Health

Insurers Accelerate Moves to Limit Health-Law Enrollment

Published

11 years ago

February 8, 2016

By Jay Hancock, Kaiser Health News

Stung by losses under the federal health law, major insurers are seeking to sharply limit how policies are sold to individuals in ways that consumer advocates say seem to discriminate against the sickest and could hold down future enrollment.

In recent days Anthem, Aetna and Cigna, all among the top five health insurers, told brokers they will stop paying them sales commissions to sign up most customers who qualify for new coverage outside the normal enrollment period, according to the companies and broker documents.

The health law allows people who lose other coverage, families with new children and others in certain circumstances to buy insurance after enrollment season ends. In most states the deadline for 2016 coverage was Jan. 31.

Last year, these “special enrollment” clients were much more expensive than expected because lax enforcement allowed many who didn’t qualify to sign up, insurers said. Nearly a million special-enrollment customers selected plans in the first half of 2015, half of them after losing previous coverage.

In addition, Cigna and Humana, another big health insurer, have ceased paying brokers to sell many higher-benefit “gold” marketplace plans for individuals and families while continuing to pay commissions on more-profitable, lower-benefit “bronze” plans, according to documents and interviews.

Gold plans typically enroll sicker members than do less comprehensive policies, say insurance experts. As of June, more than 695,000 people had enrolled in gold plans.

Those who want to buy individual and family plans can still do so directly through the Affordable Care Act’s online marketplaces or via navigators working for nonprofit groups.

But the retreat from broker sales, which includes last year’s decision by No. 1 carrier UnitedHealthcare to suspend almost any commissions for such business, erodes a pillar of the health law: that insurers must sell to all customers no matter how sick, consumer advocates say.

By inducing brokers to avoid high-cost members — whether in gold plans or special enrollment — the moves limit access to coverage and discriminate against those with greater medical needs, said Timothy Jost, a law professor at Washington and Lee University and an authority on the health law.

“The only explanation I can see for them doing this is risk avoidance — and that is discriminatory marketing and not permitted,” he said. “When people wonder why we’re not getting millions more enrollees in Affordable Care Act health plans, one reason is, the carriers are discouraging it.”

The insurance industry says it is not discriminating but adjusting to market realities including higher-than-expected medical claims and the failure of a government risk-adjustment program called “risk corridors” to cover much of that cost.

“Without making necessary changes to coverage and benefits, there was no way for health plans to remain in the market or to offer the kind of coverage as they had in the past without sustaining huge losses,” said Clare Krusing, spokeswoman for America’s Health Insurance Plans, an industry lobby.

The adjustments are critical to keeping coverage affordable and sustainable, said individual insurers contacted by a reporter.

If insurers are telling brokers they won’t be paid for enrolling people in gold plans, “that to me is pretty discriminatory,” said Sabrina Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms.

The changes don’t affect job-based insurance or the government’s Medicaid and Medicare programs.

The nonpartisan Congressional Budget Office estimated as recently as last March that 21 million consumers would be enrolled by now in private health insurance plans sold through online marketplaces. Now CBO forecasts 13 million will sign up this year.

Brokers are critical to sign-ups and the success of the health law. For 2014, 44 percent of Kentucky enrollees bought through brokers. So did 39 percent of the California enrollees. No similar figures are available for the marketplace that serves most states, healthcare.gov.

Brokers are a “very important” part of enrollment for individuals and families despite alternatives provided by the health law, said Robert Laszewski, an insurance consultant. “They’re still big.”

With varying commissions, brokers will be tempted to promote only plans they make money on, even if those aren’t the best for some customers, said John Jaggi, an Illinois broker and consultant.

“Now they’re really forcing the agent to think only of the plan that he gets compensated for,” he said.

The race to lower commissions began last year with United’s move along with decisions by several, smaller insurance co-ops to suspend sales fees shortly before they failed, brokers said. Other insurers feared they might end up getting their competitors’ unprofitable business, so they too adjusted fees.

Last week, BlueCross BlueShield of North Carolina also told brokers it would stop paying commissions for special enrollment starting April 1, reported The News and Observer of Raleigh.

“We expect that at some point in time all of these companies will continue to reduce commissions where we’re not able to be compensated in a way that we can continue to run our businesses,” said Kelly Fristoe, who sells health insurance in Wichita Falls, Texas.

Regulators in at least two states, Kentucky and Colorado, have already warned insurers that altering broker commissions violates “fair marketing” rules or the terms approved rate filings.

