If there's one thing that's followed the Patient Protection andAffordable Care Act faithfully since even before its inception,it's been uncertainty.

As first it was a mystery what was actually in the bill Congresswould subsequently pass.

Then, as the legal challenges mounted, it became a question ofwhether this landmark legislation would survive the legal siege—andto what extent. (Of course, those questions still linger.)

Last year, it became about enrollment. Would the administrationhit its numbers? And would they get more than the sick andindigent? Would anyone younger than 30 sign up? Of course, thewebsite crashed and for weeks no one could sign up at all.

Now the subsidies have been sentenced to limbo as the secondround of enrollment descended. That's when the latest question gotanswered: How much did carriers have to tweak their premiums a yearin?

And, perhaps not all that surprisingly, the answers were allover the map—literally and figuratively. In short, most premiumestimates suggested increases anywhere between 3 percent to 10percent on the individual exchange market.

But Avalere Health, a Beltway consulting firm, found that silverplans stood to jump in price the most, “by 10 percent on average in2015,” as reported by our own Kathryn Mayer.

It's worth pointing out that the public's favorite exchangeplans last year were the silver ones with 38 percent of allexchange enrollees picking up the lowest-cost silver planavailable.

A tale of two states

Of course, it also depends which state you're taking about. NewYork—with its own exchange—stands in stark contrast to some placelike Texas, which has basked in its poster child status eschewingboth the state exchange and expanded Medicaid.

“We're seeing a lot of different things,” explains New Yorkbroker Susan Combs, president of Combs & Co. “In New York, theincreases haven't been so bad, I haven't seen one over 12 percent,and we've had some instances where the premium went down in termsof the small group space.”

But, Combs points out the individual market's seen a sea changeif not in premiums increase, at least in terms of how the attitudesof clients—and prospects—have changed.

“On the individual market, this was new to New York brokers asof 2014 and the phone is non-stop and we actually charge marketingand consulting fees for this since 90 percent of the carriers don'tpay brokers in New York,” Combs explains. “We did this last yearbut it was 50/50 on if people would pay a fee or take theirchances. Now 95 percent of people calling us are more than happy topay an hourly fee because they found out the hard way what happenswhen you don't know what you are really buying.”

In New York then, at least, the struggles of enrollment season,with its changing deadlines, is at least accompanied by increasedopportunities for brokers who still have time left in their dayafter helping their group clients.

Texas, on the other hand, with its high number of uninsured, anda less-than-cooperative state government (at least as far as PPACAis concerned), is like a different country.

Broker Tanya Boyd says she gets phone calls like this all thetime: “Tanya, can my rate really be going from $424 to $1,259,because I told myself that if you didn't answer the phone toconfirm, I'd just take a shot of tequila and hit submit.”

Boyd was quick to respond, “I told her I'd like to take a shotof tequila right along with her, because, yes….rates are right.Welcome to the Affordable Care Act.”

Another client complained not only of rates that had doubledsince the year before, but which included must less coverage forthat higher price tag.

“And we thought last year was bad,” Boyd admits. “I don't liketo put too much negativity on paper, so this is really hard. Eachday I look for humor in all of the madness. Having a sense of humorand clinging on to those few 'positive' outcomes is key. But morethan once I've mentioned this year's open enrollment period maymake me lose my religion.”

Of course, all of this takes place within a much smallerwindow.

“As if a shorter open enrollment period isn't stressful enough,”Boyd adds, “let's add on several hundred clients losing theirpolicies and having 30 days to shop for a replacement. Ah, and thenthere's all of the group accounts who either migrated to a Dec. 1effective date to delay higher costs of [PPACA], or those 20percent that moved over to [PPACA] Jan. 1 because it saved themmoney. Take your whole life and imagine cramming it into…maybethree months.”

And that's when things break down for brokers scrambling to doeverything at once.

“Overflowing inboxes, nonstop voicemails, wondering if you canever reply to everyone, afraid of things falling through thecracks, delivering nothing but bad news to most people,skyrocketing insurance premiums, explaining Obamacare over and overand over,” Boyd recalls. “Busiest time of a health insuranceagent's life is right now. Thirteen-hour days and then you're stillnot done. We're tapped and stressed. We want to help our clientsand we feel helpless.”

But what's frustrating is the unpredictable nature of thepremiums she and her broker colleagues have seen so far.

“The lack of credibility and trust the rate increases havecaused? Clients grasping at anything they can find, desperation hasbecome prevalent. Mad at the system, trying to find anothersolution when there isn't one, wondering why their rate went up$300 a month when they didn't even have any claims?”

But Boyd and her Lone Star State colleagues aren't alone. Forformer broker of the year Aaron Davis, who operates out of thenortheast, it's been a long enrollment season, as well.

“Our experience, and that of every other broker I've spoken toin our region, is that this was the most challenging renewal seasonwe've ever endured,” Davis says. “The biggest issue for us was amajor carrier changing their renewal rating methodology just beforereleasing Jan. 1 renewals. In all the cases we saw (ours andothers), the new methodology resulted in significantly higher rateincreases. One of our fully insured experience-rated clients with220 enrolled employees saw their rate action increase from 11.5percent (under the old methodology) to over 29 percent. Onlythrough extensive negotiations and employee contributions modelingwere we able to lower the effective increase to 12 percent.”

And then there are the brokers, like Combs, pursuing somevariation of the fee model. Take Rob Heller, for instance, withBrown and Brown in Plymouth Meeting, Pennsylvania.

“In the Central Pennsylvania market we have had huge rateincreases—many times over 50 percent,” Heller recalls. “That'scaused a number of our clients to say 'I'm done with health care,'and are sending employees to the exchange. We've come up with astrategy that allows us to go into an employer and be the conduitto sign people up for the exchange. Through the combination ofcommissions from the exchange, adding voluntary products andcharging a fee we have in many cases been able to increase revenuefrom what we were making before.”

Tanya Boyd

So, with the “Affordable Care Act” we really do have the good,bad and the ugly.

Good

If you make about 200 percent to 300 percent of the povertylevel, you'll be happy. We actually heard a new client cry aftergetting a $500 deductible plan for $157. She can now have the backsurgery she needs. Our hearts cried with her, and we're happy forher outcome.

Bad

Cients losing their policies, experiencing shock and awe by the“new” premiums. A client called and told me she followed myinstructions and got the new rates. (God love her for reading ouremails and following instructions). Then she said, “Can my premiumREALLY be going from $479 to $1,200…because I told myself if youdidn't answer, I was just going to take a shot of tequila and hitsubmit.” Then later we joked about moving in together to shareliving expenses so we could afford health insurance. This is anaffluent couple who can handle it, so they grumble in disbelief buthave the attitude of “it is what it is and thank God I can pay forit, but what does everyone else do?”

Ugly

The middle, middle class who makes too much for a subsidy butnot enough to afford the 50 percent to 80 percent increases. Theyfuss and moan and complain, and I just nod my head with compassionand dream of chocolate and wine. I feel their pain, and I hate it.Many of them will choose to go without, and pay the fine. I'venever felt so helpless in my life. And I wonder: Why isn't this allover the news? Yeah, there's the guy who thinks the American votersare stupid, but let's talk about the premiums no one can afford.This is news. This is a problem. This is anything butaffordable.