Tuesday, November 24, 2015

Peggy & Your Private Health Data

We've been writing about who really has access to your personal health info for a very long time:

"In a time zone 17 hours ahead, a radiologist in Australia, working for a company called NightHawk Radiology Services, had been sitting before the same images ... Once your medical information travels to Australia, India or wherever you basically lose your HIPAA rights."

That's from 2006, and things haven't improved. As we noted last month, even something as innocuous as your Fitbit is fair game for data hunters. Fortunately, the folks behind that product have voluntarily agreed to comply with (some?) HIPAA privacy regs.

On the other hand, the bigger picture is much less sunny:

"At-home paternity tests fall outside the law's purview. For that matter, so do wearables ... that measure steps and sleep, gene testing companies such as 23andMe, and online repositories where individuals can store their health records."

This can lead to unfortunate consequences, primarily because the government agencies responsible for enforcing HIPAA's privacy reg's much authority to do so:

"A 2009 law called on HHS to work with the Federal Trade Commission ... to submit recommendations to Congress within a year on how to deal with entities handling health information that falls outside of HIPAA. Six years later, however, no recommendations have been issued."

Shocking, I know.

The bottom line is that, at this point, a lot of our ostensibly private health info is potentially freely available to any number of government agencies, vendors, even fellow consumers:

"Part of the lab's website address caught her attention, and her professional instincts kicked in. By tweaking the URL slightly, a sprawling directory appeared that gave her access to the test results of 6,000 people."

How many others are out there?

Monday, November 23, 2015

Another ObamaTax "Success" Story

Speaking of rates going down 3000%, here's the story of a family doing its best to not only provide for itself, but to take on another unfortunate. The Smith's had already adopted a baby several years ago, and have just recently completed the grueling task of adopting another.

In the meantime, their current medical plan - an HSA with a $12,000 family deductible - renews on January 1 with a 30% rate increase No problem, let's go shopping:

Company A offers a $13,100 family deductible for $1,006 (saving $670 a year in premiums, but raising the potential out-of-pocket by $1,100)

Company U's plan has a $13,000 family out-of-pocket, but saves the family only $300 a year (for an additional $1,000 potential exposure)

Company I's plan seems to be the "bargain:" it saves the family $840 a year in premiums, and only increases the max out-of-pocket by $500.

So, which would you choose?

Friday, November 20, 2015

404Care.gov strikes again

Via email from Anthem:

"Healthcare.gov missing information will require some individual members to re-enroll for 2016 - We recently learned that the Health Insurance Marketplace (also called the exchange) is missing some information that some of our members provided on their applications last year when they bought their plans through the exchange."

The good news is that Anthem (and, presumably, the other carriers involved) is moving quickly to notify its affected insureds and get the issue resolved. Private sector to the rescue!

If you're insured through an Exchange-based plan, might be worth your while to get ahead of this by contacting your carrier right away.

Gaba, Gaba does

Ask some great questions:

"CMS is doling out just 12.5% of the monies owed to various carriers ... **evenly** to every carrier which is owed money, regardless of how much or little they're owed ... Are they legally required to make the payments this way, or could they use their discretion to prioritize certain carriers over others if they wanted to?" [emphasis in original]

Aye, thar's the rub, no? After all, if they do "prioritize" payments, then they're guilty of playing favorites, and if they don't, they're still doing so, no?

The crux of Charles' concern is that the Big Boys can likely weather the storm, but these delays pose the very real risk of sinking smaller players (think CO-OPs writ large).

In your humble blogger's opinion, this is really just going according to plan; that is, single-payer has always been the end-game (just ask Herr Gruber), and this is just another step along that path.

Unexpected! Carrier Trick

So UHC finally decided to dip its toes into the 404Care.gov market, only to immediately yank them back out:

"The nation’s largest health insurer fired a shot across the bow of ObamaCare on Thursday, citing flagging enrollment and high-risk customers in suggesting it may have to pull out of the exchanges in 2017"

What, 2 years of miserable ObamaTax numbers were hiding in plain sight?

So what's their solution? Well, one way to dampen enthusiasm would be to drastically cut agent comp for Exchange-based business. But that would be an incredibly slimy, cynical move.

So, naturally, UHC has drastically reduced agent comp for on-Exchange business.

Now, is this their prerogative? Of course it is. Does it make sense? Well, from their perspective, perhaps: after all, if they essentially suppress the agent-driven market, they're less likely to have to face the major loss ratio music. And what with the risk corridor money looking pretty iffy, that may be the only realistic strategy.

Oh well, easy come, easy go...

Thursday, November 19, 2015

Melvin & The SubPar Plan

Readers may recall when President Obama called out pre-ACA plans as "sub-par;" that is, that they had both unreasonably high out-of-pocket exposure plus high premiums. The ObamaTax was touted as the fix-it for both problems.

Let's take a look at how well that's worked out, shall we?

