Monday, March 31, 2014

The Clock is Ticking [UPDATED]

Today is (currently) the last day of the initial Open Enrollment season. Ms Shecantbeserious has indicated that, if you've tried to sign up and met with no success, the actual final day is April 15th [ed: irony - how does it work?]. I have several clients in this boat right now, and am waiting with bated breath as to how it will play out.

Golden State readers are in a very different boat. Co-blogger Bill reminds us that:

"Under the latest deadline changes, an application has to be started on CoveredCA by MARCH 31. You have until APRIL 15 to complete it. Outside of a qualifying event, if you miss the March 31 date, you're out until next year. On the Federal Exchange, they allow you to check a box that says that you tried to enroll and couldn't and are then allowed until April 15 to start a new application. That's not the case in California!"
Best get crackin'!

UPDATED: Heh (from Bill H):

The latest (slightly edited) press release from CoveredCA:

"Record-setting numbers of people trying to sign up for Covered California™ health insurance plans overwhelmed the system on the final day of open enrollment. Because of the staggering demands on the system, Covered California announced the following policy this afternoon:
• Consumers who were unable to create an online account or start their online application because of technical difficulties can contact a Covered California Certified Insurance Agent to explain that they attempted to get through on March 31 and experienced difficulties. Those consumers will have until 11:59 p.m. April 15 to work with the Certified Insurance Agent to complete their application and choose a plan.
• Consumers who created an online account and completed the first page of the application by 11:59 p.m. March 31, 2014, will be able to complete their application for the open-enrollment period, either by themselves online or with the help of a Certified Insurance Agent. Consumers must complete the application and select a plan by 11:59 p.m. April 15, 2014. Those enrollees will receive coverage effective May 1, 2014."
Rumors that the entire system is running on two surplus Commodore 64 computers are unfounded. An Altair 8800 is also employed to dynamically balance the load.

Sunday, March 30, 2014

Happy 9th Blogiversary to the HBB!

Congratulations to my friend David Williams' Health Business Blog, which recently hit the 9 year mark (just a few months after IB did).

Kudos, David, and many more years of successful bloggetry!

Friday, March 28, 2014

Does the ICD 10 have the Metric Curse?

Headlines on all the health care outlets yesterday (3/27/2014): 

Bill also delays ICD-10, two-midnight rule and RAC audits

According to the article: “The House of Representatives on Thursday approved a temporary fix to the sustainable growth rate (SGR) for one year in a bill that also delays ICD-10 implementation until at least October 2015 and postpones hospital compliance with the controversial "two-midnight rule" and recovery audits of medically unnecessary claims until March 2015.

While several items were approved, the excitement was due to yet another delay for the ICD-10. In 1996, the new HIPAA law mandated the acceptance of the ICD 10, and much like the poor metric system, it has been delayed and delayed in its implementation.

Why has it been delayed? Cost and complexity:

There are significant differences between ICD-9, what is used now and ICD-10, what is currently used in 25 countries, which this table demonstrates:
3-5 characters in length
3-7 characters in length
Approximately 13,000 codes
Approximately 68,000 available codes
First digit may be alpha (E or V) or numeric;
digits 2-5 are numeric
Digit 1 is alpha; digits 2 and 3 are numeric;
digits 4-7 are alpha or numeric
Limited space for adding new codes
Flexible for adding new codes
Lacks detail
Very specific
Lacks laterality

Has laterality (i.e., codes identifying right vs.

What has the medical community so upset about adopting the ICD-10: moving from around 13,000 codes to 68,000 codes. Why such an increase? Because in the ICD-10 the code tells a story. Instead of a code that says “Fracture”, the new code says “Fracture, left foot, first incident, middle toe, while a passenger in a car in a car crash”. In fact, the codes are so complex, they are unintentionally funny. Here are a few real codes:
T63.442S Toxic effect of venom of bees, intentional self-harm, sequela

W56.22xA Struck by orca, initial encounter

Z73.4 Inadequate social skills, not elsewhere classified

V91.07xD Burn due to water-skis on fire, subsequent encounter

And then there is the cost. I have already had some webinars on the glory that is ICD-10, and it is recommended to the physicians that they obtain a line of credit to keep their businesses open during the transition, as the new codes will cause delay in payments. In fact, on the CMS Website, a handout for physicians states, “Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, reprinting of superbills, trainings, and related expenses.” Great, a new unfunded federal mandate, but at least this time they are stating it will be costly to transition.

