pulling out his policy papers to help his fellow union members figure out the nuances of their health care plans. Co-pays? Deductibles? In network? Easy stuff, right?
It’s like navigating your own home purchase. Do you really need a real estate broker to help you through more than 50 pages of legal documents to close the deal when you could use a teamster boss instead?
Why not do your own taxes? Uncle Sam makes it so simple. Who needs a middleman tax accountant when a mine worker will do? Maybe the AFL-CIO could take over Wall Street. (Come to think of it, that might not be a bad idea.)
Forgive me if I’m not convinced we don’t need intermediaries. They are our consumer advocates. If you have ever bought health insurance or filed a claim, you know what I’m talking about. Choosing the right health plan, navigating the murky waters of co-payments, deductibles, in- and out- of-network health providers, getting pre-approval for a medical procedure, filing claims and dealing with insurer “customer service” reps when a claim is denied can make the strongest men and women weep. Most of us have been there.
If you think it’s difficult now to navigate your healthcare,
just wait until the navigators descend on America. There is nothing in the proposed legislation that outlines what licensure would require, other than expressly stating that current agents and brokers would not qualify. Just to get a license, agents and brokers now must take education courses and pass an exam. To keep their license, they are required to take continuing education courses and meet certain market conduct and ethical standards. They also are subject to a myriad of state and federal consumer protection laws and regulations.
Agents and brokers are trained on specific health products. They have to keep up with all the complex state laws and regulations.
That’s 50+ state laws with no uniformity. Then there are the federal laws to learn: COBRA, HIPPA, ERISA, ADA, and the Genetic Nondiscrimination Act.
And they have to know the benefits of HSAs and FSAs self-employment programs, too.
Under the new proposal, we can ditch all of this knowledge for a union card or membership in an association. If only health insurance were that simple.
As healthcare advocates for consumers, brokers explore and analyze market options and explain the differences so their employers and consumers can pick the best option. Brokers and agents also design plans and forecast the cost of various options and—armed with the best market intelligence available—negotiate with sophisticated insurance carriers for the best deals possible for their clients. What navigator will have this expertise?
What else do brokers and agents do?
Arrange and implement enrollment for employers
Help educate employees on their benefits
· Monitor carrier performance
· Assist employees with claims
· Promote wellness programs and healthy lifestyles to bolster productivity
· Support the employer’s state and federal regulatory compliance responsibilities
· Act as an extension of the HR department
· Develop alternative coverage programs, such as self-insurance options to help manage costs.
And who’s going to pay for the navigators’ training? Right now, our brokers and agents spend hundreds of millions each year on education—out of their own pockets.
Finally, when something goes wrong—and it will—the first person consumers will call will be their navigator. The second will be their congressman.
Here’s to all of our good health. We’ll need it.
Ken A. Crerar
President
The Council of Insurance Agents & Brokers
P.S. In light of the reform, we might want to discuss changing the name of The Council of Insurance Agents & Brokers to The Union of Insurance Navigators.