Wednesday, August 31, 2011
Aetna Savings Plus info bleg
Looking for info on Aetna's new Savings Plus plan, currently marketed exclusively in the Cleveland (OH) area. Specifically interested in cost differential with their "regular" plans. Please drop me an email if you have relevant info.
Thanks!
Thanks!
Tuesday, August 30, 2011
More from the "D'unh!" Dept
There's actually quite a bit of schadenfreude in this article, but this damning indictment of ObamaCare© is actually far, far more damaging than anything we've ever written:
"The uninsured ranks among adults over 27 years old swelled from January through April of this year, according to Gallup, with 27- to 35-year-olds seeing the highest uptick. Nearly 27 percent of them are now uninsured."
What's so interesting about that (unvetted) number is that it represents an increase from the "record 50 million in 2009."
In other words, just like the Spendulus, ObamaCare© has actually exacerbated the problem, rather than resolve it. No worries, though, everything will be just peachy keen come '14.
"The uninsured ranks among adults over 27 years old swelled from January through April of this year, according to Gallup, with 27- to 35-year-olds seeing the highest uptick. Nearly 27 percent of them are now uninsured."
What's so interesting about that (unvetted) number is that it represents an increase from the "record 50 million in 2009."
In other words, just like the Spendulus, ObamaCare© has actually exacerbated the problem, rather than resolve it. No worries, though, everything will be just peachy keen come '14.
ObamaCare© Underwater
While the Northeast continues to drown from the effects of Irene, ObamaCare© continues taking on water, as well:
"Americans' opinion of Obamacare has reached an all-time post-passage low according to the Kaiser Health Tracking poll. Only 39% of those surveyed have a favorable view of the law"
That's a further 2 point drop since the spring of '10. What's particularly bothersome for its proponents is that support among Dems and Indies continues to fall. Inexplicably, Pubbie support has risen to 24% (kind of like being the tallest midget, one supposes).
Now, bad polling numbers doesn't equal repeal, but it certainly indicates that as the train-wreck's impact on health care and health insurance continues to further erode its support.
"Americans' opinion of Obamacare has reached an all-time post-passage low according to the Kaiser Health Tracking poll. Only 39% of those surveyed have a favorable view of the law"
That's a further 2 point drop since the spring of '10. What's particularly bothersome for its proponents is that support among Dems and Indies continues to fall. Inexplicably, Pubbie support has risen to 24% (kind of like being the tallest midget, one supposes).
Now, bad polling numbers doesn't equal repeal, but it certainly indicates that as the train-wreck's impact on health care and health insurance continues to further erode its support.
Grand Rounds is up!
Fisher at the Health 3.0 blog has a very cool edition of Grand Rounds today, selecting quotes from each post and "tagging" them based on different themes.
Monday, August 29, 2011
Look out below!
We last noted the fact that ObamaCare©=Doom for group health plans about two months ago. As we've noted all along, any sane employer is going to take a look at the Exchanges, then at the employer mandate and its concomitant fines, do some quick math, and come to the entirely rational conclusion that dropping group health coverage is a "no-brainer."
A few days (months) late and a few dollars short, the McPaper has finally glommed onto this exciting news:
"Nearly one in 10 midsize or large employers expects to stop offering health coverage to workers once federal insurance exchanges start in 2014"
Says whom?
Says Towers Watson, a major employee benefits consulting firm. And it's not just TW; Mercer (another independent health care and financial services research firm) has reached a similar conclusion: "8% are either "likely" or "very likely" to end health benefits once the exchanges start."
The TW report is actually a bit scarier (if one's spooked by these sorts of things), because it identifies another 20% of employers currently straddling the fence. What are the odds that the bulk of these are going to end up keeping their group plans?
Yeah, that's what I thought, too.
As a matter of policy, of course, I'm in the "anti-group" camp; that is, I don't think that one's health insurance should be tied to one's employment. But this isn't the way to get there.
[Hat Tip: Stop The Hit]
A few days (months) late and a few dollars short, the McPaper has finally glommed onto this exciting news:
"Nearly one in 10 midsize or large employers expects to stop offering health coverage to workers once federal insurance exchanges start in 2014"
Says whom?
Says Towers Watson, a major employee benefits consulting firm. And it's not just TW; Mercer (another independent health care and financial services research firm) has reached a similar conclusion: "8% are either "likely" or "very likely" to end health benefits once the exchanges start."
The TW report is actually a bit scarier (if one's spooked by these sorts of things), because it identifies another 20% of employers currently straddling the fence. What are the odds that the bulk of these are going to end up keeping their group plans?
Yeah, that's what I thought, too.
As a matter of policy, of course, I'm in the "anti-group" camp; that is, I don't think that one's health insurance should be tied to one's employment. But this isn't the way to get there.
[Hat Tip: Stop The Hit]
MVNHS©: Let's play "Leapfrog!"
As we noted almost 3 years ago, the MVNHS© has (at least) one dirty secret: private health insurance to help pay the bills that their "free insurance" doesn't cover.
And while we're seeking to emulate the British healthcare scheme, they're looking to dump it:
"Private patients will increasingly be able to "leapfrog" those on the NHS due to changes proposed in the Government's health reforms ... Even 14 of the elite group of foundation trusts ended the last financial year in deficit, a grim warning for the future of NHS finances" [ed: "trust" is MVNHS©-speak for "hospital"]
Wait, what?!
There's "grim news" about the British system's finances? But I thought that they're saving money hand-over-fist, all the while delivering healthcare far superior to us? And what's this about "private patients?" Haven't we been told that a nationalized scheme was so much more fair than our current system, since it deletes that very distinction?
It's almost as if we've been lied to all along.
And while we're seeking to emulate the British healthcare scheme, they're looking to dump it:
"Private patients will increasingly be able to "leapfrog" those on the NHS due to changes proposed in the Government's health reforms ... Even 14 of the elite group of foundation trusts ended the last financial year in deficit, a grim warning for the future of NHS finances" [ed: "trust" is MVNHS©-speak for "hospital"]
Wait, what?!
There's "grim news" about the British system's finances? But I thought that they're saving money hand-over-fist, all the while delivering healthcare far superior to us? And what's this about "private patients?" Haven't we been told that a nationalized scheme was so much more fair than our current system, since it deletes that very distinction?
It's almost as if we've been lied to all along.
Friday, August 26, 2011
Helping Jerry's Kids
Well, that's how I still think of them, anyway.
This year, I've agreed to participate in the "MDA Lockup" program, and hope to raise $1,600 by hook or by, well, phone, email, and the Web:
This year, I've agreed to participate in the "MDA Lockup" program, and hope to raise $1,600 by hook or by, well, phone, email, and the Web:
Please help out - all it takes is a click or two and a few dollars to help finally beat this terrible disease.
CLARIFICATION: I've had a number of folks tell me that they've decided not to participate because of how the MDA HQ (apparently) treated Mr Lewis. No disagreement here; in fact, I also did some soul-searching before agreeing to help out. For me, it came down to the fact that I didn't want to punish Jerry's kids because of rank bureauweenie stupidity. YMMV.
CLARIFICATION: I've had a number of folks tell me that they've decided not to participate because of how the MDA HQ (apparently) treated Mr Lewis. No disagreement here; in fact, I also did some soul-searching before agreeing to help out. For me, it came down to the fact that I didn't want to punish Jerry's kids because of rank bureauweenie stupidity. YMMV.
Is this a blip?
From the "Not Sure What to Make of This" Dept:
"Larry Klayman ... just won a round in court against the Obama administration's health care reform effort ... Freedom Watch, filed suit in 2009 against President Barack Obama and what Klayman called the "Obama Health Reform De Facto Advisory Committee."
Takeaway is that Big Pharma, Big Business, AARP and the AMA allegedly conspired to get ObamaCare© passed over the (vociferous) objections of the American People.
As an aside, this is pretty much what doomed HillaryCare, too: secret meetings with no transparency or accountability.
At this point, the judge has ruled only that Mr Klayman (et al) has met a sufficient burden of proof to enable him to get to the next round. It'll be interesting to see what, if anything, ultimately comes of this.
"Larry Klayman ... just won a round in court against the Obama administration's health care reform effort ... Freedom Watch, filed suit in 2009 against President Barack Obama and what Klayman called the "Obama Health Reform De Facto Advisory Committee."
Takeaway is that Big Pharma, Big Business, AARP and the AMA allegedly conspired to get ObamaCare© passed over the (vociferous) objections of the American People.
