The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Health Insurance Brokers to the GOP: “Et Tu?”

Posted by Alan on May 26, 2009

Health insurance brokers are appropriately worried about the impact health care reform will have on their livelihood. That’s human nature. Politics is about the management of self-interest. When it comes to health care reform, the list of concerned onlookers is long. Patients, doctors, hospitals, carriers, government bureaucrats, health insurance agents, employers, lawyers, dentists, chiropractors, pharmaceuticalfirms and, well, you get the idea.  Anymeaningful change is going to require sacrifice by most all of these stakeholders. 

When it comes to balancing all these competing interests, the partisan nature of American politics usually comes into play. Public policy flowing from the Democratic party tends to benefit some at the expense of others. The same holds true with the Republican party.

Health insurance brokers, for example, tend to rely on the GOP to promote policies supportive of their profession. One reason for this connection is political. I’ve no empirical data, but long experience in working with health insurance brokers leads me to believe that the majority vote Republican. Another reason, however, is ideological. Republicans tend to support market-based health care reform solutions  and brokers are integral to making the market work. Brokers take competing health plans and interpret them to their prospects and clients. One method they use is to take the different explanations of benefits used by different competitors and put them into a consistent template. They serve as consumer’s advisers and, when needed, their advocates to assure they get full value from their health plans.

As President Barack Obama’s Administration works with the Democratic majority in Congress to fashion health care reform, many brokers are relying on Republicans in Congress to stand firm against a public plan (which most brokers believe would eventually drive private plans out of existence — and take brokers down the drain with them). And they are trusting Republicans will make the case for the value brokers add to the system.

This trust may be misplaced.

Last week four leading Republicans put forward “The Patients’ Choice Act.” The Act is their call to action for fixing what they refer to as America’s broken health care system while at the same time seeking to preserve much of the current market driven arrangement. The authors of the proposal, Senators Tom Coburn and Richard Burr and by Congressmen Paul Ryan and Devin Nunes, are leading voices within their party on health care reform. It’s not clear whether the Patients’ Choice Act is the official position of the Republican caucuses in Congress, but no other proposal has been forth by the GOP. And the media is certainly treating it as the “Republican health care reform plan.”

Not suprisingly, the GOP lawmakers explicitly reject a public health program. Indeed, while acknowledging other factors leading to runaway costs (new technology, an aging population) their document proclaims the primary reason America’s health care system fails so many patients is “government intervention.”

Nonetheless, there are several elements of the Patients’ Choice Act which occupy common ground with Democrats (more on these in a future post). Some of what’s in The Patients’ Choice Act summary is, suprising and even amusing. For example, Republicans have taken to accusing Democrats of seeking to move America to “European-style socialism.” Yet, in justifying some of their ideas the sponsors of the Act turn to similar programs working in — wait for it — Europe.

Some elements of the reform package are just foolish. For example, under the Patients’ Choice Act carriers to accept all applicants regardless of their health condition (often referred to as “guarantee issue”). However, explicitly reject requiring individuals to obtain coverage stating that “if individuals do not want health insurance, they will not be forced to have it.” In fact, they go so far as to suggest that individuals be able to purchase coverage at any time “through places of employment, emergency rooms, the DMV, etc.”

In taking this position it appears the the Republicans have adopted the greatest flaw in then candidate-Obama’s health care reform plan — and made it worse. Why would anyone purchase coverage before they need it? Any reasonable person would wait until they’re on their way to the doctor, stop by the DMV and purchase coverage. In case of an accident, all they would need to do is go to the emergency room (the most expensive place to receive care), sign up at the receiving desk and enter the facility as a fully insured patient. As soon as they’ve recovered, it would be safe to drop the coverage.

(I find it hard to believe the Republicans are taking such a naive view of insurance. And, to be fair, the Patients’ Choice Act is somewhat lacking in details. However, what I’ve described comes from the Republican lawmakers’ own document. If they are creating safeguards to prevent such gaming of the system, there’s no evidence of it yet.)

