Stop and Smell the....Scooter?

On the one hand, advances in med-tech have an adverse impact on the cost of health insurance; after all, the "new stuff" often (usually?) costs more, at least for first-adopters. Of course, a couple generations in, the costs generally go down (bought a SmartPhone lately?). Sometimes, though, it's not about the money, but the result:

"The severely disabled, including those "locked in" to their bodies as a result of accidents or disease, may soon have a new way to communicate and move around ... By sniffing in and out through their noses, more than a dozen quadriplegics were able to control computers that allowed them to write and to guide a wheelchair."

It's easy to see the humor in that, but the empowerment of those who find themselves so physically challenged is undeniable. Developed by a team of Israeli scientists, the device has so far been tested on about a dozen or so "severely disabled patients," with mixed (albeit promising) success. More testing and refinement is planned, so keep your eye out for some creative ads from the local Scooter Store.

Child Health Insurance Update

The market, or lack thereof, for children's health insurance is changing daily. I got a memo earlier today from Cigna stating that any policy written for a 10/1/2010 effective date or later that contains even one family member that is guarantee issue will pay $0 to the writing agent.

Barring further refinement, children's health insurance after 9/23 is essentially guaranteed issue. That means any child under age 18 is guaranteed to get health insurance coverage at some price.

The price is still a moving target but we expect children's rates to double from current levels and possibly even higher.

Compensation to agents is a small piece of the total pie which makes this a foolish move on the part of Cigna.

Of course it is things like this that give us our "Stupid Carrier Tricks" series.

Since agents will not be paid to place business with Cigna when an otherwise uninsurable child is part of the mix you can bet Cigna will not be included in the list of possibilities. Call this mercenary if you wish, but agents don't work for free.

Because of this move, Cigna will see fewer agent initiated applications of any kind and their average premium per application will fall.

Cigna has essentially removed themselves from the children's health insurance market except on policies written direct. House accounts are not free. There is an acquisition cost associated with self generated business and that cost is usually higher than agent driven business.

In this move, Cigna is willing to accept less business at a lower premium and when they do write business it will be at a higher acquisition cost than going through agents.

It remains to be seen if any other carriers will follow this path.

JeffLinks: Good News and Bad

From FoIB Jeff M, two interesting links. The first is good news for folks trying to figure out if they've saved enough to pay for any long term care needs that might arise, and if they might need to be looking at Long Term Care insurance. This interactive tool, from LTCi giant Genworth, includes average costs for nursing care both at home and in a facility, and can even help you determine how much these costs will escalate over time.

Now for some bad, or at least disquieting, news: if you've lost a loved one in the past few years, you know that life insurers no longer just send a check. The default option (in some cases, the only option) is a checking account from which one can withdraw funds.

Actually, that should be "checking account" since it's not a real one:

"Lohman, a public health nurse ... had always believed that her son’s life insurance funds were in a bank insured by the FDIC. That money -- like $28 billion in 1 million death-benefit accounts managed by insurers -- wasn’t actually sitting in a bank.

It was being held in Prudential’s general corporate account, earning investment income for the insurer."

And unlike a bank account, this money isn't protected by the FDIC, nor is it even held in a separate, specific account. It's just considered part of the carrier's overall assets.

I always advise my clients (well, technically, their beneficiaries) to immediately cash out that "account" and transfer the money directly to their own real bank account. What they do with the money from there is really none of my business, although I do caution folks not to go on a spending spree right away.

Thanks, Jeff!

Health Insurance for Children - Open Enrollment

The Associated Press is reporting that Washington has agreed to let health insurance companies utilize an open enrollment period for children applying for health insurance under Obamacare.

Insurers were concerned the new health care law would allow parents to sign their kids up in emergency rooms while the child is in the middle of a health crisis.

The administration now says insurers can limit the sign-up to an "open enrollment" period, for example, December 1 to December 31 for plans that start January 1.

No word on how this may impact children's health insurance rates (which were expected to rise two-fold at a minimum) or if any carriers will modify their position in rejecting "child only" health insurance applications.

Details to follow . . .

Ch-ch-changes: HSA/FSA vs ObamaCare©

As if further proof were needed that ObamaCare© has little (if anything) to do with actual care, we learn from our favorite Flexible Benefits guru Pete Deist that, come January:

Health Savings and Flexible Spending Account (HSA and FSA) "funds can no longer be used to purchase OTC drugs and medicines ... unless you have a Note of Medical Necessity (NMN) or a prescription from your doctor."

In classic gummint fashion, though, one may (apparently) continue to use these tax-advantaged dollars to purchase non-medical items (such as contact lens supplies, batteries for hearing aids, etc). This just underscores how out-of-touch our CongressCritters really are. This is especially egregious when it comes to HSA money, since these types of plans are the only ones which actually impact the cost of health care.

The other "alternative benefit," HRA ([Health Reimbursement Arrangement], is similarly curtailed. And it's also worth noting that, come 2013, the cap (maximum contribution limit) on FSA's is reduced to $2500, a 50% reduction in this valuable benefit [Correction from FoIB Alissa C: "health FSAs currently have a federal cap of earned income (essentially no cap). It's currently up to the employer to set the maximum. $5,000 is the maximum for dependent care if single or married/filing jointly." HGS].

The real problem here is that this actually increases the cost of health care, in direct contradiction to the stated purpose of ObamaCare©. It makes less expensive treatments less affordable, and actually requires additional office visits (which aren't free) in order to buy Over-The-Counter med's. Sure glad we "passed it to see what's in it."

Aren't you?

[Hat Tip: FoIB Suzy R]

Cavalcade of Risk #110: Rocky Mountain High edition

Jay and Louise Norris host this week's picturesque edition of the Cavalcade of Risk. Stop by for the beautiful scenery, stick around for the thought-provoking posts.

Buying Health Insurance From the Government

Washington is excited about their consumer health insurance portal and are perhaps having visions of providing "direct to consumer" choices for health insurance. Healthcare.gov is an expanding and changing site with quite a bit of information, some of it actually useful.

The latest addition is an "Explore Your Options" button that allows consumers to share personal information with the government in exchange for ideas on how to find health insurance coverage. You start by selecting your state then proceed through different pages based on your response.

Don't want to answer a question?

Too bad. Just like Seinfeld's Soup Nazi, "no information for you!".

The site will not let you progress until you answer every question.

At first the questions seem non-threatening but gradually become more personal.

You start by telling the government where you live by selecting one of the 57 states in a drop down box. Next you must pick one of the following that best describes your situation. Are you:

Family, healthy individual or sick individual (you must decide which), pregnant woman (can males get pregnant?), someone with a disability, senior, young adult, small employer or self employed.

Assuming you pick something that best describes your situation you can progress to the next page. If you are under age 26 and a pregnant female you must pick one since the government does not allow you to be both.

Before you go on you might want to read their privacy policy. Of course they would not collect any information that is not pertinent to helping you find the best health plan for your needs.

Or would they?

We automatically collect and temporarily store the following information about your visit:

the name of the domain you use to access the Internet (for example, aol.com, if you are using an American Online account, or stanford.edu, if you are connecting from Stanford University's domain);

the date and time of your visit;

the pages you visited; and

the address of the web site you came from when you came to visit.