As an aside, this is pretty much what doomed HillaryCare, too: secret meetings with no transparency or accountability.
At this point, the judge has ruled only that Mr Klayman (et al) has met a sufficient burden of proof to enable him to get to the next round. It'll be interesting to see what, if anything, ultimately comes of this.
Wednesday, August 24, 2011
Good News/Bad News: Cardio edition
Unlike our unfortunate Neighbors to the North© or Cousins Across the Pond©, our hospitals are setting records for how quickly patients are seen:
"[H]ospitals are treating almost all major heart attack patients within the recommended 90 minutes of arrival, a new study finds. Just five years ago, less than half of them got their clogged arteries opened that fast."
In fact, whereas it took (on average) better than an hour-and-a-half "on line" only 6 years ago, that time was cut by about a third, to just over an hour in 2010. And that's not a one-off, rare occurrence, either:
"Americans who have heart attacks can now be confident that they're going to be treated rapidly in virtually every hospital of the country"
Says whom?
Says Dr. Harlan Krumholz, a cardiologist at Yale. And he should know, since he's the one who led the study that unearthed these terrific findings.
But that's still not the best part. This is:
"[I]t occurred without money incentives or threat of punishment. Instead, the government and a host of private groups led research on how to shorten treatment times and started campaigns to persuade hospitals that this was the right thing to do."
Too bad that this great news will be short-lived.
"[H]ospitals are treating almost all major heart attack patients within the recommended 90 minutes of arrival, a new study finds. Just five years ago, less than half of them got their clogged arteries opened that fast."
In fact, whereas it took (on average) better than an hour-and-a-half "on line" only 6 years ago, that time was cut by about a third, to just over an hour in 2010. And that's not a one-off, rare occurrence, either:
"Americans who have heart attacks can now be confident that they're going to be treated rapidly in virtually every hospital of the country"
Says whom?
Says Dr. Harlan Krumholz, a cardiologist at Yale. And he should know, since he's the one who led the study that unearthed these terrific findings.
But that's still not the best part. This is:
"[I]t occurred without money incentives or threat of punishment. Instead, the government and a host of private groups led research on how to shorten treatment times and started campaigns to persuade hospitals that this was the right thing to do."
Too bad that this great news will be short-lived.
Why I Dropped My Series 6: Reason #4,392
In addition to their "regular" insurance license requirements, agents who sell variable (ie securities-based) products must also have special licenses regulated by the Feds. These kinds of products would be mutual funds, and variable life insurance policies and annuities.
They do not (currently) include equity-indexed products (but don't be surprised...)
In the event, I used to hold such a license, and sold a few variable policies (and a handful of mutual funds, mostly as pre-HIPAA HSA vehicles ). After a short while, I realized that I didn't enjoy all the extra bookkeeping, accounting, and research that went with that territory, to say nothing of fielding the calls from clients unnerved by the vagaries of Wall Street. So, I turned it in and never looked back.
And boy, am I ever glad I did:
"Financial Industry Regulatory Authority Inc. communications record retention rules apply to all communications devices and technologies ... [including] member firms’ use of social networking websites and personal communications devices."
Yup: Twitter, FaceBook and text all count (no word yet on sexting or MySpace).
That means all those little messages buried in your BlackBerry or iPhone memory, and heaven help you if you delete older ones to recapture storage space.
Beep-beep.
They do not (currently) include equity-indexed products (but don't be surprised...)
In the event, I used to hold such a license, and sold a few variable policies (and a handful of mutual funds, mostly as pre-HIPAA HSA vehicles ). After a short while, I realized that I didn't enjoy all the extra bookkeeping, accounting, and research that went with that territory, to say nothing of fielding the calls from clients unnerved by the vagaries of Wall Street. So, I turned it in and never looked back.
And boy, am I ever glad I did:
"Financial Industry Regulatory Authority Inc. communications record retention rules apply to all communications devices and technologies ... [including] member firms’ use of social networking websites and personal communications devices."
Yup: Twitter, FaceBook and text all count (no word yet on sexting or MySpace).
That means all those little messages buried in your BlackBerry or iPhone memory, and heaven help you if you delete older ones to recapture storage space.
Beep-beep.
Cavalcade of Risk #138: Global to Personal
Nina Kallen, Esq hosts this week's collection of risky posts, neatly categorized from the macro to the micro.
HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.
HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.
Tuesday, August 23, 2011
How safe are your medical records? Are you sure?
It's a bit startling to consider, but we began blogging about the relative safety of medical records over 5 years ago:
"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."
More recently, we noted that the MVNHS© had put the kibosh on their latest and greatest:
"A plan to create the world's largest single civilian computer system linking all parts of the National Health Service is to be abandoned by the Government"
The Brits were unable to justify the huge sums of money already sunk into that doomed effort, let alone throwing in even more. But there's a more pressing issue than just funding: just how safe is the information being stored in these data warehouses?
Why so serious, Henry?
Well:
"Until recently, medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see ... Among the files were summaries that spelled out, in painstaking detail, a trucker's crushed fingers, a maintenance worker's broken ribs and one man's bout with sexual dysfunction."
More ooopsies.
Our co-blogger Kelley B (herself a Certified Medical Office Manager), has told me that the gummint has in place special funding incentives to get providers to move to electronic records-keeping. Early adopters are eligible for thousands (often tens of thousands) of dollars in "free money" if they opt for new data storage systems.
But is this "rush to adopt" really a good thing?
The benefits of this brave new world are touted as increased efficiency and better patient outcomes, but I've seen scant evidence of either - at least no direct links controlled for other factors. Which is not to say that such do not exist, but if that's truly the case, show me the data.
One of my favorite computer aphorisms is "garbage in, garbage out;" which is to say, these systems are subject to human error at any number of stages. I'm no Luddite, and I can see where there are certainly efficiencies in moving away from paper-based files, but I'm not convinced that these replacement systems are a step forward.
"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."
More recently, we noted that the MVNHS© had put the kibosh on their latest and greatest:
"A plan to create the world's largest single civilian computer system linking all parts of the National Health Service is to be abandoned by the Government"
The Brits were unable to justify the huge sums of money already sunk into that doomed effort, let alone throwing in even more. But there's a more pressing issue than just funding: just how safe is the information being stored in these data warehouses?
Why so serious, Henry?
Well:
"Until recently, medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see ... Among the files were summaries that spelled out, in painstaking detail, a trucker's crushed fingers, a maintenance worker's broken ribs and one man's bout with sexual dysfunction."
More ooopsies.
Our co-blogger Kelley B (herself a Certified Medical Office Manager), has told me that the gummint has in place special funding incentives to get providers to move to electronic records-keeping. Early adopters are eligible for thousands (often tens of thousands) of dollars in "free money" if they opt for new data storage systems.
But is this "rush to adopt" really a good thing?
The benefits of this brave new world are touted as increased efficiency and better patient outcomes, but I've seen scant evidence of either - at least no direct links controlled for other factors. Which is not to say that such do not exist, but if that's truly the case, show me the data.
One of my favorite computer aphorisms is "garbage in, garbage out;" which is to say, these systems are subject to human error at any number of stages. I'm no Luddite, and I can see where there are certainly efficiencies in moving away from paper-based files, but I'm not convinced that these replacement systems are a step forward.
Grand Rounds - Pretty as a Picture
The estimable Dr Bates hosts this week's collection of interesting (and often provocative) medblog posts.
Monday, August 22, 2011
Life sales up?
The Medical Information Bureau (MIB) is often the frontlines when it comes to life insurance underwriting. Typically, participating carriers turn to the clearinghouse to check up on new applicants. So this little tidbit may be more significant than might be apparent:
"U.S. life insurers researched more requests for individual coverage in July than they did in July 2010."
As we noted a few weeks ago, sales of Long Term Care insurance are on the rise; and so, it would appear, is the sale of life insurance. This shouldn't be surprising, really: with an uncertain economy, very few (if any) risk management vehicles beat life insurance for creating certainty.
I found this little nugget particularly toothsome:
"(G)rowth in activity for older applicants [age 60 and up] has been strong."
Whether this is for estate planning purposes, or because investment values have declined so sharply of late (increasing the need for estate creation), who can say? But the MIB says that "activity" in this cohort is up over 9% from just a year ago. Food for thought.
"U.S. life insurers researched more requests for individual coverage in July than they did in July 2010."
