Monday, September 30, 2013

(Un)common Sense

You know those warning labels on things like hair dryers? The ones that tell you not to use the hair dryer while you are in the tub or shower?

Or don't stick a fork in the toaster to get your piece of bread?

You would think these things are common sense. Why would you need to tell someone they shouldn't use a hair dryer while standing (or sitting) in water, or that you should not stick a metal fork in an electric toaster while it it turned on?

So why do navigators need to be told the following?
“Do not leave documents that contain PII [Personally Identifiable Information] or tax return information on printers and fax machines.”
“When faxing PII or tax return information, double-check that the recipient’s fax number is correct and that someone is able to pick up the faxed information immediately.”

Common sense, right?

Apparently not.

And these are the folks the government is hiring (and training) to help you get an Obamacare subsidy.

An ObamaTax Exchange Prediction (1,000 Words)

Breaking: Actual ObamaTax Rates (Tar Heel State edition)

A friend of mine, who lives in the Wilmington area, just received his 2014 "renewal" from Blue Cross/Shield, as well as a copy of the internal rate sheets for their new "metal" plans.

As one might expect, although he likes his current (HSA) insurance plan, he can't keep it. And contra the President's other explicit promise, his rates didn't go down "3000%"

His current premium, good through the end of 2013, is $212 per month with a $5,000 deductible (and no co-insurance). His renewal has mapped ("transitioned") him to a Bronze plan with a $5,500 deductible (and no co-insurance) with a monthly (non-subsidized) premium of $493, more than double his current premium, plus 10% more out-of-pocket.

Now, he could opt for a so-called "Catastrophic" plan (which, due to his age, would require a hardship exemption for eligibility) with a $6,350 deductible (and again, no co-insurance) for $387 per month. That's a 35% increase in premiums and a little over 25% greater out-of-pocket.

Fortunately, my friend's a non-smoker, else he could plan on adding an additional 20% to those "bargain" rates.

The ObamaTax in action.

ObamaTax Exchange Jitters - Part 1

Over the weekend, co-blogger Patrick sent me the link to an online "database" that purported to have the rates for various QHP's (Qualified Health Plans) as they'll appear on the Exchanges. Only problem was, the "data" was simply a recap of how many plans and carriers would be participating in a given state. But I wasn't all that surprised since I'd just seen this little gem from an agent in the Old Line State:

So tomorrow I’m supposed to be able to start enrolling people in the great and glorious future of health insurance. No doubt figuring that it would be helpful for me to know what plans are available to enroll people in before that date, this past weekend Maryland Health Connection emailed me a handy little quick reference guide to available plans. 876 pages of coverage grids, yay! I’ve been paging through it, and it’s really back to the future time, these are, with 2 exceptions so far*, old fashioned Major Medical (MM) plans.

Let me explain: Traditionally, a MM plan is a simple thing; you have a deductible of whatever, you pay for all your medical treatments until you spend that much, then the insurance kicks in. In recent years, most major carriers have modified MM plans so that some/much/most outpatient treatment was not subject to the deductible, but just required a copay. It works pretty well, if something major happens (i.e. hospitalization, surgery) there’s a deductible to meet but it’s not so bad because the bill’s huge, but in most normal years thing like docs, Rx, ER just require a copay. People are NOT going to be happy going back to the old model. EVERYTHING except preventive care is now subject to the deductible. It could work if the cost came down significantly, back to where it used to be, but we already know it’s going up.

And that’s the other thing. There are no prices attached to these plans. I’m supposed to start enrolling people tomorrow, wonder if I’ll have it by then? Without some idea of costs, I have no way to judge whether these are “good” insurance plans or not. They could be, if they are cheap enough. (Hell if they’re cheap enough, it would be dragging insurance back to what it’s supposed to be instead of being prepaid medical) I’m not holding my breath, however, and I’ll tell you something else: People who have been covered by comprehensive work plans that require little out of pocket from them at the point of service are going to scream bloody murder.

Also along the same everything-old-is-new-again lines, HMOs are back with a vengeance. Pre-approvals and referrals are the new black.

