Conservatives must learn Senate rules or Obamacare will never be repealed.

The world’s greatest deliberative body has some really strange rules. Many of these rules can be easily conflated, especially when referring to a “simple majority” which is comprised of only 51 votes. Since there are now 52 Republicans in the U.S. Senate and the effort to repeal Obamacare has reached a fever pitch, I thought it apropos to help clarify the difference between two of the most conflated U.S. Senate rules. They are the “Nuclear Option” and the “Byrd Rule”. The former is used for presidential appointees and the latter is used to pass or repeal laws. Although the two are similar, the latter is a much more difficult rule to follow because it involves the interpretation of the Senate Parliamentarian. Her name is Elizabeth MacDonough. Below I will address some common misconceptions in an effort to clarify the difference between these two rules.

“Republicans got a full repeal bill through in 2015! Why can’t they do the same thing now?”

No, they didn’t. Those who argue that they did need to understand that the 2015 supposed ‘full repeal’ legislation DID NOT PASS the Senate as it was written. Why? Because the Senate Parliamentarian (Elizabeth MacDonough) blocked repeal of IPAB and other non budgetary items because they were considered non budgetary in nature and as such stricken by her as extraneous. Why was Senator Cruz forced to follow the Byrd Rule via Budget Reconciliation in 2015? Because a FULL repeal vote would have required 60 votes in the U.S. Senate under Rule 22 which would require 8 senate Democrat votes which we DID NOT HAVE THEN and we DO NOT HAVE NOW.  This is the necessity of following the same rules to pass the Senate’s “Better Care Reconciliation” Act.

“Just shove it through using the Nuclear Option!” Fantasy versus REALITY.

The other bogus argument is that we can just “use the Nuclear Option” to “shove it through“.  This is NOT possible because the “Nuclear Option” used most recently by Harry Reid to shove through former President Obama’s judicial appointees IS NOT USED to pass LEGISLATION. A SEPARATE senate rule was created to pass legislation passed with only a 51 vote simple majority. It’s called the Byrd Rule (mentioned earlier) which is how we were going to attempt to pass the American Health Care act. This brings us to the next fantasy “well let’s just change the Senate rules then!Changing a Senate rule requires 67 votes which would require 15 Democrat votes in the Senate which we also DO NOT HAVE.

And lastly, the total fantasy argument being made which says Mitch McConnell should just render the 60 vote majority rule or the 67 vote rule to change Senate rules “unconstitutional” which according to this fantasy requires only a simple majority vote (at least 51 Republican senators). In order to make this fantasy a reality, those who propose it actually believe that we would somehow get the support of John McCain and his life partner Lindsey, Jeff Flake, Susan Collins, Lisa Murkowski, Rob Portman, Shelley Moore Capito and Cory Gardner (the last four want to KEEP Medicaid expansion under Obamacare). If you REALLY believe that’s possible, I have some ocean front property in Arizona to sell you.

So, we have to live within the REALITY of how the U.S. Senate works. That’s WHY the Budget Reconciliation process is being used in an effort to pass the “Better Care Reconciliation Act” which if passed will provide desperately needed relief to millions of Americans who are suffering under Obamacare, even though it isn’t a ‘full repeal‘ bill.

Why can’t we just shove it through like the Democrats did in 2009 via Reconciliation? 

Because that didn’t happen. The Democrats had 60 votes to pass the Patient Protection and Affordable Care Act (Obamacare). They met the 60 vote threshold. That bill passed with 60 votes. It was sent back from the Senate to the House and it was signed by former President Obama on March 23, 2010. Where they used reconciliation was shortly thereafter to add things to the PPACA and that bill was also restricted to budgetary items and they had more than a simple majority to pass it at the time. So they were restricted by the same Senate rules as we are today. The difference is they simply had larger majorities in the Senate at that time than we do now.

