Did Retirees Go "Thump?" [UPDATED]

As in this little ditty. Some folks believe so, others (myself included) aren't so sure. Here's the "problem:"

Nearly all plans in force as of September 23, 2010 will be subject to certain ObamaCare© provisions, whether or not they're deemed to have been "grandfathered." These include:

■ Extending coverage to "kids" up to age 26, regardless of their student, marital, financial or residence status (although this does not apply if "Junior" is eligible for coverage at his job)

■ No caps on "essential health benefits" (including ambulatory patient services, hospitalization, and maternity and newborn care, among others).

■ No lifetime maximums on plans (grandfathered plans may still impose annual caps)

Notice that "Nearly all" caveat above: it doesn't apply to retiree-only plans. This is important, because it's not clear whether this is a slap in the face for retirees, a sop for their former employers, or something else entirely. Recall also that many of these same retiree plans benefitted from some $5 billion of our tax dollars to offset costs.

In the event, retiree-only plans are exempt from the list cited above. This is something of a two-edged sword: on the one hand, such plans may be spared (for now) some of the major rate hits, er, hikes that will come about as a result of implementing these additional benefits. On the other hand, a lot of these folks have children in the affected demographic, and at least a few aren't at all happy that they can't keep their kids on (or add them back onto) the plan.

It's not clear to me that either side has a legitimate beef; or, perhaps, both sides do. The end result is that these plans are exempt from the new rules, and will have to live with the consequences. The only real question is whether or not that's a "good thing."

MIKE ADDS: If PPACA is a huge benefit to insureds, and simultaneously a meaningful relief to the budget, why exempt anyone, especially retirees who are the most expensive to cover ?

[Including retirees under PPACA would capture those retiree expense savings which would be highly beneficial to the federal budget. Isn't that so? Or maybe the savings are not so certain after all? Which is it?].

How likely an explanation is "politics" when 65% of the country opposes the whole law?

[And by the way, where was AARP on this? Doesn't AARP claim to be the retirees advocate? What was AARP advocating all this time? I'd say AARP seems to be quietly sneaking away to hide the knife they stuck in the backs of retirees!]

Excluding retiree plans from PPACA requirements can be seen as consistent with

1. Siphoning off $500 billion from Medicare, much of which will come from benefits and the rest from

2. Medicare Advantage - which is under all-out assault. (eg Harvard-Pilgrim Health Plan in Massachusetts exiting from the Medicare Advantage business entirely? H-P has about 22,000 Medicare Advantage subscribers. It seems likely that more plans--particularly smaller ones--will do the same.)

I think the treatment of Medicare is a clear retreat from the social contract expressed when Medicare was born--i.e., Americans agreed to be taxed when young so that we will have protection from medical costs when old. Uh, I guess that meant "unless it gets too expensive." Now, in reality this may be the only reasonable course and it may be inevitable, but it is being dishonestly presented. There is no admission that this administration intends to reduce Medicare cost by reducing benefits as a deliberate strategy. Older Americans are just not worth keeping alive beyond a certain point--a certain price point, I guess. And there is no one explaining (or even asking!) how "fraud and waste" will be reduced when the CMS budget for fraud detection is about the same as in prior years. Instead this administration asserts with a straight face that the new law "preserves and strengthens" Medicare.

Health Wonk Review: "Live long and prosper" edition

Peggy Salvatore takes this week's news about the UN appointing a "space ambassador" into grand orbit, as she presents a star-studded array of interesting posts from the wonkosphere.

It's obvious that she's read each and every post, and she offers them up with a hint of humor while treating each one respectfully.

Bravo, Peggy!

Another ObamaCare© Myth Debunked

Please, people: there's enough "red meat" in the ObamaCare© debacle without having to "make stuff up." In emails and on-line, there's a growing chorus of folks who believe (erroneously) that there's actually a "hidden sales tax" on the sale of people's homes.

No, there isn't:

"(T)here is no "sales" tax on home sales in the health care bill. The bill would impose capital gains taxes on some home sales made by a limited number of taxpayers." [emphasis in original]

Only a few people would even be hit by this capital gains tax: there's a floor on both income and home value. As the Tax Foundation's Tax Policy Blog notes, there's the potential for more homeowners to eventually be affected, based on increasing home values (although there's little evidence that incomes are rising).

Now, if you want to ask “what the heck does selling your home have to do with health care?” Now there’s a great point.

[Hat Tip: FoIB Joe Kristan]

Shecantbeserious vs The Truth

NRO health-blogger Avik Roy has a terrific fisking of yesterday's Wall Street Journal "op-ed" by HHS Secretary Shecantbeserious. He refutes each and every one of her "arguments" with compelling and documented evidence.

A must read for anyone remotely serious about the truth.

Fixed or Not: Ohio Kids' Insurance

Bob just sent me this little tidbit:

"[Ohio] has issued new guidelines aimed at enticing health insurers to reverse decisions to halt offering child-only policies to avoid federal requirements."

The DOI (Department of Insurance) just set forth new rules which they hope will clarify the ObamaCare© provision for so-called "Open Enrollment." The DOI says carriers must hold a one-off Open Enrollment "through Nov. 15 and, following that period, each January and July."

It will be interesting to see if this actually works: as I mentioned to Bob, there are some carriers which are not currently offering child policies, from which I infer that they would be exempt from this provision. If that's true -- and it's a BIG "if -- then I can't see other carriers being all that enthused about taking up the slack.

And lo and behold, the DOI itself acknowledges just this problem:

"Not all health insurers offer these policies, so please check with an agent or insurer to determine where to purchase this coverage."

Faced with this information, how long will it be until there are no carriers offering such coverage?

Any takers?

LTCi Rate Hikes: Outrageous or Responsible?

When sold properly, Long Term Care insurance is a terrific risk-management tool. One thing that sometimes gets overlooked is that (generally speaking) premiums on this product are not guaranteed. That is, although carriers can't single out a particular insured, they can increase the premium for a given "block" of business. John Hancock, one of the "Big Boys" in this market, has just announced that they will, in fact, be seeking a 40% rate increase. There are a lot of (thus far) unanswered questions, chief among them being: which plans, exactly, are affected? There are other questions, as well, which is why we've turned to our "on-call" LTCi Guru, Herman Bruns:

My understanding is that the rate increase will NOT apply to the Custom Care II, Custom Care II Enhanced, or Leading Edge product lines. The older Custom Care product, the Fortis plans, as well as their group offerings will be impacted. Obviously these plans were under-priced at the time.....so it is likely that a 40% rate hike would probably not even bring these plans up to today's level of LTC premiums. The steeper rate hikes will affect the plans with the more robust inflation clauses.....so they will simply be offered things like cutting from 5% compound to 4% compound to maybe keep the premium level.