* UHC has managed to retain a smidgeon of outpatient coverage not subject to the deductible, but it’s not even close to what their plans cover now. Also, what I can only call “super insurance” is available; BCBS has one plan where you pay nothing for health care, no deductible, no copay, no coinsurance, nada. Network limited, but your annual out of pocket max is $0. I really, really want to know what that one costs.

Thanks, WD!

Stay tuned for Part 2 - the other shoe drops.

On ObamaCare Messaging and Strategy

It's no secret that, like most Americans, we're no fans of Obamacare. So it's frustrating to see the political party that did not ram it down our throats being so weak-kneed in its opposition as it's being rolled out.

The latest tactic would delay the Exchanges for a year. How stupid is this? The administration is already accusing the Republicans of everything short of murdering people by not wanting them to have insurance. The one aspect of Obamacare that gets positive polling is people getting covered. Delaying that a year would be terrible press going into an election year, press the Media will heap on them gleefully. In the end they aren’t going to win that fight.

So what should they do? I have some suggestions:

1 - Waive the individual mandate for 1 year after the employer mandate is enforced

2 - Allow exchange subsidies but fund it with;

    a. Elimination of government contribution to Congress and staff premiums

    b. Force executive & Judicial branch and all staff to buy their coverage through the exchange with no subsidy from the tax payors

    c. Require passage of Keystone pipeline immediately with small small tax on oil passing through it earmarked for exchange subsidies

    d. Eliminate PCORI and allocate all collected money to exchange subsidies

Now instead of Republicans not wanting people to have insurance it will be on the administration to give up graft or shut down the government. None of the items are meaningful to the public; the majority of people would argue they should be sacrificed to fund the subsidies.

ObamaTax Eve: MVNHS© and CanadaCare© edition

While legacy media reports that the ObamaTax rolls out tomorrow aren't quite accurate (various portions have been implemented over the past 3 1/2+ years), the opening of the Exchanges is certainly a high- (or low-, depending on one's perspective) watermark. And so in that spirit, let's see what our Friends Across the Pond© and Neighbors to the North© have wrought, in order to better understand the future of health "care" in America.

■ Reader Peter K tips us to this little gem from Merry Olde England:

"A teenage girl died after doctors failed to carry out basic checks that may have revealed she was suffering from life-threatening brain damage"

15-year-old Amie Miller had been suffering from headaches and nausea, and couldn't even open her eyes. Some very simple tests might have revealed the extent of the damage, and saved her life.

But that's not the best part. This is:

It took 5 years for the Royal Rocket Surgeons to figure this out.

■ It's probably a good thing that little Amie didn't smoke, or things could have gone even worse:

"Patients are being denied minor treatments because they smoke ... a healthy middle-aged man was told he could not have a ten-minute operation to cut a small benign growth off the side of his  head, because of his habit."

One might endeavor to argue that smokers who develop lung-cancer ought to pay some penalty at claim time. But the Much Vaunted (and Totally Compassionate) National Health System© has begun denying actual care for non-smoking-related health problems to those who choose to light up.

Death Panels IPAB at its finest.

■ Meanwhile, our Neighbors to the North© prove that, when it comes to denying care to those most in need, they're no slouches, either:

"The daughter of a 67-year-old woman is planning to sue Pierre-Boucher Hospital in Longueuil [in Quebec] after her mother spent 13 hours in the emergency room without being seen by a doctor."

The good news is that Mom's health care was "free."

The bad news is that Mom's free health care killed her.

The ObamaTax Exchanges (are scheduled to) open tomorrow.

Sunday, September 29, 2013

Obamacare and Mega Blue

The Obama administration plans on Monday to announce scores of new health insurance options to be offered to consumers around the country by the Blue Cross and Blue Shield Association and the United States Office of Personnel Management, the agency that arranges health benefits for federal employees, according to administration officials.
The options are part of a multistate insurance program that Congress authorized in 2010 to increase options for consumers shopping in the online insurance markets scheduled to open on Tuesday.
Congress conceived multistate plans as an alternative to a pure government-run insurance program — the “public option” championed by liberal Democrats and opposed by Republicans in 2009-10.
And this is good because . . . .?
The federal government negotiated the benefits and premiums for the Blue Cross and Blue Shield products, so this plan carries a federal seal of approval.
But how is this good for consumers?
Supporters of the multistate plans authorized by Congress say the plans will increase competition in local health insurance markets, many of which are dominated by one or two carriers. 
Introducing a "super plan", issued by ONE carrier, will increase competition in markets dominated by one or two carriers.