As we noted a few weeks ago, sales of Long Term Care insurance are on the rise; and so, it would appear, is the sale of life insurance. This shouldn't be surprising, really: with an uncertain economy, very few (if any) risk management vehicles beat life insurance for creating certainty.
I found this little nugget particularly toothsome:
"(G)rowth in activity for older applicants [age 60 and up] has been strong."
Whether this is for estate planning purposes, or because investment values have declined so sharply of late (increasing the need for estate creation), who can say? But the MIB says that "activity" in this cohort is up over 9% from just a year ago. Food for thought.
On Packages and Details
Years ago, we discussed a (then-new) effort by Blue Cross of Minnesota to standardize how the costs of various medical procedures would be explained to insureds. We lauded this effort because, for most people, EOB's (Explanation of Benefits) provided little in the way of detailed information about those costs and how insurers made them understandable to "normal" folks.
We also appreciated that this effort was undertaken voluntarily bu Blue Cross, and hoped that it might pressure other carriers to follow suit.
So one might think that we'd also laud the latest stupidity from the still-unconfirmed CMMS Administrator Donald Berwick:
"We are telling insurance companies that they need to be more transparent about the benefits they offer, what they are spending premium dollars on, and justifications for any proposed rate increases"
Right, Donny-boy, because you've been so forthright all along.
The fact is, plain-language rules have been in place for many years, and consumers don't read those policies. So what possible reason is there to increase admin costs on carriers?
But wait, it gets stupider [ed: is that even possible?]:
"This is all grounded in the idea that the more informed the patient is, the better decisions he or she can make."
Um, no.
First, because unlike Minnesota Blue's transparency effort, it's about plan design, not claims adjudication. Your car's owner's manual may be helpful in telling you how to change a headlight bulb, or reset the clock, but it's not going to tell you how much a new transmission costs or what brand of tires to buy.
Second, this is a direct assault on ERISA (aka "self-funded") plans:
"[S]ince most large employers customize the benefit packages they provide to their employees, some health plans could be required to create tens of thousands of different versions of this new document"
So much for that much-touted 3000% premium savings.
We also appreciated that this effort was undertaken voluntarily bu Blue Cross, and hoped that it might pressure other carriers to follow suit.
So one might think that we'd also laud the latest stupidity from the still-unconfirmed CMMS Administrator Donald Berwick:
"We are telling insurance companies that they need to be more transparent about the benefits they offer, what they are spending premium dollars on, and justifications for any proposed rate increases"
Right, Donny-boy, because you've been so forthright all along.
The fact is, plain-language rules have been in place for many years, and consumers don't read those policies. So what possible reason is there to increase admin costs on carriers?
But wait, it gets stupider [ed: is that even possible?]:
"This is all grounded in the idea that the more informed the patient is, the better decisions he or she can make."
Um, no.
First, because unlike Minnesota Blue's transparency effort, it's about plan design, not claims adjudication. Your car's owner's manual may be helpful in telling you how to change a headlight bulb, or reset the clock, but it's not going to tell you how much a new transmission costs or what brand of tires to buy.
Second, this is a direct assault on ERISA (aka "self-funded") plans:
"[S]ince most large employers customize the benefit packages they provide to their employees, some health plans could be required to create tens of thousands of different versions of this new document"
So much for that much-touted 3000% premium savings.
Friday, August 19, 2011
Cavalcade of Risk #138: Call for submissions
Nina Kallen hosts next week's CavRisk. Entries are due by Monday (the 22nd).
NB: We're now using this submission tool: The BC WorkAround
Once there, you'll be asked to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")
At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.
And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.
Thanks!
NB: We're now using this submission tool: The BC WorkAround
Once there, you'll be asked to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")
At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.
And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.
Thanks!
Thursday, August 18, 2011
Alzheimer’s? I'll drink to that!
About a month ago, we mentioned a few preventive measures that seem to stave off this dreaded disease (of course, since we don't really know what causes Alzheimer's, it's all pretty much circumstantial evidence). Be that as it may, new research shows another potential "vaccine" of sorts:
Loyola University's Stritch School of Medicine "reviewed studies dating to 1977 that included more than 365,000 participants ... Moderate drinkers were 23 percent less likely to develop cognitive impairment or Alzheimer’s and other forms of dementia."
Wine showed the most promise, although the researchers were quick to point out that "this finding was based on a relatively small number of studies, because most papers did not distinguish types of alcohol."
Ooops.
Still, not sure what harm can be done by following the implied prescription.
Loyola University's Stritch School of Medicine "reviewed studies dating to 1977 that included more than 365,000 participants ... Moderate drinkers were 23 percent less likely to develop cognitive impairment or Alzheimer’s and other forms of dementia."
Wine showed the most promise, although the researchers were quick to point out that "this finding was based on a relatively small number of studies, because most papers did not distinguish types of alcohol."
Ooops.
Still, not sure what harm can be done by following the implied prescription.
Wednesday, August 17, 2011
Stupid "Beneficiary" Tricks
They say that the difference between comedy and tragedy is time. I would add "and common sense," as well:
"The suspect in the case of a Maryland woman who disappeared in Aruba took out an insurance policy before heading out on the trip"
Now, it's possible that the missing woman also took out a policy on Mr Giordano, but of course our press is too wrapped up in the story of the moment to check out this rather obvious point.
The perp Mr Giordano made a rather interesting choice in policy design, as well, opting for the "accident only" plan rather than one which might have required additional underwriting. The article mentions that he chose "the pricier one-year plan instead of a cheaper, five-year policy," which of course makes no sense unless they're comparing a "regular" term policy with the accident-only plan, thereby completely contradicting themselves in the process.
Of course, buying a large, non-underwritten plan in anticipation of an "accident" is itself rather poor judgement: after all, one is forbidden to profit from one's crimes in this manner. More critical, of course, is that if it's an accident-only policy, and there's no body, then there's no way to prove how (let alone if) the victim died, thereby neatly letting the insurer completely off the hook.
For now, anyway.
Prof James Moriarty this guy ain't.
"The suspect in the case of a Maryland woman who disappeared in Aruba took out an insurance policy before heading out on the trip"
Now, it's possible that the missing woman also took out a policy on Mr Giordano, but of course our press is too wrapped up in the story of the moment to check out this rather obvious point.
Of course, buying a large, non-underwritten plan in anticipation of an "accident" is itself rather poor judgement: after all, one is forbidden to profit from one's crimes in this manner. More critical, of course, is that if it's an accident-only policy, and there's no body, then there's no way to prove how (let alone if) the victim died, thereby neatly letting the insurer completely off the hook.
For now, anyway.
Prof James Moriarty this guy ain't.
Stupid Government Tricks
From the "What Were They Thinking?" Department:
"The Equal Employment Opportunity Commission today sued a Raleigh insurance office for not hiring a recovering drug addict who tested positive for methadone in his system."
Yes, druggies and their pals could probably use additional insurance coverage (although Underwriting may have some reservations), and of course existing clients would probably be thrilled to know that their private financial information (not to mention a nice list of all their valuables) would be under the watchful eye of a meth-user.
Pure. Genius.
"The Equal Employment Opportunity Commission today sued a Raleigh insurance office for not hiring a recovering drug addict who tested positive for methadone in his system."
Yes, druggies and their pals could probably use additional insurance coverage (although Underwriting may have some reservations), and of course existing clients would probably be thrilled to know that their private financial information (not to mention a nice list of all their valuables) would be under the watchful eye of a meth-user.
Pure. Genius.
Tuesday, August 16, 2011
MassCare© meets ObamaCare©: Travesty Ensues
It's generally accepted, "conventional" wisdom that RomneyCare© begat ObamaCare© (hence Bob's newest buzzword, ObamneyCare). Along with the (Evil) Individual Mandate, RomneyCare introduced other problems, many of which have (until now) flown under the radar.
Remember back during the original ObamaCare© "debate," when we first learned about the "Cornhustler" deal? Nebraska was vying for the very first ObamaWaiver©, wherein it would be exempted from onerous new Medicaid financing requirements. Well, that particular effort failed to pay off for the Cornhusker State, but over on the east coast, there's a new storm a-brewin':
"Sen. John Kerry inserted a provision into Obamacare that changed Medicare reimbursements for hospital pay ... The Globe reported that Massachusetts hospitals will rake in an extra $275 million a year from the change."
Or, more accurately: hospitals in most of the the other 57 states are on track to be screwed out of almost $300 million. Per year. How many indigents would this pay for? How many new doc's or nurses? How many MRI's?