I will let you decide if you really want to share this much information with big brother.

Back to the health insurance info . . .

I opted to pick a category that best described me and chose healthy individual. I admit I was lured in by the "Just two quick steps" at the top of the page. After all, if this is all they need, no big deal, right?

On the next page they tell you "Just a few more questions . . ."

Why does this seem like a visit to the dental office where he says you might feel a slight prick?

On this page you need to make some decisions again, including how much more you want to share with the government. Are you losing coverage through your employer or do you need health insurance?

Apparently if you are not losing your employer plan or if you do not have any pressing medical needs they feel there is no reason for you to even be at this site. Healthy people need go no further.

If for some crazy reason you decide you want to explore your options, even if you are healthy, you must decide which age bracket fits your situation. If you are a family and one individual is over 25 and the other is under age 26 you are again faced with a dilemma. Pick one if you want to progress.

The next category lets you make more than one selection so you can be a pregnant military veteran (presumably a woman) as well as an American Indian or Alaskan Native and still qualify for something.

The last question before leaving this page wants to know if you have trouble affording health insurance. I don't imagine they will have many "no" answers but since I like to be as helpful as I can since the government is taking such an interest in my personal life I decide to answer this as "no".

Based on the answers I have provided so far I am offered four choices. The options include finding a job with health insurance (good luck on that one), buying health insurance in the open market, exploring the PCIP plan, and finding local free health care clinics.

Already they have lured me in but I don't want to leave without finding out what is behind door number 2, so I tell the government I want to explore insurance in the private market.

Now they want to know just a bit more information before letting me proceed.

They want my zip code.

Why do I feel like there is a government drone or spy satellite watching my every move?

The next page gives me the option of going to the Georgia Department of Insurance website or picking a link to any one of 14 health insurance company websites. They currently offer 45 plans to pick spread over the 14 carriers. Some have only 1 plan while others have 13.

When you click on a carrier link you are offered a very brief description of plans that are readily available in the market either direct from health insurance companies or through an insurance broker. The difference here is, if you want rates you have to come back in October. There are no rates available at this time on the government site.

So you have given the government all this personal information only to find there are no answers.

I don't know about you but this just makes me feel used.

For what it is worth, I have offered visitors a health insurance quote engine on my site for years. Anyone looking for affordable health insurance in Georgia is free to visit my site, run quotes and apply for health insurance. They can do this on their own or solicit my advice.

Either way, I do not collect information and send it to the government.

There are some things that are constant based on my experience. Over half of those who run a health insurance quote don't want anyone to know who they are or how to contact them. On average, about a fourth are willing to seek advice about which plan to pick and how to apply.

Roughly 5% of those who run a health insurance quote will also start an application for coverage without asking for assistance. Well over 90% of those never complete the application and about half that do are turned down mostly because they did not know how to respond to the questions on the application.

I don't know what the government is expecting, but if they think they are going to provide a service that will result in thousands or millions obtaining health insurance they will probably be disappointed.

You may be able to build a ballpark and they will come, but not so for a health insurance website.

MVNHS©: Death Panels alive and well

One may argue over the efficacy and/or morality of end-of-life care, but it has long been a personal choice. The emphasis, however, appears to be on the "has been" piece; it appears that the MVNHS©:

"Plans to cut hundreds of thousands of pounds from budgets for the terminally ill, with dying cancer patients to be told to manage their own symptoms if their condition worsens at evenings or weekends."

Sorry mumsy!

And that's just the beginning. One of the primary models for ObamaCare© (now spearheaded by a major MVNHS© proponent, by the way), facing major budget setbacks, seems to have no choice but to implement some pretty draconian health care rationing:

"■ The closure of nursing homes for the elderly.

■ A reduction in acute hospital beds, including those for the mentally ill

■ Tighter rationing of NHS funding for IVF treatment, and for surgery for obesity."

Actually, three out of four isn't bad: there's no medical reason to cover IVF in the first place. But at a time when the Brits are focusing so (ahem) heavily on childhood obesity, one would think that this would be a no-no.

Which leaves one to ponder: did the Brits have to "pass it to see it," too?

Grand Rounds is up

InsideSurgery hosts this week's eclectic collection of great medblog posts.

Child Health Insurance Rates Rising

From the "What did you think would happen?" division of the land of Obamington comes this report from The Hill.

The rule barring insurance plans from turning away sick children or denying coverage for specific illnesses for children who are already covered was one of the most popular parts of the new law.

But the new rules are leading some health plans across the country to stop issuing new child-only coverage, the state officials said. That could force parents to buy costly family coverage where in the past they could have saved money by buying separate policies for themselves and their children.

Let's look at this logically, something that completely escapes the clowns in Washington.

Beginning in September, health insurance companies will not be able to refuse coverage to any child (under age 18) REGARDLESS of their medical condition(s) and must cover any all necessary treatment for those conditions. If your child is healthy or sick, you are not required to purchase coverage. There are no penalties for failing to provide health insurance for your children. You may buy health insurance on your child once their health changes and the insurance carrier is required to cover them.

In whose world is this considered insurance?

This is not insurance. This is asking someone else, in this case an insurance company, to pay for your expenses AFTER you know you are sick and can't afford to pay for your health care.

If you could buy auto insurance AFTER your car was stolen, or after the wreck, I doubt anyone would consider that a good business model. But try to apply this kind of logic to health insurance and suddenly a lot of people think that buying health insurance AFTER you get sick should be allowed if not required.

The state commissioners, who are helping write the regulations governing the overhaul of the nation's health insurance system, said they expect to see more insurers ceasing to offer new child-only coverage. They said middle-class families with healthy children, who don't have access to state public programs, will be the hardest hit.

Anyone with half a brain would have seen this coming.

Obviously the folks who designed Obamacrap are either like Dorothy's Scarecrow or they got Abby Normal's brain.

This would certainly qualify for our Stupid Government Tricks award.

When Denial isn't just a river...

So you've had that emergency earectomy, and you're relieved that the bulk of the cost will be borne by your health insurer. How disheartening, then, when the EOB (Explanation of Benefits) arrives, and you learn that the claim has been denied.

What now?

Most states require carriers to not only justify a claims denial, but guarantee the insured the right to an external appeals process (Alabama, Mississippi, Nebraska, North and South Dakota do not guarantee the latter). And so-called ERISA (self-insured) plans don't have this requirement, either.

But that's about to change:

Beginning September 23rd, new ObamaCare© rules come into effect that require "the right to appeal denials directly to their insurers, and if necessary, to external review boards." Frankly, the only really new thing here is that this blanket requirement will apply to the four aforementioned states, and self-funded plans.

And, of course, there's a nice little carrot attached: "$30 million in grants to states to establish or strengthen consumer assistance offices." That's about $600 thousand per state (or, in Obamington, about $526,000 for each of the 57 states). Your tax dollars hard at work.

One thing I found quite interesting, though, is the fact that this legislation seems to explicitly exempt the most egregious claims denier of all: Medicare.

Wonder why.

[Hat Tip: FoIB Holly R and NAMI]

Big Fat Deal [UPDATED]

Coming soon to a classroom (or physician's office) near you?