Friday, September 27, 2013

Cavalcade of Risk #193: Call for Submissions (And A Special Note)

Dennis Wall hosts next week's Cav, and he's chosen to build it around a rather interesting (and provocative) theme:

The Rich Get Richer from the Great Recession, The Unemployed Stopped Looking.

So, please try to submit a post that fits this theme (of course, non-themed posts are also welcome).

Submissions are due by Monday the 30th.

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 unless directly theme-related). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Thursday, September 26, 2013

Cute vs Real

This is how Ms Shecantbeserious sees the ObamaTax:

And this is reality, barking back at her:

[HatTip: Ace of Spades]

ObamaTax Exchange Crunch-Time edition

Poor Ms Kathy: the clock keeps on tickin', and her pet project keeps getting a lickin'.

To wit:

■ Capital City itself

"The ObamaCare exchange serving Washington, D.C. is delaying important parts of its operations less than a week before it is scheduled to open for enrollment"

Not only won't potential enrollees be unable to calculate their subsidies (if any), but they can't even determine whether or not they're eligible for Medicaid.

■ Colorado

"Colorado exchange managers revealed Monday ... that customers who want tax credits to make health insurance more affordable will have to call for help, rather than navigating the multi-million dollar computer system on their own."

I'm sure that'll go over big with the 20-somethings that hold the key to the whole train-wreck's "success."

■ Utah

"Obamacare’s insurance marketplace was supposed to have “no wrong door ... Consumers will need to find the right door ... or they will possibly face delays in obtaining coverage"

The whole "No Wrong Door" meme was heavily promoted in the Exchange Certification training. Why am I not surprised that it's DOA?

■ Oregon

When it rains, it pours:

"Oregon ... won’t meet all the requirements for its health-insurance exchange when the online marketplace opens Oct. 1 ... For at least two weeks, people using Cover Oregon won’t be able to complete their purchase without help from a certified insurance broker or community group"

Feature or bug? What difference, at this point, does it make?

A Gentle Reminder...

For HHS Secretary Shecantbeserous:

Health Wonk Review is up!

Peggy Salvatore presents this week's terrific Health Wonk Review, celebrating blogger Brad Wright's 700th post (Mazel Tov, Brad!). The main theme of this week's collection of wonky posts is (no surprise), the ACA. Lots of quality entries this week - enjoy!

Bonus: Mike's post (about how the ACA is playing out in the Golden State) got top billing - go Mike!

Wednesday, September 25, 2013

Singles for Obamacare

Psst. Wanna save money on your Obamacare plan? Stay single. If you are married, get a divorce.

The "wedding tax" is upon us.
To illustrate, let’s start with the 60-year-old married couple with no children 
If they have identical earnings totaling $65,000, which will usually net down to $50,000 or below after all income and payroll taxes, their Obamacare exchange Silver Plan premium next year with the same earnings will be $16,382, or about one-third of what used to be their take-home pay. (And they call it the “Affordable Care Act”?)
PJ Media

That's going to hurt. But wait.
What can this couple do? Well, they could decide to earn a few thousand dollars less, which will negate the five-figure premium hit. Encouraging ordinarily willing workers to put in less effort isn’t good in any economy, but especially not this one. But if either spouse’s earnings are unpredictable or hard to precisely track, they could still “mess up” and get socked with a premium they can’t afford.
The “easiest” solution would be to avoid the “wedding tax” entirely by getting divorced while still living together. Here’s what would happen if they make that choice:

 Similar occurrences at other ages. Do you suppose this was planned?

One Down, Ninety-Nine More To Go

Obamacare navigators. Much has been written about this job creation project that is tied to
Obamacare. Take 3 days of training and you are qualified to answer any and all questions about Obamacare. Background checks not required.

