Thursday LinkFest

■ Remember this: "If you like your doctor (or hospital), you can keep your doctor (or hospital)?"

Too bad, so sad. As FoIB Jeff M alerts us:

"[R]estructuring lawyers are now warning that the healthcare industry is about to experience a massive wave of hospital bankruptcies."

Of course,this isn't entirely unexpected: while insurance rates have skyrocketed, that trend hasn't translated to increased provider revenue. In fact, "[h]ealth-care bankruptcy filings have more than tripled this year."

■ Another FoIB, NDH, tips us to this helpful video explaining the Health Care Sharing Ministry model:


How Does MediShare Work?


■ And speaking of health care sharing ministries: I long ago opted to take a pass on selling them because:

"I'm an insurance agent, and I hold myself out (semi-)professionally as such. So if I sell a Medishare plan, which is specifically not insurance, I'd be concerned about an E&O claim in-the-making."

And lo-and-behold, today's email holds this warning from ARN:

"Recent solicitations from Risk Sharing Groups have caused concerns among Life Insurance Agents.   Consider a few key points when evaluating an Errors & Omissions Policy"

I had had no idea such programs existed. Apparently, they're available for agents who don't want to pay for legit Errors and Omissions coverage. The plans appear to be modeled on the health care sharing ministries, and are therefore not insurance, so there's some questions about whether any claims will actually be paid.

And there's this, which seems to be a show-stopper:

"In a Risk Sharing Plan the right to reimbursement only occurs once the wrongful act(s) have been entered in court and all appeals have been settled.  This could take years."

Yikes.

Wednesday Afternoon Linkage

■ Courtesy of FoIB Jeff M, we learn that North Carolina's Blue Cross/Shield is continuing to take on water as its customer information interface melts down:

"Moncol learned all of the information several weeks ago when she went online to check her family's health savings account and found data on the McAllister family instead. After a few more clicks, she found she could access the investment accounts tied to the HSA."

Ooops. In fact, she could have actually changed pretty much all of that other family's info, or stolen their identity were she "that kind of person" (which, thankfully, she's not). But talk about a security hole big enough to drive a Mack truck through. Looks like the Tar Heel State's Blues could give the security-flawed 404Care.gov site a run for its money. 

■ As we've long noted, the above-mentioned 404care.gov site is rife with security issues, and as FoIB Holly R alerts us:

"During the two years before the disastrous opening of HealthCare.gov, federal officials in charge of creating the online insurance marketplace received 18 written warnings that the mammoth project was mismanaged and off course but never considered postponing its launch"

Well of course not, silly: why would massive security flaws hold us up? 

■ Another long-term topic has been faith-based (primarily Christian) "sharing ministries," a sort of religious crowd-funding arrangement for health care financing. Co-blogger Bob V sent us this latest news:

"The use of so-called “health sharing ministries” has soared in the wake of President Barack Obama’s health care reforms ... membership has more than doubled, from about 200,000 to about 530,000"

At over half a million participants, this is definitely a force with which to be reckoned. The usual caveats apply, of course: "the plans offer members no guarantee their medical bills will be shared, and ministries aren’t obligated to include a range of care that insurance companies are."

Still, by saving thousands of dollars in potential fines, and tens of thousands in deductibles and co-insurance, it sure seems that these folks have found something that works for them. and the fact that their ranks have swelled so fast and so far is pretty good proof of its appeal and effectiveness.

Much ado about ... A rounding error?

Despite ample evidence to the contrary, I really don't relish playing the role of naysayer. But when  folks who should know better deceptively suggest that a particular "solution" is having a major impact on health care delivery and financing, well, I think it's important to offer perspective.

What in the heck are you babbling on about, Henry?

Glad you asked. This:

"Why health care sharing ministry memberships now top 1 million"

I beg your pardon?

In a country of about 326 million, this is barely a rounding error. So why is this "news?"

Look, I'm a fan of sharing ministries (up to a point): they're a low cost, ACA-compliant alternative to ObamaPlans, and they encourage lifestyles and behaviors that promote good health. And I like that they're not network-driven, meaning pretty much complete freedom to actually "keep your doctor."