If the plan was dirt cheap 10 years ago, and it goes up by 25-40%, is it still dirt cheap? Compared to the alternative of not having LTC coverage at all, you still have a decision to make. If the plan had a contingent non-forfeiture clause in it (a standard offering today), and the rates go up by more than a specified percentage based on your age, you get to walk away from your policy and all the money you paid in is held in reserve should you ever need care. Try that with a health plan that you could not longer afford!!!!

[But what about those 10-Pay plans which promise a shorter premium payment time?]

10 pay plans only reduce the payment to 10 years....they don't guarantee the rate for 10 years. If you want a rate lock guarantee, buy a single premium pay plan, or buy a 10 pay with a 10 year rate lock. Happy to sell you either one. Once the plan is paid for, it is paid for. Nothing can be simpler.

[Okay, that makes sense, but what about folks who now find their plans unaffordable?]

If you are concerned about buying a plan and having to bail, buy a plan that lets you walk away from it and get 80% of money back if you need it and can still fog a mirror. Some carriers offer these. Else, buy a linked benefit plan with a single pay, money back guarantee.

Either way, let's not go out of our way to scare people from buying what could be their best protection from catastrophic financial ruin when their $80/month premium jumps to $112/month 10 years after they bought it. My goodness people, we all know how cheap health insurance was a mere 10 years ago, and now we are all upset about what amounts to trivia by comparison.

Maybe John Hancock simply never should have bought Fortis' block, or perhaps they should have tightened their underwriting a little more. If you are big in the group business like Hancock, and you take the majority of people with little or no questions asked, do you think you will have more claims issues than a carrier who focuses more on the individual market? Maybe a lowly A rated carrier like Genworth, who has little group presence, and no substandard health classes to offer, will hang in there better. I'll bet Penn Treaty had more claims than they thought.......but we all know why.

Lets not scare the general public any more than we have to......or do you want the government to take control of LTC insurance too. The Class Act should give you an idea already of the stupidity of government run LTC.

Thanks, Herman!

Life and/or Death under Medicare

Two seemingly unrelated items come to our attention. FoIB Bob D tips us that " (m)illions of seniors face double-digit hikes in their Medicare prescription premiums next year unless they shop for cheaper coverage."

The article refers to so-called Medicare Part D plans (ostensibly, the "D" stands for "drugs;" IB readers know that it actually stands for "debacle"), which are due to change in January. These plans are necessary evils for seniors, who must decide not only whether or not to buy one but also which one among the myriad of choices available.

Well, best scratch that "myriad of choices available," since the market is shrinking:

"Medicare "is really reshaping the market ... There are a lot of plans that are shutting down."

Ooops.

For example, AARP's "MedicareRx Saver" plan (actually issued by United Healthcare) has some one and a half million subscribers, but it's about to be shelved in favor of the more expensive "MedicareRx Preferred" plan. And get this: "Seniors who are already in the AARP Preferred plan ... will see their premiums fall 11 percent on average," subsidized by the folks coming from the erstwhile "Saver" plan. How's that for fair?

And speaking of fair, Medicare isn't just about premiums, it's about coverage. As we saw with the recent Avastin kerfluffle [ed: you really like that word, don't you?], there's more than a little controversy about how end-of-life issues will be treated going forward. FoIB Jeff M points us to news that "Provenge, a first-of-a-kind therapy approved in April ... costs $93,000 a year and adds four months’ survival, on average, for men with incurable prostate tumors."

There are, of course, a number of questions which arise from this. The first, obviously, is the efficacy of spending nearly a hundred thousand dollars for an additional few months of life. Who gets to make this call? The patient? His family? Unaccountable government bureauweenies?

The second is how, or even if, these kinds of medications will continue to be covered. One option, of course, would be for Insurer A's Part D plan to cover it (meaning higher premiums) and Insurer B's to exclude it. That seems like a rational, free-market solution, but is that how it will unfold?

Of Gift Horses and Fine Print

"Never look a gift horse in the mouth" goes the old saw, meaning "when given a present, be grateful for your good fortune and don't look for more by examining it to assess its value." And that's often good advice. But not in the case of the little "present" given by Blue Cross of North Carolina to some of its insureds:

"Insurance Commissioner Wayne Goodwin and Blue Cross and Blue Shield of North Carolina President and CEO Brad Wilson ... a unique, one-time refund that will return $155.8 million to more than 215,000 individual BCBSNC customers as a result of the Affordable Care Act."

Now, on the surface this seems like a great deal: overpay for insurance, receive an unanticipated refund of that overpayment, and pocket the "found money."

But it's not that simple. You see, there's an interesting little caveat in that announcement, one whose long term implications seem to have flown under the radar:

"The funds come from active life reserves, which are portions of the premium set aside in the early years of a policy to pay future claims and keep rates stable as customers' medical expenses rise during the life of the policy."

Let's step back a moment, and consider the nature of insurance company "reserves." This is money that carriers are required to put away as a sort of "rainy day fund" in case their morbidity and claims estimates fall short of reality. These are generally considered very long term, since plans can theoretically stay on the books for many, many years. And as these plans age, they become less and less stable, with more and more claims arising from the shrinking pool of folks who don't "jump ship."

But ObamaCare© essentially "gifts" these plans with an exit date:

"(P)olicies purchased or substantially modified after March 23 of this year [i.e. "un-grandfathered"] will end in 2014 under the new health care reform law"

Ooops.

If your plan is one that has not been grandfathered, or has become "un"-grandfathered, it's going away in 2014. Think about the implications of that: for one thing, what happens, exactly, if you're on claim? As we saw with the nHealth kerfluffle, such circumstances don't fall under states' Guaranty plans. Theoretically, plans offered in the as-yet undefined Exchanges will be guaranteed issue, which means that one will be able to simply transition to one of those.

Theoretically. The more immediate issue, though, is noted by the Cato Institute's Mike Cannon:

"(E)very BCBS customer who is sick or becomes sick in the future will have less protection against their insurer skimping on care. Competition used to discourage insurers from providing lousy access to care, but under ObamaCare competition will reward skimping."

Still want to send Blue Cross a Thank You note?

[Hat Tip: FoIB Jeff M]

ObamaCare© for Docs

For the past week or so, Mike and I have been participating in an online ObamaCare© "event," sponsored and hosted by LexisNexis' Martindale-Hubell. It's been an opportunity for us to "strut our stuff" for a select audience of legal eagles; the "capper" was a 2-hour webinar on Wednesday, covering ObamaCare© from the perspectives of not just insurance folks, but providers as well.

It is truly scary stuff.

Surprisingly, the most important thing I learned was that it's not just the insurers that are in a tizzy. Providers are in a very bad situation: the "reform" rules hit them as much as they do the carriers. Unlike the insurers, though, many (most?) providers are small (often very small) businesses that are going to have some major tech and other expenses in short order.

