WaiverMania: Catch the Waive! [UPDATED & BUMPED]

By our most recent count, 222 plans had been granted waivers from all or part of ObamaCare©.

You just knew there'd be more, but who could have known just how many?

IB readers had a clue.

And they were right:

"President Obama’s health department made public new waivers for more than more than 500 groups."

Although I was told that there'd be no math, that figure is more than double the previous total. At this rate, we may not have to even worry about ObamaCare© at all: pretty soon, everyone will be waived.

We wish.

The current tally, by the way, stands at over 2 million participants whose plans are not subject to the draconian mandates set forth in the plan we had to "pass to see what's in it."

Never let it be said, though, that HHS Secretary Shecantbeserious has no sense of humor:

"HHS said Wednesday night that it wants to make the waiver process transparent."

Oh, it's transparent, Kathy: we can see right through you.

UPDATE: Well, well, well. Apparently, those Republican party-poopers in Congress aren't catching The Waive:

"The Obama administration’s waivers ... are a “perfect example of special interests” having influence in the administration and will be looked into by Congress"

Sen Charles Grassley of Iowa is calling the Obamastration on its early promise to eschew "special interests," citing the fact that so many of those granted waivers seem to be unions and their ilk. Although the investigations will take place in the House, the Senator has pledged to aid them in their quest to shed some light on the process.

Things could get interesting...

Waivers in the air

"Hallelujah, come on, get waivers!" is apparently the newest hit tune in DC-land. Last time we checked, the count was up to 1,040. But that's so yesterday. For those keeping score at home, the total has now climbed to 1,168 waivers, up 128 (or over 10%). At this rate, of course, by the time 2014 rolls around, only suckers will be required to play by ObamaCare© rules.

Don't worry, though, there's still time to get your own ObamaWaiver©.

Shecantbeserious Waivering: You want fries with that?

On the heels of the recent McDonad's/Mini-med kerfluffle, we now learn that over 2 dozen companies have been granted temporary ObamaCare© exemptions. This of course raises a number of -- shall we say uncomfortable? -- questions:

First, under what criteria were these waivers granted? What, if any, quid pro quo was extracted from the corporate coffers of those which benefitted?

Second, what happens next year, when these waivers expire? Will they automatically renew? If not, what process will be implemented to review whether or not such exemptions will continue?

Third, what companies applied for an exemption and were declined, and on what basis?

Fourth, why is it that not only employers and insurers were granted exemptions, but also unions?

One more little time-bomb that was in the bill we had to pass to see.

Shut Up, and Call Me in the Morning

It's as American as apple pie: the right to complain about poor service. But beware, you may have to give up that right if you want your doctor to continue treating you.

"Doctors across the country are forcing their patients to sign waivers giving up their right to post comments and reviews about them online."

Of course, just because you sign something doesn't automatically mean that you're bound by it. But there are usually consequences for ignoring the rules, especially ones to which you've explicitly agreed. In this case, the consequence is a boot out the door - of the doc's office, that is.

According to Laurence McCullough, a professor of medical ethics at Baylor College of Medicine, "(t)his is just the guild trying to protect itself from accountability to those it serves. That's not professional behavior — this is self-interested behavior." Of course, the medical profession has been under fire of late for other potential lapses in ethics, so this isn't necessarily breaking new ground.

But it is troubling:

Dr. Wendy Mariner, a law professor and director of the Patients' Rights Program at Boston University, opines that "the waivers create an adversarial relationship between doctors and patients, and could possibly limit options for patients seeking care. If this kind of thing gains any traction, medical licensing boards will, and I think should, prohibit it."

On the other hand, the reviews in question are often, well, questionable themselves. After all, how is one to know if the person posting an online complaint against Dr Smith was actually a patient of his, or simply a disgruntled employee, for example? Absent some kind of monitoring, who's to know. But that, of course, begs the question: who does the vetting? There doesn't seem to be any reasonable answer to that one.

And there's this:

"Under the terms of the agreements, patients promise they "will not denigrate, defame, disparage or cast aspersions upon" their doctors or post comments to any Web pages by name or anonymously."

Of course, if it's anonymous, how would the doc know whom to "fire?"

For now, both sides seem to be finding their way around these questions. It may be a while before we see any substantive answers.