The state of Georgia decided to pass on creating our own exchange which meant the feds had to handle that task . . . along with setting up exchanges in 32 other states.

Navigators will earn $10 - $14 per hour and even more if you are fluent in Spanish or other languages.

Georgia's insurance commissioner has not hid his feelings about Obamacare. One good thing he did for the citizens was to require 40 hours of training and a proficiency exam before you can work as a navigator.

So what's the problem?
A major part of The Affordable Care Act will go into effect and some say Georgia is nowhere near ready and the state's top insurance official won't talk about the topic.
Channel 2 political reporter Lori Geary has learned there will be very few people ready to help Georgians sign up for health insurance when the law takes effect next week.
The state has issued a license to just one navigator and there should be nearly 100. 

One navigator to serve the entire state.

That person will be very busy.
"Isn't it the insurance commissioner's job to inform Georgians about what are your options in obtaining that health care?" (State Sen. Nan) Orrock asked.
No it isn't.

There are insurance agents who can handle that task. Navigators are not now, nor were they ever needed to promote Obamacare.
"I don't think that accelerating anyone's entry into a program that I believe is destined for failure is doing anyone any kind of service," (State Sen. Josh) McKoon said.
"I think the reason we're not hearing more about it in Georgia is that we're going to see over the next couple of months, I think, is the beginning of the end of The Affordable Care Act because it is a tremendous over promise," McKoon said.



Spain's Obamacare on the Ropes

Spain is like most other European countries in providing their own version of Obamacare, a
government managed health care delivery system funded by taxpayers. And like other countries that provide "health care for all", the program is bleeding profusely.
"The impact we have seen in the year since the reform is simply devastating," the president of the organisation, Alvaro Gonzalez, told a news conference, launching a new publicity campaign against the cuts.
Citing government figures, he said 873,000 people had had their access to Spain's free public healthcare system discontinued since September 2012 -- most of them immigrants whose entitlement lapsed because they lost their jobs.

Almost a million people have lost access to "free" health care in the last year. Immigrants who lost their jobs and health insurance.

One supposes they could just pay for health care but that defeats the purpose of free.
"The government is insisting that the economy is recovering... but still our health system, which in past years was the envy of neighbouring countries, is suffering one cut after another," Gonzalez said.
Is Obama running their country too? 
Some of the regional authorities that control local health budgets have also started making patients pay part of the cost of their prescriptions.
"This has meant that 16 percent of the pensioners in our country are being cast out of the healthcare system because they cannot meet the cost of paying for medicine for their chronic illnesses," Gonzalez said.
Pensioners would be the equivalent of U.S. seniors on Social Security and Medicare. Is this a prediction of what will happen here?

Donde esta Obamacare?

Tuesday, September 24, 2013

Euthanasia in Netherlands up 13% in 2012. Aren't the Dutch happy?

The number of Dutch people killed by medical euthanasia has more than doubled in the 10 years since legislation was changed to permit it, rising 13 per cent last year to 4,188 . . . One explanation for the steep rise of Dutch cases is the introduction last year of mobile euthanasia units allowing patients to be killed by voluntary lethal injection when family doctors refused.”

Is this bad news or good news?  Does the growing use of euthanasia mean the Dutch are actually becoming less happy?  Could it be the Dutch are less happy than Americans - even though - on the prestigious, European-based "Happy Planet Index" - Netherlands ranks 67th while the U.S. ranks only 105th?

Even after 10 years, I still think it's not yet possible to know the answers to these kinds of questions.  We can measure transactions and form opinions, but can those tell us whether the Dutch are doing the right thing?  I think not.  And besides, what does euthanasia have to do with happiness?

Decisions about caring for people at the end of life remain among the most significant and difficult decisions facing families today.  The Dutch model for euthanasia is a meaningful effort to help families deal with these decisions and therefore deserves the careful observation and analysis that it is receiving.

Officially the Dutch model relies on families and family physicians to reach decisions about euthanasia. That does not entirely avoid the future possibility that someday, the Dutch national health care program, or some other government's program  - say, in the U.S. - may actually prescribe euthanasia as a matter of law or regulation, in order to save money. That’s my idea of the ultimate death panel.  Brave New World indeed.

