SMITH ISLAND, Md. — Born in 1947, Maxine Landon has spent her entire life on Smith Island, Maryland, a small island in the middle of the Chesapeake Bay.
Growing up, Maxine, like every Smith Islander, was encouraged to vote. And since 1965, Maxine made sure to vote in person on Smith Island in every election.
But this year, that won’t be possible. Smith Island’s last voting precinct was closed by election officials.
Residents can either cast a provisional ballot from the island, vote by mail or leave the archipelago, which can only be reached by boat, to vote in person. But many don’t trust provisional ballots and getting to the mainland to vote in person may be burdensome for an aging population.
That’s why Smith Islanders are fighting to get their precinct back.
“This should have never happened. We have the right to vote,” Maxine said. “We’re here on an isolated island. If (the county) wants the island’s residents to go over on the mainland or mail in a provisional ballot, we don’t want that. Residents want to vote, and they want to vote here.”
Smith Islanders have depended on the waters of the Chesapeake Bay to sustain their families for more than 300 years.
As the watermen’s way of life receded in recent years, tourism emerged as a source of income. The archipelago gained a reputation as a good place to drop off the grid and enjoy a slice of Smith Island cake — its eight to 10-layer thin layers are Maryland’s state dessert.
That isolation has influenced Smith Islanders’ language, a semi-Elizabethan/Shakespearean version of English, and their unique sense of resiliency and faith in their land.
Remote living has helped preserve the history yet it hurts the islanders in other ways.
Smith Island’s voting precinct was one of hundreds of polling places in the state to be eliminated this year. The Maryland State Board of Elections chose to consolidate precincts into larger vote centers to make up for an election judge shortage caused by the COVID-19 pandemic.
As of Oct. 3, Maryland planned to open 321 vote centers on Election Day, roughly a fifth of the 1,604 polling locations that were open on Election Day in 2016, according to data from the Maryland State Board of Elections.
Smith Islanders feel like they’re “being silenced” because their rights are being taken away, said Everett Landon, a pastor on Smith Island.
Everett took to Facebook when he found out the voting precinct was closing. Smith Islanders followed by sending letters and calling the county Board of Elections to demand their precinct be reopened.
Altogether Everett delivered more than 100 letters from residents — about half of the island’s population — to the county Board of Elections.
“This story is important because it not only touches the people of Smith Island, it touches every American,” Everett said. “Every American has the right to vote. If they can take our right to vote away and use excuses for it, they can make an excuse for other communities and take their right away.”
Smith Islanders’ might have a claim that their voting rights are being infringed, said Michael Hanmer, a professor and research director at the Center for Democracy and Civic Engagement at the University of Maryland.
The situation in Smith Island is similar to other legal cases questioning election access, such as Texas’ lawsuit surrounding election dropboxes, Hanmer said.
“In situations where there are major changes to voting options, we do often see lawsuits,” Hanmer said. “With the consolidation of precincts for this upcoming election, I wouldn’t be surprised if we saw lawsuits in Maryland as well.”
If such a lawsuit were to arise, Smith Islanders would have to demonstrate that resources were in place on the island to open the precinct, Hanmer said. They’d also have to show a court that the closure caused harm, such as the overall time it would take to vote or the ferry costs associated with going to the mainland.
Delmarva Now reached out to the Somerset County Board of Elections but didn’t receive a response.
Maryland is committed to making sure every person has the opportunity to vote this year, according to an emailed statement from Donna Duncan, Maryland State Board of Elections assistant deputy administrator.
“Given that countywide vote centers are being used during this year’s election instead of the precinct-level polling places, it is important that every ballot is verified against the voter database to ensure the integrity of the election,” Duncan said. “The internet connection on Smith Island makes it difficult to verify and scan ballots on the island.”
A constitutional right
Smith Island traces its heritage back to the original settlement of the British colonies in the 1600s, according to Paula Johnson, a curator at the National Museum of American History in Washington, D.C.
John Smith, who settled Jamestown in 1607, first charted Smith Island that year, said Johnson, an anthropologist who’s studied Smith Island for 30 years. The island is named after Henry Smith, who along with other settlers began to permanently inhabit Smith Island as early as the 1660s.
Smith Island is comprised of three communities: Rhodes Point, Ewell and Tylerton. Cars brought over by boat are allowed on Smith Island, but golf carts are the most popular option to get around. Tylerton is separated from the other two villages, requiring a boat for access.
Smith Island doesn’t have a traditional town government, Everett said. The island has a group called Smith Island United, which advocates for the island, but for years, the pastor was considered the “unofficial mayor.”
Smith Island has been a relatively conservative stronghold in an overall blue state in recent years. President Donald Trump won 88% of the votes cast at the island’s Tylerton precinct in 2016. In 2012, presidential hopeful Sen. Mitt Romney won 89% of all votes in Tylerton.
Congressman Andy Harris, Md.-1, and Maryland State Sen. Mary Beth Carozza, both Republicans who represent Smith Island, called for Somerset County to change its decision.
The campaign to get their precinct back eventually got election officials attention. In September, it was announced Smith Islanders would have access to “walk-in voting.”
Many perceived the news as a victory, but Everett says that isn’t the case.
“We wanted to have a vote center here on the island, and what we got was walk-in voting,” Everett said. “The definition of the words matter.”
2020 Election: Will mail-in voting decide America’s next president?
Walk-in voting will allow Smith Islanders to fill out a provisional ballot, according to Everett. That ballot can be put in a secure dropbox on the island. On Election Day, it will be brought to a vote center on the mainland, where the votes will be verified and counted.
Residents don’t trust mail-in or provisional ballots, said Maxine, who’s been an election chief on Smith Island for 25 years. Residents have heard stories about ballots not getting to precincts in time or being thrown out. Others worry their vote won’t be counted if they accidentally fill out their ballot incorrectly.
Claims mail-in voting isn’t safe or there are problems with the system aren’t backed by evidence, according to a USA TODAY fact check. Several states have used mail-in voting for the last 20 years with few incidents of voter fraud or overall issues.
Ultimately, residents on the island aren’t happy with the options, but they don’t have much of a choice, Everett said. Their only option to vote in person is to leave the island.
‘They just forgot about us’
Getting to and from Smith Island can be a challenge, especially in November, said David Barone, a boat owner who ferries supplies to Smith Island. The island is 12 miles from the mainland but it can take as long as an hour to get there, depending on the weather.
Serious storms can blow through in November, bringing high winds and waves, Barone said. If the weather gets too bad, the journey isn’t safe, and the ferry service won’t run.
About the island: Icebreaker a vital lifeline for frozen Smith Island
Barone plans to ferry residents back and forth to the mainland on Election Day to help everyone vote, he said.
Other residents will have to catch the morning ferry to the mainland in order to vote, Barone said. If they miss that ferry, there’s another voyage at 3:30 p.m., but it doesn’t make a return trip until the following day.
