Affordable Care Act

Houston Insurance Agents Brace For Obamacare

The Affordable Care Act will require millions of uninsured Texans to obtain health coverage in 2014. Ostensibly, they’ll be able to shop for plans on-line, starting October first. But traditional insurance agents have their doubts it will work so smoothly.


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Trademark Insurance is a family-run insurance agency off the Katy Freeway.

Travis Middleton handles insurance for small companies; his wife Jo Middleton advises individuals who need Medicare or have to buy their own private policies.

[Jo Middleton answers the office phone]

Jo Middleton says it's difficult to advise clients on the law, because so much is still unknown.

Starting October 1, new insurance plans will be available in online marketplaces.

But the federal government hasn't announced yet what plans are coming to Texas, or how much the plans will cost.

"It's a disruptor for us because they're still writing the details. So, when you're answering questions for clients now and they say ‘Well, how is this going to affect me?' You sort of have to say ‘Well, the answer today is…but tomorrow I might have a different answer because they're still writing the details.'"

Middleton insurance agents
Houston insurance agents Travis and Jo Middleton with two binders containing an entire copy of the Patient Protection and Affordable Care Act, also known as “Obamacare.”

Small companies, with less than 50 full-time workers, don't have to offer insurance under the law.

But if they do, the insurance must include certain things.

For example, pregnancies will now have to be covered, and prescriptions.

Travis Middleton says all those new services could potentially drive up the premiums on those plans.

But instead, he thinks insurance companies will try to control prices by narrowing the provider network.

Patients may have more benefits, but fewer places to get them.

"Will MD Anderson Cancer be in the same hospital system as Memorial Hermann? Or will it be out of network? Will you be getting your cancer treated at a different hospital than where you wanted to, which would have been MD Anderson?"

For people who don't have insurance at work, this online marketplace opens in October.

It will allow people to shop for policies on their own, potentially bypassing insurance agents altogether.

But Middleton says he thinks agents will be more necessary than ever, because the law is so confusing.

"If it doesn't work the way the website said it was supposed to, who are they going to go to? Who's going to be their advocate?"

The Affordable Care Act does try to address this. It includes money to hire insurance "Navigators" in every state.

These "Navigators" will receive at least 20 hours of training, to help people sign up for insurance at clinics or over the phone.

But Middleton says it's not just about buying the insurance, it's about what happens after. For example, if you have a claim dispute or your income changes.

"Who's going to be their HR? Who's going to be the person who assists them in their claim?"

Middleton says people who have never had insurance before could get easily get overwhelmed or confused by the law.

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