Needless to say, the medical community is doing cartwheels over a possible delay. (The first question on a CMS ICD-10 webinar I attended at the beginning of March “Is there going to be a delay?” The answer was "no"). Let’s all hope that the Curse of the Metric System continues to plague the ICD-10 or the next time you go to the doctor your code could be “Headache before sex, subsequent occurrence, would rather read “10 Shades of Gray”, or at the least take a long hot bath, sheesh…”

Cavalcade of Risk #205: Call for submissions

Nancy Germond hosts next week's Cav. Entries are due by Monday (the 31st).

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

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Thursday, March 27, 2014

Yo Quiero Obamacare?

The Obama administration has been helping to facilitate a series of events nationwide at
Mexican Consulate offices to enroll people in Obamacare – and a key activist says the efforts are “our responsibility” regardless of citizenship.

“Whether they’re Mexican nationals or whether they’re United States citizens or whether they’re in transition-- and if they’re there it is our responsibility within all of America to educate on the Affordable Care Act,” Enroll America Field Organizer Jose Medrano told Breitbart News on Wednesday.

The 6 Million Person Question

So there's this:

"More than 6 million Americans have now signed up for private insurance under the [ObamaTax]"

But have they really bought insurance?

Consider that we already know that Ms Shecantbeserious counts plans left unpaid for as "sold." So one is left with the real question:

How many of these (alleged) new policyholders have actually paid for their new coverage?

And here's a couple more:

How many are young and healthy (and preferably male)?

How many are paying full freight, and how many are counting on the generosity of others taxpayers?

Inquiring minds want to know.

Health Wonk Review: March Madness edition

The bad news is that this week's HWR host Chris Fleming missed a total of (sweet) 16 posts by that much.

The good news is that there are plenty of great posts from which to choose, from HWR founder Joe Paduda on ideology and business decisions to David Williams ground-breaking interviews of all 9 candidates for governor of Massachusetts - pretty amazing. And our favorite health care economist, Jason Shafrin, offers some surprising insight into genetic testing and adoptions.

Do check it out.

Buyers Remorse

Did you ever have one of those moments when you realize a decision you made, or a choice, was a really, really, really stupid idea?  

Now you know how some of our Congress critters feel.

Like roaches that scatter when the light comes on, vulnerable Representatives and Senators are running away from Obamacare as fast as they can.
Several Democratic senators reportedly plan to introduce as soon as Thursday a set of principles and legislation aimed at fixing parts of ObamaCare amid concerns the law could cost Democrats House seats and possibly the Senate in November.
Fox News

They were for the law before they were against it.
Begich and Warner have called for allowing "copper" plans on the government-run health exchanges. The new insurance plans would offer lower premiums and higher out-of-pocket costs than the "bronze," "silver" and "gold" options currently offered.
Higher deductible plans?

Most people I talk to think the current deductibles are too high. Pushing them higher won't work. Just shows how out of touch Congress zombies are.
Warner, who faces a formidible midterm challenge from Republican National Committee Chairman Ed Gillespie, said on Fox News earlier this week that he supports allowing Americans to purchase health insurance across state lines.
Buying across state lines never made any sense. Even less so now with the pricing guidelines of Obamacare.

Wednesday, March 26, 2014

One Ringy Dingy

The latest excuse for not enrolling in #Obamacare? 

According to Dirty Harry . . .
Senate Majority Leader Harry Reid (D., Nev.) said the fault of struggling to sign up on the Obamacare exchanges didn’t lie with the faulty website, but with the people who weren’t “educated on how to use the Internet.”
Explaining the reasoning behind the latest Obamacare delay, Reid said too many people just didn’t know to use their computer properly and needed more time. 
Guess they don't know how to use the telephone either.

Deadline? *What* deadline?!

Earlier this morning, Bob noted that the Obamastration itself has acknowledged that it has no "statutory authority to extend the open enrollment period in 2014."

But that was then, and this is now:

Now, leaving aside the legal challenge that this poses (as if legalities were of any interest to this regime), one needs ponder a simple question:


That is, why would they extend the enrollment period, after so vehemently denying that they would do so?

