The NAIC task force set up to look at the MLR’s affect on broker commissions is going to hold a public hearing in Austin TX March 27th.

March 28, 2011
By

AFFORDABLE TEXAS HEALTH INSURANCE PLANS 

Professional Health Insurance Advisors (EX) Task Force

2011 Charge

The Executive Committee Task Force on Professional Health Insurance Advisors shall work in an expedient manner to identify, analyze and recommend options to the Executive Committee for addressing the negative impacts on health insurance brokers/agents, insurance consumers and insurance markets, prior to and as a result of, the Medical Loss Ratio (MLR) requirements of the Patient Protection and Affordable Care Act (PPACA) and the regulation as issued by the U.S. Department of Health and Human Services (HHS).

NAIC Notice of Hearing
Professional Health Insurance Advisors (EX) Task Force
Sunday, March 27, 2011 3:30 p.m. – 5:30 p.m.
Austin, TX Hilton Austin – Austin Grand Ballroom Salon H – 6th Floor.

The purpose of the hearing is to solicit comments from all interested parties regarding the impact of the Medical Loss Ratio (MLR) requirements of the Patient Protection and Affordable Care Act (PPACA) on health insurance brokers/agents, insurance consumers and insurance markets. In particular, the Task Force is interested in comments to address the following questions:

  • What is or is likely to be the impact of removing commissions from what is defined as premium under the MLR requirements?
  • Have commissions been reduced since the passage of the federal law? If so, what is the impact of present and potential future commission reductions? Will this cause access issues? Is it likely agents/brokers will abandon health insurance markets? Please cite specific examples.
  • What will be the impact of a legislative change that treats producer commissions in the same manner as Federal and State taxes for purposes of calculating the MLR?
  • What is your opinion on the optimal solution to balance health plan/insurer concerns, consumer interests and the interests of agents/brokers?

NAIC Hearing 2011 Task Force Agent commissions.Ashmore & Associates

26 Responses to The NAIC task force set up to look at the MLR’s affect on broker commissions is going to hold a public hearing in Austin TX March 27th.

  1. Jennifer on March 23, 2012 at 11:18 am

    As the insurance regulator’s major professional group backs off on its push to exempt broker commissions from being treated as administrative costs in calculating insurers’ minimum medical loss ratios (MLRs), industry insiders suggest that some states will work around the parameters of federal regulations to pursue their own solutions to this issue.

    Arkansas, for example, is mulling an alternative that takes the insurer out of the equation in compensating brokers. It’s a proposal “that could work in many states,” Alan Katz, past president of the National Association of Health Underwriters and a principal at the Alan Katz Group, a consulting firm in Los Angeles, tells HRW.

    Alice Jones, spokesperson for the Arkansas Insurance Department, confirms to HRW that the state is considering a bulletin “which proposes to permit the agent or broker to collect a ‘compensation fee’ directly from the client/group as a consultation fee. We are seeking feedback and suggestions from health producers and brokers so the commissioner can decide what is in the best interest of Arkansas consumers.”

    Jones stresses that the bulletin is “only under discussion at this time.”

    Federal regulations that took effect Jan. 1 require health insurers to have MLRs of at least 80% in the individual and small-group markets and 85% in the large-group market (HRW 12/6/10, p. 1). Broker commissions must be included in the adjusted earned premium used in calculating the MLR, thus having the effect of increasing the denominator, lowering the reported MLR and potentially increasing the amount of rebates that the carriers would have to make to customers.

    An Aug. 29 Government Accountability Office report found that most insurers were planning to decrease commissions to brokers, in an effort to increase their MLRs (see chart, p. 3).

    In June, a task force of the National Association of Insurance Commissioners (NAIC) on broker issues voted to support a bill (HR 1206) sponsored by Rep. Mike Rogers (R-Mich.) to exempt broker commissions from the MLR calculation. Some commissioners had supported the bill, citing concerns about brokers’ livelihood in the wake of significant commission cuts by insurers, and the resulting potentially negative impact on consumers and small groups seeking help in purchasing insurance.

