Obamacare | GSU Prof. Bill Custer Whiffs It

According to Georgia Health News citizens of the Peach State will have 7 (but in reality only 6) carriers to pick from when the 2014 Obamacare exchange, uh, marketplace rolls out this fall.

Aetna, Alliant, Blue Cross and Blue Shield of Georgia, Coventry, Humana, Kaiser Foundation Health Plan, and Peach State will offer a range of plans for individuals in Georgia as part of the Affordable Care Act’s exchange, or “marketplace,” which will debut in 2014.

Aetna is/will be buying Coventry so really only 6 players.

But that isn't where Custer made his last stand. It was this comment that raised an eyebrow.

“On average, these plans are coming in slightly less than premiums of employer plans,’’ said Custer.

He said he based that assessment on premiums for a single person in employer plans in the 2012 Kaiser Family Foundation/HRET benefits survey, where an HMO plan for an individual in the South averaged $456 per month.

“A lot of the fears about premium shock are unfounded, at least in these preliminary filings,’’ Custer said.

For starters, averages are mostly meaningless unless the buyer is . . . average.

But where Prof. Custer really blows it is in comparing individual rates (and apparently nothing else) with group rates.

Small group starting rates are roughly 2x individual rates for similar plans.

It would appear Mr. Custer also failed to consider the tiny networks that will be used by carriers participating in HIX and the even skinnier drug formulary.

Custer believers will be sadly disappointed when 2014 rolls around. I wonder if we should grade his advice on a curve?

Excessive Hospital Profits

These days it seems like everyone is a financial expert and wants to cast stones at people or companies they believe are "excessively wealthy" or "unjustly profitable".

The latest group is, of all people, a nurses association, that claims that hospitals are now the villains raking in obscene profits.

The nurses' research found what appear to be staggering statistics: U.S. hospitals charge on average $331 dollars for every $100 of their total costs, a 331 percent charge-to-cost ratio. From 2009 to 2011 (the most recent year for which the data is available), hospital charges lunged upward by 16 percent, while hospital costs only increased by 2 percent.

“There is no other word for this than price gouging,” said Deborah Burger, co-president of NNU whose research arm, the Institute of Health and Socio Economic Policy produced the findings based on an analysis of publicly available Medicare Cost Reports.

Benefits Pro

I realize most of these nurses probably never took a business course, but let's hope they know how to balance a checkbook. I will go out on a limb here and assume some of them have filed a health insurance claim at one point in their life, and then took the time to review the EOB.

If they did it would be obvious that the amount collected by the hospital bares no relationship to the actual billed charges.

Hospitals are like any other business in that, they report earnings based on collected revenue less expenses.

Almost no one pays sticker price for a car, or full fare for airline tickets. I wonder if these nurses believe car companies and airlines report earnings based on the full price?

If hospitals really were guilty of making a 331% profit EVERYONE would want to get in that game. I don't know about where these nurses live, but here in Atlanta hospitals are closing their ER and L&D departments because . . . they are losing money.

I guess they want to just hang on to the surgical and critical care parts that are the money makers.

So while the nurses believe the word of the day is price gouging, I would say there is a different word. I would describe the nurses as part of the low information crowd.

Outstanding Carrier Trick

As we reported almost 8 years ago, in our exclusive interview with its Medical Director Dr Dexter Campinha-Bacote, Aetna has long been in the forefront of health care transparency.

Now, our good friend David Williams blogs that the carrier has "won an Award of Distinction  for its short videos designed to help members comprehend and use their benefits."

David offers some great reasons why he approves of this development, and singles out Aetna's terrific payment estimator in particular:

Kudos, Aetna!

About that Union Label

Nice to see the legacy media catching up with us:

"[S]ome unions leaders have grown frustrated and angry about what they say are unexpected consequences of the [ObamaTax] ... The problem lies in the unique multiemployer health plans that cover unionized workers ... union plans were already more costly to run than traditional single-employer health plans. The [ObamaTax] has added to that cost"

Gee, who could have seen that coming?