I think a good part of the answer lies here:

We already know that the vast majority of those who have enrolled are either folks who have lost their previous insurance or who are being shunted to Medicaid.

And we know that the uninsured are staying away from ObamaPlans in droves.

Seems to me, this extension means one thing: the ObamaTax enrollment numbers must be truly, epically dreadful.

Still not convinced?

Then how 'bout this little nugget, buried inside the  WaPo story linked above:

"Under the new rules, people will be able to qualify for an extension by checking a blue box on to indicate that they tried to enroll before the deadline."

Seems harmless enough: simply show that you've made a good faith effort to enroll and ... wait ... What's this:

"This method will rely on an honor system; the government will not try to determine whether the person is telling the truth."

What could possibly go wrong?

Pants on Fire

The Obamacare open enrollment deadline is just around the corner. March 31, 2014 in case you are wondering.  

If you haven't applied by then you can't buy coverage until 11/15/14.

Unless you have a qualifying event that creates a special enrollment period.

Many wonder if the deadline will be extended.

Here is your answer.
"We have no plans to extend the open enrollment period," HHS official Julie Bataille said. "In fact, we don't actually have the statutory authority to extend the open enrollment period in 2014."
Weekly Standard

When has that stopped anyone?

This from an administration that said everyone must have coverage, and then granted over 1200 exemptions. Said you had until 12/15/13 to apply for a 1/1/14 effective date . . . and then changed it. Originally started the 2015 open enrollment in October, 2014 then delayed it until after the 2014 elections. Said the mandate applied to everyone and then modified it for business.

Good thing they lack the statutory authority to modify the law.

Tuesday, March 25, 2014


A newly discovered glitch in the main ObamaCare website reportedly is
giving thousands of people the wrong information about whether they qualify for premium subsidies. 
Because of the glitch, some people may be initially told they qualify for subsidies when they don't. Others may be told they don't qualify when they do. 
Fox News

Can you say clawback?


Care to take a stab at where premiums will be on 2015 Obamacare plans? Here is a preview of things to come.   

Two months before health insurers must submit rate proposals for 2015 to government regulators, WellPoint Inc. fired a surprising shot across their bow by predicting it may ask for “double-digit-plus” increases.

Double digit.

As in 10% and higher.

My money is on higher.

Of course this rocket surgeon has his own thoughts.
“The double-digit increase surprised me,” said Stephen Zaharuk, a New York-based analyst at Moody’s Investors Service, in a telephone interview. “If everything’s working according to plan, then the increases should be where the medical trend is, which should not be double-digit.”

Obviously Mr. Zaharuk has no clue how health insurance rates are determined. Maybe he should stick to predicting grocery prices.
“The rules of the road keep changing,” said Dan Mendelson, chief executive officer of Washington-based consulting firm Avalere Health. “These companies have to hedge their bets.”
Rule changes?

No kidding.

Expect DC to call for broader networks and expanded formularies, just to name a few.

About that *Other* Big ObamaTax case

Cato's Michael Cannon has been following the Halbig case for quite some time. Last we checked, it looked like a US District judge had shot down this case, which argues that IRS enforcement of the (Evil) Mandate was illegal in 34 of the 58 states.

Reports of the case's death, however, are greatly exaggerated. As Michael reports today:

"[A]ppellate Judge Thomas B. Griffith clarified that an Exchange established by the federal government is not “established by the State.” When the government’s lawyer argued that federally established Exchanges meet that requirement, Judge A. Raymond Randolph cut him off: “That is a leap. That is not statutory interpretation.”

Interesting development.

Cost Accounting

Never let a simple thing like the cost of enforcement get in the way of a government give away
The conservative American Action Forum (AAF), which is often critical of the Obama administration,released a study Monday that estimates the regulatory costs have totaled $27.2 billion since President Obama signed the Affordable Care Act into law in 2010.
On average, the regulatory costs add up to $6.8 billion each year, while the benefits account for $2.6 billion annually.
The Hill

Private industry would go bankrupt with this kind of business plan.

Monday, March 24, 2014

Shecantbesious vs Hobby Lobby

A simple, factual accounting of tomorrow's SCOTUS hearing on Ms Kathy vs Hobby Lobby:

"Quite simply, if you read a newspaper to find out about the contraception mandate cases, you will read lies. Here are the top six."

