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Rising Complaints of Unauthorized Obamacare Plan-Switching and Sign-Ups Trigger Concern

Health Insurance

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April 9, 2024
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Federal and state regulators aren’t doing enough to stop the growing problem of rogue health insurance brokers making unauthorized policy switches for Affordable Care Act policyholders, say consumers, agents, nonprofit enrollee assistance groups, and other insurance experts.

“We think it’s urgent and it requires a lot more attention and resources,” said Jennifer Sullivan, director of health coverage access for the Center on Budget and Policy Priorities.

The Centers for Medicare & Medicaid Services, which oversees the ACA, “has acknowledged the issue,” said former Oklahoma insurance commissioner John Doak. “But it appears their response is inadequate.”

The reactions follow a KFF Health News article outlining how licensed brokers’ easy access to policyholder information on healthcare.gov has led unscrupulous agents to switch people’s policies without express permission. Those agents can then take the commission that comes with signing a new customer. Dozens of people and insurance brokers responded to the earlier report recounting similar situations.

Some switched policyholders end up in plans that don’t include their doctors or the medications they regularly take, or come with higher deductibles than their original coverage choice. If their income or eligibility for premium tax credits is misrepresented, some people end up owing back taxes.

Agents whose clients have been affected say the switches ramped up last year and are continuing into 2024, although quantifying the problem continues to be difficult. The problem seems concentrated on the federal healthcare.gov website, which is the marketplace where people in 32 states buy ACA plans, which are also known as Obamacare. CMS declined to provide the number of complaints that have been filed.

Even so, CMS representatives said during a December committee meeting of the National Association of Insurance Commissioners that they were “acutely aware” of the problem and were working on solutions.

A similar NAIC gathering was held in March. During those meetings, state regulators urged CMS officials to look for unauthorized switches, rather than reacting only to filed complaints. State regulators also want the agency to tell them sooner about agents or brokers under investigation, and to be provided with the number of affected consumers in their regions.

In an April 4 written statement to KFF Health News, Jeff Wu, acting director of CMS’ Center for Consumer Information & Insurance Oversight, pointed to the agency’s sharp prohibition on agents enrolling people or changing their plans without getting written or recorded consent, and said his team is “analyzing potential additional system controls to block unauthorized or fraudulent activity.”

It is also working with state regulators and large broker agencies, Wu wrote, to identify “the most effective ways to root out bad actors.” He also said more agents and brokers are being suspended or terminated from healthcare.gov.

Wu did not provide, however, a tally of just how many have been sanctioned.

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Low-income consumers are often targeted, possibly because they qualify for zero-premium plans, meaning they might not know they’ve been switched or enrolled because they aren’t paying a monthly bill.

Also, rules took effect in 2022 that allow low-income residents to enroll at any time of the year, not just during the annual open enrollment period. While the change was meant to help people who most need to access coverage, it has had the unintended effect of creating an opportunity for this scheme to ramp up.

“There have been bad apples out there signing people up and capturing the commissions to do so for a while, but it’s exacerbated in the last couple of years, turning it from a few isolated incidents to something more common,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.

Many victims don’t know they’ve been switched until they try to use their plans — either because agents changed the policy without talking to them or because the consumer unknowingly enrolled by responding to online advertisements promising gift cards, government subsidies, or free health insurance.

The challenge now is how federal regulators and their counterparts in the states can thwart the activity without diminishing enrollment — a top priority for the marketplace. In fact, Obamacare’s record-breaking enrollment figures are being touted prominently in President Joe Biden’s reelection campaign.

Thwarting the switches “really comes down to oversight and enforcement,” Corlette said. “As soon as regulators identify someone who is engaged in unauthorized plan-switching or enrollment, they need to cut them off immediately.”

That isn’t simple.

For starters, consumers or their agents must report suspected problems to state and federal regulators before investigations are launched.

Such investigations can take weeks and states generally don’t have access to complaints until federal investigators finish an inquiry, state regulators complained during the NAIC meetings.