But there's also no backstop: that is, there's nothing to force the organization to actually pay the bills, or accept someone with pre-existing conditions. And for catastrophic claims, well, those can be problematic:

"[T]hough they set aside a slightly larger amount as part of an optional agreement to help other members facing catastrophic needs." [emphasis added]

Do I think they have a place? Of course: it's not like ObamaPlans are any great deal, either. And I'm glad that they serve the needs of (many) of those who participate, FoIB Thomas L, for example:

"So far so good on all things Samaritan.  All current expenses are already paid, the money for the obgyn is pre-paid to the clinic (which for whatever reason they hold in escrow), and the money for the hospital’s delivery estimate I have in a separate account ready to go."

But to pretend that sharing ministries are some unstoppable, substantial force with which to be reckoned? No.

Health Care Sharing Ministries in the crosshairs

This just in:

"Nebraska published a consumer alert about health care sharing ministries - consumers should be aware of the significant limitations (like no-legal-responsibility-to-pay-claims-level limitations)"

Why this is just now being treated as "breaking news" is beyond me: we've been pointing out these very real problems for years:

"My claim from October had still not been paid. Yesterday I received a notice dated April 19, 2017 that since I was no longer a paying member my medical claims are no longer eligible for payment!"

Of course, these plans have their good sides, as well: ACA-compliant, relatively inexpensive, often include decent benefits (and omit unnecessary ones that tend to drive up rates). But as I point out to my own clients, they aren't insurance, so there's really no recourse if they decline a claim or simply fold up shop. And, as the report points out, there are often significant limitations in what's covered (and for how much).

Still, they remain a viable ObamaPlan alternative, as long as one joins up with eyes wide open.

[Hat Tip: Rachel Schwab]

From the Trenches: Sharing Ministry Update

As Health Sharing Ministries continue to gain ground, we continue to collect anecdata thoughtfully shared with us by our readers.

Today, FoIB Thomas L reports on his own recent experience:

We are using a sharing ministry, Samaritan Ministries, as of September.  In Oklahoma, the premium increase for this year was announced at 51% and all but BCBS were exiting the market statewide*.  This is after an almost 40% increase the year before.

All told we would have been paying $1,200/mo for three people, ages 1, 23, and 35 with no known health issues or prescriptions.

Given that my deductible was $6,000 (lower for my wife and daughter), we could easily be $20K out-of-pocket before insurance covered a thing.  We cannot afford such an enormous fixed expense for such a speculative return, and always with the prospect of it spiking in cost or disappearing entirely the next year anyway.

Oh, for the days when I paid $75/mo through my work.

So far we are pleased with the service experience.  I asked many detailed questions over many hours and had them all answered with equally detailed explanations, but we have had no “shares”.  That will change, as we are expecting a second child, so we will soon find out how well Samaritan works for us.

* Tulsa, and Tulsa alone, has an off-exchange alternative offered as joint operation of two local Catholic hospitals.

Thank you, Thomas!

Now, are these plans right for everyone? Of course not, and I'm not aware of any that claim to be. But they're obviously right for some folks. As I've mentioned, I'm not comfortable marketing them, but only because of the perceived conflict between my role as a licensed insurance agent and the fact that these plans are not, in fact, insurance. Still, they're not to be easily dismissed.

The Positive Side of Sharing

We try not to take too firm a stand on products we don't sell, and of course a healthy skepticism is always in order for non-insurance products that claim to pay for health care.

For example, we've blogged quite few times on Health Care Sharing Ministries, most recently here:

"My claim from October had still not been paid. Yesterday I received a notice ... that since I was no longer a paying member my medical claims are no longer eligible for payment!"

But we also know folks who've had positive experiences. This past Spring, for example, long-time IB reader Thomas L reported that:

"We are using a sharing ministry, Samaritan Ministries, as of September.  In Oklahoma, the premium increase for this year was announced at 51% and all but BCBS were exiting the market statewide*.  This is after an almost 40% increase the year before."

Yikes.

But again, it's not just about saving money upfront: how will one fare once claims start to accrue?

Well, recently Tom sent this update:

"Baby is here!

So far so good on all things Samaritan.  All current expenses are already paid, the money for the obgyn is pre-paid to the clinic (which for whatever reason they hold in escrow), and the money for the hospital’s delivery estimate I have in a separate account ready to go, but since he was just delivered on 9/17, we have not had any bills yet.

I’ll have a much fuller report after the hospital really bills us, and, if it is like last time with BCBS, that weird never-ending stream of bills from the doctors and staff that come into your hospital room but technically aren’t with the hospital, so bill you separately."

