Thursday, March 23, 2017

ObamaCare #Winning Updates

Our good friend Holly R tips us to some interesting, if obvious, ACA-related news:

Ohio Senator Rob Portman points out that, under The ObamaTax, not only was the claim that "if you like your insurance you can keep it" a lie, but that as a direct result of its implementation, 20 counties in Ohio (almost a quarter) have only one health insurance carrier still in the individual market:

From the "D'unh! Department" we learn that higher premiums in The Grand Canyon State led to, get this, "a 3.3 percent enrollment decline in marketplace plans."


On the surface, this seems like good news, and it may well be. But as we've noted before, this is really a double-edged sword: encouraging drug use by offering pricing incentives distorts claims experience:

So, may well be no "right" answer here, but certainly not an open-and-shut case, either.

Health Wonk Review: AHCA Aye or Nay Edition

Louise Norris once again lends her deft touch to crafting an interesting, issue-centric Health Wonk Review, this time focused on TrumpCare, er, the AHCA.

Don't miss it!

Tuesday, March 21, 2017

Affordable Insurance thru a National Single-Employer Plan

A National Single-Employer Plan would end unemployment, enable universal, affordable medical insurance, promote broader coverage, leave employees with more take-home pay, and make American goods more competitive in world markets.  All at the same time.   

The key concept is “single-employer” i.e., a national employment system.

At present, this does not exist in the U.S. Instead, we have hundreds of thousands of separate employers, each with its own employment practices, business practices, payrolls, and other overhead. For example, every grocery store has its own employees, stock supply chain, pricing, and purchasing arrangements, etc. This is why in the separate-grocery business model, we have grocers in some neighborhoods who don't offer fresh produce while grocers in other neighborhoods stock an ample supply of fresh, healthful groceries. More generally, the separate-enterprise model for every businesses is the cause of most problems involving duplication of service in some places, inadequate access in other places, and irrational pricing.  This affects manufacturers, retail outlets, banks, insurance companies, medical offices, schools and colleges, and thousands of other enterprises. 

Economics and common sense both tell us that consolidation reduces unit costs, usually called "economy of scale".  So it's logical that consolidation of the separate-enterprise business model should be the goal. And that ultimately leads to a national, single employer.

The single-employer would be the federal government, which would be the sole national purchaser of labor. Government single employer would eliminate duplicative and needlessly expensive overhead of our present independent and poorly-coordinated employers. The cost of business administration and related payroll costs would plunge by easily 50%.

The trillions saved would permit the single employer system to employ everyone age 16 and above

No one would be denied a job. In fact, everyone would be compelled to work under penalty of law.  Not just junk jobs, mind you, but meaningful, high-paying jobs. The government would assign all jobs fairly, using modern, efficient government planning processes without regard to gender, race, national origin, education, or ability to work. Every working-age American will have a job, and earn a decent living wage paid from public funds. Result: the curse of unemployment is gone forever, financed by savings from the change to single-employer.

This means everyone would have medical insurance through their employer – the federal government.  Our medical insurance would cost much less than today because our medical care would cost much less.  That's because all workers in the medical fields, and those who supply the medical fields, as well as all workers in the insurance field, would be salaried employees of the government, and their salaries would be under strict control.  With lower-cost medical care, it would no linger be necessary for insurance plans to contain high deductibles, copays, coinsurance, and benefit limits.   All this would result in more financial security for Americans, higher take-home pay - and would make American goods more competitive in world markets.

The benefits of a Universal Single-Employer Plan are remarkable.  It's even more remarkable that no one thought of it, until now.  

What Do Doctors Think About Gun Violence?

Gun violence is a polarizing topic that seems to come up following violent crimes that make national headlines. They also creep into the discussion during political races.

But what is gun violence and can we really change things by legislation?

While this detours from our normal subject matter at InsureBlog it is still relevant to the substance of this blog because gun injuries usually also involve health care.

I recently came across an article in The Good Life, a Dr. Oz magazine. From a professional perspective, I try to avoid conversations about religion, abortion, politics (well maybe not all the time) and things like gun violence. But this piece was quite interesting because of the subjects who were interviewed.

In spite of the inflammatory lead in, I decided to press forward.

More than double that, about 84,000, is how many are injured by guns annually. 

That certainly get's your attention. But it also begs the question, why are guns violent? Did they have a terrible time early on in their development or was the problem always then and then one day they just snapped?

The lead interview is with Dr. Milly Turakhia who is quoted as saying "You cannot tear down this problem just by taking away people's guns".

