Sunday, December 30, 2012

ObamaTax speedbump

Well, well, well:

"Late [Friday] afternoon, the Seventh Circuit granted an emergency injunction against the HHS mandate — preventing its enforcement against an Illinois business and its owners."

The business, Korte & Luitjohan Contractors of Highland, Illinois, is a "family-owned, full-service construction contractor." In this case, the court disagreed with the recent Hobby Lobby decision, and went ahead and stayed Ms Shecantbeserious from enforcing the mandate for birth control convenience items. This court's take is that the mandate itself is coercive, and in direct contravention of the First Amendment.

Interesting opinion. Hopefully, it's just the beginning.

Friday, December 28, 2012

Swiss Miss bliss [UPDATED]

As major proponents of consumer-driven health care, this post at Avik Roy's place is a treat:

"[Author Regina] Herzlinger describes the health care system of Switzerland as a case study in consumer-driven health care ... Switzerland, the only developed country with a long-standing consumer-driven health care system, provides broad evidence and important lessons about its efficacy ... in Switzerland, it is the consumers themselves who purchase their health insurance."

Gee, what a novel idea.

Seriously, read the whole thing.

ADDENDUM: While I do like Avik's analysis, and the discussion in the comments (definitely see the ones from folks currently living under the Swiss health care regime) is enlightening, I wonder about its usefulness. After all, the American people has reaffirmed its desire for socialized health care, which is now (becoming) the law of the land.

The (Young) Invincibles

A year ago:

"Seventeen million young Americans would lose promised access to health insurance if the Supreme Court strikes down [ObamneyCare©]"

Oh the irony - it burns. Today:

"WellPoint and competitors have made concerted, well-publicized efforts to sell health coverage to the "Young Invincibles" ... who are not quite sure why they should buy health coverage."

But they have to - it's the law!

Really? It's a surprise that young people, inherently rebellious in nature, might not be too keen on paying for something they believe they'll never need? Hunh. Here's a clue, DC:

"A senior fellow at the National Opinion Research Center ... talked about "Calculated Risk Takers" -- uninsured, employed individuals ages 18 to 34 who have incomes over 400 percent of the federal poverty level ... If large numbers of healthy young adults fail to buy coverage, that could expose them to huge medical bills when they do get sick, and it could deprive health plans of premium revenue from young, generally healthy adults who could help offset the claims that older, sicker enrollees file." [emphasis added]

Let's translate this, shall we:

"Healthy young people would prefer to keep their own money rather than pay for their sick neighbors' medical insurance and care."

Sounds about right.

As we noted yesterday, however, Golden State politicos are in a quandary about how to implement their ObamaTax Exchange; they need the "yutes" on-board (the yutes' money, that is):

"Calculated Risk Takers are by far the least likely to purchase a plan compared to other groups"


Okay, this really ticks me off....

Thursday, December 27, 2012

Cavalcade of Risk #173: Post-Mayan Apocalypse Edition‏

Risking the wrath of the Mayan Gods, Van Mayhall has outdone himself with a terrific collection of risk-related blogetry.

What makes Van's Cavs so delightful is that he's obviously read through the posts, and includes his own take on them.

Do stop by (and don't miss the great Mayan digs).

BTW: We still have some slots available for early Spring 2013 - just email us to claim yours.

Gold, the ObamaTax and Consequences

As in "The Golden State:"

"California officials are concerned that the federal government might scale back its share of the costs under [the ObamaTax] ... state officials fear that the Obama administration won't cover as much of the law's costs as initially planned."

What's so amusing about this is that the ObamaTax's official name includes the word "Affordable" yet California pols are only just now coming to understand that it is no such thing. They went ahead and (foolishly) set up their own Health Insurance Exchange, without fully realizing that the rules keep changing, and that they're going to be on the hook for implementing it.

As a direct result of how the ObamaTax is structured, "California is expecting a massive surge in its Medicaid rolls" which, of course, will be paid for (or not) by the state's citizenry.

As FoIB Patrick P (who tipped us to this story) puts it, "talk about a sure sign that the health care law is bad, even Moonbat Jerry Brown is worried!"

I'm thinking of a word...

The Taxman Cometh

All this talk of the fiscal cliff is enough to drive you crazy. While the idiots in DC that can't balance their checkbook continue playing the blame game, it seems falling off the cliff may be a good thing for states in financial crisis.
In an example of federal and state tax law interaction that gets little notice on Capitol Hill, 30 states next year could collect $3 billion more in estate taxes if Congress and President Barack Obama do not act soon, estimated the Urban-Brookings Tax Policy Center, a Washington think tank.

The reason? The federal estate tax would return with a vengeance and so would a federal credit system that shares a portion of it with the 30 states. They had been getting their cut of this tax revenue stream until the early 2000s. That was when the credit system for payment of state estate tax went away due to tax cuts enacted under former President George W. Bush.
Not only is DC ready to rob from the rich, but so are several states.
Merry Christmas.

Watching figures

Thanks to FoIB Holly R, here's an interesting story about the confluence of medical tech and health care, with a dash of privacy and frugality thrown in:

"Those of us trying to lose some pounds after overindulging this holiday season can get help from a slew of smartphone apps that count steps climbed and calories burned ... technology lovers are testing homemade do-it-yourself devices on people eager to measure their mind and body."