There is merit to Senator Ted Cruz’s idea of replacing the Senate Parliamentarian 

There is one idea that might actually work and it comes from the brilliant legal mind of Senator Ted Cruz. After tangling with the Senate Parliamentarian back in 2015 when she stripped non budgetary items from what was originally a ‘full repeal‘ bill, Senator Cruz came up with the idea of REPLACING Elizabeth MacDonough (Senate Parliamentarian) with Vice President Mike Pence so that items that were non budgetary in nature may actually pass since they would now have to pass muster of Mike Pence and not her. The question is would Mitch McConnell allow this? He used the “Nuclear Option” earlier this year to seat Justice Neil Gorsuch on the U.S. Supreme Court so he is certainly no stranger to “extreme” Parliamentary maneuvers. If Senate Republicans can’t come to an agreement soon on a final bill, we may just find out how far he’s willing to go.



Filed under Uncategorized

What parts of the American Health Care Act did Conservatives disagree with?

President Trump posted this tweet this morning calling out the “Freedom Caucus” the Club for Growth (who FAILED at doing everything they could to ensure President Trump lost the election) and Heritage (who published incorrect information about the bill and the Senate process) and I have to say as one of the very few Conservatives who actually read the bill, I am WITH President Trump on this and AGAINST those mentioned in his tweet.


What if anything in the American Health Care Act did you disagree with and if so why?

1.) Repealing the Individual Mandate which requires those who do not purchase overpriced Obamacare health insurance to pay a penalty to the IRS.
2.) Repealing the Employer Mandate so that employers can once again offer FULL TIME jobs instead of restricting their job applicants to 29.5 hours in order to avoid paying for overpriced Obamacare health insurance.
3.) Repealing the Obamacare subsidies, which would be the first time in U.S. history that we actually repealed an entitlement.
4.) Placing per capita caps on Medicaid enrollees.
5.) Block granting Medicaid to the states
6.) Reducing the deficit.
7.) Cutting spending by $1.2 trillion.
8.) Repealing $600 billion in Obamacare TAXES.
9.) Re-creating state High Risk Health insurance pools (which is how health insurance risk in the individual marketplace it was managed for 20 years before Obamacare under HIPAA law). By doing so we would have once again removed the sickest 5% (responsible for 50% of costs) from the healthy pool in order to once again lower premiums for those who are healthy. Remember how much lower health insurance premiums were BEFORE Obamacare?
10.) Granting $128 billion over 9 years to the states to ensure that every state has a well funded high risk health insurance pool so that the 5% who are the sickest are guaranteed coverage. Keep in mind that whilst that may seem like a lot of money, it is MUCH less than the $56 billion we will spend just THIS YEAR on Obamacare subsidies.
11.) Repealing “Community Rating” so that young people pay much less for health insurance than they do now, thereby reincentivizing them to REENTER the health insurance pool and lower costs for everyone.
12.) Providing tax CREDITS (not “entitlements”) so that you can KEEP more of your OWN money so that health insurance costs less for you and your family. A tax CREDIT is NOT an “entitlement”. It just means you pay less to the IRS so you keep more of your own money to spend on health insurance. Is a CHILD tax CREDIT an ‘entitlement’?
13.) A one year 30% underwriting load applied to those who do not keep consistent health insurance coverage and instead wait until they are sick to buy health insurance. These “system gamers” increasing premiums for everyone. This also was how risk was managed in the individual health insurance market for 20 years before Obamacare under HIPAA law.

Understanding what could have happened had we come together

Keep in mind that ALL of the aforementioned features of the “First phase” of the American Health Care Act were included in the budget reconciliation bill and would have passed the muster of the Senate Parliamentarian because they were all budgetary in nature. As such, they could have passed with only 51 Republican votes (not the normal 60 votes to pass a bill). In other words without the help of ONE Democrat. As a reminder we need 8 Democrat Senator’s to vote WITH US in the Senate in order to reach the 60 vote threshold for a FULL repeal bill. We don’t have ONE Democrat vote, let alone EIGHT.

What if “PHASE ONE” is all we could get?

Let’s say PHASE TWO “would never really happen” meaning Dr. Price just simply refuses to exercise his power as our new H.H.S. Director and REFUSES to roll back additional mandates and regulations on health insurers thereby lowering premiums even more.