Doak attended the December meeting, where he urged federal regulators to look for patterns that might indicate unauthorized switching — such as policyholders’ coverage being changed multiple times in a short period — and then quickly initiate follow-up with the consumer.

“All regulators have a duty to get on top of this issue and protect the most vulnerable consumers from unknowingly having their policies moved or their information mistreated,” Doak told KFF Health News. He is now executive vice president of government affairs for Insurance Care Direct, a health insurance brokerage.

Being more proactive requires funding.

Wu said the agency’s administrative budget has remained nearly flat for 13 years even as enrollment has grown sharply in the ACA and the other health programs it oversees.

And the complaint process itself can be cumbersome because it can involve different state or federal agencies lacking coordination.

Even after complaints are filed, state or federal officials follow up directly with the consumer, who might have limited English proficiency, lack an email address, or simply not answer their phone — which can stall or stop a resolution, said Katie Roders Turner, executive director of the Family Healthcare Foundation, a Tampa Bay, Florida, nonprofit that helps people enroll or deal with problems that arise with their plans.

Suggested improvements include creating a central form or portal for complaints and beefing up safeguards on the healthcare.gov site to prevent such unauthorized activity in the first place.

Currently, licensed agents need only a name, date of birth, and state of residence to access policyholder information and make changes. That information is easy to obtain.

States that run their own marketplaces — there are 18 and the District of Columbia — often require more information, such as a one-time passcode sent to the consumer, who then gives it to their chosen agent.

In the meantime, the frustration is increasing.

Lauren Phillips, a sales agent in Georgia, said she reached out to an agent in Florida who was switching one of her clients, asking her to stop. When it happened again to the same client, she reported it to regulators.

“Their solution was for me to just watch the policy and fix it if it happens again, which is not a viable solution, “Phillips said.

Recently, after noticing the client’s policy had been switched again, she reported it and changed it back. When she checked two mornings later, the policy had been terminated.

“Now my client has no insurance at all,” Phillips said. “They say they are working on solutions. But here we are in the fourth month of the year and agents and consumers are still suffering at the hands of these terrible agents.”

Julie Appleby:
jappleby@kff.org,
@Julie_appleby

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Do I Have to Buy Organic Produce?

Nutrition

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April 9, 2024
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Inside: Wondering whether you should buy organic fruits and vegetables for your family? Here are the facts, so you can feel good about your choices.

Key Takeaways

The most important thing to do is feed your family lots of fruits and vegetables, whether they’re organic or not.

There’s not a big difference between organic and conventional produce when it comes to nutrition.

The science behind the Dirty Dozen list deserves some scrutiny.

Ever stood in the aisle of the grocery store looking back and forth between the organic apples and the conventional ones?

You wonder whether you should spend the extra dollar per pound–and weigh worries about pesticides against worries about your budget.

Whether to buy organic food is a fraught topic for many moms.

The issue is often presented in black and white terms—healthy or unhealthy, safe or toxic. But that’s just not the case.

So if you’ve ever stood in the aisles of the grocery store, wondering what to do, here are answers to some of your biggest questions.

What does organic mean?

The term “organic” on a food means it was grown without any synthetic pesticides, fertilizers, or genetic modification. Animals weren’t given growth hormones or antibiotics and were treated humanely.

Keep in mind that this label only concerns a food’s production, not how healthy it is. In other words, organic cookies are still cookies!

And remember that organic foods aren’t pesticide-free. The USDA allows organic crops to be treated with organic pesticides–substances that are naturally occurring such as soap, hydrogen peroxide, and copper sulfate. And just because a pesticide is “natural” doesn’t mean it’s completely safe.

Is organic produce more nutritious?

There’s not a huge difference. Some studies show benefits, like an analysis that found organic produce was higher in some kinds of antioxidants.

But a review of nearly 250 studies in the journal Annals of Internal Medicine concluded there wasn’t strong evidence that organic foods are more nutritious than conventional.