History shows that governments insist on participating in financial decisions when they are paying for the outcomes.  In other words, a government health care program cannot pretend to be a fair and impartial third-party, because it is an interested participant in the outcome. It's a conflict of interests that won't go away.

How can America avoid that possible future?  For one thing, the public cannot afford to rely on lawmakers; we must do our best to watch what other governments  - such as the Netherlands - are doing.  And for another, we must watch what our own government is doing.

Feature or Bug?

Yesterday's McPaper characterized one aspect of the ObamaTax pricing regime as the "Family Glitch:"

"Congress defined "affordable" as 9.5% or less of an employee's household income ... the "error" was that it only applies to the employee — and not his or her family. So, if an employer offers a woman affordable insurance, but doesn't provide it for her family, they cannot get subsidized help through the state health exchanges."

Why is this both an "error" and a "glitch?" And why presume in the first place that it was not, in fact, intentional? After all, even the folks in Capital City had to foreseen how many employers would be dumping shifting their employees (and retirees) onto the Exchanges in an effort to gain some control over the financial hurdles being placed before them.

Our Elected Betters© wouldn't have done something stupid, right?


Patient Protection Act - Cause it isn't Affordable

With insurance Exchanges Marketplaces nearing their grand opening HHS has released another issue brief on the "low rates" people will pay after subsidies. In one of the examples they use a 27 year old in Texas who makes $25,000 per year. This person will pay $145 for the second lowest cost silver plan or $83 for the bronze plan after the subsidy.

HHS is so focused on premiums and making this trainwreck look affordable that they are missing the boat on a key component, the benefits. Without knowing the health history of the individual they may in fact be promoting the exact opposite of what the person is looking for: the greatest value for their dollar.

If I am a 27 year old with diabetes, am extremely obese, and suffer from Crohn's disease would I want to purchase a plan with a $5000 deductible and $6350 out of pocket maximum? That is what I will likely get for $83 per month. 

From a financial standpoint: 

Income:  $25,000
Premiums:  $996
OPM:  $6350

Net Income: $17,654

30% of income for insurance and health care costs. This is what HHS considers "affordable".

Monday, September 23, 2013

Alzheimer's Update: Good news (for once)

SoIB Gail S tips us to this recent story in the Dayton Daily News, recounting an award-winning therapy that's deceptively simple:

"Three years ago, Wright State University professor Dr. Govind Bharwani was given a challenge: Find a way to help people living with Alzheimer’s disease so they are less prone to becoming confused, agitated, withdrawn and falling."

And it appears that he has, in fact, succeeded:

"The therapy works by providing each person with their own “memory box” filled with family photos, books and movies they love and other special items."

Once you think about it, it's kind of intuitive: one of the reasons that Alzheimer's patients become so frustrated is that loss of "connection" to the world. I recall that, with my mother, I eventually realized that she wasn't having "good" days or "bad" ones, so much as "today she's in her own world" versus "our world" days. What better way to restore (or at least enhance) that connection than re-establishing treasured experiences?

Another benefit is that this is all done with no drugs, which can be expensive and often have undesirable side effects. Research is now continuing to see how (or if) this can be applied to those living at home with this dread condition.

Kudos to WSU and Dr Bharwani.

Take two apps and call me in the morning

Introducing the iDoc® (not really, but we're getting close):

[Hat Tip: FoIB Jeff M]

Saturday, September 21, 2013

How uninformed can NYT readers, commentors possibly be?

Every once in awhile you see a comment that just makes you stop and ask how clueless and misguided people can be, then you remember they are allowed to vote.

Your typical NYT tripe from some blowhard that doesn't understand 90% of what he is talking about. The real gem is down in the comments though;

  • mikeoshea
  • Hadley, NY
"All Republican Congresspeople - except those on Medicare - should be required to buy their own and their family's health care BY THEMSELVES, just as I must buy my wife's (I'm on Medicare, thank the gods) health insurance by myself."