WaiverMania: Piling On

Earlier this week, Bob made a compelling case that the Employer Mandate was, like the Individual one, unconstitutional. As long as we're on the subject, then, let's open this can o'worms even further:

"The Department of Health and Human Services has granted 733 waivers from one of the statute’s key requirements ... Congress can pass statutes that apply to some businesses and not others, but once a law has passed ... how can the executive branch relieve some Americans of their obligation to obey it?"

In other words:

"Are Health-Care Waivers Unconstitutional?"

It's almost as if the folks that passed this train-wreck hadn't read it.

ObamaCare© Waivering: 111 and counting...

As previously noted, HHS Secretary Shecantbeserious has no compunctions about handing out ObamaCare© waivers to select businesses, including McDonald's and Local 25 SEIU. In fact, over 100 such waivers have already been granted, on a completely rational, fair and transparent basis.

And if you believe that last part, I've got a great deal on some primo real estate for you.

The truth is far more disturbing:

[Video courtesy of Gateway Pundit]

For those playing along at home, here's a list of "the usual suspects."

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.

Obama Administration proposes to cut yet another great road thru ACA

According to Kaiser Health News, today the administration will propose exempting “certain self-insured, self-administered plans” from the law’s temporary reinsurance fee in 2015 and 2016.  Kaiser notes the exemption will affect mostly Taft-Hartley union plans which are often not only self-insured, but also self-administered.  Thus the exemption would not apply to insurers or to self-insured employers who hire a third-party to adjudicate their medical benefit claims.

I haven't been able to find authority in the ACA as enacted that supports this exemption – other than the sweeping discretionary powers given to the Secretary of HHS. (ACA 1321 (a)(1)(D) “such other requirements as the Secretary determines appropriate.”) So this exemption – as with other exemptions and waivers before it – will be implemented by administrative diktat, not by due process in Congress and public debate of the issue.

KHN also observes that “Both unions and business have criticized [the new reinsurance fee] as penalizing employer-sponsored health insurance to support plans bought directly from insurers.”

I think KHN is correct.  But it seems to me that fact makes it hard to rationalize the proposed new exemption:

■ In the first place, why exempt some union plans but not all?  Not all union plans are self-administered.

■ Second, why is it important to distinguish between self-insured plans?  Why not treat all self-insured plans the same way, regardless whether the self-insured plan sponsor is self-administered, or not?

■ Third, why should ANY plans be exempt if ALL are not exempt?  In other words, why is a self-insured plan different for the purposes of this reinsurance fee, from an insured plan?

Further I don’t find anything in the KHN article or in the proposed HHS rule that explains why it’s suddenly so important to slice the self-insured market this way. Who can or will explain all these things?

Besides, this administration’s habitual reliance on exemptions, waivers and executive orders outside due legislative process has become worrisome.  It calls to mind this exchange from the 1967 Academy-Award winner A Man for All Seasons:

Sir Thomas More: What would you do? Cut a great road through the law to get after the Devil?

William Roper: Yes, I'd cut down every law in England to do that!

Sir Thomas More: Oh? And when the last law was down, and the Devil turned 'round on you, where would you hide, Roper, the laws all being flat? This country is planted thick with laws, from coast to coast, man's laws, not God's! And if you cut them down—and you're just the man to do it—do you really think you could stand upright in the winds that would blow then? Yes, I'd give the Devil the benefit of law, for my own safety's sake!

Is the Obama administration moving America away from a government of laws?  If so where exactly are we heading?  Can Americans trust this administration to answer these questions forthrightly? The question is important - - for our own safety's sake.

ICD-9, ICD-10: Whatever it takes...

Recently, we were alerted to a potentially useful "widget" which empowers health care consumers in making informed decisions. Kate Hersch wrote to tell us about a tool that gives consumers "ICD-9 code information in an easy to use, searchable widget."

The ICD-9 tool is designed to enable health care consumers to quickly and easily determine how and why their claims are paid (or denied). As the site notes:

"Many insurance claim denials are due to human error in recording the correct ICD-9 code in medical billing forms."

We've written before about these ICD-9 codes, but now there's a new kid on the block:

"U.S. health care providers and health plans have two years left to adopt a new federally mandated system of medical coding ... there is no federal funding for the computer upgrades needed to accommodate the new medical coding."