A clinical report from the American Academy of Pediatrics states:

“Current evidence does not support any meaningful nutritional benefits or deficits from eating organic compared with conventionally grown foods, and there are no well-powered human studies that directly demonstrate health benefits or disease protection as a result of consuming an organic diet.”

Are organic fruits and vegetables safer?

Organic produce is grown without using synthetic pesticides, which are used to protect crops from harmful insects. It’s understandable to consider children’s pesticide exposure, since their bodies are smaller and their systems (including their brains) are still developing.

Here are some of things to consider:

Pesticide use has dropped: In the last few decades, the rules around pesticides have gotten stricter and their overall use has declined, thanks to government regulations.

There are safeguards: The Environmental Protection Agency (EPA) decides which pesticides are safe for use and sets allowable limits for each residue, the amount left behind on the food. The United States Department of Agriculture (USDA) regularly tests foods, both fresh and processed, for pesticide residues. Testing can detect even tiny amounts of residues that are far below allowable limits.

Research isn’t conclusive: The American Academy of Pediatrics’ report says there are no well-designed human studies that show health benefits or disease protection from eating an organic diet and no studies showing an association between pesticide exposure and harmful effects on brain development.

Is organic farming better for the environment? Many of organic farming’s practices do help protect the environment–for instance, using beneficial insects instead of synthetic pesticides that could seep into the ground water.

I

Should you follow the Dirty Dozen?

The Environmental Working Group (EWG) releases annual lists of the “dirtiest” and “cleanest” produce, based on pesticide residues. EWG creates their rankings by analyzing data from the USDA, which tests washed, peeled produce to mimic how we typically eat those foods..

The “dirty” produce included in the latest list (all conventional fruits and veggies) are strawberries, spinach, kale, grapes, peaches, and potatoes. The EWG suggests choosing organic versions of those. The “clean” ones include carrots, sweet potatoes, asparagus, and avocados.

I used to follow these lists when shopping and even recommended them. But I don’t anymore.

Here’s why: The rankings are created based on whether the fruits and veggies have residues and how many they have–not whether those residue levels are harmful in the amounts we typically eat. Just because a residue exists doesn’t mean there’s a risk.

None of the pesticide residues on the Dirty Dozen produce are more than what the USDA says is safe. And some are well below the threshold. (You can use this Pesticide Residue Calculator to figure out how many servings you or your kids could consume without adverse effects–spoiler: It’s A LOT, like thousands.)

In a 2011 study published in the Journal Of Toxicology, researchers concluded that swapping in the organic forms of the 12 items on the Dirty Dozen list didn’t result in any real reduction of risk and that the methods used to create the Dirty Dozen “lacked credibility”.

EWG acknowledges that they “do not factor in the pesticide levels deemed acceptable by the Environmental Protection Agency” but says it’s because those acceptable levels are inadequate and based on outdated science.

Most importantly, in their report, they also say this: “Everyone should eat plenty of fresh fruits and vegetables, whether organic or conventionally grown. The health benefits of such a diet outweigh the risks of pesticide exposure.”

Is organic produce more expensive?

Usually, yes. You can find deals, but organic prices are typically higher. That’s because organic food is often more expensive to produce, and there’s a smaller supply of it.

In an experiment, the Alliance for Food and Farming (AFF), a non-profit organization that promotes the safety of fruits and vegetables (and represents both organic and conventional farms), compared costs on nine produce items on the Dirty Dozen list.

Based on the same quantities, package sizes, and produce varieties for the amount a family of four might eat in a 7-10 day period, there was a 48 percent spending increase if they followed the Dirty Dozen list.

Looking at the most popular fruits and veggies, they found the cost would be 34 percent higher by following the lists.

Ever heard someone say they buy organic to avoid “chemicals”? Everything is a chemical–even water! And chemicals that occur naturally in the world (like nicotine and cyanide) can be dangerous too.

What I do about organic food

These are choices that work for our family and align with our budget, allowing us to have a variety of fresh food in our home:

I buy some organic and some conventional, depending on prices, what looks good, and what varieties I’m craving. I don’t follow the Dirty Dozen and Clean Fifteen lists when making those decisions.