This pretty much sums it up:
"It is a massive wealth transfer from the rest of the country to those seven states."
Pretty tasty ketchup, Sen Kerry.
Remember back during the original ObamaCare© "debate," when we first learned about the "Cornhustler" deal? Nebraska was vying for the very first ObamaWaiver©, wherein it would be exempted from onerous new Medicaid financing requirements. Well, that particular effort failed to pay off for the Cornhusker State, but over on the east coast, there's a new storm a-brewin':
"Sen. John Kerry inserted a provision into Obamacare that changed Medicare reimbursements for hospital pay ... The Globe reported that Massachusetts hospitals will rake in an extra $275 million a year from the change."
Or, more accurately: hospitals in most of the the other 57 states are on track to be screwed out of almost $300 million. Per year. How many indigents would this pay for? How many new doc's or nurses? How many MRI's?
This pretty much sums it up:
"It is a massive wealth transfer from the rest of the country to those seven states."
Pretty tasty ketchup, Sen Kerry.
Coming up short?
Maybe, maybe not:
We've written pretty extensively about Long Term care insurance (LTCi), but there's a new kid in town, goes by the name of Short Term Care insurance (STCi).
Issued by Banker's Life (#7 on the LTCi charts, and rising), it offers some interesting twists on the LTCi concept.For one thing, the maximum benefit amount available is $100, and there's no real "choice" in product design: there's a 30 day waiting (elimination) period and a maximum benefit period of 180 days My bad: the maximum daily benefit amount can be up to $200, and other elimination periods and benefit multipliers are available.
There's one inflation protection option (5% compound), and it's available as a facility-only or facility and home care plan.
Two things I really like about this design:
First, it's issued based on a "simplified underwriting" basis; that is, the application is fairly simple, with just a few "gatekeeper" questions. This makes it appealing for folks who may not qualify for a full-blown underwritten LTCi plan.
Second, it's a "pool" based plan. That is, once you settle on a plan, you're given a "pool" of money on which to draw, which makes it a little more flexible than it might appear at first blush.
Let's say you pick the $100 a day plan. That immediately gives you $18,000 worth of care dollars to play with. So let's say you're in a nursing home for 2 months (60 days), and the cost is actually $80 a day. Starting in the second month, Banker's would pay out $2,400 ($80 times 30 days), but you'd still have over $15,000 in your "bank."
Pretty cool.
Of course, it's not Partnership Compliant, but I'm of the opinion that, for folks looking at this kind of policy, that's not a major issue.
In any case, it's nice to see some outside-the-bun thinking.
We've written pretty extensively about Long Term care insurance (LTCi), but there's a new kid in town, goes by the name of Short Term Care insurance (STCi).
Issued by Banker's Life (#7 on the LTCi charts, and rising), it offers some interesting twists on the LTCi concept.
There's one inflation protection option (5% compound), and it's available as a facility-only or facility and home care plan.
Two things I really like about this design:
First, it's issued based on a "simplified underwriting" basis; that is, the application is fairly simple, with just a few "gatekeeper" questions. This makes it appealing for folks who may not qualify for a full-blown underwritten LTCi plan.
Second, it's a "pool" based plan. That is, once you settle on a plan, you're given a "pool" of money on which to draw, which makes it a little more flexible than it might appear at first blush.
Let's say you pick the $100 a day plan. That immediately gives you $18,000 worth of care dollars to play with. So let's say you're in a nursing home for 2 months (60 days), and the cost is actually $80 a day. Starting in the second month, Banker's would pay out $2,400 ($80 times 30 days), but you'd still have over $15,000 in your "bank."
Pretty cool.
Of course, it's not Partnership Compliant, but I'm of the opinion that, for folks looking at this kind of policy, that's not a major issue.
In any case, it's nice to see some outside-the-bun thinking.
Customer Service Carnivale - The Good Mix edition
We usually participate in only a few "carnivals" (CavRisk, of course, and Grand Rounds and Health Wonk Review). But I was so impressed with my recent experience with the Sirius radio folks that I submitted that post to the Customer Service Carnivale.
Little did I know that that submission would get top billing...
Little did I know that that submission would get top billing...
Grand Rounds, Rants and Whines edition
Dr Pullen hosts this week's interesting (despite the title) collection of medblog posts.
Monday, August 15, 2011
Movin' on up....
It is with deep-felt pride and pleasure that we are able now to announce that our own Kelley Beloff has accepted the position of Medical Office Manager for a much larger practice, in...wait for it...Tampa, Florida!
The good news for us is that she'll continue as a contributing member of the InsureBlog team; her new position, both professional and geographically, will give her even more opportunities and insights to share with us.
Mazel Tov, Kelley!
The good news for us is that she'll continue as a contributing member of the InsureBlog team; her new position, both professional and geographically, will give her even more opportunities and insights to share with us.
Mazel Tov, Kelley!
Friday, August 12, 2011
(Evil) Mandate Unconstitutional?
Maybe:
"A divided U.S. appeals court in Atlanta ruled Friday that a key provision of last year's federal health-care overhaul is unconstitutional, siding with a group of 26 states that challenged the law."
We last wrote about this particular case in June.
Of course, this is but one battle....
"A divided U.S. appeals court in Atlanta ruled Friday that a key provision of last year's federal health-care overhaul is unconstitutional, siding with a group of 26 states that challenged the law."
We last wrote about this particular case in June.
Of course, this is but one battle....
Thursday, August 11, 2011
Keeping Abreast of Cancer: Double-Standard edition
When we hear that someone has been diagnosed with breast cancer, our immediate reaction is most likely to be "oh, poor Sally, hope they caught it early."
But what if it wasn't "Sally," what if it was "Steve?"
Our first reaction in that case would probably be "hunh?!"
Sad to say, every year about 2,000 men are diagnosed with the dread disease, accounting for about 1% of all cases. But it is breast cancer, regardless of the sex of the victim.
Well, make that should be "regardless of the victim's sex."
Because, thanks to a tip from FoIB Patrick P, we learn that Raymond Johnson, a 26 year old with no health coverage, just found out two horrible things:
First, that he has breast cancer.
And second, that even though there's a special Medicaid program for breast cancer victims, he's not eligible. That's right, the obscenely mis-named "Breast and Cervical Cancer Prevention and Treatment Act" is available only to those without the Y chromosome.
And it gets worse:
New rules promulgated by HHS Secretary Shecantbeserious require regular health plans to cover:
■ Well-woman visits
■ Screening for gestational diabetes for all pregnant women
■ Human papillomavirus DNA testing for all women 30 years and older
■ Annual sexually transmitted infection counseling for all sexually active women
■ Annual counseling and screening for HIV for all sexually active women
■ FDA-approved contraception methods, sterilization procedures and contraceptive counseling
■ Breastfeeding support, supplies, and counseling, including costs for renting breastfeeding equipment
■ Domestic violence screening and counseling
But guess what?
There are no corresponding benefits for men. What about condom coverage? Or domestic violence screening for the estimated 835,000 male victims of domestic violence each year?
How come HIV screenings for men aren't covered?
Fair's fair.
But what if it wasn't "Sally," what if it was "Steve?"
Our first reaction in that case would probably be "hunh?!"
Sad to say, every year about 2,000 men are diagnosed with the dread disease, accounting for about 1% of all cases. But it is breast cancer, regardless of the sex of the victim.
Well, make that should be "regardless of the victim's sex."
Because, thanks to a tip from FoIB Patrick P, we learn that Raymond Johnson, a 26 year old with no health coverage, just found out two horrible things:
First, that he has breast cancer.
And second, that even though there's a special Medicaid program for breast cancer victims, he's not eligible. That's right, the obscenely mis-named "Breast and Cervical Cancer Prevention and Treatment Act" is available only to those without the Y chromosome.
And it gets worse:
New rules promulgated by HHS Secretary Shecantbeserious require regular health plans to cover:
■ Well-woman visits
■ Screening for gestational diabetes for all pregnant women
■ Human papillomavirus DNA testing for all women 30 years and older
■ Annual sexually transmitted infection counseling for all sexually active women
■ Annual counseling and screening for HIV for all sexually active women
■ FDA-approved contraception methods, sterilization procedures and contraceptive counseling
■ Breastfeeding support, supplies, and counseling, including costs for renting breastfeeding equipment
■ Domestic violence screening and counseling
But guess what?