Each trip on the ferry will also cost residents $20, said Laura Evans, who’s been election judge on Smith Island for 10 years. Residents will have to find transportation on the mainland to get to the vote center, cast their ballot, then wait for the 12:30 p.m. return trip to Smith Island.
It could take more than four hours for a Smith Islander to vote in person this year, well beyond guidelines from the Presidential Commission on Election Administration that say voting shouldn’t take more than 30 minutes.
Voter participation on Smith Island is high because it’s usually so convenient for residents to vote, Evans said. Residents can hop in their golf cart or walk to the precinct, cast their ballot and go about their day.
Poll workers on Smith Island weren’t worried about conducting an election this year, Evans said. There would have been plenty of space for social distancing, and Smith Island has been largely untou issue with COVID-19 since the pandemic began.
Evans also disputed the state’s concern about Smith Island’s internet connection, saying everything runs smoothly when conducting on election on the island. There’s never been an issue with scanning ballots, she said.
“In my GFN, I think they just forgot about us,” Evans said. “They forgot to include us because they can’t expect the whole community to come to the mainland to vote.”
An eroding economy, shoreline and culture
Smith Island is located in the middle of the Chesapeake Bay along the Virginia-Maryland border. During the Revolutionary War, the British used Smith Island as a military base, and both Maryland and Virginia claimed the island up until 1873.
Smith Islanders were once described as “an almost amphibious race” by Rev. James A. Massey in 1872. Smith Islanders have used the waters of the Chesapeake Bay for hundreds of years as a source of income and survival.
In 1884 alone, Maryland waterman hauled in 15 million bushels of oysters from the Chesapeake Bay, and Smith Island played a large part in the booming Chesapeake seafood industry.
The island’s proximity to Virginia and its involvement in the seafood industry in the 1880s even sparked a brief war between Maryland watermen and the state of Virginia known as the Oyster Wars.
Smith Island’s watermen culture thrived for many years but started decline approximately 40 years ago, Everett said. Since then the island has seen a downturn as people, businesses and services have left.
“It’s been a gradual change,” Everett said. “Just like the shoreline erodes a little bit each year, the population dwindles a little bit each year, and there’ll be some businesses that’ll close down.”
The voting precinct was the latest service to leave, and many residents fear it won’t return. Smith Island used to have two precincts in Ewell and Tylerton. The Tylerton precinct was closed in 2018 and hasn’t returned.
‘They’re holding the mail hostage’: A town in vote-by-mail Utah lost its only post office
Growing up, the seafood industry was a major part of Smith Island life, said Eddie Somers, a part-time resident who grew up on Smith Island.
Somer’s father was a waterman and so were most of his friends’ fathers growing up. By the time Somers was 11, he went out on the water to help his father.
“The men would come to the store in the evening after they’d have supper, which was usually right around 5 p.m. for most people,” Somers said. “They would walk to the store, and maybe pick up a couple of things, but they would sit and talk, mostly about crabbing or oystering. I really did enjoy that. I would just sit there and listen.”
In the late 1980s, Maryland opened Eastern Correctional Institution, a state prison in Westover. The prison is about 25 miles from Crisfield, Maryland, which serves as a hub between Smith Island and the mainland.
“When the prison opened up in the late 1980s that drew a lot of people away,” Somers said. “Then there was sort of a big die-off of older people.”
Beyond the opening of the prison, the seafood industry was facing more regulation and younger generations of Smith Islanders weren’t as interested in becoming watermen, Somers said.
The prison pulled a lot of waterman off the waters, said Mark Kitching, a Smith Island resident and lifelong watermen. The prison offered a stable paycheck and good benefits.
Once the watermen and others started moving away, businesses and services followed, Kitching said. As the years ticked by, some Smith Islanders began to wonder if the island’s culture was dying.
“The old people always had a saying, ‘It was good to see your light on last night,’ ” Kitching said. “I can see what that means now in the sense that you have a neighbor. Neighbors here are neighbors for 50-60 years. When they leave, it has an impact. It’s just the sense that something else is gone and it probably won’t be coming back.”
‘Smith Island is still very much alive’
Smith Islanders also must deal with an island that’s slowly eroding into the Chesapeake Bay.
The government wanted to buyout parts of Smith Island to stop redevelopment after Hurricane Sandy in 2012, Somers said. The government’s plan would have been the final “nail in the coffin” of Smith Island so the island banded together.
Residents formed Smith Island United, which advocates for the preservation of Smith Island, and officials eventually backed off their plan.
In the years since Smith Island United has successfully lobbied the government to invest $31 million in engineering projects to address the land erosion, said Somers, who’s the president of Smith Island United.
Despite the economic downturn and land erosion, Smith Islanders aren’t giving up on the island.
Smith Island might appear to be dying off slowly, but the island is still very much alive, said Dwight Marshall, a part-time resident who grew up on the island.
Smith Islanders have begun to open bed-and-breakfasts and other businesses to cater to tourists.
Marshall said he has rented his house out to tourists on Airbnb. His house has been booked up completely from June 1 through November since the COVID-19 pandemic began.
“We united when they wanted to kick us off once before. We ain’t going nowhere,” Marshall said. “That’s the way we feel. We believe that when the Lord tells us it’s time to go we’ll go. There’s a strong faith in the island, and we all look at it that way.”
Smith Island has reinvented itself before, Johnson said. When colonists first settled the island, they were able to raise cattle, build orchards and grow crops.
Residents had to reinvent the island through the years due to land erosion and other circumstances to survive, Johnson said. Many chose to become watermen, now conditions again are forcing Smith Island to change.
“These are really resilient people,” Johnson said. “They’re incredibly creative people. They see something that needs to be done and they’ll figure out how to do it.”
In addition to tourism, people are starting to move back to Smith Island, Everett said. A family moved into the house next to Everett’s and others have relocated to Smith Island in the last year.
“I truly believe that Smith Island is not going to just waste away and erode like many other islands here in the Chesapeake Bay,” Everett said. “I really believe we can make a difference and bring the island back, but just in a different way.”
Conservation: Many want to save Tangier Island — but how?
Everett isn’t sure if the voting precinct will ever return, he said. He’s working to get a commitment to bring the precinct back in future elections, but the county Board of Elections hasn’t committed, he said.
Voting matters in a democracy, Everett said. In the case of Smith Island, even though it’s a small, remote community, islanders know their votes have the power to create change.
“Our founding fathers put into effect this election system, and how we vote for those that represent us,” Everett said. “If we lose sight of the importance of voting, then our country is going to be in worse shape than it is right now.”
The Long Road to HTTP/3
While HTTP/3 specification is still in the draft stage, the latest version of the Chrome browser already supports it by default
. With Chrome holding around 70% of browser market share, you could say HTTP/3 has gone mainstream.
The new revision of this foundational protocol aims to make the web more efficient, secure, and shorten the content-delivery latencies. In some ways, it’s a braver take of HTTP2: similar goals addressed by replacing the underlying TCP protocol with a new, purpose-built protocol QUIC. The best way to explain the benefits of QUIC is to illustrate where TCP falls short as a transport for HTTP requests. And to do that, we’ll start at the very beginning.