First, one wonders if HHS Secretary Shecantbeserious will also be selling, er, handing out ICD-10 waivers?

Be that as it may, the "new" codes aren't really "new new," as our resident Medical Office Manager Kelley Beloff graciously explains:

This article is outlining the next new cost for all of medicine in America. Physicians, hospitals, etc, are paid based on two sets of codes. The CPT (Current Procedure Terminology) codes (which are owned by the AMA) specify what procedure was done. For example, code 99213 is a mid-level, established visit usually lasting 15 minutes. However, to be paid, the physician must also include a diagnosis code called an ICD (International Classification of Diseases) code. Currently, America is using the ICD-9, or the 9th revision. The rest of the western world is using the ICD-10, or the 10th revision.

The ICD-10 adds thousands of new codes to the diagnosis arsenal and the codes are formatted differently. Why would this be a problem? Because physicians are spending hundreds of thousands of dollars, mandated by the HITECH Act, to convert their offices from paper to Electronic Medical Records, which must be done by 2014. All of these EMR'S are programmed to read ICD-9 codes, not ICD-10 codes. The set date for transition to the ICD-10 format is October of 2013. The cost to change all the forms, templates, and computer systems used by America's physicians will be in the millions.

When I went back into the medical field in 2003, the transition to the ICD-10 had already been set and passed. In the years since I can recall at least three different set dates for the transition. Each date has passed without the ICD-10 being implemented. In my opinion, physicians will rebel if they have to pay twice for their offices to be compliant with government regulations: first to install the EMR and then again to reformat the EMR they purchased 12 months before. I believe that this country will go metric before we go ICD-10.

Thanks, Kelley!

ObamaTolls©

PowerLine's John Hinderaker gets the WaiverMania impetus exactly right:

"[T]he vicious strategy at the heart of Obamacare [is to] pass terrible legislation, and then collect a toll by exempting your friends--those who pay you lots of money--from that legislation, while your enemies have to live with it."

In this case, the toll actually came before the legislation: look at how many of these waivers go to PresBo's union buddies, who so vociferously (and generou$ly) supported him and his policies. These organizations allegedly represent the interests of millions of workers, those for whom ObamaCare© was ostensibly designed to protect. One wonders how to reconcile these transparently contradictory goals.

I can, however, think of a term which describes it.

Medical Tourism and the ObamaTax

Now that the ObamaTax has been affirmed, it's time to look ahead. This means a shortage of providers and major increases in both premiums and health care costs. There's not much one can do about the increased premium side of the equation, but there are indeed ways to mitigate both the provider shortage and increased cost of care.

While medical tourism has been around a while (we first posted on the phenomenon over 6 years ago), it seems poised to really take flight under the ObamaTax regime:

"US patients obtain health care treatment in foreign countries well below US rates. Treatments include dental implants, hip and knee replacements or bariatric surgeries. Americans also go abroad for more complicated procedures such as heart operations and cancer treatment, or alternative therapies such as stem cell treatment unavailable at home."

And that's already occurring. As folks begin to see hospital waits getting longer and longer, and the costs of care getting higher and higher, it doesn't seem far-fetched that those who can will opt for a short (or long) plane ride, the expenses of which are potentially more than offset by the savings (and, of course, the actual delivery of care).

Pipe dream much, Henry?

Perhaps, but then again:

"Some US businesses already persuade employees to travel for treatment. Medical tourism experts see that becoming more common in the future. With incentives like deductible waivers, the plan saves money for the insurance company, the business and the employee."

And there's nothing preventing carriers from offering optional med-tourism riders or supplements. And competition among foreign providers for American patients may also prove enticing.

Time will tell.

ADDENDUM: Can't believe I missed something so obvious, but of course the Independent Payment Advisory Board (IPAB) Death Panels will also be a major driver of MedTourism. After all, if you or your loved one (or ones) face a literal death sentence, then a quick jaunt to (say) Costa Rica may seem pretty reasonable.

An Afternoon with the Commish

Yesterday, I had the opportunity to listen to a brief presentation by our new Insurance Commissioner, Mary Taylor. Although she took office only a few months ago, she had some interesting things to say, and gamely took questions from a group of (understandably) discomfited insurance agents (I got the first one).