Odd, I thought that is exactly what the law (ACA) required.....until a Democrat President ordered OPM to ignore the law and subsidize it. I also have seen only Republicans fighting to undo the waiver.

In a news report today, Rep. Phil Gingrey, M.D., expressed his opposition to the Obamacare exemption for Members of Congress and their congressional staffs.

This is yet another example of the Obama administration changing the law for political gain,” Gingrey said. “The exemption for members of Congress and their staffs must be rescinded. Between increased health care costs, scores of missed deadlines and political handouts to friends, this is further proof that Obamacare must be repealed.”

Lets all just hope this Mike O'Shea idiot doesn't vote. And to the NYT, great job informing your readers there paper of record! 

Friday, September 20, 2013

ObamaTax Health Exchange (Marketplace) news

So yesterday, I did my Exchange training and exams. Started at about 9:30 in the morning, finished about 4:30 in the afternoon.

I understand Pat completed this in just a few hours, but he's a lot younger (and apparently smarter) than I am. And I also took the liberty of saving all the training material for future reference (which no doubt added some time, as well)

I'll have a more complete report soon, but here are some of my initial impressions fresh off the training and exams:

I'll just say this: if you're comfortable having ALL your personal medical, financial, tax and what-all info being zipped around between SSA, IRS and DHS (Department of Homeland Security?? Really??), then by all means head right for 'em on 10/1 (assuming they're actually online then).

I'm pretty knowledgeable about this stuff (really!) and even I was amazed and appalled at the level of intrusion this train-wreck has wrought. Oh, and you'll be pleased to know that as taxpayers, you'll have the double-mitzvah of paying through the nose not just for your own health care, but for all those wonderful "others" who qualify for premium and "cost-sharing" subsidies.

Here's my favorite part, though:

"QHPs [Qualified Health Plans] in a Marketplace must also provide coverage that meets one of five levels of generosity ... It is important to emphasize that AV is an average measure of generosity ... the percentage of medical costs the plan will cover after premium payments."

And just who's being generous with MY money? Oh, yeah.

And to top it off, this just in at the WSJ:

"Less than two weeks before the launch of insurance marketplaces created by the federal health "overhaul, the government's software can't reliably determine how much people need to pay for coverage"

Yeah, this is going to end well....

Thursday, September 19, 2013

ObamaTax School's Now In Session!

Learn it, live it, love it:

Wednesday, September 18, 2013

I've been remiss....

In case you missed it, I'm the newly-installed Content Expert Writer (Insurance) for It occurs to me that IB readers might be interested in some of my work in that venue, so here are some free samples:

Part 1 of a 3-part series on Universal Life

An explication of Insurable Interest


But it's a nice hat. That's because the people paid for that hat.

Remember the President's assurances that his ACA would finally “bend the cost curve”?

Despite a determined rear-guard media that clings to Obama's every word as universal truth, evidence accumulates that the President was talking thru his hat.

On September 17, 2013, CBO released it's most recent Long-Term Budget Outlook.

According to CBO, in 20 years, “major health care programs” will be the largest component of federal spending

CBO expresses its estimate relative to GDP - which is also growing.  CBO's estimate is that federal health care spending will increase from roughly 3% to north of 8% of GDP.  That's almost tripling the share of a base number that is itself growing every year.   CBO thus anticipates federal dollar spending growth for health care more like 4X's to 5X's its level in 2013.

Bend the cost curve, indeed.  

Talking thru his hat.

(btw, the same CBO estimate finds that  within the next 25 years, federal debt held by the public will be 100% of America’s entire GDP "without accounting for the harmful effects that growing debt would have on the economy."  The corresponding percentage as late as 2007 was less than 40% of GDP.  This administration's failure to bend the federal spending cost curve is clearly a serious problem that extends well beyond "health care".)

Cavalcade of Risk #192: Galloping Into View edition

Nancy Germond hosts this week's romp through the wilds of risk, a maze of medical conditions, and a not-so-*fowl* post on chickens (cluck all you want).

