CMS on ObamaCare: Epic Fail

Two of the major (purported) benefits of ObamaCare cited by its proponents are reduction of health care costs and increased availability of health insurance. Advocates also claim that we can achieve these two goals while saving tax-payer money.

As we recently noted, a study by Wellpoint put the lie to these assertions.

Now comes another report, this one from that noted mouthpiece for private insurers, the Centers for Medicare and Medicaid Services (CMS), which drives the nails even deeper into the coffin:

"With the exception of the proposed reductions in Medicare payment updates for institutional providers, the provisions of H.R. 3962 would not have a significant impact on future health care cost growth rates."

In fact, absent those hundreds of billions of dollars in Medicare cuts, the cost of health care actually increases under Obamacare. And that's based on historically low-ball gummint-touted numbers. The reality is likely to be far worse.

There's bad news about the much-touted "Public Option," as well:

"[P]ublic plan premiums would be roughly 4 percent higher than private as a result of antiselection by enrollees." [emphasis in original]

So much for the promise of lower health insurance costs.

But then, that's what we've been saying all along.

[Hat Tip: Politico]

Suicide Insurance? Setting the Record Straight

PoliBlogger Michelle Malkin has an update on a tragic story from September; news junkies may recall that a census worker was found dead, apparently hung. On his stomach was scrawled the word "Fed," leading many to believe that this was a cold-blooded murder. Suspicion fell on moonshiners and "rednecks," but there was scant evidence to support either of these theories (among others).

According to new information released by the authorities, it appears that this may well have been an elaborately staged suicide, the point of which was to leave the proceeds of a life insurance policy to the victim's son. Unfortunately, the news reports cited by Ms Malkin leave much to be desired vis: suicide and life insurance.

For example:

"Life insurance policies typically do not cover suicides within a certain time period after the policy begins."

Correct, to a point.

And:

"“If it’s deemed suicide, there’s no point in even looking at insurance,” the son said. “There’s no such thing as suicide insurance."

Again, correct - to a point.

Until just after the Great Depression [ed: what was so "great" about it?], suicide was excluded by life insurance policies. There was, it was thought, a very good reason for this: it would be against the public interest to encourage folks to kill themselves to enrich those left behind. And there's some validity to this: we don't want to make such an outcome attractive to people to leave an inheritance at the cost of one's own life.

But a lot of people who lost everything in the Depression killed themselves anyway; not for the insurance (there wouldn't be any) but out of desperation and despondence. And this left behind a lot of widows and children who lost a parent and a spouse along with their life's savings. This was also against the public interest.

So, how to reconcile these two seemingly irreconcilable principles?

New laws were enacted that required life insurance policies to cover suicide after a "reasonable" period ("reasonable" in this case meaning no more than two years). The premise is that no sane person is going to buy a policy with the intent of waiting two years to jump out a window; that a person would do this was ample demonstration of mental illness, and that would be a covered exposure. This protects the interests of innocent family members, while still discouraging a casual view of suicide.

So no, there is no "suicide insurance;" but that was never really the point in the first place.

Swine Flu Deaths Increase - Fact or Fiction?

On 11/6/2009 the CDC reported there were 129 swine flu related deaths year to date beginning 4/26/2009 and going forward. Six days later Fox news is reporting the CDC claims 4,000 have died as a result of swine flu.

So which is it?

Have over 3,800 people died in the last 6 days from swine flu? Are these swine flu cases "saved or created" like so many other numbers coming out of Washington these days?

Is it just a coincidence that the number of deaths increased after the House voted to approve H.R. 3962?

Is this just another stupid government trick?

Change you can believe in.

Cavalcade of Risk #92: Call for submissions

Next week's Cav is hosted by Jason Shafrin, the Health Care Economist. Submissions are due this Monday (the 16th), and Jason would like to remind you to include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

You can submit your post via Blog Carnival or email.

Thanks, and have a GREAT Weekend!

The Skinny on Fat Mums versus the MVNHS©

It's not enough that the MVNHS© considers newborns "at risk" if their mums are a bit zaftig.

Now comes word that expectant mums may not have the opportunity to actually be admitted to hospital (as the Brits say):

"Mothers-to-be who have a body mass index (BMI) of over 34, the equivalent of an average woman of 5ft 6ins weighing 15 stone, will be turned away from Weston General Hospital, Weston-super-Mare, Somerset."

Ooops, better watch that weight gain, gals!

