Thursday, October 19, 2017

3D Kickstarter Counting Down

FoIB Fat Dragon Games' latest 3D DragonLock Kickstarter is winding down, and if you're even the least bit interested in cutting edge 3D printed game terrain (or think you some day might be), this is a must-have:

"Snap-link dungeon terrain on Kickstarter, don't miss out on FREE stretch rewards, and our GM SCREEN OF DOOM"

Wednesday, October 18, 2017

Cost Sharing Reductions: It's Not Sabotage. It's Not a Bailout: Part 2

In Part 1, we learned the difference between subsidies and the much misunderstood CSR's, and why ending the latter isn't a bailout. Now we learn why it's also not "sabotage:"

It's Not Sabotage

Obviously if the Government won't pay their obligation and an insurer still must offer the better level of benefits they will have to factor these expected claims costs into their standard rates. This will push premiums up substantially. Many studies have been done on the financial impact but for ease of math let's assume it will increase costs to Silver plans by 20%.

Yes, 20% is a lot. But keep in mind rate increases in 2014, 2015, and 2016 all rose by significant amounts too. We didn't hear cries of "sabotage" back then. Instead we heard "this won't impact very many people because subsidies (tax credits) will protect them from the increases." So, how is this different? It's not. In fact, because the increases are on Silver plans it will raise the tax credit amounts and reduce the costs for Bronze, Gold, and Platinum plans to those who qualify for subsidies.

This leaves one income group potentially getting the shaft on Silver plan premiums. Anyone who doesn't qualify for a tax credit/subsidy must pay full price. It's easy to assume that these people will suffer because all the discussion - even in this post - has focused for insurance plans sold ON exchange. It's true that insurers must price the same product equally both on-exchange and off-exchange. But, insurers can also offer plans off-exchange that have slight benefit variations at different prices.

Using my example above, an insurer will offer this plan both on and off exchange. The new plan without CSR funding will cost 20% more. The smart insurer will also create a plan that closely mirrors their original plan with a slight tweak - let's say a $6,200 deductible. Because this plan is only offered off-exchange the insurer doesn't have to include the 20% mark up to fund CSR risk. This solves the problem of the 400% and above person not being able to afford a Silver plan.

So, who does this hurt? Over the next 10 years CSR payments are expected to cost more than $200 billion. It's either going to come from Congress appropriating the funds or through higher premium tax credits given to consumers.

The answer is it hurts everyone. Because those in DC want to focus on political agendas and not the real problem we all suffer. Higher taxes, higher premiums, lesser benefits, market uncertainty. All will continue. Because nobody wants to focus on the 80% side of the equation. That 80% side is the actual costs of care.

Cost Sharing Reductions: It's Not Sabotage. It's Not a Bailout: Part 1

Congress and the media are hyperventilating over the Trump Administration announcement that they will end Cost Sharing Reductions (CSR). The result is news feeds full of over-exaggeration, misrepresentation, blatant lies, and name calling. One side of the political aisle calls it sabotage. The other says it's an insurer bailout. Reality is, it's neither.

Before I explain, let's first start by answering what is the cost sharing reduction (CSR) and how does it work? It's quite simple when it's not used as a political football. But, like everything in our political world, the more the bureauweenie can confuse the consumer, the more reliant the consumer becomes on the bureauweenie.

Obamacare has two methods of "financial assistance" written in to the law to help low income individuals. The first method is premium tax credits to help pay health insurance premiums. Those have been funded and have nothing to do with the second method, CSR's.

Under Obamacare, insurance companies are required to offer people making between 100% and 250% of the Federal Poverty Level Silver level insurance plans that have lower deductibles, copays, coinsurance and out-of-pocket-maximums than the standard Silver level plans. Pricing for these plans to are equal to Silver level plans that don't include the CSR's. In exchange for offering these better benefits to low income individuals, Obamacare made a promise that they would refund insurers for the claims they incur between the better benefit Silver CSR options and the standard Silver plans.

Here's an example: three 42-year old's who live in the same zip code that purchase insurance through the exchange. Each has a different income. The first has an income of $19,500, the second has an income of $30,250 and the third an income of $55,000. The actual monthly cost of the lowest priced Silver plan is $248.57. It includes a deductible of $6,100, an out-of-pocket limit of $7,000 and has an office visit copay at $30.

The first person has an income below 250% of the poverty level and the other two don't. So, under Obamacare the first person is eligible for a premium tax credit (subsidy) AND a Silver plan that has better benefits (CSR). His benefits include a $1,100 deductible, an out-of-pocket limit of $2,000 and an office visit copay of $15.