Tuesday, September 17, 2013

Bored Game

If you have nothing to do, what happens? Some drink. Some go shopping. Others create board

"Everybody has to pay. Nobody ever wins,"
Each player starts out on the "Buy Insurance" square as a small business owner (except for the Occupy Wall Streeters, who begin the game unemployed). Along the way, players are taxed, troubled, hospitalized, or may even fall victim to a death panel as they make their way across the board.
CNS News

Do not pass Go.

Do not collect $200.
"We may have added some funny exaggerations in the game," LeFeber said. "But since the original bill was brought to you by the same folks who so efficiently manage the US Postal Service, Social Security Trust Fund, recent Bank Bailouts, and soon-to-be $17,000,000,000,000.00 in government debt--you know the game is rigged against us from the start."
Just like real life. You have to play the game to know what is in it.

Obamacare Cry Babies

Employees of Bibb County (GA) schools got an early peek at their new benefit plan for 2014.
Through the end of this year employees had a choice between several plans administered by UHC or Cigna. They could pick an HMO or PPO. Copay or high deductible HSA or high deductible HRA.

Choices, choices.

That was then. This is now.

The Georgia Blue's got tired of sitting on the sideline and made a winner take all offer to the SHBP (State Health Benefit Plan) administrator.

Blue won the contract. Cigna and UHC are gone.

Say bye-bye to copay plans and freedom of choice. Employees can pick from one of three plans and their choice is Blue or Blue.

No more copay plans.

They are calling the new design a PPO with an HRA wrap.

Last year the state provided this comparison between the 2012 and 2013 plans. The plans were not bad and not good. Most employees preferred the HMO because of the doc copay's.

2014 is a new year and copay's are last years news. The new PPO Wrap looks like this.

As you can guess, most of the employees are not happy.

Where are the copay's?  Gone . . . .

They can't do this to us! Yes they can . . .

I want my Obamacare plan. This IS your Obamacare plan . . .

For some reason I am reminded of that scene from Private Benjamin.
Pvt Benjamin - "I think they sent me to the wrong place. I did join the army, but it was a different army. I joined the one with the condo's and private rooms."

No doubt, many Pvt. Benjamin's will be checking out the exchange offerings when it opens in a few weeks. Some may even sign up, expecting to get a subsidy . . . or a condo with a private room.

A subsidy that will never happen.

The law says if you have an "affordable" health insurance plan through your employer, you can still buy from the exchange but you are not eligible for subsidies.

How is affordable defined?

Glad you asked. If the employee premium is less than 9.5% of the employee's W-2 gross income the plan is deemed affordable.

If the employer plan meets that criteria, neither the employee or their dependents will qualify for an Obamacare subsidy.

Elections have consequences.

Layers and Layers of Fact-Checkers

The Lame Stream Media prides itself on its unerring accuracy and commitment to getting the facts straight. As it turns out, at least when it comes to life insurance, this pride is, in fact, unjustified. As we pointed out almost 4 years ago, they can't even get the relatively simple suicide exclusion correct:

" appears that this may well have been an elaborately staged suicide, the point of which was to leave the proceeds of a life insurance policy to the victim's son ... “There’s no such thing as suicide insurance."

Which is true, but as we pointed out, irrelevant. It would have taken the reporter five minutes to interview a life insurance agent to provide clarity and context (not to mention accuracy).

And now we see the same shoddy reporting in another tragic case:

"... for Cindy Karlsen, there was the $1.2 million policy that her husband had now taken out on her life ... She learned Karlsen had invested some of the insurance money from his son's death into a life insurance policy on her."

And how did the erstwhile Mrs Karlsen learn this? Apparently it came as a big surprise to her that she had applied for life insurance, but some simple fact-checking by the (so-called) reporter might have revealed that it's almost impossible to buy life insurance on another person without his or her consent, let alone knowledge. And a policy with over $1 million on the line is going to require not just a physical examination, but (at least according to the carriers I represent), a telephone interview with the prospective insured.

So we are left to believe one of two things is true:

1) A life insurance company issued a million dollar policy strictly off an application - no exam, no blood or urine draw, no interview - and no effort to confirm the information on the application.


2) She agreed to complete and sign a lengthy life insurance application, take a fairly invasive physical exam - including, depending on her age, a stress-test and the release of her medical records - and do an exhaustive telephone interview, without the slightest clue that this was for a ... wait for it .... life insurance policy.

