Monday, December 30, 2013

Year-end chat with DOI

In an InsureBlog exclusive, we present a year-end wrap-up of some of the ACA-related issues being dealt with by the Ohio Department of Insurance. Public Information Officer Robert Denhard was kind enough to answer some of our questions:

What are you hearing from insurers regarding receiving data on the back-end that allows individuals to actually pay for insurance?

We are hearing there are still problems but that the situation is better than it was. Either way, we're concerned about any impact on consumers if information is still wrong come Jan. 1.

Have you had any feedback from carriers about missing/incorrect 834's? What are they telling you?

Anecdotally we are hearing that there continue to be issues that need worked out.

How is ODI planning to handle the continuous influx of new plans that carriers will have to submit in order to stay within the narrow parameters of actuarial value? That is, since this will require plan changes each year going forward?

We will work with companies as we did last year to review plans as necessary.
With so many folks in the individual market opting to keep their plans until December 2014, what impact do you think that will have on 2015 Exchange rates? 
It is too early to try to predict rates since we do not even know yet what enrollment will ultimately look like and what the risk composition of those enrollees will be.
We’ve had a lot of questions about Navigators. How many Navigators have actually been certified in the state of Ohio?

Information about the number of certified navigators is available here [ed: that takes you to the Ohio Agent Locator page, from which Navigator information is available. At the time of this post, there are but 70 for the entire state].

Has ODI had any (many?) complaints about Navigators? If so, what kinds of issues have been raised?

We have not received any complaints about navigators.

This seems to be an issue at the national level, would be interested to know: how many Medicaid sign ups in OH vs Exchange plans? That is, how many have (been) enrolled in Medicaid as opposed to signed up for actual insurance policies through the Exchange?

A total of 5,672 people had signed up for the exchange as of Dec. 1, according to the U.S. Department of Health and Human Services (HHS). You will have to check with the Ohio Department of Medicaid for their enrollment numbers.

Finally, do you have a sense of the percentage of agents who’ve been Marketplace certified?

Agents who are marketplace certified is information officially maintained by HHS.

Thanks, Robert!

Friday, December 27, 2013

Hasta la VISTA, baby!


"The Obama administration has told Vista volunteers and other AmeriCorps workers that their government-provided health coverage does not measure up to the standards of the [ObamaTax], and that they may be subject to financial penalties unless they obtain insurance elsewhere."

So the government itself can't provide an ObamaTax-compliant plan, and is now dumping, er, providing alternate access to well-meaning victims folks whose only crime was trusting that the government that employed them would have a clue as to what it was actually doing.

Yeah, that wasn't ever going to have a happy ending.

My new article is up...


Overseas ObamaTax Conundrum

So, had a client stop by yesterday with a very intriguing question:

His daughter is a US citizen, but is a full time student in, and permanent resident of, Italy. He is himself Italian, but has lived in the US for over 40 years. He's also retired and on Medicare, so she can't be on his plan.

He came by because he'd been reading about "this new law" that required all US citizens to have insurance, and he wasn't sure what to do about his daughter. She's a citizen, but she doesn't live here, so would she be in trouble? Could we even write a plan for her if it was necessary?

All good questions, and I promised to find the answers. As I explained to him, I am very blessed to have built up quite a large circle of insurance experts over the years, friends and colleagues all over the 58 states on whom I can call for help and advice, and it was to this august group that I threw out my questions.

I was not disappointed; within just a few minutes, Louise Norris wrote back with a link to the relevant IRS notice, which included this Q&A:

12. Are US citizens living abroad subject to the individual shared responsibility provision?

Yes. However, U.S. citizens who live abroad for a calendar year (or at least 330 days within a 12 month period) are treated as having minimum essential coverage for the year (or period). These are individuals who qualify for an exclusion from income under section 911 of the Code. See Publication 54 for further information on the section 911 exclusion. They need take no further action to comply with the individual shared responsibility provision

So it would appear that she (and her father) are in the clear, at last for now. But one wonders how many other ex-pats and the like will be caught up in the ObamaTax net as the full force of the law comes online next week.