Mazel tov!

Thanks, Tom, for keeping us updated, and have a GREAT Thanksgiving!

Sharing is Caring - Or maybe not

Over the years, we've written pretty extensively about Health Care Sharing Ministries (HCSMs), both their advantages and their flaws.

On the one hand, they are ACA-compliant, which means that they technically check the Mandate/Tax/Penalty-avoidance box. And, they are typically far less expensive than comparable ObamaPlans.

On the other hand, they are underwritten, and they are not insurance, which means that there are few (if any) consumer protections available for folks who enroll (notice that we can't call them "insureds"). They often have religious restrictions, as well, which could be problematic for some.

Back in August, we noted that Washington State insurance regulators were taking a hard line against Aliera's HCSM arrangement:

"The top insurance regulator in Washington state is accusing a high-profile health care cost sharing ministry, and its program manager partner, of trying to avoid state insurance regulation by wrapping ordinary health insurance in a health care sharing ministry wrapper."

Fast forward to now, and co-blogger Bob tips us to this item from the Peach State:

"... health shares marketed by Georgia-based Aliera, the company through which Greer bought his plan, exemplify those risks, with the company under investigation or ordered to stop selling plans by regulators in at least four states."

I can sympathize with Alierra's clients: as anyone who's recently shopped at the 404Care.gov site can attest, plans are increasingly expensive, both in premium and potential out-of-pocket, even with subsidies (tax credits). So it's easy to understand the allure of alternatives like health sharing, while overlooking the very real pitfalls.

I must say, I'm not sure how insurance regulators think they have the authority to ban an explicitly non-insurance product, but maybe that's just me.

#CaveatEmptor

States vs Ministries

Health Care Sharing Ministries, to be precise.

We've long been proponents of the concept, perhaps not so much the execution. Be that as it may, HCSMs have proven to be a viable model, with at least a million souls enrolled. And we also know that, like Direct Primary Care, these non-insurance plans are ObamaCare-compliant; that is, they satisfy the (Evil) Mandate.

Our concern has always been that folks are prone to conflate such alternatives as "the real McCoy." and this can lead to problems. The question arises, then, as to whether there's a role for The State to play, given that the plans are themselves unregulated and unsupervised (which are not necessarily "bad" things).

And it looks like we have a contender:

"Not Insurance"https://t.co/RIAEB9Fqi7

— Michael Bertaut (@MikeBertaut) August 6, 2019

As I mentioned in response, Mr Kreidler (the Evergreen State's insurance commissioner ) isn't wrong:

"member contribution payments ≠ premiums"

That is, these plans have contributions, not actuarially determined premiums, and that's an important distinction. And at least one of these ministries touts options that mimic ACA metal tiers (eg Bronze, Silver, etc). This can be terribly confusing to the uneducated consumer, and lead folks to incorrectly assume that the plans adhere to ACA regulations (which they are not required to do, and in fact do not).

I then took it a bit further:

"I have the opportunity to sell these, and have always taken a hard pass.

Why?

Well, see here."

In that post, I explained that my reluctance has nothing to do with my faith, but my profession:

"Well, what happens when my client has a claim that the Medishare folks decline? He's going to come back to me and ask why I sold him an insurance plan that wasn't insurance. And how do you think the court's going to decide?"

And that's why I think that maybe Mr K has a point, and perhaps a solid case.

Time will tell, of course.

Truth in Advertising

Got a LinkedIn invite recently from a gentleman (whose identity I've redacted) asking to be added to my network:

"Hi Henry,

I’m looking to grow my community with leaders that are interested in giving their members a better healthcare experience. If you think your members deserve more while paying less, then we should connect and chat. (Don’t worry, I’m not selling health insurance!)

Thanks,
[Redacted]"

It's that last bit that caught my eye:

"Don’t worry, I’m not selling health insurance!"

Why?

Well, because he's a regional poobah for Sedera Health.

And what is Sedera health, you ask?

Well, it's a "cost sharing community" ('community' now being the more politically correct version of 'ministry,' one supposes) to which one may subscribe. As we've noted in the past, these sharing ministries/communities/whatever are ACA-compliant, and generally much less expensive than ObamaPlans (particularly for folks who don't qualify for a subsidy or cost-sharing).