IB regulars may recall the saga of Melvin and the tricky prescription. Melvin's plan, issued by Medical Mutual of Ohio, is a "grandfathered" HSA plan with a $3000 per person, $6000 per family deductible, then 100% covered after that. We just got his 2016 renewal in the mail, complete with a 14% rate hike. The good news is that that's about half of what I'm seeing with ObamaTax-compliant plans. The bad news (sort of) is that his family's premium is increasing from $516 a month to $586. This includes Melvin, Mrs Melvin, and two Mini-Melvins. If you're looking at that $586 skeptically, I don't blame you: that is a heckuva bargain.

If you're thinking that it's way out of line, well, here's a comparable quote from another carrier (several to choose from, this one seemed the most photogenic, and is right in line with all the others number-wise):

Yes, almost $1200 a month, plus much higher potential out-of-pocket.

On the other hand, it does include "free" birth control and maternity (for his 40-something better half). Some deal.

And this is why The Grey Lady recently reported breathlessly:

"[F]or many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage."

To be fair, the new plans provide "free" colonoscopies in addition to the birth control convenience items and maternity. But most of these plans aren't even HSA-compliant, so there's no opportunity to sock away extra dollars (what few there may be left after paying the grossly inflated premiums). And of course, one wonders how many folks actually take advantage of the "free" routine exams and such.

As we've averred many, many times here at IB, insurance is - well, should be - a risk management tool, and thus cover  big-ticket items, not $9-a-month pills. What did the rocket surgeons in DC think was going to happen when they crammed all those freebies in, while simultaneously proscribing carriers from underwriting new applicants?

Having health insurance may confer access, but what good is that access if one can't afford to actually benefit from it?

Economics of Paid Family Leave

The issue of paid family medical leave is bubbling up as it becomes a talking point with some of the presidential candidates. Social media is abuzz with
various groups pushing for legislation which will require a business to provide paid family medical leave, most notably, following the birth of a child.

Sounds noble, doesn't it?

But like all other mandates, it comes with a cost.

If businesses, large and small, are required to provide even 3 months of paid leave consider the cost of such a measure.

While the woman (and her spouse) are home taking care of their newborn and collecting a paycheck, what is going on at work?

At least two, and possibly four, people are being paid during the family leave. The work load has to be absorbed by someone. Either other workers (not on leave) are performing their own jobs but also picking up the slack. Some of them may be paid overtime.

Some jobs are so unique the company has to hire a temp to take the place.

There is a cost to that, and that cost is passed along in the form of higher prices.

Advocates say the U.S. is the only industrialized country that does not provide paid family leave.

I suppose those countries would the ones with a socialized form of government that are currently on the verge of bankruptcy.

Others talk about companies in the U.S. that currently provide paid family leave. Companies like Nestle', Amazon, Google and so forth. Those are big companies that made a conscious decision to voluntarily offer paid family leave. No one forced them to offer this benefit.

Fortune 500 companies employ roughly 20% of the total workforce.

That leaves 80% of the working population employed by smaller companies.

One of the problems with government mandates is they fail to take into account the consequences of new rules.

Obamacare has consequences.

Raising the minimum wage to $15 has consequences.

The same will be true if DC requires paid family leave.

All this begs the question. How have we made it this far as a country without paid family leave? What did generations before us do?

My guess is they planned and saved for the event. That is called personal responsibility.

What a novel idea.


Wednesday, November 18, 2015

Pre-Thanksgiving Health Wonk Review

Brad Wright hosts this week's round-up of wonky posts full of helpful info and unique insights.

Who knew Norman Rockwell was a health policy wonk?

Tuesday, November 17, 2015

Universal Health Coverage in the United States

Those who cry out for "universal health coverage" like other civilized nations need to look no further than U.S. territories. Critics mention the VA as a corrupt, broken system but at the same time point to Medicare as a shining light.

Puerto Rico is a U.S. territory where 70% of the population is covered by either Medicare or Medicaid. How well is that working out?
The island is bracing for steep funding cuts to federal health care plans that serve nearly 70 percent of the U.S. territory's 3.5 million people. Local officials have been talking with the federal government about the proposed funding loss, but believe they will be implemented nevertheless.
The cuts will affect the entire U.S., but Puerto Rico is expected to feel them more acutely because the island already receives lower funding levels than the mainland, it has a poverty level higher than any U.S. state and it is already in the midst of an economic crisis and a nearly decade-long recession.
Funding for Puerto Rico's Medicare Advantage program, serving about 560,000 of the island's more disadvantaged people, will be slashed by 11 percent in January, a move expected to lead to more expensive copays and the loss of some benefits. More cuts to Medicaid are anticipated over the next two years, affecting about 1.6 million Puerto Ricans like Gonzalez who rely on the funds through Mi Salud, a local government health care plan. - My Way

If Medicare for all isn't working so well with 3.5 million people how will it work when you have 330 million on Medicare Part E?

#MedicareForAll #MedicarePartE

Sunday, November 15, 2015

1,000 Words on O'Care

[Hat Tip: Co-blogger Bob V]