Thursday, December 26, 2013

Interactive ObamaTax Premium Map

While Ms Shecantbeserious & Friends continue flailing around with the train-wreck of a website, and keep extending deadlines like there's no tomorrow [ed: heh], the folks at PricewaterhouseCoopers (PwC) have produced an interactive map of actual premiums. As they note in email:

"In just over half of states, that newly insured [27 year old] will pay between $195 and $250 a month for the second-lowest cost silver plan. In five states, that person will pay more than $320 a month ... This newly insured [50 year old] will pay more for coverage, typically about 70% more than the 27-year-old."

So, sticker shock at both ends. In any case, it's interesting to click around to see the variation in premiums from place to place, and age to age:

Thoughts about the President's enrollment in Obamacare

Obama promised early on that he would enroll in Obamacare, and apparently expects the public to view his enrollment as an act of leadership.  But keep in mind Obama and his family are covered by another, better, federal plan and so none of them needs Obamacare.  In other words, his Obamacare enrollment is a meaningless act that signifies nothing.   It’s empty showmanship, not “leadership.”

However, it’s important that everyone at least read down to the 4th paragraph of the Washington Post article.  You will find that Obama did NOT enroll Michelle or either of their two children

Besides not needing Obamacare, I think there's another reason Obama decided not to enroll his family.  Obama knows everyone's personal information on the government websites is ridiculously vulnerable to hackers.  So of course he chose to protect his family members’ privacy.  Given his situation, that’s a simple choice. 

But Americans who qualify for subsidized premiums thru an Exchange don't have a simple choice not to enroll family members.  These Americans only have the "choice" (1) to buy subsidized insurance they can afford - and expose their whole family’s health, financial, and tax information to hackers - or (2) stay out of the Exchanges and be unable to find insurance they can afford.

Some choice.

Attention Obamacare Shoppers

Having difficulty signing up for #Obamacare? You aren't the only one.
“Somebody who’s not waiting in line to enroll is the president of the United States. We learned today from the White House. Initially, they said he signed up for what they called a bronze plan, paying about four hundred dollars a month in premiums. But, then they came back to us and said – ‘Well, wait. He didn’t actually enroll. They said his staff did it and that’s because of his unique circumstance obviously, as commander-in-chief, that his personal information is not in various government databases, so could not actually verify his identity, oddly enough. So, he had to do it in person this weekend, so he was signing up for the D.C. exchange, but his staff did it.”
World Net Daily


Signing up by proxy? Isn't that illegal?

You are probably wondering what kind of information is required to apply for coverage?

What was the problem? His Social Security number?
On Sept. 12, 2011, WND reported the Social Security Number being used by Obama did not pass a check with E-Verify, the electronic system the U.S. Citizenship and Immigrations Services of the U.S. Department of Homeland Security created to verify whether or not prospective employees have the required authorization to work legally in the United States.
Makes you wonder doesn't it?

You can be "hired" to run the country but can't pass the E-Verify requirement to work at McDonalds.

Tuesday, December 24, 2013

Monday, December 23, 2013

Still Sneaky

So the stealth deadline extension was apparently put in place to facilitate the President's own enrollment:

"According to a White House official, the president enrolled in the District of Columbia marketplace and selected from among the lowest-cost options available."

Well of course: it's his money, not ours.

Unsurprisingly, even this modest claim had to be immediately walked back:

"Obama made the selection while on vacation in Hawaii, though his staff signed him up in person in DC"

So how did we miss this awesome money-making opportunity:

"For hire: ObamaTax signer-uppers. For a modest fee, we'll assume your identity and sign you up for coverage."

How about: because it's illegal? "Legal, shmegal, we've got more important things to do."

Import from The Sceptered Isle?

Last Friday (Dec 20) David Prior,  the chairman of the NHS Care Quality Commission, said NHS quality and patient service are “wholly unsatisfactory.”  