Fear not, though, portly preggies have to travel but 20 miles to the next closest facility. Assuming, of course, that they can make it that far when contractions are minutes apart.

Quick - Let's do that here!

Unconstitutional, But "Fair"

Seems that the lower chamber of Congress echoes the sentiments of the upper:



"The legislation is very fair in this respect."

Dear. Lord.

[Video courtesy of RedState]

Southwest Ohio Network Alert: Medical Mutual Edition

Once again, Premier Health (and its associated hospital network, including Miami Valley) is on the outs with a major carrier. This time, Medical Mutual of Ohio has declined to renew its contract with Premier, effective January 1st of next year (about 7 weeks away). This could mean a potentially huge disruption of service: in addition to over 100 local doc's, the network includes Miami Valley and Good Samaritan Hospitals, and a home health care agency.

This isn't the first time that the network has clashed with insurers: about this time last year, Humana and Premier parted ways, and have yet to reconcile. And a few years before that, Anthem and Premier separated for quite some time before they kissed and made up.

My guess, based on the timing, is that MMO is looking to pressure Premier into concessions on price; this isn't a bad tactic, per se, and could result in some savings for their insureds. This far out, it gives both sides time to posture, and still come to an agreement before the clock runs out.

We'll keep you posted.

Small Town, Big (Insurance) Troubles

Recently, FoIB Rick Byrne tipped me to a fascinating, if convoluted, story out of northeast Ohio. There's as much small-town politics as group health insurance in this tale; I'll be focusing on the latter as much as possible.

Briefly, this suburb of Youngstown is home to some 12,000 residents. It's governed by an eight-person city council, and and has about 60 employees. These employees (and some of the city council staff) are covered by a group health insurance plan issued by Anthem, which has recently notified them of a renewal rate increase.

And thus our story unfolds.

A short time ago, one of the council members proposed deleting staff from the group plan. Dan Yemma, an insurance broker himself (although not the agent for the city's plan), thought that only certain classes of employees should be covered, and that shrinking the group would be an efficient way to save money. For whatever reason, this proposal was deep-sixed, and things went on as they had.

To a point:

The Anthem renewal increase was for 13% (a not unreasonable percentage in this market, but well above the city's anticipated budget for insurance). The agent of record, Michael Caparso, agreed to "shop" the group, which is generally a good idea. Until recently, this would have involved simply generating a census (a list of employees, their family status and ages, etc) and adding whatever additional underwriting information was available (autistic dependendents, pregnant spouses, etc) in order to generate a "pre-screened" rate. Absent that medical information, the carrier would simply issue a "street rate" quote; that is, one which assumed (rightly or wrongly) that everyone was in fine health. In the past year or so, though, carriers have become more stringent in their screening process, and now require completed applications (or waiver form) for each employee. This can be a real burden if one is seeking quotes from multiple carriers; the good news is that pretty much every carrier will generate a quote off of a UHC application.

And so, the agent supplied apps to everyone, and all but one were completed and returned. The one holdout was the aforementioned council member with an apparent axe to grind. He refused to submit either a completed application or a waiver; without that, the carriers wouldn't issue a "pre-screened" quote.

[ed: it should be noted that throughout the linked article and the emails I've received, folks keep referring to these as "binding quotes." They are not: a "binding quote" in this instance is an oxymoron. What they're really talking about are "pre-screened" numbers]

The city's dilemna was that they really couldn't afford the 13% hit from Anthem, but their agent's hands were tied because of the missing form.

And there things stood. And (apparently) stand.

When I first read Rick's email, I was a bit puzzled by a number of issues. First, I didn't understand why the other council members didn't force their recalcitrant colleague to cough up the form (although I really didn't know what leverage they may have had to do so). I was also puzzled by the revelation that the city auditor, who was tasked with getting and evaluating the quotes, was on the city's plan and apparently felt it was her only option. Finally, I wondered about some of the things that Mr Yemma allegedly said, which did not reflect well on his professionalism or ethics. A number of things just didn't add up for me, and so I decided to do a little research.

Jeanne Starmack, the reporter who broke the initial story, quickly and graciously responded to my email asking if she'd be willing to discuss the situation. In reply to my questions, Ms Starmack told me that, as of the 5th, Mr Yemma had yet to submit either a completed application or a waiver. She also noted that the other council members really had no means by which to force him to comply: "He's not an employee, he's an elected official and they can't make him do anything." That makes sense, of course, and explains why there's been no official sanctions. I had wondered if there was perhaps some professional jealousy involved (since he's an agent, but not the agent), but Ms Starmack quickly quashed that. She also helped me understand exactly which kinds of folks he'd have preferred be taken off the plan: "the city council, the mayor, the law director and the auditor." Interestingly, she also told me that the city's group insurance is the auditor's "only source of insurance."

