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.

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!

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.

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.

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]

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.

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!

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?

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.

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.

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.

Your Tax Dollars at Work. Maybe.

Joe Kristan at Roth & Co continues to be one of my absolute favorite bloggers (and it's not just because we run into each other dropping off and/or picking up our kids at college). He completely destroys the stereotype of the staid and humorless CPA, while making substantive, piercing insights into tax law folly.

I rest my case.

Lest we forget: Intriguing Alzheimer's news

The last time we discussed Alzheimer's, we learned that cell-phones may hold a key towards preventing the dread disease. Now comes word that we may be closer to predicting whether or not we're at risk for it:

"A simple blood test to predict Alzheimer's disease up to 10 years before symptoms appear could be developed after researchers found high levels of a protein can be an early sign of the condition."

Apparently, a protein called "clusterin" may exhibit higher than normal levels many years before the actual onset of symptoms, which could enable doc's to begin early treatment to minimize the disease's impact down the road.

Of course, there's are moral considerations, as well:

"The ethics of any blood test to identify those in the very early stages of Alzheimer's disease would need to be examined carefully as there is no cure for the condition."

That's not necessarily an easy call to make, since you can't unhear the news.

What do you think?

Celebrating Grand Rounds

MedBlogger John Schumann, an internist and educator at the University of Chicago, hosts this week's celebratory round-up of the best medblog posts. Come for the fireworks, stay for the great info.

ObamaCancel©?

Well, well, well:

"Sixty percent (60%) of voters nationwide favor repeal of the recently passed health care law, including 49% who Strongly Favor repeal."

For those keeping score at home, that's a significant majority of folks who want this train wreck derailed, and a sizable plurality that really, really, really want it to just go away. A smaller plurality understand that it's a major job-killer, which seems to indicate that folks are beginning to do the math.

On the other hand, most of us are (understandably) skeptical that the erstwhile minority party can (or will) pull off that repeal: "just 41% believe the law is even somewhat likely to be repealed." Still, momentum is on the angels' side in this.

Exit question: How do you think those Town Halls will go this summer?.

[Hat Tip: Ace of Spades]

Sliding into Obamalivion

Looks like Harold & Kumar will have to find a new place for eats:

"The White Castle hamburger chain fears that a health insurance reform law adopted earlier this year will put its profits on a downward slide ... [ObamaCare©] levies a $3,000-per-employee penalty on companies whose workers pay more than 9.5 percent of household income in premiums for company-provided insurance."

As of 2014, our national health care train-wreck will make it nearly impossible for the home of the "slider" to stay in business:

"White Castle, which currently provides insurance to all of its full-time workers and picks up 70 to 89 percent of their premium ... will likely end up paying those penalties. The financial hit will make it hard for the company to maintain its 421 restaurants, let alone create new jobs..."

The late-night bastion of belly-bombs currently employs some 10,000 nationwide, including over 1200 here in its home state. That's likely to change in a few short years, since that $3000 per employee hit will make it nearly impossible for the chain to show a profit. That's because these are part-time, often minimum-wage jobs - you know, the kind that Barry, Harry and Nancy tout as being the major beneficiaries of ObamaCare©.

And White Castle's far from an outlier here:

"(T)he National Council of Chain Restaurants ... says the entire restaurant industry will have trouble dealing with costs the bill imposes in 2014, including a $2,000-per-worker penalty that companies with more than 50 employees must pay if their workers end up purchasing federally subsidized insurance rather than getting insurance from their employers."

The other side of that coin, of course, is that that $2000 "hit" is actually much less expensive than what health insurance premiums are likely to be under the new, draconian coverage regime. As we've predicted many times, the most logical and financially sound choice will be to eat that fine rather than continue to pay premiums.

Bet a "slider" still tastes better than that.

[Hat Tip: Ace of Spades]

A Wonderful Independence Day...

Baruch Atah Adonai Eloheinu Melech Ha-Olam Shehehchiyahnu vekiyamanu vehegianu lazman ha-zeh.

Blessed are You, Lord our God, Ruler of the universe, for giving us life, for sustaining us, and for enabling us to reach this season. Amen.

Friday Updates: Privacy and Solvency

FoIB Rick B tipped us that Anthem's recent security breach may have been a bigger deal than originally thought. Now comes word from California insurance blogger David Fluker that "more than 200,000 affected so far by the security breach of the Anthem Blue Cross Online Application Tracker."

Indeed, he points us to an article in the Orange County (CA) Register that reports "the confidential information was briefly accessed, primarily by attorneys seeking information for a class action lawsuit against the insurer." Ironically, these erstwhile "officers of the court" apparently jiggered the system in support of their own lawsuit against Anthem's (WellPoint's) online privacy standards.

Meanwhile, Mr Fluker (who's also an agent), tells us (and his clients) that, while "this security breach does not impact HIPAA applications (nor small group) ... This PDF file contains the full application information including PHI and financial information." Kinda scary. Interested parties should plan to check for updates at David's blog.

On the other side of the continent. FoIB Jeff M reports that Virginia's Department of Insurance has been hammering out a "negotiating agreement ... for the potential purchase of Shenandoah Life Insurance Company ... The 90-day exclusivity agreement with Prosperity Life Insurance Group, LLC, which may be extended, will afford the parties the opportunity to negotiate a definitive purchase agreement."

This is potentially a great outcome, because it puts the interests of the policyholders first (unlike some others).

The sale, and subsequent recapitalization, isn't yet a "done deal," but the sign are encouraging.

Stupid Carrier Tricks: Dental Edition

This morning's mail brought this gem from Companion Life (which markets non-medical products like dental and disability insurance):

"Companion Life ... is pleased to announce (that) it will accommodate young adults ... by allowing (them), up to age 26, to stay on their parent's group dental and vision plans in accordance with the [Un]Affordable Care Act ." [emphasis added]

The PP[U]ACA does no such thing:

"Generally, the "insurance market reform" provisions of PPACA, such as the ... requirement to cover dependent children to age 26 ...apply to "group health plans," which are defined as employee welfare benefit plans providing medical benefits."[emphasis added]

So what kinds of plans are specifically excluded from this definition?

How about:

"Benefits that are not an integral part of a group health plan. Examples of these benefits include limited-scope dental and vision benefits ..."

Full Disclosure: I have (happily) represented Companion Life for many years. But I also believe that this alone does not exempt them from being "called out," especially when they intentionally and proactively cave in on requirements which don't apply to them.

So why would a carrier willingly, indeed proactively, seek to labor under ObamaCare© rules? What do you think?