    This issue, however, appears to have lost steam within the NAIC. In a recent conference call, NAIC President-Elect and Florida Insurance Commissioner Kevin McCarty, who chairs the task force and backed the bill, acknowledged that “while we may be supportive of the Rogers bill in the task force, we have to be realistic about the opportunity of it becoming law” (HRW 7/18/11, p. 5).

    “I don’t think the NAIC is going to take further action on this unless something changes pretty dramatically,” Timothy Jost, J.D., a health law professor at the Washington and Lee University School of Law in Virginia and an NAIC consumer representative, tells HRW.

    Jost says the broker issue had been left off of the agenda for NAIC’s canceled summer meeting, though he acknowledges that “there wasn’t a lot of health care business” scheduled for the meeting to begin with. “I think it’s fair to say that the main agenda was to start looking at 2014, looking at exchange implementation and new market regulations,” he says of the meeting’s planned health reform discussions. “There weren’t any big agenda items that were set for decisions; it was to start talking about how various issues were going to be dealt with.”

    In light of the canceled meeting, McCarty spokesperson Jack McDermott tells HRW, “I do not think there have been any more developments on this.”

    Jost was also skeptical that lawmakers in Washington would take up the broker pay issue, in either the Rogers bill or other legislative avenues.

    The Rogers legislation, which has about 100 co-sponsors, has not yet been marked up in a House committee and is actively opposed by consumer groups and some prominent Democrats, including Sen. Jay Rockefeller (D-W.Va.). “If Congress decides this is a top priority, and they may try to attach it to a bill, the president would have a hard time vetoing and push it through — but right now Congress has so many other things on its plate, it’s hard for me to imagine this is a top priority,” Jost says.

    If any action takes place on broker fees, it may be on the Senate side where Sen. Mary Landrieu (D-La.) said she was going to introduce legislation to exempt the fees from the MLR calculation, he continues. “I don’t know where that stands, but the last I heard, she was asking HHS if this is something they could do, and…the position from HHS is there is nothing they can do, they’re just implementing the law, and if Congress wants to change the law, it can.”
    States May Try to Circumvent MLR Regs

    Attorney Bruce Merlin Fried, a partner in the Washington, D.C., office of law firm SNR Denton US LLP, acknowledges that “the feds have decided how they’re going to handle the broker agent issue. And while there may be members of Congress willing to fight the good fight for the brokers and agents, at the end of the day Jay Rockefeller is not going to let this change.”

    While Congress may have drawn the line on the MLR, it’s also important to note that states have the ultimate authority over brokers and agents, Fried contends. “In that respect, states could have a lot of sway” in addressing the matter of broker compensation in the MLR.

    As an example, the states could “basically take brokers and agents out of the realm of insurance, so they aren’t acting as agents of insurers, but instead are acting as the agent of the purchaser,” to possibly circumvent the issue of counting their commissions as administrative costs in the MLR, he says. Under Arkansas’ proposal, for example, employer groups would pay brokers as consultants, and the insurance carrier essentially would act as a third-party clearinghouse, Katz says. In other words, the carrier would aggregate all of the broker’s fees into one lump sum, list that distribution fee as a separate charge on the employer’s premium bill, and then pay it out to the broker. This way, the fee never gets counted toward the administrative cost of the carrier.

    “It’s the facilitation of the fee between the client and the broker,” and there’s no violation of the reform law in that, Katz explains.

    Some, but not all, states may be looking at these types of options, he predicts.

    It’s a more transparent arrangement, but as David Tuomala, director of actuarial consulting at OptumInsight, suggests, one that may not necessarily work in favor of brokers. They still could face reduced compensation, he tells HRW.

    Specifically, brokers might find it more difficult to justify the compensation they’re getting for selling a product every month if it’s separated out as a line item, Tuomala says. Once employers know how much they’re paying brokers for their services, “they may want to ratchet that down if the amount is higher than they might like it to be,” or if they feel they’re not getting value for the amount of broker fees they’re paying, he adds.