Among other things, Prior emphasized that NHS can no longer be treated as a “national religion” in which service reached the brink of crisis because it was “too powerful” to be criticised.   He said parts of the NHS were “out of control” because honest debate about the weaknesses of the health service was not tolerated.

On the other hand, Paul Krugman asserts that when Americans hear stories about failures within NHS, we should know that “these stories are false.”

So, who do you believe? 

Americans who look to the U.K.’s National Health Service as a model for how government-run health care ought to work, should perhaps be looking more carefully at how government-run health care actually works.

The increasingly impersonal NHS is quite obviously responsible for more and more frequent personal medical care disasters.  Will Obamacare bring the same failures here?  It's not looking so good right now, is it? 

Americans must not hesitate to voice our objections to known failures of Obamacare and other clear weaknesses that threaten our personal health.  And we must not back down when we see our own government officials trying to stifle, deflect, or ignore criticism of Obamacare - and disparaging anyone who dares criticize it.

My opinion of Obamacare? We are finding out what is in it.  And we are appalled.  If you are not worried about this, you’re not paying attention.

Sneaky (as usual) [UPDATED]

Even when they're doing something "good," the Obamastration just can't do things honestly. To wit:

"...without any public announcement, Obama administration officials have changed the rules so that people will have an extra day to enroll"

If it's such a great, altruistically-driven idea, then why the subterfuge?

I think we all know the answer to that.

UPDATE: (via Ace of Spades) Here's the official photo of the ObamaTax Situation Room as this latest decision is reached:

Deadline Day

[Click picture to embiggen]

[Hat Tip: FoIB Holly R]

Obamacare Pitchman?

Obamacare is ailing. Young invincibles are not signing up. Old and sick are opting for coverage in droves. Michelle is promoting Obamacare in your Christmas stocking instead of candy.

Talk about getting a lump of coal.

Now comes word about the latest push for #Obamacare enrollees.
Washington’s new health insurance exchange dispatched a sign-up envoy to one of the city’s gay clubs one recent night to get out the word about Obamacare. It envisioned men mingling on the dance floor, a cocktail in one hand and enrollment information in the other.
But the brochures about DC Health Link, as the exchange is called, weren’t snapped up as quickly as the free condoms provided by a local clinic.
Condoms or Obamacare.
Tough choice.
Either way you are getting screwed.

Friday, December 20, 2013

Stupid Government Tricks [UPDATED & BUMPED]

[Please scroll down for update]

From the Now-They're-Just-Making-(Stuff)-Up Department:

So yesterday, with 4 days to go until "The Deadline" (until they change it again, natch), the folks in Capital City have declared that those sub-par plans are okay, after all, at least when they're bought through the Exchange:

"The Obama administration said Thursday it would allow some of the millions of Americans whose insurance policies had been canceled to purchase bare-bones plans next year"

Now, in and of itself, a truly catastrophic plan isn't a bad idea. In fact, it's what a health insurance policy should be: coverage for large, unexpected claims, not every sniffle or paper cut (or birth control pills convenience items). While the mandate is evil, it would at least have been more palatable if it required folks to have at least this level of coverage. And if it were deemed Health Savings Account (HSA) compatible well, then, Bob's your uncle.

Alas, that's not to be.

But there are a few problems with how this is being handled, not the least of which is that it is blatantly, spectacularly illegal.

Here's the relevant section from the ObamaTax itself (emphasis added):
(1) IN GENERAL.—A health plan not providing a bronze, silver, gold, or platinum level of coverage shall be treated as meeting the requirements of subsection (d) with respect to any plan year if—

(i) except as provided in clause (ii), the essential health benefits determined under subsection (b), except that the plan provides no benefits for any plan year until the individual has incurred cost-sharing expenses in an amount equal to the annual limitation in effect
under subsection (c)(1) for the plan year (except as provided for in section 2713);
(2) INDIVIDUALS ELIGIBLE FOR ENROLLMENT.—An individual is described in this paragraph for any plan year if the individual—
(A) has not attained the age of 30 before the beginning of the plan year; or
(B) has a certification in effect for any plan year under this title that the individual is exempt from the requirement under section 5000A of the Internal Revenue Code of 1986 by reason of—
(i) section 5000A(e)(1) of such Code (relating to individuals without affordable coverage); or
(ii) section 5000A(e)(5) of such Code (relating to individuals with hardships).
Seems pretty clear-cut to me.