Read the whole thing.

The Morally Bankrupt MVNHS©

[Content warning - this is NOT for the squeamish. To access this post, click on the "Read More" button. But I'm serious, this is a VERY disturbing article. HGS]

Impeach Mitt Romney!

Close your eyes and let yourself go back in time. What if this had been our last few years...

It's November 7th of 2012 and Mitt Romney has just defeated Barack Obama to become the President of the United States. Much has been made of this being a referendum on Obamacare but Mr. Romney has come out and said it is the law of the land.

Even before taking his oath of office Romney takes to numerous talk shows, dances with Ellen, and spends a morning with the ladies at The View. He shares his vision for health insurance and promises everyone that they can keep their current insurance and doctors. Period.

Not even a month into office, and Mitt is already on the offensive in hurting Obamacare. Immediately he hires his "health care advisor" Avik Roy to replace Kathleen Sebelius as Secretary of HHS. Then the decimation of Obamacare begins.

First he delays the Basic Health Program for low to moderate income individuals who don't qualify for Medicaid expansion. Two weeks later he announces that he will give leeway to allow plans that have higher out of pocket maximums than set forth in former President Obama's law. In April he delays the SHOP exchange for a year, too.

As the Romney administration continues to bury headlines by making announcements late on Friday afternoons or around holidays, the biggest shoe to drop from Obamacare hits. On July 2nd, 2013 HHS and the President announce that the employer mandate will be delayed until 2015. This requirement will cost the government $12 billion in revenue and will also mean a higher uninsured population.

As the fall approaches Romney is at it again. This time he is delaying signing final agreements with insurance companies on their plans that will be sold on exchanges. The delay could cause the government to miss its deadlines and gives tight time-frames for people to see what benefits and rates will look like when they go to purchase health insurance at

On October 1st goes live - sort of. Romney and his family go skiing while putting Secretary Avik Roy in front of the cameras to explain the "glitches" in the website. For the next several weeks we see Secretary Roy promise that the site is being fixed and compares it to the roll-out issues Apple had with their iOS7 release. In a blog post at the Washington Post, columnist Ezra Klein calls for Romney to fire Secretary Roy for botching the website roll-out. Democrats unite and hold a rally charging that Romney should be impeached and that HHS Secretary Roy immediately step down from his role. The MSM leads with this coverage for two straight weeks and highlights the problems that Republicans are causing and the abuse of power Mitt Romney is using to unilaterally change Obamacare.

As the website continues to fail, we find out that Mitt Romney's promise that people will be able to keep their current plan was nothing more than a lie of the year. To smooth things over as much as possible, the President issues an executive order that people will be allowed to keep their current plans for another year. Still angered, former Obama deputy director, and now president of Enroll America, Anne Filipic announces that they will no longer associate with HHS Secretary Avik Roy and that they don't want him to help with fundraising efforts any longer as this new administration is Anti-Obamacare.

Heading into 2014 Harry Reid continues to push the Senate to take action against President Romney. He pushes a bill through that is called "The Enforce the Law Act". Before the bill even gets off the ground Romney issues a veto threat. Besides that, Speaker Boehner has already said he won't take up this or any other bill that changes the law. He quotes his predecessor, Nancy Pelosi, by saying: "we had to pass it to find out what is in it." The tweaks that President Romney is making will make it better.

Democrats everywhere are furious. They are making one promise. 2014 elections will have consequences. All of these changes to the health care law that Mitt Romney has made will be the focal point for Dems to take back the House of Representatives.

Now open your eyes. It's March of 2014. Everything above has happened. You simply have to change the names.

Sunday, March 23, 2014

Happy Anniversary, Baby: The ObamaTax at 4: - "Success!"

For a certain value of "success."

It seems appropriate to note, four years to the day of its passage, that the over-arching purpose of the ObamaTax - insuring the uninsured - has managed to cover....wait for it...hmmm:

"[J]ust 1.4% of uninsured Americans."


Friday, March 21, 2014

Ms Kathy Overreaches (Again)

What rational person confuses Critical Illness (CI) coverage with major medical? Well, apparently Ms Shecantbeserious believes it's a pretty substantial demographic, because she's proposing new reg's to significantly decrease the availability of CI plans.