There are no corresponding benefits for men. What about condom coverage? Or domestic violence screening for the estimated 835,000 male victims of domestic violence each year?
How come HIV screenings for men aren't covered?
Fair's fair.
Wednesday, August 10, 2011
Here's a Puzzler
You wake up one day with a growth in your nostril, big enough to interfere with your breathing and hinder your sense of smell. Most folks might not be too upset at the latter, but what if your job requires you to discern between varieties of wine?
So, you schedule an appointment with the local surgeon to have it removed. It's medically necessary (since it impedes breathing), so it's most likely covered by your medical plan, but you have a high deductible, HSA-style policy; you're responsible for the first $2,500, and the procedure, after in-network re-pricing, comes to only $1,200.
You understand that it's also a tax-deductible medical expense, but only if you itemize and it's part of a bunch of medical expenses that hit that magic 7.5% of Adjusted Gross Income.
Now here's the puzzler:
“Can I write this off as a business expense? After all, I need my nose for my job.”
This is pretty important: since you're generally pretty healthy, it's unlikely that you'll hit that 7.5% of AGI's worth of medical expenses.
The Fox News story on which this post is based offers several possible outcomes, but I've just added a twist that makes it a lot simpler.
See if you can spot it, and let's discuss in the comments...
So, you schedule an appointment with the local surgeon to have it removed. It's medically necessary (since it impedes breathing), so it's most likely covered by your medical plan, but you have a high deductible, HSA-style policy; you're responsible for the first $2,500, and the procedure, after in-network re-pricing, comes to only $1,200.
You understand that it's also a tax-deductible medical expense, but only if you itemize and it's part of a bunch of medical expenses that hit that magic 7.5% of Adjusted Gross Income.
Now here's the puzzler:
“Can I write this off as a business expense? After all, I need my nose for my job.”
This is pretty important: since you're generally pretty healthy, it's unlikely that you'll hit that 7.5% of AGI's worth of medical expenses.
The Fox News story on which this post is based offers several possible outcomes, but I've just added a twist that makes it a lot simpler.
See if you can spot it, and let's discuss in the comments...
Cavalcade of Risk #137: Headline Grabbers edition
Jason Shafrin presents this week's terrific collection of risk-related blogetry. Do stop by.
HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.
HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.
Tuesday, August 09, 2011
CLASS Warfare
FoIB Avik Roy has some profound thoughts on the mis-named CLASS Act, and especially on a recent article in Foreign Affairs magazine by former Obamastration official Peter Orzag. In the FA piece, Mr Orzag acknowledges what we said some time ago, namely that:
"There is a serious risk that healthy people may be reluctant to join the program, whereas those who most need long-term care will be eager to do so, jeopardizing the idea of a broad and stable risk pool."
No kidding?
Avik then quotes, verbatim, Mr Orzag's proposed "solution:"
"[T]o make the purchase of such insurance mandatory or to require employers to provide it by default unless employees opt out."
Hmmm....a mandatory health insurance program. What a novel idea!
In response, Mr Orzag took Avik to task for...wait for it...quoting him verbatim:
"You (and Sen. Thune, for that matter) mischaracterize and misunderstand the sentences cited from my Foreign Affairs article. It was not that we should mandate CLASS. "
Seriously? You're going with that? Because that's precisely what you said, Mr Orzag. It's one thing to "walk back" what you said, but to deny it altogether?
I'm actually a bit disappointed that Avik let that go; frankly, Mr Orzag should be embarrassed by his own amateur attempt at spin.
What's worse, of course, is Mr Orzag's - and, by extension, this regime's - understanding of even basic insurance principles. Long Term Care insurance is a complicated product, but it's not rocket surgery. Folks like Mr O appear to be totally clueless as to how these risk management tools work, and for whom they're designed.
Let's start with some basics:
The LTCi market is, by definition, narrow and focused. That is, neither the very wealthy nor the poor need it. One of the most fundamental rules of the insurance business is that first there must be a need for the coverage.There's a specific, well-defined middle-class swath that most benefits from LTCi, and that's further diminished by the fact that it's not inexpensive coverage.
Perhaps the most important benefit of modern LTCi products is Partnership Compliance, which encourages folks to buy policies in order to stave off the Medicaid folks. But CLASS Act plans are not Partnership compliant, making them even less attractive and less valuable.
On the other hand, one must admire the chutzpah of Mr Orzag to suggest that purchasing these plans must be mandatory, with an optional opt-out mechanism. One can easily imagine the nature of that mechanism, by the way: how soon until we see HHS Secretary Shecantbeseriousselling handing out CLASSWaivers©?
Mr Orzag and his ilk may protest all they wish, but it is past disingenuous to claim that he's not calling for a CLASS Act mandate.
Several years ago, my eldest misplaced her keys. She became increasingly frustrated as we tried to help her noodle out where she might have left them, until, finally, she bellowed "they're not lost - I just can't find them!"
Where are your keys, Mr Orzag?
"There is a serious risk that healthy people may be reluctant to join the program, whereas those who most need long-term care will be eager to do so, jeopardizing the idea of a broad and stable risk pool."
No kidding?
Avik then quotes, verbatim, Mr Orzag's proposed "solution:"
"[T]o make the purchase of such insurance mandatory or to require employers to provide it by default unless employees opt out."
Hmmm....a mandatory health insurance program. What a novel idea!
In response, Mr Orzag took Avik to task for...wait for it...quoting him verbatim:
"You (and Sen. Thune, for that matter) mischaracterize and misunderstand the sentences cited from my Foreign Affairs article. It was not that we should mandate CLASS. "
Seriously? You're going with that? Because that's precisely what you said, Mr Orzag. It's one thing to "walk back" what you said, but to deny it altogether?
I'm actually a bit disappointed that Avik let that go; frankly, Mr Orzag should be embarrassed by his own amateur attempt at spin.
What's worse, of course, is Mr Orzag's - and, by extension, this regime's - understanding of even basic insurance principles. Long Term Care insurance is a complicated product, but it's not rocket surgery. Folks like Mr O appear to be totally clueless as to how these risk management tools work, and for whom they're designed.
Let's start with some basics:
The LTCi market is, by definition, narrow and focused. That is, neither the very wealthy nor the poor need it. One of the most fundamental rules of the insurance business is that first there must be a need for the coverage.There's a specific, well-defined middle-class swath that most benefits from LTCi, and that's further diminished by the fact that it's not inexpensive coverage.
Perhaps the most important benefit of modern LTCi products is Partnership Compliance, which encourages folks to buy policies in order to stave off the Medicaid folks. But CLASS Act plans are not Partnership compliant, making them even less attractive and less valuable.
On the other hand, one must admire the chutzpah of Mr Orzag to suggest that purchasing these plans must be mandatory, with an optional opt-out mechanism. One can easily imagine the nature of that mechanism, by the way: how soon until we see HHS Secretary Shecantbeserious
Mr Orzag and his ilk may protest all they wish, but it is past disingenuous to claim that he's not calling for a CLASS Act mandate.
Several years ago, my eldest misplaced her keys. She became increasingly frustrated as we tried to help her noodle out where she might have left them, until, finally, she bellowed "they're not lost - I just can't find them!"
Where are your keys, Mr Orzag?
Stupid Insurance Company Death Claim Tricks
Perhaps the most important part of my job is delivering death claims. This is never a "fun" experience, but it's very rewarding to hand a grieving widow or widower, or son or daughter, or business partner a check that will help ensure that the kids get to college, or the house is paid off, or the business will go on.
Although I almost always prefer to handle these personally, sometimes that's just not possible, and I'll let the carrier handle it for me. I expect my companies to handle the claim in a professional but kind manner, and to treat the beneficiary with the respect and dignity that he or she deserves.
And then there's these bozo's:
Although I almost always prefer to handle these personally, sometimes that's just not possible, and I'll let the carrier handle it for me. I expect my companies to handle the claim in a professional but kind manner, and to treat the beneficiary with the respect and dignity that he or she deserves.
And then there's these bozo's:
Grand Rounds: Music Lovers edition
Dr Deb takes the term 'Rounds" pretty seriously - and it shows in the great job she does with this week's collection of great medblog posts.
Monday, August 08, 2011
MVNHS©: That does not compute!
Last time we looked at Electronic Medical Records (EMR), we noted that early-adopter Google had finally thrown in the towel. Now, that still left more than a few players in that market, but it (again) raised the question as to the viability, let alone the effectiveness, of this phenomenon.