My guess is that a lot of them are going to be forced to sell out to the hospitals and/or larger provider "umbrella" organizations. And look for a lot of them to drop out of all insurance networks. I'm also thinking that a lot of them - especially specialists - are going to be shedding Medicare/Medicaid patients.

Hey, a lot of folks wanted "change."

Time for a break from ObamaCare©

We'll continue to bring our readers the latest news and implications, but we certainly don't want to be seen as "All ObamaCare©, All The Time." In that vein, then, consider this:

■ Most wage earners - and even many trusted advisors - simply don't think about disability or its impact.

■ Most wage earners are not prepared for an income limiting event; nearly 40% [say] they could only pay their expenses for 3 months or less if income ceased.

■ Regardless of health and behavior, disability can happen to anyone at any time - plain and simple.

[Courtesy CDA - Council on Disability Awareness]

Concerned yet? You should be. And if you'd like to know just how concerned you should be, the CDA has posted a printable Personal Disability Quotient (PDQ) test that you can take in the privacy of your own home.

Take it for yourself, take it for your family, but take it.

Keepin' it clean (Or not)

With few exceptions, we try very hard to keep InsureBlog "family friendly." Sometimes, though, events overtake us; as vocal (and vociferous) opponents of ObamaCare©, we strenuously object to the characterization attributed to us by Ohio Democratic Party Chairman Chris Redfern [warning: foul language]:



Soap + mouth. Some assembly required.

Cavalcade of Risk #114 now online Down Under

Russell Hutchinson presents this week's glorious round-up of risky posts. You'll be glad you took the chance.

Real Life ObamaCare©: A Tale of Two Clients

This past week, we've been looking at the macro; that is, some of the changes about to be wrought by ObamaCare© from a "big picture" perspective. As we head into the mini-Armegeddon that is 9/23/10, it may be instructive to now consider the micro:

Yesterday, I fielded a call from a long-time client who had some tough questions about grandfathering. He had just received a letter from his insurer offering him the one-time opportunity to re-grandfather his plan.

[ed: under ObamaCare© rules, any changes that were made between March 23rd and June 1st that "un-grandfathered" a plan could be reversed - once! - to reestablish grandfathered status]

My client asked me to explain to him why he received the letter, what it meant, and what he should do. That's one of my roles, by the way: any monkey can sell a policy, professionals understand that it's a much deeper relationship, and part of that means some hand-holding. His plan had become un-grandfathered because he changed his deductible to lower the premium after receiving his renewal in April. At the time, no one knew about this whole "grandfathering" business (hey, we had to "pass it to learn what was in it," and at 2000+ pages, it takes a while for things to become crystallized). That simple change was enough to render his plan un-grandfathered. Who knew?

I explained to him that he had two choices, neither of which was particularly attractive: he could "repair the damage," but then have to cough up the additional premium he would have paid for the intervening 6 or so months. The benefit would be that, theoretically, he would be spared some of the major rate hikes that are about to hit new ObamaCare©-compliant plans. Or he could stick with the plan as is, to which will now be added additional "benefits" he may not want or need, and the next renewal will reflect that reality.

I also spoke with a nice young single mother, whose group plan will be changing significantly on October 1 [ed: one wonders if her employer understands all the ramifications of the changes he's okayed, but he's not my client]. This young lady was underwhelmed by the new plan and its premiums, and wanted to avoid it by purchasing her own plan on the individual market. It was quite disheartening to have to tell her that she was out of luck: there are no carriers currently writing new business for families such as hers (that is, in Ohio and Georgia; YMMV). So much for "more choices and lower rates," not to mention that old saw about keeping the plan you already have.

Hope and Change, Washington style.

"so you can find out what is in it"

Health Affairs recently published an article co-authored by 6 actuaries and economists within the Medicare Office of the Actuary in Baltimore.

It’s a good article, focused on spending projections. Exhibit 5 in the article summarizes the Medicare Actuary’s estimates of enrollments in various insurance programs – both public and private - under current law and under the new (reform) law, for the years 2009 thru 2019.

In particular the enrollment projections for the years 2013 and 2014 are interesting because 2014 is the first year for “full” implementation of health care reform, including the individual mandates and insurance exchanges. Comparing the enrollments projected for 2013 under current law with 2014 under reform law illustrates just how remarkably the insurance landscape is expected to change in 2014.

By far the largest changes are projected for two areas.

First, the uninsured, and this should not be a surprise. The uninsured are estimated to reduce from 50.9 million projected for 2013 under current law, to 25.5 million in 2014 under the reform legislation, a reduction to the uninsured of 25.4 million. That’s a 50% reduction in the number of uninsured. Of course a 100% reduction is unrealistic but couldn’t one have hoped for a reduction larger than 50% in exchange for committing those trillions of our grandchildren’s dollars? Oh, never mind.

The second expected large change is in the number of Medicaid/CHIP insured. This number is expected to grow from 63.4 million projected for 2013 under current law to 85.2 million in 2014 under reform legislation – an increase of 21.8 million people.

Fewer uninsured by 25.4 million. More Medicaid/CHIP by 21.8 million. In other words, health care reform is expected to reduce the uninsured by half, and just about all those people will gain insurance through Medicaid/CHIP. That may be a rather more surprising outcome to many observers.

But actually, growing Medicaid/CHIP is about the only way a meaningful reduction to the number of uninsured could be achieved.

Ohio Health Insurance: Now on hold

Bob's been doing a yeoman's job keeping us updated on the Peach State's health insurance market; now it's my turn to recap what's going on in the Buckeye State.

First, Anthem Blue Cross is in hibernation: no rates, no plans, no quoting for anything past Wednesday (in anticipation of the 9/23/10 mini-Armageddon). We can quote and write Short Term Medical and conversion plans, but that's it on the medical side. No major medical plans for either adults or children. You might say they're on a self-imposed "lockdown."

Next, Humana and Medical Mutual will continue to quote and issue adult-only policies, but no "family" plans which would include children. Humana will not write children-only plans, and it's unclear whether or not Medical Mutual will continue to offer them past the 22nd.

Aetna says that they'll continue to write plans with children if one or more adults are also included. Unfortunately, we don't have rates or plans available yet.

Assurant Health (a relatively minor player in this market) is also closed for business after the 23rd, but hopefully will have plans and rates available in time for October effective dates.

Finally, United HealthCare's individual plans seem to be in flux: for one thing, the soonest you can have coverage effective is 30 days from when they receive the application (or when it's completed online). So the soonest one could have coverage is now October 20th. The quoting system also still includes lifetime and other caps, which are a no-no going forward. I spoke with the Home Office, which confirmed that the caps will not, in fact, be included but the rating system doesn't yet reflect that. They also confirmed that they will also no longer offer child-only coverage.

Hope and change for all!

[Thanks to Kelly W for her help on this post]

Buh-bye, Gramps!

