Insurance Brokers Key To Kentucky's Obamacare Success

Insurance Brokers Key To Kentucky's Obamacare Success

6:33pm Sep 23, 2014
David Combs, an insurance broker in Kentucky, wound up benefiting from the Affordable Care Act, even though early on he had figured the law would put brokers out of business.
David Combs, an insurance broker in Kentucky, wound up benefiting from the Affordable Care Act, even though early on he had figured the law would put brokers out of business.
Jenny Gold/Kaiser Health News
  • David Combs, an insurance broker in Kentucky, wound up benefiting from the Affordable Care Act, even though early on he had figured the law would put brokers out of business.

    David Combs, an insurance broker in Kentucky, wound up benefiting from the Affordable Care Act, even though early on he had figured the law would put brokers out of business.

    Jenny Gold/Kaiser Health News

  • Mary Gray bought health insurance through Combs. Gray qualified for subsidies under the Affordable Care Act and is paying a lot less than she did for last year's policy.

    Mary Gray bought health insurance through Combs. Gray qualified for subsidies under the Affordable Care Act and is paying a lot less than she did for last year's policy.

    Jenny Gold / Kaiser Health News

David Combs has been a health insurance broker in London, Ky., for more than 15 years. When the Affordable Care Act became law, he read it, from cover to cover. Then he sold his agency.

The mainstay of his business had been selling insurance coverage to small companies, and, the way he saw it, here was the government, stepping in and offering to sell it online instead. Combs and many others thought brokers would go the way of travel agents, no longer needed in a do-it-yourself online marketplace.

But he started to think about the law in a new way once he learned that brokers could still earn a commission for selling coverage through the exchange

"I knew there was going to be a massive change in our industry, and anytime there's a massive change, there's opportunity," says Combs. So he started a new agency in 2013.

Some of the states that were most successful in enrolling consumers via the exchanges embraced brokers. In California, 39 percent of people who signed up for a private exchange plan enrolled with a broker; in Kentucky the number reached 44 percent.

Combs' key insight was that many of his small-business clients could do better dropping their small group coverage and helping their workers sign up for individual insurance on the exchange. The law allows companies with fewer than 50 full-time workers not to offer insurance.

Frisch's Big Boy, a bustling franchise diner off the highway in London, is the kind of small business where Combs always sold insurance. The restaurant's policy was available only to full-time workers, and, in the past, it was expensive — costing the company and the workers each $150 a month per person. On top of that, they were facing an 86 percent rate increase in 2014.

Before the federal health law offered new options, few of the restaurant's workers who were eligible to buy insurance policies through Frisch's actually did so. Given the new options of Obamacare, "it didn't make sense for [the restaurant] to continue to offer health insurance," explains Combs. "It was actually a detriment to their employees."

Here's why: Because most of the restaurant's employees were low-income, they would qualify for free or low-cost coverage on Kynect — Kentucky's state health insurance exchange. Switching everybody over to the exchange was win-win-win: cheaper for the restaurant, cheaper for the employees; plus, more people got coverage, including some part-time workers.

"I thought to some degree it was too good to be true, what people were paying," says the franchise diner's co-owner Herman Hatfield. "But it worked out to where a lot of people got better care for less money."

Mary Gray bought health insurance through Combs. Gray qualified for subsidies under the Affordable Care Act and is paying a lot less than she did for last year's policy.

Mary Gray bought health insurance through Combs. Gray qualified for subsidies under the Affordable Care Act and is paying a lot less than she did for last year's policy.

Jenny Gold/Kaiser Health News

Combs earns a commission of $20 per month for each person he enrolls, including spouses and children. That commission is paid by the insurer and is already built into premiums. Combs enrolled all the employees at Hatfield's London, Ky., diner in just two days.

Before the advent of Obamacare, waitress Mary Gray was one of only 12 people at the restaurant who bought her health insurance — the old, expensive policy – through Frisch's. This year, she enrolled in a silver plan through Kynect that was completely subsidized, so she pays nothing toward her premium. She is one of the 28 employees at Frisch's whom Combs helped enroll in a private Kynect plan; most of the rest of the 60 full- and part-time employees at the London restaurant qualified for Medicaid, while a few had employer-sponsored coverage through a spouse or parent.

Virtually all the small businesses Combs had sold coverage to in the past were eligible to make a transition similar to the one the London diner made. "We're running into an industry as many of our fellow brokers are running out," he says, because instead of signing up small companies, the other brokers are signing up individual people, one at a time. If you take that approach, Combs says, "you'll go broke."

But brokers' roles are not so significant everywhere. In Kentucky, 44 percent of consumers who bought private health plans bought them through brokers; that compares with just 8 percent nationwide, according to a survey from the Kaiser Family Foundation.

In many states, brokers fought against the health law and against navigators (the government workers who help people sign up for Obamacare). But in Kentucky, Kynect's director, Carrie Banahan, set up a special committee for brokers and navigators that got them talking.

