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Tony Ondrusek is founder and publisher of Insurance & Financial Advisor and IFAwebnews.com.

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As reported on IFAwebnews.com, broker Steve Salamon and other professionals – including business owners – have launched the Health Insurance Buyers & Brokers Coalition (HIBBC) of Maryland to ensure brokers still have a place in the health insurance distribution chain.

The effort is wholly commendable: Get brokers and business owners to lobby state legislators to pass laws that will both fulfill federal requirements to establish health insurance exchanges and keep brokers in the mix. Exchanges must be in place in every state by 2014 as mandated by the Affordable Care Act.

It is the type of initiative that I believe in and have rallied around for many years. But could it be too late?

Not that Salamon and his peers shouldn’t proceed with all due haste and forcefulness. Quite the contrary. They have to put the past behind them, and work like the dickens to make a change.

But one has to ask if it is an uphill battle.

Carriers are already cutting commissions in anticipation of the medical loss ratio limits that are set to go into effect as a result of the law. Even the NAIC (National Association of Insurance Commissioners), which was tasked to find a way to keep broker commissions viable, were not able to argue that commissions should be part of the cost of medical care, and not part of the 15%-20% administrative costs of the MLR that the new law allows.

This is exactly the kind of program that the National Association of Health Underwriters (NAHU) should implement immediately. Contact Salamon, learn how he is doing it, enlist a cadre of like-minded brokers from chapters in every state, and it then becomes a grass-roots effort that can be replicated across the country.

Admittedly, Salamon’s main concern is Maryland, where he is a principal at Landmark Insurance & Financial Group. He wants the Maryland exchange to keep him and his agency viable and profitable. He doesn’t have the time or inclination to deal with the legislature in, say, Michigan, although he understands the challenges that brokers in that state and the other 50 are also facing.

“Not since 1993 have we seen such a threat to our profession,” Salamon told a group of about 300 health insurance professionals during a recent local event whose purpose was to rally the troops. He was referring, of course, to the failed attempt of former First Lady-turned Secretary of State Hillary Clinton’s attempt to create a national health care plan.

In the years since then, the industry has done a dismal job in communicating to the public the real causes of escalating health care costs, which have resulted in higher health insurance premiums. Instead, the industry has allowed itself to be the scapegoat for consumers unhappy with the rising cost of care, even though their displeasure was mistakenly directed at the health insurers, and not at a system that demands more care, better care, immediate care and care for chronic conditions that are allowed to deteriorate without preventive intervention.

It is tantamount to consumers being ticked off at the local BP gas station owner over the Gulf of Mexico oil spill disaster. The gas station owner is just the middle-man in the equation, yet was seen as an easy target by those who – rightly or wrongly – wanted to send a strong message to BP about the disaster.

Likewise, health insurance companies and brokers have been portrayed as the bad guys when they simply are the ones that gather the premiums and divide them up to pay for the medical care that consumers expect and demand.

Consumers don’t look at their itemized statements, in the same way that they don’t look at the gross pay on their paychecks; they are only concerned with net pay. Consumers look at co-pays and deductibles, and whether or not their doctor is in their network.

If they were to get a bill when they left the doctor’s office (they don’t, all they get is a receipt for their co-pay), and saw that a $200 visit only cost them $20, and that 10 years ago the exact same visit might have cost them $75, they might understand that other factors than the insurance companies are in play when it comes to rising costs.

Not that the carriers couldn’t have done a better job. Oh, no. They hold their own responsibility for rising costs. But it is only a fraction of the actual cost of care.

By the same token, insurance companies have not presented the real message. They sat back smugly after Hillary-care was defeated, and did little to explain – in a coordinated and consistent manner – the root causes for a rise in health care. And, they did little to try to convince others for the need to lower costs, or alternatives that might have lowered costs.

Instead, the money flowed in, people got better care, and there was little cause for alarm.

And then came Obamacare.

Brokers and carriers are behind the eight ball. But they are not in the pocket yet. As Salamon said during the recent presentation, brokers should not count themselves out. But they are in a fight for their lives.

HIBBC is a first step. It’s trying to get a wild stallion back into the corral after it jumped the gate. But with a large group of cowboys holding hands and forming a circle around it, perhaps they can guide the wild beast in a direction that would do little or no harm to the public that relies on tamed horses, and to the cowboys themselves, who find themselves under threat from a new sheriff intent on sticking his nose into every bit of town business, even when the townsfolk have said repeatedly that he is overstepping his bounds.