Looks like the promise that "if you like your current plan, you can keep it" is officially dead.

How did I arrive at this morbid conclusion?

By taking this test (and Hats Off to BCBS of Georgia for this interactive tool).

We've covered the "grandfathering" issue before, but it's important to understand that, come this Thursday, (9/23/10), that promise officially goes under the bus. You see, that's the next ObamaCare© "expiration date," and it's by far the most crucial one. After Thursday, the "grandfathering" provisions of ObamaCare© go online, and the countdown to the end of your current plan begins.

How can I be so sure?

It's quite simple, really: when you cut through all the other provisions, there are two which will will make it impossible to keep your current plan. These affect both individual and group plans, and we'll look at both.

The first thing to understand is that being grandfathered means being exempt from certain ObamaCare© provisions, such as Community Rating (coming in '014) and unlimited preventive care (coming this Thursday). The former will increase premiums dramatically, the latter somewhat less. Some employers think that they can insulate themselves from these changes, but one provision in particular makes that impossible: to remain grandfathered, an employer can't increase employee's share of the premiums by more than 5% of the 2010 levels. Not just in 2011, but ever. This means that (to maintain grandfathered status) an employer could never increase the percentage of employee's contributions by more than 5%, while his own premiums begin their inexorable climb upward.

Think you're exempt because you have an individual medical plan? Wrong. As you know, premiums increase because the cost of health care increases; in the past, you could insulate yourself by switching carriers every couple of years. No more: if you switch carriers, you lose grandfathered status. Lose that, and your premiums will go even higher as your plan will now have to include a host of "benefits" you may or may not want or need (and those are just the ones we currently know about - it seems like each day brings revelation of another gotcha as we "learn what's in it").

The bottom line is that you will not be able to keep the plan you have. And if you're in a group, don't think for a minute that your employer isn't seriously considering dropping the group plan altogether. Think that's scare-mongering? Fine, but keep this in mind: businesses exist to make money. The cost of health insurance is already high, and heading higher. Employers aren't (yet) required to offer health insurance, so it's a very easy (and cost-effective) thing to jettison.

Kind of changes one's hopes, doesn't it?

Adverse Selection and the Uninsured

Let's connect some dots, shall we?

According to the folks at Kaiser Health News, the US Census Bureau reports that "[t]he number of people with health insurance in the United States dropped for the first time in 23 years ... percentage of people without health insurance increased to 16.7 percent."

Certainly not great news, but then, not unexpected, either.

Why's that, you ask?

Some of it's basic economics: if Mom and/or Dad has lost their job (as a record number of folks have over the past 2 years), then there's less income. Some expenses are pretty much unavoidable: rent or mortgage payments, food, utilities, that kind of thing. Others are important, but expendable: cable and internet, cell phones, maybe the second car. And some things are "necessary evils:" say, insurance. The life insurance is probably the first to go, but the health insurance is pretty expensive, and the folks are relatively healthy...

If you're down to one (or no) income - as so many Americans are - then you start looking at ways to trim the budget that may not be all that attractive, but are necessary nonetheless. If Dad had a heart attack last year, you're not dropping him, but Mom's past the baby-making years and in good health, and her health insurance premiums could pay a good chunk of the mortgage. Little Timmy is epileptic, so he stays, but his sister Suzie is in pretty good shape, we'll roll the dice on her.

There are some long-term problems with that kind of thinking. For one thing, you're assuming that, if little Suzie gets sick, ObamaCare© will allow her to buy health insurance. As we've seen, that's not necessarily the case. But no one really knew that until now (although a lot of us suspected it). And it also means that the healthier folks are the first ones to bail, leaving behind a sicker insured population. Sicker people means more expensive and frequent claims, which means higher premiums, which means more people dropping their insurance, which means...well, you get the picture.

Is this good news or bad news for folks who see ObamaCare© as the solution? It seems to me that the overarching problem is that it doesn't address the problem that health care costs keep going up, and it's actually driven back any gains we might have made because of what's happened (and continues to happen) to the insurance marketplace. Fewer people working means more people on Medicaid, but also fewer people paying taxes to fund Medicaid (and SCHIP and all the rest). Now, that’s not completely accurate, because there are any number of folks who have ditched the corporate world (some voluntarily, some not) and started their own businesses. But even if they stay insured, that's a wash, no net loss in the pool of insured folks, but no gain, either.

And there's this: as we pointed out some time ago, a rather large cohort of the uninsured is those here illegally. They have health care expenses but no insurance. What portion of that 16.7% are illegals? Who knows, but it's more than a couple. How does ObamaCare© plan to deal with them?

Well, we had to pass the bill to find out what's in it; maybe that's next.

Anthem Blue Cross suspending sales of Child-only plans

Ten minutes ago, I received an email from Anthem stating that they were suspending sales of child-only plans effective today, September 17. The reason cited was the uncertainty created by the Patient Protection and Affordability Care Act. Adverse selection was also cited...because some carriers stopped selling child-only plans, the remaining ones were going to get saddled with the kids with medical problems.

There will be some cases when child-only plans will continue to be available:

"The suspension of child-only plans will apply to all states unless a particular state requires the offering of child-only policies. Based on state specific requirements, we will continue to offer Child-only plans in Maine and New York, and in open enrollment periods in Ohio and Virginia. Child-only plans will also be offered in those states requiring such policies for conversion and HIPAA eligible individuals. Existing policyholders will not be impacted by this action and they may continue in their current coverage."

Also unaffected are family plans where the primary subscriber is over 19.

ObamaCare strikes again...just another example of this well thought-out law.

ADDENDUM [HGS]: Bill's up early this morning, and beat me to the punch. For those who may be interested in the fine print, a pdf of the "News Flash" is available here.

Cavalcade of Risk #114: Call for Submissions

Russell Hutchinson hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 20th). 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.

HCSC Info Bleg [UPDATED]

[Important updates below]

An anonymous (but vetted) reader tells us that HCSC (the holding company for Blue Cross Blue Shield franchises in Illinois, Texas, Oklahoma and New Mexico, and the fifth-largest health insurer by enrollment) is in "lock down mode" following a gag order imposed last Friday (September 10, 2010). If any of our readers have details, we'd appreciate a heads' up as soon as possible.

Just drop us a line here, and your information will be treated as confidential.

Thanks!

Clarification: I was very hesitant to run with this because so many details are lacking, but my correspondent is very credible, and there does seem to be some urgency involved. I did leave voicemail with both HCSC media contacts (and emailed them, as well). There's nothing about it on the corporate website, but that's not necessarily indicative of anything untoward. There may be nothing to this, but again, this came from a reliable source, and it seems relevant to what we do here at IB. We'll keep you posted.

UPDATE [1:10PM]: Just spoke with HCSC media contact Ross Blackstone, who assured me that there is no "gag order" in place.