Federal regulations prohibit insurers from marketing practices that “have the effect of discouraging the enrollment of individuals with significant health needs.” Violations can bring penalties of up to $100 a day for each adversely affected person.

The Department of Health and Human Services did not respond to requests for comment on the practices.

Insurers “can’t market their plans in ways that discriminate,” said Sarah Lueck, a policy analyst at the Center on Budget and Policy Priorities, a left-leaning think tank. “It’s going to take some more statements from regulators to make sure insurers get the message.”

What’s unclear is whether insurers intend to resume paying full commissions when open enrollment begins for 2017.

In its Monday letter to brokers, Anthem said it “remains committed” to individual and family insurance. United, however, said last year it might leave that business altogether — a drastic move because under federal law it couldn’t reenter for five years.

Few if any carriers want to go that far, said Laszewski.

“They can’t withdraw from the market,” he said. But by adjusting commissions, “they’re doing everything they can to slow it down until it gets fixed.”

Special-enrollment business is typically costlier than average because sick people are more motivated to sign up outside the normal marketing season, insurance experts say.

But last year’s special enrollments were especially unprofitable because regulators did little to ensure that consumers followed the rules — that they had lost previous coverage, gotten married, moved or otherwise qualified for off-season sign-ups, insurers say. As a result, any consumer could wait until he or she needed care to enroll, they say.

Aetna told HHS that a fourth of all its marketplace members joined through special enrollment last year and that many dropped out soon after receiving expensive care. Special-enrollment members used as much as 50 percent more care than those who sign up before the deadline, said the Blue Cross and Blue Shield Association.

Of the top seven health insurers, only Kaiser Permanente and Health Care Service Corp., which owns Blues plans in Illinois, Texas and elsewhere, haven’t changed commissions recently for gold plans or special enrollment, brokers say.

“Kaiser Permanente won’t be making any broker commission changes,” said spokeswoman Amy Packard Ferro. “It’s business as normal but we are always evaluating our commission structure,” said HCSC spokesman Greg Thompson.

The risk corridor program was supposed to reimburse insurers with sicker-than-average members. In November, however, HHS said it had only enough money to pay 13 percent of what it owed under the program for 2014.

The result for gold plans is that “the risk adjustment system does not work at all,” said Ana Gupte, a health insurance analyst at Leerink Partners. “So it’s impossible to make money.”

Analysis by Standard and Poor’s shows Humana, which is owed $243 million for 2014, as the biggest risk-corridor loser. United, Anthem, Aetna and Cigna, however, aren’t in the top 20.

For most of the largest insurers, blaming risk corridors for cutting broker fees “seems more like an excuse than a reason,” said Jost.

For more information, go to khn.org

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Prostate Cancer is Twice as Likely to Kill Black Men. Talking to Your Doctor Could Help Save Your Life

BLACKPRESSUSA NEWSWIRE — The American Cancer Society recommends that African American men speak with their doctor at age 45 about whether prostate cancer screening is right for them. Men at even higher risk should have that discussion at age 40, especially those with one or more close relatives who were diagnosed at an early age.

Published

10 hours ago

September 10, 2026

Post News Group

Prostate Cancer is Twice as Likely to Kill Black Men. Talking to Your Doctor Could Help Save Your Life

American Cancer Society board member Dr. Robert Winn discusses risk factors for the disease and why too many Black men still aren’t getting screened

September is Prostate Cancer Awareness Month, and as both a Black man and a cancer center director, I know many men in our community think it’s bad luck to talk about cancer. But I’m here to tell you it’s bad luck not to talk about it.

We, Black men in the U.S., are nearly 70% more likely than White men to be diagnosed with prostate cancer. We’re also twice as likely to die from the disease.

But I’m telling you, if you’re diagnosed early, you can still enjoy a long, happy life doing the things you love, whether that’s playing with grandkids or staying active in your community. That’s because although it can become a serious illness, most men diagnosed with prostate cancer won’t die from it.

In fact, more than 3.5 million U.S. men who’ve been diagnosed with prostate cancer are still alive today. And when it’s diagnosed early, you boost your odds of survival. It’s that simple.

Generally, prostate cancer is most likely to develop after age 50, but when it develops in Black men, they tend to be younger. That means we need to be on the ball about understanding our personal risk. The risk factors include a family history of prostate cancer and certain genetic health risks that come from a parent.