"They look like happy, healthy children - and that is exactly what they are ... Yesterday their parents told how they were sent letters which began with the stark warning: 'Your child is overweight for their age and sex."

Turns out, the MVNHS© is using something called the Body Mass Index, ostensibly a measure of one's overall health based on height, weight and percent of body fat. Which sounds reasonable, until one considers:

"Those of you who are in great shape yet feel betrayed — and baffled — by your BMI, take heart. A study released earlier this month by the American College of Sports Medicine finds that you can be in great shape, yet deemed overweight by your BMI."

Confused? Wondering why we even bring it up?

Well, it's about to get murkier:

"New federal regulations issued this week stipulate that the electronic health records ... record not only the traditional measures of height and weight, but also the Body Mass Index: a measure of obesity."

"This week?!" Wasn't ObamaCare@ passed months ago?

Yes, yes it was. These new reg's are part of the new Stimulus Bill that extended unemployment benefits. And yes, I'm as confused as you as to what one has to do with the other.

To paraphrase Bob, Poppa Washington: Less common sense, more nanny state.

UPDATE [7/26/10]: It appears that Germany's weighing in on this issue, as well:

"Marco Wanderwitz, a conservative member of parliament ... said it is unfair and unsustainable for the taxpayer to carry the entire cost of treating obesity-related illnesses ... The German teachers association recently called for school kids to be weighed each day ... fat kids could then be reported to social services."

There appears to be ever-growing concern over this weighty issue; assuming our readers can stomach it, we'll continue to provide the skinny as best we can.

[Hat Tip: Bob V]

COBRA Subsidy to End

Nothing lasts forever, even in the LaLa world of Washington. The land where money seemingly grows on tree's has at least for now seen a halt in reckless spending. 

U.S. workers who lost their jobs as of June 1 won’t be eligible for a 65 percent federal subsidy to help pay for health insurance under an unemployment bill Congress will send to President Barack Obama for signing.

Eligibility for the financial help expired May 31, meaning workers who lost their jobs after that date don’t qualify. Those already receiving the benefit may continue to pay reduced premiums for up to 15 months, according to the Department of Labor.

Had Washington spent their resources on encouraging the private sector to create jobs instead of pissing money away on welfare programs there might not be a need for continued assistance.

Workers who lose their job and are no longer eligible for the health-insurance subsidy should check if they or their children may be eligible for other public aid such as Medicaid and the Children’s Health Insurance Program, said Kaiser’s Schwartz.

Most folks would rather have a job than rely on public assistance. Given the anti-capitalist mood of the White House it doesn't appear the economy and the jobs that come with it will turn around any time soon.

More CLASS

As mentioned previously, ObamaCare@ includes a half-hearted attempt to encourage folks to insure their own long term care expenses. Called the CLASS Act (for Community Living Assistance Services and Supports), it posits a voluntary (for now) program enabling folks to purchase, through payroll deduction at their worksite, a long term care "assistance program." On the one hand, it's nice that the gummint is making an effort to get folks to consider buying long term care insurance. On the other, I'm not convinced that this is the way to do it.

Still, it is the law, and we may as well make the best we can of it. To that end, carriers like John Hancock are putting out informative presentations that help cut through the clutter. Hosted at Brainshark, this 15 minute slideshow provides a solid, basic explanation of what the CLASS Act does and doesn't do, and what other alternatives may be available.

And if you haven't already read it, I highly recommend guest-blogger Herman Bruns' thoughtful, insightful post on why and when you should be considering Long Term Care insurance.

Cavalcade of Risk #110: Call for submissions

Jay Norris hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 26th). Please remember 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.

Children's Health Insurance, Scarce and Expensive

The next shoe to drop in Obamacare involves providing health insurance for children from birth to age 18. As we have indicated in prior posts, some Georgia health insurance companies are no longer offering "child only" health insurance and at least one will no longer accept child only applications after 8/15/2010.

Now word comes that Blue Cross plans in two different states are taking a different approach. The Blues in Texas and Illinois have announced filing for approval of a new child only health insurance policy.

No details on rates or benefits but the announcement to insurance agents in those states includes this comment.

Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to offering the broadest possible range of products for our members, as well as to maintaining its strong financial position. Thus, on Friday, July 16, 2010, it filed a new policy called Blue Pathway to provide coverage for children age 1 through 18 when the child is the primary insured (commonly called “child-only” policy) with the Illinois Department of Insurance (DOI).

This new coverage option responds to an Interim Final Rule that was issued by the Department of Health and Human Services (HHS) to implement several provisions of the Patient Protection and Affordability Act of 2010 (PPACA). In this Rule, HHS has determined that provisions limiting the application of pre-existing condition exclusions for children under 19 means that all children under 19 who apply for insurance for which they are eligible on or after Sept. 23, 2010, cannot be denied coverage—this is commonly known as “guaranteed issue.”

BCBSIL has long supported guaranteed issue as a way to ensure access to affordable, quality health care for all Americans, particularly children and young adults. However, that must be accompanied by an effective mandate for individuals to obtain coverage. PPACA itself recognizes the importance of pairing guaranteed issue with an effective mandate to ensure a sustainable insurance marketplace, with both being required in 2014. However, this Interim Final Rule addresses only guaranteed issue for children under 19, not any current requirements for them to have health insurance.

Without the mandate, it becomes too easy for people to buy insurance only when they feel they need services. This could be compared to allowing drivers to buy auto insurance once they have a fender-bender, and then drop coverage after their car repairs (financed by the insurance company and other insureds) are complete. This leads to what insurers term as “adverse selection,” which ultimately leads to unaffordable coverage for everyone. The Wall Street Journal recently published an article that demonstrates how this happened in Massachusetts, whose mandate has not proven as effective as originally hoped. This is based on a study commissioned by the Massachusetts Division of Insurance by the consulting firm Oliver Wyman.

Translation, the premium rates for this plan will start high and get even higher the longer the plan is on the market.

The lawyers that designed Obamacrap clearly had no idea what they were doing. This is not surprising given that most elected officials have never held a real job in the private sector. 

During the interim period while we are waiting for authorization to sell this new product, BCBSIL will temporarily suspend issuing new policies to children under 19 when the child is the primary insured. BCBSIL will stop quoting its current child-only policies on July 30, and the last assigned effective dates for those policies will be Sept. 15, 2010. Any application that has not been approved by Sept. 1, 2010, will be withdrawn from consideration.

The memo from Texas Blue Cross contains language that is virtually identical to BCBSIL.

So far BCBSGA has not given any indication they will follow suit. We will continue to monitor changes in the market place, particularly as they relate to Obamacrap, and keep our readers advised.

Dog Days HWR

Workers' Comp maven Julie Ferguson hosts this week's Health Wonk Review, and boy is it HOT.

So grab a cool beverage and enjoy the best wonkery around.

Resource Extravaganza: Alzheimer's edition

We've written pretty extensively on this dread disease, but I've never seen anything quite like this:

"With millions of people each year being diagnosed with Alzheimer’s or a similar dementia, and millions more dying from it, it is still possible for caregivers to feel lost, confused, and alone. We’ve searched the Web to find some of the most helpful resources for families coping with Alzheimer’s."