Back in the day, pedometers were the go-to method for determining how far we'd walked on a given day, and (presumably) how many calories we'd burned by doing so. Now, their descendants are linked to GPS and other devices capable of tracking a slew of different metrics.

Which is all well and good, up to a point:

"[S]ome experts worry that the data collected could be used against users in the long run ... Two years ago, some users of a leading self-tracking brand, Fitbit, were logging their sexual activity as exercise and found the sex logs somehow popping up on Google searches."

Of course, anyone who still believes that we truly have any real privacy anymore (especially on-line) is sadly mistaken.

There's another facet to these new devices, as well:

"Chang raised $9 million for a new kind of tracker that he promises is "the world's first very accurate heart rate monitor on just a wrist watch — no chest strap, no other device" ... if the company turns a big profit ... it will be from selling the data aggregated on a smartphone app and analyzing it for you, the user."

After all, the raw data won't likely be of much help to most of us. But I can  foresee a metaphorical brick wall ahead: who, ultimately, will own that data?

Reason I ask is this:

"The small box inside Amanda Hubbard's chest beams all kinds of data about her faulty heart to the company that makes her defibrillator implant ... it apparently doesn't prohibit Medtronic from seeking to make a buck off that data."

It's possible, one supposes, that the User Agreements that come with the new apps will cover this, but how many of us actually read these?

Thought so.

Wednesday, December 26, 2012

Big Brother Takeover

Health insurance is changing. In case you have been under a rock for the last (almost) 3 years, what you thought you knew about insurance, and Obamacare, is most likely 100% wrong. 

The idea of a free market with increased competition to bring down prices is a lie. There will be no free market. Prices will rise, not fall. This is not Burger King. You can't have it your way.
Government has long elbowed its way into these free exchanges, setting rules and regulations for how buyers and sellers must act. Yet there comes a point when government’s prescriptions are so great, that they distort markets beyond recognition. The actors in the exchange are really just carrying out government’s dictates, not responding to the needs and desires of potential customers at all. 
The health care exchanges are meant for exactly such a bureaucratic takeover. Consider that states that establish an exchange will have to monitor what types of plans are bought and sold via the exchanges. While markets should have free entry and exit, states will be telling certain insurance companies that certain plans cannot participate in the so-called “marketplace.” This will shut out (usually smaller and less politically connected) companies from competing, and will limit the choices available to exchange participants. That’s exactly the opposite of a true market. 

The government will decide what kind of coverage you need, and they will set the price. Carriers are just puppets manipulated by a power hungry government.
 Americans should be concerned as government gets into the business of controlling this flow of information. After all, what’s to stop bureaucrats and politicians from more strongly highlighting the benefits of health plans offered by, say, an insurance company who happens to be a political donor?
That's some scary stuff.
Rather than offering free entry and exit, voluntary exchange, perfect information, competition and choice, the exchanges will simply offer more bureaucratic jobs to monitor the redistribution of tax dollars in the health system. And as Americans instinctively know, bureaucracies tend to fail; markets succeed.
So true.

Boxing Day Roundup

Here in southwest Ohio, we're getting our White Christmas a day late. It's quite beautiful, if treacherous, and the added treat of thunder-and-lightning is a real joy.

In that spirit, then, here are some interesting (if disheartening) health- and health insurance-related tidbits:

■ First up, co-blogger Bob shares this news on the anticipated growing costs (both financial and otherwise) of treating folks with dementia over the next few years:

"The fiscal climate may be challenging, but the Alzheimer's Association is estimating that, unless the country finds some way to prevent Alzheimer's disease (AD), cure it or substantially improve treatments for disease, the condition will cost the United States alone about $20 trillion over the next 40 years"

And as if that's not scary enough, turns out that those great Electronic Health Records mandated by the ObamaTax aren't necessarily safe from prying eyes:

"Security researchers warn that intruders could exploit known gaps to steal patients’ records for use in identity theft schemes and even launch disruptive attacks that could shut down critical hospital systems."

If you're one of those folks classified as "poor," you're about to get even poorer:

"[F]amilies earning as little as $19,000 will face a tax up to $2,085 if they don't buy health care under Obamacare by 2016 ...  A family of four will face the highest tax, a penalty of 8 percent to 10 percent."

Finally, lest the rest of us think we've gotten off easy, here's a handy list of many of the new ObamaTaxes arriving in '14:

"Upper-income households. Starting Jan. 1, individuals making more than $200,000 per year, and couples making more than $250,000 will face a 0.9 percent Medicare tax increase on wages above those threshold amounts" [ed: lest you think these are "elites," remember that a great many of those in that bracket are business owners who may well have to scale back their companies - and your job]

And of course there's more at the link.

Happy Holidays!

Where do these numbers come from?

Not that I would ever question my academic betters but a quote from my previous post raised another question;

"Hadidi paid $40,000 in Baltimore for pediatric orthopedic surgeon Shawn Standard to do a procedure called core decompression with stem cell implantation, which is not approved in B.C. for any child with the disease."