Oh, yeah.

And it's not just the unions, either. A large majority of Americans (56%) believe it would be "[b]etter to go back to previous system" (pre-ObamaTax).

And this is before the Exchanges and (Evil) Mandate kick in.

What could *possibly* go wrong - An Update

Last week, we noted that the IRS was knee-deep into building the enforcement mechanisms for the ObamaTax. But just how deep are they really?

This deep:

"The Internal Revenue Service ... has created eight offices and special "teams" to handle the chore, way more than initially revealed."

And just how "special" are those teams? Here's 1000 words on them:

[Click graphic to embiggen]

Hospital Claim of the Day

Received an audit back on behalf of a client. When we can our plans only pay Hospitals their cost plus a 12% profit margin or Medicare plus 20%, which ever is greater. A member went to a new Spine Surgery Center and the bill was $8,300. Medicare + 20% was $620.28. Billed Charges are 1300% increase of Medicare allowable.

Luckily this new facility was out of Network so we don't have a PPO telling us we have to pay inflated prices. Even a 50% discount, top side for this market, would have been over a $4,000 bill.

Cavalcade of Risk #184: Call for submissions

Jeff Rose hosts next week's Cav. Entries are due by Monday (the 27th).

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

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.

Obama Skinny Plan Irony

Prior to ObamaCare a few million people had these not-quite-insurance insurance mini med policies. The administration and pro-reform crowd decided people who purchased these plans needed protection from themselves and set out to wipe them away. Some of these forsaken plans had limits only in the tens of thousands. They might only pay a few hundred dollars per day for hospitalization or surgery.The requirement that plans have no limits, annual or lifetime when fully implemented would see these plans die a deserved death.

These helpless souls had much to look forward to under Obamacare, why they would have full comprehensive coverage at an affordable price....

....or not:

"Wonder what a “skinny” or “low-benefit” insurance plan is? The terms may vary, but the basic idea is that policies would cover preventive care, a limited number of doctor visits and perhaps generic drugs. They wouldn’t cover things such as surgery, hospital stays or prenatal care"

Thanks to ObamaCare they now have even fewer benefits then they had before.

Health Wonk Review: Cereally? Edition

Brad Wright offers up a clever, lighthearted and (his word) sardonic take on the Health Wonk Review. From Einstein to Beckham, angels and bell curves, you're sure to find something to amuse, enlighten and/or enrage you.

Kudos, Brad!

Insurance Library

The editors of InsureBlog are pleased to add Insurance Library to our all star blogroll.

I am very familiar with the originators of Insurance Library and know how much they give back to the public in the form of educational blogs and forums. Insurance Library is a new site but is rapidly growing their visitor count on a daily basis.

Consumers can review questions and answers on over 3,000 topics ranging from auto insurance to homeowners, life insurance, health insurance and Medicare. Insurance Library tries to take the mystery out of a complex problem and provide solutions that are workable.

Agents are allowed to participate by invitation only and will provide answers to a wide range of questions.

If you don't see a question that addresses your issues you may pose your own. In most cases a response will appear in 48 hours or less. Some very specific questions take more time to research, especially those that ask if a particular drug is covered by insurance.

Agents that participate have biographical information available including links to their website. If you would rather have your question addressed in private you may contact an agent of your choosing.

We hope you will visit Insurance Library and find it helpful.

You'll also find the link in our Blogs of Interest in the sidebar.

Doctor's orders

"ObamaCare is ... demoralizing doctors, distracting providers toward bureaucracy and away from patient care. It is disrupting quality and access, and damaging health."

Says whom?

Says Dr Charles Willey, "CEO of Innovare Health Advocates in St. Louis, a medical group employing five physicians and five nurse practitioners in five offices."