The list includes caregivers' blogs, links to educational sources, even survival tips for caregivers.

Recommended.

ObamaCare© rate hikes: Some traction, finally?

Is the third time finally the charm? As we've previously noted (here and here), a lot of the squawking about ObamaCare© being the primary cause of rate increases seem, at best, unfounded. But a more credible claim has emerged, as The Grand Canyon State advises its own employees:

"State and university employees with families can expect to see their monthly health-insurance costs rise as much as 37 percent next year ... The Department of Administration cited federal health reform as the reason the state's health plans will carry "greater expenses and higher premiums for members..."

There are a number of interesting trends here:

First, the rate of increase is greater for those insuring children. This makes sense, since the rule that now mandates covering "kiddies" through age 26 "will ultimately increase the claims paid under the plan, and that added claims expense will eventually be passed on to the planholder."

The second is one that I think has been flying under the radar: "the federal legislation's ban on lifetime limits." This one's not as "sexy" as the kiddie-coverage or guaranteed issue provisions. But it's important because carriers can no longer accurately assess (or price for) the risk. Bob likens health insurance to a line of credit; that is, one walks into (for example) a hospital with a card that essentially says "do what you need to do, until I've hit my limit." That limit has grown rather high of late: most carriers offer $5 or even $7 million lifetime maximums. But of course, those caps are going away, so the equation now becomes "money is (literally) no object." How does a carrier put a price on that?

The state's employees are also the canaries in the coal mine: "Because the state is one of Arizona's largest providers of health insurance, its estimates could provide an early glimpse of how large employers will pass along health-reform costs to their employees." That's true, up to a point, but I think the long term effect is a lot simpler: kiss your group coverage good-bye.

Do you believe in Magic?

On Monday July 19, the Wall Street Journal ran a story on page A14 headlined “German Hospitals can Ill Afford End to Draft” [subscription required]

Huh?

Well, simple. Most German draftees apply for conscientious objector status, and most applications are approved. Germany permits military draft objectors to complete their service in civilian jobs and the majority choose hospitals, nursing homes and other social programs. The draftees perform these service jobs at military pay levels - below civilian wage levels.

Personnel officers at German Hospitals are worried because of the financial impact to them if the draft is curtailed or ended. That would mean - horrors! – their source of cheap, government-supplied labor would dry up. The hospitals would – gasp! - have to hire replacement workers at the prevailing wage. Specifically, at one hospital alone, “nearly 50 civilian servants perform basic nursing tasks and run errands, work that would otherwise need to be taken over by better-compensated employees . . . [that] would certainly drive costs up.”

And so we learn that one way Germany has contained its health care delivery costs has been forced labor at under-market rates. And all this time, I thought it was the magic of its nationalized health system. Come to think of it, that may be a good illustration of the “magic” of a nationalized health system. At least in Germany.

Brits in Denial

It appears that we've pricked a nerve amongst some of our Cousins Across the Pond©:

"This american blog (insureblog) has been pissing me off of late. It appears to be devoted to pissing on the NHS and scaremongering about universal health care."

If by "scaremongering" the erstwhile Capt McIntyre means "accurately and exhaustively" chronicling the vast catalog of dangerous, indeed deadly, actions of the MVNHS©, well then we agree.

Where we'll have to part ways is "Trapper's" reluctance to speak up here because he fears that "the writer will probably not be talked around by me."

Unlike the "Community" at LJ, we don't require an extensive registration process, nor do we limit comments only to those "in the family." Indeed, one must be invited to join the "ontd_political" community. Here, anyone may comment, even anonymously; fact is, we only routinely delete "ad hominems" and obvious spam.

So come on in, Trapper - the water's fine!

Preventive Care Benefits

Certain preventive health care services are now mandated as part of Obamacare. By law, these benefits are "free" to the consumer in that your health insurance plan will not be allowed to charge a copay or deductible.

But they are not free. Doctors and labs have not suddenly decided to deliver health care services at no charge. The cost of these benefits is added to the premium you pay each month.

Premiums will rise by about 3%-5% to cover the additional cost of these benefits. The plan you have recently purchased may already have these benefits and the premium adjusted accordingly.

In addition to your routine annual exam, the new "free" benefits will include screening for alcohol abuse, high blood pressure, sexually transmitted disease, obesity, tobacco use and more. Some of the services are segregated by gender and age while others are universal.

These new benefits are retroactive to the date Obamacrap was signed in to law so you may receive a notice that your premiums are going to be adjusted upward retroactively. If so, not to worry, this is done to bring the plans into compliance with the new, higher benefits.

If you are looking for health insurance now you may encounter plans that have deductibles, copays or waiting periods for preventive care. Again, you should not worry as these plans will eventually be corrected to bring them into compliance once Washington decides to tell the health insurance companies how the benefits are to be administered.

In the interim you can refer to this nifty summary of mandated preventive care benefits as brought to you by the folks who gave us Obamacrap.

More surprises are on the way including children's health insurance under Obamacrap.

Ezra Klein Whiffs It

Twin sisters Obamacare and Romneycare are not looking so great these days. Romneycare was introduced in Massachusetts in 2006 and barely 4 years later is on life support.

Don't take my word for it. The folks at the Wall Street Journal and Cato Institute say the same.

From the WSJ -

While Massachusetts' uninsured rate has dropped to around 3%, 68% of the newly insured since 2006 receive coverage that is heavily or completely subsidized by taxpayers. While Mr. Romney insisted that everyone should pay something for coverage, that is not the way his plan has turned out. More than half of the 408,000 newly insured residents pay nothing, according to a February 2010 report by the Massachusetts Health Connector, the state's insurance exchange.

When half the newly minted insureds pay nothing, and another 28% pay less than the full price of admission, how is this considered a success? If 408,000 unemployed residents found jobs but half of them were placed in volunteer positions (without pay) and another 28% found jobs at less than what they would normally earn, no one would consider that a success.

But Ezra Klein says Romneycare is working.

Between 2006 and the fall of 2009 (which is the most recent data [pdf] we have), insurance coverage among non-elderly adults jumped from 87.5 percent to 95.2 percent.

And half of those (according to the WSJ) paid NOTHING for their coverage so Ezra says this is a successful program.

That's like testing a new STD (sexually transmitted disease) treatment on 408,000 healthy people where half of them get a placebo and the other half get the real deal, but all of them are also injected with an STD.

Cato's take on Romneycare is . . .

Massachusetts requires health insurance companies to sell to all applicants, and imposes price controls that require insurers to charge all applicants the same premium, regardless of their health status. ObamaCare would do the same.

Those price controls have two principal effects on healthy people. First, they increase the premiums that insurers charge healthy people (the additional premium goes to reduce premiums for sick people). Second, they enable healthy people to wait until they are sick to purchase coverage. Since insurers must take all applicants, and charge them the same premium, there is little or no downside to waiting until one gets sick to purchase coverage.

Insurance is designed to indemnify you for a financial loss that is unpredictable. If you were able to buy life insurance from the EMT while being rushed to the hospital with a life threatening condition, and you could buy as much insurance as you wanted at the same rates as triathletes, do you think that would impact the rates everyone would have to pay?

