Thursday, July 02, 2015

Beaver $tate Bucks

Regular readers may recall the Oregon health insurance Exchange as a spectacular failure:

"Things haven't gone so well in Oregon, however, where authorities have spent over $300,000,000 (that's 300 million dollars) to sign up ... well:"...not even one person has yet to enroll online"

Things got a little better, but eventually the state decided to pull the plug altogether. And yet, questions linger:

"A key House oversight panel is demanding ... all documents related to the failed Cover Oregon health care information exchange, which was abandoned last year after the state spent an estimated $300 million of federal grant money to build it."

That's a lot of cash for a failed effort, with apparently no accountability at the state level. One supposes that the state's case isn't helped by the fact that it's then-governor suspended the Exchange mid-reelection campaign, nor that he was ultimately forced to resign amid (apparently unrelated) criminal allegations.

Messy, that.

[Hat Tip: Hot Air
]

Wednesday, July 01, 2015

Yes, We Have Your Money

But we haven't posted it yet so you don't have coverage.

This is essentially what United Healthcare told Reynaldo Tamez.

Diagnosed with aplastic anemia, Tamez needs a hip transplant. UHC is not disputing the necessity of the transplant. But until they post his premium he doesn't have coverage.
The trouble began with a letter Tamez received on June 3, which stated he was not current with insurance payment.
The family called the insurance company, United Healthcare, and they told them that the payment was received, but it was not posted.
After weeks went by, Tamez called the company again. United Healthcare said he would receive his money back, but would not reinstate Tamez’s insurance. - KRGV

At least they weren't going to keep his money.

But then this happened.
CHANNEL 5 NEWS contacted the company; they said the company had a technical issue. United Healthcare reinstated Reynaldo Tamez’s insurance and paid his outstanding medical bills.
Wasn't Obamacare supposed to cure these problems?

Don't Bogart that Policy, Bro

Here's something you don't see every day:

"Marijuana users, who can now buy weed without fear of arrest in some U.S. states, can also get life insurance without facing a smoker penalty — if they shop carefully."

Apparently, some carriers are more lax regarding casual pot use than others. I know that we've seen a slight lifting of restrictions on occasional cigar smokers, so one supposes that this is just an organic outgrowth of that policy (SWIDT?). According to Munich Re (a major reinsurer), some 80% of life insurers have some kind of marijuana-use policy in place, and about a third of these classify such folks as non-smokers (presuming, of course, that there's no actual tobacco use).

This could save insureds significant premium dollars, so it's worth checking out if you use (or plan to use) the ganja.

Life & Death & The MVNHS©

Now that SCOTUS has pretty much locked in The ObamaTax, it may be helpful to know what's in store for us in the (not so distant) future:

"Mother of Two and Her Unborn Baby Both Die Just Days After She’s Diagnosed With Breast Cancer"

On the one hand, this is a great cost-savings device: no more care is required for either the mother-to-be nor her unborn son, and of course neither will be making any more claims on Britain's Much Vaunted National Health System©. So, win-win-win.

Doctors had at first dismissed her symptoms as nothing serious; even when they finally figured it out - too late, of course - they also found that it had metastasized to her lungs. She and the baby died a few days later.

Of course, the providers were all stripped of their credentials, fired and then sued into poverty by her now-widowed husband.

Hahahaha!

Oh, there'll be an inquiry, and much gnashing of teeth and wringing of hands, and that will be that. Such is life (and death) and the MVNHS
©.

Tuesday, June 30, 2015

Creative Writing

A long time ago I took a college course in creative writing. The instructor encouraged us to use our imagination to write stories, fact or fiction. Just make sure it is entertaining.

Seems an insurance agent in North Carolina decided to do his own kind of creative writing.

Using a bird dog, Charlotte agent Will Kennedy submitted some 600 Obamacare applications in a relatively short time frame.

All from homeless people.

Many with the same address.

And all having exactly $11,700 in projected income.

Just enough to qualify for the maximum subsidy.

If you look beyond the questionable tactics, otherwise known as creative writing, there is this.
Huggins is among dozens in Charlotte who are learning that their “free” coverage requires them to cover a $5,000 deductible and costs them eligibility for some of the free medical services they’ve relied on.
“We have people who really need their medicine, and we can’t give it to them,” said Susan Royster of Charlotte-based NC MedAssist, which provides free prescription drugs for the uninsured. - Charlotte Observer

The homeless gained insurance they neither wanted nor could afford.

In gaining coverage they lost other "free" social services.

The agent picked up commissions on some 600 new clients.

Such a deal.

Minnie the Moocher would be proud.


Monday, June 29, 2015

Monday LinkageFest

■ Death. Taxes. Health Insurance. New ObamaTax forms are soon to be on their way (most likely):

"If the Internal Revenue Service (IRS) implements the current rules as planned, insurers will have to send 1095-B coverage notice forms for the 2015 plan year in early 2016."

What's that mean? It means that large employers will have to send these forms to covered employees (kind of like W-2's or 1099's), which employees will then need to enclose with next year's tax returns. The ostensible reason is to allow the Feds to confirm that said taxpayer did, indeed, have appropriate coverage.

Exit question: who really believes that these forms won't ultimately result in additional taxes?

