A new Gallup poll shows the U.S. currently has the lowest percentage of uninsured Americans since 2008. It's particularly important for the broker and adviser community to consider the health and economic impact of this fact, as we head into the second half of the year and toward open enrollment for 2015 insurance coverage.

As author Steven Brill writes in Time recently, there are new cliffs that must be conquered in the quest for insurance coverage and affordable care, and some may rise up in the not-so-distant future. There are the inequities in the subsidies offered to folks on the Affordable Care Act’s health insurance exchanges based upon their salaries.

In one scenario, a couple making less than $94,200 a year will receive a subsidy for the plan they choose, and a couple making even one dollar more will not. This matters as the Internal Revenue Service starts to tally reported income versus actual and adjustments (and overcoming any reporting mistakes) and will charge folks who misreported their earnings or earned more than the qualifying amount for the subsidy. And, they’ll have to pay it back.

If the hypothetical couple (both under the age of 65) instead live in my home state of Florida, they can make up to $62,040 and still receive a subsidy. But, one dollar more and they lose that subsidy — which amounts to $9,024, or 17% of their income. Paybacks are not fun.

Hence, a remarkable opportunity for the broker and adviser community arises, which I will walk you through:

1.People do not like end-of-year surprises that spoil holiday gift giving, such as losing 17% of their hard-earned cash.

  1. People will be surprised to learn that this is coming.
  2. People will become less engaged, less adherent to behaviors such as managing chronic care or getting prevention screens that matter. This will lead to still-higher costs, particularly if they haven't met their deductibles.
  3. Brokers/advisers can build a business case and outreach for new clients to save them from angst at the end of 2014.
  4. Brokers/advisers can build a business case for existing employers that they currently service, particularly if the clients have employees who are over age 65 (and therefore have income to manage that could result in the Social Security paybacks) or who are low-wage earners with second jobs (and therefore have to watch how much income they make to avoid deductible exclusions and potential paybacks).
  5. Brokers/advisers can build new business within existing plan sponsors and individual clients by developing protocols and services for lowering out of pocket costs, tracking deductibles, and choosing care wisely.

I've never believed that the Affordable Care Act would destroy the broker/adviser business, but that the business growth would come from new ideas, new health plan designs and individual guidance. This is one of the first opportunities and a heads-up to colleagues in the consulting world to embrace opportunities to discuss these issues with current and new clients.
For me, the real acceleration in health access and decline in total costs will occur next year and beyond, as telehealth, digital communication and electronic health record access by patients expand. I'm focusing my efforts on my core competencies of population health management, using data to look forward (not just claims to look backward) and envision the future of affordable, accessible, predictable health care that delivers sustainable health. What was before — an inefficient, inaccessible (for some) and unaffordable (for most, including US businesses) — is developing into the vision we all saw: safe, affordable, preventive and predictable care. My goal is to push the innovation that will expand this vision. I'll look forward to hearing from you on your successes, too! 

Nayer is a speaker, strategist with the Center of Health Engagement. She can be reached at cyndyn@me.com.

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