Or perhaps your house catches fire and while you are calling 911 your spouse is calling Allstate to buy a homeowners insurance policy. But Allstate can not turn you down and they have to charge the same rate they would have yesterday when your house was not burning. How long would Allstate remain in business if those were the rules?

Ezra tells us "the plan's popularity also remains quite high: The Urban Institute study found approval at 67 percent".

And why wouldn't it be popular? When you can wait to buy insurance AFTER you get sick or injured, that's a great deal for you.

But not so for the rest of the folks who have to pay for your claims in the form of higher premiums.

Ezra does admit the system isn't totally idiot proof.

The Massachusetts reforms, unfortunately, were not designed to deal with cost. They weren't even designed to improve the delivery system.

To recap, Romneycare added 408,000 on to insurance plans (half of those got coverage for "free") but did nothing to lower the cost of health care or make health care more accessible.

And this is a good thing?

Health insurance premiums are driven by the cost of health care. If nothing is done to control health care costs premiums will continue to rise. Additionally, when you provide health insurance at NO COST to 200,000 people overall utilization of health care will rise. This results in more limited access to care, and more total dollars spent on health care.

Once more Ezra makes a statement that refutes his initial premise that Romneycare is working.

Before the reforms, Massachusetts had the highest health-care costs in the nation. That's still true after the reforms

The baseball trading deadline is approaching and it is looking like Ezra will be sitting on the bench for the remainder of the season and soon become a free agent.

Grand Rounds: John, Paul and Ringo edition

With a little help from his blog-friends, Captain Atopic presents this week's great round-up of medblog posts.

(Out, out darned earworm!)

Finally, A Carrier with "Sechel"

"Sechel" is a Yiddush word meaning common sense. As noted previously, some carriers don't seem to demonstrate that characteristic, but at least one "gets it." One of ObamaCare©'s rules requires health insurance carriers to cover "children" through their age 26. Non-medical plans, such as dental, are specifically excluded from this requirement, and for good reason:

"Covering more dependents for an extended period of time will ultimately increase the claims paid under the plan, and that added claims expense will eventually be passed on to the planholder."

That comes from an email I received from Guardian, another carrier that offers group dental and vision (and other) plans. In fact, they also "found that at least two-thirds of employers will delay extending the age limit on their medical plans as long as possible," which they're allowed (so far) to do.

As for their dental (and other non-medical) offerings, "Guardian is not mandating that planholders increase the dependent age limit on their dental and vision plans." Of course, those who choose to implement this cost-raising strategy are free to do so, which makes sense (from Guardian's perspective, at least).

Kudos!

When is a Tax not a Tax?

Simple: When it's a tax.

If that's difficult to follow, don't be alarmed - our esteemed leaders in DC can't seem to keep it straight, either:

"When Congress required most Americans to obtain health insurance or pay a penalty, Democrats denied that they were creating a new tax. But in court, the Obama administration and its allies now defend the requirement as an exercise of the government’s “power to lay and collect taxes.”

As we've already noted, there was never any doubt that the individual mandate is evil because it is a tax on simply living. There is no legal requirement to own or drive a car, or buy or sell property, or eat or drink. But there is now a tax on breathing.

What will they think of next?

Higher Premiums, Fewer Choices, Poppa Washington

Just like Victor Frankenstein, the folks that designed Obamacare have unleashed a monster on the American public. By tinkering with a system that worked for the vast majority of people they have unleashed a fury of unrest among the great unwashed. Obamacare is finally showing its' true spirit and has morphed into Obamacrap.

In an effort to provide more affordable health insurance to the masses, and still be in compliance with Obamacrap rules, the health insurance companies are designing new plans by digging up body parts from the 90's and piecing them together in ways that will please the monarchy in Washington but will draw the ire of the torch and pitchfork crowd.

The new and improved Obamacrap plans will promote health insurance with lower premiums, but at the same time will offer a limited number of choices when it comes to doctors and hospitals.

Insurers and consultants expect that, over time, businesses of all sizes will gravitate toward these plans in an effort to cut costs.

The tradeoff, they say, is that more Americans will be asked to pay higher prices for the privilege of choosing or keeping their own doctors if they are outside the new networks.

What happened to "if you like your doctor you can keep him or her"? 

Well, that went away with the new mandates placed on health insurance companies to deliver plans with lower premiums and higher benefits.

Companies may be able to reduce their premiums by as much as 15 percent, the insurers say, by offering the more limited plans.

“What we’re seeing is a definite uptick in interest because, quite frankly, affordability is the most pressing agenda item,” said Dr. Sam Ho, the chief medical officer for UnitedHealth’s health-care plans.

There you go.

Since one of the chief complaints of health insurance was the cost the carriers have responded with lower premiums. Who wouldn't like that? 

“Back in the H.M.O. days, it was tight networks, and it did save money,” said Ken Goulet, an executive vice president at WellPoint, one of the nation’s largest private health insurers, which is experimenting with re-introducing the idea in California.

The concept was largely abandoned after the consumer backlash persuaded both employers and health plans that Americans were simply not willing to sacrifice choice.

HMO's do save money and deliver quality care. We expect to see more HMO offerings as well as PPO and POS plans with multiple reimbursement tiers. This kind of shift is already taking place in existing health insurance plans as the carriers negotiate more favorable pricing on commonly prescribed medicines. At the same time they are moving higher priced med's into higher tiers which results in a higher out of pocket when the consumer opts for more expensive medication. Many plans are also imposing a penalty when the consumer chooses a higher priced med and there is a lower cost equivalent medication available.

The new health care law offers some protection against plans offering overly restrictive networks, said Nancy-Ann DeParle, head of the office of health reform for the White House. Any plan sold in the exchanges will have to meet standards developed to make sure patients have enough choice of doctors and hospitals, she said.

That most likely will mean plans offered via the Exchange will have significantly higher premiums than those available outside the Exchange. 

So how is this hope and change thing working for you so far?

The MVNHS© Strikes Again

Those who continue to conflate health care with health insurance may, in fact, have a point.

Just not the one they thought they were making:

"Women in labour have been forced to wait while epidural equipment was borrowed from other hospitals ... consultants have been misled into carrying out operations when it was not safe to go ahead because of bed shortages ... The trust [hospitals] in different areas had run out of under water sealed chest drains, epidural packs, gynaecological disposables, radiological disposables..."

This is health care under a nationalized scheme, something our new head honcho at CMMS finds laudable.

Ah, the glories of ObamaCare©.

[Hat Tip: Power Line]

Talk about haves and have-nots . . .

This is a possibility I have not seen before:

"So the ideal arrangement is for the hotel to fire the lower-paid employees—simply cutting their plans is not an option since federal law requires nondiscrimination in offering health benefits—and contract for their labor from firms that employ them but pay fines instead of providing health insurance. The hotel could then provide health insurance for all the remaining, higher-paid employees. Ultimately, we could see a complete restructuring of American industry, with firms dissolving and emerging based on government subsidies."

Unlikely? Well, consider that companies have a clear economic interest in finding ways to minimize the cost of the health care legislation. Also keep in mind that companies would not necessarily have to restructure themselves to accomplish what the linked article suggests; so-called Professional Employer Organizations already exist, and their business could very likely grow under this scenario.

