Friday, August 30, 2013

HHS wants you to meet Howard

I subscribe to and their Exchange online marketplace blog. Lately they have been sharing stories about people who will be impacted in a positive way under Obamacare. The most recent person we have been introduced to is Howard. He is a self employed software designer. Here is part of Howard's story pulled directly from the article.

          Uninsurable until 2014

          Howard shared his story with us:
“Five years ago, I was diagnosed with Diabetes. Once you get that diagnosis, the insurance company says, ‘you’re uninsurable.’ To get access to medical care now, what I do is participate in clinical trials on diabetes. I’m one of the people who actually are guinea pigs for new drugs. Insurance companies want perfect people, which is totally impossible. Everybody is going to get something at some time."
The average software designer makes roughly $90,530 per year according to the Bureau of Labor Statistics. So Howard's issue isn't cost as much as it is his health status and the fact he hasn't had insurance for five years.

One question: If Howard has been uninsured for five years and affordability isn't the issue, then instead of being a "guinea pig" doing clinical trials why didn't he enroll in PCIP?

Cavalcade of Risk #191: Call for submissions

Julie Ferguson hosts next week's Cav. Entries are due by Monday (the 2nd).

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.

Thursday, August 29, 2013

Open wide and say...Yikes!

One of the "core" elements of the train wreck's Essential Health Benefits mandate is the requirement to provide pediatric dental benefits.

FoIB Jeremy from Assurant Employee Benefits has some news about how that's going to play out in real life. As with so many aspects of the ObamaTax, there's little guidance from Capital City as to what's going to actually be enforced come January. It appears that large groups (ie over 50 employees) probably won't have to make any changes to their plans to remain in compliance.

Small groups, though, will see "pediatric dental EHB services embedded in their medical plan...but those will generally be only dental services for the pediatric population (under age 19)." [ellipses in original]

But what are these services? In general, they'll mirror current coverage available with the SCHIP program, with perhaps some broader coverage available for additional screenings.

But the truly scary part is what's going to happen to the cost of orthodontia.


One of the key "features" of the dental benefit is coverage for "medically necessary orthodontia." But FoIB Fred of Companion Life wonders, since "a definition of medically necessary orthodontia has not been yet established, it is unclear" how many ortho claims will fall in that category?

It's perfectly clear how many such claims will fall under that rubric: 100% of them. Count on it. And, as we have seen in, for example, the higher education, when the government subsidizes something, its cost always skyrockets.

Sounds like the brace-fitters, at least, have reason to rejoice.


Need health insurance? Think transparency. Think lower health care costs. Think lower health
insurance premiums. Think Oscar-care. 

Oscar-care is a start-up health insurance company making their debut on the New York health insurance exchange in a few weeks.
Oscar will have one plan in each of the ACAs metal-tiered categories, and additional plan options for the Bronze and Silver tiers. Although Oscar will have some of the familiar pillars of the health care industry like co-pays and deductibles for in-person visits, it introduces new elements like free telemedicine, free generic drugs and online price comparisons. Oscar health insurance will pioneer “a consumer experience, not a processor of claims,” explained Nazemi, with the goal of simply guiding individuals through the complex health system in an integrative and safe way.

This is a great idea. Color me skeptical, but if it delivers anywhere close to the promise, Oscar should run for public office.

New York mayor comes to mind . . .
For frequent conditions or issues, patients will be able to find treatments right on the website and have 24/7 access to a physician through their unique partnership with the telemedicine company, TeleDoc. Additionally, the creators claim there will be no need to discuss prescription refills in-person with an expensive physician when a user can have “one-click refills” through a health records feed that resembles a Twitter timeline.
Oscar will also offer services at many hospitals and retail locations such as New York CVS CareMark. The partnership that Oscar and CVS have is so strong that CVS is building sites for Oscar. 
One concern to me is, HIPAA privacy. Just how secure is this?
The founders of Oscar claim that consumers will have access to a doctor by phone within 20 minutes of a request, with no co-pay. Perhaps the concept is not revolutionary, but if it works, the behavioral changes associated with seeking care could be seismic. Currently, not many patients log onto insurance carrier webpages before seeing a doctor, unless they are seeing if the doctor is in-network. Oscar, however, wants patients to start their care with the insurer, not just use it for payment submission.
Someone put a lot of thought into this.

Wednesday, August 28, 2013

We've got Answers!

Recently, I was invited to apply for the position of Content Expert Writer (CEW):Insurance for The process was interesting: an intense, comprehensive on-line writing and editing test and a requirement to craft real answers for several entries (both within and without my subject area).

They took a few weeks to evaluate the candidates (there were apparently several); I have been offered the position ("there can be only one").

