Monday, March 27, 2017

PCIP v2.0?

We were long-time fans of the PCIP (Pre-Existing Condition Insurance Plan), the one part of ObamaCare that actually seemed to make sense. So of course it was designed to sunset after a time, leaving a lot of folks with few choices and less care.

Now, FoIB Dr Val Jones writes about "stability funds," part of the ill-fated AHCA, funded at (gulp) $100 billion over the next 10 years, and which was designed to allow "states to start to repair their individual insurance markets ... With better policy choices, states can make coverage cheaper and more attractive for consumers and coax insurers back into the market, and the stability fund is a powerful tool."

On its face, the idea has merit: the gummint (thee and me) serve as reinsurers, backstopping major claims. This was tried in Maine back in 2011, where an "invisible high risk pool ...  picked up the total cost of claims above $10,000." This seems to me to be a legitimate role of the state (although I could be persuaded, for example, that $10k is too low). If it were included as part of a total reformulation - and of course after O'Care was totally repealed - then I think the concept has merit.

I recently had a conversation with NYT reporter Reed Abelson, and mentioned that I was a fan of PCIP, and that I'd like to see something like it incorporated into whatever new scheme our congresscritters managed to cook up. The idea is that it encourages carriers to take on some additional risk without breaking the bank. I'd also like to see it coupled with some kind of assessment, so that that carriers are incentivized to spread that risk amongst themselves.

I know: Wishes in one hand....

Dutch Digging Deeper


Now granted that was almost 5 years ago, so certainly the country's found a better path to healing, right?

Right??

Not so much, apparently:

"A Dutch woman doctor who asked an elderly patient’s family to hold her down while she administered a fatal drug dose has been cleared under Holland’s euthanasia laws ... as the doctor tried to administer the injection, she began to struggle and the doctor had to seek the family’s help to complete the procedure.”

The poor woman, suffering from dementia, had previously expressed "a desire to have her life ended when she felt the ‘time was right.’" The time wasn't right, however, and she began to fight for her very life while being administered the lethal concoction.

She lost.

Coming soon to an IPAB near you?

Friday, March 24, 2017

Does it make sense?

Last week, we noted the curious case of Joaquin Shadow Rams, who seems to have made a habit of collecting on life insurance policies he took out on family members (one hesitates to use the phrase "loved ones"). Last we heard, he was on trial for the murder of his year old infant son, on whom he had purchased a sizable ($500,000) life insurance policy.

Now, as then, we're going to focus on the underwriting aspect of this case, specifically:

"What rocket surgeon underwriter approved a half million dollars of life insurance on a toddler?"

Since that post was published, I've had a fruitful conversation with my underwriter at our primary life carrier, whose bottom line observation provided the title of this post.

In addition to the various issues we discussed previously, he explained that, if the father was, in fact, applying for multiple policies on his son's life, this would (likely) generate an "excessive applications" hit at the MIB (Medical Information Bureau), which tracks these over the course of several years (let alone one). This alone would have set off a red flag or three.

Alternately, if Mr Rams had purchased just the one $500,000 policy on his infant son, this too would have raised some eyebrows. As FoIB Jeff M noted in comments to the previous post:

"Every life insurance company that I have ever used required an amount of life insurance on the parents to be at least 2x that which was being applied for on a child."

My underwriter confirmed that, for the most part, this is true, but that New York has recently ruled that the child's death benefit amount allows at certain ages a face amount equal to the parents'. Still, there's a floor. We also discussed my observation that, if this was Bill Gates, Jr there might very well be justification, and my underwriter added that there may be other extenuating circumstances.

For example, he mentioned a case where the parents had no life insurance, but were applying for a large amount on their son (who, it should be noted, was not an infant, but a teenager at the time). When queried, it turned out that Dad didn't have coverage because he was uninsurable, and the primary reason they were seeking coverage on the progeny was to protect his future insurability. So it made some sense in that case.

Of course, the MSM can't be bothered to do even that much rudimentary fact-checking, so we have no idea how much - if any - life insured Mr Rams had on himself (there's no mention of a Mrs Rams).

The bottom line, it seems to me, continues to be that there were some highly questionable actions taken by whichever insurer is left on the hook for this tragedy, which apparently failed to ask "Does it make sense?"

[Many Thanks to FoIB Rob P]

Thursday, March 23, 2017

ObamaCare #Winning Updates

Our good friend Holly R tips us to some interesting, if obvious, ACA-related news:

Ohio Senator Rob Portman points out that, under The ObamaTax, not only was the claim that "if you like your insurance you can keep it" a lie, but that as a direct result of its implementation, 20 counties in Ohio (almost a quarter) have only one health insurance carrier still in the individual market:


From the "D'unh! Department" we learn that higher premiums in The Grand Canyon State led to, get this, "a 3.3 percent enrollment decline in marketplace plans."

