Anthem Blue Cross and Blue Shield has announced that they are suspending payment of commissions on individual and family policies issued under the Affordable Care Act with effective dates between April 1st and December 31st.  In order to obtain a policy with an effective date within this range, a person must have a qualifying event that generates a Special Enrollment Period.

In my opinion, the reason that Anthem is taking this step is because they want to discourage the purchasing of their policies by individuals and families that have a Special Enrollment Period.  Such an action would be premised on the belief that the cohort of policyholders who come onto Anthem’s book via a Special Enrollment Period represents unfair or unacceptable risk.

Conceding that the current system provides no effective policing as to whether individuals and families truly qualify for a Special Enrollment Period and that many consumers are using this as their opportunity to wait until they need coverage to apply, Anthem’s action in suspending payment of commissions is still misdirected.  This action hurts their most valuable distribution channels while not addressing the root of the problem.

A consumer seeking healthcare under the Affordable Care Act can go through any one of several avenues to obtain coverage.  They may go directly through The Marketplace via phone or via computer at Healthcare.gov.  They may also receive assistance through this process by contacting the health insurer directly, a large national broker, a local insurance agent, a Navigator, or a Certified Application Counselor.

It is important to note that this suspension of commissions affects only two of these distribution channels.  It is only the large national brokers and the local insurance agents who are paid commissions by the health insurers.  It follows that, if it cannot be demonstrated that the brokers and agents are at least as responsible as the other distribution channels for the enrollment of consumers without a true Special Enrollment Period, then brokers and agents are being singled out and treated unfairly by the health insurers.

I would further argue that this suspension of commission payments affects local insurance agents even more than the large national brokers.  The large national brokers can respond to the situation by simply pulling the health insurer from their menu of offerings.  Because of the unique relationships that local insurance agents have within their communities, they do not have this option.  Local insurance agents have built referral relationships with other professionals in their communities that they would put in jeopardy should they refuse to help those referred to them simply because a Special Enrollment Period is involved.  Local insurance agents depend on the goodwill and referrals from their current customers which they would also endanger by refusing to help those sent to them by their clients.  We have to keep our shingle out, our doors open, and offer our services to our communities now without compensation for doing so.

I call on Anthem or any other carrier that is suspending payment of commissions on the basis of a Special Enrollment Period to make their case with hard numbers that it is the broker and agent channel that is the source of the problem.  If they can’t or won’t do this, then they need to do the right thing and honor their commitments to these presumably values business partners.  I encourage my fellow agents to join me in making our position known.