Health Insurance Reform Issues

For Practicing Agency Brokers, Trusted Insurance Advisers, And Financial Planning Consultants….

From time to time, there is a need for guidance in Financial Services Practice; now is definitely one of those times. There are two distinct issues working in tandem which determine modifications in the future conduct of our business: The Economy and the Reforms. Here are ideas on how to navigate our way through the maze. This can most certainly be done. With care, thoughtful performance, and innovation, Financial Services Professionals can serve the general public and make the experience satisfying and profitable. Let’s begin with some commentary on the general economic circumstances first. Following that, we’ll take up the Reform issues, how to move through them, and how the way we advise members of the general public on savings, insurance, investment, and retirement concerns.

1.To begin the economic discussion, we need to address the full and true extent of just what we as a nation and we as practitioners are up against. As of this writing, in the winter of 2009, unemployment, including the employed, self-employed, and business owners, has passed 10%, about 15 to 16 million people. Add another 6 to 7 percent to that, which includes the part-timers, disabled, retired, and those of working age who have stopped looking. We are looking at about 22 million Americans not drawing active paychecks. The closing of businesses, branch locations, shops, stores, retail, wholesale, and service sectors, adds to the severity of the overall problems. It is conceded that there are many who are drawing from savings, taking early pensions/Social Security income, receiving extended unemployment compensation, and retirees on full pensions. That said, the loss of productivity is simply staggering. All this decreases the taxes available from which cities, counties, states, and the federal government must fund budgets. Naturally, all this leads to ever worsening annual deficits and unfunded liabilities. Finally, federal government for the past 30+ years has pursued deficit-spending policies which add to all of this. A look at USDEBTCLOCK.ORG tells the whole story in real time. Take a look and notice a few things.

The national debt stands at some $12+ trillion, while the federal budget shows in the neighborhood of $3+ trillion. Take a closer look and it can be seen that $1.7 trillion is taxes, while the difference is annual debt – sale of treasuries, printing of currency. The unfunded liabilities of Medicare/Medicaid, Prescriptions, Social Security top $106 trillion! To get an idea of what these liabilities mean, consider that this funding is what must be contractually paid out in entitlements over the lifetime of those presently enrolled in these programs, say, from now and over the next 20 to 30 years. And that will become progressively larger as the Baby Boomers begin checking into the systems. This is merely the highlighted treatment of the issues and doesn’t take in figures on the levels below the federal programs and subsidies: state, and related deep concerns over inflation, tax increases, brain drain, not to mention the TARP, STIMULUS, industry handouts/loans, and funds to individuals and non-governmental organizations under Acts in force, such as new mortgages and existing mortgage relief.

We read, see, and hear the word “unsustainable” a lot. Another phrase is ” the debasing of our currency.” Still another is “breaking the buck.” Are these figures actually important to us? Well, yes. One example will suffice: the interest alone on just the national debt is about $340 billion/year, or about 12% of the national budget. And that is going to get much higher. Relate that to a family making, say, $75,000/year. With this level of household debt, that family will pay some $9,000/yr. merely to pay interest, not even to reduce its debt obligations! Just recently on CNBC, a professor of finance designated the U.S. Dollar as fiat currency, which it is. Watch just about any television station and note all the advertisements about gold. Yet, many Americans just roll on as if everything is going to be just fine. Let’s hope for that miracle. The American People have been through some very difficult times over the past 250+ years and have managed to rebound. That could happen again. This time, however, things are quite different and difficult.

Does all this mean that Americans should just roll over, play dead, and let the federal government take care of everything? As a nation, will we file for default and a kind of national bankruptcy? This may be a legitimate senario; and it could be solved through establishment of a new currency sometime in the future, after everything gets paid off in near worthless U.S. currency. But, nations and the people in them, get hurt—badly. Russia, Panama, Argentina, Germany, Cuba (and there are more examples out there), all went through this, and the people there know just how bad this is: a national nightmare from which one cannot awaken. Special note on Argentina: The collapse of that country’s currency, the Peso, not long ago, lead to black markets, swap meets, trading for needed goods with hard assets, such as gold, bartering and trading in kind, not to mention increases in violence and crime. When new prices and wages readjust to some new currency, the resultant pricing of goods and services is extremely unfavorable to individuals and businesses. One can hope and pray that this does not happen or at least is some years away. Some experts suggest anything from 2 to 20 years—-read: nobody knows for sure! That said, this leads to strategies that we in the financial services industry can and should probably look into and maybe adopt. If all this sounds like gloom and doom and just too ridiculous, let me assure readers that this writer has done his research, can back it all up, and is most assuredly not making it all up as he goes along! Independent corraboration and documentation on all of this is readily available on the internet, libraries, university papers/archives, and other public records.