And so, by the stroke of a pen on March 23, the administration may well have set this country on an irreversible course toward a two-tier health insurance system - one for haves, and one for have-nots.

$65 Billion in Medicare Fraud

The government run health insurance plan for seniors continues to lose money every year and fraud continues unabated. The Miami Herald reports that  Florida has become the Medicare fraud capital of the United States.

Florida mental health clinics submitted $421 million in bills to Medicare last year -- about four times more than Texas and a whopping 635 times higher than Michigan, both also hotbeds of healthcare rackets, according to government records.

Florida rehabilitation facilities billed $310 million for physical and speech therapy -- 140 times more than New York and 10 times higher than California, records show.

 

With all the criticism heaped on health insurance companies I have never heard a single report on fraud that comes anywhere close to this kind of crime. Yet to listen to politicians and the lame stream media you would think a government takeover of health care is the best thing that could ever happen.

Miami Dade has about 250,000  residents. If the government can't control fraud in such a small population how will it ever prevent fraud when they take over health care for 320 million? This is a problem Ray Charles could see from a mile away.

In 2008, Medicare paid $520 million to Miami-Dade home healthcare agencies for treating diabetic patients -- more than what the agency spent in the rest of the country combined, according to federal authorities.

 

Why isn't this a red flag? It doesn't take a rocket surgeon to figure out there might be a problem. Even Forrest Gump would realize something is not right.

This tells you something about the level of incompetence in the Medicare system when obvious abuse is allowed to grow to this magnitude unabated.

Overall, Medicare fraud in South Florida costs taxpayers between $3 billion and $4 billion annually, according to experts. Nationwide, Medicare and other healthcare fraud is estimated to cost $68 billion annually -- about $18 billion more than the Obama administration plans to spend on education in the next fiscal year.

 

Teachers take note. When the government pisses away more money on fraud than it will spend on education this should be a warning. Where is the torch and pitchfork crowd? Why isn't someone demanding a halt to this kind of incompetence?

There are currently 40 million people on Medicare. Over the next 10 years the baby boomer generation will add 70 million participants. It is common knowledge that Social Security is flat busted and has been for years. This year Medicare will pay out more than it receives in tax collections for the first time ever. This problem will only get worse, not better, and it doesn't help when dollars are leaking out in the form of fraud.

Wasn't Obamacrap supposed to end this kind of fraud? A snowball has a better chance in Hell.

A Very Cool Tool

United HealthCare has put together a nifty little "tax credit modeling tool ... [that] helps estimate ... customers’ potential credit amounts if they qualify for the recently enacted IRS Small Business Health Care Tax Credit program."

That's the good news; the catch is that it's currently available only to the company's agents and insureds. They do provide a brief "teaser" that explains both the benefit and how the tool works (click here for that).

As we've pointed out previously, it's unlikely that many employers will actually benefit from the credit program, but yours may be the exception.

Good luck!

Aborting ObamaCare©? [UPDATED & BUMPED]

In the run-up to ObamaCare©, we were promised that abortions would not be covered. This made sense, since it's not a medically necessary procedure, and because it would constitute an end-run around the Hyde Amendment. It will come as no surprise, though, that the folks in charge of implementing this train wreck believe that abortion should be covered, so that particular promise has been thrown under the bus:

"The Obama administration has officially approved the first instance of taxpayer funded abortions under the new national government-run health care program ... The Obama Administration will give Pennsylvania $160 million to set up a new "high-risk" insurance program ... which ... will cover any abortion that is legal in Pennsylvania."

We previously made the point that anything not specifically excluded would be covered; Rep Stupak's cowardly retreat made this development inevitable.

Isn't it great that we had to "pass the bill to see what's in it?"

[Hat Tip: Best of the Web]

UPDATE: Turns out, New Mexico is also receiving federal taxpayer dollars to fund abortions:

"NRLC legislative director Douglas Johnson ... said New Mexico state officials have put together a new $37 million high-risk pool that will begin enrolling members on July 1 ... including federal funding for elective abortions according to the state insurance department's website."

How's that Executive Order working out for ya, Bart?

[Hat Tip: RWN]

More on (Moron?) Bart Stupak (D-Oz)

In case you had any doubts about the perfidy of the Wolverine State Representative, this should put them to rest:



[Hat Tip: Bob Vineyard]

The MVNHS©: Finally getting the message?

It appears that, even as we speed toward health care oblivion, the Brits have figured out what we used to understand: that health care professionals, not government bureaucrats, are best positioned to actually determine and implement health care. First, the good news:

"Tens of thousands of administrative jobs in the health service will be lost as a result."

Now the better news:

"About £80billion will be distributed to family GPs in a move that will see strategic health authorities and primary care trusts scrapped."

That's about $160 billion of British taxpayer money that will go to the folks who are primarily responsible for providing actual health care. The current system distributes those funds to local administrators, who have almost unlimited discretion in how they're used. So a hospital in, say, York may be allowed to treat a specific condition, but another facility a hundred kilometers away may forbid that treatment (as we saw in the case of the late Ms O'Boyle). These decisions are currently made by bureaucrats, who may or may not have an actual medical background.

That's likely to change now (it's in the planning stages). It's still problematic:

"NHS services will be taken over by new statutory bodies called GP Consortia – groups of GP practices that will manage the healthcare budget – except in areas such as dentistry, community pharmacies and ophthalmic services that will be the responsibility of a new NHS Commissioning Board."

It's almost as if they've traded one set of pencil pushers for another. And there's the problem of getting the doc's themselves on board with this. Paul Bates, chief executive of the Worcestershire Health Trust, reports that “[q]uite a few [GP's] are saying to me ‘Thanks very much but I want to see my patients’.”

There are a number of lessons here: first, our Cousins Across the Pond© recognize that health care decisions belong in the hands of providers and patients, not bean counters. Second, it certainly demonstrates that the MVNHS© has been no more successful than us in holding down health care costs; in fact, it appears that they're beginning to believe that reducing government's footprint in the system is a likely way to begin controlling those costs.

Time will tell.

Cato clobbers ObamaCare©

The Cato Institute's Michael Tanner has compiled a comprehensive - and scary - list of what this train wreck really costs, in both dollars and lives. For example, ObamaCare© will:

■ cost far more than advertised, more than $2.7 trillion over 10 years of full implementation

■ increase taxes by more than $669 billion between now and 2019

■ [set] the stage for government rationing and interference with how doctors practice medicine

The entire analysis is available for download here. Recommended.

Health Care Changes

Obamacrap is coming and with that comes new benefits. The folks at Google News provide some insight into upcoming changes.

First lady Michelle Obama is announcing better health insurance coverage for preventive care, from counseling for kids who struggle with a weight problem to colon cancer screenings for their middle-aged parents.

True or false?

Partial credit on this. Preventive health care is changing and in some situations has already come about. Most adults and children will now be able to have annual exams including state mandated screenings at no charge other than a routine doctor visit copay.

Counseling is NOT included in the new Obamacrap enhancements for children. In most cases the parent can opt for an increased mental health benefit rider which will cover psychological testing and counseling as any other medical condition.