Where does this $40,000 get accounted for, in US spending or Canadian? I tried finding out, with no luck, how our national healthcare spending is calculated. Best I can find they calculate/estimate  what healthcare providers collect in revenue then divide by the US population(just citizens or census?), I can not find any reference to adjustments for care provided to foreign nationals. When our average spending is $8,400 per person it doesn't take many visitors at 40K+ each to skew this number. Unlike Americans going to foreign countries for affordable care, people aren't coming to the US to save a penny. Maybe someone knows the answer to how these numbers used to brow beat our system are calculated.

"Mayo Clinic in Rochester, Minn., which treated about 8,000 foreigners last year at its hospitals, including several hundred children.

The federal government does not track how many of the millions of people who come here on tourist visas are seeking medical care."

One patient who doesn't count in the average...

"Years of lobbying convinced the New Zealand government to cover the $1.4 million cost of Matisse’s planned transplants."

Do we really spend twice as much per citizen as any other country or is it some really sloppy academic work, or just outright propaganda?

Don't second guess the Canadian Healthcare System

NHS has long denied treatment to patients that received non-approved care, often from the US where we are more aggressive in trying to save lives. Canada is following their lead.

"An eight-year-old boy with a rare childhood disease has been refused care by at least one Canadian specialist because his mother took him to the U.S. for a treatment not approved in B.C.

“When it’s your child, you feel outraged,” said mother Sima Hadidi, of Surrey, B.C. “He needs to be monitored. And you just cannot punish people because they didn’t do what you suggested.”

The same people that will be first to berate our system for spending twice as much as Canada or England would also be the first to demand an eight year old get this treatment or any other that might add even a day to his life; no matter the cost.

We can't expect the same cost outcome when we also insist on providing twice the care.

Friday, December 21, 2012

Hospital Bonus or Penalty

Under Obamacare, the federal government wants to rein in costs for Medicare and Medicaid patients. Starting in 2013 they will do this with a carrot and stick approach that rewards hospitals with "good" outcomes and penalizes those with "poor" outcomes.

All this sounds wonderful in principle, but what does it really mean?

The program is one of several Medicare is launching to make hospitals and doctors accountable for quality and more careful stewards of public money. In October, Medicare also began reducing payments to 2,217 hospitals because too many of their patients ended up back in their care within a month. Medicare already gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.
The way the program works is that Medicare is reducing payments to all hospitals by 1 percent, estimated at $964 million. It then calculated a score on how much money each hospital deserved to get back based on the quality of its care. While every hospital is getting something back, almost half aren't recouping the 1 percent they forfeited and thus are net losers.
Studies like this have been tried before but I question the relevancy.
Under such a system, hospitals with the sickest patients would receive the lowest scores while those who treat individuals that are just sick enough to be in the hospital but don't really require specialty or acute care will have more positive scores.
If you read the article
New York-Presbyterian in Manhattan and Massachusetts General Hospital in Boston, both dominant hospitals in their cities, will have their payments reduced.
These large facilities handle a lot of high risk patients which can naturally skew their results towards the negative.
Treasure Valley Hospital, a physician-owned, 10-bed hospital in Boise, Idaho, that is getting a 0.83 percent increase in payment for each Medicare patient
I am sure this is a very good hospital, but what kind of patients are treated in a hospital that has fewer beds than a Motel 6? I can't imagine they are folks who need a high level of specialized care.
All this begs the question. If you operate a hospital that is in danger of being penalized because you handle a number of high risk patients, do you suppose they might have a tendency to "cherry pick" the healthier patients and let someone else take the really sick folks?
Seems like a way to ration care while maximizing profits.

Hobby Lobby Round 2

Having lost round one of religious rights vs Obamacare, the founder of Hobby Lobby vows to take his battle to the next level.

A federal appeals court on Thursday refused to shield Hobby Lobby Stores from the Obama administration's contraception mandate -- and the fines that come with it for not complying -- in a blow to the largest employer to challenge the ObamaCare rule. 
In response, the Christian-owned company vowed to appeal the case to the Supreme Court. 
CEO David Green, who had taken his case to the appeals court after losing in a lower-court ruling, had argued that his family would have to either "violate their faith by covering abortion-causing drugs or be exposed to severe penalties." 

Fox News

We posted on this earlier, prior to the election.

That was then, this is now and it seems obvious that a country founded on the principle of religious freedom will be bulldozed over by the federal government's desire to control and dictate every aspect of our lives.

Apparently a woman's right to "free" contraception medication trumps our rights to religious expression.

If the Supreme Court takes up the case, it would only be deciding narrowly on whether to give Hobby Lobby a temporary reprieve, as opposed to ruling on the merits of the mandate itself. 
There are currently more than 40 cases pending against that rule, though the Supreme Court has not yet stepped into the fray. 
Which court will show up?

The one that blessed the Obamacare mandate but also decided it was a tax, or the court that says our rights as individuals shall not be trampled upon?

Thanks to Henry Stern

From the P&C Files: Are your gifts protected?

The Insurance Information Institute (I.I.I.) has some good advice: make sure your expensive holiday gifts are properly insured. Whether it's that beautiful engagement ring or shiny new HD television set, thieves and winter storms pose a risk.