2. Here are some practical suggestions for Financial Services Professionals. While nobody can predict the future, this portion of the narrative is best described within two arbitrary time frames: A. 2010 to 2014-2015. B. Beyond that to, say, 2020-2025. This time division is established for specific reasons. At the time of this writing, the U.S. Government is poised to pass and place into effect a national healthcare/health insurance reform act. It doesn’t much matter whether or not one is in favor of this particular piece of legislation or some others, reform is necessary and will come very soon regardless of what the final act turns out to be.

Care rationing is a matter of fact, already in place for some years, and will get more pronounced for everyone. There really is no other sustainable way to do any kind of reform in attempts to control steeply increasing costs of insuring seniors and those below age 65 yr. who can either not afford to be insured, can’t qualify, or act as though they don’t want to protect themselves(checking into their local hospital ER so we can all pay for that; and hospitals, in order to remain in business are already tightening up on the emergency provisions of the law). The projected costs of the one that looks like it will become the law of the land, warts and all, is estimated at between $1 and $2 trillion over the next 10 years. It will no doubt end up by 2019 considerably more. If it doesn’t, it will stand alone among all the U.S. entitlement programs in the history of the Republic to come in at or below the CBO cost estimates. Look for increasing income taxes, fewer paychecks to tax, very slow employment recovery, very fragile equities markets, more federal currency creation, more inflation, weakening U.S.Dollar.That’s the context in which we find ourselves and determines what we do as financial services advisors and implementers. Good luck. That said, let’s discuss Part A – the next 3 years.

Part A. During the next three years, things will proceed at more or less normal conduct of business in an atmosphere of continuing inflation and increasing taxes. As practitioners, we can expect to market the same or similar coverages as we do now. Adverse Selection(taking into account pre-existing conditions) will still be there to control premiums on life, individual, family, group healthcare, disability coverage, long term care insurance, retirement plans(more on this later), to mention the prominent ones. We still will be doing our due-care, due-diligence, financial planning, fact finding, observing compliance, and doing what is best for the client. There are going to be less people and businesses with which to work, and they will have less money with which to do things. Remember, the client always comes first. Words to live by.

Certainly, we owe it to those who favor us with their business to let them know what is coming as soon as we know what is in store for them and for ourselves. For the most part, we will try to continue as before – for about the next several years. After that, things begin to get very different. Let us progress to Part B, Beyond that.

Part B. After 2014-2015, health insurers drop Adverse Selection and pre-existing conditions no longer play a part in the health underwriting process, at least for much of the individual, family, small group medical insurance, and Medicare Supplementary coverages. We’ll all most likely be undergoing training, certification testing, and more state/federal regulation. There’s an upside to all of this. As long as the health insurance industry remains in play, we should be able to make as much or even more money. Nobody knows what the effect of some U.S. Health Insurance Company, Co-op, or Exchange might have on the viability of the health insurers. The CBO states that some very small percentage of the public will enroll in the Public Option plans. That remains to be seen. Many people will be subject to non-enrollment penalties and fees.

What we do know about public plans and elimination of pre-existing conditions is the example we have in Texas. This public option is called the Texas Health Insurance Risk Pool, under the jurisdiction of the State of Texas. In Pool plans, there are no pre-existing conditions to stop one from procuring a pretty good major medical insurance coverage; in fact, one actually has to have significant medical condition or conditions to be eligible. Approximately 29,000 Texans are presently enrolled, out of the millions who have commercial coverage of individual, family, or group coverage. Even with State and Federal subsidy grants each year, the premiums on these plans run 2.5 to 4 times what a similar commercial plan might cost and the coverage is not as good. In a word, it is really expensive. It may be that, since the great majority of Americans probably generally qualify by providing medical evidence of insurability anyway, the impact of accepting all applicants by the commercial insurance companies may not send the overall individual/group premiums skyrocketing(an outcome with which this author does not agree). Those who can’t afford health insurance may get federal subsidies. The fact is that nobody really has a clue. We won’t discuss the MA and OR state-run health care/insurance plans. Not working out very well. Adverse Selection Elimination is a main culprit, leading into healthcare rationing and increasing premiums.