We only had her for about half an hour; she spoke for maybe 20 minutes, but that was fine since it left time for questions.

Right out of the box, she mentioned that Ohio is a fairly competitive state, health insurance-wise. That is, we have several carriers vying for market share, which helps to keep rates in the reasonable range (by comparison to other states only, of course).

She spoke at length about ObamaCare©, as would be expected (she also observed that we probably had our own name for it, which was, of course, correct). One major concern is that it's expected to increase Buckeye state Medicaid rolls by 1 million people. When questioned about that later, she re-confirmed that this expansion was due exclusively to ObamaCare©, not the current economy (which, of course, also adds to those numbers).

Ms Taylor also expressed her regret at how Washington has forced so many ill-conceived mandates on the states (more on this in a few moments), and the current administration in Columbus is very much in the Repeal-and-Replace camp, with an emphasis on state-based reforms.

As mentioned, I got the first question. Before I asked it, though, I told her that "my co-blogger calls it ObamaCrap," which got chuckles from both her and my fellow agents.

My question for her was: "Given the boundaries of McCarran–Ferguson, why aren't state DOI's screaming bloody murder at HHS usurping their regulatory power?" Since I knew that she was relatively new to her job (she, like pretty much every Insurance Commissioner I've ever heard of, has no background in the industry), I gave her examples such as Waivers and Guaranteed Issue for kiddies (which has killed the child-only market), which were never in ObamaCare© itself but "forced" on the states by Shecantbeserious. Her answer was a bit disappointing, if not unexpected: she and her boss (she's also the Lt Governor) feel that the best way to fight it right now is by educating the public. Meh.

The other interesting question that came up was about Medical Loss Ratios (MLR). The question was why hadn't we (Ohio) applied for a waiver on MLR. She answered that they didn't think MLR was a problem here, since we have a pretty competitive market (for now). The guy who asked it followed up by pointing out that it does have a direct affect - on us.

She replied that she'd be happy to hear more about that - we'll do our best to oblige.

Overall, color me impressed: she only took office in January and, as much as I hate to admit it, health insurance is not her only raison d'etre. Hopefully, we'll see more proactive initiatives out of Columbus, especially in the fight against ObamneyCare©.

For the Chillun'

Another day, another ObamaTax "glitch." This time, we're talking about 2 million kids who may not only lose their current coverage, but be left with no affordable alternative:

"One of Obamacare’s ongoing structural problems is preventing close to 2 million low-income children from getting affordable health coverage ... prevents children who would be eligible to participate in the Children’s Health Insurance Plan ... from getting access to their own subsidized coverage if the program is to end when it’s up for reauthorization this year."

We've blogged on the (infamous) SCHIP program before, but this is a new twist. It's up for re-authorization later this year, and there's a possibility that it will be shut down (much like the promising PCIP program). Should that happen, the kids currently covered under SCHIP would have few (if any) alternatives.

But Henry, they can just buy an ObamaPlan on the Exchange!

Um, maybe, maybe not. A couple of issues arise:

First, it's not entirely clear that losing such coverage would automatically trigger a Special Open Enrollment. The relevant definition says "losing eligibility for Medicaid or CHIP." Technically, though, the children aren't necessarily "losing eligibility," the plan is going away.

Look at it this way:

COBRA lets you keep your previous employers' health insurance for a while. But if that previous employer goes out of business, and the health plan goes away, then there's nothing to continue, and you're outta luck.

I think this falls in the same category: you didn't lose eligibility, the program went away. Now, given the reckless/feckless way this administration has implemented the ObamaTax, it's entirely likely that these kids will be issued waivers and granted Special Open Enrollment Periods.

Which would be nice, but that then brings us to the second issue:

Who's going to pay for that new ObamaPlan? As co-blogger Bob V explains it, "the health-care law doesn’t offer subsidies to workers whose employer offers what the federal government deems affordable coverage — but doesn’t consider whether employer coverage for workers’ families is affordable as well. The structure potentially bans spouses and children from receiving Obamacare’s much-touted help with premium payments while their available insurance is extremely costly."

Double-whammy.

But hey, we had to pass it to learn....

[Many Thanks to Bob V for his help in noodling this one through!]