She goes on to address another public health issue, obesity. "We don't talk about locking up refrigerators" (in an effort to reduce obesity). Instead "We focus on wellness, education and prevention".

Her next comment is telling. She comes from Baltimore where the gun violence rate continues to rise despite the fact more guns are being seized.

More violence with fewer guns. Interesting paradox.

The article is a mix of moral, political and emotional comments. Overall it is balanced and a good read for those who are interested.

Feel free to read and offer your own comments. What doctors think about gun violence.


Monday, March 20, 2017

Becoming a Christian Nation Because of Obamacare?

The 44th president of the United States proclaimed more than once that we are not a Christian nation. Whether his point was valid or not is subject to debate, but his claim will not be discussed in this post.
christian health care sharing minsistry

One thing that is clear, the plan that promised "If you like your plan you can keep your plan, and if you like your doctor you can keep your doctor" is also a divisive issue. #Obamacare has been, still is, and will be one of the health care hot points dating back to the backroom Missouri compromise and continuing through "repeal and replace".

My personal opinion is that Obamacare did more harm than good and we may never recover from this train wreck. I see no reason to repeal a plan that will most certainly be dead by the end of 2017. If the folks in DC had any sense they would craft a replacement plan and have it ready for roll out in 2018. Keep Obamacare in place, or at least what is left of it. And roll out Trumpcare/Ryancare as a competitor.

Let the people choose the option they want.

But then, no one ever said the folks in DC that make our laws had good sense.

Rather than DC picking winners and losers based on their interpretation of voter viewpoint, let the public decide.

About that opening question. Are we becoming a more Christian nation because of Obamacare?

Hard figures on enrollment in Christian health care sharing programs are difficult to come by but this report from US News offered up their findings.

Since Obamacare’s passage, health sharing membership has more than doubled, from about 200,000 to about 530,000, according to the Alliance of Health Care Sharing Ministries. The law exempts health sharing members from having to abide by its “individual mandate,” which obligates people to buy health insurance or pay a penalty.

While some may argue that covering 300,000 new members is a small number in the big scheme of things, the fact remains, something is causing people to abandon traditional health insurance and seek out a non-insurance solution. As a percentage, the ranks of Christian sharing programs grew more than any other health care financing options, including Medicaid. A 265% increase in members is nothing to make fun of.

And the better news is, no taxpayer dollars were involved.

Not just anyone can join these plans. You must sign an affidavit attesting to your religious beliefs and accept the lifestyle tenants of the bylaws. Some of the sharing ministries require an affirmation of your character while others do not.

This not-so-impartial site comes up in searches and can serve as a guide to those seeking refuge from Obamacare and into the waiting arms of sharing ministries. We are not endorsing the site, nor do we believe it is a substitute for your own vetting. Medical Cost Share is a slick marketing site to steer visitors toward enrolling in Liberty Healthshare. That program, or any of the competing programs may or may not be right for you but they are all considerably less than Obamacare premiums which look more like mortgage payments than health insurance premiums.

Caveat emptor.

#Obamacare #ChristianHealthcareSharingMinistry

Friday, March 17, 2017

New Final Expense Plan: KickStarter-style

Co-blogger Bob V tips us to this interesting new effort initiated by the folks at Legal and General America Life (corporate parent to Banner Life and William Penn Life), which "officially launched last week, its new crowdfunding website dedicated solely to memorial funds."

Turns out, a lot of folks either don't buy or can't afford life insurance to pay final expenses, leaving families desperate for funds at their most vulnerable time. This led exec's at L&GA to launch this new crowdfunding program:

"We recognize that not everyone has gone through financial planning ... We deal with families every day that have gone through the planning. We just wanted a way to be there for those who haven’t."

Unlike established online crowdfunders like GoFundMe, L&GA's won't be skimming off the top to cover overhead; it's worth noting, however, that funds do go through PayPal, which does charge transaction fees (although these are likely nominal).

There's even a way for folks to set up memorial funds for others who may not be as tech-savvy, or who don't have internet access themselves. The one thing that might be a turn off for some is that there's no anonymity for the beneficiaries:

"The person who is receiving the funds is disclosed on the website, so donors know who they are paying and that person can receive the money."

Nice to see carriers spearheading these kinds of efforts.

Kudos to Legal & General America.

Thursday, March 16, 2017

Anthem's Top 20 (Percent, that is)

This is interesting: Ohio law requires health insurers to publish a "list of the top 20% of services based on use" as well as how much each insured has to pay for each of them.