Ms Starmack told me that, in a series of emails, the auditor and Mr Yemma had quite a few disagreements about what was necessary to obtain pre-screened quotes. According to the article, and Ms Starmack's email, Mr Yemma claimed that it was not, in fact, necessary for him to submit an app or waiver in order to obtain the necessary quotes. Since we already know that this is untrue, I was a bit nonplussed that he would make this claim; as an agent himself, he either knew it and was lying, or he'd slept through a few CE classes. Neither of those alternatives seemed likely to me.

In Part 2, we'll learn the Insurance Department's reaction, as well as information directly from two principles: Mr Yemma and the city auditor.

[A Very Warm InsureBlog Thank You to Jeanne Starmack for her help]

Health Wonk Review, Live from Colorado

FoIB Louise Norris hosts this week's round up of wonky posts, with an emphasis on PelosiCare. Lots of good stuff here, do check it out.

Constitution?! We don't need no stinkin' Constitution!

Or so opines Sen Jack Reed (D-RI). Addressing one of the many new mandates included in PelosiCare (buy insurance or go to jail) the Constitutionally-challenged senator observed that:

"it is not unusual that the Congress has required individuals to do things, like sign up for the draft and do many other things too, which I don’t think are explicitly contained [in the Constitution]."

[ed: our apologies to readers who must now clean their monitors]

Really, Senator? You're equating forcing citizens to buy something they may not want or need, with serving in the armed forces? Putting aside for the moment the sheer audacity of this position, let's examine what the Constitution says about the draft:

"The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence ... To raise and support Armies ... To provide and maintain a Navy ... [and to] make Rules for the Government and Regulation of the land and naval Forces" [Article I, Section 8]

Now let's see what the Constitution has to say about forcing Americans to buy health insurance:

...

Singing lessons are over.

Maine is the Charlie Brown of Health Care

Poor Charlie Brown. Problems with the kite eating tree. Lucy always pulls the football away just as he is about to kick it. A dog that is more popular than him.

Maine is the Charlie Brown of health care. The state’s legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded. Indeed, many overhauls to the system have done little more than squeeze a balloon — solving one problem while worsening another.

Sound familiar?

Like the great health care debate in Washington.

But like the Peanuts character, the state keeps trying. Indeed, Senator Olympia J. Snowe, Maine’s senior United States senator and so far one of only two Republicans in Congress to vote for an overhaul, spent two years in the late 1970s as chairwoman of the State Legislature’s joint Health and Human Services Committee pushing small reform efforts. “That’s where I garnered an enormous deference to the issue of health care and its complexities,” Ms. Snowe said in an interview.

Based on what I have read Ms. Snowe in Washington it seems like she hasn't learned that much over the last 30 years. If she can't fix health care for Mainiacs then how can she expect to fix it for a nation of 330 million?

To conservatives, Maine proves that government efforts to strictly regulate the nation’s health insurance market are doomed. Many of the reform proposals circulating on Capitol Hill have already been tried in Maine.

“These reforms are very well-intentioned, but in reality they have yet to produce the promised results or even be financially sustainable,” said Tarren R. Bragdon, chief executive of the Maine Heritage Policy Center, a conservative research organization in Portland.

And nothing in the House or Senate version will do anything to control the cost of health care either.

To others, Maine’s failures show why some reforms can be tackled only on a national level. Maine has the nation’s oldest population, its poor are among the sickest, and its median income ranks low.

That sounds like the Medicare population. Another government albatross that is a financial Titanic.

Every time the government tries to fix things it only get's worse and costs more than it did before. Why is that so difficult to follow?

More COBRA Bites

Earlier this year, IB was the "go-to" place for COBRA/ARRA info, and we certainly wouldn't want to let our readers down. This morning's email brought news from COBRA admin Ceridian about new developments on the COBRA and ARRA front.

First, that 65% COBRA subsidy on which so many folks count? Well, it sunsets at the end of this year. If and/or when that happens, folks who lose their group benefits on or after December 31st won't be eligible for the subsidy (although insureds currently receiving it won't be cut off on that date).