    The broker issue remains controversial and “isn’t just going to go away,” Joe Paduda, a former insurance executive who now is a principal in Health Strategy Associates, tells HRW. “It will wax and wane, but as pressure mounts on insurers and regulators, broker fees will come back to the fore as everyone tries to ensure their piece of the pie remains as big as possible.”

  2. Sabrina on March 29, 2012 at 2:49 am

    There’s been lots of drama at this year’s first meeting of the NAIC (National Association of Insurance Commissioners) in Austin, TX – way more than any of us consumer representatives to the NAIC expected. The good news, as you may have heard by now, is that the NAIC decided to delay a vote to endorse Congressional legislation that would remove broker commissions from the Medical Loss Ratio (MLR). But that outcome seemed like a pipe dream when the NAIC’s consumer representatives first landed in Austin on Thursday night.

    Consumer reps had all been told for weeks that nothing was going to happen at this meeting, no votes would be taken, there’d be just a few hearings – that’s all. So when we got word just the day before we arrived that a number of Commissioners were pushing hard to endorse the Rogers bill we were all taken off guard. Even more alarming, we heard from a number of sources that support for the brokers’ position was so strong the vote was almost a “done deal.”

    But after intense advocacy by all sides, including from many consumer groups all around the country, the NAIC decided to take another look at the proposal. After all, not only is it likely that the Rogers bill would result in premium increases for consumers, but there’s simply no evidence that consumers or small businesses are suffering from a lack of access to brokers, or whether reductions in broker commissions are actually a result of the MLR. The only state to provide before and after data on MLRs – Colorado – showed that broker commissions were cut from 20 percent to 10 percent of the premium, suggesting they were way above market norms to begin with.

    The NAIC’s health committee will now take a few weeks to actually analyze data in the market about broker commissions and the impacts on consumers and small business owners. We think this is the right approach, and applaud NAIC for taking a more thoughtful and deliberative approach.

    Addressing broker compensation is not the only thing NAIC was up to this weekend. The meeting kicked off on Friday with a hearing on health insurance Exchanges. The Exchange Working Group heard testimony from Medicaid experts about some of the very challenging issues states are facing to effectively coordinate public programs with the commercial insurance markets, and got demonstrations of Utah and Massachusetts’ web-based health plan finders. Both states have clearly put a lot of work into designing a web interface that is consumer friendly. That said, by emphasizing how easy their process is for employees, Utah’s presentation was slightly misleading. They neglected to mention that enrollees need to undergo health status underwriting before they can access the website, and they glossed over the difficulty many employees have in choosing a plan among more than 100 different product options.

    Joel Ario, head of the Exchange division at HHS’ Center for Consumer Information and Insurance Oversight (CCIIO) also testified. He was asked a number of questions about the feds’ plans if a state doesn’t set up its own Exchange. Ario indicated that HHS has been working on a federal fallback plan, but that HHS does not intend to produce a one-size fits all model. And even if they do have to set up a federal Exchange, HHS would have every intention of working with the states to tailor the Exchange to states’ markets and ensure coordination with state-run public programs such as Medicaid and CHIP.

    Next up for the Exchange group is to finalize white papers on issues like financing, adverse selection, and Navigators, as well as to issue additional draft white papers on governance and active purchasing. NAIC consumer reps have submitted extensive comments, and will continue to try to shape NAIC’s recommendations on these issues.

    Last but not least, NAIC is looking ahead to 2014 and has a task force working to develop a model state law to implement reforms like elimination of pre-existing condition exclusions, the new premium rating rules, and guaranteed issue. They hope to have a model law adopted by the end of this year, which is pretty darn ambitious.

    As for the proposed broker bill, we have a short four to six week reprieve before NAIC takes it up again – and consumer advocates will need to continue to make sure their voices are heard during this process.