What they are not, however, and as my would-be associate notes, is insurance. That's because "Members agree to share one-another’s medical expenses through an act of voluntary giving." That's very different from a government-regulated (and enforced) insurance contract.

Which is not to absolve the carriers of their various and sundry shenanigans, oft-reported here at IB. But in those cases, there are avenues of redress: arbitration, litigation, and even criminal prosecution.

Not so with these plans.

Does that make them evil (or carcinogenic, or fattening)?

Of course not!

But certainly food for thought if one is considering signing up.

Health Sharing Ministries: Information Bleg

I recently wrote about a product, newly available to me, that relies "on the kindness of strangers" to help pay medical bills. Today, I learned about another new (to me) product that also relies (but only in part) on this Health Care Sharing Ministry concept.

One of the sticking points is that all of them do require a "statement of faith;" I'm not sure how well that might go over, but that's not really my biggest objection.

Here's the thing: I get that there's a certain amount of risk one takes going this route, but I also look and see these horrendous premiums and out-of-pocket expenses before ObamaPlans actually pay anything. And men especially draw the short stick: we get to pay for maternity and female birth control and the like, but can never benefit from this coverage.

So we pay out thousands, often tens of thousands of dollars with no real discernible benefit (other than - maybe - avoiding the ObamaTax).

So the sharing ministry's shortcomings have begun to look less and less onerous to me.

What I'd really like, and here's my bleg, is to know what experience my readers have had with them, either as customers or agents. Please feel free to leave a comment, or send me an email. And of course your privacy will be respected if that's a concern.

Thanks!

Sharing & Caring: A Veteran's Perspective

Once again, reader Brian J brings helpful insights, this time about health care sharing ministries and the VA: 

All those caveats about the "healthcare sharing ministry" are eerily reminiscent of what it’s like to be a military veteran with non-service-connected non-emergency medical needs.

If you’re a military veteran – and enrolled in the VA healthcare system (which does meet the minimum essential coverage standard) – you’re disqualified from obtaining subsidized medical coverage through the Obamacare marketplace. (If you’re married, the marketplace will give your non-veteran spouse coverage with a subsidy, but you – being enrolled in the VA healthcare system – would have to pay the full [unsubsidized] amount for ACA health insurance coverage.)

Now, one might ask why is that a bad thing? If the veteran already is enrolled in VA coverage that provides care that meets the minimum essential standard for health care coverage, why would the veteran be concerned about obtaining health insurance outside of the VA?

The reason is that (1) VA health coverage is not considered to be “health insurance” and (2) because of the healthcare eligibility “Priority Group” that the VA assigns a veteran when that veteran enrolls.

Years ago, when the VA realized that budgets were tight, they began a system of rationing health care, so that the veterans who needed health care assistance the most – and the ones who had made the greatest military sacrifice – obtained priority in coverage (and were assigned to higher “priority groups”). I think that was an appropriate and reasonable decision.

Here’s a link to a pamphlet that is produced by the VA that describes those priority groups.

But, what that means is that those veterans who do not qualify to a higher priority group based on their (lesser) military sacrifice are assigned to lower priority groups and are enrolled (and obtain coverage) determined by the amount of money Congress gives the VA each year, which then determines the amount of co-pay the veteran has to pay, and affects the healthcare services and benefits made available to the veterans in those lower priority groups. (If you’re assigned to Priority Group #7, you’re near the bottom of the list.)

The VA clearly states that “VA health care is NOT considered a health insurance plan.”

I think there's a disconnect between what the ACA considers to be minimum coverage in the VA healthcare system and what healthcare benefits a veteran enrolled in one of the lower Priority Groups might actually be entitled to and paying for. (Basically, if you have a non-service-connected non-life-threatening injury – say, you get the sniffles or stub your toe and go to your primary care physician down the street -- the VA is not likely to pay for that treatment.)

The VA warns (advises) veterans to keep their private health insurance – if they have it – due to the risks of being in one of the lower priority groups. See the section titled “Risks of Giving Up Your Private Insurance” in this VA pamphlet.

Many low-income military veterans with non-service-connected medical needs are dis-enrolling from the VA Healthcare System in order to be eligible for enrollment in the ACA (Obamacare) and obtain subsidized coverage for themselves and their spouses. (At least until they become Medicare-eligible -- then, they're re-enrolling into the VA Healthcare system.)

Thanks again, Brian!