I try to buy from small local farms when I can to help support their business, whether the produce (or meat) is organic or not.

I always wash produce well under running water, whether it’s conventional or organic. That includes scrubbing potatoes and rinsing the outside of melons before I cut through them.

I vary the kinds of fruits and veggies I buy to enjoy seasonal produce and get a variety of nutrients and antioxidants. (That also limits exposure to one single pesticide.)

Over the years, I’ve also had the chance to tour a lot of different farms and talk one-on-one with farmers–many of whom grow both organic and conventional food. I have a lot of faith in farmers because they work incredibly hard to grow safe, nutritious food. Calling their crops “dirty” isn’t fair or accurate.

Believe me, I haven’t always felt this confident. I used to agonize a lot more about my purchases–and spend more money than we could afford on groceries. But now I feel good about my choices (read: How I Stopped Stressing Out About Grocery Shopping.) I hope you can too!

What should you do?

Do what you feel good about and what’s best for your family. Do not feel pressure to spend beyond your means. Do not feel guilted by a blog post, a photo on Instagram, or the person’s cart behind you at the check-out.

If you want to choose organic and have room in your budget, go for it!

If you want to follow the Dirty Dozen list, that’s okay too! Just be aware of the limitations.

No matter what, eat lots of fruits and veggies, and don’t stress out. Eating lots of fresh food is good for health–but fear of food is not.

Fear of food may actually be causing some people not to eat enough fruits and vegetables. In one study, when researchers mentioned the “Dirty Dozen” list to shoppers, those shoppers said they were less likely to buy any fresh produce.

That’s worrisome, considering only about one in 10 adults gets the recommended number of fruits and vegetables. Kids don’t get enough either.

Bottom Line: The most important step to take is to feed your family lots of fruits and vegetables. A diet full of fruits and vegetables (organic or not) is proven to be good for health, helping to lower blood pressure and the risk for heart disease and even some types of cancer.

And certainly don’t avoid buying fruits and vegetables because they’re not organic.

What else you should know

April 8, 2024 – iRunFar

Running

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April 9, 2024
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Forget about the eclipse, we’ve got your totality right here — a totality of ultrarunning results. Istria by UTMB, the Skyrunner World Series, and the Paris Marathon are among the diverse highlights from the past weekend.

Istria 100 by UTMB – Umag, Croatia

The event dates back to 2013, first known as the 100 Miles of Istria. This year it was expected to host some 2,000 runners across its five distances on Croatia’s northwestern peninsula.

168 Kilometers (105 miles)

The event’s longest race packed in 21,620 feet of elevation gain for 376 starters.

Two Czechs were the first to finish the men’s race. Marek Causidis and Jan Procházka finished in 18:58 and 19:21. Juuso Simpanen (Finland) was third in 19:35.

Each of the first three women finished under 24 hours. Alessandra Boifava (Italy) led the group in 20:51. Ida Sophie Hegemann (Germany) was runner-up in 21:27, and the indefatigable Claire Bannwarth (France) ran 22:26 for third. Bannwarth is known for her frequent extra long-distance race results. In January, she won the Spine Race in the U.K. and in March she won Spain’s 301k TrailCat200. Those finishes took 92 and 59 hours each, respectively.

A springtime view from along the 100-mile course at Istria 100 by UTMB. Photo: UTMB/Ian Corless

110k (68 Miles)

Janosch Kowalczyk (Germany) beat out a pair of strong Spaniards for the race win. Kowalczyk finished in 9:52, and Pablo Villa (Spain) and Pau Capell (Spain) came next in 10:19 and 10:31. It was only two weeks ago that Capell was seventh at the Ultra-Trail Chianti by UTMB 100k race in Italy.

Women’s winner Monika Stejskalová (Czech Republic) squeaked under the half-day mark with an 11:59 finish, beating the buzzer by 17 seconds. Inês Marques (Portugal) and Biborka Krisztina Fazakas (Romania) podiumed in 12:13 and 12:36, respectively.

