Health

Insurers Accelerate Moves to Limit Health-Law Enrollment

Published

10 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

Oakland Post

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Business

Oakland Children’s Hospital Workers and Patients Rally for Pediatric Medical Care

OAKLAND POST — “Children who go through a bone marrow transplant are immunocompromised, meaning that their immune system has been wiped out,” and having to take public transport to San Francisco exposes patients to the risk of getting a dangerous infection, said Paola Portillo, a social worker.

Published

20 hours ago

July 26, 2026

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Staff and family members of patients at UCSF Benioff Children's Hospital Oakland in Oakland, Calif., hold signs during a rally on Thursday, July 9, 2026. Rally participants protested the relocation of specialized care clinics to the hospital's San Francisco campus. Photo by Kayla Chan/Bay City News.

By Post Staff

Staff, patients’ families, and supporters held a rally recently at UCSF Benioff Children’s Hospital in Oakland to protest the hospital’s decision to relocate specialized treatment clinics to San Francisco.

Protesters said the move is creating barriers for patients to access care and raised concerns over whether the hospital was appropriately using funds partially designated for pediatric services.

In response, hospital officials say they are concentrating resources for highly specialized procedures so patients can receive the highest quality of care.

One of the speakers at the rally, Paola Portillo, a social worker, said the hospital started transferring the clinics a year ago when UCSF Health integrated with the Children’s Hospital Oakland, located at 747 52nd St. in North Oakland.

According to Portillo, patients who need bone marrow treatments and interventional radiology are forced to travel to UCSF Benioff Children’s Hospital in San Francisco, which can be dangerous, she said.

“Children who go through a bone marrow transplant are immunocompromised, meaning that their immune system has been wiped out,” and having to take public transport to San Francisco exposes patients to the risk of getting a dangerous infection, she said.

UCSF spokesperson Kristen Bole says the move improves the hospital’s quality of care, giving bone marrow treatment (BMT) as an example.

“Inpatient BMT is a highly complex service where patient volume, specialized infrastructure, faculty coverage and 24/7 support are essential,” she said in a statement. “Concentrating non-gene therapy inpatient BMT care at Mission Bay allows us to provide the safest and most sustainable model for patients and families.”

Hospital officials also emphasized that moving care was not a one-way street. Beginning this month, patients admitted for rehabilitative treatment have been directed to the children’s hospital in Oakland, Bole said.

Speakers at the rally also claimed UCSF has not been transparent about how it has allocated funding from 2020’s Measure C, a measure that created a half-percent sales tax that partially funded pediatric health care at the children’s hospital.

“The community fought so hard for Measure C because every child deserves access to lifesaving, pediatric, high-quality care right here in Oakland,” said Agnes Cho, a policy advisor speaking on behalf of Alameda County Supervisor Nikki Fortunato Bas. “The funding should go towards strengthening care for children right here in Oakland.”

Protesters also said UCSF’s $3.3 billion endowment has been misused. Last October, the University Professional & Technical Employees union published a report on the University of California’s spending, which highlighted projects such as the $4.3 billion UCSF Helen Diller Medical Center at Parnassus Heights.

“What I have a problem with is saying the kids from the East Bay have to go to San Francisco to get care, so that UC can build a fancy hospital for its richest patients in San Francisco,” said union President Dan Russell.

The UCSF spokesperson said UCSF has been investing in its Oakland campus, explaining that upgrades that are expected to be completed in 2030 at a cost of $1.6 billion.

“Oakland is central to our pediatric health system, and we are making the largest investment in the campus’ history,” the spokeswoman said. “We do not make investments of this scale in a campus, workforce or community we plan to leave behind.”

This article includes coverage from Bay City News Service and media releases.

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Commentary

NPRC to Meet with California Attorney General’s Office on to Urge Guardianship Reform

OAKLAND POST — Black has been a professor of law and finance at Northwestern University and Northwestern Pritzker School of Law since 2010. Before joining Northwestern, he served on the faculties of Stanford University, Columbia University, and the University of Texas at Austin, earning international recognition as one of America’s foremost empirical legal scholars.

