Friday, April 18, 2014

We’re lost, but we’re making good time

Today's Wall Street Journal reports President Obama saying that eight million people had picked health-insurance plans through the Affordable Care Act.  “The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working..."

Well yeah, it's a start, but it's still at most only 20% of America’s uninsured, leaving aside what this obsessively word-smithing president might mean by "picked".

The insurance underwriter in me knows what Obama said is sales talk.  His are not the words of a knowledgeable experienced salesman, or an experienced executive, or even a realistic person. They are the words of someone trying to persuade me with weak logic, scant evidence, and a story contrary to what I can see with my own eyes.  They are the words of a man trapped inside some Mary Poppins fairy tale in which “Well begun is halfway done.”  In short, it's sales talk.

And the problem with the president's sales talk is that he is selling a fantasy world, not the real world.  The real world sets a higher bar for "it's working":  people who have enrolled must be able to obtain services they need when they need them; their personal costs counting premiums, deductibles, co-pays, and wait times must be truly affordable; after first enrolling, people must be willing to re-enroll for the next year.  Not only that, but in the real world, almost all the remaining 30+ million uninsured Americans must soon also enroll.  In the real world, physicians and hospitals must be able to accommodate millions of additional patients without harming quality or accessibility. In the real world the insurance companies must be able to set premiums with confidence based on hard facts about the covered populations.  In the real world, the feds must actually, you know, get around to building the back-end systems needed to transmit enrollment info and premiums to the insurance companies.  And of course, in the real world, our president promised back in 2009, “I will not sign [The ACA] if it adds one dime to the deficit, now or in the future, period.”  And yes, he really did say “period”.

All of that and more is how the real world will decide if “it’s working.”  Clearly, despite what the president wants me to believe, this administration still has promises to keep, and miles to go before it sleeps.  Those promises cannot yet be counted as kept.  That's why I think it's misleading to say The Affordable Care Act "is working."

For right now at least, it's much closer to the truth to say, as Yogi Berra once said, “We’re lost, but we’re making good time.”

Friday Spindle-Clearing Time

Each of these may well deserve their own post, but alas, 'tis not to be:

■ The Obamastration's touting the latest (fake) number of sign-ups at 29 gazillion (or 8 million - I've heard it both ways). Thing is, that seems to include thousands of actual prison inmates.

Kudos, Kathy!

■ From the MVNHS© Files comes this unfortunate statistic:

"Majority of foreign doctors in the UK, including from India, would fail Britain's health service exams if they were held to the same standard as their British colleagues."

But hey, it's free!

■ More ObamaTax lies:

"A New York woman suffering from a neurological disease that has required four brain surgeries has been dropped by all of her doctors and denied medications due to her Obamacare plan."

According to Harry Reid, though, this woman is lying:

Lose Your Husband, Insurance [UPDATED]

Apparently, the ObamaTax is all about the "glitches:"

"More than two dozen widows who were married to retired Madison county employees, lost their health insurance coverage earlier this year."

That's Madison County, Alabama (no, not that Madison County), which had been self-insured. It's not really clear to me why that would preclude them from offering coverage of some kind, but according to county commission chairman Dale Strong, "new regulations in Obamacare would amount to an extra $25 million dollars per year."


UPDATE: Okay, turns out that (of course), there's more to the story. Yes, the county was self insured, and yes, the ObamaTax would have made it too expensive to continue covering these poor widows. So the county "instead joined a statewide network that dozens of county governments already are in. That plan, though, does not offer coverage to husbands and wives when their government employee spouses die."

That makes a lot more sense than just dropping deceased employees' spouses. And, of course, it reinforces the truth that, dead or alive,  you can't keep your plan..

Thursday, April 17, 2014

Cavalcade of Risk #206: Work in Progress edition

Dennis Wall hosts this week's roundup of risky posts. One risk, of course, is that one may encounter various technical glitches, which is why you'll need to check back from time to time to see what's new.

Wednesday, April 16, 2014

HSA and LTCi: What a match!

Long term readers know that we're big fans of both Health Savings Accounts (HSAs) and Long Term Care insurance (LTCi). What a lot of folks may not know, though, is that these two seemingly unrelated risk-management tools can actually work together to help you stretch your health care dollars.

How that, you ask?

According to FoIB (and LTCi Guru) Randy Gallas:

"If you're not eligible to deduct your LTCi premiums through self-employment or as an unreiumbursed medical expense on your federal income tax return, HSA funds may be an attractive option. Since LTCi premiums are considered a qualified medical expense, folks who who meet the criteria may withdraw money tax-free from their HSA to pay premiums."

Go on....

"Consider this example: you're 52 years old and looking for a tax-advantaged means of paying your LTCi premium (and good for you for buying at an early age!). You don't own a business so, so you can't deduct premiums as a self-employed person. Your accountant told you that you can't deduct the premiums as unreimbursed medical expenses. But if you own an HSA (or are eligible to open one),you may be able to use tax-advantaged funds from that account to pay that LTCi premium."

