Insurance broker outlines 'family glitch' in ACA


Keith Stehling and other CMS certified insurance brokers can help guide policy seekers through the ACA rules and regulations. — Standard-Radio Post/Ken Esten Cooke

By Ken Esten Cooke —

Among the dozen local business leaders who met with U.S. Sen. Ted Cruz last week was Keith Stehling, a 34-year insurance broker and agent.

Like others, Stehling expressed concern over the Affordable Care Act, also known as “Obamacare,” and a large part of the meeting was a discussion of the act and needed changes to improve it.

The Standard-Radio Post sat down with Stehling last week to discuss the ACA, as the new enrollment period will begin Nov. 15. He urged those seeking policies to let a broker assist them, and said there is no additional charge or higher premium for their help.

‘Rough rollout’

“The health insurance business is in turmoil because, as of the first of the year, a lot of the ACA became law,” Stehling said.

“It was a rough rollout, and I mentioned to Sen. Cruz that we (licensed brokers) didn’t have a whole lot of guidance in what should be done,” Stehling said. “A lot of us didn’t even know that we were going to be able to participate in the marketplace.”

Stehling said the “marketplace” is where one goes to buy health insurance, whether through a broker, on the healthcare.gov federal website or by calling the toll-free enrollment number.

“When we called healthcare.gov to enroll ourselves, the people who run the operation were ordinary individuals they hired off the streets — some company that the government contracted to man the phones.

“When I called about a problem I was having getting someone enrolled, to my surprise, they found out I was a broker and began asking me to help them out with something, like ‘What is co-insurance?’ or ‘How does a deductible work?’”

Stehling was told the people manning the phones received little training and told him they were primarily keyboard operators and were not supposed to give any guidance on the insurance products.

“So we heard from a lot of people during and after enrollment who didn’t know what they bought, or they enrolled in HMOs, which for our purposes are not viable here (we have to be in a PPO),” he said.

“So I told the senator when they are spending millions of dollars on advertising during open enrollment, it puzzled me why they don’t say ‘contact us at healthcare.gov or contact a certified CMS (Center for Medicaid Services) broker,’” he added.

Stehling said brokers usually deal with the CMS or the Department of Health and Human Services, but also that the Department of Homeland Security, the Census Bureau and the Internal Revenue Services also are connected, adding to the complication and bureaucracy.

Family glitch

Stehling said the main problem with the ACA is the “family glitch” in the law. If the employer’s plan meets the new (minimum essential coverage) criteria, and if an employer pays the bulk of an employee’s health insurance cost, it is considered “affordable” if the employee’s premium contribution doesn’t surpass 9.5 percent of the employee’s income.

But when an employee looks at covering his spouse and children, it’s a huge bite out of the employee’s check — as much as $1,500 for a spouse and two children, in some cases.

“You would think that the employee could call an insurance agency to see about getting an individual policy for his wife, where you’d typically find a lesser-cost product,” Stehling said. “But since Jan. 1, those rules have changed and the employee will not be allowed to buy insurance on an individual basis either in or out of marketplace, because he has access to group insurance.

“I would have thought that the common-sense thing was, if a person cannot afford the cost of his dependent coverage where he works, that surely the government would provide help with tax credits. Nope, that’s the glitch,” Stehling said. “So even if they could buy a policy out of the marketplace, the government doesn’t allow them to do that. That’s absurd.”

“Because of that, a lot of people now have their dependents uninsured, which defeats the purpose of the law,” Stehling said.

Stehling said most of his customers are small businesses, where the business pays for the owners’ insurance. But if they wanted to add, say a son, they would be socked for hundreds a month, whereas an individual policy would usually run $125 or so for a young person.

For more on this story, read this week’s print and online editions of the Fredericksburg Standard-Radio Post. If you are a print subscriber, your full online subscription is free. All you need to do is call 830-997-2155 to get a password. If you are not a subscriber, call 997-2155 or click on the ‘Subscribe’ button on the left side of the home page and sign up today!

Rate this article: 
Average: 5 (1 vote)