Last year, that top 20% of health care services covered by Anthem were:

■ Primary care office visits
■ Lab and Pathology services

To be frank, this surprised me: I would have bet money that prescription med costs would have broken into the top two.

Which is not to say that they didn't play a major role, but apparently far less than primary care and lab services. Which is also, perhaps, a decent argument in favor of Direct Primary Care.

We shall see.

Wednesday, March 15, 2017

A Puzzling Crime [UPDATED & BUMPED]

[Scroll down for Update]

We've posted before about folks who concoct elaborate schemes in order to profit from another's death. It's against public policy (and, of course, the law) to profit from one's crimes. So if you're caught burning down your house, your insurance isn't paying off, and if you kill someone and get caught, you're not getting that sweet life insurance cash.

But there's another facet to this, and it has to do with underwriting.

Here's what I'm talking about:

In this story, tipped to us by FoIB Holly R, we learn about Joaquin Shadow Rams, who seems to have a habit of buying, and then collecting on, life insurance policies for his intended victims, including (allegedly) his mother and his girlfriend. And he might still get away with his most recent adventure:

"Prosecutors say Rams drowned his son after taking out more than $500,000 in life insurance on the boy."

Of course, Mr Rams is still entitled to his day in court, and that's fine, because I really want to focus not on the (alleged) murder itself, but on a much more curious item (from an insurance agent's viewpoint):

What rocket surgeon underwriter approved a half million dollars of life insurance on a toddler? Perhaps if the family name was Gates or Rockefeller, but here? I just don't see it. That just screams moral hazard.

I don't get it.

UPDATE: A Twitter buddy asked me "is it possible though he took out a whole bunch of smaller policies?"

Which is a really good question, because if there were a series of smaller plans, then theoretically the underwriter wouldn't necessarily know.

Here's where that falls apart, though:

When applying for insurance, one must list other plans already applied for or in-force, and then that particular plan is underwritten based on the sum of all those others, as well.

For example, Johny owns a $100,000 policy with Acme Life, and applies for $150,000 with Mutual of Podunk Life. The agent would have to use Podunk's underwriting requirements for $250,000.

Let's say, though, that the agent didn't know about the Acme plan, and the client didn't disclose it. That's called a material misrepresentation, and Podunk could deny the claim when Johny passes.

It gets better, though (for certain values of "better"): the Incontestibility Clause in a policy limits the amount of time that an insurer can contest a claim to the first two years. So it's possible that Mr Rams "jumped the gun" (so to speak) by not waiting until his son was at least 2 years old.

Oh what a tangled web...

(I've also reached out to my underwriter at our primary carrier to see if there's any circumstance where they'd approve $500,000 on a baby. I'll update again as appropriate)

Spring Break Beckons. Are You Covered?

From our friends at Global Underwriters:

Students and Families are getting ready to embark on Spring Break travel and study abroad programs.  Many students and families don't realize that their health insurance will not provide adequate coverage while traveling and living outside of the United States or in many instances, that they have no coverage at all. This is a terrible financial burden for anyone. Several countries and study abroad programs, also require health and medical evacuation insurance, in order to obtain a visa or participate in their program.

We have travel medical plans available (in the sidebar), or contact your own favorite local, independent agent.

Tuesday, March 14, 2017

Heads' Up, Nor'easters!

Our friends at the Property Casualty Insurers Association warn folks: Before a winter storm, know what to do “When the Sky Turns Gray."

And they back it up with this helpful video:

Friday, March 10, 2017

The Stupidity of The GOP Congressman

AHCA. Another acronym that falls short on facing the real problem with our health care system.

Republicans' latest attempt to change Obamacare is nothing more than misdirection. It replaces "subsidies" with "tax credits", continues Medicaid expansion until an election year (when nothing gets done), and keeps the most costly items such as guaranteed issue, community rating, and no pre-existing conditions exclusion in place.

It eliminates the individual mandate and creates a new continuous coverage rule allowing insurers to charge 30% higher premiums for up to 12 months to those who have a break in insurance coverage greater than 63 days. The new rule, like the mandate tax, has no teeth.

Speaking of taxes, it eliminates almost $600 million over ten years - which is a good thing. Except for the fact that over half of that amount does nothing to reduce or influence costs of health care or health insurance. More than half ($275 million) is going back to high income earners who are currently paying more in taxes for Medicare and investment income. We should also note these two taxes aren't indexed so as incomes rise more of us would pay these over time.

For Medicaid, it would roll back the enhanced matching rate for the expansion population. This has serious implications for states who fell hook, line, and sinker for the bait of government funding that they knew wasn't financially sustainable.