As with any health care reform proposal, there’s elements to like and to dislike in the the Patients’ Choice Act. What will be most troubling for brokers, however, is the GOP’s call for creating state-based exchanges. The benefits of such exchanges includes a “one-stop marketplace for health insurance. Individuals would get a hassle-free opportunity to choose the plan that best meets their needs through an Exchange.” Most brokers believe that’s their role in the current system. To have Republicans propose a state agency to take on this responsibility is disconcerting at best; a betrayal at worst.

Then there’s the “auto-enrollment” feature touted by the Republicans allowing individuals to obtain health insurance at the DMV and other locations. Apparently the GOP sees little value in having consumers work with licensed, regulated agents and brokers, not when there’s a clerk at the DMV available.

To be fair, the Republicans are not explicitly excluding brokers from their version of a new health care system. In fact, they are expected to remain a part of the system. In the GOP’s “Patients’ Choice Act Q&As they write, “Whether an individual uses an insurance broker, an internet [sic] comparison page, or calls a toll free number, individuals are provided the information needed to choose a plan tailored to their individuals [sic] needs.” This basically equates the knowledge, skills and expertise of  independent brokers to what can be delivered by an Internet site or a customer service rep at the state Exchange. How comforting.  Perhaps they are relying on the Exchange to standardize health insurance so much that professional guidance is no longer required. Although if coverage is that standardized, then perhaps calling their proposal the Patients’ Choice Act might be somewhat misleading.

The National Association of Health Underwriters, the primary professional organization for health insurance brokers, is working hard to educate lawmakers concerning the value independent brokers add to the system — value which should be preserved in whatever reform package emerges from Washington.  To the extent the Patients’ Choice Act represents Republican thinking on health care reform, relying on the GOP as an ally in this effort could be a painful path to disappointment.


9 Responses to “Health Insurance Brokers to the GOP: “Et Tu?””

  1. e said

    This is so exciting! I don’t think you’ve taken into account the human factor, but still a good post.

  2. I would agree with Erwin, and ask who is going to foot the bill for this bill. The total cost will never be known as time goes on.

    I also agree that the need for good insurance agents will always be there.

  3. Erwin Chua said


    I still have a question on who’s going to foot the bill on all this. I am of the opinion that if people are offered health insurance at a low price, they’ll take it if it is a law that says they have to and if it doesn’t create large blip on their comfort radar.


  4. I am a health broker obviously and am scared not for myself but for our way of life as American’s. I believe that every American has a right to health care regardless of health or wealth, but how can we afford this and a bank bailout and a defense program without borrowing more money and running more deficits. Eventually, they will stop buying our absurd bond issues and just like housing was never going to crash the bond market might be next. I am worried for this country first and then this particular health care bill with the Cornhusker Kickback and all the other myopic nonsense is not going to help anyone.

  5. There will be a need for insurance agents under the Patients’ Choice Act but we cannot determine to what degree. If the plans are made very simple for the public to pick from, then the observation that Patients’ “Choice” Act is misleading, stands ground. However, i do not see something substantial that would clear the suspicions that insurance agents have about the importance of having a place in the new system, whether administered by democrats or republicans. We need a clearer picture of anything that republicans propose and they need to go beyond the surface level to secure their votes.

  6. The bloodbath is about to begin after Thanksgiving. I don’t think the public option will pass, but we might see the “trigger” option.

  7. jeremy said

    Thank you for your points of view Alan! I have been wondering what the future holds for Insurance Agents for quite sometime. It makes sense that there will always be a need for Agents since people will still need things explain with a public option…but who knows?!

    My family had been in the insurance business since 1979 and has seen California change quite drastically over that time.

    I blog about insurance benefits, current events and would like to have some posts on the public option. If you would ever like to exchange guest posts I would love to include your thoughts in our blog!

    Thank You

  8. Some people are paying for an extra Medicare program that they dont need. I sure hope the health care reform can balance the issue to help both the consumers and the brokers.

  9. Alison said

    All I can say is uggggg.

Sorry, the comment form is closed at this time.

%d bloggers like this: