Thursday, December 08, 2016

Another One Bites the Dust

Last we looked, there were only a handful of Co-Ops still fogging a mirror (metaphorically, of course). And that list just got shorter:

"Evergreen Health Cooperative Inc. (“Evergreen” or “company”) will not be issuing or renewing individual health benefit policies ... Evergreen Health plans are not available on Maryland Health Connection for the 2017 plan year"

This means that folks currently insured by the faltering carrier will have to choose a new one, and they have just about a week to do so (if they want to remain insured come January 1). Now, if they'd purchased their current plans through the Old Line State's Exchange (Maryland Health Connection), they'll be automatically "transitioned" into a comparable plan with another carrier. If they don't wish that to happen, then they'd best get crackin'.

Those who bought off-Exchange are on their own.

Still, I'm a bit puzzled as to how this can be happening. After all:

[Hat Tip: FoIB WeirdDave]

Wednesday, December 07, 2016

Obamacare Conflict: Losing The Personal Touch

I've been fielding a lot of questions from individuals looking for health insurance lately. They wonder why I tell them up front that it's unlikely I will have time to personally meet with them on their needs - especially considering many of them are losing their plans. So, in an effort to explain my situation here is what I'm sharing. 

Hi Jane, 

I'm sorry our affiliate isn't able to suit your needs. Unfortunately the ACA forces everyone to renew their plan January 1st which makes a personal touch almost impossible to achieve. Also unfortunate is most of my professional colleagues that have true knowledge and understanding of the industry aren't willing to work in this market. This is because they are astute business people and know that most of the insurers participating don't value our personal touch. We know this because many of them have completely eliminated our compensation and others have dramatically reduced our compensation. I hope you understand that we simply can't work for free.

If you are looking for a personal touch I can tell you that you do have options available. 

The first are Navigators. Navigators are unlicensed people that have been hired by non-profits who received government funded grants to help you through the process. Unfortunately these folks aren't able to advise you on specific plan choices or make any recommendations. Of course why would you take their advice since they are not licensed to sell insurance and haven't had any formal training. Not to mention, they are unable to service your account throughout the year.

The second option is to head on over to your local WalMart. You will need to find the person standing up by the checkout lines behind a table with a "health care" banner next to it looking bored out of their mind. This person is licensed to sell health insurance and can walk you through the process. I'm sure they will have time to meet with you.

If you would still be interested in a phone consultation and my recommendations please let me know. I'd be happy to assist you - if I can.

Attaboy, ObamaCare Style

So you've just spent several hours helping a client navigate Open Enrollment v4.0, sifting through the various options, checking to see which (if any) of his doc's are in-network, helping to determine whether or not he's eligible for a subsidy, helping him set up an account and verifying his identity at How do you think you should be compensated? Well, co-blogger Bob V tells us that the Rocket Surgeons in DC© have just the thing:

"[T]he Centers for Medicare and Medicaid Services (CMS) is offering health insurance brokers who enroll 20 or more individual consumers or 20 or more employers through the marketplace the opportunity for a “gold star” in the form of membership in the Circle of Champions."

Gosh, who wouldn't prefer this kind of recognition to icky commission dollars?

As we've pointed out, many agents have bailed on this season because carriers have drastically reduced or, in some cases, done away with agent compensation. As Ronnell Nolan, president/CEO of Health Agents for America points out, it's really just "throw ‘em a bone but not pay any money.”

And stay tuned: Co-Blogger Patrick has a very personal experience to share coming up shortly.


Tuesday, December 06, 2016

Tomayto, Tomahto

Potayto (via FoIB Jeff M):

"Newly issued federal data shows that North Carolina has among the highest health insurance costs under the [ObamaTax] ... North Carolinians covered by the ACA receive some of the nation’s highest subsidies per person."

Here's the thing: prices get distorted as soon as the government steps into the equation. Tar Heel State ACA insureds provide ample proof of this; by insulating them from the actual cost of plans, our Betters in DC© are able to gloss over the devastating effect that the ACA has had on health insurance rates.


The folks at HotAir point us to what's happening on the macro scale:

"Steven Lopez has gone without health insurance for 15 years, and the Affordable Care Act hasn't changed his mind. Once again this year, he will forgo coverage, he said, even though it means another tax penalty."

Mr Lopez is a 51 year old IT pro; last year, he and his family coughed up almost $1,000 to cover the fine tax penalty. It was either that, or 4 or 5 times that much in premiums, plus actual out-of-pocket for any healthcare they inadvertently received.

For all the talk of how many folks have signed up for ObamaPlans, some 28 million of our fellow citizens have taken a pass. And that's not counting the tens of millions on Medicaid (which, as we've repeatedly pointed out, is not insurance).


Up, up and away!