But in case it's not, the helpful folks who provided training to become certified to sell on the Exchange confirm:
Eligibility for catastrophic plans is limited to:
• Individuals under age 30
• Individuals who otherwise do not have an affordable coverage option, or who otherwise qualify for a hardship exemption to the minimum essential coverage rule
So again, we just throw the actual reg's out the window because they're, well, "inconvenient."

But that's not the only problem. With roughly 84 hours left on the clock - and a weekend taking up most of that - carriers are supposed to price these plans for people aged, oh, 35 or 45 or 55. This, despite the fact that rates have already been reviewed and approved (or not) by the 58 different states' departments of insurance, which will now also have to review and approve (or not), these new rates.

Rostsa ruck with that.

It gets better, though, if by "better" we mean "worse:" what if you've already bought an ACA-compliant policy (hey, it could happen!) but would prefer the less expensive catastrophic plan? The good news is that it appears that you can make this change (or pretty much any other) during the Open Enrollment season. Of course, you'd still be stuck with the old plan for a month, and good luck getting through to, but at least it's an option.


UPDATE: It's also worth noting that - as the ObamaTax legislation is written (not that this continues to have any significance) - Catastrophic plans are not eligible for premium subsidies. So folks who opt for this choice may be in for a rude surprise. And as Bob would remind us, this is another great reason to shop (and buy!) OFF the Public Exchange.

Trick Question below

Q: When is a subpar plan not a subpar plan?

A:  When I change my mind.

Exchange Nightmare

Anyone remember Phil Conners? You know the weatherman in the movie Groundhog Day. He's a guy I can relate to.

Loyal readers may remember my post about Jane. She was the lady who is a cancer survivor, exhausted her COBRA, then had to go bare for six months before PCIP would begin. However, the Government shut down the program during her six month window. This left her without coverage.

For the last month we have been trying to get her enrolled through, I mean, Time and time again we would log in only to get kicked off. We finally made it through to where she was able to pick a plan and put it in her "shopping cart". That was two weeks ago.

Ever since then we keep getting stuck.

It's not for a lack of effort though. She has tried to log on daily. I have done the same on her behalf. We have done "chats" and gotten the same canned answers so many times that I have it memorized.

"Thank you for your interest in the Marketplace and for sharing your feedback. We apologize for any technical difficulties you may be experiencing as you use We know this can be frustrating, and we're working around the clock to improve and to make sure your experience with it is a positive one."
Tuesday was different. We logged in, got to the same issue and instead of these great responses we were simply told: "You have to call the toll free number." So we did. It was 4:30pm Eastern time when we got Shelby on the line. Outside of being cold, monotone, and unfriendly she was a very pleasant woman to talk to. After reading her script she was able to use my clients' information to log in and see the exact same thing we were seeing! In fact she got the same spinning hourglass that went round and round. Then she told us what we figured was coming:
"I'm sorry, this is our peak time. There are too many people on the system and your going to have the same problems if you try again. You need to try again later."
With that we bid farewell to Shelby and I told my client that I would try and log in after hours. On Wednesday I logged in at 7:30am. Had the same issue and called 1-800-GOOD-LUCK again. This time it was Markeeta on the line. She read me her script (same as Tuesday) and logged in with me just like Shelby had done. This time I was told:
"I'm sorry, this is our peak time. There are too many people on the system and your going to have the same problems if you try again. You need to try again later."
Just as Phil had Ned Ryerson, I have

CavRisk 2013/2014 Transition

For the first time in its 7 1/2 year history, the next Cav would fall on Christmas Day. So we'll be skipping that edition, and picking back up on Wednesday, January 8, 2014 at Michael Stack's place.