Second, there are currently two House bills and one in the Senate that seek to extend the subsidy into (at least) next year. As Ceridean notes, with unemployment officially at over 10% (and unofficially at 22%), it's a pretty good bet that a lot more folks will be clamoring, not to mention eligible, for the subsidy. This, of course, will put even more pressure on Congress to "do something."

We'll keep you posted as things develop.

Oh, something else that caught my eye in that aforementioned e-mail: in analyzing their enrollment data, Ceridian found some interesting patterns. For example, "COBRA enrollments increased approximately 40 percent from pre-ARRA rates. About 18 percent of eligible workers chose COBRA health care continuation coverage, up from about 12 percent." Since someone else was footing up to 65% of the bill, that's not exactly a surprise. Click here for a copy of their full report.

Eleven Eleven Campaign: For Our Veterans [UPDATED & BUMPED]

[Welcome Industry Radar readers!]

The Beyond Tribute Coalition has put together a bipartisan program to raise money for veterans' groups like Gold Star Mothers, Vietnam Veterans of America, and the Wounded Warrior Project, among others.

According to its organizers "(t)he objective of the Eleven Eleven Campaign is simple: to get 11 million Americans to donate $11 to support America’s Veterans." Although we promised no math here, that's $121,000,000 for our Vets. And they've chosen a unique way to go about it: by harnessing the power of the blogosphere.

How can you help? It's simple: starting today, and continuing until we've reached that magic number, you can text "VETS" to 85944 to contribute. Or, you can simply click on the 11-11 widget near the top of the sidebar to contribute $10 (Beyond Tribute will kick in the other $1)

If you'd like to show your appreciation to those who've served, then I encourage you to contribute the cost of a couple of lattes to this great cause.

Grand Rounds: Veterans' Day Edition

Flight nurse and medblogger Emily McGee presents a Veterans' Day-themed round-up of great posts.

Wishful Thinking: Ohio Edition

If, as we've maintained here at IB, the states comprise 50 individual laboratories for health care "reform," then it makes sense to look at how these "experiments" are going. Case in point: Ohio's recently enacted HB 1 which the Department of Insurance claims, among other things, will result in some 52,000 currently uninsured Buckeye's gaining coverage.

Uh-hunh.

Immediately upon its implementation, I received this in an email from Anthem:

"Effective January 1, 2010, Anthem Blue Cross and Blue Shield will no longer offer the HIPAA-HIC (basic and standard) Open Enrollment plans in Ohio."

So what does this mean, exactly?

Currently, Ohio citizens who are either Federally Eligible Individuals (i.e. folks who were eligible for COBRA continuation, elected it, and "rode it out" for the maximum 18 months) or have been declined for individual medical insurance are offered specific, state-designed plans. Anthem was, of course, the go-to carrier for them, since it offered several "flavors" at almost-reasonable prices (although that last is debatable, they were certainly competitive). In addition, Ohio gives each carrier a "quota" of such policies to sell, based on market share. Since they're the 800 pound gorilla, they "got" the lion's share of this business [ed: way to mix those metaphors!].

Because HB1 set new - much lower - premium differentials for these plans, they become even less profitable for the carrier. If it sounds like I'm taking the carriers' side in this, it's because (for once) I am: the free market works when the government doesn't meddle. In this case, "meddling" means further restrictions on the companies' ability to make a profit, which means they're going to shed the less profitable business as quickly as possible.

What that means to insureds is that they'll have less choices, and there will be fewer "slots" available (supply and demand). It's not as if these things fly off the shelves to begin with, but they were at least a viable alternative to those with serious, chronic health issues.

So what's the lesson here? When you restrict carriers' ability to compete in the market, consumers end up with fewer choices. Maybe that was the point of this exercise (wonders the cynic), but it certainly does not bode well for similar efforts on a national scale.

1,000 Words: What (Barely) Passed

Comments Update (Good News): Importing Complete

Thanks to the folks at Disqus, our archived comments from HaloScan/Echo have been imported and are now online.

That was really the final piece of the transition, and we're pleased as punch to bid JS-Kit/Echo "adieu!"

Health Care Lottery

Health care reform has become a lottery windfall for members of Congress willing to sell their vote in exchange for dollars.

Washington correspondent Jamie Dupree Tweets and blogs on a regular basis, giving readers and insiders view of sausage making inside the beltway. It is not a pretty sight.

The recent debate in the House resulted in a narrow approval of health care reform. The debate over abortion funding with taxpayer dollars got the headlines but there was more going on behind the scenes.