Well, we need wait no longer:
"A plan to create the world's largest single civilian computer system linking all parts of the National Health Service is to be abandoned by the Government after running up billions of pounds in bills."
Ooopsies!
The premise behind this effort was a centralized data repository, administered (for lack of a better term) by the Much Vaunted National Health Service© itself. As is typical of nationalized health care "systems," of course, the whole effort cost, well, tonnes of pounds, with precious little (to be charitable about it) to show for it:
"The department has been unable to demonstrate what benefits have been delivered from the £2.7bn spent on the project so far," Margaret Hodge, chair of the PAC, said." [ed: PAC is The Commons Public Accounts Committee, which seems to be analogous to our own CBO]
So we have a bloated, inefficient bureaucracy which spends wads of taxpayer cash on a gargantuan and ill-conceived system, which is finally scrapped when it becomes blindingly obvious that it's an epic waste of resources.
Sound familiar?
Well, we need wait no longer:
"A plan to create the world's largest single civilian computer system linking all parts of the National Health Service is to be abandoned by the Government after running up billions of pounds in bills."
Ooopsies!
The premise behind this effort was a centralized data repository, administered (for lack of a better term) by the Much Vaunted National Health Service© itself. As is typical of nationalized health care "systems," of course, the whole effort cost, well, tonnes of pounds, with precious little (to be charitable about it) to show for it:
"The department has been unable to demonstrate what benefits have been delivered from the £2.7bn spent on the project so far," Margaret Hodge, chair of the PAC, said." [ed: PAC is The Commons Public Accounts Committee, which seems to be analogous to our own CBO]
So we have a bloated, inefficient bureaucracy which spends wads of taxpayer cash on a gargantuan and ill-conceived system, which is finally scrapped when it becomes blindingly obvious that it's an epic waste of resources.
Sound familiar?
Friday, August 05, 2011
More Swedish Meatball Medicine
Again and again we've documented the utter failure of the alternative medical schemes on which ObamaCare© has been modeled. Less than two months ago, we reported on how Swedish "medical authorities" dealt with a critically injured young girl:
"After sustaining an open chest wound of 10cm long while trimming her horse’s mane, Sweden’s emergency response services refused to send an ambulance, suggesting the 11-year-old girl take aspirin instead."
As if to prove their incompetence - or is it just lack of compassion? - these same "authorities" risk the life of a senior citizen:
"Rather than send an ambulance to respond to a call from an injured woman in Borlänge in central Sweden, emergency services operator SOS Alarm elected to call on an elderly couple living nearby to check on her instead."
In fact, the couple thus called upon couldn't even find the injured woman's apartment, wasting precious time.
But remember: nationalized medicine is so much more efficient, and compassionate, than our "broken" system.
"After sustaining an open chest wound of 10cm long while trimming her horse’s mane, Sweden’s emergency response services refused to send an ambulance, suggesting the 11-year-old girl take aspirin instead."
As if to prove their incompetence - or is it just lack of compassion? - these same "authorities" risk the life of a senior citizen:
"Rather than send an ambulance to respond to a call from an injured woman in Borlänge in central Sweden, emergency services operator SOS Alarm elected to call on an elderly couple living nearby to check on her instead."
In fact, the couple thus called upon couldn't even find the injured woman's apartment, wasting precious time.
But remember: nationalized medicine is so much more efficient, and compassionate, than our "broken" system.
We'll have a gay old time (Revisited)...
So this week's National Underwriter/Life & Health edition hits my desk, and the cover catches my attention:
"Born This Way: Could same-sex couples be the next big market opportunity?"
Okay, I'll bite (metaphorically speaking, of course).
Truth is, I've never really cared one way or the other about my clients' sexual orientation. On the few occasions that it's been brought up, it's always been the clients who do so. Off the top of my head, I can name just 2 cases where this information was discussed, and in neither case was it particularly relevant.
Still, the marketing possibilities are intriguing: if one takes the generally-accepted percentage of gay Americans as about 3%, well, that's a lot of potential clients. And with gay marriage a hot-button issue, and now legal in several states, that number seems to be growing.
In many regards, one supposes that gay couples (married or otherwise) face pretty much the same financial issues that their straight counterparts must address: life insurance and estate planning, retirement plans and health insurance. I've noticed for a while, for example, that most of the health insurance quote engines no longer automatically assume an "F" for the secondary when the primary is an "M." Of course, one presumes that two guys won't really worry too much about maternity coverage.
But where it gets really interesting is when we take a look at life insurance.
There are typically two ways that heterosexual couples buy life insurance: either two separate policies (with the other spouse as the beneficiary), or one policy with a primary and secondary insured. In the first case, John and Mary each buy a life insurance policy; John names Mary as his beneficiary, and Mary names John as hers. The second way would be for John to buy a life insurance policy, and then add Mary as a rider (of course, it could be the other way around, as well). The second way is typically less expensive (at least early on), but has some disadvantages (but that's another post). The point is, both methods are tried and true.
But let's suppose that instead of John and Mary, we're talking about Bruce and Tim. Traditionally, the only way that they could go the first route - naming each other as beneficiaries of separate policies - would have been as a business-related buy-sell agreement. There would have been no way for them to access the second method.
Now, though, with the onset of legalized gay marriage, the rules have changed, and it's not just in states which recognize them. I spoke with the underwriter at my primary life company, and asked how this would play out now in this Brave New World. Turns out, both the times and the opportunities have changed.
The key principle here is "insurable interest;" that is, whether or not one person would be financially harmed by the death of the other [ed: yes, this is an oversimplification, but it'll do]. Let's assume that Bruce and Tim live in a state that does not recognize same-sex marriage. Could they name each other as beneficiaries of their (separate) life insurance policies? Turns out, they probably can: the key is that insurable interest. If they can honestly claim to be life partners, or have bought a property together (for example), then the carrier is most likely going to issue those policies (assuming they pass underwriting).
In states that do recognize same-sex marriage, the second method becomes relevant, as well. My primary carrier no longer offers spouse riders at all, so I turned for help to the insurance department of a state which recognizes same-sex marriage. On condition of anonymity (really!), my source confirmed what I had already suspected: that state's law recognizes "marriage," period, and so a company which offered spousal riders to hetero-sexual married couples would have to extend the same courtesy to same-sex married couples.
Bob brought up another interesting point as regards this issue: the increased likelihood of running into an HIV-positive applicant. I'm side-stepping that issue for now, because it's really an underwriting question, not an insurable interest one.
Something else that the article failed to mention was long term care insurance: very often, these plans are written on married couples. Would a a healthy same-sex couple in, say, their 50's be declined? It would seem to be less and less likely, especially in same-sex marriage states.
So, is there really a great new untapped market out there? It seems logical that there is. Now, how to tap into that market is a whole 'nother question.
Okay, I'll bite (metaphorically speaking, of course).
Truth is, I've never really cared one way or the other about my clients' sexual orientation. On the few occasions that it's been brought up, it's always been the clients who do so. Off the top of my head, I can name just 2 cases where this information was discussed, and in neither case was it particularly relevant.
Still, the marketing possibilities are intriguing: if one takes the generally-accepted percentage of gay Americans as about 3%, well, that's a lot of potential clients. And with gay marriage a hot-button issue, and now legal in several states, that number seems to be growing.
In many regards, one supposes that gay couples (married or otherwise) face pretty much the same financial issues that their straight counterparts must address: life insurance and estate planning, retirement plans and health insurance. I've noticed for a while, for example, that most of the health insurance quote engines no longer automatically assume an "F" for the secondary when the primary is an "M." Of course, one presumes that two guys won't really worry too much about maternity coverage.
But where it gets really interesting is when we take a look at life insurance.
There are typically two ways that heterosexual couples buy life insurance: either two separate policies (with the other spouse as the beneficiary), or one policy with a primary and secondary insured. In the first case, John and Mary each buy a life insurance policy; John names Mary as his beneficiary, and Mary names John as hers. The second way would be for John to buy a life insurance policy, and then add Mary as a rider (of course, it could be the other way around, as well). The second way is typically less expensive (at least early on), but has some disadvantages (but that's another post). The point is, both methods are tried and true.
But let's suppose that instead of John and Mary, we're talking about Bruce and Tim. Traditionally, the only way that they could go the first route - naming each other as beneficiaries of separate policies - would have been as a business-related buy-sell agreement. There would have been no way for them to access the second method.