■ A few short weeks ago, it was the prospect of UHC eyeing Aetna, and Anthem smacking its lips over Humana. But things are never what they seem:

"Aetna, the second-largest U.S. health insurer by market value, is closing in on an acquisition of Humana"

First, consider me gobsmacked: I coulda sworn that UHC occupied the #2 slot. Second, expect this kind of consolidation to continue as profit margins shrink and companies vie to position themselves as administrators of the coming Single-Payer scheme.

■ Folks in smaller groups ought not be pointing and laughing at Item #1 above:

"Employers in the 51-100 employee size bracket are anxious about the prospect of being added to the “small group” market that under the Affordable Care Act (ACA) currently cuts off at 50 employees."

And why is that?

Well, those considered "small groups" have more stringent coverage requirements than their larger brethren, including the "10 Essential Health Benefits" mandate. Net result: "an immediate impact on premiums due to new rating rules."

And they don't mean "downward."

You Say Goodbye, I Say Hello

The "Hello, Goodbye" song by the Beatles could be fitting in light of the
SCREWTUS decision on same sex unions. The New York Times finds that some companies with domestic partner health insurance coverage may say goodbye to those benefits now that there are no barriers to marriage.

Some large employers — including Verizon, Delta Air Lines, IBM and Corning — already have. They rescinded domestic partner benefits to employees living in states where same-sex marriage was legalized and replaced it with spousal coverage. Last July, Verizon gave its employees until the end of the year to decide whether to marry. IBM gives employees a one-year grace period, though a spokeswoman said the time frame was under review; Delta said it provided a grace period as well, about two years. And some states have sought rollbacks as well. - NYT

Elections, and Supreme Court decisions, have consequences.

Be careful what you wish for.

Thursday, June 25, 2015

SCOTUScare Fallout

Well, that didn't take long:

"Obamacare Ruling May Have Just Killed State-Based Exchanges"

Indeed. Why would a state - any state - continue to throw money and other resources into maintaining their own HIX? Actually, there's a delicious irony here: Herr Gruber himself maintained that the law was written to encourage states to set up their own Exchanges (in order for their citizens to qualify for subsidies). Absent that bribe, er, motivation, the only rational action is to move your folks to 404Care.gov.

[Hat Tip: FoIB Holly R]

And thus ends the Rule of Law

Words mean nothing:

"[T]he Supreme Court on Thursday upheld ObamaCare subsidies in states that did not set up their own health care exchanges. 

The decision was 6-3."
And thus is born SCOTUSCare.

And BTW: This means that both the (Evil) Individual and Employer Mandates stand. So we have that going for us, which is nice.

Risky Roundup

■ Last month, we mentioned some of the very positive results that would arise from a Plaintiff's victory in King v Burntwell. Today, Cato's Michael Cannon offers even more, noting that "the benefits of a ruling for the challengers would swamp all other effects."

A few:


·  Over 11 million citizens "freed from an illegal tax averaging $1,200

·  A pay raise of over $900 for affected employees

·  Almost 240,000 new jobs
And the list goes on.

■ FoIB Allison Bell wonders about the implications of a failed Palmetto State CO-OP, which left (on average) some $2,400 per enrollee in unpaid claims. Some are covered by their states' Guaranty Fund, but some aren't. It depends on whether or not the plan is considered a MEWA, and thus not eligible:

"South Carolina Health Cooperative was a nonprofit, member-owned MEWA formed outside the PPACA system. Because it was not classified as a health plan under South Carolina law, its members were not eligible for guaranty fund protection"

This could prove to be a major problem as these types of plans continue to fail.

■ Ever heard of Bitcoin? It's a non-government-backed "virtual" currency that's become attractive as both an alternate payment method and an investment strategy. But it's also risky business: with no government to backstop it, what happens if the value collapses? And since it's virtual (that is, completely on-line, with no physical analog), there are added cyber-security risks, as well:

"[G]lobal insurance giant Lloyd’s of London released a report titled *Bitcoin: Risk Factors for Insurance* ...  businesses seeking to enter the virtual currency marketplace—whether by running an exchange, holding bitcoins in secure “wallets” for users, or simply accepting bitcoins as payment—must be aware that Bitcoin’s “security risk will never be reduced to zero.”

On the one hand, I'm not convinced that **any** risk can be "reduced to zero" (else it's no longer "risk") but the point here is that the currency is now ubiquitous enough that it represents a significant risk factor for businesses.

Interesting stuff.

Tuesday, June 23, 2015

Generous Carrier Tricks

Our on-going Stupid Carrier Tricks series is generally over-represented, so it's nice to be able to add one on the positive side. Medblogger Lisa Emrich daily chronicles her thoughts and strategies as she battles MS; she also reports significant events on Facebook, where she recently posted this:

"Some readers doubted my description of an insurance company who pays much more than hospital charges for an infusion. See details from the EOB."

Turns out, her Grandfathered health insurance plan (from Carefirst BCBS) allows for very generous benefits, especially when it comes to treating her MS.

How generous, you ask?


This generous:
 

That's right, they actually allow a greater amount than what her provider ended up charging her, and this was in turn reflected in her balance due. And, of course, the amount she pays in co-insurance helps reduce the balance for the rest of the year.

Reason I mentioned her Grandfathered status is that this plays a role in the overall scheme of things. Lisa tells me that "I absolutely appreciate the 10% coinsurance which is why I've kept this grandfathered plan. After Carefirst processes the 2nd infusion (in June), I will have fulfilled my max OOP (for medical) for the year." Nice.

Bottom line: it's nice to know that some carriers really do try to help out their insureds whenever possible. Chalk one up for the good guys.