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    • Vanessa on April 25, 2012 at 4:07 am

      Every state will be slightly dffeirent, but I’ll give you the proverbial swine slap across the face about why Medicare is generally the worst thing invented by modern liberalism in this nation, in only ONE word: Access.In my state, there are 1,127 primary care Medical Doctors, and 130 Osteopaths in family practice. That’s 1,257 doctors that handle routine care (non-emergency care, not otherwise in a named specialty).Of that 1,257, less than 11% accept Medicare assignment. CMS provides these figures, so my point is irrefutable. As others have noted, Medicare pays a fraction of an already deep discounted rate that is substantially below what providers call usual and customary (a fancy phrase for retail prices ).When a doctor refuses to sign up for Medicare assignment, they still get paid for treating Medicare patients, but they get EVEN LESS than the already bottom dollar (read: guaranteed loss) reimbursements of the doctors that willingly accept Medicare assignment. This is not my opinion. This is verifiable, irrefutable fact, and the source is CMS. Nobody knows better how bad Medicare is than Medicare itself.Of the several hundred doctors I advise in my practice, more than 95% go out of their way to refuse Medicare patients. Some go as far as sending out birthday letters prior to age 65 politely asking the patient to find another doctor (if you schedule an appointment after age 65, they aren’t always so polite some instruct their staff to refer Medicare patients to CMS for the very short list of doctors willing to work for the absolute lowest wage a doctor can possibly earn).What this means to you is this: More than 89% of primary care doctors do NOT want Medicare patients, because they are guaranteed to lose money on those patients.What this also means to you is this: Private insurance subsidizes Medicare in an off the books fashion, via cost-shifting. Take away private insurance, and not only would Medicare go broke virtually overnight, providers would vanish faster than a modern liberal can fail at math (and they fail 100% of the time faster than any other group).Doctors aren’t going to work for free. Neither will nurses, and other support staff (and you can’t force them outside of a chattel slavery system of forced labor). They will all seek other ways to earn a living. This will lower access even further from the abysmal point it is now, and lower access ALWAYS equals higher costs, lower quality, and more early deaths among those modern liberals who failed at math so fast.Other points of interest: Largest and fastest growing form of crime in the USA is identity theft. Among that large group of crimes, the single fastest growing aspect is medical Identity theft. A Medicare card has a street value of $500 to $700 ten times that of a stolen credit or debit card.The second most profitable crime in America today? Medicare fraud. The source for that is the same government that built the failed collectivist system. The smart criminals are leaving the drug trade and turning to Medicare fraud. The numbers are staggering. A mid-level drug trafficker might make $300,000 a year, taking extraordinary risks. The same crook can make $30,000,000 stealing from Medicare, and never get shot at.Talent and capital go where it is rewarded, and stay where it is well treated. This axiom applies to the talent that goes into medicine, and it also applies to talent when it comes to criminals seeking to profit from the system that has ZERO financial incentive to fight fraud (ONLY a for-profit enterprise will root out the thieves, and find ways to detect them before they cause real damage the government just asks for more funding to replace what was stolen).

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    • Chaimae on April 23, 2012 at 4:10 pm