On "Mini-Med's" and Clarity

This month's issue of Employee Benefit News (an industry publication) has an interesting article on so-called "mini-med" plans, and their role (and rules) under ObamaCare©. We've written extensively on these plans previously, but what I learned yesterday offers a somewhat different perspective.

The first thing I learned is that, as Inigo Montoya might say, "this term 'mini-med:' I do not think it means what you think it means." You see, I've been using the terms "mini-med" and "limited benefit" interchangeably, but they are not necessarily the same thing. According to John Ferguson (President of South Carolina-based BasicPlus Insurance Services), a "mini-med" plan may include deductibles and co-pays, and even co-insurance ("80/20"), while a "limited benefit" plan pays a fixed benefit for specific services (a $40 reimbursement, for example, for a doctor's office visit). While these may not seem like significant distinctions, they are treated very differently under ObamaCare©.

As we've mentioned, one of the new regulations is that policies may no longer have lifetime maximums or internal benefits caps. That's a problem for the "mini-med" plans, which are generally priced much lower than a "regular" major medical policy because the carrier has a much more limited exposure. Under ObamaCare©, though, those caps become problematic:

"So-called mini-med plans that provide bare-bones health care coverage at an affordable rate to mostly blue-collar and entry-level workers, as well as part-timers, temporary staffers and seasonal employees, were nearly- given a death sentence under health care reform." What saved them (for now), is that the carriers which offer them can apply for a temporary waiver; according to Mr Ferguson, Allstate and Cigna have both applied for, and been granted, that reprieve. The problem is that these waivers are only good for a year, so next year they'll have to re-apply.

The other major problem facing "mini-med" plans is that, starting January 1st, they'll be subject to another ObamaCare© sandtrap: MLR. The "Medical Loss Ratio" is a (dubious) metric which requires that a carrier pay out at least 85% of its revenue in claims. We'll debate the merits of this requirement in another post, but suffice it to say that it will be exceedingly difficult for a "mini-med" carrier to meet this requirement. One industry rumor has it that carriers will combine various "lines of business" to meet this goal.

Which brings us back to those "limited benefit" plans. Unlike the mini-med, limited benefits plans aren't subject to the most egregious elements of ObamaCare©, including the onerous MLR requirement. Mr Ferguson believes, and I tend to agree, that these types of plans will be much easier to market under the new regimes.

One final note, somewhat off-topic, but related: There are a spate of both mini-med and limited benefit plans which tout themselves as "HIPAA Compliant." The implication of this claim is that a limited benefit or mini-med plan will be considered "Creditable Coverage" for folks obtaining new group health insurance (assuming group insurance survives, which is not a given). This is at best misleading, and at worst untrue: there is no magic wand that one carrier can waive that will obligate the next one to recognize a given plan's portability. If you see this phrase on a sales piece, be very skeptical. If it's too good to be true...

ObamaTax Compliance heads' up

Received a sample notice that will (when finalized) have to be sent from employers to their employees later this summer. If you're interested, click here to download it. It's 3 pages, and pretty scary.

Scary, Henry?

Well, here's the thing. The employer will need to complete this form, and attest that, for example, his group plan meets the "minimum value standard." That is, that "the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs."

One presumes that the carrier will notify employers whether their group does, in fact, meet that criteria, but it's not entirely clear that this will be so for all carriers in all markets.

There's a related issue that so far seems to be flying under the radar: Exchanges and participation requirements. All carriers require that a minimum percentage of eligible employees sign up for coverage. This is to help reduce the chance of adverse selection, where only the least healthy enroll. The term "eligible" is somewhat flexible, but in general it's full-time employees who don't have "valid waivers." A valid waiver might be, for example, coverage through a spouse, or Medicare. Oddly, an individual medical plan does not qualify as a valid waiver, so that employee must be accounted for in the grand total.

So here's a question: if an employee opts off the group plan in favor of a (subsidized) individual plan from his state's Exchange, is that a "valid waiver?" This matters - a lot - because if enough folks opt off the group plan, it's going to go away, whether or not this is what the employer (and the other employees) want.

But remember: if you like your current plan, you can keep your current plan.

Or not.

[Hat Tip: FoIB Beth D]

HHS Secretary Shecantbeserious in HD?