I am very flattered, and eager to begin.

Needless to say, this position is in addition to my real job and InsureBlog, so I'll be learning (re-learning?) some time management skills. Fortunately, I have the best co-bloggers on the 'net, so if I end up slacking in my IB duties for a brief while as I come up to speed, I know that our readers won't be neglected - Thank you all!!

Obamacare for Dummies: Navigator Edition

Navigator grants have been awarded! HHS announced that funding would be $67 million spread across 33 states. As Mike noted in his post earlier, the funding magically increased from $54 million thanks to the Prevention and Public Health Fund Obamacare Slush Fund  that authorizes Kathleen Sebelius free reign over how to use it.

Anywho, with funds distributed, the hiring should begin and Navigators will soon be able to go online and complete their required training. In fact, they can already get a head start on the educational part.

Today CMS released a 217 page Standard Operating Procedures Manual for Navigators. The manual includes important stuff such as: making sure you smile, occasionally nod, say thank you, and most importantly, become an 34 days.

This is going to run so smoothly...

Tuesday, August 27, 2013

Such a deal!

I'm from the Government and I'll take you to the New World. Trust Me. Uh, do you happen to have a map?

In Connecticut, "Navigators" have been designated in each county -  after a nominally competitive bidding process - to manage "assisters" in the county who will actually be responsible for helping people enroll in Obamacare.  Connecticut is operating its own Exchange.   More info here

Here is Connecticut's definition of "Navigators"
The following organizations can qualify as Navigators:

• Community and consumer¬focused nonprofit groups
• Trade, industry and professional associations
• Unions
• Resource partners of the Small Business Administration
• Indian tribes, tribal organizations, urban Indian organizations
• Other public or private entities that meet Navigator requirements
The following organizations cannot be Navigators:

• Health insurance issuers
• Subsidiaries of health insurance issuers
• Associations that include members of the insurance industry or that lobby on behalf of the insurance industry
Actual advice to real people will be doled out by the "Assisters".  Connecticut promises this:
Assisters are individuals in your community – they work at nonprofits, small businesses, faith-based and other community organizations . . .  Assisters will be:

• Certified with training in the Affordable Care Act, Access Health CT, providing appropriate support based on language and culture, and more
• Trusted community members who have undergone thorough background checks
• Ready to help individuals, families and small businesses during the initial enrollment period (October 1, 2013-March 31, 2014)
Assisters apparently cannot be licensed insurance agents unless they happen to work for one of the specified community organizations.  So it appears Connecticut is not allowing anyone to become either a Navigator or an Assister who might actually, you know, have expert insurance knowledge but instead intends to employ people who must learn everything they need to know about Obamacare in what? - 30 days?  But - don't worry! - they will all be "certified" and "trusted" and they will all have undergone "thorough background checks."   All information they give you will be "based on language and culture".  Oh,  "and more".

Well, what can possibly go wrong?

Underwriting Cancer

Recently, I had an interesting experience with a client which I'd like to share as an example of how important agent communication can be.

A gentleman called up inquiring about some additional life insurance. I did my usual pre-screen process, and he was in decent health, no tobacco use, "normal" height and weight. Got the quote, agreed on a plan design, and sent in the application.

As with most policies nowadays, this one required a routine "paramed" exam (blood, urine, physical measurements, nothing major). The exam was scheduled for this coming Friday.

Today he called with some discouraging news: as part of a routine test last week, he learned that he had prostate cancer. Thankfully, it's in the early stages, but of course this poses a problem with the new life insurance application.

When he called to tell me the news, he assumed that we'd just pull the plug on the application, but I suggested that perhaps all was not lost. There have been some significant changes in life insurance underwriting the past few years, and all was not necessarily lost. I promised to call my underwriter and then we'd go from there.

So, I called my underwriter (one of the perks of my primary carrier is that I have access to the actual underwriter, not just an assistant), and explained the situation. I expected that she'd agree with the client, and pull the application. To my surprise, however, she started asking questions. Turns out, their underwriting guidelines are more flexible than I'd believed, and there's actually a decent chance that we can still get the policy issued (albeit at a temporarily much higher rate). All of this will depend on the conversation my client has with his surgeon next week, but things are at least hopeful.

Live and learn.

Monday, August 26, 2013

Early Renewal Fever - catch it!

Previously, we reported that several carriers have begin offering early renewal options to  small group clients in an effort to stave off (if only for a while) some of the more egregious effects of the ObamaTax.

This morning's email brought the first such offer I've seen for individual clients. From Medical Mutual of Ohio:

"For your clients in a non-grandfathered plan.... an opportunity to consider an early renewal of their individual plan for December 1, 2013.  This will allow them to keep their current plan until December 2014 if they choose."