A good place to start is a home inventory, and keep it updated regularly:

And don't forget to call your insurance agent to make sure that new piece of art or set of golf clubs (such a deal!) are covered for the right risks, and the right values.

Billion Dollar Santa

If you've ever seen Elf or the Rudoph movie, you know that Santa's workshop isn't exactly a state-of-the-art manufacturing facility. Nevertheless, he and his hard-working assistants do face some daunting challenges, not the least of which include reindeer and elf injuries, potential mid-air collisions, and more.

According to risk management biggie Lockton, the big red guy will need "about $1.2 million to pay for insurance coverage.That will buy him peace of mind and about $1.175 billion in coverage for all of the exposures his workshop faces in the making and delivery of toys to children around the world."

Click on through to see all the other exposures the big guy may need to address.

[Hat Tip: FoIB Julie Ferguson]

Cavalcade of Risk #173: Call for submissions

Van Mayhall hosts the last Cav of 2012 next week. Entries are due by Monday (the 24th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

We've started scheduling 2013 Cav's, and need hosts for March and April. Just click here to grab yours!


Thursday, December 20, 2012

The ObamaTax and the MVNHS©

As our existing health care system winds down, it's worth noting how even the most vulnerable among us benefited from it:

"[D]uring my wife’s pregnancy with our second child ... this fight changed from political to personal. This is Zoe’s story.The doctors examining the ultrasounds consistently made unwelcome suggestions during the pregnancy. They would find something “abnormal” on a test, and request another scan. At the rescan, they would rule out the first concern, but find another."

Sad, yes, but a story that's told many times every day, due in large part to the incredible advances we've made in medical tech and the like.

"In May, we were blessed with a beautiful baby girl. Three of her fingers were fused together ... We have met with various medical professionals to discuss treatment options. There were several possibilities discussed, and we were able to weigh these options for the best fit: Zoe’s surgery is scheduled for the day after Christmas."

So, a happy ending, no?

Well, for baby Zoe perhaps, but not her siblings or cousins yet-to-be:

"There will certainly be appointments before and after treatment that include the specialist and the primary care physician. Both offices are reporting that access to doctors is becoming more difficult. Both offices are reporting decreased options for medical services and for drug therapies. There is now a two-week wait for the doctor"

Wait a minute, Henry, this all sounds very familiar. Why is that?

Ah, so glad you asked:

"A seriously ill baby was forced to wait in an Accident and Emergency ward for more than 12 hours because there were no suitable beds available anywhere in the UK."

This is "health care" under a government-run  system. And it's only going to get worse in Jolly Ol' as "specialists yesterday warned the Department of Health about a national shortage of intensive care beds for children this winter."

Welcome to OUR future.

A Very Merry Health Wonk Review

Come join Julie Ferguson as she hosts a holiday-themed edition of the Health Wonk Review. If you've ever wondered why Rudolph's nose is red, well you'll learn about that, too.

On a serious note, don't miss Jaan Siderov's very timely post on balancing privacy rights, Electronic Health Records and mental illness.

Wednesday, December 19, 2012

Silly State Tricks

While I certainly appreciate the sentiment, I fear that stunts like this are counter-productive:

"South Carolina state Rep. William Chumley, R-Spartanburg, S.C., has prefiled a bill, H. 3101, that could make trying to implement PPACA in South Carolina a felony punishable by a fine and imprisonment."

Five other states have proposed similar legislation, but enforcement may, problematic.

In this instance, it seems pretty clear that Federal law trumps state (although anyone with actual citations to the contrary is welcome - nay, encouraged - to share them in the comments).

The problem with this strategery is that it sucks needed oxygen from the far more viable efforts to derail the ObamaTax via Fed-run Exchanges. While the intent is certainly praiseworthy, these legal maneuvers are actually counter-productive.

Court: Obama must rewrite contraception mandate to accommodate religious liberty

 As many are aware, there is a serious ongoing dispute between the Obama administration and employers - particularly religious employers such as churches, hospitals and schools - over the issue of mandated coverage of contraceptives in medical insurance plans.  These employers have filed many lawsuits based on the First Amendment.

Within the past 2 weeks, the Obama administration has suffered two separate defeats in court.

Yesterday, December 18, in Wheaton College v. Sebelius, the U.S. Court of Appeals for the D.C. Circuit ordered that the Obama administration must rewrite its regulation:

"Health and Human Services Secretary Kathleen Sebelius cannot enforce the Obamacare contraception mandate as it is written, but must follow through on a promise to rewrite the rule to accommodate religious liberty".

This order was reported in the Washington Examiner here.

The Examiner also reported on this previous decision on December 7th.  In this decision, the United States District Court for the Eastern District of New York dismissed a DOJ challenge to Archdiocese of New York v. Sebelius.  The dismissal thus allows that lawsuit to proceed.  The Archdiocese of New York is contesting the same contraceptive mandate. 

In the earlier decision the trial judge noted that the president promised to accommodate the concerns of religiously-affiliated institutions - even while HHS went ahead and finalized the proposed regulation without change. The judge mocked the administration in his opinion, stating "“There is no, ‘Trust us, changes are coming’ clause in the Constitution.”

Calling up the Reserves

Co-blogger Bob, FoIB Rick B and I have been engaged in an email discussion about carriers using their reserves to "buy down" current premiums. The uncertainties inherent in the ObamaTax make it even more complicated.

