Commissioner Jones: Superhero or Opportunist?

BAM! POW! WHAM! Insurance Companies take cover. CA Insurance Commissioner Dave Jones has changed into his spandex and cape! (Play superhero theme music.)  And, with the help of his sidekick (Proposition 45), he’s ready to challenge his arch nemesis (aka insurance companies) and protect the good people of Gotham (California) from their tentacles and stinging rate increases. (Aside: Isn’t anyone concerned that there are no more phone booths for Superman to change in?)

Proposition 45 is an attempt by, the authors of Prop 45,  and Commissioner Jones, to give the commissioner sole authority to approve individual and small group rate changes requested by health insurance companies. This includes any changes that would affect costs such as copays, deductibles, premium financing and more. So, in essence, one elected politician would have the power to determine insurance premiums and coverage. Are you as concerned as I with the consequences of such a dramatic power grab?  What’s the motivation behind this?

We already have CoveredCA, California’s version of ObamaCare, which determines plan benefits and rates.  A five-member board currently oversees and negotiates rates and plan changes with insurance carriers. Is it any wonder why CoveredCA higher-ups have serious concerns with Prop 45?  Talk about your buzz kill.  If passed, the proposition would give the commissioner individual authority to overrule CoveredCA’s Board decisions on rates and coverage, and lawyers would get the final say in the event of disputes.

So, a new bureaucracy would be created (yes, there will be more of that) to oversee another bureaucracy to protect you from insurance rate increases.  Never mind that healthcare reform already determines the percentage of premium insurance companies must spend on claims, what they can make, benefits covered, and how much financial exposure consumers face. This villain has already been pummeled.  Is the masked Commissioner chasing after rate increases in pursuit of justice or something more?  What would be the purpose of interfering in the initial and delicate stages of our new healthcare system?  I have a theory what’s behind the disguise.

Healthcare reform requires that all legal CA residents obtain health insurance.  There is no requirement that health insurers must offer it, and it’s pretty clear to me that Commissioner Jones would not be sweeping off his welcome mat for insurers if Prop 45 passes.  Some major insurance carriers have already chosen not to offer plans in California and more will follow suit if the proposition triumphs. With the carriers that remain, limiting provider access further will be necessary to stay price-competitive. The result will no doubt be a chaotic mess and major disruption in healthcare delivery, and (dun-dun-duh) the best opportunity for a single-payer initiative to pass; something Commissioner Jones would like to champion all the way to the Governor’s mansion, another of his likely objectives. A single-payer system is one in which the government (CA in this case) negotiates with providers and pays for all healthcare costs eliminating insurance carriers.   Note: Both and the Commissioner are advocates of a single-payer system.

CoveredCA may have spoiled single-payer chances initially, but this brash effort to seize control of the health insurance market in California will renew the cause soon enough and find its way back on a future ballot. Just when we thought we understood how health care reform was going to work in the future, POW! things could change, again.

Proposition 45 is a means to a single-payer end, and it’s not a superhero, but an opportunistic Commissioner Jones who would like to make it happen. Even if you’re an advocate for single-payer, Prop 45 is not the solution. Instead, it would fracture our developing health insurance marketplace and irreversibly damage the future of California’s healthcare delivery.

Stay tuned. We’ll keep you updated at the same bat-time and this same bat-channel. 

Phil Dougherty

It’s not just what’s on the ballot that matters; it’s when the vote is held.

There is no better example of this than the upcoming November election.

Originally set for October 15 – December 7, this year’s annual open enrollment period, when consumers can enroll in ACA compliant coverage for the first time or change plans for the next plan year, was pushed out to November 15 – February 15.  CoveredCA, California’s version of ObamaCare, has followed suit and will match the new open enrollment schedule.

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How to Choose a Carrier.

Health Care Reform has leveled the playing field as far as coverage benefits and eligibility goes. Plans are standardized and fall into four distinct benefit levels (Bronze, Silver, Gold, and Platinum) and must be actuarially equivalent. Pre- existing conditions no longer restrict your access to coverage or result in higher premiums. By removing these two critical elements, what’s left to compare? Plenty!

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Next Open Enrollment Period Uncorked…

In addition to sizing up a turkey or sniffing a yam, you might add squeezing a health plan or two into your Thanksgiving shopping list. This year’s open enrollment period was moved from October 15 – December 7 to November 15 – February 15, 2015, and if you want to ring in the New Year with a “fresh” plan, you’ll have a shorter amount of time to act this year.  Let’s look a little closer to see what this enrollment period date change really means. Continue reading

Employers & Employees Beware.

Popular among small employers was an arrangement by which they would pay the employee’s individual insurance plan premiums on a pre-tax basis. Market reforms within our new healthcare law now prohibit this.

Starting January 1, 2014, employers who reimburse or pay premiums directly to a carrier for any employee’s individual or family health insurance policy will no longer be able to do so tax-free. This may adversely affect both employer and employee. Continue reading

Short Term Insurance still has a place.

Our new health care reform law has made it possible now for virtually anyone to obtain health insurance. Those with a pre-existing condition(s) cannot be denied insurance, charged a higher premium or have coverage restricted in any way. This is a huge step forward in our health care system and the ramifications of this step are being played out as I write this message.

But there has been another significant change that was less publicized. There are only certain times of the year when you can enroll in or change coverage, called Open Enrollment. What! Did we fix one problem in our system just to create another?

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Special Open Enrollment Period (limited to certain life change events).

With open enrollment now over, obtaining individual or family health insurance before the next open enrollment (currently scheduled for October 15 – December 7, 2014) is only possible with certain “life change” events.  Some of these events must result in a loss of minimum essential coverage such as a divorce or legal separation, a move out of state or service area, change in employment status (i.e., reduction in hours), loss of employer coverage, or the death of a parent or spouse.  Proof of a loss in minimum essential coverage is required. 

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Tax day is also the last day to enroll in coverage.

Presentation3It appears no more delays or postponements are in the works.  April 15 is the last day to enroll in a plan for individuals and families.  In the private marketplace (not CoveredCA) several carriers (Anthem Blue Cross, HealthNet, and Blue Shield) have kept their doors open for those who have not yet enrolled in coverage and do not have a qualified alternative (group insurance or a grandfathered plan, for example).

You can obtain a quote and enroll online on our website:

The next open enrollment is October 15 – December 7, 2014 for a January 1, 2015 effective date.

Phil Dougherty


ACA open enrollment ends on Monday, March 31.

When the initial open enrollment period winds up at the end of March, the opportunity to purchase an ACA-compliant plan will close until the next open enrollment, which runs from October 15 through December 7th, 2014, for an effective date of January 1, 2015.  In the meantime, a “Special Enrollment Period” is available to change plans, or enroll for the first time, for those with a life changing event.  These include marriage, divorce, birth or adoption of a child, or loss of a job. Continue reading