Losing Money on the Obamacare Rollover

obamacare-reenrollingWaveland     The window opened on the Affordable Care Act for changes in policies and closed again after a short month. The reports from CMS indicate that some 9 million or so either renewed by their own volition or automatically rolled over their renewal with their existing carriers in mid-December. This is good news, but there are some clouds around this silver lining that are worth tying a reminder around the toe of new enrollees and everyone renewing next year. Bottom line: you may be spending money you don’t need to spend by not shopping on the marketplace to see if better deals have emerged for your health insurance.

James Surowiecki, the financial columnist for The New Yorker, called this the “inertia” factor, just letting the plan rollover for another year because it is such a hassle to go back on the website, reconcile your doctors to the plans, and navigate the myriad twists and turns of these policies. Throughout the year, we’ve referred to this as a consequence of “choice architecture,” providing the semblance of choices and the attraction of going with the default.

The record is clear about the lure of such automatic responses. Surowiecki cites the experience of both the Netherlands and Switzerland. In the Netherlands after managed competition was introduced for health insurers in 2006, “almost twenty per cent of the insured switched after a year. But by 2012, less than four per cent did.” Same-same for Switzerland where research has found the “average switch rate between 1997 and 2007 was three per cent.”

The price of inaction is severe in the early years of Obamacare because new companies are entering the marketplace who had watched and waited during the first year in 2014. Many of them are coming in with cheaper and more attractive benefits in order to catch up and gain a toehold in the healthcare market, and this includes both new players as well as historically big dogs in the business. On the other side of the coin, some of the players from the first year are jumping up the rates and counting on the fact that their new clients have been lured into the renewal pattern already. As the years add up, if anything, this is going to get worse. It’s going to be caveat emptor – let the buyer beware – on steroids.

One study “found that ‘fully informed’ consumers saved a couple of thousand dollars compared with those who were less well informed.” There are some possible fixes for this problem. Just looking is obviously one, but that’s more “I told you so” and a waste of breath, practically speaking, though for new enrollees over coming months, it’s worth remembering. Getting a letter from CMS would be helpful. One study mentioned by Surowiecki found that “when Medicare Part D consumers got a letter telling them that they could save money by changing plans the chance of their actually doing so rose by fifty per cent.” That seems worth a stamp to the troops, doesn’t it? Local 100’s Citizen Wealth Centers are also putting their shoulder to the wheel to help many of the people we enrolled last year.

It’s pretty much either get smart or get screwed now, so it’s worth the effort to not be on the losing end on either health insurance or the price you’re paying for the coverage.

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Mamas, Don’t Let Your Organizers Grow Up to be Developers

Cowboy BuilderWaveland    The activist and academically oriented quarterly journal, Social Policy, trades out subscriptions with a publication called Shelterforce, which, as the name indicates, specializes in housing related issues. A random email called “rooflines” that I get from time to time featured their best articles of the year.   Scrolling through, one piece caught my eye because the title was “Mamas, Don’t Let Your Organizers Grow Up to be Developers,” a play on the great Willie Nelson song cautioning mothers to not let their children grow up to be cowboys.  To have a housing development publication running an article cautioning community organizers to not become developers was bound to be something special, and the fact that it was written by John Emmeus Davis, a career developer and housing policy expert based in Vermont with a long history of projects and teaching behind him was intriguing as well.  What’s up with all of this?

Luckily for me Davis gets to the heart of his argument right from the get-go:

When a community-based developer of affordable housing incorporates community organizing into its programmatic repertoire, there is almost always added value—for the persons housed, for residents of the area served, for the organization itself.

The reverse is less often true.

Community organizers rarely become better at cultivating collective power and agitating for social change when they leave the streets, exchanging ball caps for hard hats. Not only do they stop doing what they do best; they start doing something that takes everyone a terribly long time to do well.

Wow!  Talk about hitting the nail on the head.  Davis is clear throughout the piece that in his field of housing development, the addition of experienced and skilled community organizers is a huge benefit, but he
is equally clear that community organizing rarely gets much of anything in return and in fact is more likely the loser in the tradeoff.  His argument reminds me of the answers we often used to give when outsiders
would ask us if we ever hired ACORN leaders to be ACORN organizers.  We would answer factually that, “yes, we did,” but we would be equally frank that it was easier for us to hire and develop a good organizer
than to find and develop a great leader, so in some cases we resisted the transition unless the leader or member insisted.

Davis understands he’s arguing the righteous truth but is doing so against the grain, but charges forward in the midst of the contradiction.

I can’t help feeling a sense of loss. It leaves a hole in the political landscape every time another group of hard-riding cowboys (or kick-ass cowgirls) settles down after years of punching out politicians, bureaucrats, bankers, and speculators without having to worry about permits, grants, credits, loans, or donations being withheld from projects they are planning to build. With a whisper of apology to Willie Nelson, a silly ditty plays silently in my head:

Mamas don’t let your cowboys grow up to be builders
Don’t let em pluck spreadsheets and beg for old bucks
Make em play guitars, stage protests, and such

Okay, my feelings are definitely confused. If nonprofit developers become more accountable to the people and places they serve when they begin acting more like organizers—listening, engaging, recruiting,
educating, advocating—perhaps community organizers become more strategic and effective when they begin casting their campaigns and framing their demands with an eye toward supporting development they
plan to do.

What he leaves unspoken is the question of resources and the role it plays in driving these cowboys off the right ranch.  Community organizations and their organizing staffs desperate for resources frequently decide to till another field hoping to grow money trees there when support for community organizing is so fallow.In a conversation in France not along ago about a different topic, I answered that the book that really needed to be written was the history of community organizing told through the lens of how it had been driven and adapted to resource problems and opportunities.

Regardless, today, we’ll just thank Davis for singing our song.

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