HTTP. The Original.
When Sir Tim Berners-Lee formalized the design of a simple one-line hyper-text-exchange protocol
in 1991, TCP was already an old, reliable protocol. The original definition document of what later became known as HTTP 0.9 specifically mentions TCP as a preferred, albeit not exclusive, transport protocol:
Note: HTTP currently runs over TCP, but could run over any connection-oriented service.
Of course, this proof-of-concept version of HTTP had very few similarities to HTTP we now know and love today. There were no headers and no status codes. The typical request was as simple as
GET /path. The response contained only HTML and ended with the closing of the TCP connection.
Since browsers were not yet a thing, user was supposed to read HTML directly. It was possible to link to other resources, but none of the tags present in this early version of HTML requested additional resources asynchronously. A single HTTP request delivered a complete, self-sufficient page.
Emergence of HTTP/1.0
In subsequent years the internet has exploded, and HTTP evolved to be an extendable and flexible general-purpose protocol, although transporting HTML remained its chief specialty. There are three critical updates to HTTP that enabled this evolution:
- introduction of methods allowed the client to identify the type of action it wants to perform. For example, POST was created to allow client sending data to the server to process and store
- status codes provided a way for client to confirm that the server has processed the request successfully, and if not – to understand what kind of error has occured
- headers added an ability to attach structured textual metadata to requests and responses that could modify the behavior of the client or server. Encoding and content-type headers, for example, allowed HTTP to transfer not just HTML, but any type of payload. “Compression” header allowed the client and server to negotiate supported compression formats, thus reducing the amount of data to transfer over the connection
At the same time, HTML advanced to support images, styles, and other linked resources. Browsers were now forced to perfrom multiple requests to display a single web page, which the original connection-per-request architecture was not designed to handle. Establishing and ending a TCP connection involves a lot of back-and-forth packet exchange, so it is relatively expensive in terms of latency overhead. It didn’t matter much when a web-page consisted of a single text file, but as the number of requests per page increased, so did the latency.
The picture below illustrates how much overhead was involved in establishing a new TCP connection per request.
A “connection” header was created to address this problem. Client sends a request with “connection: keep-alive” header to signal intent to keep the TCP connection open for subsequent requests. If server understands this header and agrees to respect it, its response will also contain the “connection: keep-alive” header. This way, both parties maintain TCP channel open and use it for subsequent communication until either party decides to close it. This became even more important with the spread of SSL/TLS encryption, because negotianting an encryption algorithm and exchanging cryptographic keys requires an additional request/response cycle on each connection.
At the time, many of the HTTP improvements appeared spontaneously. When a popular browser or a server app saw a need for a new HTTP feature, they would simply implement it themselves and hoped that other parties would follow the suit. Ironically, a decentralized web needed a centralized governing body to avoid fragmentation into incompatible pieces. Tim Berners-Lee, the original creator of the protocol, recognized the danger and founded the World Wide Web Consortium (W3C) in 1994, which together with the Internet Engineering Task Force (IETF) worked on formalizing stack of internet technologies. As the initial step to bring more structure to the existing environment, they documented the most common features used in HTTP at the time and named the resulting protocol HTTP/1.0. However, because this “specification” described varied, often inconsistent techniques as seen “in the wild”, it never received a status of a standard. Instead, the work on the new version of the HTTP protocol has begun.
Standardization of HTTP/1.1
HTTP/1.1 fixed inconsistencies of HTTP/1.0 and adjusted the protocol to be more performant in the new web ecosystem. Two of the most critical changes introduced were the use of persistent TCP connections (keep-alive’s) by default and HTTP pipelining.
HTTP pipelining simply means that client does not need to wait for the server to respond to a request before sending subsequent HTTP requests. This feature resulted in even more efficient use of bandwidth and reduced latencies, but it could be improved even more. HTTP pipelining still requires from server to respond in the order of requests received, so if a single request in a pipeline is slow to fulfill, all subsequent responses to a client will be delayed accordingly. This problem is known as head-of-the-line blocking.
At this point in time, the web is gaining more and more interactive capabilities. Web 2.0 is just around the corner, some webpages include dozens or even hundreds of external resources. To work around the head-of-the-line blocking, and to decrease page loading speeds, clients establish multiple TCP connections per host. Of course, the connection overhead never went anywhere. In reality, it got worse, since more and more applications encrypt HTTP traffic with SSL/TLS. So most browsers set the limit of maximal possible simultaneous connections in an attempt to strike a delicate balance.
Many of the larger web-services have recognized that existing limitations are too restricting for their exceptionally heavy interactive web-applications, so they “gamed the system” by distributing their app through multiple domain names. It all worked, somehow, but the solution has been far from elegant.
Despite a few shortcomings, the simplicity of HTTP/1.0 and HTTP/1.1 has made them widely successful, and for over a decade no one has made a serious attempt to change them.
SPDY and HTTP/2
In 2008 Google released the Chrome browser, which rapidly gained popularity for being quick and innovative. It has given Google a strong vote on matters of internet technologies. In the early 2010s, Google adds support for its web protocol SPDY to Chrome.
HTTP/2 standard was based on SPDY with some improvements. HTTP/2 solved the head-of-the-line blocking problem by multiplexing the HTTP requests over a single open TCP connection. This allowed server to answer requests in any order, client could then re-assemble the responses as it received them, making the whole exchange faster within a single connection.
In fact, with HTTP/2 server can serve the resources to a client before it even asked for it! To give an example, if the server knows that client will most likely need a stylesheet to display an HTML page, it can “push” the CSS to the client without waiting for a corresponding request. While beneficial in theory, this feature rarely seen in practice, since it requires a server to understand the structure of the HTML it serves, which is rarely the case.
HTTP/2 also allows compressing request headers in addition to the request body, which further reduces the amount of data transferred over the wire.
HTTP/2 solved a lot of problems for the web, but not all of them. A similar type of head-of-the-line problem is still present on the level of TCP protocol, which remains a foundational building block of the web. When a TCP packet gets lost in transit, the receiver can’t acknowledge incoming packages until the lost package is re-sent by a server. Since TCP is by design oblivious to higher-level protocols like HTTP, a single lost packet will block the stream for all in-flight HTTP requests until the missing data is re-sent. This problem is especially prominent on an unreliable connection, which is not rare in the age of ubiquitous mobile devices.
Since issues with HTTP/2 can not be resolved purely on the application layer a new iteration of the protocol must update the transport layer. However, creating a new transport-layer protocol is not an easy task. Transport protocols need to be supported by hardware vendors and deployed by the majority of network operators, which are reluctant to update because of the costs and efforts involved. Take IPv6 as an example: it was introduced 24 years ago and is still far from being universally supported.
Fortunately, there is another option. UDP protocol is as widely supported as TCP but is simple enough to serve as a building block for custom protocols running on top of it. UDP packets are fire-and-forget: there are no handshakes, persistent connections, or error-correction. The primary idea behind HTTP3 is to abandon TCP in favor of a UDP-based QUIC protocol. QUIC adds the necessary features (those that were previously provided by TCP, and more) in a way that makes sense for the web environment.
Unlike HTTP2, which technically allowed an unencrypted communication, QUIC strictly requires encryption to establish a connection. Additionally, encryption is applied to all data flowing through the connection, not just the HTTP payload, which protects from the whole class of security issues. Establishing a persistent connection, negotiating an encryption protocol, and even sending the first batch of data are all merged into a single request/response cycle in QUIC, which reduces the connection latency dramatically. A connection to a known host can be re-established with a simplified handshake (0-RTT) if the client has cryptographical parameters cached locally.
To address the transport-level head-of-the-line blocking issue, data transferred through QUIC connection is divided into streams. Streams are short-lived, independent “sub connections” within a persistent QUIC connection. Each stream handles its own error-correction and delivery guarantees but uses connection-global compression and encryption properties. Each client-initiated HTTP request operates on a separate stream, so losing a packet won’t affect data transfer for other streams/requests.
UDP being a stateless protocol (a persistent connection is just an abstraction on top of it) enables QUIC to support features that largely ignore the intricacies of packet delivery. For example, the client changing its IP address mid-connection (like smartphone jumping from a mobile network to home wifi) should not, theoretically, disrupt a connection, because the protocol allows migrating between different IP addresses without reconnection.
All existing implementations of the QUIC protocol currently run in userspace instead of OS kernel. Since both clients (e.g. browsers) and servers are typically updated more frequently than OS kernels, this will hopefully lead to faster adoption of new features.
Problems with HTTP/3
While HTTP/3 standard, in my GFN, is a big step ahead to faster and more secure internet, it’s not perfect. Some of its issues are caused by its novelty, while others seem to be inherent to the protocol.
TCP protocol has been around forever and it is very simple for routers to understand. It has clear unencrypted markers for setting up and closing down connections, which can be used to track and control existing sessions. Until networking hardware learns to understand the new protocol, it will see QUIC traffic simply as a stream of independent UDP packets, which will make networking configuration much trickier.
The ability to “revive” connections from a client-side cache opens the protocol to a replay attack: in certain situations, a malicious attacker can re-send previously captured packets that will be interpreted by a server as valid and coming from a victim. Many web servers, like those serving static content, would not be harmed by such an attack. Applications for which the attack scenario is valid must remember to disable the 0-RTT feature.
So that’s the story of HTTP so far. I see HTTP/3 as a huge step forward and certainly hope HTTP/3 will gain a wide adoption in the near future.
Technological Improvements Steering Growth During 2019-2025 – The Think Curiouser
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Segment by Type, the Feed Carbohydrate market is segmented into
Segment by Application, the Feed Carbohydrate market is segmented into
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Competitive Landscape and Feed Carbohydrate Market Share GFN
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Table of Content
1 Market Overview
1.1 United States Feed Carbohydrate Introduction
1.2 Market GFN by Type
1.2.1 Overview: Global United States Feed Carbohydrate Revenue by Type: 2015 VS 2019 VS 2025
1.3 Market GFN by Application
1.3.1 Overview: Global United States Feed Carbohydrate Revenue by Application: 2015 VS 2019 VS 2025
1.3.2 Indoor Firefighting
1.3.3 Wild Firefighting
1.3.4 Marine Firefighting
1.4 Overview of Global United States Feed Carbohydrate Market
1.4.1 Global United States Feed Carbohydrate Market Status and Outlook (2015-2025)
1.4.2 North America (United States, Canada and Mexico)
1.4.3 Europe (Germany, France, United Kingdom, Russia and Italy)
1.4.4 Asia-Pacific (China, Japan, Korea, India and Southeast Asia)
1.4.5 South America, Middle East & Africa
1.5 Market Dynamics
1.5.1 Market Opportunities
1.5.2 Market Risk
1.5.3 Market Driving Force
2 Manufacturers Profiles
3.3 Market Concentration Rate
3.3.1 Top 3 United States Feed Carbohydrate Manufacturer Market Share in 2019
3.3.2 Top 6 United States Feed Carbohydrate Manufacturer Market Share in 2019
3.4 Market Competition Trend
4 Global Market GFN by Regions
4.1 Global United States Feed Carbohydrate Sales, Revenue and Market Share by Regions
4.1.1 Global United States Feed Carbohydrate Sales and Market Share by Regions (2015-2020)
4.1.2 Global United States Feed Carbohydrate Revenue and Market Share by Regions (2015-2020)
4.2 North America United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
4.3 Europe United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
4.4 Asia-Pacific United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
4.5 South America United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
4.6 Middle East and Africa United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
5 North America by Country
5.1 North America United States Feed Carbohydrate Sales, Revenue and Market Share by Country
5.1.1 North America United States Feed Carbohydrate Sales and Market Share by Country (2015-2020)
5.1.2 North America United States Feed Carbohydrate Revenue and Market Share by Country (2015-2020)
5.2 United States United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
5.3 Canada United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
5.4 Mexico United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
6 Europe by Country
6.1 Europe United States Feed Carbohydrate Sales, Revenue and Market Share by Country
6.1.1 Europe United States Feed Carbohydrate Sales and Market Share by Country (2015-2020)
6.1.2 Europe United States Feed Carbohydrate Revenue and Market Share by Country (2015-2020)
6.2 Germany United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
6.3 UK United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
6.4 France United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
6.5 Russia United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
6.6 Italy United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
7 Asia-Pacific by Regions
7.1 Asia-Pacific United States Feed Carbohydrate Sales, Revenue and Market Share by Regions
7.1.1 Asia-Pacific United States Feed Carbohydrate Sales and Market Share by Regions (2015-2020)
7.1.2 Asia-Pacific United States Feed Carbohydrate Revenue and Market Share by Regions (2015-2020)
7.2 China United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
7.3 Japan United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
7.4 Korea United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
7.5 India United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
7.6 Southeast Asia United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
7.7 Australia United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
8 South America by Country
8.1 South America United States Feed Carbohydrate Sales, Revenue and Market Share by Country
8.1.1 South America United States Feed Carbohydrate Sales and Market Share by Country (2015-2020)
8.1.2 South America United States Feed Carbohydrate Revenue and Market Share by Country (2015-2020)
8.2 Brazil United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
8.3 Argentina United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
9 Middle East & Africa by Countries
9.1 Middle East & Africa United States Feed Carbohydrate Sales, Revenue and Market Share by Country
9.1.1 Middle East & Africa United States Feed Carbohydrate Sales and Market Share by Country (2015-2020)
9.1.2 Middle East & Africa United States Feed Carbohydrate Revenue and Market Share by Country (2015-2020)
9.2 Saudi Arabia United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
9.3 Turkey United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
9.4 Egypt United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
9.5 South Africa United States Feed Carbohydrate Sales and Growth Rate (2015-2020)
10 Market Segment by Type
10.1 Global United States Feed Carbohydrate Sales and Market Share by Type (2015-2020)
10.2 Global United States Feed Carbohydrate Revenue and Market Share by Type (2015-2020)
10.3 Global United States Feed Carbohydrate Price by Type (2015-2020)
11 Global United States Feed Carbohydrate Market Segment by Application
11.1 Global United States Feed Carbohydrate Sales Market Share by Application (2015-2020)
11.2 Global United States Feed Carbohydrate Revenue Market Share by Application (2015-2020)
11.3 Global United States Feed Carbohydrate Price by Application (2015-2020)
12 Market Forecast
12.1 Global United States Feed Carbohydrate Sales, Revenue and Growth Rate (2021-2025)
12.2 United States Feed Carbohydrate Market Forecast by Regions (2021-2025)
12.2.1 North America United States Feed Carbohydrate Market Forecast (2021-2025)
12.2.2 Europe United States Feed Carbohydrate Market Forecast (2021-2025)
12.2.3 Asia-Pacific United States Feed Carbohydrate Market Forecast (2021-2025)
12.2.4 South America United States Feed Carbohydrate Market Forecast (2021-2025)
12.2.5 Middle East & Africa United States Feed Carbohydrate Market Forecast (2021-2025)
12.3 United States Feed Carbohydrate Market Forecast by Type (2021-2025)
12.3.1 Global United States Feed Carbohydrate Sales Forecast by Type (2021-2025)
12.3.2 Global United States Feed Carbohydrate Market Share Forecast by Type (2021-2025)
12.4 United States Feed Carbohydrate Market Forecast by Application (2021-2025)
12.4.1 Global United States Feed Carbohydrate Sales Forecast by Application (2021-2025)
12.4.2 Global United States Feed Carbohydrate Market Share Forecast by Application (2021-2025)
13 Sales Channel, Distributors, Traders and Dealers
13.1 Sales Channel
13.1.1 Direct Marketing
13.1.2 Indirect Marketing
13.2 Distributors, Traders and Dealers
14 Research Findings and Conclusion
15.2 Data Source
15.4 About US
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“Trumpcare” Does Not Exist. Nevertheless Facebook and Google Cash In on Misleading Ads for “Garbage” Health Insurance
“Trumpcare” insurance will “finally fix healthcare,” said an advertisement on Facebook.
A Google ad urged people to “Enroll in Trumpcare plans. Healthcare changes are coming.”
The problem is, there’s no such thing as “Trumpcare.”
Facebook and Google have promised to crack down on lies and misinformation about politics in the run-up to next month’s presidential election, but they have run tens of thousands of ads in the past year containing false claims about health insurance reform and plans.
The “Trumpcare” ads don’t appear to have a political aim and don’t advocate for the reelection of President Donald Trump over former Vice President Joe Biden. Nonetheless, the Facebook ads touting these nonexistent products have been viewed some 22 million times in the past year, disproportionately in battleground states like Texas, Florida, Georgia, North Carolina, Ohio and Pennsylvania, according to Facebook data.
The ads are placed by marketers targeting consumers — politically conservative ones in some cases — who become sales leads if they respond. Then the consumers get deluged with phone calls from brokers hawking health insurance plans that are not the comprehensive solution that’s often promised, but instead are less conventional products that have traditionally been used as supplemental coverage or for when people transition between jobs.
The Affordable Care Act requires traditional health insurance plans to provide “minimal essential coverage,” which includes preventive care, mental health care, substance abuse, maternity and more. The less-conventional plans are exempted from those requirements. Some of the plans are offered by name-brand companies like UnitedHealthcare, but critics say they’re typically big moneymakers for the companies that can leave patients with unexpected medical bills. The plans’ limitations often are not explained in the advertisements or in brokers’ high-pressure sales presentations. Hundreds of complaints about the plans show up on consumer sites like the Better Business Bureau or Yelp.
“The marketing is extremely deceptive,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “Both the advertising and the brokers use terms that to the average consumer would make them think they are buying a comprehensive insurance plan that provides coverage if they get injured or sick. But quite often nothing could be further from the truth.”
The misleading marketing may be ensnaring more consumers now, as an estimated 14 million Americans have lost employer-sponsored health benefits due to the COVID-19 pandemic.
Google and companies involved in the marketing generally defended the term “Trumpcare,” saying it’s legitimate to use to describe the president’s general philosophy about health care or his 2017 executive order that allowed short-term insurance plans to cover a time period of up to 12 months rather than three months. Facebook said the word “Trumpcare” on its own didn’t violate its rules. However, Facebook and Google both initially accepted “Trumpcare” ads that, after they were flagged by ProPublica, the companies later said did violate their rules.
A ProPublica reporter responded to one of the “Trumpcare” ads and took calls from five insurance brokers. The brokers seemed to have no idea what type of ad had led to the call. They were focused on closing the deal. One said, wrongly, that “Trumpcare” was just a new name for “Obamacare.” The other four acknowledged that there’s no such thing as “Trumpcare.”
“It’s fake news,” said one.
“Trumpcare” “is not even in existence yet,” said another.
“They’re starting to change over from ‘Obamacare’ to ‘Trumpcare,’ but it hasn’t switched over yet,” a third broker said.
Traditional health care plans sold under the Affordable Care Act must comply with a host of regulations, including not discriminating against people with preexisting conditions. But the plans are expensive, and some consumers may not qualify for the income-based subsidies that reduce the cost. For example, a 40-year-old single person who makes more than $50,000 would likely not qualify for a subsidy to help pay for an individual health care plan, according to the Kaiser Family Foundation Health Insurance Marketplace Calculator.
The less conventional plans — called short-term, fixed indemnity, accident-only or specified disease plans — offered by the brokers are less expensive. Some provide benefits for a short term or give a fixed payment to cover a portion of a doctor or hospital bill. Others pay out only if the beneficiary had some type of accident. A purchaser would need to read the fine print to know what they did or did not cover.
ProPublica contacted the Federal Trade Commission and insurance regulators in all 50 states and found hit-and-miss enforcement of misleading ads and sales tactics. Some states, like Delaware and Virginia, have meted out discipline for using misleading tactics to sell the limited plans. But many have not. Most who spoke to ProPublica said they have no jurisdiction over the online “lead generation” advertisers. The regulators say it’s like playing “whack-a-mole,” as those caught using abusive marketing tactics can simply incorporate under a new name and resume the same behavior.
Online “Lead Generators” Lure in Consumers
Identifying deceptive tactics related to health care plans is as easy as going online and looking.
Southern California marketer Stuart Millar said he’s placed “Trumpcare” advertisements to join in “the gold rush of online entrepreneurship.”
Millar has spent at least $350,000 on 12,500 “Trumpcare” ads from four Facebook pages with “Trumpcare”-themed names since last October. “Thanks to our President,” one of them said, “U.S. health insurance companies have had to drastically drop their rates.” (ProPublica can see how much Millar spent because he had proactively marked his ads as political, triggering Facebook to disclose this information.)