Hunh.


On the surface, this seems like good news, and it may well be. But as we've noted before, this is really a double-edged sword: encouraging drug use by offering pricing incentives distorts claims experience:


So, may well be no "right" answer here, but certainly not an open-and-shut case, either.

Health Wonk Review: AHCA Aye or Nay Edition

Louise Norris once again lends her deft touch to crafting an interesting, issue-centric Health Wonk Review, this time focused on TrumpCare, er, the AHCA.

Don't miss it!

Tuesday, March 21, 2017

Affordable Insurance thru a National Single-Employer Plan

A National Single-Employer Plan would end unemployment, enable universal, affordable medical insurance, promote broader coverage, leave employees with more take-home pay, and make American goods more competitive in world markets.  All at the same time.   

The key concept is “single-employer” i.e., a national employment system.

At present, this does not exist in the U.S. Instead, we have hundreds of thousands of separate employers, each with its own employment practices, business practices, payrolls, and other overhead. For example, every grocery store has its own employees, stock supply chain, pricing, and purchasing arrangements, etc. This is why in the separate-grocery business model, we have grocers in some neighborhoods who don't offer fresh produce while grocers in other neighborhoods stock an ample supply of fresh, healthful groceries. More generally, the separate-enterprise model for every businesses is the cause of most problems involving duplication of service in some places, inadequate access in other places, and irrational pricing.  This affects manufacturers, retail outlets, banks, insurance companies, medical offices, schools and colleges, and thousands of other enterprises. 

Economics and common sense both tell us that consolidation reduces unit costs, usually called "economy of scale".  So it's logical that consolidation of the separate-enterprise business model should be the goal. And that ultimately leads to a national, single employer.

The single-employer would be the federal government, which would be the sole national purchaser of labor. Government single employer would eliminate duplicative and needlessly expensive overhead of our present independent and poorly-coordinated employers. The cost of business administration and related payroll costs would plunge by easily 50%.

The trillions saved would permit the single employer system to employ everyone age 16 and above

No one would be denied a job. In fact, everyone would be compelled to work under penalty of law.  Not just junk jobs, mind you, but meaningful, high-paying jobs. The government would assign all jobs fairly, using modern, efficient government planning processes without regard to gender, race, national origin, education, or ability to work. Every working-age American will have a job, and earn a decent living wage paid from public funds. Result: the curse of unemployment is gone forever, financed by savings from the change to single-employer.

This means everyone would have medical insurance through their employer – the federal government.  Our medical insurance would cost much less than today because our medical care would cost much less.  That's because all workers in the medical fields, and those who supply the medical fields, as well as all workers in the insurance field, would be salaried employees of the government, and their salaries would be under strict control.  With lower-cost medical care, it would no linger be necessary for insurance plans to contain high deductibles, copays, coinsurance, and benefit limits.   All this would result in more financial security for Americans, higher take-home pay - and would make American goods more competitive in world markets.

The benefits of a Universal Single-Employer Plan are remarkable.  It's even more remarkable that no one thought of it, until now.  

What Do Doctors Think About Gun Violence?

Gun violence is a polarizing topic that seems to come up following violent crimes that make national headlines. They also creep into the discussion during political races.

But what is gun violence and can we really change things by legislation?

While this detours from our normal subject matter at InsureBlog it is still relevant to the substance of this blog because gun injuries usually also involve health care.

I recently came across an article in The Good Life, a Dr. Oz magazine. From a professional perspective, I try to avoid conversations about religion, abortion, politics (well maybe not all the time) and things like gun violence. But this piece was quite interesting because of the subjects who were interviewed.

In spite of the inflammatory lead in, I decided to press forward.

NINETY-TWO PEOPLE A DAY TIMES 365…THAT’S MORE THAN 33,000 AMERICANS WHO ARE KILLED BY GUNS EVERY YEAR.
More than double that, about 84,000, is how many are injured by guns annually. 

That certainly get's your attention. But it also begs the question, why are guns violent? Did they have a terrible time early on in their development or was the problem always then and then one day they just snapped?

The lead interview is with Dr. Milly Turakhia who is quoted as saying "You cannot tear down this problem just by taking away people's guns".

She goes on to address another public health issue, obesity. "We don't talk about locking up refrigerators" (in an effort to reduce obesity). Instead "We focus on wellness, education and prevention".

Her next comment is telling. She comes from Baltimore where the gun violence rate continues to rise despite the fact more guns are being seized.