For insurance professionals, the marketing opportunities may just turn out to be positive. Bringing into the insuring public millions of previously uninsured and underinsured younger people may be a good thing. Supplementing health insurance for seniors will be there. We need to work hard at staying in the game and not getting squeezed out by federal competition. All people out there will certainly still need competent financial services professionals, maybe even more than at present. There are those in professional positions of economics, demographics, medicine, actuarial science, and other disciplines who think that any public option may not drive out the insurers, especially knowing that private enterprise, ingenuity, innovation, increased efficiency, would allow the private sector even to drive out the public option. Look at how the Post Office, Medicare, Medicaid, VA hospitals, Social Security, and other entitlements have worked out. Remember that $106 trillion(and climbing) of unfunded liabilities and where that has put the nation and the American People. As these liabilities keep coming due, they increase the federal budget! Doesn’t sound like some great efficiency to this writer.

Finally, there is this prediction regarding earned and renewal compensation. Don’t look for some sudden drop off just because of Reform. This author has found from experience that most people are quite cautious and suspicious of new programs and will tend to retain what they have for just as long as they can, until they gain confidence in such programs, or are forced into them. Even then, many, if not most, will still retain current health insurance coverage in some form to pick up what Reform does not. That was this writer’s great surprise with Harris County here in Texas, when in 1970, the County government replaced an outdated and woefully inadequate set of fringe benefits with full comprehensive coverage. Most all the supplemental coverages that were marketed to large numbers of employees from 1965 to 1970 remained on the books for many years. That is likely to happen in our national future. So take heart.

Earlier, the topic of currency debasement, creation of trillions of dollars by the Fed out of thin air, and inflation(about 2.5% annually, by the way) was touched upon, especially as related to obtaining goods, services, and accumulation/distribution of retirement funding. This leads into the arena of retirement capital, funds formation, equities markets, cash value life insurance, annuities, precious metals, commodities, bank deposits, money markets, treasury instruments, and the like. This also includes non-tax qualified and tax-qualified retirement vehicles, such as IRAs and 401(k)s, as examples. One suggestion is the recommendation that some portion of a client’s capital or retirement portfolio of funds be placed in hard assets. Gold and silver come to mind. We would defer to a precious metals specialist for that. Hedging and potential gains are two objectives that come to mind.

Everything is open to new ideas based upon the changing circumstances. Your practice is obviously going to change; caution and creativity are the guides. Whether we operate in single needs, multiple needs, or comprehensive planning modes and implementations, all of our recommendations are going to be different as compared to past years. It is a bit like attempting to walk in quicksand. And this applies to all product implementation, not just the health insurance arena. So be careful out there.

The way we operate in ethical conduct of business will change. The suggestion is put forth that in the future, starting in 2010 and beyond, we in financial services when advising businesses and individuals, will need to either form alliances with other financial professionals who are licensed in areas where we are not, or refer people to other trusted advisors in order to fully inform the people we serve of the risks and rewards to allow them to make proper, informed decisions that work for them and provide them the opportunity to form strategies and thus to protect themselves. We are definitely in for quite a ride; so fasten your seatbelts. A tip from one who is an investor, not a sales agent: dollars are currency;gold is money. Get to know the difference. Know all the new rules, regulations, and compliance requirements. Study. Engage with other professionals. There is a big job ahead for all of us, starting now.

This is by no means an exhaustive analysis of what’s ahead, but it is a beginning. Still, taken to heart, it gives us inspiration to continue to provide the most excellent advice and coverage implementation to our clients and would-be clients. We who are true professionals are in the unique position to guide, advise, offer direction, clarify, and eliminate confusion. No government bureaucrat can come close to what we do. Imagine that!