Full results.

The start of the 2024 Istria 100 by UTMB 110k. Photo: UTMB/Goran Jakus

Calomorro Skyrace – Benalmádena, Spain

The year’s second Skyrunner World Series went 27.5k and with 2,270 meters of elevation gain. That’s 17 miles and 7,448 feet.

It’s going to be Roberto Delorenzi’s year in skyrunning. The Swiss all-star won for the second-straight race, and this one wasn’t at all close. Delorenzi stormed the course in 2:25. Antonio Martinez (Spain) and Luca del Pero (Italy) were second and third men in 2:34 and 2:36, respectively. Spanish runners took six of the top 10 positions.

The Spanish women did even better. They swept the podium with Sara Alonso edging out Julia Font for the top spot. Alonso ran 2:59 to Font’s 3:00, only 50 seconds apart. Naiara Irigoyen ran 3:09 for third. In total, seven Spanish women finished in the top 10.

Full results.

Sara Alonso clawing her way to the women’s win at the 2024 Calomorro Skyrace: Photo: Antton Guaresti

Patagonia Run – San Martín de los Andes, Argentina

For the Spartan Trail event, there was a $15,000 prize purse for the 100 miler and $10,000 for the marathon.

100 Mile

Only 17 minutes split the top three men after 20 hours of running in the 100 miler. Sergio Gustavo Pereyra (Argentina) earned the victory in 20:25, and Cristofer Clemente (Spain) was second in 20:31. Maximiliano Vazquez (Mexico) was third in 20:42.

The women were particularly close, too, and after 26 hours of competition. The three leaders, all from Argentina, were Claudia Veronica Ramirez, Maria Eugenia Gabrielli, and Magdalena Aristi in 26:01, 26:25, and 26:32, respectively.

Marathon

The host country swept both the men’s and women’s podiums.

Joaquin Narvaez, Hugo Rodriguez, and Ignacio Reyes finished in 3:22, 3:35, and 3:42.

And for the women, it was Roxanna Paola Flores, Florencia Soledad Iuorno, and Ruth Irene Oñate Guerrero all in 4:16, 4:37, and 4:43.

Full results.

French Trail Championships – Buis Les Baronnies, France

The national crown was decided on a 57k course, and Benjamin Roubiol won in 4:44. Roubiol won the 80k race at the Trail World Championships last year in Austria. Hugo Deck and Thomas Cardin were both barely two minutes back for the rest of the men’s poodium, and only 12 seconds apart. Both finished in 4:46 and with Deck ahead of Cardin.

Blandine L’Hirondel was the best of the women’s field in 5:35. Julie Roux ran 5:41 for second and Adeline Martin was third in 5:49.

Full results.

Additional Races and Runs

Paris Marathon – Paris, France

Twelfth at last year’s Sierre-Zinal race, Swiss orienteer Mathias Kyburz did way better on the road at the Paris Marathon. He was seventh overall in 2:07:44, and it was his debut marathon. Full results.

Ancient Lakes Trail Run – Quincy, Washington

In the 50 miler, the longest of the event’s four races, David and Kayla Dierdorff won in 7:50 and 9:06. Mr. Dierdorff set a new course record by 2 minutes.

Kayla Dierdorff enjoying herself on her way to winning the 2024 Ancient Lakes 50 Mile women’s race. Photo: Juan Montermoso

American River 50 Mile – Folsom, California

The top four men finished under seven hours in the long-time race. Jayson Hefner was first in 6:46, and Kat Seeba scored the women’s crown in 8:40. Anthony Fagundes and McKayla Lally championed the accompanying 25-mile race in 2:47 and 3:45, respectively. Full results.

Diablo Trails Challenge 50k – Walnut Creek, California

Adam Zastrow and Isabel Diaz won the Brazen Racing event in 4:58 and 5:50. Full results.

Brazos Bend – Needville, Texas

The Trail Racing Over Texas event saw Art Hurtado and Martina Dujic win the 50 miler, in its 1oth running, in 6:21 and 7:05, and Zach and Nicole Bitter won the 50k in 3:19 and 3:55. Full results.