Think about it: traditional Medicaid funding for those the program was intended to help is paid at roughly a 63%/37% federal to state ratio. By law the range is set at 83% all the way down to 50%. Under expansion the funding started at 100% federal and will reduce to no lower than 90%. Not only is the expansion paid at a higher level, it is also paid to fund able bodied, working adults.

With Medicaid expansion running significantly over budget already it's amazing that the GOP hasn't pushed this financial disaster to the forefront. They should be putting pressure on the other side of the aisle to address how Obamacare gives more to fund those who can work while penalizing states for trying to care for those who need help most. Instead these clowns roll out cuts to the program without explaining why they might be necessary or focusing on who the cuts are geared towards.

We should have known this was going to be a poo-poo platter. Anything short of full repeal - which takes 60 senators to accomplish - is nothing more than lip service.

Going forward my advice to Congressman Ryan, Secretary Price, and President Trump is simple: Stop pretending you can do something that we know you can't. Be truthful. Democrats own Obamacare. They used a supermajority to pass a bill on a party line vote. They then used the Nuclear Option to push it through. Retaliation isn't the answer. Instead it ensures an endless cycle of political warfare that leaves constituents in the crossfire.

You owe it to the people who elected you to stand up and say that because Democrats are being obstructionists there is nothing you can do to make our health care and health insurance systems better. While you would like to see things change for the positive it falls on Democrats to come up with solutions that can come as a compromise. The compromise can't include their go-to move of throwing more money or expanding an entitlement program that is already financially unsustainable.

It must be the opposite, which is coming up with a solution to the real problem: how do we control costs of care and what ways are best to utilize insurance to help protect us from health issues that we can't control or predict.

Thursday, March 09, 2017

An Alternate Viewpoint

Our friend Rich W offers a different perspective on PubbieCare©:

"I had an epiphany: This new bill creates wage growth and cost control. You just have to use leftists' logic:

The $5,000 tax credit encourages employees to leave the non-group (ESI) market to chase the credit. Employers will recompensate employees with taxable wages to adjust for healthcare savings (new tax revenue/ wage growth). Employees will choose High Deductible plans so they can bank as much of credit into HSA (Health Savings Accounts) as possible.

These High Deductible plan buyers presumably use the system less because of out of pocket costs (cost control). It's all the same theory used to sell ACA Cadillac Tax to American people. How can the left deny the conclusions? They've already used this methodology.

And now we even have a detailed analysis of how indexing to inflation impacts the credit, the exact same math as happens to current Cadillac tax. Sad!"

Thanks, Rich, for sharing this with us.

Health Wonk Review: Interesting Times edition is up

Peggy Salvatore presents this week's lively roundup of interesting health care-related posts, with a major emphasis on the pros and cons of Repeal/Replace.

Wednesday, March 08, 2017

Replacement Wish List - Part 1

As I mentioned yesterday, I'm pretty underwhelmed by the newest iteration of PubbieCare©. For one thing, it's much longer than it needs to be, which means it's more complicated and top-heavy than it should be. And I noticed that they simply swap insurance carriers for The Tax Man for mandate compliance [ed: what else would you call the 30% surcharge?].

And, of course, they switch out subsidies for tax credits.

Here's a clue, fellas:

If you have to subsidize it, it's too expensive to begin with. One reason is that, like ObamaCare, it seeks to keep the government's hands in the financing of health care at the retail level.

So what would I like to see?

Well, since you asked....

Let's do away with this notion that health insurance needs to cover every little nick, bruise and routine expense (physicals, pap smears, prostate exams - that kind of thing). Maternity and sex-change coverage is also a no-go. These are all either budgetable or lifestyle choices.

On the other hand, there ought to be a way to make these expenses more easily affordable, and that comes through competition, and that comes about through personal accountability: let's expand Health Savings Accounts to anyone that wants one (regardless of what kind of plan one owns, or even if one is insured at all).

Is this a panacea? Of course not, but it's a start. By restricting coverage to things that are medically necessary, we cut out a large swath of expenses that need to be covered, thus forcing premiums down. And that means that plans can be truly affordable, and usable.

I have zero objection, of course, to carriers choosing to offer these kinds of "benefits" as options - hey, that's what a free market should be about.

Obviously, this is simply a place to start; the problems created by ObamaCare loom large: narrow networks coupled with HMO model coverage, fewer carrier choices offering ever more expensive plans and higher out-of-pockets, the whole Medicaid expansion issue fiasco.
But there needs to be a first step, and PubbieCare© isn't it.

We'll have more over the coming days.