Dr Willey is suing the Feds to try to derail the "train wreck," focusing on the IRS's unique and powerful role in enforcing ObamaTax provisions. He points to government overreach like  the IRS's "attempt to enforce those penalties in states like Missouri" which, like 32 others, opted out of establishing its own state-run Exchange.

Best of luck to you in your efforts, Dr W.

[Hat Tip: FoIB Holly R]

The Grease Fire Spreads [UPDATED]

First HHS "suspended" enrollment into PCIP because of insufficient funding. Now comes word that HHS will be cutting payments to providers who treat those in PCIP. From the New York Times:

Under a new policy issued by Kathleen Sebelius, the secretary of health and human services, “health care facilities and providers will get paid less” for providing the same services to patients in the federal program, known as the Pre-Existing Condition Insurance Plan.

The article further stated:

Federal health officials said the alternatives were worse. If the program runs out of money, they said, some sick people will lose access to health care, and others will be unable to pay for the treatments they receive, forcing doctors and hospitals to write off large amounts of “uncompensated care.”  

In a regulation to be published Wednesday in the Federal Register, the administration says that doctors and hospitals must accept the amounts set by the government as “payment in full” for services in the high-risk pool administered by the federal government. 

On a related note, Ms. Shecantbeserious was busy touting the law in Europe. She "characterized the Affordable Care Act as part of a global movement toward better health through government-led reform."

Based on her words, one would guess that Government will need to seek additional funds (taxes?) while also cutting payments for health services (rationing?) Yep. This is our future under Obamacare.

UPDATE [HGS]: And some breaking news this afternoon on the PCIP front:

"Eighteen states have decided to turn their state Pre-existing Condition Insurance Plan (PCIP) programs over to [HHS Secretary Shecantbeserious]."

As Patrick notes above, the reduced payment scheme is going to really hurt prospective providers, and hence any patients that might want to be treated. But let it never be said that Madame Secretary's minions lack a sense of humor:

"These actions will help ensure the program's smooth transition to 2014"

Droll.

On the Oregon ObamaTrail

Well, some good news for Beaver State residents who may be shopping for health insurance this fall. Unlike so many other states, carriers seem to be supportive of Oregon's Exchange:

"The Oregon Insurance Division has posted individual and small-group rate proposals for 2014 ... rate proposals from a total of 16 conventional carriers and two new CO-OP plans for the exchange and non-exchange markets."

Oregon is one of the minority of states that has chosen to implement its own Exchange, rather than rely on Ms Shecantbeserious and her minions to do so on its behalf. Noticeably absent from the list of participating carriers are Blue Cross and United Healthcare, two rather large elephants in the room. They've chosen to cast their lot with the non-Exchange market, instead.

Interesting developments.

Just 12 Easy Payments

Need Obamacare insurance? No problem. Click or call the exchange in your state using your Obama-phone. Complete the 20+ page Obama-application for financial assistance. Once approved you pick an Obama-plan and then in just 12 easy payments you will be the proud owner of your new Obamacare health insurance plan.

But wait.

Paying for it (even after financial assistance) may be a challenge for some.

For ordinary Americans deemed unbankable, those who don’t have a traditional checking or savings account, it can be hard to simply pay bills. And that is about to become a big problem for those who also lack health coverage -- and for the health insurance companies trying to sell them coverage. After all, how do you sell a product to a customer who has no way to pay you?

KHN

Money order? 

This is a problem for about 20% of the population. Wonder if the folks at HHS thought about this?

Nah.

The new federal health law which requires most Americans to carry health insurance starting in January presents a particular problem for those households, since most health plans accept a credit card for the first month’s premium payment and then require customers to pay monthly with a check or an electronic funds transfer from a checking account.

The solution is simple.

REQUIRE everyone to have a credit card and a bank account.

Or REQUIRE the insurance carriers to accept EBT cards.

Buy here. Pay here.

No problem.