It's worthwhile noting that, as Megan McArdle hints, it is disturbing that the actions of the folks behind ObamaCare© make claims of a gag order credible. Thankfully, these fears appear to be unfounded in this case.

By the way, I ran this story early because, if there had been a gag order, there was no way to know if and/or when I would have received corroboration. A vicious circle.

Another twist [4:00PM]: This may, in fact, be a self-imposed "gag order.". On an insurance agents' forum, we find this post (#14):

"BCBS-IL just sent out a Special Bulletin to the field telling us to stop talking to our customers about what BCBS-IL may be doing in regards to healthcare reform. It also said that BCBS-IL will communicate with us when they have something to say.

They're probably about to implement a big rate increase for the 101 new preventive services. Wait a minute, they can't do that without state approval now...right? Could take MONTHS. Since all the brochures were removed from the Blue Cross Blue Shield of Illinois - Health Insurance Illinois - BCBSIL website this afternoon, a "hold" on sales may coming? "

That certainly explains why my correspondent was unsuccessful in communicating with folks inside HCSC.

Health Wonk Review is up

Louise Norris hosts this week's compendium of wonky posts from around the 'sphere. Check it out.

Humana vs PPACA

First, Humana continues to be a valued player in the health insurance market, which is a good thing (I'm a big proponent of competition). This post is about mail I received from them this morning, but is not to be taken as a slam on Humana; rather, it is illustrative of the destruction being wrought by ObamaCare©. I fully expect to see similarly worded missives from other carriers over the next few days.

Remember that promise that "more people will be able to get insurance?"

Well, not so much going forward.

From the letter:

"As of Sept. 18, 2010, we will stop quoting coverage for applicants under age 19 ... We will not issue a policy for applicants under age 19 with an effective date on or after Sept. 23, 2010"

This is a direct result of the Guaranteed Issue provisions of ObamaCare©. Since the carrier cannot turn a minor away, and it's unlikely they'll be able to price for the as-yet-unknowable risks, they've shut the door. This is an entirely rational and justifiable decision, by the way, and one which should have been seen by HHS Secretary Shecantbeserious as her agency started implementing the various provisions.

"If a dependent under age 19 applies with a parent or legal guardian and the parent or legal guardian is uninsurable, the dependent is ineligible."

This is consistent with the first condition stated above, and makes sense from a risk-management perspective. The overarching theme is that we now have fewer, and much more expensive, choices.

That extra expense, by the way, doesn't buy better benefits. Quite the contrary. In another Humana mailing we received this morning, the carrier announced substantial changes to its prescription drug benefits. For example, there are increased pre-authorization requirements for refills. On the other hand, quantities of refills are being reduced, which will add to the total out-of-pocket cost of their members' health care.

Most PBM's (Pharmacy Benefits Managers) assign medications to various "tiers," which then dictate a medication's co-payment amount. Those are changing, as well:

"[I]f members fill or refill a prescription for one of the drugs changing levels ["tiers"], they may pay a higher copayment."

Again, this makes sense, but, as we noted previously, it puts the lie to the notion that ObamaCare© will lower the cost of either health care or health insurance.

As Bob says: Smaller cars, bigger health insurance headaches, Poppa Washington.

On "Mini-Med's" and Clarity

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

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

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

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

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

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

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

And so the first shot is fired...

One of the interesting, and frustrating, elements of ObamaCare© is its unprecedented power-grab at the expense of the individual states. It's heartening to see, however, that the 10th Amendment isn't completely dead yet, and that a dozen-and-a-half states have taken the Obamistration to court in an effort to derail (or at least defang) ObamaCare©.

Today marks the beginning of the first major round of court battles, as the "Justice" Department asks U.S. District Judge Roger Vinson to enjoin the states from even pursuing their lawsuit, countering that:

"[O]verturning the health care law would unduly expand judicial review of Congress and other government branches. More specially, the DOJ argues that Congress has the power to determine how federal money appropriated for Medicaid may be spent and can give states an option of setting up their own health exchanges or having the federal government do so."

Overstepping bounds? Hey, that's the Fed's job!

And by the way, that little "option" at the end is an interesting red herring: the unconstitutional (and evil) mandate is about individual rights, and have nothing to do with the exchanges (except tangentially).

We'll keep you posted.

HHS Shecantbeserious Steps in it...

The reason that she's so dangerous is because she's so ignorant:

"There will be zero tolerance for this type of misinformation and unjustified rate increases," Health and Human Services Secretary Kathleen Sebelius said in a letter to the insurance lobby."

Now that may seem brave - after all, she's taking on the fierce and vicious health insurance industry - but it is, in fact, quite stupid. For one thing, she has no (zero, nada, zilch) power to enforce her little threat. For another, even if she was able to carry through, she would do far more harm than good in doing so.

Why's that, you ask?

It's pretty straightforward: insurance companies need to make a profit. It's how they (or any other business) stays in, well, business. Beyond that, though, there are statutory and regulatory regulations that require carriers to have a certain amount of reserves and liquidity. Under ObamaCare©, carriers are forced to cover an ever-expanding list of expenses; if they can't price for the increased risk, they'll lose money. That has the medium-term effect of draining reserves, but, as Moody's rating service reminds us, HHS Secretary Shecantbeserious' "warning to health insurers about “unwarranted” rate increases could raise questions about the insurers’ ratings." If a carrier's financial rating plummets, so does its ability to conduct business.

One begins to suspect that the folks in DC consider that a feature, not a bug.

Grand Rounds, End of Summer edition, now online

Julie Rosen, proprietress of the Bedside Manner blog, hosts this week's round-up of medblog posts. Come for the beautiful scenery, stay for the insights.

1099's Hit the Radar*

*Or: Why it's called the "Stupid Party:"

"Many Democrats have joined Republicans in pushing for the repeal of a tax provision in the new health care law that imposes a huge information-reporting burden on small businesses."

The fact that Democrats, facing a potential tidal wave of electoral punishment, are on board with this is quite understandable. Anything to mitigate the damage would be, from their standpoint, a win-win.

But for Republicans to even entertain this idea is abhorrent: ObamaCare© wasn't foisted on us piecemeal, it was jammed down our throats all at once. And that's how it must be defeated, not by "a thousand cuts," but total and complete destruction. It doesn't need to be "fixed," it needs to be eradicated. And you don't accomplish that piece-by-piece, it must be eliminated all at once, as well.

Proof of concept:

"The White House is nervous about a repeal, fearing that it could set a precedent for rolling back other unpopular features of the law."

No, it isn't. The President knows full well that the opposite is true: identifying and lopping off one little piece validates the remainder. One hopes that what passes for Republican leadership understands this, as well.

Not so bad after all ?

[Welcome Reason readers!]