Published

21 hours ago

July 26, 2026

bpusa-syndication

By Tanya Dennis

The National Probate Reform Coalition (NPRC) has announced that Bernard ‘Bernie’ Black, a nationally respected legal scholar, will meet with California Assistant Attorney General Eleanor Blume on July 27 to discuss the urgent need for guardianship, conservatorship, and probate reform.

The meeting marks another important step in NPRC’s effort to encourage California’s governor and attorney general to take a leadership role in addressing systemic abuse, financial exploitation, and the lack of meaningful oversight within probate and guardianship courts.

Black has been a professor of law and finance at Northwestern University and Northwestern Pritzker School of Law since 2010. Before joining Northwestern, he served on the faculties of Stanford University, Columbia University, and the University of Texas at Austin, earning international recognition as one of America’s foremost empirical legal scholars.

Despite his legal expertise, Black says neither his knowledge nor his professional reputation protected his family from what he describes as a deeply flawed guardianship system.

Following the death of his mother in 2012, Black’s sister, Joanne, who had lived with schizophrenia for more than 35 years, became the beneficiary of approximately two-thirds of their mother’s $4 million estate through a special needs trust established to provide for her lifetime care.

Seeking to preserve his mother’s estate plan and protect Joanne’s eligibility for public benefits, Black petitioned the Denver Probate Court for a temporary conservatorship and requested judicial approval for actions necessary to preserve assets. According to Black, the case initially appeared to proceed appropriately. Both the court-appointed counsel and a guardian ad litem supported his proposed conservatorship plan.

Black says the case later took a dramatically different turn.

According to Black, court-appointed professionals used family disagreements to seize control of the family trusts. What followed was 12 years of litigation and 96 probate court decisions, resulting in millions of dollars in professional fees.

Black says repeated settlement proposals intended to preserve assets for his sister’s benefit were rejected. He also strongly disputes adverse findings made by the probate court against him, his wife, and his son, arguing the court lacked jurisdiction over members of his family. Appeals were unsuccessful, reinforcing his concern that probate courts exercise extraordinary discretion with insufficient oversight.

Joanne Black passed away on Aug. 14, 2025. Black contends that millions of dollars that should have benefited his sister and preserved his family’s legacy have instead been consumed by litigation and administrative expenses. He continues to fight efforts to deplete the remaining family trusts.

“My sister has died, yet the Denver Probate Court and the guardianship professionals are still pursuing what is left of our family’s money,” Black said. “I’m talking millions of dollars.”

Black believes his family’s experience demonstrates that even experienced attorneys can become overwhelmed by a probate system that often lacks transparency and accountability.

Joining Black at the July 27 meeting will be Rick Black, founder of the Center for Estate Administration Reform (CEAR), who will present his organization’s proposed Victims’ Bill of Rights for individuals and families involved in probate and guardianship proceedings.

Together with the NPRC, they will urge the Attorney General’s Office to investigate fraud, financial exploitation, and predatory practices while aggressively enforcing existing laws that protect elders, disabled adults, and vulnerable families.

NPRC asserts California’s Attorney General, as the state’s chief law enforcement officer, has both the authority and responsibility to investigate fraud, public corruption, and financial exploitation occurring within probate courts.

The Coalition also hopes California will lead a national initiative by working with attorneys general across the country to develop coordinated enforcement strategies and meaningful reforms that restore integrity, transparency, and accountability to probate courts nationwide.

Bernard Black’s experience echoes hundreds of similar stories documented by probate reform advocates throughout the nation. His message to the Attorney General is both simple and sobering:

“If this can happen to one of America’s most respected law professors, it can happen to anyone.”

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Business

Mount Zion MBC, Church of Jesus Christ of Latter-day Saints Partner to Bring 29,000 Meals to Alameda County

OAKLAND POST — A semi-truckload of food arrived at MZMBC in Oakland on Tuesday, July 21. This was one of 250 trucks the LDS church is sending throughout the United States. By the end of the year 10 million pounds of food will be donated. Each truck carries approximately 40,000 pounds of shelf-stable pantry staples that can feed 1,400 families for one week.