Unexpected Insurance Headlines

Offered without comment:

MetLife removes alien status from captive

Help Wanted

We've already noted that carriers seem to be actively avoiding the Exchanges due to go online in the next few months. Of course, that's for the individual market - the small group market must be doing gangbusters, though, right?

Right?

Turns out, maybe not:

"The California Health Benefit Exchange has put out a call for general agents ...  to recruit, train, supervise and support the retail agents that help the small employers that sign up for the state's Small Business Health Options Program (SHOP) exchange plans."

But why should they?

All along, agents have been told, at least implicitly, that their services aren't necessary (cf: Navigators). Agents must undergo fairly extensive scrutiny and training, and must continually update their professional education. All of which comes at a cost, in time and in money. Of course, the folks in Sacramento understand the value of the agent in the process, and are willing to pay for the very best.

No, I didn't think you'd fall for it:

"Exchange managers want general agents to keep estimates for total costs under $3 million"

Really, and just how many groups do they think will sign up?

Small Businesses are Exempt from PPACA?

A couple of weeks ago The Hill reported that 48% of small business owners believe that PPACA will hurt their business. In the article there is a quote from President Obama about the impact this will have on small business. He said: "Some small businesses are being told their costs are going to go up, even though they're exempted from the law" or stand to benefit from it.

I am a small business owner working within a large insurance agency. I have two employees and I provide benefits including medical insurance. Under our arrangement I currently pay 100% of the premiums. I have been able to do so because we are a healthy low risk and because my employees understand the value of the benefit and know that it is part of the overall compensation package.

I strongly object to the notion that I am exempted from the law. It is true I can drop coverage and not pay a penalty. But that would put my employees into exchanges where every dollar they have to spend in premiums is more than what they currently pay. My key employee, based on family income, wouldn't qualify for a subsidy. She (52) and her spouse (53/smoker) would be looking at a $15,000 pay cut. For this key employee I currently pay around $8,700 a year. Even if I gave her a raise by that amount it still costs her a ton of money out of pocket.

We will also see our premiums go up. Our insurance company has informed us that because of community rating we are looking at an increase of 50% or more. On top of this factor we also will pay a PCORI fee, a reinsurance fee, a risk adjustment fee, and a market share fee. In total these fees will represent roughly a 3% increase. Add to that we now must provide an array of additional benefits without limitations that we don't use nor need. Last, they will also charge us more because our industry code is a low risk one.  In total my guess is the costs will rise by close to 75%.

My premium increases are going to make it unaffordable to remain in business and dropping coverage simply shifts an enormous burden onto the people who help the business be successful. So, my question to President Obama and HHS is please explain how my business stands to benefit from PPACA?

Dumber and Dumberer

As the Exchange Countdown Clock slowly - inexorably - winds down, our attention turns to the eternal question: "what's next?"

Ostensibly, folks who plan on buying their new health insurance from one of the public Exchanges will turn to one of those new-fangled "Navigators" for help. After all, these folks are new to the insurance purchasing process, and need highly trained folks brimming with integrity and advanced insurance knowledge.

Or maybe not:

"At a private briefing with federal officials last month, committee aides say they were told there would be no criminal background checks for navigators or requirements that they hold a high-school diploma"

Contrast this to actual licensed insurance agents. Here in Ohio (and I imagine these requirements are fairly universal across the other 57 states) one must have (at least) a high school diploma (or equivalent), take 40 hours of pre-licensing training, pass a rigorous licensing exam with a minimum of 70% correct answer, and complete over 20 hours of Continuing Education every two years.

Now who would you trust with your financial and personal information, let alone to help guide you to an informed purchasing decision?

Yeah, thought so.

PCIP Could Save the World

or at least the US Private Insurance system. It is an old rule of thumb that 20% of your population accounts for 80% of your claims. Hospitals account for 50% of all spending and most of the excessive cost and profit.