Race director Cal Neff (left) with 2024 Brazos Bend 50k women’s and men’s winners Nicole and Zach Bitter. Photo: Trail Racing Over Texas/Jeremiah Justis

Ozark Foothills Endurance Runs – Wildwood, Missouri

Zach Boyle and Gibson Kelley won the 100 miler, the longest of the weekend’s seven races, in 20:42 and 26:53. Full results (when available).

Gibson Kelley putting in the miles on her way to winning the 2024 Ozark Foothills 100 Mile women’s race. Photo: Elaine Collins

Red River Gorge 25k – Pine Ridge, Kentucky

Red River Gorge isn’t just for climbing. Run Bum race director Sean Blanton won the race in 2:10 and Kyla Daniels was first woman in 2:54. Full results.

Kanawha Trace 50k – Oma, West Virginia

Alex Minor scored a new men’s course record in 3:46, and Raegan Good won the women’s race in 5:41. Full results.

Eagleton Trail Challenge 50k – Lock Haven, Pennsylvania

Joshua Hayes and Sophie Kotok fronted a small field of 42 finishers in 4:41 and 5:09, respectively. Full results.

Mt. Toby Ultra 50k – Sunderland, Massachusetts

Matt Pacheco and Britta Clark were the fastest in 5:16 and 5:23. Full results.

Bull Run Run 50 Mile – Clifton, Virginia

It was the race’s 30th year and almost 200 runners started the 50-mile race. The race recognizes the Civil War battles that happened in the area. Less than two minutes separated Brandon Fogarty and Linford Fritz at the finish, but Fogarty scored the win in 7:30 to Fritz’s 7:32. Walt Barnett was third in 7:56. The first two women had a close finish too with Nora Jodrey edging out Steph Hill for the victory, 8:12 to 8:16. Nelle Fox was third in 8:56. Full results.

The 2024 Bull Run Run 50 Mile men’s and women’s winners: Brandon Fogarty and Nora Jodrey. Photo: Keith Knipling

Umstead 100 Mile – Raleigh, North Carolina

They went fast on the multi-lap state park course. Jim Sweeney and Tara Dower came through in 15:23 and 14:58 to win the men’s and women’s races, respectively. Sweeney was second last year and fourth in 2022. [Editor’s Note: We are editing to add, Dower was the first finisher across the line, with the fastest time on the day.] Full results.

Jim Sweeney winning the 2024 Umstead 100 Mile men’s race. Photo: Hope Squires

Running Up for Air Moab – Moab, Utah

The Running Up For Air fundraising race series expanded to Moab for its inaugural event on Saturday. The event raised money for two nonprofits, Clean Air Utah and the local Youth Garden Project. Runners experienced a calm, cool morning that gave way to volatile afternoon weather including high winds and passing snow squalls.

Approximately 45 participants across the event’s three races, 12-hour, 6-hour, and 3-hour races, ran 1.8-mile counterclockwise loops on the town’s famous Stairmaster and Moab Rim Trails, racking up about 940 feet of climbing per lap.

While lap tallies are yet to be finalized, the 12-hour race saw Kyle Curtin and Kaylie Knoles as victors. Mike McMonagle and Stacey Dorais won the 6-hour race, and Griffin Briley and Leah Yingling took home wins in the 3-hour race.

Full results.

Kaylie Knoles (left), 2024 Running Up For Air Moab 12 Hours women’s winner. Knoles is pictured with other 12-hour participants (l-to-r): Taylor Wall, Courtney Bowen, and Jessica Wiigham. Photo courtesy of the event.

Griffin Briley on his way to winning the 2024 Running Up For Air Moab 3 Hours men’s race. Photo courtesy of the event.

Call for Comments

What a great sporting weekend! There were the women’s NCAA basketball championships, Major League Baseball, the National Basketball Association is nearing the playoffs, and Wrestlemania. What caught your eye from this past weekend?

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