Let’s say “PHASE THREE” (further legislation) “would never really happen” because we will never get 8 Democrats to agree on repealing the rest of Obamacare by reaching the 60 vote threshold in the U.S. Senate necesary to pass a bill. I find that hard to believe by the way after we STARVE Obamacare of it’s primary funding sources which would have been done in ‘PHASE ONE’ (the Individual and Employer mandate repeal, repeal of $600 billion in taxes etc.). Would that not result in Obamacare dying MUCH faster than it already is resulting in more willingness from Democrats to support an alternative?


Someone PLEASE tell me where I’m wrong!

UPDATE April 26 2017: MacArthur amendment added to allow states to waive both the Essential Health Benefits and Community Rating provision.

UPDATE May 3, 2017: Upton/Long Amendment added to provide an additional $8 billion for states to establish risk mitigation programs for applicants in the individual health insurance market who are otherwise uninsurable and do not keep consistent coverage in place.

See all proposed amendments here. Read the original American Health Care Act here.


Filed under Uncategorized

Obamacare Individual and Employer mandates are still codified IRS law now that Republicans failed to pass AHCA.

Just so everyone understands correctly. Thanks to the failure of certain Republicans to pass the American Health Care Act which would have provided immediate relief to MILLIONS of Americans, the PPACA (Obamacare) Individual Mandate is still FULLY in force and codified by IRS law. In addition, the Employer Mandate is still FULLY IN FORCE and codified by IRS law. So, we will still be a “Part -Time” nation until at least 2019. There is a REASON both the Individual and Employer mandates were “zeroed out” and set to be repealed in the AHCA. It’s because President Trump’s executive order is just that, an order, it is NOT codified law. The AHCA would have ensured that his order became codified law and that the IRS code was permanently changed officially so that no one ever pays those penalties again. Also, for the 19 million Americans who have to purchase their own health insurance, be prepared for premium increases of at least 50% next year, if you can find a health plan since there is now only ONE carrier left to ‘choose’ from in 1/3rd of our nation’s counties. Buy hey, what do I know? I’ve only been doing this for 21 years. I’m sure the “Freedom Caucus” knows better than I do. Keep waiving those flags everyone, forget about ADVANCING them. “The enemy of better is perfect.” – Dennis Prager

1 Comment

Filed under Uncategorized

Why health care policy experts support the GOP Obamacare replacement plan.

It’s been a while since I’ve put fingers to keyboard to write about health care policy. That’s primarily due to the fact that I’ve been a bit busy for the last four months helping consumers navigate what is left of the individual health insurance marketplace during the annual PPACA (Obamacare) open enrollment period. I say “what is left” because we have lost 19 health insurance carriers since the passage of Obamacare and the taxpayer funded Obamacare co-op ‘health insurers’ that were supposed to replace them are also now bankrupt. This rapid demolition of the individual (non employer sponsored) health insurance market place has robbed my clients not only of access to their doctors but also to their preferred hospitals. Worse yet, they have lost their health plans every year now for 4 years in a row and their health insurance premiums have increased up to 150% since the passage of Obamacare. In other words, they have been forced to endure the exact opposite of what they were promised by Barack Obama and the Democrat party.

To say the individual health insurance marketplace in this country is in a dire situation is an understatement. In fact, if something is not done now to preserve what is left of that marketplace, we will have no health insurance carriers left to choose from in 2018. United Healthcare has already exited after losing more than a billion dollars. Aetna exited after losing more than half a billion dollars and Humana now has wisely exited the marketplace as well in most states. This leaves consumers with a monopoly dominated mostly by Blue Cross entities all of which have lost hundreds of millions of dollars since the inception of Obamacare. These few remaining carriers will not continue to contribute to their own demise forever. Something has to be done now, not later and that is the impetus behind the current GOP proposal to repeal and replace Obamacare. This is also why myself and other health care policy experts like Betsy McCaughey support the proposal. It is also important to note that because President Trump is an intelligent, informed and proven leader, he too supports this plan. Why? Because he understands how dire the situation currently is and how many people will be “hurt and hurt badly” if we do not act NOW. Watch his weekly address by clicking below:


To be frank, if you’re just reading this and you’ve never been on the other end of the phone with a woman with Ovarian cancer who’s calling you for help whilst she’s lying in her bed at Northwestern Memorial hospital weeping because she can no longer receive care there, you cannot possibly understand how dire the situation is. The worst part is that for the first time in my 20 year career as a licensed health insurance broker, there was nothing I could do to help this woman. There were literally no other options for her. There were only two other carriers I could offer her and those carriers offer only restrictive HMOs, none of which provide access to her preferred hospital or any of our other teaching hospitals. There are 19 million Americans just like her who are self employed sole proprietors and as such have to purchase their own health insurance in the individual marketplace. Their choices will soon be zero if something is not done now to incentivize health insurance carriers to once again reenter the individual health insurance marketplace. Already nearly 1/3rd of all counties in this nation have only ONE health insurance carrier to choose from. Soon it will be NONE.

The American Health Care Act

So, how do we accomplish that? The Republican party has chosen to do so in three phases. Paul Ryan did a power point presentation and I must say as a guy who has given hundreds of power point presentations, Ryan did a very good job explaining the process and I encourage you to watch it by clicking on the image below. I’m going to go a few steps further by breaking it down even more in bullet points listed below the video.


As aforementioned, three phases comprise the process of developing what will eventually be known as “The American Health Care Act“. They are as follows:

1.) The first phase of the GOP’s current proposal to repeal and replace Obamacare is the Budget Reconciliation Bill released on Monday March 6, 2017 which goes a long way towards doing so. Because it deals with only budgetary issues, it only requires 51 votes in the U.S. Senate to pass which means it should pass quickly. This budget reconciliation bill accomplishes the following:

a.) Repeals $600 billion in Obamacare taxes AND the individual & employer mandates. This means we will no longer be a ‘part time nation’ and individuals will no longer be unconstitutionally TAXED by a rogue I.R.S. for simply existing and refusing to purchase overpriced, government designed and mandated health insurance plans. It also repeals the  2.35% Obamacare payroll tax hike and the 3.8% tax on unearned income (capital gains).

b.) Puts caps on Medicaid enrollment to discourage over spending and allows states to structure their own Medicaid programs in order to better serve their Medicaid recipients.

c.) Creates innovation grants for states to redevelop health insurance risk abatement programs such as high risk pools which were abolished under Obamacare. These high risk pools help isolate and better control costs for those with the highest health care costs which makes health insurance for the healthy less expensive.

d.)  DOUBLES the amount one can deposit into an HSA.

e.)  STOPS all abortion funding under Obamacare.

f.) Creates a tax favored status for individual health plans by providing a refundable tax credit to purchase those plans. Currently there is no tax favored status for individual health insurance plans. Tax favored status has traditionally only been awarded to employer sponsored group health insurance plans. Ever try to deduct your health insurance premiums as a sole proprietor? Or for that matter deduct any of your medical costs above 10% of your A.G.I.? It isn’t possible now. If the American Health Care Act passes, sole proprietors will finally enjoy tax favored status for purchasing their own individual health insurance. It’s about damned time! In addition those who are not offered coverage via an employer will have a portable refundable tax credit to help pay for health insurance and a refundable tax credit is NOT a ‘subsidy’ that you did not EARN. It is simply a way of you keeping more of YOUR money by not paying as much in taxes so that you can use it to pay for health insurance. It is NOT‘new entitlement’ Rand Paul… but I digress.

g.) Covers preexisting conditions but rightfully penalizes those who attempt to game the system by waiting until they are sick to purchase health insurance. Such conduct increases health insurance costs for everyone and that is why that conduct was originally prohibited under 1996 HIPAA law. That law outlined specific waiting periods before one could qualify for coverage for preexisting conditions if they did not keep consistent health insurance coverage in place. There were also financial penalties for those who attempted to game the system that way. Obamacare allowed anyone who claimed a ‘loss of income’ to game the system throughout the year by jumping on and off health plans which resulted in massive losses to health insurers and their subsequent exit from the marketplace. That conduct MUST stop and the only way to do so is to penalize such bad behavior and no Rand Paul the 30% penalty (which is far too low) is not “another individual mandate”!  It is instead proper management of risk. The Obamacare individual mandate was an unconstitutional IRS enforced penalty for simply existing and refusing to purchase overpriced, government designed and mandated health insurance! Without such proper management of risk which includes the aforementioned penalties for bad behavior we will have more of the same and by that I mean fewer choices, higher prices and a rapid collapse of the entire individual health insurance marketplace. “NeverTrumper” Rand Paul was WRONG about President Trump during the election and he is WRONG about the American Health Care Act. Period.