Randy also points out that there are are some limitations and considerations for people who have HSA accounts or those who are eligible, and provides this link to a more complete explanation of those.

Thanks, Randy!

Monday, April 14, 2014

You Can Check Out But You Can Never Leave

As we posted before, sometimes getting OUT of Obamacare is as difficult as getting in. 

Well, it get's worse.

A fellow agent in the midwest has two clients that are turning 65 and would like to get OUT of Obamacare and INTO Medicare.

But they can't.

Both bought through the exchange.

In his own words . . .
First case tried to log in (to healthcare.guv) and do life event and change the needed information on the application. It removes any/all subsidy for the spouse who is not Medicare. Agent in my office could have made this easier by putting the account in husband's name, not the wife.
The second, my 10am this morning, was a DIY case, no log in, will have to call the exchange this morning. Same, account should have been put in his name and not hers since she was only a few months off Medicare.

Yes my friends, it seems it is easier to enter the U.S. illegally than to get rid of your Obamacare plan.

Pesach 5774 / Passover 2014

Tonight marks the first evening of Passover, and the first of the two traditional meals called "seders" ("seder" means "order"). It's a ritual and a meal, and commemorates the end of the Israelites' 400 year stint as slaves to the Egyptians.

I use the term "Israelites" because there is a significant school of thought which holds that we didn't really become "Jews" until the Covenant at Sinai.

The ritual itself, at least as practiced today, dates back about 1000 years or so, so it's actually a rather recent addition to our history. Still, it's by far my favorite "Chag" (holiday). This year, as most, we will host seders both nights, with a great (and different) mix of folks at both.

Chag Pesach Sameyach!

(PS Click here for a detailed and interesting deconstruction of so-called "Christian Seders")

Caution, Socialism at Work

Universal health care is a wonderful consideration, but the political dogma doesn't match up with results.  

We were told the U.S. was the only civilized nation that did not have free health care. 


Is free better?

Half of nurses are working through breaks or beyond their shift, revealing a health service under severe strain
Three out of five of those questioned felt that staff numbers led to lower standards of care, while almost half said they were looking after eight or more patients.

And this is good in what way?
"Despite all the government rhetoric, despite the Francis, Keogh and Cavendish reports, the spectre of another Mid Staffs still looms large over theNHS. Progress on safe staffing levels has been glacial and that means poorer care and patients still at risk.
"It's clear that despite nurses working through breaks and beyond their hours, they simply do not have enough time to give patients the care and attention they need. That is distressing for patients and for the staff trying to care for them.
Government rhetoric.
Has a familiar ring . . .
"The government needs to face up to the damage it is inflicting on patients and staff, by not introducing legally enforceable nurse-to-patient ratios, and take urgent action."
So a problem created by the government needs a government fix?
Egad. It's worse than I thought. Does Britain have low information voters too?
Stupid is as stupid does.

Goodbye Shecantbeserious, Hello Burntwell

While I realize that it's not a "done deal," the latest from DC tells us that the ObamaTax is in the very best of hands:

Dumpster-diving Diva Burntwell seems to be eminently qualified to continue the ObamaTax.

Sunday, April 13, 2014

Split Personality

The creators of Obamacare envisioned a massive overhaul of the U.S. health care system that
would insure millions. Noble idea, long on grand intentions, short on effectiveness.
Liz Linton feels stuck in health insurance limbo. She has policies protecting herself and her husband, but no coverage for her two children. "They pretty much told me I'm out of luck," said Linton. "If something happens, you're responsible for the bill." On December 16th, the Goreville mother met with an enrollment counselor. She discovered her children qualified for the All Kids state program.  "I signed up," said Linton. "She told me it would probably be a month or two before we hear anything." However, two months have now stretched into more than four. Her youngest child also came down with a case of bronchitis.

The Medicaid angle isn't working so well. Too many people want free health insurance.

But Mrs. Linton should share some of the blame. Open enrollment started October 1, but she waited until December 16 to start the process.

She rolled the dice and lost.

Friday, April 11, 2014

Cavalcade of Risk #206: Call for submissions

Dennis Wall hosts next week's Cav. Entries are due by Monday (the 14th).

To submit your risk-related post, just click here to email it.

Dennis would specifically like to see posts about residential mortgages, force-placed insurance, the participants in the mortgage process, the participants in securitization of mortgages.
You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Patrick's in The Federalist (Again)!

For the second time in as many months, co-blogger Patrick has penned a post for The Federalist. This time, he discusses O'Care's impact on Employer-based (ie group) health insurance plans:

"Now that there is a tax for not having it many have simply added on to their employer’s plan. As shown in the Kaiser Employer Sponsored Benefits Survey from 2013, small employers foot a significant portion of the premium."

Definitely read the whole thing.

Is your healthcare different today than it was yesterday?

The Center for Medicare services has released how much it paid doctors in the year 2012. The big news is that one doctor in Florida made a lot of money:

Let’s take a look at these doctors based on CMS own data:a small sliver of the more than 825,000 individual physicians in Medicare's claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.

