Brokers’ big role? Clearing up PPACA confusion

A consumer reads over a pamphlet about health care offerings under PPACA. (Photo: Wilfredo Lee, Associated Press) A consumer reads over a pamphlet about health care offerings under PPACA. (Photo: Wilfredo Lee, Associated Press)

We’ve heard it all before. Survey after survey finds consumers are still blissfully unaware of or simply confused by the Patient Protection and Affordable Care Act. This despite the fact that the exchanges have been open for weeks now and the law’s other main provisions go live in just a few weeks.

Many are even confused about the name of the law, not realizing PPACA and Obamacare are one and the same, as revealed by a recent bit on Jimmy Kimmel Live, in which the show’s film crew took to the streets of Hollywood, underscored confusion seen in polls about the federal health care law.

“It’s a challenge, having to skirt the line between what’s going on with the politics of it, what the health plans actually offer and what the facts of the matter are,” says Rudy Garcia of Qandun Insurance Agency in California. 

Garcia formed the agency in Los Angeles earlier this year to cater to small-business owners and individuals struggling to navigate PPACA’s complex — and changing — landscape. He serves about 40 small businesses, most with fewer than 50 employees. Garcia has been an agent since 1995, working with larger firms, public and private entities and small businesses. He decided to focus solely on small businesses and individuals, who have regularly asked about health reform and what it will mean for them.

“There’s so much information out there, and misinformation, people aren’t really sure whether they like it — is it socialism? Can someone get a tax credit? Will there be lower premiums? Is it something that could benefit them?” he says. “If you take politics out of the conversation, it becomes about laying out the facts, helping businesses become compliant and letting people make decisions about what plans they like or are best for them.

“There are people who believe they can just walk into a doctor’s office Jan. 1 and have national coverage. That’s not how it works. This is about educating consumers.”

No doubt, PPACA is very much a part of the public conversation. Public relations firm WCG found 8.5 billion online references to the law over the past year on news sites, blogs, forums and Twitter.

It’s easy to see where confusion lies — in conversations mentioning PPACA, more than half of them make no reference to specific components of the law and were focused on defunding or repealing efforts.

“It is all about marketing – calling it the Affordable Care Act is, in my opinion, misleading,” says Margareth Flowers, a Maryland pediatrician and a Congressional fellow for the Physicians for National Health Program. “Studies show most people just don’t understand at all the complexities of health insurance, what networks are or what it means to have a high co-pay. It’s a complicated subject.”

“It’s easy to believe half of the population has been living under a rock and does not know the difference (between ACA and Obamacare), but anyone with an ounce of brains should know exactly what this all is. There’s no excuse,” says Clark Newhall, a physician and the executive director of Health Justice, which opposes the health care law.

Once people do understand it, their opinion of it becomes pretty clear, Garcia says.

“Many do not realize, a major milestone is that they can buy a medical plan without questions from the insurer about their medical history, and they cannot be denied,” he says. “Others do not realize that, if they do not get on a plan by March 31, open enrollment has ended and they may face fines or not be able to get a plan until the following year.

“Some are pleasantly pleased, some unhappy. What’s important is that they understand.”

Garcia, who says he expects the questions about the reforms to grow as 2014 draws closer, is among a number of brokers who have tapped into a market of baffled consumers as insurance exchanges have launched.

But for the most part, people are not aware that going through a broker is even an option, says Dennis Watkins, a health insurance broker for Select Insurance Group in Viera, Fla.

“I’ve spoken to so many people who have told me they had no idea they could sit down with an agent; they were convinced they had to go through the government, that they had to use the website,” says Watkins, who has been licensed for more than 20 years. “People are genuinely confused and think they are buying insurance from the government rather than from a government-regulated insurance carrier.”

Watkins has launched a campaign to educate people in Florida’s Brevard County, speaking at churches, businesses, rotaries, civic organizations and hospitals. He says that PPACA has changed his role in the community.

Read: 8 groups that might help roll out PPACA

“I am now partly an educator, and with my clients it’s no longer just their height, weight and do they smoke or not; I must also act as a financial adviser, to find out whether they qualify for a subsidy,” he says. “This is confusing and my job all changes now. It’s a whole different formula.”

Watkins worries that PPACA is not only confusing to consumers, but also to a raft of newly certified brokers looking to profit.

“Because everyone feels the need now to explore the opportunity to buy health insurance, there are so many people jumping into this market,” he says. “But if you don’t know the ins and outs of the providers, if you don’t know the plans forwards and backward — the maximum out of pocket, deductibles - then you can’t really give any valuable guidance, you will only add to the confusion.”

David Cagliola, senior vice president of Radnor Benefits Group in Wayne, Pa., agrees that the market is changing.

“You have to well understand what the laws are, and you have to act as a consultant, not just a salesman,” he says.

What many consumers shopping for insurance may not realize is that they have nothing to lose by hiring an agent, experts says. Insurance brokers get paid commissions through carriers, which varies by state, so policy costs are already set to include this fee. For individual consumers, the policy will cost the same whether it is bought through a broker or directly from a carrier.

Some states are doing their best to help residents navigate the law. The Texas Association of Health Underwriters, for instance, offers a directory of certified agents.

Many carriers are also working on educating their customers. Tufts Health Plan, already familiar with working within an exchange environment since Massachusetts began offering universal coverage in 2006, has been working closely with brokers to prepare for the change in federal law.

“There’s much to learn with ACA, so we’ve created a health care reform microsite with information; we developed an “ACA 2014 and beyond” booklet which we’ve distributed at our sessions with them; we've provided updates during our regular meetings with them; and also done emails blasts with information and articles on ACA,” spokeswoman Sonya Hagopian says.

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