"It was contentious at first," Banahan admits. "But once they got to know each other, they built a level of trust and they get along very well."

If brokers want to survive, Combs says, they have to embrace the federal health law, even if they don't like it. "The ones that don't want to get into it and educate themselves about health reform — I think they are going to become kind of a dinosaur fairly soon," he says.

But those brokers who can evolve have a huge opportunity, Combs believes. By December 2014, he expects his new agency to hit $1 million in revenue — the most business he's done in his 15 years as a broker in Kentucky.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

Transcript

ROBERT SIEGEL, HOST:

When the Affordable Care Act became law, health insurance brokers were afraid that they'd be out of a job. The marketplace is online, and the federal government hired navigators to help people sign up. Well, it turns out the expertise brokers can offer is still valuable. And in some of the states that signed up the most people, they have been key. Reporter Jenny Gold brings us this story from Kentucky.

JENNY GOLD, BYLINE: David Combs has been a health insurance broker in London, Kentucky, for more than 15 years. When he first read the health law, he panicked and sold his agency. But then he began to see things differently.

DAVID COMBS: I knew there was going to be a massive change in our industry, and anytime you have massive change in the industry there's opportunity.

GOLD: So he started a new agency. He's sipping an iced tea at the counter of Frisch's Big Boy, a bustling diner off the highway. It's the kind of small business he's always sold insurance to. The policy he could offer to Frisch's before the health law was only available to full-time workers, and it was expensive.

COMBS: Once healthcare reform got passed and subsidies were in place, it didn't make any sense for them to continue to offer health insurance. It was actually a detriment to the employees.

GOLD: That's because under the health law most of Frisch's employees would actually qualify for subsidies to help them buy health coverage on the state's exchange, but only if the business didn't offer them a plan. And that meant a lot of workers at small businesses would actually be better off if the company dropped their coverage so their workers could buy on the exchange instead.

MARY GRAY: My name is Mary Gray, and I'm a server here at Frisch's.

GOLD: Gray's been working here for 10 years. She whizzes around the restaurant with her ponytail bobbing, filling coffee cups and dropping off enormous burgers. Gray was one of only 12 of the 60 workers at Frisch's who bought the company's old insurance policy, but a few months ago Combs came in to help Gray and her coworkers sign up on the exchange instead.

GRAY: I sat down with him, and he signed me up for it. (Laughter).

GOLD: Are you happy with it?

GRAY: Oh yeah - sure. (Laughter). I'm going out of pocket right now, so - just had my deductible which I had that before with the other insurance, so.

GOLD: Gray's plan is also free for the restaurant. Herman Hatfield is part owner of Frisch's.

HERMAN HATFIELD: I thought to some degree it was too good to be true, you know, for a lot of people, what they were paying and stuff like that. But it worked out to where a lot of people got better coverage for less money.

GOLD: It also worked out well for Combs. The key to his success is signing up as many people in small businesses as he can at once. He was able to enroll everyone at Frisch's in just two days.

COMBS: We're running into an industry. A lot of our fellow brokers are running out 'cause they're trying to do it on a onsie-onsie basis. And you'll go broke.

GOLD: About 28 of the workers here qualified for a private plan on the exchange for little or no cost because they don't earn much money. Combs gets a commission of $20 per month for each person that he enrolls. Most of the other workers qualified for Medicaid. He doesn't get a commission for them, but still, Combs is thrilled.

COMBS: Our growth potential is incredible right now, especially as we move into the fall.

GOLD: He says a successful agent might sign up 14 new small businesses in a year. Since Obamacare went live last year, he's been doing that much in a month. Carrie Banahan is the director of Kentucky's exchange.

CARRIE BANAHAN: We've had a great relationship with the agent community here in Kentucky.

GOLD: She says brokers like David Combs enrolled 44 percent of consumers who bought exchange plans in Kentucky. That's compared to just 8 percent nationwide.

In many states, brokers fought against the health law and against navigators - workers paid by the government to help people sign up for Obamacare. But in Kentucky, Banahan got brokers and navigators talking by putting them on a special committee.

BANAHAN: It was contentious at first, you know? But once they got to know each other - once they built a level of trust, they get along very well.

GOLD: Navigators were mostly busy signing up the poorest people in the state for free Medicaid coverage. The brokers were more concerned with the private exchange coverage where they could earn a commission. David Combs says brokers have to embrace the health law even if they don't like it.

COMBS: The ones that don't want to get into and educate themselves on healthcare reform - I think they are going to become, you know, kind of a dinosaur fairly soon.

GOLD: But those that can evolve have a huge opportunity. By December, Combs expects his new agency to hit $1 million in sales. For NPR News, I'm Jenny Gold.

SIEGEL: And that story was from our partner, Kaiser Health News, a nonprofit news service. Transcript provided by NPR, Copyright NPR.

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