Administration officials speaking on condition of anonymity ahead of Wednesday's announcement said 41 million Americans will benefit initially from the new requirements, in effect for plans starting on or after Sept. 23. Premiums will go up by 1.5 percent on average.

Probably good that they spoke anonymously since this is Obamabull. Premiums will rise significantly. The 1.5% figure quoted is pure fantasy.

Carriers are hedging their bets but privately admitting premiums on children can easily double by 9/23/2010.

Inside Baseball: Rule 151A

There are basically three varieties of life insurance and annuity products: fixed, variable and indexed. Fixed products are those in which the insurer decides (based on a number of factors) what interest rate to credit its policies; these plans include a guaranteed minimum interest rate, and are regulated by the states. Variable products leave the rate of return to the owner, through the use of sub-accounts that look (and act) very much like mutual funds. The sub-accounts don't have a minimum interest guarantee, and the plans are regulated by both the states and the Fed's (and require special, additional licensing).

The third type is called "indexed," and is somewhat of a hybrid between the other two: indexed plans credit interest based on the behavior of the stock market, but also include minimum guarantees. They are not as flexible as the variable type, in that the insured has no direct control over the interest rate. How, and by whom, these plans are regulated has been the subject of much debate. As part of the on-going financial services "reform" efforts in DC, it looked like indexed annuities would come under the jurisdiction of the Fed's by way of the so-called Rule 151A.

Today's email brings news from a variety of sources that this rule has been "vacated," meaning that these plans will continue (for the time being, at least) to be regulated at the state level.

So what does this mean, exactly?

Well, for one thing, it means less paperwork (compliance) for agents, and agents won't necessarily have to be dual licensed" (that is, by both the state and the Fed's). It also means that these plans will continue to be covered by states' Guarantee Funds. That's the good news (or bad, depending on one's perspective).

I'm not convinced that this is necessarily a "good thing." On the one hand, I am enthusiastically in favor of keeping things simple, and in regulating insurance at the state level. But I'm also rather ambivalent about these products: it seems to me that they are complicated enough to require someone with expertise in a variety of investment areas, which would necessarily rule out a lot of us "regular" (non-SEC-licensed) agents. It's not that they're "bad" products, just not as easily understood (on either side of the desk) as fixed ones.

[ed: Please don't lambast me that Indexed Plans are also "fixed;" they are different animals]

It will be interesting to see if the SEC continues to push this.

Cavalcade of Risk #109: Picnic Time!

Ribs, burgers, salad and brews are just some of the tasty brain food served up by Dr Jaan Sidorov as he hosts this week's picnic-themed Cavalcade of Risk.

Bring your appetite for knowledge (and a couple of clean napkins wouldn't hurt, either).

From the MailBag: The funniest thing...

I've read all day. From the Center for American "Progress:"

"These regulations provide a promising foundation for encouraging the effective use of health information to improve patient care. With coming payment reforms, these incentives will give doctors and hospitals needed support for improving health care quality and efficiency,” said Mark B. McClellan, MD, PhD, director, Engelberg Center for Health Care Reform and Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution."

So a 21% cut in Medicare reimbursement rates (followed, of course, by the inevitable rate cut by "regular" insurers) will be more than offset by some shiny new tech.

Uh hunh.

Grand Rounds: Post-World Cup edition

Put away those vuvedoodads, and head straightaway to Other Things Amanzi, where you'll find this week's eclectic round-up of great med-blog posts. Trust me, it's a winner.

After Repeal: What next?

Okay, let's fast forward a bit, and engage in a bit of prognostication: The now-minority party makes substantial gains in November, and is poised to repeal ObamaCare©. On the one hand, this is an exercise in a risk management strategy known as "indemnification." It's the same principle behind auto and home owner's insurance: to put you back "whole;" that is, where you were (financially, at least) before the crash or the burglary.

But in the case of the current health care train wreck, is that really good enough?

The Center for Freedom and Prosperity thinks not, and offers this rather enlightening insight into why we must go beyond just "putting it back the way it was:"



[Hat Tip: Hot Air]

Speaking of Pools (ObamaPools©, that is)

Why, you might ask, are we spending so much time on the so-called "high risk pools" for folks who've had difficulty obtaining insurance on their own? The reason is quite simple: the pools are exemplars of how ObamaCare© will ultimately work (or not work). The premise was that there are millions upon millions of people who couldn't qualify for and/or afford health insurance on the open market because the evil, greedy, incompetent insurance companies were being difficult.

So what's the solution?

A government-instituted plan that is every bit as difficult to obtain, and likely even more expensive than that which it's ostensibly to replace. You may wonder, how can I say this with a straight face?

Easily.

This morning's email brought a missive from Medical Mutual of Ohio, the insurer tasked with implementing the Buckeye State's new ObamaPool©. Here are the requirements for eligibility:

■ Be a citizen or national of the U.S. or lawfully present in the U.S. (documentation will be required) [Really? Have we moved to Arizona now?]

■ Be uninsured for six months prior to application date. [Hence: folks who will now drop their current coverage in order to jump in the pool]

■ Be ineligible for coverage under the federal Medicare program, Medicaid program, [SCHIP] or an employer-sponsored group health plan, unless the individual is subject to a mandatory initial waiting period. [Essentially expanding the Medicaid rolls]

■ Have a qualifying pre-existing condition as evidenced by a denial of coverage by two insurers or by documentation from a health professional. [More hoops through which to jump]

I'll just pick on that last item: in order to qualify, one must now apply to, and be denied by, two separate carriers. Imagine now that hundreds, perhaps thousands of new applications begin flooding the carriers still in the Ohio market which are being sent in specifically to be denied. Carriers, already short-staffed, will have to give these the same attention as legitimate applications, thereby holding up coverage for folks who actually applied in good faith. How many of these will grow disgusted and throw in the towel? And would that be considered by ObamaCare© proponents as a bug or a feature?

Perhaps they'll go the alternate route, and now hundreds, perhaps thousands of new patients will be flooding doctor's offices specifically to determine whether or not hey have a qualifying medical condition. What kind of strain is that going to put on an already shrinking provider population? And who's going to pay for that?

This is a microcosm of how ill-conceived ObamaCare© really is. But remember, we had to "pass it to learn what's in it."

Everybody outta the pool! [UPDATED]

FoIB Holly R sent along this story:

"Sheila Hokes thought she’d found a lifeline to keep her family from drowning in health insurance costs ... [Ohio] recently outlined its proposal for a federally backed pool for high-risk individuals with pre-existing conditions ... The pool to be run by Medical Mutual of Ohio is open only to those who have had no coverage for six months."

As Bob's pointed out, this is a "feature" of ObamaCare©, one of those things that we had to "pass it to know what's in it."

So what's the problem?

Well, it's not really with the new pool (although it may have its own issues), but with the story. As we saw with the nHealth kerfuffle, it pays not to believe everything one reads in the paper (or on the intertubes).

Let's start with this little doozy:

"The Delaware County resident understood when a surgery for her son’s lifelong digestive condition caused her premiums to shoot up by $700 a month."