We reached out to the Director of Health Product Sales of one of the most successful CI carriers, who told me that this was a surprise to him and his colleagues, as well. He thinks there may be some push-back from the NAIC (National Association of Insurance Commissioners) as this infringes pretty far on their own autonomy and authority.

In the event, we'll have an in-depth interview with him on the issue in the next week or so. Stay tuned.

Shocker: Ezekiel Emanuel doesn't know anything about employee benefits

It always amuses me when academics and politicians who think themselves so smart really know so little.

"Mr. Emanuel expects the law to produce an unadvertised but fundamental shift in where most working Americans get their health insurance — specifically, a sharp drop in the number of employers who offer coverage to their workers"

 "But now Mr. Emanuel thinks that a number of well-known national companies will break the mold and begin a trend. By his estimation, the proportion of private-sector workers who receive health care from employers will fall below 20 percent by 2025. Currently, just under 60 percent of private-sector workers get health care from employers."

Why do employers offer their employees insurance? In most states they are under no legal obligation to do so. Surely it is a cost to them not to mention a huge time consumer. Because it was a benefit and benefits are part of what attracts employees.

Lets compare ACA Insurance tomorrow to insurance of the past;
  • Considerably more expensive
  • Requires enrollment through a dysfunctional website
  • no assistance in understanding your insurance plan
  • no one to turn to for help if your insurance company isn't doing what was expected
By all appearances offering insurance will be an even bigger benefit going forward then it was in the past.

ADDENDUM [FROM HGS]: This is not our first run-in with Mr Zeke. He's been somewhat of a cause celebre for Mike (here and here). And guest-blogger Dr Stuart Fickler was none-too-pleased with Mr Zeke's cavalier attitude towards life itself.

AMA Plays Catch-up

Thursday, March 20, 2014

Clearing the ObamaTax Spindle

■ As we recently reported, getting off an ObamaPlan is almost a hard as getting onto one:

"When there is something that needs to be changed on the policy through the marketplace, no one seems to know how to fix it — not people at the marketplace nor their supervisors."

Mr and Mrs Carpenter may have had it easy, though, compared to the plight of Florida resident Melissa Battles:

"When I tried to enroll my entire family... it is very convoluted and it takes a very long time to enroll.”

But enroll she did, and eventually even qualified for a subsidy. Soon after, though, she was fortunate enough to find a new job - complete with benefits, no less - so she "contacted her insurer, Florida Health Care Plans, to terminate her policy. They told her she could not disenroll from her policy with them, instructing her to do it with the marketplace."

Well, we know how well that worked out for the Carpenters, not to mention Larry Basich. After multiple calls, she was finally able to cancel her coverage (maybe), but is stuck paying for at least an extra month's premiums for a plan she doesn't want or need.

What a bargain.

■ "Bill Hobson" (not his real name, for reasons well-explained at the link) has a different sort of problem:

"I've had individual health insurance policies since 1989 ... As with most folks, I saw my premiums go up incrementally over the years as age and health care costs rose, but nothing like what happened in the past year."

So, he made the entirely rational decision to see if he could qualify for a subsidy and thus buy a less expensive plan on the ObamaTax Exchange. According to the calclators he used, he determined that he was, in fact, eligible, and went about applying for a new plan.

Problem was, when he was through inputing all his information, denied his subsidy. So, he called the toll-free "support line," where he spoke with one of the on-call Navigators. This Navigator asked a few questions, and then honed in on what he (erroneously) believed to be the culprit:

"When he asked whether I had indicated I currently have health insurance, I said I had … because I do have health insurance.

"Ah," he said, "that may be the problem.


What happened next illustrates an underlying, fundamental problem of the ObamaTax, which is mis- and dis-information. The idea that being previously insured disqualifies one from a subsidy is mis-information; that is, it's a mistake (and/or poor training) on the Navigator's part. But the next exchange qualifies as dis-information:

"But surely, I maintained ... I can't be the only self-employed person who's applying for tax credits who already has insurance. How do other people qualify?

There was a pause on the phone line, then the young man said, "Well, I'm sure that not all people give the, uh, correct answer to all the questions

Hint, hint.

So why would a Navigator actively encourage an enrollee to lie about being previously insured?