Friday LinkFest

In no particular order:

■ We've discussed Health Care Sharing Ministries many times here at IB; one thing they all tend to have in common is that "ministry" part, which at least implies a Christian slant (NTTAWWT). I get the sense that many (most?) aren't particularly heavy-handed about it, but still, as a Member of the Tribe, it gives me a brief pause.

Now, thanks to FoIB Dutch R, we learn about a "kibbutz of healthcare:"

"After some online research Mazie, who lives in Miami, found something he thought was a godsend: United Refuah HealthShare, a Jewish alternative to traditional insurance. (“Refuah” is Hebrew for healing.) He was thrilled by the bargain-priced plans."

As with its gentile counterparts, Refuah (which one presumes refers to "r'fuah shleima," a blessing for healing) satisfies the (currently defunct) mandate, and a way to pool resources to help others pay for health care. And, as with those other ministries, there are additional risks that come with being uninsured.

Still yasher koach ("kudos").

■ For fans of Medicare4All, a warning about what one wishes for:

"THE number of patients who die while languishing on NHS waiting lists has rocketed, new figures suggest. At least 10,000 extra people every year never receive the treatment they have been waiting for compared with five years ago."

But hey: Free!

■ And speaking of M4A, despite all the positive press it's currently garnering, a funny thing happened on the way to the potential implementation:

"A new poll finds that about only one in 10 registered voters want the equivalent of Medicare for all if it means abolishing private health insurance plans."

If you like your plan.....

The Creation of Obamacare's Individual Market Mess

It has been four years since insurers submitted their initial rates to buy market share in Obamacare's individual market. Back then insurers were using assumptions that the segment would grow through government forcing people to purchase their product, existing policyholders coming over from "crappy" insurance plans, the promise of enforcing the rules, huge transfers of funds from competitors, and large sums from taxpayer funded subsidies.

Nevermind the ginormous turd of a website, the bigger problems occurred when those in power issued major changes - literally weeks into the first open enrollment. Some problems have continued because of a lack of enforcement. Others have come from bipartisan Congressional changes that were signed by President Obama.

The first was a reprieve for those already insured who found out that "if they liked their plan" they couldn't keep it. These transitional plans (Grandmothered) kept a large number of healthy folks out of the Obamacare markets when HHS issued a rule allowing people to retain their medically underwritten insurance.

The second problem was the expansion of - but no policing of - "hardship waivers". There are a plethora of waivers people can take advantage of. Some are legit. Others, not-so-much. The most egregious (IMO) is the exemption for Christian Health Care Sharing Ministries (HCSM). HCSM's aren't insurance products. They don't have mandated benefits nor do these Ministries pay in to the Obamacare taxes and fees. Don't get me wrong, if it's the right fit for a person they should look at it as an alternative. My objection is the double standard that Obamacare considers this "good" but a mini-med/limited benefit plan is considered crap.

Lack of enforcement continues to be a significant contributor. The primary culprit on the enforcement front stems from Special Enrollment Periods (SEP). While these have been tightened under the Trump Administration, the first three years under Obama was a free-for-all. In discussions with insurance company underwriters and executives, all had a similar response to how HHS policed SEP's. The short answer was, they didn't. As one insurer put it:

"They (Obama's HHS) rubber stamped everything. Politically they had to. Think of it this way. If someone was without insurance in January then was diagnosed with cancer in March they would have to wait until January of the following year to obtain coverage. These type of situations happen more often than you know. Imagine the backlash if people were diagnosed with major health conditions then were denied insurance due to Obamacare's own rules? The simple way to make it work was to allow people in, then place blame on insurers when rates went up."

A final problem is revenues. "Not one dime to the deficit" was BS. When you have an initial CBO score that uses 10 years of revenues but only 6 years of expenses and it barely is at breakeven we know it won't be true. Making matters worse, the expenses continue to exceeded expectations. The bending of the cost curve is going in the wrong direction. Instead of shoring up the costly overruns Congress does the opposite - cuts revenues. Look at this list of changes to Obamacare that are causing the fiscal crisis to rise:

• Doc-Fix Tax
• 1099 Repeal
• CLASS Act Repeal
• Defund of CO-OPs
• Risk Corridor Budget Neutrality
• Cadillac Tax Delay
• Delay of Medical Device Tax
• Delay of Health Insurance Tax

Every one of these revenue cuts had bipartisan support.