Tuesday, March 07, 2017

About "Repeal & Replace"

Because people have been calling and emailing about the new Republican plan:

My initial reaction is that anything over 10 pages is a non-starter (and this one clocks in at 60+, let alone what the final product will actually look like). Still, it's a start, and I'm sure we'll have any number of posts about it over the coming days, weeks, whatever.

In the meantime, I recommend watching and reading what Michael Cannon, Avik Roy and David Harlow have to say. Each brings a unique perspective and political bent, and each of them are serious thinkers whose writing is nevertheless accessible and understandable to experts and laypeople alike.

Truth Bomb

[Hat Tip: FoIB Brian D]

Monday, March 06, 2017

Good news, Bad news Monday

First the bad news:

"ObamaCare's Popularity Is A Myth — Satisfaction Craters To 22% As Law Continues To Collapse"


Now the good:

"ObamaCare's Popularity Is A Myth — Satisfaction Craters To 22% As Law Continues To Collapse"


Of course this is just a poll of anti-ACA activists, so no need to get worked up, right?


"[J]ust 22% of the 44,200 ObamaCare enrollees polled rate their health plan as good to excellent. That's down from 77% who gave their ObamaCare plans high marks last year"

So why the sudden sea change? Well, that one's kinda hard to determine, right?


"The reason for the sharp decline was higher premiums, worse service and lack of choice."

That comes from narrower networks, fewer carriers left in the market, and ever higher premiums and out-of-pockets.

What's not to love?

Friday, March 03, 2017

Singin' the Blues (Cross, that is)

FoIB Jeff M tips us to a pair of stories about our "friends" at Blue Cross/Shield of North Carolina. Regular readers may recall our recent reports on this bunch.

Turns out, they're still pushing the boundaries:

"North Carolina’s largest health insurer says it turned a $185 million profit in 2016 by cutting its exposure to the sicker-than-usual customers who bought [ObamaPlans] ... last year had 26 percent fewer ACA customers after increasing premiums by 32 percent"

Looks like they've found the magic combo:

Increase Prices
Decrease Insureds
But that's not all!

Remember last fall, when they got dinged for over $3.5 million for billing and other issues?

If you thought that would deter their highest execs from cashing in, well:

"Blue Cross and Blue Shield of NC execs get $1 million-plus bonuses despite technology fiasco"

Nice gig.

Be nice if they'd pay the folks that actually generated that income for them, though.

Thursday, March 02, 2017

Penn Treaty: Epilogue

This past October, we reported that the long, sordid Penn Treaty saga was winding down, leaving behind it a trail of financial devastation:

"Penn Treaty and its affiliates are so broke that their unpaid obligations for Pennsylvania are expected to top $500 million"

Well, it looks like we're finally at the end of this particular journey:

"After eight years of legal struggle among state regulators, investors, and policyholders, Commonwealth Court Judge Hannah Leavitt signed off on a plan Wednesday to liquidate Penn Treaty"

That's nice, of course, but at what cost?

Well, it looks like that October estimate of some half a billion dollars was, um, a bit short:

"The decision leaves solvent insurers, their owners, and customers to pick up the cost for more than 70 percent of the up to $4.6 billion in projected long-term-care claims" [emphasis added]

That's $4.6 billion* (with a B), or just shy of 10 times what we thought it would be just a few months ago. About two-thirds of that will come from the state's Guaranty Fund (which money comes from all life and health insureds); the balance will be funded by an extra surcharge for other life and health insureds for the foreseeable future.

So the story may be over, but the impact will ripple on for years.

Oh, and exactly why did they go under? Wonder if it had something to do with this:

[Hat Tip: Co-blogger Bob V]

Wednesday, March 01, 2017

Show us the money

As we've previously noted, "off-Season" Special Enrollment Periods are fraught with challenges and contradictions. Perhaps the most egregious is the fact that no one in government seems to care about the massive fraud being perpetrated right under their noses during this time.

I speak, of course, of this:

"To Our Valued Broker Partners ... we have decided we will no longer pay SEP commissions effective 04/01/2017."

This from John Molina, CFO of Molina Health Care. Conspicuously missing (as usual) is the statement that policyowner's rates will be decreased to reflect the fact that agents aren't being paid. That's because they're keeping this extra cash for themselves, with zero legal justification for doing so. Carriers' cost of doing business is directly and positively affected, and yet they don't have the corporate decency to acknowledge their greed.

To be fair, neither do any of the other carriers benefiting from this unethical sleight-of-hand, so there's that.

Would be nice if our legislators (and DOI bureauweenies) actually did something about this.