More violence with fewer guns. Interesting paradox.

The article is a mix of moral, political and emotional comments. Overall it is balanced and a good read for those who are interested.

Feel free to read and offer your own comments. What doctors think about gun violence.

#gunviolence

Monday, March 20, 2017

Becoming a Christian Nation Because of Obamacare?

The 44th president of the United States proclaimed more than once that we are not a Christian nation. Whether his point was valid or not is subject to debate, but his claim will not be discussed in this post.
christian health care sharing minsistry

One thing that is clear, the plan that promised "If you like your plan you can keep your plan, and if you like your doctor you can keep your doctor" is also a divisive issue. #Obamacare has been, still is, and will be one of the health care hot points dating back to the backroom Missouri compromise and continuing through "repeal and replace".

My personal opinion is that Obamacare did more harm than good and we may never recover from this train wreck. I see no reason to repeal a plan that will most certainly be dead by the end of 2017. If the folks in DC had any sense they would craft a replacement plan and have it ready for roll out in 2018. Keep Obamacare in place, or at least what is left of it. And roll out Trumpcare/Ryancare as a competitor.

Let the people choose the option they want.

But then, no one ever said the folks in DC that make our laws had good sense.

Rather than DC picking winners and losers based on their interpretation of voter viewpoint, let the public decide.

About that opening question. Are we becoming a more Christian nation because of Obamacare?

Hard figures on enrollment in Christian health care sharing programs are difficult to come by but this report from US News offered up their findings.

Since Obamacare’s passage, health sharing membership has more than doubled, from about 200,000 to about 530,000, according to the Alliance of Health Care Sharing Ministries. The law exempts health sharing members from having to abide by its “individual mandate,” which obligates people to buy health insurance or pay a penalty.

While some may argue that covering 300,000 new members is a small number in the big scheme of things, the fact remains, something is causing people to abandon traditional health insurance and seek out a non-insurance solution. As a percentage, the ranks of Christian sharing programs grew more than any other health care financing options, including Medicaid. A 265% increase in members is nothing to make fun of.

And the better news is, no taxpayer dollars were involved.

Not just anyone can join these plans. You must sign an affidavit attesting to your religious beliefs and accept the lifestyle tenants of the bylaws. Some of the sharing ministries require an affirmation of your character while others do not.

This not-so-impartial site comes up in searches and can serve as a guide to those seeking refuge from Obamacare and into the waiting arms of sharing ministries. We are not endorsing the site, nor do we believe it is a substitute for your own vetting. Medical Cost Share is a slick marketing site to steer visitors toward enrolling in Liberty Healthshare. That program, or any of the competing programs may or may not be right for you but they are all considerably less than Obamacare premiums which look more like mortgage payments than health insurance premiums.

Caveat emptor.

#Obamacare #ChristianHealthcareSharingMinistry

Friday, March 17, 2017

New Final Expense Plan: KickStarter-style

Co-blogger Bob V tips us to this interesting new effort initiated by the folks at Legal and General America Life (corporate parent to Banner Life and William Penn Life), which "officially launched last week ALittleHelp.com, its new crowdfunding website dedicated solely to memorial funds."

Turns out, a lot of folks either don't buy or can't afford life insurance to pay final expenses, leaving families desperate for funds at their most vulnerable time. This led exec's at L&GA to launch this new crowdfunding program:

"We recognize that not everyone has gone through financial planning ... We deal with families every day that have gone through the planning. We just wanted a way to be there for those who haven’t."

Unlike established online crowdfunders like GoFundMe, L&GA's ALittleHelp.com won't be skimming off the top to cover overhead; it's worth noting, however, that funds do go through PayPal, which does charge transaction fees (although these are likely nominal).

There's even a way for folks to set up memorial funds for others who may not be as tech-savvy, or who don't have internet access themselves. The one thing that might be a turn off for some is that there's no anonymity for the beneficiaries:

"The person who is receiving the funds is disclosed on the website, so donors know who they are paying and that person can receive the money."

Nice to see carriers spearheading these kinds of efforts.

Kudos to Legal & General America.

Thursday, March 16, 2017

Anthem's Top 20 (Percent, that is)

This is interesting: Ohio law requires health insurers to publish a "list of the top 20% of services based on use" as well as how much each insured has to pay for each of them.

Last year, that top 20% of health care services covered by Anthem were:

■ Primary care office visits
■ Lab and Pathology services

To be frank, this surprised me: I would have bet money that prescription med costs would have broken into the top two.

Which is not to say that they didn't play a major role, but apparently far less than primary care and lab services. Which is also, perhaps, a decent argument in favor of Direct Primary Care.

We shall see.