MLR: Agent allies may take indirect approach

Posted by sys on 05/15/2013 12:00 am  

MLR: Agent allies may take indirect approach

July 13, 2011

Producers have argued that the customers are the ones who really pay the commissions, and that the insurers simply collect the commissions as a courtesy to the customers. The producers have asked regulators to reflect that view by keep producer commission payments out of the MLR formula.

Some consumer representatives -- individuals that the NAIC has picked to represent consumers in NAIC proceedings -- say there is evidence that health insurance commission levels and consumer access to health insurance agents and brokers may be more stable than producers have suggested.

Janet Trautwein, chief executive officer of the National Association of Health Underwriters (NAHU), Arlington, Va., said NAHU never expected the committee to vote on the issue so soon.

NAHU has provided the NAIC and HHS with a 120-page report showing the devastating impact the MLR provision is having on health insurance producers, especially those serving the individual and very-small group market, Trautwein said.

The companies serving these markets have been cutting services, closing up, or laying off employees as a result of the federal MLR provision, Trautwein said.

Negotiations with HHS are ongoing, and “HHS has modified or delayed many other provisions of the health care law that have been criticized by interested parties,” Trautwein said.

Ethan Rome, executive director of Health Care for America Now, Washington, a group that supports PPACA, said the NAIC executive committee decision not to back H.R. 1206 is a “victory for consumers and businesses.”

“I think it does send a clear message to Congress that this is not an issue that should be taken up, because it is simply too divisive,” Rome said.

H.R. 1206 asks members of Congress to pick winners and losers, and it pits brokers against consumers and all small businesses, Rome said.

Implementing the bill as law would “take $1.3 billion in rebates from consumers and give it to the insurance companies without any guarantees that it will solve any of the problems that brokers have raised,” Rome said.

Trautwein said any rebates consumers get as a result of the MLR provision “will likely be quite modest.”

One on One with Anne Sperling - ABQ Journal Business Outlook

Posted by sys on 05/15/2013 12:00 am


One on One with Anne Sperling

By on Mon, Aug 29, 2011

Anne Sperling never had the little girl dreams of being a dancer, or becoming a veterinarian just so she could be around animals all the time, or simply marrying to become a bride. Even before she could drive, she had her sights on what, at the time, were considered even by many adults to be male professions, and she didn’t bat an eyelash about it.

“For the longest time I thought I wanted to be in more of a medical field. I wanted to be in physical therapy,” said Sperling, employee benefits manager for Daniels Insurance in Santa Fe. That was until her father, the chief financial officer of The Bristol Hospital in Connecticut for 35 years, took her to the physical therapy department as an intern.

“And I lasted one day. I hated it. I absolutely hated it. Because I couldn’t help anybody,” she said. “They’d be reaching up for the pull bar after having surgery, and I’d want to pull it down for them. It was too frustrating for me to watch the slowness of the whole environment. I was very impatient for it.

POSITION: Employee benefits manager for Daniels Insurance in Santa Fe; served on Gov. Richardson’s Steering Committee to the Health Care Coverage and Access Task Force and on the Department of Health’s task force for Statewide Comprehensive Health Care Planning; served on many state task forces dealing with health reform; been the chairman of the Insurance Reform Committee and Benefits Committee under the direction of the N.M. Health Policy Commission in 1993; and served as chairman of the board of the Santa Fe Chamber of Commerce.
WHAT YOU DIDN’T KNOW: “I used to make all my own clothes. I remember one job interview in particular I went to … thinking I wanted to be a financial planner. And I had worn a suit that I was very proud of that I had made. It was a black pinstripe wool suit. It had a nice, cute little bolero jacket, and a nice pair of pants, and I walked into the interview to meet with one of the vice presidents or something, and he said, ‘You know, you’re going to have to go home and change because our clients do not like working with females in pants.’ And I looked at him and I said, ‘I’m going home, there’s no doubt about it, and I’m never coming back.’ I was probably 25 at the time, and that’s when I made up my mind that I’m gonna wear pants, and I’m gonna wear pants proudly. … I still sew.”

“So then he brought me down into the business district of his hospital, and when he did that, it was like yeah, this works, I can do this. And so it clicked right then and there. … That’s what I wanted to do.”

It was the late 1970s when Sperling attended business school, and while the women’s movement was in full swing – more women than men entered college for the first time in 1978 – females stood out in business like a pink iPod in a drawer of black Sony Walkmans.

“I was actually one of 40 female students out of a (graduating) class of 500 back in 1980. There just weren’t that many women going into business administration degrees at that time.”

College, or rather a college hangout, was also where she met the man who would become her husband. (He is now Santa Fe County’s interim fire chief.)

“We met in a bar. The name of the bar was Rasputin’s, but we used to call it Raspukin’s,” she said.

After they married, the couple decided to leave the East: “We piled everything into our little Chevrolet Vega, which I think was on its second engine at that point. And we drove clear across the country with everything we owned in that Vega to Santa Fe because my husband had family friends that had retired here. … We stayed in their house for three months. … And they kinda mainstreamed us into the community of Santa Fe.”

As a health insurance agent, Sperling has since served on numerous state task forces addressing health care coverage and health care reform, and helped thousands of New Mexico residents gain access to health insurance.

Q: You wanted at one time to be a physical therapist. Are you pretty athletic?

A: I run pretty much every morning. I’m out on the trail probably by quarter to 7, 7 o’clock every morning and doing either three to seven miles a day, six to seven days a week. … It’s for me to clear my mind and recharge my batteries and get ready for my day. … That’s pretty sacred. That’s my time.

Q: What is it that you like about your career?

A: I’m absolutely passionate about this industry because of the people. I am able to help the employers, their employees, individuals who are not employed, people who have health care needs that are destitute financially. I work with all sorts of government committees. Any place I feel like my institutional knowledge will help, I bring it. So it really is a career of passion.

Q: What do you think has been your greatest success?

A: I was instrumental in having the New Mexico Health Insurance Alliance implemented. I was one of a team of people that got that legislation passed, and then I served on its initial board of directors. … And they hired me as the first executive director. That program was created primarily because small groups were not able to get health insurance. … If you had a small group, two to 50 employees, and there were a number of health conditions going on in that group, the insurance industry had the right to decline them. … This was back in 1994. So our answer in New Mexico to fixing that problem was to bring the insurers of the state as members of that alliance. So the alliance … was the insurance carriers, and (they) decided they would share the expenses together of these potentially high-risk groups that were out there. So what were able to do was issue group insurance with no medical questions asked. … We insured quickly close to 10,000 people overnight. So it was an incredible experience.

Q: What is one of the most unique experiences you’ve ever had?

A: My husband and I had always said as soon as we got married that we want to live in a log cabin. So, we purchased land out in Glorieta, … and we lived in a Coleman 8-by-10 tent, a canvas camping tent, for three months while we built that house. And I was working in the insurance industry then. We put our queen-size mattress in it, and that was our home for three months while we built this Air-Lock log home. We had it all set up in the woods. We had a separate tent for all of our clothes, and then we had a separate set-up for our kitchen area. (They lived in the cabin for 19 years.)

Q: What are the things that make you most enjoy being alive?

A: I love good food. I love being outside. Dancing. I’m a fiend on the dance floor. I just love swing dancing, and I took a lot of dancing courses when I was in school. It’s that kind of vibrance that just makes me think that, oh yeah, I’m gonna get up today, and I’m gonna have a good day.

Q: Is there anything you would like to add?

A: The only thing I would like to add I think is just how proud I am of my kids. They’ve done great. I’m really lucky.