As we inch closer to Winter Christmas break, many students are planning international journeys. Some will be strictly for fun (think ski trips in the Alps) while others will begin studies abroad. Our friends at Global Underwriters remind us that, either way, they'll need to plan for the unexpected:
"Many students don't realize that their health insurance will not provide adequate coverage while outside of the United States or in many instances, they have no coverage at all. This is a terrible financial burden for any young person. Several countries and study abroad programs, also require health and medical evacuation insurance, in order to obtain a visa or participate in their program."

So where to begin? Well, a quick phone call or email to your favorite professional insurance agent is a good start. There are any number of plans available to help "close the gap;" some include not just medical coverage, but even medevac and war risk cover.

Perhaps best of all, these plans are generally inexpensive, and easy to acquire.

Safe travels!

Monday, December 05, 2016

UnAffordable Health "Care"

Years ago, my parents bought a small piece of property. I don't recall the particulars, but it was part of a larger parcel which was divvied up. The idea was that property always increases in value, so it was a "safe" investment.

Problem was, the whole thing was kind of "landlocked" such that it was pretty much unusable and undevelopable. Nevertheless, the folks had to keep paying the property taxes on it or it would be forfeit (which I'm not altogether sure wouldn't have been just as well).

Reason I bring this up is that sometimes owning something isn't really that beneficial, especially when one has to keep pouring more money down the hole, with only the vague promise that it would one day be utile.

And so it is becoming [ed: has become?] with ObamaPlans: as we've pointed out before, just because you buy an ObamaPlan doesn't mean that you can afford to actually use it.

Case in point:

"Twenty percent of Ohio adults reported that they or a household member go without medical care because of the cost even though more than 90 percent of them have health insurance"

The problem is that the steep "barrier to entry" that is the deductible (and then co-insurance) renders plans pretty much unusable (well, except for free birth control convenience items and the like). This is really just an extension of something we've been saying for many years here at IB: health care ≠ health insurance. That is, just because one has purchased a health insurance plan doesn't mean that one can then afford to actually use it.

Quite the conundrum.

[Hat Tip: Jennifer A]

Friday, December 02, 2016

Some more anecdata

Another in our informal series chronicling the sad state of ACA as it relates to previously insured ("grandmothered") folks:

First up, Ben and his family have been clients for many years. His current plan isn't fully ACA-compliant, but he's being "allowed" by the Rocket Surgeons in DC to keep it another year. It boasts a $3,000 per person ($6,000 family) deductible, then pays 100% for covered expenses. The plan just renewed, and the premium for his family of four is increasing by 45%(!), from $705 a month to just over $1,000.

But fear not, it's open enrollment season, so a great opportunity to shave some costs.



The cheapest alternative I could find has a $7,150 per person deductible, and clocks in at $926 a month. So they’d save about $1,200 per year in premium, but face an additional potential out-of pocket increase of over $4,000 each.

On the other hand, a comparable plan with a $2,500 per person deductible is over $1,200 a month, and includes 10% co-insurance, meaning an out-of-pocket exposure of over $6,500 per person (more than twice their current plan).


Meantime, Patty's plan (which is identical to Ben's) includes herself and her husband, and is increasing by "only" 12%, from $885 a month to just under $1,000.

The least expensive alternative I could find for them has a $7,150 per person deductible, and clocks in at $1,410 per month. So, an additional $4,800 a year in premiums plus $4,000 in potential additional out-of-pocket.

How's that old saying go again?

Friday LinkFest

Odds-and-ends from the past couple of weeks:

■ Continuing to defy the "death by attrition" model of Long Term care insurance, almost 97% of federal employees participating in government-sponsored LTCi plans opted to keep them, despite rate hikes averaging 83%.

What does that tell you?

■ Regular readers may recall the frustrating story of Martin Shkreli, who "jack[ed] up the price of a life-saving drug more than fiftyfold."

Well, FoIB Holl R tips us to some motivated and talented students from "Down Under" who have just "recreated the drug's key ingredient for just $20."

Good on them!

■ And from other FoIB Jeff M comes this heart-warming tale of greed and redemption punishment:

"Federal prosecutors say a Charlotte woman has been sentenced to 16 years in prison for orchestrating an $11 million Medicaid scam involving false medical claims and identity theft."

Seems that Ms Cynthia Harlan must also "reimburse Medicaid $3.1 million."

That's a lot of license plates.

Thursday, December 01, 2016

News from the Front

Regular readers know that I've decided to sit out this Open Enrollment season. I'm far from alone in this, but got email yesterday from good friend and colleague Scott M with a first-hand report of what he's experiencing, and he's graciously allowed us to share it:

"I was talking with a client earlier today and I found an old renewal for him.  It was a $5,000 deductible and the premium (prior to renewal) was $345.72 for him, his wife and three kids.  The plan he is going with for 2017 is a $5,500 deductible and the premium is $1,317.90.  I sent the attachment to him and he said, “the funny thing is I was just as pissed back then as I am now”.  I told him I made more when his premium was $345 than I do at $1,300.

