Brokers and the ACA
As health care exchanges struggle to get more people covered under the Patient Protection and Affordable Care Act, at least one state is making a concerted push to enlist brokers to help.
While both the federal and state exchanges allow brokers to help individuals enroll in insurance policies since they opened for business in October, the Maryland Health Benefit Exchange last month launched a more formal initiative.
The Producer Referral Program is designed to boost sagging enrollment on the state’s exchange. About 55 brokers have volunteered thus far to help assist consumers in navigating the website, Maryland Health Connection, or enroll individuals directly with carriers.
As of Jan. 25, 26,832 people have enrolled through the website for private coverage, though the exchange did not say how many of those actually made their first policy payment.
To recruit more brokers to volunteer, the state exchange is working with three trade groups, National Association of Insurance & Financial Advisors of Maryland, the Maryland Association of Health Underwriters, and the Insurance Agents & Brokers Service Group.
“The people who will use this service are people who are determined to get insurance, but have been unsuccessful getting it on the exchange website,” said Bryson Popham, a partner in the Annapolis law firm, Popham & Andryszak, P.A. who represents brokers.
He said that one of the fundamental reasons trade group members are volunteering to help is their belief that uninsured individuals deserve access to health insurance.
Diane Boyle, vice president of federal government relations for the National Association of Insurance & Financial Advisors in Washington, D.C., said that its Maryland affiliate is on the forefront of formalizing a broker assistance program, but that other state affiliates are considering similar moves.
The decision for individual brokers to help consumers enroll on the health care exchanges depends a good deal on their own client make-up, Boyle said.
“If they have clients that are eligible for subsidies, they need to enroll through the exchanges, and that is really the only way that decision is going to make sense,” she said. “But if their client base is not eligible for subsidies, they can purchase policies outside the exchange. It really depends on who the broker wants to serve in their community.”
Many brokers, however, are shying away from helping consumers enroll through the exchanges, said Anne Sperling, employee benefits manager at Daniels Insurance Inc. in Santa Fe, N.M.
Sperling ticked off a number of reasons why she made “a professional decision” not to aid in the application process, including the lack of security associated with the healthcare.gov website, which she believes jeopardizes consumers’ protected health information and private financial information.
“I don’t want the communication liability … It could be construed as an error and omission, which obviously doesn’t help my practice; it hurts in a huge way.” —Anne Sperling, employee benefits manager, Daniels Insurance Inc.
She also noted that the labor-intensive application process is cost-prohibitive, as brokers do not receive commissions when they aid individuals to enroll via the public exchange; and that she is concerned the federal tax credit process will be improperly handled — to the point that she fears patients will be denied care should the carriers not receive their share of the government premium. All the premiums must be collected to put the policy in force, she said.
“Lastly, the public doesn’t understand that the tax credits are based on a last year tax return, which ultimately may be miscalculated and could result with the insured owing the government,” Sperling said.
“I don’t want the communication liability of all these points. It could be construed as an error and omission, which obviously doesn’t help my practice; it hurts in a huge way,” she said.
Sperling was one of the founders and the first executive director of the NM Health Insurance Alliance, a small group high-risk pool program for businesses with 50 or fewer employees, which was replaced by the NM Health Insurance Exchange. That exchange is accessed through the federal healthcare.gov website.
In Maryland, officials have given brokers permission to enroll individuals directly with carriers, if they have trouble completing enrollment applications on the state’s website, Popham said. However, only two of the four carriers on the Maryland exchange currently have the capability to allow for direct enrollment.
Moreover, individuals won’t receive federal subsidies to offset the cost of the health care policies unless they enroll through the exchange.
The Maryland Health Benefit Exchange also announced that, beginning in April, brokers can help eligible small businesses establish small group health insurance plans certified by the Small Business Health Options Program (SHOP) Exchange, as well as help them sign up for the corresponding federal tax credits.
Maryland is doing this because the state’s SHOP exchange is again being delayed until January 2015, in line with the delay of the federal SHOP exchange. Small businesses in Maryland can also establish such plans and apply for tax credits directly through carriers or third-party administrators.