Rick got the ball rolling by posing this conundrum:

"When ObamaCare starts, how will carriers be assured of enough reserves to cover all the pre-ex that they’ll be paying?  You know there will be an obamaload of claims in the first few months."

Bob was quick to reply that "for certain they will get all the sick folks, just like what happened with PCIP. It won't take long for claims to exceed premiums. Of course the $63 per head reinsurance premium will help . . . . some. I doubt that money will flow quickly enough to really matter.

Reserves are for claim fluctuations and runoff claims. My guess is the carriers will start a new block for Guaranteed Issue (2014 business and later) and will run that as a separate line of business. Reserves will be established from excess premiums (ha-ha) and those reserves will be used to cover as much of the influx of big claims as possible. They can do some internal shifting of funds as needed, but in order to collect the reinsurance I am certain they will have to show losses.

A lot depends on the exchanges, subsidies, etc as to how much backlash there will be over being forced to give up the plan you had and the new premium levels.

I still maintain the feds don't have the money to pull this off nor will they have the mechanism in place to monitor everything, calculate subsidies, etc.

It will be interesting to say the least."

I was invited to join the fray, and wondered if there would actually be any reserves left. After all, it's not unreasonable to predict HHS Secretary Shecantbeserious mandating their use to subsidize costly new premiums.

Bob quickly jumped on that prediction:

"If HHS demands carriers use reserves to stabilize premiums, it is game over for the carriers. Statutory reserves are set by the states and designed to protect the policyholder (as well as the state guaranty fund). If reserves are depleted for this nonsense it jeopardizes the entire system."

[He says that if as if it's a bad thing, from Mme Secretary's point of view]

"Internally, carrier reserves are not one big pool but are separate accounting blocks. Statutory reserves by line of coverage, reserves by block (including closed books), claim stabilization reserves. There is nothing prohibiting the carrier from borrowing from one reserve block to shore up another but it is rarely done. States will conduct audits of carriers from time to time and if the reserves do not meet state guidelines the carrier is put on a watch list."

Mike disagrees with my premise altogether:

"This is not going to happen.  A reserve isn't a stack of money lying around pretending it's not profit.  It's really just part of claims already incurred that the insurance company must eventually pay.  One can argue about the level of required reserve, but HHS will lose any battle to use reserves as a  . . reserve.  As I've already said, "reserve" is a lousy name and induces people to misunderstand what they are.  Reserves are already committed to pay claims.  Therefore they cannot be spent a second time."

He also points out that " the cost of pre-existing conditions for people who buy a new policy on or after 1/1/2014 will be a cost the insurance company has not previously insured and which its premiums do not currently reflect. And therefore the insurance company will reflect the higher cost of its new policyholders on and after 1/1/2014 in its premium rates. It is from this latter group of policyholders - not the already-insured group -  that the obamaload of pre-ex claims will emerge."

Which brings us to yet another challenge: what happens when carriers, forced to use reserves to subsidize premiums, lack the funds to pay claims? Typically, that's where the states' Guarantee Funds step in, but it's not entirely clear what will happen when multiple carriers go down the tubes.

Perhaps the Mayans were optimists.

Tuesday, December 18, 2012

PCIP Dominos Begin to Fall

North Carolina's Pre-Existing Condition Insurance Plan (PCIP) is shutting its doors to new business:

Seems they've run out of funds, and the state legislature has closed the purse. Two classes of folks are "grandfathered in," however: folks who are HIPAA-eligible and those who are eligible for the Health Coverage Tax Credit.

Some observations:

First, I found it interesting that the Tar Heel state's program allows folks coming off of COBRA to sign up (even after February 1). Here in Ohio, one must be uninsured (no COBRA, etc) for at least 6 months before signing up.

Second, it's hard to imagine that this isn't just the first hole in the PCIP wall - once the other 57 states catch wind of this development, look for at least a few others to follow suit.

Third, I found this caveat chuckle-worthy:

"If you are currently enrolled as an Inclusive Health member, this does NOT affect you. Your coverage and your renewal, if applicable, will continue."

6 words.

[Hat Tip: Jeff M]

ObamaTax Anxiety

A very good question here is whether Xanax will be covered under the ObamaTax:

"President Obama pledged repeatedly that his health care scheme would not touch the vast majority of Americans who are satisfied with their coverage ... "If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period."

As we have seen, these are all lies. And now, on the eve of the Exchanges, and of massive rate hikes, Americans are more anxious than ever about how badly they're going to be mauled.

Wonder if dog-bites are covered?

ObamaTax Increases

Obamacare and Those (redacted) Subsidies

Obama promised our health insurance premiums would be (redacted) by (redacted). Now that we are almost three years in to Obamacare and our premiums have (redacted) rather than (redacted), do we feel like we have been (redacted)?

Will our premiums really (redacted) when Obamacare is fully (redacted)?