Yep, those were the good ole days

Now, how is it possible that a premium one third the size of the renewal actually generated more income (commission) to the agent? Well, Scott explains that, too:

"I’m writing very little.  And only with BCBS.  The on-exchange folks around my area are completely screwed as none of their doctors nor the local hospital is in network of the on-exchange plans.  Plus, Blue Cross is really the only one paying anything ($10 Per Member Per Month if you have a total of 10 members or more).  I’ve been preparing quotes for my existing clients in the Blue Cross system and having them emailed with the instruction to enroll using the link if you want one of these plans.  If not, you’re on your own.  Can’t waste any time on it.  Especially for the single folks.  $10 per month for that headache?  No thanks.  At least the one I sent you guys is a 5 person household where I’ll make $50 per month.  For him I’m willing to do a little work."

Remember, agents make their income from commissions (both new business and renewals). And why should you care? Because a professional agent is uniquely positioned and qualified to help you figure out the best, most cost-effective plan available.

Which is kinda the point, no?

Health Wonk Review: Puppies and Kittens edition

After a contentious election season, where my preferred candidate didn't even show up, I thought it'd be nice to focus on something a bit more pleasant. And nothing quite brings the smiles like pics of our little furry friends [ed: bonus points to anyone able to guess the significance of the first one].

And so, without further ado, this week's hectic, eclectic, fur-bally HWR:

HWR co-founder Joe Paduda  offers the first two entries in his new series The Flash vs Spiderman "Getting Serious About Health Reform" (Part 1 here, Part 2  here), wherein he offers his own suggestions about where we go from here. As usual, interesting stuff.

One of our favorite wonks, David Harlow is actually traveling quite a bit lately, most recently to an innovation in healthcare convo in The Big Apple. He graciously took time out to send in his take on how the election will likely affect not only the ACA, but what the various pols are likely to propose.

It's been a while since Adam Fein's participated in the HWR, but he's back and in fine form with this post on "The 2025 Payer Market for Prescription Drugs" (wait, Adam's the new Dr Who?). 

The Health Affairs blog's Karen DeSalvo and Georges Benjamin offer their thoughts on what the future of public health will (should?) look like, including how to compete in a global economy.

Our good friend David Williams sends in this post on  legalizing marijuana, both for recreational and medicinal purposes. Considering how well pot-related ballot issues did this year, it's likely to be a hot topic for a while. In his post, David interviews a "marijuana entrepreneur" about implementation.

Another HWR favorite, Louise Norris, looks past the election results to dispel some misinformation currently making the rounds: she thinks it's likely that the mandate/tax will still be in force for 2017, and explores what that means to thee and me.

  Uber-wonk Roy Poses submits his take on the "Bio Telemetry Settlement" (see, I told you he's an uber-wonk 😊), wherein he continues his long-standing exploration of ethics (and/or the lack thereof) in healthcare, this time specifically about physician kickbacks and medical devices.

[ed: And pay special attention to the sidebar pic for that post]

Dr Jaan Siderov, still another long-time 'Review regular, takes a respectful (and insightful) look at the potential winners and losers in the upcoming ACA battles, focusing specifically on "organized medicine" and mHealth.

Our very favorite Healthcare Economist, Jason Shafrin, talks about "Precision Medicine" and how it potentially offers both vast benefits for patients and challenges for providers (and government regulators).

Peggy Salvatore waxes philosophical about the "Healthcare Industry in an Age of Uncertainty;" her concern about special interests is quite thoughtful, especially when we really don't know how things will ultimately shake out.

Our dear friend Julie Ferguson asks "what's in store for OSHA and the Department of Labor under the new administration?" Reading the tea leaves in her crystal ball [ed: heh], she takes the President-elect at his word about the ACA being on the chopping block, and what that may portend for OSHA and worker's comp.

Our own post explores the changing landscape of specialty prescription meds, specifically the effect of   manufacturers' coupons on claims and balances.

And please tune in again on the 15th, when Julie Ferguson works her own Health Wonk Review magic.

Wednesday, November 30, 2016

An Update on The Risk Corridor - Death Spiral Edition

I've written about Obamacare's Risk Corridor provision many times. From the Rubio Amendment to Suing for the Slush Fund we have learned that not only was government funding this leg of the 3R's likely illegal but it was also never going to be budget neutral. In fact we can conclude from the year-to-year view that the losses insurers are incurring through Obamacare marketplaces are on an expedited death spiral.

Recently (and quietly) released payment and charge amounts show just how far off of budget neutral this mess really is. More concerning, what every insurer thought was bad last year is even worse this year. And. It's. Not. Even. Close.

In two years this temporary program that was budget neutral (allegedly) has lost a total of $7,871,900,000. Payments due to insurers have more than doubled from 2014 to 2015 and revenues have been reduced by almost 75%. With numbers like this how much longer can insurers remain before they are put on life support?