The second person has an income just above 250% but below 400% of the poverty level. Under Obamacare he is eligible for a premium tax credit (subsidy) but not a Silver plan with CSR. He will pay less than the full premium price but have the standard plan with a $6,100 deductible.

The third person is over 400% of the poverty level. He pays full price for the standard insurance plan.

Now that we understand CSR's let's explain why it's not a bailout or sabotage.

It's Not a Bailout

When insurers price their plans they are based on the standard plan. This is where the $248.57 premium comes from. The insurance company math nerds (actuaries and underwriters) develop rates based off assumed risk. This risk does not include the difference between the standard plan benefits and the better plan benefits available to those between 100% and 250% of FPL. The Federal Government -through Obamacare - agreed to reimburse insurers for these claims that they have not financially accounted for.

The amount the insurer hasn't accounted for is the difference in deductible, copay, coinsurance, and maximum out-of-pocket the consumer is liable for. Let's assume all three guys from above have a claim for $25,000. The lowest income guy is only liable for a maximum of $2,000. The second and third guys would be liable for $7,000. Insurers priced for $7,000 out-of-pocket knowing that Obamacare promised to pay the difference in claims between the standard plan limit and the better benefit limit due to Cost Sharing Reductions. In this scenario the difference in the first guy's liability and the standard liability ($7,000-$2,000) would be submitted by the insurer to the Government for reimbursement. It's also important to note that if the first guy is healthy with no claims the Government doesn't pay the insurance company at all.

As you can see, this isn't a bailout to insurers. It's reimbursement for claims they incur that weren't factored in to insurer pricing. Under Obamacare the law states that CSR's are a financial obligation of the Federal Government to insurers. Failure to pay represents a default of our Government.

We explain how it's not "Sabotage" in Part 2.

Tuesday, October 17, 2017

Canary in the Coal Mine – This Sceptered Isle, Part LXXIX

Unprecedented abuse of power by NHS?  Well of course it’s abuse of power.  But unprecedented?  Not so much.  Remember this? 

Fortunately, the public outcry over that one caused NHS to back down.  Who knows what NHS will do this time?

People who believe these things cannot happen in the US are seriously misinformed. Nearly the same thing happened in my own town.  It happened to neighbors of ours whose daughter was diagnosed with mitochondrial disease.  And then the hospital and bureaucrats in the State of Massachusetts took over and tortured the whole family for years.  

People who say nothing like this happens in a nationalized insurance scheme are living in a dream world. These situations will surely arise in the US even if  - and maybe especially if - we end up with some kind of government single-payer medical welfare scheme.

Mark my words.

Making Strides Against Breast Cancer

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is just a few days away now, his coming Saturday (October 21st) in Dayton, Ohio.

Will you please help out by making a donation - any amount helps.

Thank you!

More ObamaCare Rate Lies

Remember this?

Well, it appears that someone didn't get the memo.


From the Centenniel State:

"Colorado premiums will rise by 6% on top of existing hikes"

And finally, from the Keystone State:

"Insurance premiums for plans sold on Pennsylvania’s ObamaCare exchange will increase by an average of 30.6 percent for 2018"

It appears that most of these are as a result of President Trump's decision to follow the actual law.

Refreshing, that.

[Hat Tip: FoIB Holly R]

Friday, October 13, 2017

Obamacare - When Facts Don't Matter

Former White House COS and current Mayor of the Windy City has been quoted as saying "Never let a serious crisis go to waste.".

Taking a page from Rahmbo's playbook, the current WH resident is doing just that.

Obamacare is failing. Has been from day one. But the only folks who don't see that happening are folks that are either ignorant, those who believe the 44th president walked on water, or they are covering their ears and refusing to listen to facts.

If you are the Gordon Gekko of health insurance and believe that "Obamacare is good" no need to read further. Go to HuffPo or TMZ and have fun with that.

But the Twitterer in Chief who is not known for holding his tongue (or Twitter fingers) has thrown down the Obamacare gauntlet with this tweet.

The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix! - The Real Donald Trump

Never let it be said that the man is indecisive.

He calls a spade a spade.

But some folks can't handle the truth.

What is extremely entertaining (to me at least) is found in the comment section below the Real Donald's tweet.

Anyone with a pre-existing condition is going to see premiums skyrocket from TrumpCare. He isn't working with the facts here. Studies, plz!