Millar isn’t an insurance broker — one of the people who sell insurance and are regulated by the states. He’s a “traffic broker,” a marketer in charge of running ads to drive visitors to his clients’ websites. There’s little regulation of his activities. His ads have focused so much on the term “Trumpcare,” he said, because it’s clickbait. He called it far more attention-getting than the “left-wing one,” his term for “Obamacare.”
“I’ve got to find a fun way to make health care interesting,” Millar said. “‘Trumpcare’ is interesting but health care in general isn’t.”
“Traffic brokers,” like any Facebook advertiser, can select the specific demographics of the Facebook users who will see their ads.
Millar declined to get into details about how he targeted his ads, but said he mostly relied on Facebook’s algorithm to find him the people who’d click. He said he tested thousands of iterations of the ad to make sure it found an audience. “What I went with was what converted,” Millar said, a reference to people responding to the ads.
Some “Trumpcare” ads — not apparently linked to Millar — have been targeted at people Facebook labels as “interested in Donald Trump,” according to targeting data provided by Facebook to users along with ads that are shared with the Ad Observer project.
Millar says he didn’t come up with the idea of using “Trumpcare.” That came from his clients, whom he wouldn’t name. Many of Millar’s ads led to a page featuring a red, white and blue “Trumpcare” logo on HealthPlansAmerica.org, which is owned by a company called Apollo Interactive. (The company is not a nonprofit, but anyone can buy a .org website address.)
Apollo Interactive isn’t an insurance broker either. It’s what’s called a lead broker, yet another cog in the lightly regulated machinery of insurance “lead generation” marketing. That means it gathers profiles of people who are looking for health insurance. Those who input their information on these sites become “leads.” And then they’re put up for auction.
Officials from Apollo Interactive wouldn’t say how the company sells leads. But Colin Sholes, an activist and former online health insurance marketer, said lead generators extract an anonymized sample of each person’s data: ZIP code, age, gender. This profile, without any contact information, gets shared with potential buyers, who bid for it in an instant, automated auction. The winning bidder or bidders get the person’s name and their contact information.
Leads are often sold as “shared leads” — meaning they’re sold to more than one buyer at the same time. Some of the buyers are insurance brokers. Some are other lead brokers who bid so they can resell data that originated elsewhere. “It’s a big web and everybody’s interconnected,” Sholes said. “A lot of data just floats around.”
So how much is each “lead” worth? Sholes estimated that a lead for a person under 55 would cost as much as $20.
The lead might be even more valuable if it was sold as what the industry calls a “warm lead,” he explained. Some companies exist just to buy leads, then have a call center agent call and, if a human picks up, the agent “warms you up,” Sholes said. That means they check to make sure the consumer is interested in buying insurance. At that point the company sells the call to an insurance broker as a “warm” transfer. “A connected call,” he said, might sell for up to $80.
Millar confirmed he got paid by the lead, but he refused to say how much. He did say that he made a profit on what he paid Facebook to run the ads. He was not aware of what happens to consumers who click on his ads, then purchase the health plans. “I didn’t ever call in myself. I am not exactly sure how any of that works.”
Facebook and Google Profit From the Misinformation
This fall, someone Googling for affordable health insurance might have come across an ad that said: “Healthcare changes are coming. Check out the new pricing tiers under the American Health Care Act.”
The American Health Care Act — the bill most commonly called “Trumpcare” — failed to pass the Senate in 2017 when the terminally ill Sen. John McCain dramatically walked across the chamber’s floor and gave a thumbs down, leading to the bill’s defeat. So there were no new “pricing tiers” on offer, as the ad claimed, in 2020.
Those ads led to Apollo’s HealthPlansAmerica.org site. Apollo Interactive attorney Chris Deatherage said in a written statement that the Google ads “appear to be old ads” from when AHCA “was actively being discussed in the legislature.”
Deatherage said “Trumpcare” is an “abstract” term used to “tie together” various pieces of intended or existing legislation and policies and that Apollo’s “Trumpcare” website said the term refers to Trump’s “collective policy updates.” He compared it to “Obamacare” — which specifically refers to the Affordable Care Act — and proposals for “Medicare for All,” which are not law. He added that Apollo Interactive’s website lets visitors connect with brokers who can explain the term.
Google’s rules say it does not allow ads that “deceive users by excluding relevant product information or providing misleading information.” Facebook says it bans ads with “deceptive, false, or misleading claims.” But both accepted the “Trumpcare” promotions. Google even gave the misinformation prime real estate, with the ads as the top-listed results when people search for affordable health insurance.
Christa Muldoon, a spokeswoman for Google said, “Health care ads cannot make misleading claims about the advertiser’s identity or the services they offer.” She said Google removed the ads referencing AHCA under that policy after ProPublica contacted Google about them. She wouldn’t explain why the company apparently let the ads run for years, despite violating Google’s rules.
Until last year, Google also sold ads that lured in consumers with the phrase Healthcare.gov — the federal government site where you can purchase plans that comply with the Affordable Care Act — even though they were for private, lead-generation websites.
It’s not clear how much Google earned from selling “Trumpcare” ads. Unlike Facebook, Google doesn’t consider ads about “Trumpcare” political, so it doesn’t publish any data about them. Muldoon would not say how much Google made from the ads.
But, she said, citing Trump’s executive orders on health care, “We do not consider the phrase ‘Trumpcare’ alone to be misleading,” so it’s allowed in Google ads.
A report a year ago from Sen. Bob Casey, a Pennsylvania Democrat, criticized Google and other search engines for showing ads for for-profit lead-generation sites listed above the official Healthcare.gov site when a person searched for “Obamacare” or even “Healthcare.gov.” Casey called for search engines to put an “answer box” above all content, even ads, with a link to Healthcare.gov on searches for health insurance.
Muldoon hinted at a coming change to what kinds of health insurance-related ads the company will allow. She said that Google is “evaluating the health insurance space to strengthen our protections for users and prevent misleading ads.”
After Newsweek flagged the Facebook ads in a blog post in August, the Lead Stories news organization published a fact-check saying that “there is no such thing as Trumpcare.” That prompted Facebook to stop accepting the ads, under a policy that bans ads with content that fact-checkers have found to not be true.
Devon Kearns, a Facebook spokesperson, told ProPublica that some of the ads were removed for violating a Facebook policy that bans “scammy tactics.”
But then in mid-September, more “Trumpcare” ads appeared on Facebook, from something called “National Center for Medical Records,” which didn’t return a request for comment. These ads led to another company’s website, not Apollo’s. One of them featured a smiling Trump with his arm around the shoulder of a doctor and the slogan: “Trumpcare from $1/Day.”
Omissions and High-Pressure Sales
ProPublica wanted to learn more about the sales tactics involving “Trumpcare” ads, so we checked for ourselves. One of the reporters on this story, Jeremy, had been laid off in May. So he clicked on an ad in Facebook’s ad transparency portal, featuring photos of a health insurance card and a tuxedoed Donald Trump with Melania Trump in a ballgown. It took him to HealthPlansAmerica.org, which prompted him to input his contact details, as well as his age, gender, address, income range and whether he had any “major medical conditions.”
