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Enrollment 2018

Brokers Are Reluctant Players In A Most Challenging ACA Open-Enrollment Season

Lee Nathans, like insurance brokers in many states, expects to be crazy busy for the next several weeks, fielding calls from 鈥減eople who are not going to be happy.鈥

Open enrollment for Affordable Care Act coverage started Nov. 1, and the approximately 10 million people who buy their own health insurance are only now getting a look at what鈥檚 being offered. It鈥檚 daunting.

鈥淭here will be a lot of people who will need to use a broker,鈥 said Nathans, of Columbus, Ohio.

The enrollment period is also shorter than in previous years, ending Dec. 15.

In many places, there are fewer health insurance carriers offering coverage 鈥 and those that remain have sharply raised prices and changed their networks of doctors and hospitals.

More perplexing for people sifting through these options is the fact that this year there鈥檚 less on-the-ground assistance to help decode those complexities because of Trump administration funding cuts.

All that means brokers are coping with what may be the most challenging sign-up period since the ACA marketplaces, also known as exchanges, debuted in 2014.

When the ACA became law, some thought the days of brokers were numbered.

The ACA鈥檚 rules and online state and federal exchanges were supposed to make comparing plans and purchasing health insurance easier.

But for many consumers 鈥 particularly those who have never bought insurance before 鈥 having help is vital.

鈥淵es, health insurance is complicated,鈥 said Lisa Hamler-Fugitt, executive director for the Ohio Association of Foodbanks, which provided such help for the past four years through federal grant-funded navigator programs in the state. Navigators are trained individuals or groups that guide consumers and small businesses through the process, for free.

鈥淸Customers] didn鈥檛 turn to us just during open enrollment, but also when they had questions about how to use their plan, about deductibles and copayments.鈥

This year is different.

The Trump administration, criticizing the navigator effort nationwide, slashed funding. The learned it would get a 71 percent cut and reluctantly closed its doors for this enrollment season.

There were also cuts to other states, which varied, but averaged . In Tennessee, for example, navigator funding was reduced by 16 percent, while in Indiana it fell 82 percent.

The Department of Health and Human Services appears to be turning to brokers to fill this gap. It announced in late October that the federal online marketplace, healthcare.gov, has a new resource under its 鈥淔ind Local Help鈥 tab. Consumers can enter their contact information in the 鈥 and get a call back from a state licensed broker.

It isn鈥檛 known how many brokers signed up to participate, but agent John Dodd thinks it鈥檚 a good idea.

鈥淭his move of working more with brokers will help make up some of the difference [from losing the navigator program], although anytime you remove help, that鈥檚 not a positive step,鈥 said Dodd, president-elect of the Ohio Association of Health Underwriters and owner of his own agency in Westerville.

But growing pressure on brokers 鈥 from smaller commissions to increased complexity of the health offerings 鈥 means they may be harder to find.

Last year, several big Blue Cross Blue Shield insurers cut or reduced their commissions, citing it as a cost-cutting move, following a similar action in 2015 by UnitedHealthcare. Some brokers then began charging a fee to help people enroll, while others stopped entirely.

When insurers pay commissions, the amounts are included in premiums and can be between 2 and 5 percent, depending on the carrier.

This year, 鈥淚鈥檓 still going to help my clients, but I鈥檓 not doing direct enrollments,鈥 said Nathans. He will refer customers who need this assistance to a colleague.

There are reasons why the enrollment process is a heavy lift.

Licensed insurance broker John Jaggi of Forsyth, Ill., said he and his daughter, Anne Petri, also a broker, often spend the first 35 minutes of appointments just helping clients figure out the math to determine if they can get a premium subsidy. People who qualify earn less than 400 percent of the federal poverty level ($48,240 for an individual) and don鈥檛 have other coverage.

By that point, clients are exhausted and don鈥檛 even want to talk about the details of the plan, Jaggi said. And he鈥檚 paid 鈥渁lmost nothing鈥 for his efforts.

Still, Jaggi and Petri plan to continue helping individuals with this year鈥檚 enrollment.

A Trump administration decision in October likely has created even more demand for these services. President Donald Trump said then that he was stopping federal 鈥渃ost-sharing reduction鈥 payments to insurers. These payments were used to offset the costs of coverage for certain low-income policyholders by reducing their deductibles and copayments.

Even without the federal assistance, insurers are still required to provide these cost reductions. To make up for them, insurers boosted premiums, particularly in middle-level 鈥渟ilver鈥 plans. Because the cost of these plans is also the benchmark used to set the tax-credit subsidy many people receive to help pay their premiums, eligible consumers will likely receive more federal assistance this year and have more affordable options from which to choose.

In other words, people who receive the tax credits are not likely to feel a financial pinch. People who don鈥檛, though, will likely take a hit.

鈥淵ou have to feel bad for them,鈥 said Petri. 鈥淗ow can they afford another $100 to $200 a month in premium?鈥

The individual market has always been volatile, but brokers say the situation is bad this year.

Dodd, the Westerville, Ohio-based broker, said he hopes Congress acts to stabilize the market. And soon.

Without that, 鈥2019 could be Armageddon, off-the-charts bad,鈥 he said.

Related Topics

Insurance States The Health Law