Last week the Wall Street Journal carried this article. In it, we learn that Max Baucus has news for us about health care reform, via a recent town hall meeting with his constituents in Montana:

"Senate Finance Chairman Max Baucus, who wrote most of the bill, attempted this line at an August townhall in Billings, Montana when he tried to calm an angry voter by saying, "Mark my words, several years from now, you're going to look back and say, 'Well, that wasn't so bad after all.'"

There's a ringing endorsement for you.

In other words, Baucus is telling me not to worry about all the rattles I hear in this Cadillac he sold me (that I can't afford). I'm not to worry because in a few years I won't think they're so bad. After all.

Anybody else buy a Cadillac from this guy Baucus? Does yours rattle, too?

On Grapefruit and Lemons

Despite its tart reputation, grapefruit may indeed be the sweetest of all (metaphorically speaking):

"New joint research by scientists at the Hebrew University of Jerusalem and Harvard University’s Massachusetts General Hospital (MGH) has demonstrated the mechanism by which a single compound in grapefruit controls fat and glucose metabolism ... causing the liver to break down fatty acids. In fact, the compound seems to mimic the actions of other drugs, such as the lipid-lowering fenofibrate and the anti-diabetic rosiglitazone."

In short, a team of American and Israeli scientists my have found a naturally-occurring treatment for diabetes. Not only that, but it may also help lower cholesterol. Dig in!

Some doctors, on the other hand, are more like lemons:

"San Diego anesthesiologist Adam Dorin, founder of PhysiciansAgainstObamacare.org, writes in the fall issue of the Journal of American Physicians and Surgeons that the AMA is more interested in its prestige and financial contracts than physicians' interests."

Well, dunh!

As we noted months ago:

"[G]rowing opposition (to ObamaCare©) makes the actions of the AMA, which represents only 17% of the doctors in the U.S., look very bad."

The good news is that fewer than 1 in 5 doctors actually belong to the American Medical Association. The bad news, of course, is that it's the "go-to" source for the media in its effort to drive the ObamaCare© narrative. As Dr Dorin notes, "the AMA makes $70 million to $100 million a year from its exclusive contract with the federal government for the sale of coding books that physicians use to bill insurance." This is the "billing bible" that health care providers use to determine pricing and reimbursement. By controlling this key tool, the AMA is in a unique position to profit from the 3rd party reimbursement system (aka insurance and Medicare).

It's enough to give one a headache.

Um, about those terrific ObamaCare© cost savings...

Not happenin':

"The nation's health care tab will go up -- not down -- as a result of President Barack Obama's sweeping overhaul."

Oh, those nasty Republican naysayers and awful bloggers! They just keep spouting the company line.

What?

It's not the GOP or IB saying this?

Well, then: whom?

"That's the conclusion of a government forecast released Thursday ... said economist Andrea Sisko of Medicare's Office of the Actuary, the nonpartisan unit that prepared the report."

Where's Emily Litella when you need her?

MORE: As the Fox item above notes, even the "modest" increase assumes certain levels of reduction in Medicare reimbursement rates, all the while "guaranteeing" seniors continued access to necessary health care.

Unfortunately, that prediction may be a bit, um, rosy:

"Richard Foster, Medicare's chief actuary, noted that Medicare payment rates for doctors and hospitals serving seniors will be cut by 30% over the next three years. Under the policies of the Patient Protection and Affordable Care Act, by 2019 Medicare payment rates will be lower than under Medicaid."

Ooops.

And remember, under ObamaCare©, more Americans on the Medicaid rolls is considered a feature, not a bug. And that's the good news; it actually gets worse from there:

"The drastic reductions in Medicare reimbursements under ObamaCare will create havoc and chaos in health care for seniors."

I must respectfully disagree with the gentleman making those remarks (Peter Ferrara, director of entitlement and budget policy at the Institute for Policy Innovation). "Havoc and chaos" are necessarily predicated on choice. Why would he assume seniors will have any?

Rosh HaShannah 5771: L'Shannah Tova!

Happy New Year to all of our Jewish readers. For those not of the Jewish faith, Rosh HaShannah ("Head of the Year") begins this evening; it marks the beginning of what we call the "Days of Awe," a 10 day period of introspection and, hopefully, renewal, culminating in the fast day of Yom Kippur ("Day of Atonement").

As with all Jewish holidays, this one begins at sundown the night before, hence the afternoon posting.

Factoid: Reform Jews (by far the largest denomination in the US) celebrate but one day of Rosh HaShannah, while Conservative and Orthodox (among others) observe 2 days.

It is traditional to celebrate the New Year by eating apples and honey; I would encourage those who wish to do so to share their favorite apple and/or honey dishes in the comments.

And for those interested in a slightly off-beat (in the sense of strange and new), check out these new arrangements of traditional High Holiday melodies.



May you and yours be inscribed in the Book of Life.

Stranger-than-fiction Life Insurance: Deja Vu edition

Regular readers may recall this story from 4 years ago:

"A pair of Los Angeles women may have insured the lives of homeless men, then arranged fatal hit-and-run “accidents” so that they could collect the death benefits, officials say."

As I said at the time, this was "sick."

But someone else (actually, four someone else's) have gone one, um, better:

"Federal Bureau of Investigation headquarters today highlighted a recent conviction in a scheme by four individuals in the Los Angeles area to invent a man out of whole cloth, hold his funeral, and then reap in the insurance benefits from his death."

This guy wasn't just homeless - he was bodiless, as well. The article lacks more than a few details, but we can infer that at least two carriers were involved, since the total amount at risk would have required at least some additional underwriting beyond an application. Makes one wonder, though, how many of these schemes are successfully pulled off.

[Hat Tip: Best of the Web]

CDHP's: The Expanded Version

National Review health blogger (and FoIB) Avik Roy has written an insightful and helpful post on the role of Consumer Driven Health Plans (CDHPs). He examines the pro's and cons (including a link back to our own exclusive expose on network re-pricing problems).

His conclusion - that Consumer Driven plans will shine under ObamaCare© - may be a bit controversial, but it's certainly well-reasoned and supportable. Recommended.

Clue for the Gray Lady: D'Uh!!

Full disclosure: several years ago, I had the privilege of being interviewed by the NY Times' Reed Abelson, a very nice lady. She apparently has (or shares) the "health beat" for the "Paper of Record," and seems at least interested in what the blogosphere has to offer.

That said, I really wish reporters like Ms Abelson would spend at least an hour or so boning up on simple economics:

"Instead of sharing the pain, as they have generally done in the past, employers chose to keep their costs steady by passing the higher costs onto workers."

Here's that clue, Reed & Co:

Employers don't pay any premiums. They don't share in them, they don't "pass them along."

Once more: Employers. Don't. Pay. Premiums.

They collect them and send them along to the insurer(s).

Of course, reporters aren't the only folks guilty of this ignorance: President Obama (and others) are currently touting a "tax break" for businesses, which is based on another false assumption; as with premiums, businesses don't pay taxes, they (you guessed it!) collect them.

