The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Sixth Month Anniversary of Health Care Reform Law Highlights Role of Brokers

Posted by Alan on September 23, 2010

For brokers, regardless of their opinion on health care reform, a question they need to answer is, “Who will explain health care reform to my clients – the government,  the press, my competitors  or me? Because regardless of a broker’s feelings about health care reform, the fact is the law is the law, clients will be impacted, and someone needs to help them navigate the new world.

Today, September 23rd, several key (and popular) components of the Patient Protection and Affordable Care Act take effect for plans sold or renewing as of this, the sixth month anniversary of President Barack Obama’s signing the PPACA into law:

  • specified preventive care must be available to insureds with no cost sharing
  • carriers ability to rescind coverage is limited to cases involving fraud or intentional misrepresentations of material fact
  • annual benefit limits on “essential” benefits are limited to $750,000
  • lifetime benefit limits are no longer permitted
  • dependents may stay on their parents’ plans up to age 26 (most carriers already implemented this change, but now all carriers must do so)
  • pre-existing conditions must be covered for children up to age 19.
  • While the law doesn’t require carriers to accept children for coverage on a guarantee issue basis, regulators have determined that this will be required. Whether health plans must guarantee issue children-only policies year-round or only during a limited times (e.g., a group’s open enrollment period or the child’s birth month) is an open question. As a result many carriers have decided to stop offering children-only medical policies)
  • Rules concerning discrimination in favor of highly compensated individuals now applies to health insurance coverage
  • Emergency room treatment must be covered at in-network levels regardless of whether the provider is actually in the network
  • Carriers must have in place a coverage appeals process
  • Plans with gatekeepers must allow enrollees to designate any in-network doctor as their primary care physician (including OB/GYNs and pediatricians)
  • There are other provisions that have already taken effect (e.g., small group tax credits, rebates to help offset the Medicare Par D “Donut Hole” concerning prescription drugs) and some will take place in the very near future (e.g., grants for small employer-based wellness programs).

    The White House has begun touting these provisions of the new health care reform legislation. The media is highlighting them as well. As a result, employers and consumers are likely to have lots of questions. There are lots of sources for information. The Obama Administration has posted a wealth of health care reform information online. While an attempt has been made to make the information accessible, comprehensible, and comprehensive, no one web site can fully realize those goals. And let’s just say the site puts a positive spin on each and every provision. Carriers are sending out (digital) wheelbarrows of information to employers, members and their brokers. The National Association of Health Underwriters offers its members a tremendous amount of valuable information (health insurance brokers who are not members of NAHU are making a huge mistake – they’re failing to support an organization that fights hard to have the voice of their profession heard by policy makers and they are missing out on a treasure trove of critical information). And, of course, there are plenty of producers out there calling on clients (their own and others) offering to help them understand the new health care law.

    So there’s no dearth of sources consumers have for learning about the PPACA. The question is whether brokers are appropriately establishing themselves as the primary resource for their clients. Doing so is, after all, an important part of brokers’ responsibility to their clients. It also makes business sense.

    As I’ve written about elsewhere (this would be a shameless plug for my book, Trailblazed: Proven Paths to Sales Success available over there on the right hand side of this page), brokers who contact their clients only on their annual renewal date are failing to provide the service those clients deserve. (They also risk being associated in a very Pavlovian way with bad news). Here is an opportunity to demonstrate to our clients – who also happen to be constituents of our elected official’s – the value brokers add to America’s health care system. This is good for brokers, but it’s even better for clients. When it comes to educating employers and consumers, no mass of news stories, media events, and web sites can match the reach and depth tens of thousands of professional brokers represent.

    Until its changed (somewhat likely in part) or repealed (don’t hold your breath) the Patient Protection and Affordable Care Act and the regulations its spawned are the law of the land. Brokers can wish it would go away. They can argue, complain and agitate about the PPACA. But we have an obligation to our clients to help them understand the law, avoid its pitfalls and seize its benefits. Brokers are providing this service every day. The sixth month anniversary of the Patient Protection and Affordable Care Act simply highlights this fact.


    2 Responses to “Sixth Month Anniversary of Health Care Reform Law Highlights Role of Brokers”

    1. Brandy k said

      If anything, 50 dollars is great compensation for an application that a person can do for himself for free.

    2. Malcolm Cutler said


      Thanks again for your thoughts about the importance of brokers to our client and to delivering plans that meet our clients health insurance needs. It has always been a pleasure to solve employer and individual health insurance and and then find that I was being adequately paid for my service, which incented me to continue providing service and resolve health care issues. I certainly hope this does not become the old world.

      I say this in the context of my meeting yesterday with the brother of client who just got out of jail and it seems he is a perfect candidate for new California PCIP high risk pool. He has not had health insurance for six months and will undeniably be rejected for individual coverage.

      So, I am in the process of helping him to complete the PCIP application, the MRMIP application that needs to be completed, a Blue Shield application, so he can be rejected – all important steps for securing his coverage, the reason I am in this business. It felt good.

      The problem I have with is that the submission to Blue Shield, the submission to PCIP, and the submission to MRMIP – according to one of the seminar discussions I listened to – will net my agency $50.

      I am glad I can afford to be of help to this client, but it seems very a world of help for the uninsured could be accomplished, if agents were properly paid under this new risk pool and it also brings into question that State’s value of agents and brokers to bring these important benefits to the uninsured population.

      My best.

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