When it comes to family medical history, we need to get a lot better at talking. For me, it turned out I had uncles who’d died from prostate and other cancers, but I didn’t always know that, so I couldn’t use that information to help me make smarter screening choices.

The American Cancer Society recommends that African American men speak with their doctor at age 45 about whether prostate cancer screening is right for them. Men at even higher risk should have that discussion at age 40, especially those with one or more close relatives who were diagnosed at an early age.

Look, I get that no one looks forward to a screening, but it typically starts with just a simple blood test, called a prostate-specific antigen, or PSA.

Even if you end up needing a digital rectal exam, it takes less than a minute and could save your life. So, what I say to people is, what’s the price of your life? Isn’t it worth a minute of being uncomfortable?

Brothers, this is essential for you to know: just because you’re feeling good doesn’t mean you don’t have early-stage prostate cancer. By the time you start to actually experience symptoms, the disease could be at an advanced stage and might be harder to treat.”

Prostate cancer is significantly impacting our fathers, our brothers, and our sons. That’s why the American Cancer Society is working with health systems and professionals in your community to help remove barriers in the fight against the disease.

We can help you find low-cost or free screening locations. And for men who need cancer treatment, the American Cancer Society can reduce the financial burden of traveling to medical appointments by providing free rides and, if you live far away from where you receive treatment, a free place to stay.

When it comes to prostate cancer screening, one size doesn’t fit all. So, it’s important for all men – and especially Black men – to talk to their doctor about what’s best for them based on their age, risk, and health history. Please make that appointment, because we don’t want you to risk missing out on the best years of your life.

For more information, call the American Cancer Society’s 24/7 helpline at 1-800-227-2345 or visit cancer.org.

Dr. Robert Winn is a nationally recognized physician-scientist and researcher. He currently serves as cancer center director at Temple Health’s Fox Chase Cancer Center. Since 2021, he has served on the board of directors for the American Cancer Society, a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone.

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Arnold Perkins: At 85, a Life of Service, Faith and Giving Back

Perkins believes that health is not simply physical. It is emotional, mental, and spiritual. And for much of his life, he says, his faith and philosophy of service have kept him vibrant, happy and connected to the world around him.

Published

2 weeks ago

August 29, 2026

Post News Group

By Tanya Dennis

The Post’s Healthy Aging Series addresses key components for healthy aging: mind, body and spirit. This article addresses the importance of having a strong spiritual or religious foundation.

As America’s population grows older, conversations about healthy aging often focus on diet, exercise and medical care. But for Dr. Arnold Xavier Cornelius Perkins, who will celebrate his 85th birthday next month, another ingredient has been equally important: a spiritual foundation and a lifelong commitment to serving others.

“I am my brothers’ and sisters’ keeper,” Perkins said. “I am a ‘we’ person,” and referenced the South African expression of ‘Ubuntu,’ which means ‘I am because we all are.”

Born in Miami, Florida, Perkins came to California in 1954 with his family to attend a Seventh-day Adventist General Conference. His family ultimately decided to remain in California, unwilling to return to the harsh racism of the segregated South.

He grew up in Berkeley, attending Golden Gate Academy, Willard School, and Berkeley High School before joining the Navy during the Vietnam War era. He later attended Merritt College when the Black Panther Party was emerging in Oakland, where he became involved as a volunteer for the Student Non-Violent Coordinating Committee (SNCC). He graduated from San Francisco State University and completed additional coursework at Cal State East Bay.

His professional career became a remarkable journey through public service. Perkins served as Alameda County’s homeless coordinator, became a program officer with the San Francisco Foundation, headed a drug and alcohol program, and ultimately served as director of the Alameda County Public Health Department for 12 years before retiring in 2006.

But retirement did not mean stepping away from service.

Perkins jokingly describes this stage of his life as being in “preferment,” doing what he pleases. What he pleases, however, is continuing to help people.

He has worked with young people, served on San Quentin Prison’s warden advisory council, previously served on the Oakland Police Department Selection Commission, and completed two terms as chair of the Alameda County Juvenile Justice Delinquency Prevention Commission. He chaired the University of San Francisco’s Helen Diller Stanley Comprehensive Cancer Center for 10 years and is now in his 11th year serving on the California Wellness Foundation board.

Perkins even views a hereditary heart defect through the lens of his spiritual philosophy.

“I have a hole in my heart, so I’m not physically perfect,” he said. “But I look at it as I have a hole because I pour my heart out to people.”

That perspective may be one of his greatest lessons about healthy living. Perkins believes that kindness, compassion and community have a direct impact on a person’s emotional and spiritual well-being.