Again, this is only a short-term fix; eventually, they'll have to move over to an ObamaTax-compliant plan. But for a little while at least, they'll be able to keep the insurance they currently have.

And the check'll be in the mail.

Saturday, August 24, 2013

Crash Landing

Friday, August 23, 2013

Do You Think This Might Impact the Cost of Vacation?

Where will you go on vacation next year? Some place close by or maybe take an airplane to some exotic isle? Or maybe just a fun place to play a round or more of golf.  

You might want to buy your ticket now before the price goes up.
large employers who self-insure should be exempt from most of Obamacare’s most onerous regulations. It turns out, however, that even America’s largest companies face higher costs due to the health law. A recently-leaked letter from Delta Air Lines to the Obama administration states that the “cost of providing health care to our employees will increase by nearly $100,000,000 next year,” much of it due to Obamacare.

$100 million isn't peanuts.
Self-insurance works a different way. Many large employers, instead of paying premiums to an insurance company, cut out the middleman and pay directly for the health costs that their workers incur. This involves additional financial risk for the employer, but the company saves money that would otherwise go to an insurer’s overhead.
This is important.

With any self funded plan, including Delta, the PLAN design can have a major impact on the number of claims paid as well as the total dollars spent on claims.

If a plan has to cover more things (such as birth control at no cost to the insured) that cost directly impacts claims and is passed on in the form of higher premiums.
The law charges Delta a “reinsurance fee” that goes toward funding the law’s subsidized insurance exchanges. But Delta employees get coverage from Delta, not from the exchanges; hence, the fee is effectively a $10 million tax on Delta for other government purposes.
Just another of those hidden Obamataxes.
“More than 8,000 (adult) children [have been] added to our rolls resulting in a permanent increase in our overall costs of about $14 million per year.” 
That's the provision requiring health insurance plans to cover "children" up to age 26.

All these free and wonderful things Mr. Teleprompter wants us to have come with a price.

Se Habla Obamacare?

If you ever wondered why the government is spending so much money and effort to SELL us on a plan that is law, this will make you scratch your head. 

Recent polls show that 2/3 of those here legally do not want Obamacare. So what is the plan now?

Recruit people from outside the country to come here so they can get government subsidized health insurance.

"Well, the (Obamacare) bill is crafted in such a way that those who are undocumented will not have access to the tax credits or shopping in the (health insurance) marketplace. That has been limited, which is, frankly, why -- another very keen reason why we need comprehensive immigration reform," Sebelius told a gathering of Latinos in Philadelphia. 
CNS News

Did you follow that logic?

Only with immigration reform, AKA amnesty, will they have enough people covered by Obamacare to make it popular.

Mid Friday Good news, Bad news

First, from our friend Holly R, the good news:

"5 Body Parts Scientists Can 3-D Print"

As we've mentioned before, this tech is a potential game changer for dealing with diseased or damaged organs, blood vessels, even bones.

Now the bad:

"Gallup surveyed 1,021 U.S. adults ages 18 and older in mid-August, it found only 15 percent of all participants “were very familiar” with PPACA. Eighteen percent said they were “not too familiar,” and 12 percent admitted they were “not all familiar” with the law."

Now admittedly, this is only "bad news" to proponents of the train wreck. That is, after all the money and efforts thrown at educating the public about the (supposed) benefits of the ObamaTax, for its most crucial demographic to be this uninformed is quite amusing.

Oh, and this just in: President Obama's promise that premiums would decrease 3000% under the ObamaTax appears to be coming true:

"The average employer-provided family health insurance premiums have climbed $2,976 since 2009"

This from the right-wingers at the Kaiser Family Foundation, so there's that.

Thursday, August 22, 2013

First Big Brown, now the Cavaliers

Bob noted yesterday that UPS was on the bleeding edge of employers dumping spousal coverage. Today we learn that - surprise! - the domino's are starting to fall:

"The University of Virginia said Wednesday that it will stop offering health insurance to some employees' spouses because of rising costs under ObamaCare."

But remember folks, "if you like your current insurance plan, you can keep your current insurance plan."

Until you can't.

He's only MOSTLY dead.... [UPDATED]

Here's something you don't see every day:

"After showing no signs of life for 45 minutes and being declared dead, a 37-year-old Ohio man suddenly came back to life ... doctors treated Yahle with every medicine they could for 45 minutes, but he didn’t respond and was officially declared dead."

Mr Yahle had had some breathing problems earlier in the day, which had prompted a 911 call and ambulance ride. After hearing that his father had been pronounced dead, his 17-year-old son rushed to his side, yelling “Dad, you’re not going to die today."

Turned out he was right.