By way of analogy:

A few years ago, I was treated to lunch at a fairly nice restaurant. As I was chewing my salad, I felt something cold, hard and metallic clatter against my teeth. Spitting it out, I saw that - along with the croutons - I had been served a nut (as in "nuts-and-bolts" nut). When I pointed out this faux pas to our server, she offered to take the cost of the meal off the check. Which was nice but, seeing as how it wasn't my check (but they were my teeth!), I failed to see how this helped me.

Just like me and my "free" lunch, businesses don't pay the tax tab, so offering them a "freebie" is of dubious value. What would be beneficial would be a "regulations" break; a respite, as it were, from the onerous new rules encompassed in Obamacare©. Now that would be a break worth chewing on.

Cavalcade of Risk #113 now up and running

Host David Williams applies a "pretty tough filter" to this week's roundup of risk-based posts. The result is a terrific, on-target collection without a lot of fluff. Stop on by!

In which we reflect that it really is important to see the right physician

One of the consistent themes at InsureBlog has been the inadequate participation of physicians in setting health policy, for lo! these past 40+ years. See here and here and here and here.

I ask you – what do you truly prefer? Medical policy guidance from physicians ? Or from Nancy Pelosi, Harry Reid, and Max Baucus? Insufficient physician participation over the years created a policy leadership vacuum. Nature abhors a vacuum. And just look what rushed in – Pelosi, Reid, Baucus, et al.

Yes, most physicians are kinda busy with other important stuff.

But here is just one illustration of what I mean by inadequate participation: ModernHealthcare's 2010 list of the “100 Most Powerful People in Healthcare”.

The top 50 in 2010 include 8 physicians – 16%. There is exactly 1 physician in the top 10. There are 5 politicians in the top 10, including the top 4 in the entire survey – the aforementioned Pelosi, Reid, Baucus, plus of course, the President.

So it is no surprise that PPACA - "health care reform" signed by the President - is a political instrument rather than medical reform; is power-driven rather than public health driven; will spend a trillion dollars, not save a trillion dollars; and creates bureaucracy but does not create ways to help physicians and hospitals reduce their cost. As Pelosi predicted, we are finding out what is in this law. And we are rightly appalled.

IMO, too few doctors have been constructively engaged in the health policy debate. As a result, the nation relied on the wrong “doctors” - - who made the wrong diagnoses and wrote the wrong prescriptions. In these circumstances, the patient's prognosis ain't all that rosy.

Flooding the Zone

Comedienne Kathleen Madigan has a cute line about a farmer whose home along the banks of the Mississippi has been flooded (again): "And he's just as surprised this year as he was last year!"

Which also summarizes the folks who run the National Flood Insurance Program:

"In Wilkinson County, Miss., a home has been flooded 34 times since 1978 ... an insurer has paid claims every time, required no flood proofing, never raised premiums after a claim and vowed to continue insuring the house. Forever."

The home's valued at just under $70,000, but all those claims total over $660,000. It's been paid-for ten-times over.

By what brain-damaged insurance company, you ask?

The clueless folks at the McPaper want you to think it was "[t]he federal government."

But you and I know better: the government has no money. The correct answer is: thee and me.

The rocket surgeons at FEMA "manage" the National Flood Insurance Program (NFIP). This isn't our first brush with this brain-trust, either. As Bob wrote about NFIP almost 2 years ago:

"If you crash your car repeatedly, you can count on your insurance premium shooting up. Crash often enough and your insurer will drop you. But there's a special kind of insurance that doesn't punish you for having the same accident over and over again. And here's the punch line: It's a government program that's already left tax-payers like you on the hook for $17 billion—and counting."

The problem is that, although the goal is to be self-sustaining, the agency continues to run "deeply in the red." How deeply? How about almost $20 billion in crimson? But FEMA/NFIP isn't alone. As we also mentioned almost 3 years ago, Florida's "high risk" carrier, Citizens Property Insurance (a wholly owned subsidiary of the unfortunately non-profit Citizens of the State of Florida), has much the same structure, and (not surprisingly) similar results:

"[O]ver $400 billion (yes, billion with a "b") in liabilities ... [and] something like $3 billion in premiums."

Ooops.

These dollars are dwarfed, of course, by Hurricane ObamaCare©, which is slated to cost in the trillions, but serve as stark and sobering examples of government-run "insurance" programs which eschew risk for votes. We know that there are going to be at least a handful of hurricanes each season, and can infer, with some degree of accuracy, how many will strike land, causing "x" amount of damage. Same with floods. An exact science? No. A pretty good track record of estimates? Yep.

But how do you assess the risk for literally hundreds of millions of Americans - some smokers, some not; some fat, some fit; some healthy, some diabetic - and further, how do you price that risk with any degree of accuracy when you won't even acknowledge that the risk exists?

That is the insurmountable conundrum of ObamaCare©. Well, not "insurmountable," exactly. Feel better?

Take me out to Grand Rounds

This (short) week's Grand Rounds is up at Dinosaur Musings. Make sure to bring along some peanuts and Cracker Jack!

Cut Me a (Tax) Break!

Last month, we debunked an email which claims that folks will have to pay taxes on their group health benefits starting next year. That is patently false.

But it is true that new reporting requirements go into effect in 2011, and that's where I "missed the mark:"

"First, the relevant portion of Obamacare© doesn't take effect until 2018.

Second, only so-called "Cadillac plans" are subject to this provision."

Wrong, Henry.

Bob Graboyes, Senior Healthcare Advisor for the National Federation of Independent Business (NFIB), points out to me (in email) that:

1) The W-2 reporting provision does kick in in 2012. (That is, the form filed in 2012 on 2011 wages.) However, we believe the provision really starts earlier. If someone leaves his job in 2011, the employer must provide the W-2 – with the added info – within a few weeks of the employee’s departure.

2) It applies to all health insurance benefits, and not just to Cadillac plans. To my knowledge, there’s no difference in the reporting of Cadillac plan benefits and other insurance benefits.

Further research confirmed Bob's points. The reason that this is so important is that all of these additional requirements increase the actual cost of sponsoring a group health insurance plan (as if rate increases alone aren't onerous enough).

Now, I did get the third point correct: benefits aren't taxable - yet. But two outta three is not acceptable, so I'll dock myself a days blog-pay.

As long as we're on the subject of how ObamaCare© will increase the cost of doing business, it's worth noting another cringe-worthy provision that's been under the radar (but won't be for long), which "mandates that all businesses, tax-exempt organizations, and federal, state and local government entities will be required to issue IRS Form 1099 to vendors from which they purchase goods totaling $600 or more during a calendar year beginning in 2012."