      Every state will be slightly diefrfent, but I’ll give you the proverbial swine slap across the face about why Medicare is generally the worst thing invented by modern liberalism in this nation, in only ONE word: Access.In my state, there are 1,127 primary care Medical Doctors, and 130 Osteopaths in family practice. That’s 1,257 doctors that handle routine care (non-emergency care, not otherwise in a named specialty).Of that 1,257, less than 11% accept Medicare assignment. CMS provides these figures, so my point is irrefutable. As others have noted, Medicare pays a fraction of an already deep discounted rate that is substantially below what providers call usual and customary (a fancy phrase for retail prices ).When a doctor refuses to sign up for Medicare assignment, they still get paid for treating Medicare patients, but they get EVEN LESS than the already bottom dollar (read: guaranteed loss) reimbursements of the doctors that willingly accept Medicare assignment. This is not my opinion. This is verifiable, irrefutable fact, and the source is CMS. Nobody knows better how bad Medicare is than Medicare itself.Of the several hundred doctors I advise in my practice, more than 95% go out of their way to refuse Medicare patients. Some go as far as sending out birthday letters prior to age 65 politely asking the patient to find another doctor (if you schedule an appointment after age 65, they aren’t always so polite some instruct their staff to refer Medicare patients to CMS for the very short list of doctors willing to work for the absolute lowest wage a doctor can possibly earn).What this means to you is this: More than 89% of primary care doctors do NOT want Medicare patients, because they are guaranteed to lose money on those patients.What this also means to you is this: Private insurance subsidizes Medicare in an off the books fashion, via cost-shifting. Take away private insurance, and not only would Medicare go broke virtually overnight, providers would vanish faster than a modern liberal can fail at math (and they fail 100% of the time faster than any other group).Doctors aren’t going to work for free. Neither will nurses, and other support staff (and you can’t force them outside of a chattel slavery system of forced labor). They will all seek other ways to earn a living. This will lower access even further from the abysmal point it is now, and lower access ALWAYS equals higher costs, lower quality, and more early deaths among those modern liberals who failed at math so fast.Other points of interest: Largest and fastest growing form of crime in the USA is identity theft. Among that large group of crimes, the single fastest growing aspect is medical Identity theft. A Medicare card has a street value of $500 to $700 ten times that of a stolen credit or debit card.The second most profitable crime in America today? Medicare fraud. The source for that is the same government that built the failed collectivist system. The smart criminals are leaving the drug trade and turning to Medicare fraud. The numbers are staggering. A mid-level drug trafficker might make $300,000 a year, taking extraordinary risks. The same crook can make $30,000,000 stealing from Medicare, and never get shot at.Talent and capital go where it is rewarded, and stay where it is well treated. This axiom applies to the talent that goes into medicine, and it also applies to talent when it comes to criminals seeking to profit from the system that has ZERO financial incentive to fight fraud (ONLY a for-profit enterprise will root out the thieves, and find ways to detect them before they cause real damage the government just asks for more funding to replace what was stolen).

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    • Norma on April 23, 2012 at 10:18 am

      You may deduct quliifaed medical expenses you pay for yourself, your spouse, and your dependents, including a person you claim as a dependent under a Multiple Support Agreement. You can also deduct medical expenses you paid for someone who would have quliifaed as your dependent for the purpose of taking personal exemptions except that the person did not meet the gross income or joint return test. You deduct medical expenses on Form 1040, Schedule A (PDF), Itemized Deductions. The total of all allowable medical expenses must be reduced by 7.5% of your Adjusted Gross Income. For more information, refer to Publication 502, Medical and Dental Expenses.

    • Kim on April 25, 2012 at 5:29 am

      I don’t know where you got your figures, but as sonmoee who has had private medical insurance and now am on Medicare, private does much better. Yes, it is higher priced, but Medicare is far from being free either. We pay a monthly premium for it that totally exceeds $150 a month each and the coverage is horrible. I used to be part of an employer based plan where I paid less than that, and got excellent coverage. The only thing I ever had to pay was a small co pay for doctor and prescriptions.I think the best plans are those offered by employers because they are group plans. Medicare SHOULD BE the largest group plan but the group it covers are those who have the biggest health problems so it is a lot of money.Medicare recipients can get better coverage for less money if they take out a private plan where they can become of a group comprised of all ages. That is actually what Obama was attempting to do with the uninsured in the country. The problem is .those uninsured did not have to pay anything for it at all so that only means that the premiums will go up for everyone else to pay for them.I would happily pay my $150 per month to a group plan to get better coverage.

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    • Antoni on April 25, 2012 at 5:04 am

      I have had Medicare since about 1999/2000. Medicare pays 80% of what they consider is reslanaboe cost. Believe me that isn’t much. For example: Suppose I have a bill of $1000. Medicare determines that reslanaboe cost is $400; they pay 80% of that. And even though I have a private insurance which supplements Medicare, Medicare still sets the reslanaboe cost which means in my example that my private insurance will pay 20% of $400. Whoever performed the service (doctor, hospital, whoever) is out $600. When my doctor retired about five years ago I called four places which wouldn’t take me on as a patient because I have Medicare.Even though private insurance companies are in it for profit, because they charge much higher premiums than the government does for Medicare, they can afford to pay more out because of those higher premiums. It’s truly a case of you getting what you pay for.Because I don’t work, Medicare is primary and my Blue Cross/Blue Shield is secondary so Medicare sets the reimbursement rate. Secondary insurers REQUIRE that a person be entitled to Medicare if they are eligible to cut down on the costs of the secondary insurance.If I didn’t have Medicare and I wasn’t eligible for it, my Blue Cross/Blue Shield would be reimbursing my doctors and hospitals at a much higher rate than what Medicare does.Now why doesn’t everyone in the United States have Medicare? The insurance companies wouldn’t stand for it and the medical community would be backing them up. Our representatives and senators wouldn’t dare extend Medicare to all Americans!Frankly I think Medicare should be extended to everyone with increased premium rates and higher payments to providers of services and it could be administered through the private companies. But who am I?