Maybe she just can't help herself; after all, when you're not the sharpest scalpel on the tray, you're not really expected to make a lot of sense. And, of course, Ms Shecantbeserious is rather dull, which may explain this little non-sequitor:

"[I]f I don’t have a 27-inch TV for the Super Bowl, I can’t demand on the day of the Super Bowl that somebody deliver that TV because I have a right to it. On the other hand, if I don’t have insurance, I come through the door of an emergency room and get treated and get cared for, and somebody else picks up the tab."

What Madame Secretary is referring to is EMTALA, a law that predates ObamaCare© by decades, and requires only immediate, critical care, not a long-term return to health. It should surprise no one, of course, that Kathy thinks that watching the Super Bowl is akin to saving someone's life; after all, these are the folks bringing us Death Panels.

Her point, so far as she actually has one, is that citizens should be forced to buy health insurance, whether they want to or not. It's not clear whether or not she also wants to make watching the Super Bowl mandatory; in such an event, perhaps the Death Panels don't look so bad after all.

It's almost amusing: having lost the "health insurance is the same as auto insurance" debate, the forces of ObamaCare© are reduced to "the Super Bowl is the same as health insurance." What's not funny, of course, is that these are the same folks granting waivers hither and yon, and who think that the public is stupid enough to buy their silly arguments.

Don't bet on it.

FACEPALM!

In the comments, Bob (correctly) points out that he'd made this call some ago. Timeless, and timely.

An Embarrassment of (Link) Riches

The Inbox is filling up with interesting linkage: many of interest, few really blogworthy on their own.

So, in no particular order, some (hopefully) interest-piquing links:

■ "By February, CMS had spent an average of about $92 per HHS exchange QHP enrollee"

That is, they'd spent almost $100 per (successful?) ObamaPlan victim enrollee. That may not seem like much, but if the numbers HHS is touting are true [ed: uh-hunh], then we're talking hundreds of millions of IT dollars.

■ Does the ObamaTax actually contain wording that contains the seeds of its own destruction?

"The Patient Protection and Affordable Care Act (PPACA) contains a provision — Section 1332 — that states can use to turn it inside outside"

The little-known Section 1332 allows state Departments of Insurance the opportunity to solicit waivers for certain plan provisions, including Qualified Health Plan requirements. Something to keep in mind, though:

The verbiage in question is actually called "Sec. 1332. Waiver for State innovation," and allows states to "apply to the [HHS] Secretary for the waiver of all or any requirements described in paragraph."

But it's not open-ended; rather, it's an opportunity for a given state to experiment a bit, while requiring of the state a "10-year budget plan for such plan that is budget neutral for the Federal Government."

Sweet deal for the Feds.

■ As if confirmation was needed that the ObamaTax has lead to provider shortages, and at least a suspicion that rationing is just around the corner (if not already here):

"5 ways insurers can limit care access in this brave new world ... Insurers are not sitting back with open arms and welcoming all of the poorest, sickest and most costly patients"

No kidding. When increased demand (in the form of newly insured, both on ObamaPlans and Medicaid) meets static (or perhaps even shrinking) supply, something's gotta give. 

■ Here's a new twist on the ol' Three R's: reinsurance, risk corridor and risk-adjustment. These also happen to comprise some underlying reasons why insurers' own financial health may face some challenges.

According to Steve Zaharuk, a senior vice president at Moody’s Investors, "although exchange qualified health plan (QHP) enrollment has been strong, insurers have given few details about QHP underwriting results ... At best insurers were predicting a break-even scenario, but most were anticipating losing money on the business for the full year.”

Not a great long-term business strategy. Which actually ties in nicely with... 

■ FoIB Jeff M tips us to this news out of The Tarheel State:

"Carolinas HealthCare System has eliminated roughly 100 jobs and is looking to cut its 2015 budget by $110 million"

Which seems to me to be a combination of the four previous links. One wonders how many more such reductions we'll see as we enter the next Open Enrollment season, and even more folks jump in (or don't).

Audited lately?

No, I don't mean by the Infernal Revenue Service, but by your boss.

Hunh?

A brief primer: when putting together a group plan, carriers require a rather strict accounting of eligible employees. They want to make sure that everyone who's on the plan is eligible, and that all those who are eligible are on the plan or have appropriate waivers.