Published

21 hours ago

July 26, 2026

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Pastor Michael Wallace of Mt. Zion Missionary Baptist Church (center) and David Kimball, president of the Oakland Stake of the LDS church listen to remarks before volunteers began their work. “We are grateful to partner with these organizations to help care for those in need in our community,” Kimball later told the assembled volunteers. Courtesy photo.

By Special to The Post

The interfaith community effort commemorates the 250th anniversary of the U.S.

More than 29,000 meals were received and distributed at the historic Mount Zion Missionary Baptist Church in West Oakland as part of an interfaith community effort to commemorate the 250th anniversary of the United States.

The Alameda County Community Food Bank (ACCFB), Mt. Zion Missionary Baptist Church (MZMBC), and the Church of Jesus Christ of Latter-day Saints (LDS) partnered to address food insecurity throughout Alameda County.

A semi-truckload of food arrived at MZMBC in Oakland on Tuesday, July 21. This was one of 250 trucks the LDS church is sending throughout the United States. By the end of the year 10 million pounds of food will be donated. Each truck carries approximately 40,000 pounds of shelf-stable pantry staples that can feed 1,400 families for one week.

Pastor Michael Wallace of Mt. Zion Missionary Baptist Church provides instruction as volunteers unpack pallets of food to be distributed. “We believe that having food is a basic human right and to address it is our Christian duty,” Wallace said. “That’s what makes this partnership so meaningful.” Courtesy photo.

The need for food is significant. According to the ACCFB, 1 in 4 members of the community they serve is experiencing or at risk of hunger.

“The challenges get much harder during the summer when children no longer have access to healthy meals at school,” says Regi Young, executive director of Alameda County Community Food Bank. “Our community and our food bank face similar challenges accessing some of the highest quality and high demand foods because they are typically also the most expensive.

Oakland Mayor Barbara Lee speaks at the JustServe event.

“Fresh milk is among the top items on these lists, so we are extremely grateful for this donation to help more families stretch their budgets and get through these challenging summer months,” Young said.

Two days later, on July 23, another semi-truck, this one bearing fresh milk from the LDS church, arrived at the ACCFB.
Event organizers share a commitment to caring for those in need and fostering meaningful service connections within communities.

“After 250 years, there is still food insecurity in America, and this is an interfaith community effort to eradicate hunger in our communities and cities,” said Pastor Michael Wallace of Mount Zion. “We believe that having food is a basic human right and to address it is our Christian duty. That’s what makes this partnership so meaningful.”

“Members of the Church of Jesus Christ of Latter-day Saints believe in following the Savior’s commandments to love God and to love our neighbor,” says David Kimball, president of the Oakland Stake of the LDS church. “We are grateful to partner with these organizations to help care for those in need in our community.”

Word Assembly First Lady Denise Clark, left, joined Mt. Zion Missionary Baptist Church First Lady Velma Wallace at the food distribution site, where the first of the 250 truckloads of food LDS will provide to places across the country was distributed. Courtesy photo.

Welcoming the truck’s arrival at 10 a.m. at MZMBC were Kimball, Young, Wallace of MZMBC, and civil rights activist and Post News Group Publisher Paul Cobb. Oakland Mayor Barbara Lee was in attendance and addressed the hundreds of volunteers. Inspiring music was provided by members of the Oakland Interfaith Gospel Choir under the leadership of Terrance Kelly.

Teens from both churches were on hand to assist with loading food items for various local nonprofits and community groups to distribute to those in need. The teens also assembled 1,000 hygiene kits for the unhoused. Each kit will include a note of encouragement written by the children and youth of each church.
The churches and organizations that received food include:

Mt. Zion Missionary Baptist Church
ECAP (Emeryville Citizens Assistance Program)
Support Life Foundation/Islamic Cultural Center of Northern California (ICCNC)
Serenity House
CRECE (Central American Refugee Committee)
ION (Impact Oakland Now -Word Assembly, Center of Hope and Abyssinian Baptist Church)
True Faith Baptist Church (East Oakland)

“These two large shipments of food and milk, along with this interfaith, community event, exemplify the spirit of volunteerism and community service that this country was built on,” says Gregg Ankenman, assistant director of Community Service for the Oakland/San Francisco Communication Council of the LDS Church.