Rep. Jim Costa (D-CA) made clear he had won money for a medical school in his Fresno-based district and more.

"During my negotiations to help improve the bill for our Valley, I was able to achieve funding for a medical school in the Valley, with studies at UC Merced and residency in Fresno, as well as additional incentives to bring health professionals to our Valley," Costa said in a statement.

Rep. Dennis Cardoza (D-CA) - who last week was quoted as saying he was leaning against the bill - said he won $167 million in health care funding for hospitals in his district.

So Rep. Cardoza was against the bill before he was for the bill.

Of course all of this is transparent, as promised by Obama during his bid for the White House, right?

Not necessarily.

I went through the final version of the House bill, as printed in the Congressional Record, and couldn't find anything related to what these members were taking credit for, which means that probably would be worked out through grant funding by the Obama Administration.

So when is a budget item not a budget item?

When funding falls outside the scope of health care reform.

That would mean these figures are not part of the CBO's price tag for H.R. 3962.

So what else is included in health care reform that has nothing to do with health care? Here is a partial list.

• Patterson Irrigation District Pumping Plant and Fish Screen

• Patterson Irrigation District Pipeline Project

• Diversify Level 2/Level IV Refuge Program

• Announce 2011 rescheduled water decision in the Spring, 2010

• Additional federal support for the Westside Water Use Efficiency and Conservation program

• Support the removal of restrictions under the Emergency Drought Relief Act which restrict funds to temporary projects

• Mendota Dam Replacement

• San Luis Drain Rehabilitation

Transparency you can believe in. Yes you can.

The Double Decker Secret

[Welcome Industry Radar readers!]

What do double decker buses and heart attacks have in common? Drivers of double decker buses have a lesser risk of heart attack than do drivers of more traditional buses.
The WSJ Blog reports on a study by Dr. Jeremy Morris.

Morris thought there might be some link between occupation and heart-attack risk. And when he looked at the men who worked on London’s double-decker buses, he found a striking result: The conductors — who went up and down the stairs on the bus all day long — were half as likely to die of heart attacks as the drivers, who sat at the wheel all day.

The data held up; among postal workers, Morris found, those who delivered mail by bike or on foot were far less likely to die of heart attacks than those who sat behind the counter at the post office.

New information?

Not really.

Dr. Morris reported his findings in 1953.

So why is this news?

Dr. Morris died two weeks ago at the age of 99.

He swam, rode an exercise bike or walked for at least half an hour on most days until he was well into his 90s. And in recent years, he often walked up and down the stairs of the London School of the London School of Hygiene and Tropical Health, where he was an emeritus professor.

“I’m constantly being asked: ‘Your long life, what would you advise?’ and so forth,” Morris told the FT. “To start telling other people what to do – I’m very reluctant. Except on exercise, where to a large extent I feel it’s what I’ve done myself that’s contributed to longevity.”

Sounds like good advice.

DiabetesMine and Keas Get Crackin'

Our friend and healthblogger colleague Amy Tenderich has teamed up with the former honcho of Google Health to offer a first-of-its-kind tool for the estimated 23 million American diabetics. Called the "Keas plan," this interactive, web-based program empowers these folks to actually do something about their health.

The tool goes live today; please click here for details.

Swine Flu and Goldman Sachs

Seems the folks at SNL "porked" a little fun at the CDC and Goldman Sachs over swine flu vaccines . . .



Just another stupid government trick.

Swine Flu Created or Saved

The CDC reports 129 confirmed swine flu deaths through 11/6/2009. They also indicate that, on average, there are 36,000 flu related deaths each year.

They report there are 38,000,000 doses of swine flu vaccine "ordered or available."

Why does this sound like jobs "created or saved" rhetoric?

It has been reported that doctors and clinics are running low on seasonal flu vaccine. So far, over 70,000,000 doses of seasonal flu have been delivered with another 40,000,000 on the way.

I have no idea how much of taxpayer dollars is being spent on the swine flu vaccine promotion, but I have trouble reconciling 129 deaths to 36,000 during the course of normal flu season. Not to be dismissive, because any death is not insignificant, but it seems almost like the fuss about Y2K.

It makes me wonder, after all this is over, if some will be asking "what was all the fuss?". Is this just another stupid government trick?

UPDATE [HGS]: Via Common Cents

Carnival of Personal Finance is up

This week's Carnival of Personal Finance is hosted by the Canadian Finance Blog. It's chock full of helpful tips.