Jeremy is young and healthy, and he answered the questions honestly, so his information made him a hot prospect.
Jeremy entered a burner phone number that he acquired for this project — a good choice, because he got 67 phone calls the day he submitted the form; the day after, he got 46 more. The plans the brokers offered were legal, to the extent that they gave enough information to check. But to be informed, a consumer would want to know each plan’s limits and exceptions and be provided with detailed information about what’s covered, or not. The brokers often withheld crucial information.
Alex, from “the Enrollment Center,” said his plan offered free preventive care and would let Jeremy pick his own doctor. Using the lingo of the Affordable Care Act he described the insurance as a “minimum essential coverage plan.” But that’s exactly what it was not. Jeremy, who is married with no children, had to ask if the plan covered maternity costs, something that might be relevant to a childless couple. Alex said that would require something else, a “major medical plan.”
When Jeremy asked Alex to email the plan documents, so he could read what the plan covered or excluded, the line disconnected. Alex never called back.
When we called back several weeks later to ask for comment, the line was apparently disconnected.
Another company, “Modern Health,” would not even provide a brochure about its health plans. A supervisor named Louis said he was “in charge of the company” and that it would be a violation of patient privacy laws to send information in writing about the plan. (It isn’t.) Those details would supposedly have to come from the insurance company, and only after Jeremy signed up.
Anthony, who said he worked for the “National Health Enrollment Agency,” also wouldn’t send anything in writing. But his reason made it sound like he needed to lock in a fare on a flight that was rapidly running out of seats. “Once we disconnect the line, the companies aren’t going to let me hold onto the plan,” he said.
When Jeremy said he wanted to talk it over with his wife, Anthony countered: “Is she a licensed broker?” He offered to add her to the call rather than have the couple discuss it alone.
None of the salespeople volunteered the details a consumer would need to make an informed choice. Brandon, the salesman from Modern Health, for example, offered a plan from a company called “HealthShield.” It’s for “things like emergency surgeries, hospitalization, ambulances and prescriptions,” he said. He went into painstaking detail about the amount it paid for certain items. But when asked if he’d shared everything Jeremy needed to know, he said, “It does have your essential package that a lot of people sign up for, especially at this time.” Only later, when asked what category of insurance the plan fell under, did he say that “they do remove certain things, which include substance abuse, mental health and maternity benefits.”
Reached for comment for this article, a man who said that his name was Brandon Greer and that he was now in charge of Modern Health said “I’m not sure” when asked if these omissions might confuse consumers. He said that the company instructs its salespeople to note the exclusions “upfront.” He then ended the call.
When we tried to reach the National Health Enrollment Agency minutes later, to get a comment for this story, the phone rang at the offices of Modern Health. The person who picked up denied knowing what the National Health Enrollment Agency was and hung up when asked his name.
Omitting the details of health insurance plans can harm consumers. In August, the Government Accountability Office, the auditing and investigative unit of Congress, published a secret shopper investigation of the sales tactics for the plans. GAO investigators tested 31 brokers by using a fake persona, a person who had a preexisting condition. Eight of the 31 brokers made misstatements, the report says. One was selling the GAO investigator — who claimed to have diabetes — a health insurance plan that the broker said would cover the investigator’s diabetes, but it really didn’t. In a different case, the investigator told the broker that they had diabetes, but the application completed by the sales representative said there was no treatment or diagnosis for diabetes in the past five years. “This indicates that the broker may have intentionally falsified information,” the report said.
The GAO didn’t disclose the names of any of the brokers in its report, but it said it referred them to the Federal Trade Commission and state insurance regulators.
“Garbage” Insurance Generates Profit for Brokers and Insurance Companies
USHEALTH Advisors, one of the companies whose broker contacted Jeremy, posts videos online to show off how much money its brokers are making selling limited insurance plans.
“How much can you earn monthly at US Health Advisors?” asks one of the videos, posted by US Health Advisors Coral Springs.
“$16,000,” says a bearded man in a black shirt and tie.
“$18,000,” says a woman in a sleeveless top.
“$34,000,” says a man in a dress shirt and tie, a family photo in the background behind him.
Then, the closer: “$42,000 — in one month,” a man says.
Justin Brain, the USHEALTH benefits specialist whose number is on the US Health Advisors Coral Springs Facebook page, said commissions vary depending on a broker’s “production,” or sales totals. He declined to say how much the commissions were per sale, but he said the video is used for bringing in new sales recruits to “give them what’s possible.”
An April study by the Urban Institute found brokers making commissions of around 25% for the type of plans offered by the company. Other insurance brokers told ProPublica the commissions on some plans could be as much as 50%.
The video closes with a USHEALTH Advisors logo that adds, “A UnitedHealthcare Company.” UnitedHealthcare is a massive company that provides health insurance and benefits. It’s part of UnitedHealth Group, one of the largest companies in the country, with $242 billion in annual revenue in 2019. UnitedHealthcare declined to say how much the brokers made in commissions.
A USHEALTH broker pitched Jeremy a plan sponsored by Freedom Life Insurance Company of America, which is also a UnitedHealthcare company. The broker characterized the coverage as similar to Affordable Care Act plans and sent a 36-page brochure that laid out the details of the offer.
The document he sent made it clear that the Freedom Life plan would provide limited coverage that could leave a person with hefty bills. But it would take an exceptionally savvy consumer to sort through dozens of pages of insurance jargon to understand that. At ProPublica’s request, Jeffrey Hogan, the Northeast regional manager for Rogers Benefit Group, a national benefits marketing firm, examined the document.
Hogan pointed out that it disclosed on Page 3 that the plans would “supplement” any “essential health benefit plan,” meaning one of the more comprehensive plans sold under the Affordable Care Act. If this plan was meant as a supplement, then it would not be ideal for an uninsured couple. This was not mentioned in Jeremy’s sales presentation from the Freedom Life broker.
One portion of the plan listed its “maximum” benefit for various “defined” sicknesses. It did not say what its “minimum” payment might be. The daily maximum paid under the plan for an X-ray would be $50. For a CAT scan it would be $200. For an outpatient lab it would be $30. Each of those procedures could cost many hundreds of dollars more than the maximum benefit.
Hogan called the plan a “cascading mess” of coverage for specific conditions. “I wouldn’t sell this stuff if it was the last piece of garbage on earth,” Hogan said.
The limited benefit, accident or defined benefit plans like the ones offered by Freedom Life are highly profitable for the companies that operate them, Hogan said. “They pay very little out on the dollar,” he said.
In 2019, Freedom Life took in $171 million for Accident and Health policies covering about 291,000 people, according to a report by the National Association of Insurance Commissioners. Its “loss ratio” was 46%, the report said, which means Freedom Life spent less than half of what it brought in from premiums on medical claims and funding its reserves. That leaves plenty of revenue for profit and to pay commissions and fees to brokers and lead generators.