2.) The second phase will be performed by our new H.H.S. Secretary Dr. Tom Price who will roll back the massive pile of regulations that were put in place by the fourth branch of government known unaffectionately as the ‘administrative state’. There are 1,400 references in the Obamacare legislation that state “the secretary may” or “the secretary shall” so Dr. Price can fix or roll back a lot of things on his own as our new H.H.S. Secretary.

3.) The third phase is the final repeal legislation which will take an act of congress requiring 60 votes. It will take longer because of this to pass and be signed by President Trump but no longer in my estimation than summertime. This is so because health insurers have to begin providing their 2018 plans and prices for review by state and federal regulators in the early fall of this year. So, there isn’t a lot of time for this final bill to pass. Vice President Mike Pence stated that we could see this legislation by April and I concur. This legislation will include all other things that we Conservatives want in a repeal and replace legislation. Those things include:

a.) “Selling across state lines” a.k.a. repeal of the McCarron Ferguson Act which requires and act of congress and 6o votes and cannot be done via the budget reconciliation process.

b.) Repeal of the Obamacare mandates on health insurers so they can offer new plans that are less expensive and do not include all of the onerous Obamacare mandates, many of which required coverage for non medically necessary expenses like sexual reassignment surgery, maternity for 64 year old women and so much more. This of course also requires an act of congress and 60 votes and cannot be done via the budget reconciliation process.

c.) Association health plans so that groups of people who work in the same field can pool together and purchase lower priced, group health insurance plans.

d.) Medical Malpractice Reform a.k.a. “Tort” reform.

e.) The income threshold for the deductibility of medical expenses drops from 10% to 5.8% which will provide $85 billion in tax relief to individuals

f.) Other parts of Dr. Tom Price’s reform legislation originally released in 2009 entitled “Empowering Patient’s First” which is the best piece of health care reform legislation I have ever read and I have read many. This is the template for the final repeal bill along with Paul Ryan’s “A Better Way” which he also worked with Dr. Price in devising.

But Steve! Why can’t we just suspend the filibuster and repeal and replace the whole thing all at once?! Because there is not enough political will to do so in the U.S. Senate and Senate Majority Leader McConnell has stated that he is not willing to do so. Why? Because there are political ramifications for doing so which could easily come back to haunt us in the future if we lose our narrow Senate majority.  Just ask Harry Reid. Why expose ourselves to that risk if there is another way forward?

In conclusion as Dennis Prager said so eloquently “the BEST is the ENEMY of the BETTER“. In other words when you spend all your time screaming for the best you inhibit the progress currently being made on the better and the American Health Care Act is far, FAR better than Obamacare. As Dan Proft also said so eloquently, “instead of WAIVING the flag, help ADVANCE the flag.” This is the BEST shot we have had in 7 LONG years to repeal and replace Obamacare. Please everyone, let us work TOGETHER to get this done!

March 21, 2017 UPDATE:  7 EXCELLENT manager’s amendments added to President Trump’s American Health Care Act thus far:

1.) End most of Obamacare taxes THIS year, not next year.

2.) BAR any new states from expanding Medicaid.

3.) Establish a WORK REQUIREMENT for Medicaid enrollee adults who aren’t disabled, elderly or pregnant; states that institute a work requirement would receive a 5% extra administrative payment.

4.) Give states the option to receive Medicaid funding in a BLOCK GRANT or receive it in the form of per-capita allocations.

5.) Increase the growth rate of capped federal payments to the states for elderly and disabled beneficiaries by the medical component of the consumer price index plus one percentage point.

6.) Delay implementation of the Obamacare excise tax on high-value employer health plans for an additional year, from 2025 to 2026.