Seriously, without name calling or rudeness, here are the facts: the ACA saves lives. You are making it worse for poor people and all of us.

I wonder why Obamacare is imploding! Weird! Not sabotage, right?

Well, you get the idea.

Unless you have been indifferent to facts and truth since this mess called Obamacare came into existence.

Obamacare IS in crisis.

Obamacare HAS BEEN in crisis mode since 2013, a full year before it was completely implemented.

At this point there is no way to fix it. Too late to save it for 2018 and possibly beyond. Act II will most likely be a federally funded expansion of Medicaid for anyone not covered by employer group health insurance.

If there are any carriers offering individual health insurance in 2019 it will be those who are able to offer plans that gut the high cost parts of Obamacare, such as guaranteed issue. Medicaid  would then be not only for those who fall below a designated income level but also function as a high risk pool for those with serious health issues.

Those who want to keep Obamacare have some serious denial issues and should seek counseling while they can.

#Obamacare #TrainWreck #Snowflakes

The First Cut is the Deepest

[Note: This is an insurance-free post]

For as long as I can remember, I've always owned good kitchen knives (Wusthof, Henckels, etc). A short time back, I participated in an Indiegogo campaign for a new brand, Misen (as in mise-en-place). This new venture promised high-quality knives at more affordable prices, and I thought it looked promising.

Well, I've had my chef's knife for some months (perhaps a year?) now, and I must say that it performs very well: nice balance, able to keep an edge, comfortable grip.

What isn't so great is how well it's "aging:"

See those spots? Rust, even though I carefully hand wash and dry it after each use.

So I sent an email about it to the Misen folks (including that picture), and this is their reply:

"Hi Henry,

Thanks for sending through that photo. While not common, small stains like this can occur (even on stainless steel knives) for any number of reasons, and they’re not something to worry about!

In my experience with some other knives I’ve used in the past, a product called Bar Keeper’s Best Friend is really effective at removing minor stains like the ones in the photo. Of course, if the issue does get any more serious, please let us know and we’ll be happy to help!

All the best,

To which I say: Bull Feathers.

As previously noted, I've owned similar knives for many, many years, and have never experienced this, let alone in one that's practically brand new.

So I ask, dear readers, am I justified in my disappointment, or unreasonable?


Thursday, October 12, 2017

A Better Pill ?

As a registered Democrat, I receive several emails a day from DNC telling me what to think and what to support and asking for money.  About a week ago, one of the DNC emails told me this about employer-sponsored medical insurance: 

“Today, the Trump administration announced that they're rolling back a mandate requiring employer-provided health insurance to cover contraception -- a rule that has helped at least 55 million women across the country access care.”

There are many sources (here’s one)  that discuss this rollback; it’s far more complex than DNC suggests. But whether the issue is simple or complex; whether details are offered or suppressed; and whether facts are understood or ignored - I think this issue will remain just as controversial, emotional, and resistant to logical analysis as it was before Obamacare.    

Why is that?  Because insurance for contraception has been politicized.  It's a good example how the expanding role of government in providing medical insurance, politicizes medical coverage decisions.  The experience in many other countries teaches that politicizing medical coverage decisions is usually not a good thing.

Keep in mind DNC raised the question of coverage for women who are employed and have incomes.  The great majority of working women can buy contraception using their own income.  For them, insurance is not necessary to access contraception.  So then why do some advocates insist that coverage is unacceptable if it pays a penny less than 100%?  Is $50 a month unaffordable for most working women?  $25 a month?  And why is my own party telling me that coverage less than 100% will reduce access to care for 55 million working women? 

Also consider that employers do not pay their employees above & beyond their wages to cover food, clothing, or utilities.  Is contraception a higher priority than food, clothing, or utilities?  Is there a persuasive argument that employers are denying their employees access to food, clothing, or utilities? I’ve not seen one. Or that the federal government must step in to mandate such extra payments in the name of employee access to food, clothing, or utilities?   I think not.  And that's why I doubt that “free” contraceptive coverage for working women is necessary.   

My opinion: the fundamental issue here is less about the cost of contraception or the level of insurance coverage for it or even access to care.  Instead, the fundamental question is more about whether the federal government has a duty to mandate 100% coverage of contraception for working women.

My opinion:  coverage of contraception for employees is better left voluntary, purchased by employers who choose to purchase it (e.g., Hobby Lobby) based on their own employees' preferences and needs  And I think regardless of the employer’s choice whether to buy such coverage, it is not unreasonable to ask working women to share some part of the cost.  Maybe even the full cost.