Um, no, it didn't: by law, carriers can't single out individual insureds for rate increases, expensive surgeries notwithstanding. Perhaps Ms Hokes misunderstood how insurance works, and honestly believed that she (and/or her) son had been singled out for a rate hike. CORRECTION: After much searching, it appears that there is, in fact, no law against such practices. The relevant section of the Ohio Revised Code (3923) does not speak to this issue.

Unfortunately, that doesn't fly, either: Ms Hokes knew (or should have known) darn well what the relevant laws are, since She herself is an independent insurance agent and (as pointed out to us by FoIB Rick B), she's co-chair (or perhaps immediate past co-chair) of the Ohio Association of Health Underwriters' Political Action Committee, something Carrie Ghose should have pointed out. So Ms Hoke's no amateur.

And Rick noticed a few other "details" that call into question the veracity of this little drama. For example, the story says that Ms Hokes "canceled their policy with .... American Community Mutual Insurance Co."

But as we reported almost a month ago, United HealthCare's Golden Rule recently bought American Community book of business. This is not nit-picking: a professional (of all people!) should know that you don't cancel existing coverage until your new plan is in place. And since there was so much in flux during that time, why would you jeopardize coverage, especially with a dependent who may have insurability issues?

And that's another thing: if the Hokes' family premiums really had gone up that high that quickly, why wouldn't she simply have left her son on the existing plan and move the rest of the family to a new one (as she acknowledges she could have done)? As Rick points out, the son's "only medication is generic" and he apparently already underwent the corrective surgery (although we don't know this for sure due to the reporter's apparently sloppy fact-checking).

Regular readers know that we're hardly shills for ObamaCare©, but this reeks of opportunism. Once again, I call BS.

"'Cause I'm the taxman"

Apparently, the Fab Four had the gift of precognition, at least as regards ObamaCare©:

"If you drive a car,
I'll tax the street.
If you drive to city,
I'll tax your seat."

If you do any business, I'll tax that, too:

"With a new mandate looming that will require business owners to file millions more tax forms, the Internal Revenue Service has begun the daunting process of figuring out how to turn the law's sweeping demands into actual rules for taxpayers."

Now, you may be asking: why the heck is Henry blogging about taxes? Isn't that Joe's job?

Good question.

The simple answer is that, as we've pointed out "ad nauseum" [literally: "this is making me nauseous"], ObamaCare© has little to do with actual health care, and more to do with gummint wresting even more control of our lives. In this case, one of the new rules is that any taxpayer with any business income will be required to issue 1099's to anyone else from whom they purchase $600 or more in a given year. And unlike some other provisions, this one is just around the corner: it goes into effect January 1, 2012.

So what, you say? It's just a little extra paperwork.

Au contraire:

"[This new rule] promises to launch a fusillade of new paperwork: An estimated 40 million taxpayers will be subject to the requirement, including 26 million who run sole proprietorships."

For example, let's say you run a seasonal business, say manning a grill over the summer to pick up a few extra bucks. It's likely that you'll pick up at least $600 worth of buns, hot dogs and condiments at the local megamart along the way. If so, you'd better make sure to get their corporate address so you know where to send that 1099.

And while we're at it, could someone please explain to me what this has to do with health care??

[Hat Tip: RedState]

Southwest Ohio Update: Good news for Anthem & Premier

A little over four years ago, we reported that Anthem (Blue Cross) and Premier Health Associates had ended their year-long separation, which had caused patients and insureds (but I repeat myself) a lot of anguish, uncertainty and inconvenience. Thankfully, it appears that a reprise of that kerfuffle has been averted.

According to an email I just received:

"Anthem Blue Cross and Blue Shield ... and ... Premier Health Partners (PHP) have signed a renewed and extended agreement giving Anthem members the ability to receive in-network health care services from Miami Valley and Good Samaritan hospitals, Premier HealthNet physicians and affiliated ancillary and professional services through December 31, 2013."

That's good news for both entities, of course, but especially helpful for the many, many Premier patients insured by Anthem here in the Miami Valley.

Nice way to start the weekend, I'd say.

[Hat Tip: FoIB Beth D]

Cavalcade of Risk #109: Call for submissions

Dr Jaan Sidorov hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 12th). Please remember 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.

Vanishing Act

FoIB Jeff M tips us to this story about Conseco Life Insurance Company's recent travails with their interest-sensitive whole life plan:

"Insurance regulators from California, Florida, Indiana, Iowa and Texas led efforts to come to terms with Conseco Life Insurance Company ... The settlement affects consumers who bought Lifetrend whole-life policies from Conseco Life from 1978 to 1997."

Interest sensitive whole life plans (ISWL) were a popular alternative to universal life policies, offering potentially greater cash value guarantees. The problem arose when some unscrupulous (and/or ill-trained) agents began using them as the funding vehicles for something called "vanishing premium life." In its heyday, VPL was touted as a "guaranteed" method of owning a completely paid up life insurance policy in a few short years. The benefits included a reasonably short premium payment period, guaranteed death benefit and cash value, and some significant tax advantages.

Which reminds me: I have a bridge to sell you...

In the event, many (perhaps most) of these plans failed to perform as promised, with the result that unsuspecting policyholders ended up owing more premiums (often a lot more premiums) to keep their plans in force. Under the agreement, Conseco has agreed to pony up some $10 million that will (presumably) go towards paying down those premiums.

Folks who bought a Lifetrend policy from Conseco will be hearing from them shortly with details and contact information.

Another State fires back at ObamaCare©

We've already noted that a dozen and a half states have already expressed their dissatisfaction with the health care train-wreck; now comes word that some high-power folks from The Show Me State are showing something of their own:

"Lt. Governor Peter Kinder joined a group of three Missourians in filing a legal challenge against the recently enacted federal health care law ... This lawsuit challenges those provisions of the federal health care law which actually reduce Missourians access to affordable health care and which violate our United States and Missouri state Constitutions."

Among the named defendants in the lawsuit are Tim "Tax Boy" Geithner and HHS Secretary Kathy Shecantbeserious.

Should make for an interesting summer.

Linda O'Boyle vs. the NHS

Linda O'Boyle was told by her doctors that taking Cetuximab would "boost her chances of fighting" the bowel cancer that had invaded her body.

There was only one problem. Cetuximab is not funded by the National Health Service. If she wanted the medication she would have to pay for it herself.

But in doing so, she created a Catch 22.

Some cancer drugs not yet available on the NHS can markedly increase the chance of survival.

But Alan Johnson, the Health Secretary, claims that co-payment will create a two-tier NHS, with preferential treatment for patients who can afford the extra drugs.

So yes, the drug may well help, but allowing patients to pay for the drugs privately would create a two-tier system of preferential treatment for those who can afford to pay for health care.

However, by denying coverage for this drug the NHS discriminates equally across social and economic classes by refusing to make it available to anyone, whether rich or poor.

A spokesman for Southend NHS Trust said: "A patient can choose whether to continue with the treatment available under the NHS or opt to go privately for a different treatment regime.

"It is explained to the patient that they can either have their treatment under the NHS or privately, but not both in parallel."

Herein lies the problem.

You can accept the "free" care from the NHS or you can pay for medical care privately . . . but you can't have both.

And this is the system that is favored by Dr. Donald Berwick, head of CMS (Center for Medicare and Medicaid Services).