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    • Sulis on April 23, 2012 at 10:56 am

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    • Yuana on April 25, 2012 at 4:22 am

      The simple aenswr is Freedom of Choice. First of all you must understand that there is a great deal of fraud involved with Government run Medicare. Scam artists regularly milk Medicare out of BILLIONS of dollars. Private insurance companies are out to make a profit and therefore investigate the claims much better.It should also be noted that Medicare has approx $1100 deductible each year for hospital coverage and $162 per year for Outpatient deductible. After that the member is responsible for 20% co-insurance. Add to that the fact that there is no routine dental coverage, no routine vision coverage and no prescription drug coverage.Private plans are requires by law to follow federal guidelines that either meet or exceed original Medicare coverage. Most of them far exceed these guidelines. Many plans offer dental, vision part d coverage and even health and wellness, transportation and/or fitness classes (health club memberships)The private insurance companies receive a set monthly per member fee as determined by our federal government and not a percentage. If this amount is less than the cost of care for a certain individual the insurance company is liable to pay with no additional reimbursement.Insurance is actually defined as pure-risk but closely monitored by underwriters. They have an idea of what health care costs but there are so many variables that there is no clear cut number that can actually be obtained. It is all based upon estimates.Private insurance competes for more business and thus offers additional benefits and lower co-payments in order to entice more people to join their plan. We can all keep blaming the big bad insurance companies or give the reigns over to the government who will dictate what we deserve and what they feel we need. What a novel idea. Our government thinks they are more intelligent than we are and has decided that we are too stupid to decide what is best for ourselves.With all of that being said. Everyone still has a choice to have original Medicare or choose a private plan. Medicare advantage is growing at an incredible pace and there are over 11 million seniors and growing who have made this choice. I will side with Seniors on this one. They know what works because they use these programs every day. Not everyone will ever have the same opinion but the overwhelming majority of seniors will tell you quit screwing with my Medicare They like what they have

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  14. Jozefina on April 23, 2012 at 10:22 am

    Yes. Ins premium, docotr visits, prescription drugs, contact lenses, and necessarily surgery or purchases are deductible. Over the counter drugs and unnecessarily surgery like boob jobs are not.You add them all up, substract any medical reimb and thats your medical tax deduction. but it is limited to 7.5% of your Adjusted Gross Income (which is your income adjustments), so if you make too much money you most likely cant take the benefit. If you want to save more money, add in you over the counter drugs.

  15. Aisha on April 25, 2012 at 5:40 am

    That was debated in Congress in 2009 and retcjeed Medicare for those from 55 to 65. It would have cost too much for the U.S.A. to subsidize more people when they are not getting enough revenue to pay for current recipients. Medicare does subsidize private health care providers and insurance companies that accept Medicare patients. It is not socialism if the Medicare enrollees pay for it. By monthly Part B premiums that range from $96.50 to $600 some of whom did not work and reside in the U.S. long enough or had over $85K annual income, or are also covered by employer health plans. Medicare patients also pay 20%+ of all their medical bills, unliked Medicaid where the government foots the entire bill or they purchase another policy called Medigap or supplemental insurance for $125 to $150 a month additional. Even though Medicaid is supposed to be shared funding with the states, the states have been using stimulus money since 2009 to pay their share. That money ends in July.Dont forget that millions of children and adults who are disabled and handicapped also have Medicare.

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