May your Holidays be warm and wonderful, and we'll see y'all next year!

Thursday, December 19, 2013

Sugar Daddy - Part II

Last month, Bob posted on the "news" that some hospitals, looking to bolster potential losses, have begun considering "supporting premium payments and cost-sharing obligations with respect to qualified health plans purchased by patients in the Marketplaces." The idea is that the hospitals (or other providers) would somehow subsidize their patients' premiums in order to make sure they remained insured, and therefore more likely to pay (or have someone pay) their bills.

Before we address the latest news on this front, I'm not convinced that this will be any great boon for the providers: after all, if they pay for low-end plans, where are their patients going to come up with the $4,600 and up "cost-sharing" funds? Or are they going to pop for Gold or Platinum plans, with lower out-of-pocket risk but substantially higher premiums?

In the newest twist, "A Better LA, a decade-old Los Angeles nonprofit, said last week it was signing up 50 low-income people for health plans in California's health-insurance marketplace." In this case, it's not the providers footing the premiums, but a charity. The plan allegedly has the blessing of the state's Exchange folks, but that doesn't mean that it's clear sailing: "A spokesman for Covered California ... [said] that individuals should ask their own lawyers if the payment would violate any other statute or code."

Here's a question: if you can't afford even subsidized insurance, how are you paying those legal fees?

Meanwhile, the hospitals seem intent on "fulfilling the law's mission of extending coverage to millions of Americans, said Melinda Hatton, the American Hospital Association's general counsel." Yes, I can just feel the warm fuzzies. Such altruism is so rare these days.

On the other hand, critics argue that it's "a conflict of interest for hospitals and drug companies to pay patients' premiums and cost-sharing for the sole purpose of increasing utilization of their services and products." That comes from AHIP's Karen Ignagni.

Um Karen? Here's some free advice about glass houses and stones: don't. Remember, you guys were all in on the ObamaTax before you flip-flopped (unconvincingly, I might add). So lecturing another industry about conflicts of interest, when yours stood to make a great deal by forcing people to buy your product, is more than a bit self-serving.

And of course, Ms Shecantbeserious would like to have it both ways: in October, she told a Congresscritter that "she didn't consider plans sold through the insurance exchanges to be federal health-care programs, and so weren't subject to rules that prevent health providers from giving subsidies or rebates to enrollees."

But the next week, one of her minions said that HHS "would "discourage" hospitals and other commercial entities from paying premiums. It asked insurers to reject such payments and warned that it would take further action if necessary."

One can only imagine how the carriers were quaking in their boots at the implied threat.

As for me, well, I think that it's a great example of unintended consequences, and puts the lie to "Affordable Care Act."

Yes, Virginia, there IS a Health Wonk Review

Julie Ferguson hosts this year's final round-up of health care bloggetry, with a wonderful Christmas-themed HWR. Come for Jolly Ol' St Nick, stay for the terrific insights.

Wednesday, December 18, 2013

Annnd...They fold

Wednesday Afternoon Linkfest

As I observed to a friend this morning, the silver lining (such as it is) to the ObamaTax is an embarrassment of riches, blog-fodder-wise.  To wit:

■ First up, looks like 'staycations' will be the new normal going forward:

"As Americans realize they must pay for all non-emergency medical care when they leave their home county, their decisions may have a profound impact on the real-estate market, particularly the second home sector, and on the travel business."

The issue: unlike current (but now outlawed) plans, Exchange-based policies won't cover non-emergency care outside one's network. Not necessarily an issue if you're headed to the neighbor's, a big one if you're headed to Disneyland.

Jonah Goldberg wonders when insurance companies are going to stand up to the bullies at HHS:

"In other words, the insurers knew the administration never had their best interests at heart, but got in bed with it anyway."

Asked and answered.