But there's another kind of accounting that comes into play, as well:

Many employer groups don't subsidize dependents' coverage; in fact, a lot of groups are dropping dependent coverage altogether. Not only that, but there's a significant movement towards requiring working spouses to opt for coverage under their employer's plan instead of electing dependent coverage.

Those that have retained that option are becoming more proactive in making sure that dependents are truly eligible for coverage. That is, requiring an employee to prove that they're really married, or have children, or both. Absent such proof, "the dependent loses coverage."

According to those "in the know," as many as 12 percent of covered dependents aren't really eligible for coverage. That's a lot of people who may not be as financially secure as they think.

In a way, this is a good thing: my experience has been that dependent coverage on group plans is much more expensive than comparable cover in the individual market (assuming reasonably good health). And by opting off the group, those dependents have a lot more choices in plan design. And it also makes that coverage portable: no need to elect COBRA, since you already own the plan.

Something to think about as we begin the new year.

Lest We Forget: ObamaWaiver© Mania Rolls On...

Last time we checked (about a month ago), ObamaWaivers© appeared to have peaked at about 1400. That seemed to be the saturation point for these little political nuggets.

Or so we thought.

Turns out, HHS Secretary Shecantbeserious still had a few burning a hole in her purse:

"The Health and Human Services Department granted 39 new waivers last month from part of the healthcare law, bringing the total to just shy of 1,500."

But let's say you're not a union or other major Dem contributor. Is there any hope for a change for you?

Well, maybe so:

"Sen. John Barrasso (R-Wyo.) said he will introduce a bill next week to let every American apply for a waiver from the healthcare law."

No word yet on the cost, but if you have to ask...

All aboard the Exemption Train

Remember back in the day, when we had over 40 million uninsured folks, and we had to completely upend the existing health care delivery and finance systems to get them coverage?

Ah, the good ol' days:

"The CBO report ... also finds that about 30 million Americans are currently without health insurance"

Wait, what?

That can't be right: we've got this state-of-the-art enrollment website, comprehensive health care plans with low, affordable premiums (thanks in part to easily understood and verifiable subsidies), and the threat of substantial penalties for failing to buy a plan.

Right?

Right??!!

Turns out, not so much: that same CBO report projects that "the number of those who don’t have to pay fines to opt out of Obamacare — the exempted class — is going to hit 25 million by 2016."

Hunh.

Part of the problem, of course, is that the fine penalty tax is pretty much pre-empted for millions of people who have been given (illegal) waivers by the Obamastration. And it's only going to get worse as this year's Open Enrollment season spins up this Fall, and folks start to see their January renewals nuking their bank accounts, even as their subsidies begin to dry up.

Wait a second there, Henry: what do you mean about those subsidies "drying up?"

Oh, sorry, got ahead of myself:

"People who decide to stick with the coverage they've already gotten through Obamacare, rather than switching plans, are at risk for some of the biggest premium spikes anywhere in the system."

At issue is the so-called "auto-renewal" process (about which Pat has written), which allows folks who've bought ObamaPans to just set-it-and-forget-it; rather than face again the frustration of the 404Care.gov site and all its machinations, one can simply step back, do nothing, and one's current plan is "good" for another year (although that process may be short-lived as the Actuarial Value catastrophe beckons).

Problem is, there's a pretty good chance - bordering on a likelihood - that one will then face not one but two rate increases: an explicit one ("Thanks for choosing Amalgamated Health Insurance, your rate increase for the coming year is 10%") but also an implicit one:

"[M]any of those consumers will find that their subsidies don't go as far next year, even for the same plans ... The size of each person's subsidy is tied to a "benchmark" plan ... But as those plans raise their rates and new options come to the market, they'll often lose their benchmark status to cheaper competitors"

Bet you didn't know that.

Don't feel bad: most folks don't, and that's likely by design. Carriers don't want you to move, and the government certainly doesn't want you to know the true cost . But that doesn't make the problem go away: as new carriers enter the market (and they will - having sat out the initial season to get a feel for how things play out, they're more likley to want to jump in this year). And since they don't have last year's losses to make up, they can offer plans at lower rates, which then become the benchmarks, which then cause a lot of auto-renewers to lose even more ground.

Sweet deal, no?