PCIP found this out when they blew through their allotted 5 billion to quickly. Being from the Government and always looking to help they had a very effective solution;

http://www.lifehealthpro.com/2013/05/17/feds-post-pcip-regs

"The federal PCIP program run by the U.S. Department of Health and Human Services (HHS) will set most reimbursement levels at just 100 percent of the Medicare reimbursement rates, officials said"

For doctors this might be a slight haircut but for large hospitals, the ones racking up large bills, used to getting 300-400% of Medicare, or more, this will be noticeable.

If the Government was truly interested in being useful they would provide catastrophic insurance to reign in hospital spending and leave all the day to day care and the other 80% of the population alone. This would immediately make insurance affordable for the majority of the country which would likewise drop the percentage uninsured. It would also do so without all the other intrusive programs and requirements of the ACA.    

The ObamaTax Dodge

As employers quickly realize that the ObamaTax will not, in fact, be lowering premiums by 3000%, they (and their agents) have begun looking for ways to minimize the impact.

Contrary to popular belief, new ObamaTax plans don't actually have to be all that benefits-rich. In fact, the Feds themselves agree that a plan which covers basically just the Minimum Essential Benefits "would appear to qualify as acceptable minimum coverage under the law, and let most employers avoid an across-the-workforce $2,000-per-worker penalty for firms that offer nothing."

That is, an employer could drop his existing full-coverage (or Catastrophic, for that matter) plan in favor of one of these "bare bones" configurations (Bob, you were way ahead of your time!). Coupled with a supplemental plan to cover some days in the hospital and the like, and the landscape suddenly changes.

This may prove especially attractive for employers with low-wage employees, who want to avoid the ObamaTax employer mandate penalty but can't afford to offer full-blown coverage. And if the premiums are low enough, perhaps those subsidies will cover the lion's share of their premiums.

Interesting concept.

JeffLinks Tuesday

FoIB Jeff M sends along two very helpful ObamaTax items.

First, courtesy of the Kaiser Foundation, a helpful (and free!) ObamaSubsidy calculator. This will no doubt help take some of the edge off those massive premiums hikes looming on the horizon.

But probably not.

Second, if you're a business owner, heads' up. Ms Shecantbeserious has released  a handy little FAQ sheet with timely (right) info on the SHOP (Small Business Health Options Program).

'Course, that presupposes that these things will ever actually get off the ground.

You can download the FAQ here.

Stupid Carrier Trick - Logging edition

Recently, I sold and delivered a policy to a client who, when applying, chose the monthly draft ("check-o-matic") premium payment option. This is a convenient way to budget premiums and, at least with this company, the second least expensive way to do so (typically, carriers impose a surcharge depending on how often premiums are paid - monthly, quarterly, etc). When the policy was approved and we had set an appointment for delivery, he indicated that he'd decided to change to annual pay.

Not a major issue - I notified our general agent (GA) for that carrier, and an amendment form was included with the policy. So far, no big deal. When I delivered the policy, I had the client sign that form (along with approximately 273 others) and sent it back in the handy, pre-paid envelope.

So far, so good.

You can imagine my surprise, then, to receive an email from the GA that "the new, re-issued policy" was on the way.

What new, re-issued policy?

Turns out, this carrier - even though we had signed and returned the amendment form - has decided that it needs to re-issue the entire policy, and over the weekend I received another half pound of paper (really!). Sent to me for a mere $2.50 of USPS postage.

I am far from a "tree-hugger," but even I find this offensive. Nothing substantive changed in the policy - why wouldn't the carrier simply print up and send out a little "certificate" noting the change?

Sheesh!

Rate Kaboom!

We've been warning about this for quite some time: if you think health insurance rates are bad now, just wait until the ObamaTax is in full swing.

But what do we know, anyway? Remember our Dear Leader promised rates would plummet by 3000%.

Turns out, not so much:

"Internal cost estimates from 17 of the nation's largest insurance companies indicate that health insurance premiums will grow an average of 100 percent under Obamacare, and that some will soar more than 400 percent"

Math sure is hard.

[Hat Tip: FoIB Jeff M]