Remember the 1st Amendment? Apparently the folks in charge of The Beaver State don't:

" order to contract with Cover Oregon, so-called “community partners” are forced to sign a far-reaching non-disparagement agreement that could put the organizations at risk of losing all their grant money if Oregon state officials decide they disagree with any unfavorable statements about the Obamacare exchange."

Denial ain't just a river in Egypt, y'know.

In the nothing-new-under-the-sun Department:

"Some health care providers are offering credit cards designed to cover uninsured costs ... These cards ... are designed for consumers paying out of pocket for dental, vision, audiology and other treatments not covered by patients' insurance."

We blogged on this phenom five-and-a-half years ago, including the part regarding vet expenses for Fido and/or Fifi.

La plus ca change...

And on a completely different subject, how about this lucky break for some Seattle-area new car buyers:

"Jet Chevrolet promised 12 people $35,000 apiece in a drawing if the Seahawks shut out the Giants on Sunday, and Seattle, being very good (and New York being very bad), did just that."

That little stunt cost the dealer over $400,000. Or did it?

"The owners of Jet Chevrolet ... had to be breathing a sigh of relief Monday morning after covering their tails and taking out an insurance policy for a special promotion"

We've talked about "special event" coverage before, way back in 2006:

"Special Event insurance is just that: coverage to protect one from a sudden loss during some unusual activity or promotion. Think "$1 million Hole In One Contest." That kind of thing."

So apparently the Seahawks winning is as rare as a hole-in-one? Who knew?

Widespread Panic

Way back in the 60's the question was posed, "What if they gave a war and nobody came?".
That was then. This is now.

HHS wakes up this morning asking, "What if we gave away free health insurance and nobody bought?".
As The New American reported, however, of the nearly 365,000 who have selected plans on exchanges, the administration isn’t saying how many have actually paid for, and therefore attained, coverage. That may be, in part, because no one really knows. Writing for ForbesAvik Roy cited insurance-industry insiders’ estimates that only five to 15 percent of individuals who have selected plans have actually paid their first month’s premiums
The New American

They can't even give this stuff away and now they are attempting to blackmail health insurance carriers by threatening to take away their exchange privileges.

This is like Bre'r Rabbit pleading "Please don't throw me in the briar patch"
The administration is also being tight-lipped about the types of individuals enrolling on the exchanges, suggesting that most of the people signing up for coverage are those with pre-existing conditions that will be costly to treat, not the young and healthy whose premiums are needed to offset the cost of this coverage.
Well duh!

Obamacare is the under-funded PCIP on steroids.

Where is Oliver Hardy when you need him?

This is another fine mess you have gotten us in to.

My new article is up...

Tuesday, December 17, 2013

Real, or PhotoShop?

[No fair clicking through before guessing]

Cheese, Louise

Via The Corner at NRO, here are some results of two polls that aren’t likely to get much  attention in the media – at least, not side by side.

One poll was conducted by Washington Post/ABC News [WAPO] and was released Tuesday December 17, 2013.  The other poll was conducted by Public Policy Polling [PPP] and was released April 2, 2013.

It’s highly amusing to compare these poll results - although the comparisons don't prove anything in particular.

The WAPO poll found the following percentages of its respondents who believe:
· their own health-care costs will decrease as a result of Obamacare = 5%

· their coverage is improving as a result of the law = 8%

· Obamacare is decreasing overall costs = 11%

Well, that’s terrible, isn’t it? And contrary to what The Fair Nancy and other miscellaneous minions in this administration assured us, Americans apparently are NOT liking Obamacare more, as we find out what is in it.

Meanwhile the PPP poll found the following percentages of its respondents who believe:
· Paul McCartney died in 1966 and was secretly replaced in the Beatles = 5%

· Osama bin Laden is still alive = 6%

· the moon landings were faked = 7%

· the government adds fluoride to our water supply, not for dental health reasons, but for other, more sinister reasons = 11%

· media or the government adds secret mind-control technology to television broadcast signals = 15%

· the government is hiding a UFO that crash-landed near Roswell = 21%

As I say, comparing these poll results don’t “prove” anything.