Now, though, with the onset of legalized gay marriage, the rules have changed, and it's not just in states which recognize them. I spoke with the underwriter at my primary life company, and asked how this would play out now in this Brave New World. Turns out, both the times and the opportunities have changed.
The key principle here is "insurable interest;" that is, whether or not one person would be financially harmed by the death of the other [ed: yes, this is an oversimplification, but it'll do]. Let's assume that Bruce and Tim live in a state that does not recognize same-sex marriage. Could they name each other as beneficiaries of their (separate) life insurance policies? Turns out, they probably can: the key is that insurable interest. If they can honestly claim to be life partners, or have bought a property together (for example), then the carrier is most likely going to issue those policies (assuming they pass underwriting).
In states that do recognize same-sex marriage, the second method becomes relevant, as well. My primary carrier no longer offers spouse riders at all, so I turned for help to the insurance department of a state which recognizes same-sex marriage. On condition of anonymity (really!), my source confirmed what I had already suspected: that state's law recognizes "marriage," period, and so a company which offered spousal riders to hetero-sexual married couples would have to extend the same courtesy to same-sex married couples.
Bob brought up another interesting point as regards this issue: the increased likelihood of running into an HIV-positive applicant. I'm side-stepping that issue for now, because it's really an underwriting question, not an insurable interest one.
Something else that the article failed to mention was long term care insurance: very often, these plans are written on married couples. Would a a healthy same-sex couple in, say, their 50's be declined? It would seem to be less and less likely, especially in same-sex marriage states.
So, is there really a great new untapped market out there? It seems logical that there is. Now, how to tap into that market is a whole 'nother question.
Cavalcade of Risk #137: Call for submissions
Our favorite health care economist, Jason Shafrin, hosts next week's CavRisk. Entries are due by Monday (the 8th).
NB: We're now using this submission tool: The BC WorkAround
Once there, you'll be asked to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")
At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.
And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.
Thanks!
NB: We're now using this submission tool: The BC WorkAround
Once there, you'll be asked to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")
At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.
And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
HOSTING BLEG: We're currently scheduling for Fall Cavs. Just drop us a line to claim yours.
Thanks!
Thursday, August 04, 2011
Survey says: LTCi on the rise
Got an email the other day from Broker World magazine [motto: "You really don't want to see our swimsuit issue"] announcing that they'd published "the industry's most comprehensive Individual Long Term Care Insurance Survey." This was, in fact, the 13th consecutive such polling. My interest piqued, I asked for (and received) a .pdf copy of the article for review. Details on how you, too, can get a copy are at the conclusion of this post.
In the event, I turned to our resident LTCi guru, Herman Bruns, for assistance in noodling through the article (which ran to 28 pages). We were primarily interested in the first 8 or so, which digested and analyzed the results, which were based on the responses of the 18 carriers which participated (out of only 25 companies that market LTCi in any serious way). The results were interesting, but there were only a few real "surprises."
First, overall sales of LTCi increased last year; it's estimated that the industry sold about 6% more policies than in 2009, with a corresponding 10% increase in premium dollars. This tracks with our own experiences: as Boomers (and immediate pre-Boomers) hit their senior citizenship, there's an increased awareness of the need for these plans.
Claims data was even more interesting: total claims hit over two-and-a-half billion dollars. Of these, home health care (and adult daycare) accounted for about 40%, nursing home care a tad under that, and assisted living facility-related claims came in under 25%.
One reason cited for the near-equal distribution of home health and nursing home claims is the large number of older policies, which typically pay only for the latter; as these "age off" the books, look for that distribution to be more home health-weighted.
We're big fans of the Partnership Program; the study found that, had this program been fully implemented in all 58 states, over two-thirds of the plans sold would have been Partnership compliant.
We're not such big fans of the newly-minted CLASS Act, but the article claims that it's "stimulating workplace sales" as more front-line workers become aware of the importance of long term care coverage. This may also explain the apparent shift toward less expensive product designs (no doubt underscored by John Hancock's recent, and highly publicized, rate increase on many existing plans).
Herman and I were both rather startled by this chart:
In the event, I turned to our resident LTCi guru, Herman Bruns, for assistance in noodling through the article (which ran to 28 pages). We were primarily interested in the first 8 or so, which digested and analyzed the results, which were based on the responses of the 18 carriers which participated (out of only 25 companies that market LTCi in any serious way). The results were interesting, but there were only a few real "surprises."
First, overall sales of LTCi increased last year; it's estimated that the industry sold about 6% more policies than in 2009, with a corresponding 10% increase in premium dollars. This tracks with our own experiences: as Boomers (and immediate pre-Boomers) hit their senior citizenship, there's an increased awareness of the need for these plans.
Claims data was even more interesting: total claims hit over two-and-a-half billion dollars. Of these, home health care (and adult daycare) accounted for about 40%, nursing home care a tad under that, and assisted living facility-related claims came in under 25%.
One reason cited for the near-equal distribution of home health and nursing home claims is the large number of older policies, which typically pay only for the latter; as these "age off" the books, look for that distribution to be more home health-weighted.
We're big fans of the Partnership Program; the study found that, had this program been fully implemented in all 58 states, over two-thirds of the plans sold would have been Partnership compliant.
We're not such big fans of the newly-minted CLASS Act, but the article claims that it's "stimulating workplace sales" as more front-line workers become aware of the importance of long term care coverage. This may also explain the apparent shift toward less expensive product designs (no doubt underscored by John Hancock's recent, and highly publicized, rate increase on many existing plans).
Herman and I were both rather startled by this chart:
The top two carriers held 54% of the market; both of us expect this to change as the aforementioned John Hancock reaps the results of its rate hike (which is not to say that it was unjustified, or even necessarily a "bad thing"). But what really had us scratching our heads was who held the #3 slot: Northwestern Mutual. This carrier, while financially solid as a rock, is not known for price competitiveness, and we marveled at its much-higher-than-expected results.While it's tempting to label LTCi as "insurance for old people," the average issue age continues to hover at around 58 - not exactly ancient. That makes sense, of course: one's old enough at that point to have accumulated enough assets to be worthwhile protecting, yet young enough that the premiums aren't a huge drag.
Finally, the buyers' "gender gap" was surprising:
"58 percent of buyers are women, but 71 percent of single people who buy are female."
This makes sense, as well: like it or not, there's a much greater likelihood that a widow's going to need long term care than a widower (lot's more of 'em).
Obviously, there's a lot more information in the article itself:
"The complete findings have been published in Broker World Magazine's July 2011 edition. To receive a free, no obligation subscription to Broker World Magazine, compliments of DAI, please click here."
[Hat Tip: Dean Dumond]
What Were They Thinking?
A few weeks ago, physicians were once again faced with the possibility of Medicare Cuts based on the Sustainable Growth Rate (SGR) - that was adopted in the Balanced Budget Act of 1997. Since the SGR went into effect, each year physicians are threatened with a pay cut from Uncle Sam. This time it is close to 30% for year 2012.
However, now we have the Debt Deal, which changes the game AGAIN. In the past years, Congress has either let the cuts go into effect and then rescinded them after the New Year or simply stalled the cuts for days, weeks, months, or the next year, without fixing the policy that determines how physicians are paid. But now the government has decided that it is best to penalize physicians:
There are so many things wrong here, where to begin:
Reality One: People are living longer, into their late 70’s and early 80’s. With Medicare enrollment at age 65, a person could conceivable be on Medicare for 20 years.
Reality Two: The majority of healthcare spending is at the end of life.
Reality Three: Payments to physicians have not changed significantly for over a decade. That includes all payments from all insurance companies, not only Medicare, because commercial insurance companies base their payments to physicians from the Medicare Fee Schedule.
Reality Four: America is facing a physician shortage.
My own practice is booked out for new patients 8 weeks and it usually takes an established patient at least two weeks to get in to be seen. We have increased our hours to accommodate more patients; however, the demand is greater than the supply. In a normal capitalist business, a greater demand would drive up prices, and profits, which would entice more people to get into that business, thus alleviating the demand and meeting the needs of the people. However, the government regulates how much physicians are paid through the Medicare Fee Schedule
Let’s review the purpose of Medicare: To provide Healthcare Insurance for the elderly so that they can continue to have access to healthcare professionals after they retire and, in theory, lose their employment based Healthcare Insurance. However, it that Insurance has determined that it will cut what it pays to physicians, then physicians will not be available to service the population that Medicare professes to want to help.