7.) Establish a reserve fund of at least $75 billion for tax credits to help Americans between the ages of 50 and 64 better afford health insurance with larger tax credits. The original amount was $4,000 for those over the age of 60. Read all the amendments here.

For an excellent fact based comparison between the PPACA (Obamacare) and the AHCA -American Health Care Act – see this > Kaiser Family Foundation comparison grid.

UPDATE April 26 2017: MacArthur amendment added to allow states to waive both the Essential Health Benefits and Community Rating provision.

UPDATE May 3, 2017: Upton/Long Amendment added to provide an additional $8 billion for states to establish risk mitigation programs for applicants in the individual health insurance market who are otherwise uninsurable and do not keep consistent coverage in place.

See all proposed amendments here. Read the original American Health Care Act here.

P.S. To Daniel Horowitz. SHAME on you sir for writing this hyperbolic TRIPE at Conservative Review. The Budget Reconciliation bill which you shamefully refer to as “Obamacare 2.0” is NOT a ‘gift to illegals‘. You would know that if you had linked the ENTIRE Budget Reconciliation bill to your ridiculous piece. Instead, you linked only a small part of the actual bill leaving out 66 pages, including pages 19 & 20 which specifically requires PROOF of CITIZENSHIP or LEGAL residency status before receiving benefits. No one eats their own like Republicans aye Daniel? Pathetic.






Filed under Uncategorized

Obamacare open enrollment for 2017. Highest premiums, fewest options and good luck finding a broker or agent.

November 1, 2016 will be the first day of the third national PPACA (Obamacare) open enrollment period. This will be the most challenging open enrollment period yet. Not only because we now have so few health insurers to choose from but also because residents in states like Illinois, Minnesota, Arizona, Montana, Oklahoma, Pennsylvania, Tennessee and new Mexico are now facing annual premium increases of 50% to 93%! The state hit hardest is Arizona with a historic 145% increase. These are the highest annual renewal increases in recorded history. I guess we’ll now have to wait until 2018 to enjoy that “$2,500 premium reduction for a family of four” that our dear leader promised us way back in 2009.

In my home state of Illinois a.k.a. “The People’s Republik of Madiganistan” we now have 17 LESS health insurance carriers to choose from than we did before the wonders of Obamacare were implemented. In fact, this year we’re now down to 3 major carriers. Namely, Aetna (and their company Coventry) United Healthcare (and their company Harken Health) and Blue Cross Blue Shield of Illinois. Of those three major carriers only one is offering ‘subsidized’ plans ‘on the exchange’. United Healthcare/Harken Health has pulled out of nearly every state exchange in the country and Aetna/Coventy has pulled out of 11 state exchanges, including ours. So, you can still buy Aetna, Coventry, United Healthcare and Harken Health plans but you cannot get a subsidy to lower the premiums even if you qualify. This should work out famously! Forward!

Why pay an agent or broker when you can have an unlicensed “Navigator” for free?

Oh, I almost forgot to mention! Commissions. Since the implementation of Obamacare thousands of licensed, experienced health insurance broker agents have left the industry entirely since our commissions were cut from an average of 20% of first year annualized premium to 6% but “hey, you’ll make it up in volume” the masterminds said. Tell me masterminds, how exactly are the few remaining licensed health insurance brokers like myself supposed to “make it up in volume” when Aetna, Coventry, United Healthcare and Harken Health have all made the decision to no longer pay ANY commissions? That’s right, all of these carriers have decided that they will no longer pay ANYTHING to agents and brokers. But never fear! You can always call your friendly unlicensed and inexperienced “Navigator” over at Healthcare gov to help you navigate the system. To all of my clients, don’t worry, you can still call me. I’ll figure out another way to eat.

Narrow PPO & HMO networks provide NO ACCESS to the best hospitals and specialists.