“If I see an unsheltered relative, I’d give them that $20,” he said. “My responsibility is to take care.”

For Perkins, giving does not deplete a person; it gives life back. “My life’s mission is to give,” he said. “And what I get back is life.”

He knows firsthand that one person can change another person’s destiny. As a young man, Perkins stuttered and often fought in response to the teasing and humiliation he experienced. A teacher, Jeff Tedisco, defended him and changed the direction of his life.

“If it hadn’t been for him,” Perkins said, “I would have been in San Quentin.”

Instead, Perkins now goes to Indaba Court, a restorative justice program, to help young people who have made wrong choices understand that they are part of a larger community.

“When they harm one person, they harm the community,” he said.

His prescription for a vibrant life is simple: be understanding, be kind and remember that life is not all about you.

“When we fold our arms, we can’t receive anything,” Perkins said. “But when we stretch out our arms and serve one another, we build community.”

At nearly 85, Arnold Perkins continues to prove that a life rooted in faith, service and love may be one of the most powerful foundations for healthy aging.

Next Week: Brenda Dennis Harris “The Body Temple.”

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Commentary

NPRC Elder Justice Symposium Invites Community to Join Effort to Protect Alameda County Elders

“Two of our most vulnerable populations are elders and the disabled, and many times that combination resides in one individual,” said Tanya Dennis, lead facilitator of NPRC. “At our symposium, NPRC will bring decision makers and elders together in one space for a day to develop strategy and policy to protect and empower.”

Published

3 weeks ago

August 19, 2026

Post News Group

The National Probate Reform Coalition (NPRC) will host an Elder Justice Symposium on Friday, Sept. 25, from 9 a.m. to 5 p.m. at Oakland City Hall, bringing elders, families, advocates, policymakers and community leaders together to address elder abuse, financial exploitation and problems within probate and conservatorship systems.

The symposium is designed to inform and empower the community while developing strategies and policies to better protect Alameda County’s vulnerable elders and disabled residents.

Dennis said NPRC has drafted proposed legislation intended to make conservatorship a true last resort by adding safeguards before and after a petition is filed. Proposals include mandatory private mediation before entering probate and placement of an ombudsman in probate proceedings to advocate for the rights and interests of prospective or current conservatees.

The coalition also wants stronger protections for elders’ estates and assets, arguing that money accumulated over a lifetime should be preserved for elders, families and intended beneficiaries rather than unnecessarily depleted by court-related expenses.

NPRC meets monthly through Zoom and has expanded into a national coalition because elder abuse, financial exploitation and guardianship and conservatorship concerns extend well beyond Alameda County.

“Members share horror stories of being isolated from their parents and children, many times physically abused and overmedicated; seeing estates drained for court costs, and assets that parents spent decades saving to leave a legacy depleted instead and going to strangers,” said Venus Gist, an NPRC co-facilitator and former victim of the probate system. Gist said she spent more than $80,000 trying to protect her parents’ estate.

“Eighty thousand dollars is nothing compared to the people in our group losing millions and having to sell their businesses and homes to pay court fees,” she said.

The symposium will also examine forms of elder exploitation including telephone scams, bank fraud, identity theft, family financial abuse and exploitation by trusted individuals. Participants will learn to recognize warning signs involving caregivers, financial professionals, health and social service workers, attorneys and guardians.

NPRC is seeking a California lawmaker willing to champion legislation that strengthens elder protections and increases accountability in the conservatorship process.

The symposium follows Supervisor Nate Miley’s 23rd Annual Healthy Living Festival on Thursday, Sept. 24, at the Oakland Zoo. The free event for adults 55 and older will feature health screenings, vaccinations, nearly 100 community resource booths, lunch, entertainment and complimentary zoo admission for eligible attendees.

Dennis said the two events offer a comprehensive two-day focus on elder well-being.

“The health fair will cover the physical care of our elders, and the next day NPRC’s symposium will cover the mental and social health,” Dennis said. “Together, we are offering a comprehensive two days of care for Alameda County elders.”

Both events are free, and advance registration is recommended because space is limited. Community members, elders, families, advocates and public officials are encouraged to participate. Breakfast and lunch will be served at both events.

For registration: Sign-up is required via Supervisor Nate Miley’s Eventbrite page NPRC registration is https://www.eventbrite.com/e/elder-justice-symposium-tickets-1998385423597?aff=oddtdtcreator