Well, here's a clue:

"A headline in the LA Times this past week answered the question. "Obamacare meeting goal of reducing number of uninsured"

Anyone surprised?

Hey, Big Spender

Stimulus is not dead, just redirected.
From January until the end of March, the Centers for Medicare and Medicaid Services, which runs the site and administers the Affordable Care Act, will have spent $52 million on paid media, officials said. 

That may not sound like much to folks inside the beltway but I wonder how much money is spent reminding people they must file an income tax form?

Wednesday, March 19, 2014

Cavalcade of Risk #204: Bountiful edition

Once again, Van Mayhall presents a cornucopia of risk-related posts, from  frat boys to folks who've fallen and can't get up (hmmm, may be some overlap there).

Do check it out.

Hertz Hurts - How NOT to do Customer Service

According to its Mission Statement, Hertz strives to be the "most customer focused rental company in every market [they] serve." Recently, FoIB Bill M had the opportunity to put this to the test.

Hertz failed. Miserably:

"On March 3, my daughter rented a car from Hertz in Lafayette, IN.  Upon renting she asked about adding me (her father) as a driver.  She was told (in this technology age) that she and I would have to be there at the same time (inconvenient as I live in Ohio).  When she was informed of this, the Hertz rep assured my daughter that we could stop at any Hertz together and they could take care of it.

I then called two different Hertz locations in Dayton and they told me the same thing.  However, when we stopped at the Wayne Ave location in Dayton the rep said she could not access our information.  She was helpful in contacting the Lafayette Hertz and asking them to fax down a form which we signed and she faxed back for us.  They also finally mentioned that there would be an additional $ 13.00 charge per day for me to be able to drive the car (this was the first time we were informed of this).  I attempted to call Hertz customer service to discuss this and bailed on the call after 25 minutes on my cell with no live person yet.

On the 4th day of our trip the Service Engine light came on.  After a 20 minute phone call, we finally spoke to a gentleman at Hertz who told us to stop at any Hertz location (apparently a favorite lie told to customers) and we could trade it in for another model to continue our trip.  Being wiser from the first try we called several locations, and were told that this was not true (surprise!), and that we needed to go to the Airport Location (out of our way and extremely inconvenient).  After a 2 hour good faith attempt to help Hertz, we gave up and decided to drive it back to Lafayette IN (hoping that the vehicle didn't blow up in the meantime).

Needless to say Hertz will not be on our radar to rent from in the future: horrible customer experience. Next time, we'll take our busuiness to a company that actually cares about doing the right thing.

Thanks, Bill, for sharing that - hopefully it will save our readers from a similar fate.

Tuesday, March 18, 2014

Harry's $407,000 Bind: Liar or Victim

On the one hand, we know that Harry Reid considers all reports of ObamaTax problems to be lies.

On the other, there's this little problem for Harry:

"Basich, 62, bought a plan through the state’s Nevada Health Link insurance exchange in the fall ... Yet the Las Vegan is stranded in a no-man’s-land where no carrier claims him"

Mt B claims that he attempted to sign up for a new ObamaPlan on October 1, but that it took him until mid-November to enroll in a plan that would become effective January 1.

Except: the folks that run the Silver State's Exchange, Xerox, claim his plan was really effective as of March 1. Which wouldn't necessarily be a problem (beyond some premium refunds), except for this small, um, bump in the road:

"[O]n Dec. 31 ... he had a heart attack. His treatment, which included a triple bypass on Jan. 3, resulted in $407,000 in medical bills in January and February that no insurer is covering."

Well, darn!

He's been working closely with his agent, Tamar Burch, and has even called upon his Senator, the aforementioned Mr Reid, for help. For his part, the esteemed Senator has vowed to help (although one might question his commitment, considering he must certainly believe Mr B a liar).

For its part, Xerox seems to be pulling out all the stops:

First, it tried to put him with a different carrier than the one he'd actually selected. When that didn't work, they redoubled their efforts by  promptly calling in the lawyers and clamming up.

Perfectly understandable, don't you think?

As it stands, Mr B is facing almost half a million dollars in unpaid medical bills and uncertainty as to when (or even if) they'll be paid and he'll have coverage.

The good news, of course, is that this is obviously a one-off, isolated event.

Wait, what?


