Lacking health care details means murky business picture - Odessa American: Health

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Lacking health care details means murky business picture

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Posted: Sunday, September 29, 2013 5:00 pm

Tuesday begins the sign-up period for roughly a quarter million West Texans who don’t have health insurance under the Affordable Care Act, commonly called Obamacare.

But many of the logistics remain unclear, leaving a murky picture for the insurance business, particularly local agents.

While it is clear that the insurance providers can expect more customers before major provisions of the law go into effect on Jan. 1, there’s been no release of the providers people can actually buy from.

The federal government released averages of premiums in parts of the country, including Texas.

“That’s a very good amount of choice available to people in Texas,” said Gary Cohen, a deputy administrator and director of the Centers for Medicare and Medicaid Services’ center for consumer information and insurance oversight, who oversees the exchanges, according to the Associated Press. “The rates in Texas are looking good.”

But those published rates don’t include West Texas, and analyses of plans in states that chose to set up their own version of the healthcare exchange showed sometimes stark differences between regions. Texas has 26 different “geographic market rating areas” corresponding with metropolitan statistical areas measured by the U.S. Census Bureau. Ector and Midland counties will be in different rating areas, according to CMMS.

The El Paso-based non-profit Project Amistad, which is one of the agencies authorized to help people sign-up under the exchange as so-called “navigators” has reported that such information won’t likely be available until the Tuesday roll-out. On Friday, Bob Moos, a spokesperson for the CMMS region including Texas, confirmed that in an email.

Meanwhile, some of the insurance agents certified to enroll people — there’s no publicly released list of those, either — are readying themselves. It’s unclear whether they’ll see a boon.

Some argue they will, because navigators can’t actually enroll people.

But navigators can explain the types of “metallic” plans people can buy — bronze, silver, gold and platinum, which each represent a differed co-pay ratio and rate. Navigators can also direct people to the online portal.

And some argue that the online market will undercut local insurance agents.

“You can’t beat the economy of scale that buying direct is going to have,” said J. Holland Powell, the president and CEO of Benefit Development Group, which helps negotiate insurance plans for companies in Texas between 50 and 5,000 employees. “And you can’t load up a 10 percent commission and expect to compete against a system that has none.”

The flip side of that is that the only people who can actually enroll someone is a licensed agent with additional certification to do so. They’ll be better equipped to help people find subsidies that will reduce cost, said Mike Avery, a local insurance agent certified to enroll people under the health exchange and the treasurer of the Texas Association of Health Underwriters. They can also talk product specifics.

“There’s a lot to picking out health insurance,” Avery said. “It’s not going to Google.”

In his capacity with the TAHU, Avery said he does not take a position on the law, but he expressed concern about how well it would work out, particularly in the first months. Avery said he advises people wanting to sign up for the exchange to wait a few months while the kinks are worked out.

People don’t face penalties until after registration for the exchange closes at the end of March.

But Gene Collins, another local agent who sells health insurance, says there’s no reason for people who need insurance to wait.

“Why risk getting penalized when you can be in a good program,” Collins said. “Plus those who are not, they can become ill at anytime. People with families, they get maternity care. There’s so many good things about the plans and a lot of the plans that are coming out of the exchange are better than what people have anyway.”

Collins still has concerns. One, he said, is that facts have been slow so far to replace rumor, leading to a heightened anxiety over the enrollment opening. The others are pragmatic concerns: A lot of the uninsured are identified through Internal Revenue Service data, he said, wondering where that leaves homeless people.

And as far as business, Collins said retention might be an issue as it was when states began requiring automotive liability insurance; some people bought plans to meet their obligations, then bailed on the payments. Some kinks, Obama administration officials have argued, are to be expected with the rollout of any new major program.

In the meantime, one quantified sense of what’s to come was offered by the Department of Health and Services in a release that said a family of four in Texas with an income of $50,000 per year, the lowest bronze plan would cost only $57 per month. A 27-year old living in Texas who makes $25,000 per year and is awarded tax credits, will, on average, pay $83 per month for the lowest cost bronze plan and $145 per month for the second lowest cost silver plan

But critics have argued the federal government released averages of the cheapest and thus, most favorable plans.

“It’s supposed to be up and running,” Avery said. “But we don’t know what up and running is yet.”

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