There are lots of nails in the coffin of the individual health insurance market. Many come from the sledgehammers that Obama's administration pounded. Some have come from a Republican controlled Congress.

Both sides continue to point fingers. Which brings me to something I was told as a young child. When you point a finger at someone remember that three fingers are pointing at you.

Couple interesting product news

■ What if you could add collision coverage to your car after hitting that tree? Well, thanks to FoIB Holly R, we learn that health insurance startup Bind offers pretty much that for its self-insured corporate clients:

"Technology has made on-demand services a reality for everything from food deliveries to gym classes and car-sharing. What if you could have on-demand health coverage for big-ticket procedures like knee surgery?"

It does sound kind of 'too good to be true,' but it's apparently a legit service available to companies willing to take the leap. Bind in't actually an insurance company, but a third party administrator for some of UHC's self-funded groups.

Interesting.

■ Thanks to the folks at United Healthcare, we're privy to next year's new IRS limits for group and HSA-compliant plans:

"Maximum out-of-pocket limit for 2019 group plans:

•$7,900 for self-only coverage ($7,350 in 2018)

•$15,800 for family coverage ($14,700 in 2018)"

That's an increase of almost 10%, and of course the premiums will also be headed north, although we don't yet know by how much. There's a term for this: "unsustainable." And it makes alternatives like sharing ministries and Direct Primary Care (not to mention Short Term plans) more and more attractive.

On the other hand, maximum HSA contributions are increasing almost $50 a year for individuals. WooHoo!

Monday Morning LinkFest

■ We've posted fairly often about Health Care Sharing Ministries, most recently here:

"After some online research Mazie, who lives in Miami, found something he thought was a godsend: United Refuah HealthShare, a Jewish alternative to traditional insurance ... He was thrilled by the bargain-priced plans."

This was news because this model of health care financing is typically offered with a Christian slant (NTTAWWT). Regardless, they're gaining in popularity (sort of: there are about 1 million folks on these plans, which makes it a rounding error), and the movement wants a seat at the table as we look for ACA alternatives:

"The health sharing plan movement made itself felt recently at the Inter-Company Marketing Group’s 2019 annual conference."

Good for them!

■ It's true that we spend a lot of time dissing on Britain's Much Vaunted National Health Service©, and with (very) good reason. For example, FoIB Sally Pipes alerts us to this latest news:

"NICOLA Sturgeon has admitted she is not “surprised” that NHS waiting times are still getting worse despite bringing in a legal guarantee to prompt treatment seven years ago ... [Last] week, official figures showed a record 27.3 per cent of patients waited longer than 12 weeks in the last quarter of 2018, the equivalent of 200 breaches each day."

But hey, it's free!

And on its way here, if the M4A folks have their way.

■ Even with ObamaCare's actual body count, we're still doing pretty darned well in the health care results metric. From FoIB David Balat:

"The world’s leading medical journals report the U.S. has superior results, including for cancer, heart disease, high blood pressure, diabetes, and high cholesterol."

The Tweet links to an article behind WSJ's paywall, so...

MediShare: Epilogue

So, the other day I asked about folks' experiences with Health Care Sharing Ministries and, as usual, our readers came through in a big way.

Thank you!

One thing missing, though, was an agent's perspective; that is, from someone who'd actually sold such a plan. Fortunately, I received an email from one such, who's graciously agreed to let me share her story:

"I'm a financial advisor and licensed insurance agent (since ’97). I moved my family to Samaritans two years ago when that insurance we were promised we could keep was no longer available. It took me some time to get comfortable with the idea of believers sharing burdens like this. In part my skepticism was a result of my training in the industry; insure risk, insure risk, insure risk.

Also, my skepticism was partially anchored in knowing human nature. This year we had a small need, $1,800. The plan worked as explained, and receiving notes of encouragement from all those folks was encouraging. It's a privilege to pray for and encourage those to whom we send our monthly contributions, so to receive it in return warmed my soul.

We have found that generally telling doctors that we are cash pay affords better treatment, better pricing, easier appointment times and we've become much more aware of cost [ed: which tracks with what other commenters have noted] as we don't wish to burden the group any more than is absolutely necessary. It's been eye opening to see just how badly and invasive the insurance industry has injected itself between the doctor/patient relationship. Now, even if the ACA is repealed, I don't think I'll go back to regular insurance."

Thank you, this is exactly the kind of input I was seeking.