His agent reports that "of nearly 200 Branch Benefits Consultants client sign ups via Nevada Health Link, only 5 percent have gone through problem-free. More than 20 customers have the same plan-selection issue as Basich." In addition, she reports "widespread enrollment problems, including frequent website error messages; inaccurate federal subsidy calculations; payments missing in the system despite clients’ canceled checks; and wrong effective coverage dates."

And that's just Nevada. What about the other 57 states?

Help is on the Way [UPDATED]

Are you confused about your #Obamacare options? Is healthcare.flub a mystery? Have questions? Where do you turn? 

No fear.

Dumbed down navigators will be there to guide you.

Obamacare has taken a formerly confusing product and turned it into a simple Bronze, Silver, Gold and Platinum choice. Insurance agents with years of training, licensing requirements, errors and omission insurance and accountability are no longer necessary.

Consumers will be encouraged to rely on guidance from people with little or no education, no accountability, and almost no training to guide them through the process of finding and purchasing health insurance.
Under the new HHS proposal, states would be able to impose some requirements, such as fingerprinting and background check requirements, but they could not impose requirements that would shut out non-agents, such as requirements that exchange helpers hold errors and omissions coverage.
Benefits Pro

No fingerprinting or background checks. Consider this.

Navigators are charged with the responsibility of not only helping you find a plan that meets your needs and budget, but also have access to your personal financial data, used to determine your taxpayer funded subsidy.

Information like your name, address, Social Security number and tax filing status.

What could possibly go wrong?
In most cases, a state could not require an exchange helper to refer some or all consumers to licensed agents or brokers.
Last month your navigator was asking if you want to super-size your order. Today they are offering advice on health insurance.

There is certainly no need to challenge their advice, right?

Gotta run. I hear McDonalds is hiring and the government is going to make them pay $15 an hour. I need to get my application in before the rush.

[Added by HGS] Pat did an especially thorough job explaining the implications of background checks (or rather, the absence thereof) for Navigators here. And it's also worth pointing out that E&O coverage simply isn't available for Navigators, at any price.

Cliff, Kathy and PCIP

As we've remarked on numerous occasions, the PCIP (Pre-Existing Condition Insurance Plan) was actually a pretty great idea, and one of the very few pieces of the ObamaTax that was well-executed. And it's been scheduled to be executed for some time now: first, at the end of 2013, then the end of March, and now, well:

"Enrollees in the federally-run [PCIP], who have not yet found new health insurance coverage through the Marketplace, can purchase an additional month of PCIP coverage through April 30, 2014, while they continue their search."

That helpful news popped up on their site last Friday (the 14th), to little immediate fanfare. Now, of course, the news is all over the net, but as usual, we're only getting bits and pieces.

Because I have a client who is in the midst of this situation, and because we strive always to keep our readers better informed, I did some digging.

Here's the challenge: it is indeed true that the final day of the initial Open Enrollment "season" is March 31 [ed: unless DC wavers on that, as well]. Which is fine, but under the new rules, one must have one's application submitted at least two weeks prior to one's desired effective date. Since no one wants to work Saturdays, that also meant last Friday (again, the 14th) was the real cut-off date. So if you were on PCIP, and you knew for a fact that your coverage was ending March 31, you'd better have your ObamaApp in by last Friday.

Fortunately for my client, she did. Yes, it was a harrowing afternoon, but we got it done.

Imagine my surprise to walk in yesterday morning to find that - surprise! - the condemned had been given a one month reprieve.


After all, just because Ms Shecantbeserious has decreed it doesn't necessarily make it so (although one would think). So I called our broker rep for the carrier that actually issues (issued) the Ohio PCIPs, Medical Mutual; it was no surprise that they were also caught unaware, and had no idea how to answer any of my questions. I was directed to the Department of Insurance (of course).

So, called the DOI and was quickly routed to Chris, a supervisor who, no surprise, was also unaware of the details. It seems that just because it was decreed in DC, it doesn't mean that the troops in Columbus need to be informed. Since administration of Ohio's PCIP program was handed off to the Feds a while back, I would have to move higher up (or down, as applicable) the food chain, and my next call was to the folks at, who were also very nice and eager to help.

Once I explained who I was and why I was calling, I asked how this was gong to work. Amanda told me that they would indeed be mailing out "coupons" (premium notices) and information...