In the fall of 2015 our premier carrier, BCBSIL – Blue Cross Blue Shield of Illinois – made the decision to remove access to their “Broad PPO” for all policy holders who purchase their own individual and family policies (non-group plans). The “Broad PPO” includes access to Northwestern Memorial Hospital, the University of Chicago Medical Center, Rush University Medical Center and the Ann and Robert H. Lurie Children’s hospital (among others). That decision drove tens of thousands of unwitting Illinois consumers into the arms of “LOL Health” a.k.a. “Land of Lincoln Health” our state’s only Obamacare ‘co-op’. Last year, I warned every consumer I could via article, radio and in person that “LOL Health” had, at that time already suffered more than $90 million in net underwriting losses. They SHOULD have been placed into receivership BEFORE innocent Illinois consumers ended up without insurance. Sadly, it took our department of insurance an entire year to place “LOL Health” into liquidation. This action left many thousands of Illinois consumers without coverage and scrambling for alternatives one month BEFORE the next annual open enrollment period begins on November 1st. This, my friends is central planning at it’s absolute finest.

Great! What now? What am I supposed to do? My doctors are all at Northwestern?

Good question! Good question! There is still a way for individuals to buy a plan that includes a “Broad PPO” with access to Northwestern Memorial, University of Chicago Hospital and Rush University Medical Center and the Ann & Robert H. Lurie Children’s hospital BUT their is ONLY a 45 day window to do so. From November 1st to December 15th of 2016. To find out how, contact me after November 1st. Or, you can call those helpful “Navigators” over at Healthcare gov. I’m sure they have all the answers you need. Good luck with that.


Filed under Uncategorized

Aetna is leaving EXCHANGES in 11 states NOT the states themselves.

For clarification Aetna is not “leaving 11 states”. They are simply no longer offering SUBSIDIZED plans in those 11 states. If you purchased your Aetna plan OFF the exchange WITHOUT a subsidy you will most likely NOT lose your Aetna plan in 2017. Below is a statement from Aetna.

We will narrow our individual on-exchange participation for 2017

Individuals and families

Aetna believes that everyone should have access to high-quality health care at an affordable cost.  Over the past three years, we made significant investments in the individual public exchanges, working closely with regulators and lawmakers to provide options for consumers.  Unfortunately, the public exchange environment remains more volatile than expected. 

Following a thorough business review, we will reduce our individual on-exchange participation for 2017 to 242 counties, maintaining an on-exchange presence in Delaware, Iowa, Nebraska and Virginia.  We will continue to offer an off-exchange individual product option for 2017 to consumers in the vast majority of counties where we offered individual public exchange products in 2016.

These changes do not affect coverage for the 2016 plan year.  We will communicate to impacted members before the 2017 open enrollment period begins, and provide resources to assist them in transitioning to other plans as appropriate.

Policy changes are needed for the public exchanges to remain viable. The public exchange model needs to evolve from its current state to address the inadequate risk adjustment mechanism, increase product diversity and attract the remaining uninsured population who could improve the risk pool. 

Moving forward, we are hopeful that we can work with policymakers to create a sustainable solution that meets the needs of the uninsured.  With that in mind, we may expand our footprint in the future should there be meaningful exchange-related policy improvements.

Thank you for your continued support.  As per our normal practice each year, we will publish 2017 commission schedules before the start of 2017 open enrollment.       

Aetna health insurance plans are underwritten by Aetna Life Insurance Company, Aetna Health Inc., and/or by Aetna Health of Utah Inc. (Aetna).

Coventry health insurance plans are underwritten by Aetna Health Inc., Aetna Health of Iowa, Inc., Aetna Health of Utah Inc. and/or the following affiliates of Aetna Life Insurance Company: Coventry Health and Life Insurance Company, Coventry Health Care of Florida, Inc., Coventry Health Plan of Florida, Coventry Health Care of Kansas, Inc., Coventry Health Care of Nebraska, Inc., Coventry Health Care of Illinois, Inc. and Coventry Health Care of Virginia, Inc. 

Coventry Health Care of Georgia, Inc., Coventry Health Care of the Carolinas, Coventry Health Care of Delaware, Inc, Coventry Health Care of Louisiana, Inc., and HealthAmerica Pennsylvania, Inc., plans are underwritten by Aetna Health Inc. (8/16)


Filed under Uncategorized

Broker: Doomed business model, politics fuel Land of Lincoln failure

Broker: Doomed business model, politics fuel Land of Lincoln failure

Contributed photo


There is unquestionably a hefty amount of blame that should be laid on the role Illinois politicians played in the demise of Land of Lincoln Mutual Health Insurance Co., the Illinois Obamacare co-op that was in the marketplace, C. Steven Tucker, founder and principal broker at Health Insurance Mentors, said.