Reality Five: By sparing beneficiaries the reality of the cost of healthcare, the government is also sparing them the ability to see physicians, because physicians will close their doors to Medicare Patients.
In conclusion: The government cannot balance the budget on the backs of our physicians.
Health Wonk Review - Heat Wave edition
HWR co-founder Joe Paduda hosts this week's outstanding collection of insightful, yet wonky, health care-related posts.
Wednesday, August 03, 2011
Another sip of COLI
Also known as 'Dead Peasant Insurance," we last considered corporate Owned Life Insurance (COLI) plans almost 5 years ago, when we reported on their (apparent) demise. It seems, though, that George Romero must have been a life insurance mogul, because COLI plans are back in the news:
"Some state insurance regulators are looking into the idea of allowing tax-free exchanges of corporate-owned life insurance policies"
The problem arose out of the solution. That is, just because one couldn't sell new COLI plans, old ones didn't just fade quietly away. They stayed on the books (generating premiums and claims), but with little incentive to do much else with them. Some companies, looking at the cash values of these plans, recognized a treasure-trove of cash sitting idly by. In fact, some of these plans were beginning to self-destruct, as the internal costs ate up the cash build-up.
What to do?
One alternative is to roll the existing, poorly-performing policy into a new, presumably better-performing one. The problem is that old standby, "insurable interest." In this case, it's a legitimate concern, "because a COLI policy may insure former employees as well as current employees, and the employer may have difficulty re-establishing insurable interest on all lives covered by a COLI policy."
Not to mention medical insurability issues, but that's not addressed in the article.
So far, it's all talk, but we'll keep an eye out for any resolution (and any zombie life policies).
"Some state insurance regulators are looking into the idea of allowing tax-free exchanges of corporate-owned life insurance policies"
The problem arose out of the solution. That is, just because one couldn't sell new COLI plans, old ones didn't just fade quietly away. They stayed on the books (generating premiums and claims), but with little incentive to do much else with them. Some companies, looking at the cash values of these plans, recognized a treasure-trove of cash sitting idly by. In fact, some of these plans were beginning to self-destruct, as the internal costs ate up the cash build-up.
What to do?
One alternative is to roll the existing, poorly-performing policy into a new, presumably better-performing one. The problem is that old standby, "insurable interest." In this case, it's a legitimate concern, "because a COLI policy may insure former employees as well as current employees, and the employer may have difficulty re-establishing insurable interest on all lives covered by a COLI policy."
Not to mention medical insurability issues, but that's not addressed in the article.
So far, it's all talk, but we'll keep an eye out for any resolution (and any zombie life policies).
Tuesday, August 02, 2011
Rewarding Customer Service
Several years ago, I received as a gift a "gently-used" Sirius satellite radio, which I've rather enjoyed. The monthly fee is reasonable, although it basically follows the cable-tv model: 350 channels available, and I only listen to 2 or 3 (guess which kind?).
For the past two months, reception has been spotty; at first, I thought it was clouds or sunspots, but after checking with customer service, we eventually determined that the unit was reaching the end of its useful life, and needed to be replaced.
I'm on a month-to-month plan, and I have a unit that's "semi-permanently" mounted in the car [ed: "semi-permanently?" Isn't that like "sort of pregnant?"]. I was looking for a similarly configured unit to replace it.
Poking around the Sirius web-site, I found just the thing: a Stratus 6 (speaking of clouds). Priced at $50, it seemed a good choice. But when I clicked on it to order, I was told that it required that I switch to a 3-month payment plan, which I didn't want to do (if I chose "no subscription," the price jumped to $70!). I also felt that, as a long-time customer, the $15 "activation" fee needed to be waived.
So I called 'em up.
I spoke with "David," a very nice young man who tried very hard to meet my demands. He had no issues with waiving the activation fee, but told me that there was no way he could sell me the radio at the $50 price point if I insisted on staying with the monthly service plan.
At that point, I explained that, having lived the better part of two months without the service at all, I was prepared to just cancel and walk away altogether. But David was tenacious, and came up with a wonderfully creative solution that made everyone happy. He would keep me on the monthly plan, but give me a $20 credit on my account, to make up the difference. He then offered to credit the $4.89 sales tax on the new unit to my account, as well This was a terrific demonstration of outside-the-box thinking, and a true to commitment to great customer service. The new radio is on its way, and I am, in fact, a very happy customer.
Kudos, Sirius!
For the past two months, reception has been spotty; at first, I thought it was clouds or sunspots, but after checking with customer service, we eventually determined that the unit was reaching the end of its useful life, and needed to be replaced.
I'm on a month-to-month plan, and I have a unit that's "semi-permanently" mounted in the car [ed: "semi-permanently?" Isn't that like "sort of pregnant?"]. I was looking for a similarly configured unit to replace it.
Poking around the Sirius web-site, I found just the thing: a Stratus 6 (speaking of clouds). Priced at $50, it seemed a good choice. But when I clicked on it to order, I was told that it required that I switch to a 3-month payment plan, which I didn't want to do (if I chose "no subscription," the price jumped to $70!). I also felt that, as a long-time customer, the $15 "activation" fee needed to be waived.
So I called 'em up.
I spoke with "David," a very nice young man who tried very hard to meet my demands. He had no issues with waiving the activation fee, but told me that there was no way he could sell me the radio at the $50 price point if I insisted on staying with the monthly service plan.
At that point, I explained that, having lived the better part of two months without the service at all, I was prepared to just cancel and walk away altogether. But David was tenacious, and came up with a wonderfully creative solution that made everyone happy. He would keep me on the monthly plan, but give me a $20 credit on my account, to make up the difference. He then offered to credit the $4.89 sales tax on the new unit to my account, as well This was a terrific demonstration of outside-the-box thinking, and a true to commitment to great customer service. The new radio is on its way, and I am, in fact, a very happy customer.
Kudos, Sirius!
Grand Rounds is up!
Dr James Logan hosts this week's collection of interesting (and often thought-provoking) medblog posts.
Monday, August 01, 2011
The Lighter Side: 9 Reasons Why You Should Fire Your Broker
From FoIB Chad:
9. He named his first daughter Erisa.
8. He thinks AD&D coverage requires the participation of a Dungeon Master.
7. She took a correspondence course to be a lawyer but just missed passing the bar exam because she didn't know how to make a mojito.
6. She thinks STD isn't a problem as long as you get a penicillin shot right away.
5. He would rather wear a tinfoil fedora than purchase alien abduction insurance from Lloyd's.
4. He thinks Inland Marine insurance is what you buy for your BassTracker.
3. She recommends prize indemnity insurance just in case you don't win the Powerball next week.
2. She thinks Excess and Surplus lines is primarily for fat people.
And the number 1 reason you should fire your broker. . . .
1. He thinks Health Care Reform was about health, care or reform.
9. He named his first daughter Erisa.
8. He thinks AD&D coverage requires the participation of a Dungeon Master.
7. She took a correspondence course to be a lawyer but just missed passing the bar exam because she didn't know how to make a mojito.
6. She thinks STD isn't a problem as long as you get a penicillin shot right away.
5. He would rather wear a tinfoil fedora than purchase alien abduction insurance from Lloyd's.
4. He thinks Inland Marine insurance is what you buy for your BassTracker.
3. She recommends prize indemnity insurance just in case you don't win the Powerball next week.
2. She thinks Excess and Surplus lines is primarily for fat people.
And the number 1 reason you should fire your broker. . . .
1. He thinks Health Care Reform was about health, care or reform.
DDDUUUHHH
Hank recently posted a short blog with a headline that stated the obvious as if it was new information. I have one to add to his list, “Physicians compensated for volume, not quality.”
Really, is this news to anyone? All medical professionals bill using the “Current Procedural Terminology” Handbook; known in the field as CPT codes. The middle name is Procedure, i.e. what you did, not the “Current Outcome Terminology” handbook. Since a physician is paid based on what he does, then he needs to have many procedures in a day in order to make money. He does so by doing more procedures, seeing more patients: volume is the name of the payment game.
Really, is this news to anyone? All medical professionals bill using the “Current Procedural Terminology” Handbook; known in the field as CPT codes. The middle name is Procedure, i.e. what you did, not the “Current Outcome Terminology” handbook. Since a physician is paid based on what he does, then he needs to have many procedures in a day in order to make money. He does so by doing more procedures, seeing more patients: volume is the name of the payment game.
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