Currently, the threshold is $2000, certainly a more reasonable number. This is particularly problematic for small businesses, which may have a number of vendors with whom they spend just at or above $600 (think business cards and letterhead, a new laser printer or fuel). Rotsa ruck, by the way, prying loose Office Depot's or BP's EIN (Employer Identification Number) in order to comply.

Now, one might think that accountant-types would view this new requirement (and the billable hours that would accrue as a result of it) as a major windfall, but one would be wrong. Noted tax-blogger Joe Kristan sets the record straight:

"Unless you are in the write-up business (basically, bookkeeper-for-hire), it’s an unmitigated nightmare. It generates an enormous compliance burden – for us, as well as for our clients – while generating paper that we will ignore in preparing business returns. The 1099s are cash basis, while most businesses are accrual, so matching the 1099s is pretty much impossible."

Of course, one might be tempted to believe that "hey, government-types are smart, surely they know what they're doing."

And again, one would be wrong. Christina Romer, the outgoing chairperson of the President's Council of Economic Advisers, said on Wednesday (September 1st) that:

"[s]he had no idea how bad the economic collapse would be. She still doesn't understand exactly why it was so bad. The response to the collapse was inadequate. And she doesn't have much of an idea about how to fix things."

And these are the kinds of people now in charge of our health care.

Is there a pill for that?

Your Wyden Waffles Post

Apparently, Sen Ron Wyden (D-IHOP) agrees with us that the so-called Individual Mandate is evil. Previously, of course, he was all for it; in fact, it was a centerpiece of his own "Healthy Americans Act." But that was then, and this is now:

"Last week Mr. Wyden sent a letter to Oregon health authority director Bruce Goldberg, encouraging the state to seek a waiver from certain ObamaCare rules ... One little-known provision of the bill allows states to opt out [of the mandate] ... I believe that the heart of real health reform is affordability and not mandates..."

Last year, for example, we reported that he was not only "on board" with the mandate, but that it was integral to his proposal. This despite the fact that, as we pointed out at the time (and which has since been validated):

"[I]f one is required to buy insurance, it certainly follows that the market will be forced to offer it to them. And that, of course, sets up a whole 'nother set of issues."

Hence, ObamaCare©.

Cavalcade of Risk #113: Call for Submissions

David Williams hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 6th). 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.

Health Wonk Review: In the Here and Now

I continue to be impressed with the quality of wonkery displayed by the folks whose submissions you'll see below. Looking back at the first 'Review I ever hosted, I was struck by how many wonk-bloggers [ed: is that even a word?] have left the 'sphere, but quite pleased to see names I recognize as still active: the Health Business Blog's David Williams, my favorite econ-blogger Jason Shafrin, and Workers Comp guru Jon Coppelman (all of whom appear in this edition, as well). I also noticed how short that review really was. I'm all for brevity when appropriate, but there's also no shame in piling on, especially when you read this week's entries.

In keeping with my newfound penchant for minimalism, posts appear in order of submission:

■ Rita Schwab has the sad tale - and important lesson - of little Taylee Blischke, who died at the hands of survived despite the efforts of incompetent, and unrepentant, physicians.

■ Bradley Flansbaum (aka The Hospitalist Leader) shares his comparison of The Great Emancipator and (what we at IB call) ObamaCare©. Guess who wins?

■ Peggy Salvatore uses an old (but timely!) joke to demonstrate the folly of government-supported EHR initiatives.

■ Rich Elmore at Healthcare Technology News reports on the Tiger Team on security and privacy recommendations regarding the handling of personally identifiable health information. Important stuff.

■ Joanne Kenen's post is about how CareOregon, a Medicaid managed-care plan, has created patient-centered medical homes and adapted to its own population a successful care coordination program for patients with multiple and/or complex chronic disease. Interesting.

■ HWR co-founder Joe Paduda weighs in on the cost of voluntarily forgoing necessary health care. While I disagree with his reasoning (high deductibles and/or co-pays are to blame), he makes a valid point:: delaying or forgoing primary care will increase future health care costs

■ Uber-wonk Dr Roy Poses posits that maybe - just maybe - having health care leaders' incentives actually aligned with patients' and the public's needs, and not so large as to elevate the leaders into the "Superclass," might work out better in the long run.

■ My favorite health care economist - Jason Shafrin - examines key provisions of ObamaCare@ from (you guessed it!) an economist's viewpoint.

■ Boston's Tinker Ready talks about "e-patient" Dave, and the contrarian's view of "positive thinking."

■ What does Joe's suddenly accelerating Camry have to do with HWR? Well, you'll have to click through to newcomer Michelle Woods' post on HIT (Health Information Tech).

■ Austin Frakt, The Incidental Economist, believes that Rep. Ryan's plan for Medicare is unlikely to control costs because it is too much like the current [ed: but soon to be "late"] Medicare Advantage program.

■ Maggie Mahar takes a look at former HCA honcho - and current Florida gubernatorial candidate - Rick Scott and finds him wanting.

■ Ken Terry sings the Motown Blues, taking to task the waste of dollars being thrown at Detroit's hospitals. Stop, in the name of...common sense!

■ Workers Comp Insider's Jon Coppelman reports on the case of Americans with Disabilities versus the Occupational Safety and Health Administration. Who wins? Guess you'll have to read the post.

■ Jay Norris, of the Colorado Health Insurance Insider blog, writes about the newly-created Early Retiree Reinsurance Program, which enables federal funding to help pay for retirees’ health insurance.

■ Avik Roy, of The Apothecary (and a featured NRO blogger, as well), takes the contrarian viewpoint in defending the FDA's position in the recent Avastin kerfluffle.

■ Over at the Health Access Blog, Anthony Wright points out that California was the first state in the nation to have its legislature pass a bill to set up a health insurance exchange under health reform.

■ Dr Jaans Sidorov compares and contrasts this Administration's most recent spins with academic writings that "say it ain't so."

■ The eponymous John Goodman's Health Policy Blog reports that the the NCPA [ed: National Center for Policy Analysis] has released an evenhanded consumer’s guide to health care reform, focusing on both new benefits and costs, in a helpful Q&A format.

■ At the Health Affairs Blog, Michael O’Grady and Jennifer Baxendell Young propose an automatic adjustment mechanism in which federal Medicaid financing would increase for states suffering economic hardship, without the need for special Congressional legislation. Left unanswered: why only Michael's picture is on the post.

■ The Health Business Blog's David Williams interviews one of my favorite med-bloggers: Dr Evan Falchuk. What makes him a fave? Here's a sample: "We connect with people because we’re talking about real stuff." Trust me, this guy is important.

■ And finally, our own Bob Vineyard puts the smackdown on all the "wonderful" changes promised by ObamaCare©, including the fact that we now have fewer choices at higher costs.

That wraps up this week's episode of Health Wonkery. Please be sure to tune in again on the 16th when Jay's better half, Louise Norris, hosts the next edition.