The healthcare law provides subsidies for most people who buy insurance through a new insurance exchange. The law envisioned each state operating its own exchange, but authorized a federally-run fallback in states that don't act.
The statute refers to subsidies flowing through a "state exchange" — which, to the law's critics, means subsidies shouldn't be available in the federal exchange. The IRS has said it determined that Congress intended for subsidies to be available in both state- and federally-run marketplaces, but Republicans have pressed the tax agency to back up that assertion.
Camp and Issa — respectively, the chairmen of the House Ways and Means Committee and Oversight and Government Reform Committee, said their staffers were allowed to view certain documents about the IRS's decision-making, but only with heavy redaction.
Will they they get the skinny on this issue or will they be (redacted)?
Stay (redacted)

Monday, December 17, 2012

Health Insurance, Blurring the Lines

Seems like these days everyone wants to be in the health insurance business. The folks in DC are scrambling as fast as they can to earn your business via Obamacare and now hospitals want to be your BFF when it comes to insurance.
Piedmont Healthcare and WellStar Health System, two powerful medical organizations, are moving into a new realm: health insurance.
The hospital systems intend to create a health plan that will offer Medicare Advantage and commercial insurance in 2014, as well as serving the two organizations’ employee base that, with their families, exceeds 35,000.
The insurance plan follows the announcement last month that Piedmont and WellStar had formed a collaboration to develop health care delivery models.
By commercial insurance I assume they mean major medical coverage on a group or possibly individual basis. They may or may not be gearing up to offer coverage to more than just their employees. The article seems to hint they will target local (Atlanta) employers.
I find it odd that a hospital system would want to jump into the fray now, with Obamacare and exchanges a little more than 12 months away. Health insurance carriers are hesitant to do too much until they get more direction from HHS, so why would a hospital be in a better position to gear up for this new direction?
Adding Medicare Advantage plans is even more puzzling. Not only are there compliance issues at the state level but you must get approval from CMS as well.
Makes me wonder if they really understand what they are getting in to.

Docs + Hospitals: 1,000 Words

What happens when hospitals buy up doc practices? Well, they're now called ACO's (Accountable Care Organizations), but it appears that the only "accounting" is in the increased cost of that care. FoIB Jeff M tips us that:

"Some routine cardiac tests cost more than twice as much in hospital-owned clinics as they do in independent cardiology offices."

Or to put it another way:

Saturday, December 15, 2012

Add One More Obamacare Lawsuit

The founder of Domino's Pizza is suing the federal government over mandatory contraception coverage in the new health care law.

Tom Monaghan, a devout Roman Catholic, says contraception is not health care and instead is a "gravely immoral" practice. He's a plaintiff in a lawsuit filed Friday in federal court, along with his Domino's Farms, which runs an office park near Ann Arbor.

Monaghan offers health insurance that excludes contraception and abortion for employees. The new law requires employers to offer insurance that includes contraception coverage or risk fines. Monaghan says the law violates his constitutional rights, and he's asking a judge to strike down the mandate.

The government says the contraception mandate benefits women and their role in society. There are similar lawsuits pending across the country.

Read more:

Foundering Exchanges

As noted in our sidebar, the new ObamaTax Exchanges are due to go online in about 10 months. That is, if all goes well. But how likely is that?

You be the judge:

What's so amusing about this is that I have some pretty good second-hand knowledge of how this will likely turn out. My better half is a highly successful Professional IT Project Manager. When I shared with her how and when this whole Federal effort was supposed to play out, she shook her head in disgust. You see, she's worked on projects of this nature many, many times, and understands what's necessary to implement them.

I was also discussing this remarkable (unprecedented?) effort with co-blogger Mike, who told me of a seminar he'd attended, years ago, that included both executives and IT-types. At one point, Mike told me, the "suits" asked "why cant you just build what we want?"

To which the IT guys replied: "because you don't ever TELL us what you want!"

And this was in the profit- and success-driven private sector.

Rotsa ruck with this in the not-so-driven gummint one.

[Hat Tip: FoIB Holly R]

Friday, December 14, 2012

Avik on Medicare Age Eligibility

Earlier this week, we posted our take on a recent HealthBeat blog post decrying the idea of raising the Medicare eligibility age. Forbes blogger (and FoIB) Avik Roy also weighed in, with a thoughtful and provocative post at The Apothecary. His thesis is that raising the Medicare eligibility age would be a major step in the right direction:

"[I]n fact, raising the retirement age will help free up resources that could be used to achieve true universal coverage in the United States ...  Obamacare subsidizes health insurance for everyone under 400 percent of the federal poverty level—$60,520 for a two-person household—lower-income seniors would be protected under any increase in the retirement age."

That sounds right to me, and Avik offers several more on-target rebuttals to those who oppose the concept, including the fact that the "Congressional Budget Office projects that this would save $148 billion between 2012 and 2021."

I suggest reading the whole thing, but I want to focus here on some of the comments folks left.

Two in particular stand out:

"[T]he Republicans did everything within their power to protect the status quo with regard to the 44 million working and yet uninsured Americans."

The fact is, the ObamaTax, even if/when fully implemented, will leave some "30 million non-elderly Americans" without health insurance. By design. So who are the obstructionists here?

This one did provide a nice chuckle:

"You appear to be supporting cost shifting from government to everyone’s pocketbook"

Self-awareness: how does it work?