At the same time if Obamacare must truly compete for the oxygen of favorable public opinion with the theories of the nutter and conspiracy crowds . . . then it’s probably in real trouble.


The White House tweeted this little gem today and used the hashtag #obamacareinthreewords. The three words they used...

Saving People Money.

Many of us have seen our premiums increase by 30% to 50% since 2010. If I paid $10,000 in premiums back in 2010 and now pay $15,000 in 2014, under the MLR rule in 2010 my insurer was able to retain $2000 for administration and other fixed costs. Based on the new premiums my insurer will be able to retain $3000. 

As a business owner I would argue that #Obamacareinthreewords is:

Insurance. Company. Racket.

Riddle me this...

So someone plays "Stump the Navigator" (admittedly a very low bar), and then, using her Google-fu, tracks down an online copy of the Navigator's Handbook. So far, so good.

Turns out, though, that the document in question - a training manual for folks who will have access to your most private health and financial information - is itself "Top Secret."

[ed: I always thought James Bond was a secret agent, not an insurance agent]

Here's the puzzler: Why would this be a secret? What's in there that would cause HHS Secretary Shecantbeserious to lose sleep if disclosed? What is she hiding?

Monday, December 16, 2013

Proceeding apace... [UPDATED]

So you may have seen this story floating around the 'net:

"[A] House Oversight and Government Reform Committee ... has found that Obamacare Navigators have been giving Americans misinformation and, in some cases, actively encouraging enrollees to commit fraud in order to raise their subsidies."

Of course, this is only a surprise to the folks in Capital City; we've been pointing this out for quite some time.

The report also notes that "there is no way for Americans to find out whether their Navigators are properly certified."

Again, something we've covered for a while. But then, we're just a bunch of greedy, evil insurance agents (who have to be trained, licensed and our backgrounds checked), so what do we know?

My favorite, though, is the headline: "Ill-Trained Obamacare Navigators Encouraging Fraud, Jeopardizing Private Info"

I would argue that they are most certainly not "ill-trained:" they are doing exactly what they've been trained to do.

More: Over the past few days, phone calls from clients, would-be clients and colleagues have really picked up. There is just so much confusion and misinformation (and not just from the Navigators, but so much of the Lame Stream Media): no, you don't have to keep your insurance for a year if you renew early; and no, you don't have to rely solely on the site (unless you qualify for, and wish to take advantage of, a subsidy).

But it seems that every day a new slew of "suggestions" from our Betters in Capital City seem to indicate they they really have no idea what they're doing, or a cogent strategy for getting it done.

Here's an example: Ms Shecantbeserious is urging carriers to allow folks who successfully navigate [ed: I see what you did there] the site and signed up for a plan to be "deemed" to be covered, even if the carrier has received no premiums. This is not new: there's always been a grace period for coverage, and as long as the premiums are paid within that time frame, the plan is in effect. The real issue is the 90 day window, but they don't address that.

Which still leaves two major problems: first, that carriers are being asked to treat non-par claims as par, and to pay for meds that aren't actually covered.

Anyone else see a slight problem there?

Gaming the system: We *may* have a winner

Last month, FoIB Dr Stuart Fickler posed a challenge:

"It appears to me that a system as complex as Obamacare is vulnerable to a vast range of gaming.  To be clear, I am not referring to just the computer aspects of the system, but the entire system, from applying to delivery of the care itself ...  if they don't want to take the risk of "second class medical treatment", they can switch over to the "marketplace" insurance."

I was skeptical that this would be a viable strategy, asking "what if the diagnosis came, and treatment was scheduled to begin, between regularly scheduled Open Enrollment periods?" There was also the challenge in finding a suitable "Special Open Enrollment period [SOE]."

While perusing another blog, I noticed that someone observed that simply moving to another state would be sufficient to trigger such an event. Again skeptical, I began researching to see if this might be the elusive "viable strategy."