Health Wonk Review: Pink edition

October is Breast Cancer Awareness Month, so please forgive this brief detour:

I'm raising money to fight breast cancer with my team: Love, Hope and Faith. Our walk is on Saturday, October 21st in Dayton, Ohio.

Will you please help out by making a donation - any amount helps.

Thank you!

And now, on with the show:

First up, Bradley Flansbaum isn't bullish on long term care: over 70% of seniors will need it at some time, and they're ill-prepared to pay for it. The good news is that Bradley offers some hopeful ideas about how to resolve that.

Next, Andrew Sprung makes the case that the ACA most closely resembles London after the Blitz, citing the Trump administration's meddling as the culprit, and he's not happy about the current situation, or sanguine about the program's future.

Uber Wonk Roy Poses offers his take on what he calls the Health Care Revolving Door. He's concerned about the seemingly endless stream of folks hopping from private industry into government advisory jobs, and vice versa.

HWR co-founder (and dear friend) Julie Ferguson is our guru of WC (Workers Comp), and offers us an insight into how WC costs and benefits are distributed amongst the 50 states. I know very little about WC, and found her information pretty interesting.

Our good friend (and fellow long-time HWR host) Louise Norris offers something I've never seen before. I'll let her explain:

"This post was written by myself and three colleagues: David Anderson, Charles Gaba, and Andrew Sprung. It's an overview of the different approaches that states and insurers have taken with regards to the CSR funding uncertainty for 2018, and the impact that those various approaches have on consumers and overall plan pricing."

Okay, so very interesting Henry, but what makes this unique?


"We all published it concurrently on our blogs this morning."

Isn't that cool? I don't think I've ever seen a post co-written and then concurrently posted like this before.


Our friend Dr Dana Beezley-Smith has been published once again in The National Psychologist, this time on the subject of price transparency in health care (Spoiler Alert: she's for it).

Our own Mike Feehan has a scary pre-Halloween story to tell, as he warns us that the Health Insurance Fee that was temporarily put back on the shelf for 2017 will loom large next year. Why's that? Well, last year it cost insureds about $13 billion. So do the math.

The next 'Review is in two weeks over at David Williams' establishment.

Wednesday, October 11, 2017

Single Payer Blues

So let's see what our Friends Across the Pond© have been up to. Via our friend Rich W:

"A growing crisis in hospital safety is revealed in official figures showing a doubling in the number of legal warnings issued by NHS watchdogs."


The number of "enforcement actions" (basically citations) has more than doubled in the past year, and it doesn't appear that that rate's slowing down:

"Recent actions include a warning notice to Royal Cornwall Hospitals trust after inspectors found patients dying and left to go blind after long waits for treatment."

But hey, free!

On the other hand, it's not as if our own hands are clean:

"VA conceals shoddy care and health workers' mistakes"


Fortunately for those who served our country, putting their lives on the line for all of us, VA healthcare professionals are top-notch.

Oh, wait:

"Medical experts from the Department of Veterans Affairs blamed one botched surgery after another on a lone podiatrist ... In 88 cases, the VA concluded, Franchini made mistakes that harmed veterans."

Good thing the VA bureauweenies caught him in time, and that he paid a severe penalty.

"They let him quietly resign and move on to private practice, then failed for years to disclose his past ... He now works as a podiatrist in New York City."


Okay, well then, good thing this was just a one-off.


"In other cases, veterans’ hospitals signed secret settlement deals with dozens of doctors, nurses and health care workers that included promises to conceal serious mistakes ."

Words fail.

On the bright side, it's not as if single payer systems promote murdering patients to save precious and scarce health care dollars, right?

Um, you may want to be sitting down for this:

"Now, in Canada, a doctor can not only deny life-saving treatment for a person in their right mind who wants it, but actually have that patient, against the patient’s will and with their full mental faculties, outright executed by lethal injection."

"Free" health care: worth every penny you pay for it.

Tuesday, October 10, 2017


"Majority of Households Paying Obamacare Penalty Are Low and Middle-Income"

Almost 4 out of 5 of those penalized bring in under $50,000 a year.

Please remind me what the first "A" in PPACA stands for?

As we noted yesterday, folks who don't qualify for subsides (because they make just a tad too much, but not enough to get out from underneath this trainwreck) are facing record rate increases, and now those folks who can't even afford to buy insurance are getting hit with penalties for going bare.

Something's got to give.

Methinks Maxine was right all along.

[Hat Tip: AssocAmerPhys&Surg]