By the end of the week.

Here's the thing: that means that at least a few of these will go out in Friday's mail, and will arrive in participants' mailboxes sometime during the last week of March, far too late to find other coverage, and barely enough time to meet the deadline for payment to be received (a very generous April 4th).

Now, they have the option of preemptively mailing in their April payment (which, thankfully, is the same as their March), making sure to note their billing number on their check.

Which may or may not arrive in time, either.

Oh, one more thing from the PCIP site's announcement:

"Enrollees will be notified by mail ... along with details about cost-sharing" [emphasis added]

Hunh? What does "cost sharing" even mean in this context? We use it in Medicare and in certain ACA plans, but PCIP?

Don't feel too bad: it also stumped Amanda. But she offered to find out for me, and I spent a scant few minutes on hold as she consulted a supervisor. The good news is that it's merely a case of someone being a bit too clever with their wording: it refers only to the co-insurance already built into the plan.


Now, maybe Cliff can get back to delivering those coupons.

Monday, March 17, 2014

ObamaTax Logic

In 1,000 words:

[Hat Tip: FoIB Jeff M]

Isolated incident? Meaningless anecdote? I wonder.

Yeah, an anecdote is not data, it's just . . . an anecdote.  But anecdotes can make one wonder.

Like this anecdote from New Zealand:

"But at the start of May the couple were told they must leave as Albert’s health was no longer acceptable . . . [Immigration New Zealand's] medical assessors have to consider to what extent there might be indications of future high-cost and high-need demand for health services."

This anecdote suggests New Zealand is deporting people it considers health risks, as a tactic to manage costs within its socialized medical program.   Who knows if INZ uses this tactic a lot? Or for that matter if other countries do the same?

Well, we do know other countries (e.g., U.K., Canada) ration medical services either thru explicit rules, or global budgets, or by queue.  We do know Germany has been using a different creative tactic of its own: "one way Germany has contained its health care delivery costs has been forced labor at under-market rates."   And we do know that European Union countries under the Schengen Convention have “rejected the notion that their citizens areobligated to pay for medical expenses of foreign visitors.”

Even a collection of anecdotes may not be “data” but at some point is there enough to make you wonder?

I think our media have generally done a poor job reporting information - such as the anecdotes above - which illuminates the actual experience in other countries, pro and con, with governmental control of medical delivery and finance.  As a result, the American public was not well-informed during the health care debate and therefore susceptible to smoke-blowers.   So now, sadly, the only practical way for most Americans to anticipate how Obamacare is likely to work is to accept it, so that we can find out what is in it.

Sound familiar?

Sunday, March 16, 2014

Bigger better?

This is interesting:

"An unnamed Silicon Valley billionaire has purchased the world's most valuable life insurance policy."

First, Mazel Tov to the anonymous buyer for his foresight, and to Dovi Frances, the agent who put the deal together. The premiums for the $201 million of coverage apparently run into the "low ... millions of dollars," which is actually a pretty good deal: even $5 or $6 million (what most would consider the high end of the low end), represents a very small fraction of the total amount at risk.

I do take exception to the characterization "most valuable," however: perhaps "the biggest" or "the largest face amount," but "the most valuable policy" is the one that's in-force on the day anyone who's bought a policy dies.

A few other factoids from the article struck me as interesting:

As many folks who have bought life insurance can attest, the underwriting process can involve some pretty invasive medical underwriting (exams, blood work, and the like). But what many folks don't know is that there is often financial underwriting, as well; that is, it's not just whether one is healthy enough to buy the plan, but whether one's financial health justifies the face amount. For a plan with hundreds of millions of dollars at risk, one might imagine both of those processes being, well, painfully invasive.

This also caught my eye:

"The firm has represented the billionaire since he responded to a direct mail solicitation in 2010."

Musta been one heckuva mailer.

Finally, the unnamed policyholder acknowledges purchasing the plan to cover any estate tax liabilities. This is an often overlooked use of life insurance, and further underscores its value: paying a few dollars (or even millions of dollars) for a life insurance policy to cover a large estate tax exposure is also a great tax planning tool.

So, thanks to Mr Frances and his anonymous client for some terrific lessons, whether our own life insurance needs run into the hundreds or millions of dollars (or somewhere in between).