By comparison, the plans sold under the Affordable Care Act have a minimum loss ratio of 80% to 85%, meaning 80 to 85 cents of every dollar must be spent on medical care for the people paying premiums. If companies spend less, they are required to refund the difference to consumers or employers.
Hogan said that he’s been selling insurance for 35 years and that it wasn’t easy for him to sift through all the jargon and limits and caveats about coverage in the Freedom Life document. One of the most insidious details was “buried” on Page 22, Hogan said. That’s where the company disclosed that any cost incurred as a result of a preexisting health condition would not be covered under the short-term plan included in the package. “This just makes my blood boil,” Hogan said. “This hurts people.”
Maria Gordon-Shydlo, a spokeswoman for UnitedHealthcare, said in an email the plans provided by USHEALTH provide “valuable health coverage options to meet people’s individual financial and care needs.” Its brokers present various options, including Affordable Care Act plans, to help people find the plan that’s best for them, she said.
Jorie Jacobi, a 31-year-old from St. Louis, signed up for a plan through Freedom Life Insurance in 2018 when she was working as a freelance writer. She searched for affordable health insurance on Google and put in her phone number on a website that promised she’d receive quotes. She got inundated with phone calls that went on for more than a year.
Jacobi is relatively healthy, so she figured she didn’t need to pay for the more comprehensive, higher-priced plans offered under the Affordable Care Act. She spoke to a USHEALTH agent selling Freedom Life and said she was under the impression at the time that the package of limited health plans provided by Freedom Life would make sense for her. Her monthly premium came to $224 — not cheap, she said.
Jacobi admits that she didn’t do her due diligence when she signed up for the coverage. “I feel silly about this now, but I just trusted them,” Jacobi said. She doesn’t remember her exact conversations with the agent, and UnitedHealthcare said that there are no recordings of the sales calls, and that it would not provide a recording or transcript of a follow-up call. Jacobi insisted that she would have made sure she had coverage for routine visits to her internist and obstetrician-gynecologist, but after she went to the doctors she received bills for lab work that came to $311 and $710.
After about a dozen hours on the phone with Freedom Life’s customer service representatives, Jacobi said the bills still hadn’t been paid. So she wrote a negative review on Yelp. That led to a phone call from a company vice president who helped make sure the insurer paid the bills.
In another case, the Freedom Life plan did not cover a drug Jacobi needed. And when she needed a minor surgical procedure she learned it would not be covered by the plan, so she paid cash.
Gordon-Shydlo, the UnitedHealthcare spokeswoman, said Jacobi had selected coverage that had a lower premium but only covered specific diseases, accidents and other items. The insurer complied with its “stringent application process” and addressed Jacobi’s questions and correctly paid her claims, Gordon-Shydlo said.
Jacobi is now covered by a health plan sponsored by her employer. She regrets getting caught up with Freedom Life. “It makes you feel really stupid that you fell for it,” she said.
Regulators Play “Whack-a-Mole”
Frank Pyle has been chasing junk insurance companies for years as the director of market conduct enforcement for the Delaware Department of Insurance. “As soon as you take one down another one pops up in its place.”
Pyle said regulators across the country are aware of misrepresentations by insurers selling limited, short term, accident and defined sickness plans.
Pyle and his team in Delaware have to get throwaway phones when they play secret shopper on the lead generating websites, because the lines get inundated with so many calls from brokers.
In one investigation, Pyle said his team listened to a random sample of 87 recorded sales calls from a particular company. At least half of them contained some form of deception, he said. The level of misrepresentation seemed to depend on the savviness of the consumer, he said. A consumer would ask if the limited plan was the same as an Obamacare plan and the broker would tell them it’s just as good. If the consumer asked if the plan covered diabetes, the broker would tell them it did when it didn’t, he said. The case resulted in a fine against the company, he said.
When some states identify violations, they impose weighty penalties, like fines or revoking the license of a broker. But in others the penalties are light or sometimes limited to warnings.
The Virginia State Corporation Commission settled a case for $6,300 with Freedom Life that alleged the company misrepresented benefits or terms of a policy with advertising that was “untrue, deceptive or misleading” and failed to give applicants a summary of their rights. The company agreed to a corrective action plan that addressed the alleged violations, documents show. Gordon-Shydlo, the spokeswoman for UnitedHealthcare, which owns Freedom Life, said in an email that the company’s brochures included notices about the limitations of the products and that the company did not admit to any violation of the law.
It was hard to find state regulatory agencies that had taken action against lead generating companies. One state insurance regulator, who spoke anonymously because he didn’t want his colleagues to be criticized, said his agency “probably” has the authority to regulate the lead generators, because they are engaged in selling or soliciting the sale of insurance. “But it’s something we haven’t done in the past,” the regulator said. “It’s something that hasn’t been the best use of our time.”
New Mexico’s superintendent of insurance issued an official warning, saying it intended to hold insurance brokers and companies responsible for “abusive marketing practices by lead generators.” It also said the kinds of sales tactics used by brokers — such as referring to limited plans with terms associated with “Obamacare” plans — were misleading and deceptive, and banned them.
Corlette, the Georgetown insurance expert, said the Federal Trade Commission could take a “more aggressive” look at deceptive advertising and lead generating. An FTC spokeswoman said in an email that the agency is “concerned with illegal lead generation across the board,” but could point to only five enforcement actions that related to the deceptive marketing of health care plans. Only one of the cases took place within the past five years. None involved Millar or Apollo Interactive.
The FTC’s jurisdiction includes almost any sales claim that is “unfair” or is misleading and would affect a consumer’s decision to buy, says Aaron Rieke, a former FTC staff attorney. Because the agency is “super understaffed for their jurisdiction,” he said, its attorneys aim to take enforcement actions that yield real systemic improvement for consumers. But the fact that the lead-generation ecosystem includes many small players who buy ads on Google, Facebook and elsewhere presents a “structural challenge” — because “swatting [them] down doesn’t feel like a very effective way to go.”
Pyle said the state regulators should hold the insurance companies responsible for their advertising tactics, including the actions of lead generators. In 2016, the Delaware Department of Insurance fined Companion Life Insurance Company $487,000 for violations that included “deceptive acts,” documents show. Many of the problems in the case came from the lead generators the insurer was paying to do the outreach to consumers, Pyle said.
A person in the Companion Life compliance department referred ProPublica to its parent organization, BlueCross BlueShield of South Carolina. But no one returned requests for comment.
Pyle said he’s troubled that legitimate insurance giants own some of what he calls the “bad companies.” “I’ll be honest with you,” he said. “I am surprised UnitedHealthcare is involved as much as it is.”
Pyle said regulators from various states have regular meetings and are considering pursuing criminal action against insurance company executives. “If the insurance company is paying someone to work on their behalf, they are responsible for their actions,” Pyle said. “You can fine these companies and they consider it the cost of doing business. But if you lock up their CEO in federal prison, they’ll think twice about harming our consumers.”
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