Thursday, December 13, 2012

Unclear - Breathlessly Unclear - On the Concept

Hank just referenced this LA Times article that is dramatically headlined “Blue Shield of California seeks rate hikes up to 20%.”  The article also suggests Blue Shield “. . . use some of its record-high reserve of $3.9 billion to hold down premiums.”

The headline and article are misleading about rates, and the surplus suggestion is a bad idea that won't go away.

The rate discussion in the article is another example of the sensationalism typical of most media reporting on medical insurance.  The Times actually does supply a little good info  - but you'll find it only if you read past the first few paragraphs. That's also typical of medical insurance reporting,

In the very first sentence Times says:  “Blue Shield of California wants to raise rates as much as 20% for some individual policyholders” I think it’s clear that the Times means fewer than half of these policyholders  The individual market makes up less than 10% of all policyholders.  So fewer than 5% of Blue Cross policyholders are getting a 20% increase.  That’s not sensational, so the Times spun its reporting the other way.

The article goes on to state “In filings with state regulators, Blue Shield is seeking an average rate increase of 12% for more than 300,000 customers.” (the article suddenly falls silent about whether these “customers” are individuals or groups).  OK, how reasonable is 12%?

You must read down to the 13th paragraph (!) of the Times article to find out:

“The insurer said its medical costs for this segment of the business grew 10.6% and what it actually pays is rising 12.5% after adjusting for its portion after customer deductibles.”

Other insurers not only in California but all across the US are experiencing similar rises in their annual medical costs.  So it seems to me an average premium increase of 12% is perfectly reasonable. LA Times chose to sensationalize these mundane facts.  I'm not saying a 12% increase is something anyone will like.  I am saying 12% is reasonable based on the cost of medical care Blue Shield is obligated to pay for.  Remember, medical insurance premiums are high because medical costs are high.  Medical insurance premiums rise because medical costs rise.

LA Times also sensationalizes its discussion of surplus.  It says there are calls for Blue Shield to “use some of its record-high reserve of $3.9 billion to hold down premiums."  Well, are we expected to check our wits at the door when confronted by terms such as "record-high" or big numbers like "$3.9 billion"?

The Times lead source for these calls is Laurie Sobel, a senior attorney for Consumers Union in San Francisco: "Blue Shield is sitting on a huge surplus that is beyond what is required or necessary," and she said "It should be used to hold down rate increases when it hits these extraordinary levels."

Neither Attorney Sobel, nor Consumers Union, knows what level of surplus is the right amount, yet both are quite certain that present surpluses are too high.

Sobel also says the excess surplus “should be used to hold down rate increases”.  As Hank states, that’s a bad idea. It was a bad idea when Consumers Union touted it back in 2010.  It’s a bad idea now

Following CU’s lead, the Times swallows the notion that the BCA and regulatory minimum requirements are sufficient – ignoring the many changes in business conditions (including passage of PPACA and the MLR requirement as Hank notes) that have occurred since those minimums were established.  The shortcomings of the Consumers Union position were noted at InsureBlog back in 2010.

Consumers Union could do a better job of preparing when it advocates on this issue  - and so could LA Times.

One final comment.  One must read to the very end of the Times article  - the 24th and 25th paragraphs – to find this:

“Larry Kirsch, a healthcare economist in Portland, Ore said . . . "There ought to be a reasoned analysis for when is enough," Kirsch said. "There always seems to be a 'sky is falling' story. I say prove it to me."

Kirsch appears to be referring to insurance companies who claim the sky is falling.  But his comment applies with equal force to advocates like Consumers Union and the media who seem always show up with their own breathless claims that the sky is falling.  Kirsch is right though that analysis and proof are necessary to establish appropriate yearly premiums AND for the appropriate level of surplus each not-for-profit insurer should hold.  I’m certain Blue Shield provided a full analysis of their premium calculations in their rate filing with the State.   Perhaps it’s time for an industry-wide, rigorous update of surplus requirements.

Unclear on the concept

Contrary to popular belief myth, the ObamaTax will not "lower premiums by 3000%" Anyone with health insurance has already seen the rate increases (above and beyond medical "trend"), and it's only going to get worse.

Case in point:

"Health insurer Blue Shield of California wants to raise rates as much as 20% for some individual policyholders"

But that's not the point of this post.

This is:

"prompting calls for the nonprofit to use some of its record-high reserve of $3.9 billion to hold down premiums"

Reserves are the "cushion" insurers are legally required to hold back to fund potential future claims. Using them to subsidize current premiums is not only illegal, it is incredibly stupid.

The promise that is the basis for an insurance contract is the one to pay for (legitimate) claims. If those funds have already been spent on premiums (and remember, under MLR at least 85% of those dollars must be spent), where's that "cushion" when it's really needed?


Three's a charm

Could the Buckeye State save almost a quarter of a billion dollars with a new  Medicare/Medicaid pilot program?


"Ohio is the third state to get approval from the federal government for an experiment to improve health while reducing costs to care for a population of disabled Ohioans with multiple chronic conditions who receive both Medicare and Medicaid benefits."

Five carriers - Aetna, UHC, CareSource and two others - will participate in the program, scheduled to launch next September. It's basically a capitation plan; insurers receive a monthly stipend per insured (or "beneficiary" in gummint-speak) to cover all care. Like the ObamaTax MLR requirement, carriers must pay out at least 85% of those dollars in claims.