How dumb does the LSM think we are?

[Major IB Thanks to Jeff M for helping me noodle through this post]

Monday, September 16, 2013

Monday Afternoon LinkFest

Lately, we've had an embarrassment of riches concerning the ObamaTax and other related news. Because there are only 24 hours in a day, it's not really possible to give each one the blog-space it probably deserves, but at least we can give our readers a heads' up on what's hot:

1 - We've been warning folks about the very real probability of fraud in the new Navigator program. From FoIB Holly R here's the latest:

"...officials are watching for look-alike websites that could lead consumers to be the victims of fraud or simply confuse people ... States are on the lookout for websites created by interest groups, private insurance companies and sometimes scammers that have similar web addresses and the appearances of the official state exchange websites."

So-called "phishing" sites have been around for a long time, this seems to be the latest iteration of that phenomenon.

2 - Holly also tips us to this story - surely only one of many to come - about pushback on so-called "wellness" programs. In this case, certain employees at Penn State University are protesting a new requirement that they either participate in one of these, with the added benefit that they'll get to divulge some very personal information, at least some of which seems pretty intrusive (and doesn't seem to be particularly "health"-related):

"The plan requires nonunion employees, like professors and clerical staff members, to visit their doctors ... and submit to an extensive online health risk questionnaire that asks, among other questions, whether they have recently had problems with a co-worker, a supervisor or a divorce"

Cost for declining to participate? $100 a month (or $200 if they're married and have their spouse on the plan).

Potential solution (and probably rationale for the whole exercise): opt out of the Penn State plan and onto the Exchange.

3 - We've noted before that the Public Exchanges seem to be having a problem attracting (and keeping) carriers. Our Friend Jeff M reports from North Carolina that the Tar Heel State is no exception:

"FirstCarolinaCare Insurance abruptly pulled out of the North Carolina market, saying there are too many unknowns about how the Affordable Care Act will play out here."

So what if they gave an Exchange and no carrier came?

We may find out.

4 - And circling back around to Navigators and the likelihood of shenanigans, Florida has banned them from county health departments:

"Local health departments can accept public exchange brochures and other exchange outreach material, but they can distribute the materials only if consumers ask for information"

Florida heath officials wanted to make sure that they're agencies know that Navigators "aren't acting on behalf of the state."

Gee, one wonders why anyone would think that.

Not just No, but Heck No!

As Bob noted last month, the grand folks in Capital City aren't too keen on  rubbing elbows with us rubes waiting on line at the Health Insurance Exchange. Far beneath their stations in life, don'tcha know.

Well, it should probably comes as no surprise, then, to learn that Federal "workers" really don't want to give up their gold-plated (but Yugo-priced) health insurance. After all, they were promised that "if they liked their insurance, they could keep their insurance."

[Ironic, I know]

But if you'd really like to know just how much they don't want to forced off those great/affordable plans, "[a] new survey of 2,500 federal employees and retirees found that 92.3 percent believe federal workers should keep their current health insurance and not be forced into ObamaCare."

Frankly, I'm surprised that number's so low.

Exchange THIS

The LA Times reports some major California insurers have built "narrow networks" of doctors and hospitals for plans that will be offered thru the State's Obamacare Exchange.

Insurance companies (and consultants and many large employers) say that these narrow networks reduce costs by increasing the insurers' ability to negotiate price discounts.  Physicians and hospitals say they oppose these narrow networks because they fear patients won't be able to find the doctor or hospital they like, in the plan they like.

As for the State, Peter Lee - executive director of Covered California [the State's Obamacare Exchange] - says "Our interest is in assuring everyone enrolled in a plan has ready access to the clinicians they need . . . That means if a plan can't serve patients, we'll close it down from taking new enrollment"

So if a plan doesn't provide what the Exchange deems sufficient access, the Exchange will make sure the plan can't provide ANY additional access.

Is that a solution?

The Times goes on to say "Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor."

Isn't that exactly what people say who worry about rationing under Obamacare - and have been relentlessly ridiculed for saying it?