Even the veteran voices of our sales struggles past and present have died down concerning a fantasy return to the “good old days.” There is nothing standing in front of us that will resurrect surging individual sales and meaningful penetration of the middle market that would resemble our successes of 20 years ago. It is past time for new beginnings, new directions, new goals and rejuvenated primary stakeholders willing to support what the readers of this column would call the “Cause.” Meaning substantial sales that strike directly at those most at risk (my estimate—incomes of $50,000 to $150,000). I would strongly recommend that you review a recent publication from the New York State Department of Financial Services Long Term Care Insurance—Looking Back and Thinking Ahead—June 7, 2023. It is an exceptional historical summary of exactly how we got here. It is a well documented admission of past Department of Insurance culpability in not recognizing the necessity of allowing sufficient and timely rate increases. It includes a detailed summary of the past events that fueled market forces. In my mind it provides an accurate backdrop for understanding what must happen to once again move forward.
Here are the Highlights:
- In 2018 alone Americans paid out $55 billion for long term care expenses and Medicaid paid out triple that amount—$59 billion.
- By 2050 long term care expenses are expected to climb to three percent of gross domestic expense.
- The long term care market has struggled since it began 35 years ago. Recent experience in New York (probably true across all 50 states) reveals policy ownership has fallen from a high of 754,000 insured in 2002 to 394,000 in 2020.
- Our struggles can be largely attributed to “pricing errors made from its inception.” Premiums were initially severely underpriced. Insurers lost money, maintaining adequate reserves became systemic. Departments facing consumer backlash took a very conservative approach to needed rate increases throwing gas on carrier retreat from the market. A retreat that became an exodus.
- Long term care expenses are very expensive. Current per person nursing home expense is $108,000, home care is $61,000.
- New York has been a leader in providing managed long term care services for Medicare Advantage, PACE and Medicaid participants. About half of the states have growing MLTSS programs.
- Reliance on Medicaid “may prove infeasible.” Consumer private pay would have to rise. Private insurance has simply not been the answer with only two percent of Americans owning a policy. This sentence screams off the page: “Private long term care insurance is underutilized relative to potential demand.”
- In New York’s view they have tried to help consumers with cost offering one of the first Partnership initiatives and relief with state income taxes. They even added a 10 percent tax credit in 2020. Ownership continued to fall. NY speculates that the still high cost, the possibility that they may not ever use benefits and prevalent Medicaid planning strategies have contributed to poor sales. Yet they acknowledge that ”consumer reliance on Medicaid in its current form is untenable.”
- The NY department has presented an extensive “Mea Culpa.” Like others they approved rates based on projected lapse rates, mortality rates, morbidity rates and interest rates. Insurers and regulators now freely admit they relied on “erroneous assumptions.” We simply got it all wrong. Projections utilized by carriers and regulators relied on “inaccurate projections.” Current financial losses projected down the road accelerated company retreat from the battlefield and a strong and immediate cry for more ammunition in the form of higher rates. It was acknowledged that the reluctance to grant timely and sufficient rate increases lies at the root of our current predicament. History must record that the approval rate across most jurisdictions can only be described as too little too late. The truth is that further rate increases will be needed; “increases are burdensome to consumers but they are necessary to safeguard policy holder benefits over the long term.”
- It was acknowledged that rate actions can be mitigated by the use of “landing zones” and tiered increases that can exclude the oldest policy owners.
- NY is clearly and painfully aware of the subsequent financial stress on our sparse product market both on insurers and consumers. They have liberalized their acceptance of different forms of insurance designed to reduce cost. They have installed a new Health Insurer Guaranty Fund. They are currently working on a new NY State Master Plan for Aging and they are keeping a close eye on developments in Washington State.
I think the initial and most important ingredient of behavior modification is open acceptance of personal guilt and core responsibility in the creation of the dysfunction. NY has faced its own culpability and established a platform for meaningful reform. I believe all stakeholders now recognize there are absolute certainties that are required if a sales renaissance has any chance of success. There must be a problem solving partnership between the insurers’ necessity to offer profitable policies and the States desire to soften the strain of Medicaid dependence. Innovation and reality must be shaken up in the same cocktail. We must stop only paying lip service to our desire to provide risk sharing options to the mass middle market, recognizing that the dimension of that risk may be our industry’s greatest doughnut hole. Posterity has loudly provided Google maps with the shortest distance between two points. We cannot “return to the route” but we don’t have to go exploring directions to find our destination.
Other than that I have no opinion on the subject.
