INSIGHT ON: Business Services – Taking steps

Posted on Dec 6, 2013 :: Business Services , Insight On
Posted by , Insight on Business Staff Writer

No matter your political view of the Patient Protection and Affordable Care Act (ACA), there is one thing that everyone can agree on – this law has ushered in the most massive change to our health insurance and coverage system that this country has ever seen.

It is interesting to look at the responses that states have taken when faced with the ACA. Generally, you see two approaches. The first is blind support, promoting the law and avoiding negative critics at all costs. The second is unfettered opposition, ignoring its existence and withholding any resource or effort to make it work. Neither approach is helpful. Wisconsin has taken a much more pragmatic approach. It is our responsibility to make it work as best as we can for our consumers and taxpayers. In that vein, being truthful about the law is imperative to protecting our citizens.

For a variety of reasons, Wisconsin did not set up its own exchange. That doesn’t mean we have done nothing, nor does it mean that we have abdicated our responsibility to consumers. On the contrary, we decided that the best approach to protect consumers was for Wisconsin to regulate our insurance market. That means that we regulate insurance rates, review all plan filings, and regulate agents. We also thought it was important for the state to regulate the new PPACA “assistors” like navigators and certified application counselors.

It was also crucial to inform Wisconsinites about the ACA. To that end, we issued frequently asked questions at We issued press releases and conducted 16 town hall meetings to explain the federal law.

We also felt it was important to let consumers understand that their insurance benefits are going to change. Insurers are required to cover a specified package of benefits (essential benefits) for both group (employer coverage) and individual policies. Further, the law specifically defines how those benefits are covered and what a consumer must be limited to in cost sharing. The result is two-fold. First, you will not be able to keep the exact plan you currently have, and second, it is possible that your provider may change, too, or could now be considered out-of-network. Irrespective of subsidies, these changes have resulted in a significant increase in the cost of insurance.

We have also worked behind the scenes. A few state efforts include:

» Conducted rate reviews on hundreds of insurance plans both on and off the exchange

» Reviewed hundreds of insurance company product filings both on and off the exchange

» Drafted rules to implement licensing requirements for navigators and registration requirements for certified application counselors

» Trained, coordinated training, or approved training that helped more than 700 people satisfy navigator or certified application counselor state requirements

» Worked with trainers to ensure more than 400 agents received training on issues for vulnerable populations


Managing Change

A few important tips will help you to better manage these confusing changes:

1. Look before you leap. The Office of the Commissioner of Insurance provides answers to common questions on our website (

2. Shop around. Consumers and businesses have a lot of options, and it is always best to shop around. Your best deal may not necessarily be purchasing coverage through the exchange and for some businesses shopping on the exchange may not even be an option.

3. Consult with a professional. Navigators, certified application counselors (CAC), and agents can help you understand the exchange, find information you’re looking for, and enroll.

4. Be careful. With any new program there are scammers. Contact our website to verify that the agent, navigator, CAC, or insurer is licensed.


Dan Schwartzer was appointed state Deputy Commissioner of Insurance in January 2011. He is a licensed insurance intermediary holding property, casualty, life, accident and health insurance licenses.