And it appears that it just may be. According to Ms Shecantbeserious:

"Outside open enrollment, you can enroll in a private insurance plan through the Marketplace only if you have certain life events that give you a special enrollment period ... "Permanently moving to a new area that offers different health plan options"

Now this would seem to indicate that a SOE period is triggered simply by moving to (for example) a different state (notwithstanding the difficulties inherent in this if one is incapacitated).

I'm not entirely convinced that this is a "winning" strategy, for a number of reasons:

1 - From a strictly practical viewpoint, how likely is it that you'll find an oncologist who's taking new patients?

2 - I'm concerned about the "offers different health plan options" verbiage: it seems to imply that one is already insured, but that one's current carrier doesn't have a presence in the state to which one is moving (or has moved). On the other hand, it is in the "Special" open enrollment category, which defines circumstances under which someone who is not currently insured may buy coverage.

To quote Jamie and Adam, I'll call this one "Plausible."

[Hat Tip: Ace of Spades]

Sunday, December 15, 2013

This Sceptered Isle, Part MMXIII

Warning - this is not easy reading.  These are some findings contained in three reports released in Britain December 11th, together with other reports released earlier,  regarding the performance of Britain’s NHS:

(1)  a quarter of new mothers were abandoned by their midwives during labour, with some left to give birth on the floor or in corridors; midwives due to help women give birth at home were failing to turn up; others were unable to read machines that monitor babies’ heartbeats.

(2) 148 events April to September were deemed so serious they should never happen.  These included a fallopian tube removed instead of an appendix; another woman left infertile after doctors operated on the wrong side of her body; the wrong patient having heart surgery; another man had laser surgery on his right eye rather than his left; 37 other patients had the wrong part of their body operated on or treated; another 21 were given the wrong implant or prosthetic limb; there were 69 instances of objects including swabs and scalpels left in patients’ bodies after surgery; and five patients died or incurred severe harm after nursing staff incorrectly inserted feeding tubes into their lungs.

(3) thousands of patients have reportedly all but given up trying to secure appointments with their family doctor.  In fact, one of the biggest concerns of patients was the inability to see a GP – a key finding of an NHS survey showing how patients had lost faith in family doctors. Nearly a third said they did not trust their out-of-hours service.

(4) the NHS watchdog detailed a catalogue of failings at GP surgeries, including consulting rooms infested with maggots and patients being given dangerous, out-of-date drugs.

(5) at Mid Staffordshire hospitals, hundreds are feared to have died needlessly because of neglect.  This particular hospital trust has pretty much been a public embarrassment for several years.

(6) 12 [hospital] trusts were put into special measures after inspectors found staffing shortages and an obsession with targets were putting patients at risk.

(7) Police [were] called in to probe claims that staff at Colchester Hospital fiddled figures to hide the fact that some patients waited up to six months for cancer treatment.

And the official response to these findings?  “A Department of Health Spokesperson said: ‘People have a right to expect the best standards of care from their GP practice and hospital. A global study last month showed, the NHS is one of the best health services in the world.”

Spokesperson, I'm sure it's an immense relief for all British subjects to know that a "global study" says they enjoy such fine health services.  But you omit to say that people also have a right to expect the NHS to meet the same standards of excellence as you assert for GPs and hospitals.

Meanwhile in America, the economist Paul Krugman famously stated in a 2009 New York Times op-ed article that  “In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false.”

False?  If they were "false" in 2009, how likely can it be that the NHS suffered such significant deterioration in just 48 months?  Isn't it much more likely - and more truthful - that stories like these were not “false” in 2009, and they are not "false" now? 

Given this unpleasant window into NHS, what should be the takeaway  for Americans?  What must we do - what must we demand be done - to protect medical care in the United States from this kind of deterioration?   (I don't know the answer but FWIW, my opinion is that Obamacare cannot be a meaningful part of it.)

Saturday, December 14, 2013


Actual photo, Saturday, 12/14/13

Friday, December 13, 2013


This is not a photoshop:

Top. Men. And, of course, Ms Shecantbeserious.