So, I think at this point that I need to "move on" from my skepticism of this model, at least insofar as this new product is concerned.

Sharing, Caring and Talking

So Politico's Paul Demko reached out to me yesterday to ask about Health Care Sharing Ministries (HCSM), and specifically about whether or not I'd decided whether or not to market them. He was also interested in connecting with any (former?) clients who'd made the leap from Major Med to HCSM.

I was intrigued, and we agreed to speak this morning. In the meantime, I contacted several folks I knew who'd gone that route, especially hopeful that one in particular will respond.

Why her?

Well, because she was actually referred to me by a mutual friend at our synagogue. We had looked into ACA major med plans for her, but she ultimately chose a Ministry. Since these tend to be church-based I was intrigued, and Paul thought that would be really interesting to hear more about, as well.

Ultimately, we had a very nice conversation, and I told him that I'd let him know if I was able to connect with any of these folks so that I could send them his way (if they agreed that would be a good idea).

I don't know when (or even if) this article will be published, but will post a link to it here once it is.

Twisting in the Wind

So, yesterday I fielded a call from a young lady looking for health insurance help. It seems that she travels quite a bit all over the country, and is having a very interesting (well, to me; problematic for her) issue:

She and her husband had been covered under his employer's plan, but that's gone away (I inferred that he'd been let go, but didn't pursue since I didn't need to know). She's been searching for replacement coverage herself, and is running out of time (they have but 5 days left on the Special Open Enrollment eligibility). The problem is that she needs a plan that will cover her while she's on the road.

Sorry, Charlie!

As we've mentioned, plans used be built on the PPO model, which offered (reduced) out-of-network coverage. Now (at least in this market) the only plans available are built on the HMO chassis, which basically covers out-of-network charges only for life-threatening emergency care.

So, get sick in Dayton, no problem.

Get sick in Milwaukee, problem.

I did tell her her that there are options:

First, Short Term Medical plans. These are still PPO-based, so she'd have coverage wherever she traveled in this great land of ours. But, they aren't ACA-compliant, and she can only keep a plan for 3 months at a time. And, of course, they don't cover any pre-exisiting conditions.

Second, I mentioned Dave's plan.

And third, I brought up Sharing Ministries.

She demurred on all three.

I did tell her I'd be happy to answer any other questions if she wants to cal back, but reminded her that the clock is ticking....

(Potentially) Exciting HSA News

Keep in mind that this has been proposed, it is far from law.

But it's a start:

"U.S. Sens. Ted Cruz (R-Texas) and Mike Braun (R-Ind.) this week introduced the Personalized Care Act (PCA), legislation to make Americans' health care more portable, accessible, and tailored to meet their unique needs by dramatically expanding Heath Savings Accounts (HSA) - a pre-tax savings tool millions of Americans use to cover the costs of their health care."

Some highlights:

• Expand HSAs to Millions of Americans

This is perhaps the most important feature, since, as we've been proposing for years, it "decouples HSAs from high deductible health insurance plans (HDHP)." In fact it seems to go even further, and, as we've also long endorsed, it includes alternative mechanisms and policies like Sharing Ministries and Short Term Medical plans.

• Allow HSAs to Pay for Direct Primary Care and Other Direct Medical Care Arrangements

This is fantastic: by allowing folks to use HSA funds to pay for DPC, these plans should become even more popular, both with patients and as a model for doc's.

One disappointment is that it doesn't seem to contain any mechanism for re-legalizing true catastrophic plans. Still, it's a great step in the right direction.

Kudos, Senators!

[Hat Tip: FoIB Dr Lee Gross]

Words. Fail. Mandate. Lives.

While we've never been fans of the (Evil) Individual Mandate, we've recognized that it's limited in how draconian its enforcement is allowed to be. Worst case scenario, a big check to Uncle Sam (and even that's difficult to actually enforce).

But as terrible as the (Evil) ObamaCare Mandate is, it pales in comparison to the new iteration recently passed by the Rocket Surgeons in the District of Columbia:

"DC Passes Law Requiring People To Buy Health Insurance Or Have Their Property Seized"

So, "nice house you've got there, be a shame if something happened to it because you passed on buying health insurance."

Worse yet, it doesn't appear that there's a carve-out for Direct Primary Care or Health Care Sharing Ministries (as there is in the ACA).

Yikes, indeed.