“The state has a tremendous responsibility,” Tucker said. “It’s not like they weren’t warned. It’s not like they didn’t know. A lot of this is ideological and political. People turned the other way because this was a co-op; and everybody wanted it to work because in their false ideas, they thought this was creating competition.”

Land of Lincoln is a 3-year-old nonprofit cooperative created under the Patient Protection and Affordable Care Act (PPACA), known colloquially as Obamacare, during Democratic Gov. Pat Quinn’s last term in office.

U.S. Rep. Randy Hultgren (R-Dist. 14) said the failure of Land of Lincoln and other co-ops like it, and Obamacare as a whole, has left health care consumers in worse shape than before the bill’s passage.

“The end of Land of Lincoln means the end of affordable health coverage for tens of thousands of people in my home state,” Hultgren said. “The ACA-mandated insurance exchange will now be left with even fewer, more expensive options as the law cripples under its own weight. States can’t take this anymore.”

The co-ops were created to spark competition in state insurance marketplaces. Land of Lincoln has some 10,000 policyholders who received coverage through their employers and roughly 39,000 enrollees who bought insurance on or through a broker, like Tucker.

The only nonprofit health insurer formed in Illinois under Obamacare went operational in 2013, after being passed by a Democrat-controlled General Assembly and signed into law by Quinn, with a $160 million loan from the U.S. government. Since then, financial issues had been strangling Land of Lincoln for months. The failed insurer had seen a loss of more than $90 million last year, and it owes a payment of $31.8 million to other insurers as part of the risk-balancing stipulations of the PPACA.

Prior to the Illinois Department of Insurance takeover on July 14, Land of Lincoln sued the federal government for an estimated $80 million the company said it is owed because the federal government allegedly violated federal law and cut funding for a federally authorized program.

Now the Illinois Department of Insurance has taken control of Land of Lincoln’s operations to ensure its claims are paid, debts are collected and assets are liquidated, the department, which is working with the federal government to institute a “special enrollment” period in the marketplace, said.

This special enrollment period would give Land of Lincoln policyholders 60 days to obtain new coverage from another plan on the Illinois exchange. If this special enrollment opens Aug. 1, as hoped, Land of Lincoln coverage would end Sept. 30.

So in the end, Tucker said, competition hasn’t been created.

“When you wipe out 17 health insurance companies since the passage of the PPACA, that’s where your competition went,” Tucker said. “The creation of taxpayer-funded entities to create so-called competition is not creating competition, and the evidence of that is the death of 17 of the 23 co-ops thus far.”

Furthermore, Tucker said the remaining co-ops will go under by the end of the year because their formation has been based on a bad business model that has set them up for failure, i.e., extremely low-interest-rate loans from the federal government, governing boards and CEOs inexperienced in the health insurance industry and no reserves to pay claims.

“But the Illinois Department of Insurance looked the other way because it’s Obamacare; it’s the president’s signature law,” Tucker said. “But when you look the other way, and you don’t do your job as a regulator, these are the consequences, and innocent people suffer.”

In addition, four of the state’s major teaching hospitals – the University of Chicago Medical Center, Northwestern Memorial Hospital, the Ann and Robert H. Lurie Children’s Hospital, and Rush University Medical Center, all in Chicago — should carry some of the burden, Tucker said.

“Most shamefully, besides the Department of Insurance not taking action when they should have, are these hospitals that promoted replacing Blue Cross Blue Shield of Illinois policies with Land of Lincoln health policies,” Tucker said.

Tucker said all four hospitals were recommending such policy replacements with Land of Lincoln health policies when the co-op was $90.8 million under water.

“So they recommended enrolling these people into a co-op that was already upside down,” Tucker said. “That is just reprehensible, and that’s why thousands of these consumers are now in this situation.”

Leave a comment

Filed under Uncategorized