For a bit of perspective, keep in mind that Ohio currently spends something like $5 billion a year in Medicare/Medicaid claims, and the program (if successful) is expected to save $243 million over three years. That's about $81 million a year (at best), or about 1.5% of that $5 large.


[Hat Tip: FoIB Holly R]

Wednesday, December 12, 2012

Mo Taxes

DocFix Cliff

Last time we looked, Kelley noted that - once again - the government had chosen to kick the "doc fix" down the road. The "doc fix" is the temporary patch necessary to keep physicians' Medicare (and by extension, every other 3rd party) reimbursements from crashing to the ground.

As Peter Suderman points out, the "doc fix" is inherently unfixable because, well:

"The way the doc fix developed is somewhat convoluted ... The formula tied total spending on physician payments to inflation, in hopes of keeping physician spending from growing faster than the economy as a whole ... If the doc fix is allowed to occur this year, physicians face a 26.5 percent cut in Medicare fees."

The end result is that, by not realistically addressing the problem, it gets larger and larger, so that (for example), the "doc fix" today represents $25 billion. While that may seem small potatoes in comparison to the overall debt, it's still a pretty good chunk of change that may or may not go into doctors' pockets.

Your doctor's pocket.

[Hat Tip: HotAir]

Medicare Eligibility

It's often difficult to draw a bright line between policy and politics, but we'd be remiss if we didn't point out a rather glaring double-standard. Last week, we hosted the Health Wonk Review, which included this diatribe from Maggie Mahar:

"Boehner proposes slicing social safety net programs ... he continues to insist that we raise the age when Americans can apply for Medicare from 65 to 67 ... asking those who have worked harder to wait another  two years before receiving Medicare seems cruel."

But that's not all:

"But, fairness aside, when you look at the numbers, it turns out that the claim that we can save billions by requiring that everyone wait until 67 before applying for Medicare is bogus."

Okay, so when will we see her post lambasting President Obama for suggesting this very thing:

"President Obama didn’t rule out raising the Medicare eligibility age from 65 to 67 as part of a comprehensive package to avert the so-called “fiscal cliff,” during an interview with ABC News  ... Obama told Barbara Walters that keeping younger seniors out of the health care program is “something that’s been floated” and didn’t immediately reject the idea."

But why woudn't he reject it out of hand if, as Maggie (and others) claim, it's both "cruel" and "bogus?"

We await with bated breath.

[Hat Tip: FoIB Holly R]

Cavalcade of Risk #172 now online

Michael Stack and Rebecca Shafer make their CavRisk hosting debut this morning with this week's roundup of risky posts. Ever considered the risks of using Social Media in your business? How about disability insurance for nannies? Do stop by.

Reminder: We're scheduling 2013 Cav's, and need hosts for February and March. Just drop us a line to claim your slot.

Tuesday, December 11, 2012

ObamaFees: Missed one!

Earlier today, we discussed the ObamaGotcha due in 2014, but inadvertently omitted one due in just a few weeks. The Patient Centered Outcomes Research Institute (PCORI) fee starts out at the low, low introductory rate of just $1 per insured per year, then doubles the next year (such a deal!), and is then further "indexed" (a Latin word meaning "increased") every year after that.

But Henry, it's such a small amount, and surely it's for a good cause, right?

You be the judge:

"The assessed fees are to be contributed to the Patient-Centered Outcomes Research Trust Fund (PDF) that will fund comparative effectiveness research. The research will evaluate and compare health outcomes and the clinical effectiveness, risks, and benefits of two or more medical treatments and/or services."

Of course, of course.

And we all know how well that line of reasoning works out.

By the way, the PCORI price tag? A cool $2.6 billion (that's with a B). Nice.

[Hat Tip: Medical Mutual of Ohio]

MLR = More Lousy Results

Medical Loss Ratios (defining how much of each premium dollar must go to claims) continues to wreak havoc with the health insurance business, with the individual market taking the brunt:

"Large and small group plans seem to have done better in 2011 than in 2010, but individual insurance operations seem to have done worse"

The end result is that underwriting has tightened, carriers have left the market (and thus reduced competition), and carriers are laying off employees (granted, some of those were likely overdue, but still).

As the individual market dries up, and as the ObamaTax Exchanges come on-line, look for things to get worse.

Oh come on now, Henry, how could they get worse? After all, the Exchanges will be professionally run, carriers will have to take all comers, and pre-ex is a thing of the past.

Well, the "professionally run" claim is dubious, at best, and the guaranteed issue provision - coupled with an end to limiting pre-existing conditions - means that premiums are set to skyrocket. Of course, the subsidies will ameliorate that problem.


ObamaTax "Gotcha!"

By now, you've probably seen the news that, much like your phone bill includes a charge to pay for others' "free" service, come 2014 your new health insurance bill will include one to pay for folks with pre-existing conditions:

"The [$63 per covered person]  charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies"

Of course, you'll never see that, because employers usually pick up all those costs.

Just kidding!

Here's my favorite quote:

"Most of that is likely to be passed on to workers."

No: all of it will be passed on to employees - employers never pay any health insurance premiums. Never have, never will.