So if only 344 physicians earn the top dollar out of 825,000 physicians how much did the other 824,656 physicians make?

The median payment — the point at which half the amounts are higher and half are lower — was $30,265.

While we don’t know what the other physicians made, we do know that the median amount paid to all physicians was $30,265. Medicare makes up about 30% of the payer mix for an average physician’s office. So what we can concur from this information, from the most transparent administration in the history of America, is that 30% of a physician’s revenue was approximately $30,000. Does this information in any way change how you choose a doctor?

Employers, insurers, consumer groups and media organizations pressed for release. Together with other sources of information, they argued that the data could help guide patients to doctors who provide quality, cost-effective care

An argument for releasing this information is so consumers can be better educated on choosing their doctors based on how much Medicare pays the doctor for the service provided. One piece of insight already data mined from all this information is that Medicare pays for cataracts and cancer treatment.

In the $3 million-plus club, 151 ophthalmologists — eye specialists — accounted for nearly $658 million in Medicare payments, leading other disciplines. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments.

So using the rationale that this data will allow consumers better decision-making on choosing physicians, are we shocked that Medicare -  insurance for the elderly - pays out a significant amount of money for cataracts and cancer treatment, both illnesses of the elderly?

Having been both a provider and an administrator in the medical field for close to 15 years, what this information tells me is that doctors are for the most part underpaid by Medicare. If the median amount is $30,000 that any one physician makes in treating Medicare patients and the Medicare population is rising, then it is obvious that the reimbursement rates are lowering. This is exactly what is been happening since the year 2003 with a Medicare fee schedule that, while it does not cut, it does not give raises. As a medical administrator, all this information has done is prove to me that Medicare is not adequately paying for the work performed by physicians.

Thursday, April 10, 2014

When failure is achievement

To remind us how little they really know about health insurance the Obama Admin decided to brag about a failure thinking they did well;
"White House officials were quick to point out the many successes during Ms. Sebelius’s tenure: the end to pre-existing conditions as a bar to insurance"
In the dark ages prior to ACA an individual could buy an insurance policy any time they like. No matter the month if you wanted insurance you could buy it. If you waited till you were sick you might pay more. A very small group of people were denied or had to enroll in high risk pools. But 85 to 90% of the population could buy any time they liked.

Now that ACA is in place and open enrollment closed unless you have a qualifying event you can't buy insurance no matter what, and that applies to 100% of the population.

That is progress under the Obama Administration.

Breaking: Oy!

HHS Secretary Shecantbeserious is resigning:

"Sebelius leaves the administration after the tumultuous launch of the Affordable Care Act exchanges last fall. Despite calls for her ouster from Republicans at the time, she stayed on until the enrollment period ended at the end of March."

That;s the good news.

Now the bad:

"White House budget office director Sylvia Matthews Burwell [will] replace the outgoing secretary"



What to do, what to do....

Ms Kathy has Sgt Schultz Syndrome

Just a reminder that, two weeks after the (ostensible) end of Open Enrollment, Ms Shecantbesrious still can't (or won't) say how many of the "billions and billions" who signed up were simply victims of the ObamaTax "You Can Keep Your Plan" Hoax.

Imagine that.

Obamacare Regulates Doctor Profit Margins

Here's one I bet you didn't know. 

A key provision in Obamacare requires doctors to spend at least 80% of their gross revenue on patient care, leaving them 20% for overhead.

It seems that the onerous MLR rules for carriers also apply to physician practices.

Some doctors say they need to charge the extra fees because of the rising costs of running a practice. Some even cite the Affordable Care Act, also known as Obamacare, as adding to their costs.
Anthony Wright, of the consumer watchdog group Health Access California, says that reason doesn’t fly.
“The Affordable Care Act has another provision that puts a limit on how much your premium can be spent on patient care, rather than administration and profit. So, again, having an outside fee that is for administration is in violation in the spirit of the law, which is to try to limit the amount of money that’s spent on administration profit, and really target those dollars towards patient care,” Wright said.
It's on the internet, therefore it must be true.

Health Wonk Review: Not So Foolish (Early) April edition

Billy Wynne hosts this edition of the Health Wonk Review, and you'd be foolish to miss it. And definitely check out Julie Fergosun's take on Workers Comp and GoogleGlass.

Free Contraceptives aren't that important after all

Interesting fact among a few;

"The top 10 therapy classes by claims volume for exchange enrollees and those in a commercial health plan were largely similar, with a few notable exceptions. The proportion of pain medication was 35% higher in exchange plans; the proportion of anti-seizure medications was 27% higher in exchange plans; the proportion of antidepressants was 14% higher in exchange plans; the proportion of contraceptives was 31% lower in exchange plans." [emphasis added]

As major an issue as Saundra Fluke and free birth control was, those actually buying the plans don't seem to need it. By the time you're signed up for ObamaCare you have already been screwed so they don't need it?