Which by the way brings up an interesting (well, to me, anyway) question: given that he was pronounced dead by a licensed physician at an accredited facility, is his wife eligible to file a claim on his life insurance? Generally, that requires a death certificate, but if he was legally pronounced dead.... [ed: see update, below]

On the other end of the spectrum, here's some good news for folks who are having problems conceiving a child:

"European and American scientists say a simplified version of the entire procedure aimed at developing countries could be done for about 200 euros ($265) with generic fertility drugs and basic lab equipment that would fit inside a shoebox."

Currently, IVF is an expensive proposition (although, to be fair, a whole lot less than actually raising one's progeny), so this may be the breakthrough for which anxious parent-wannabes have been waiting.

UPDATE: On a hunch, I posed this question to the claims folks at our primary carrier. Good sports that they are, they replied:

"NO Claim. We would require a certified death certificate, and there wouldn’t be one issued because they are not dead."

Oh, well - easy come, easy go.

The ObamaTax doesn't affect you

Well, unless you call theft "affecting me."

As Bob pointed out yesterday, large companies aren't stupid - they simply find ways to manage the stupidity raining down on them from Capital City. Sometimes, though, it's not just raining, but pouring.

Case in point? Delta Airlines:

"The [ObamaTax] requires large employers to pay an annual fee of $63 per covered participant in 2014. For Delta’s roughly 160,000 enrolled active and retired employees and their family members, this represents more than $10 million added to the cost of providing health care next year."

Remember also that employers don't pay this fee: customers do. So next time you fly. remember to tip your friendly TSA groper agent and stop grumbling about the extra few bucks you're transferring to folks who - unlike you - actually get those subsidized health insurance rates thanks to the $63 slush-fund Pre-Existing Condition Fee.

Back to school time...

And for many folks, that means moving day for Junior. Laptops, TV's, clothes, and all the rest are potentially at risk for theft or damage, and the question then becomes:

"Are they covered?"

Well, that depends.

The Insurance Information Institute recommends:

1 - Create a “dorm inventory” to document what’s leaving home. Too much bother? Needn't be: just use their handy (and free!) widget. And yes, there's an app for that (available at the site, for both Androids and iPhones)

2 - Check homeowners or renters policies for off-site coverage. Many homeowners and renters policies include coverage for personal belongings even when their off-site (such as residing in the dorm with Junior).

As always, check with your agent for specifics on your policy, including things like jewelry and instruments. You'll be glad you did.

Wednesday, August 21, 2013

Obamacare Navigators - Now Hiring

Need extra money? Do you enjoy conversation with strangers? Do you consider yourself a
"people" person?

If so, this may be for you.
The "in-person counselor" jobs, located in every corner of the state, range from a $9-an-hour part-time evening job in Clinton County to a $45,000-a-year project coordinator position in Chicago for someone with experience in community organizing and public speaking.
The workers will help consumers apply for coverage, and will answer questions and explain differences between the insurance policies offered on the new online marketplace. They will help consumers figure out if they're eligible for Medicaid or for new tax credits that will help many people pay for coverage.
Community organizing and public speaking experience. Who do we know with those qualifications?
Job applications are being collected online and anyone hired will get three days of training about health insurance, enrollment rules and other complicated aspects of the health law.
Three days of training on a 2300 page law + 15,000 pages of rules and regulations.
What could possibly go wrong?

Exchanges Plus/Minus

On the "plus" side, we learn today that:

"More Americans than predicted may decide to flock to the new public exchanges for health coverage ... at least 8.5 million consumers plan to buy insurance through exchanges ... a prediction far outpacing what the Congressional Budget Office has projected"

So, success.

That is, if they actually open on time, and if there are actually carriers participating, and if enough folks aren't turned off by the thought of their their personal financial, medical and tax information being in the hands of unlicensed, uninsured and under-educated Navigators.

Seems like that's a lot of if's, doesn't it?

On the other hand, it appears that the legacy media is just now learning something that InsureBlog readers have known for a while: that the subsidy reimbursement scheme has some major holes:

"One of the major concerns insurers have is whether the millions of individuals who buy insurance when the [ObamaTax] kicks in will be able to send in a premium check promptly every month"

Whoa there, Nellie! "Will be able?  How 'bout "why would they bother?" After all, as Bob asked earlier this summer, what if "a policyholder decides to exercise their right to a 90 day grace period and does not pay their premium for 3 months?" They (arguably) had coverage, but was it ever really in force?

And who cares?

Well, the providers do, and they've petitioned Ms Shecantbeserious to change a key provision:

"CMS’s approach also unfairly burdens providers who treat these patients because they will not get paid by the (insurance company) for covered services and will have to wait to try to obtain direct payment from the patient"

Maybe that's just the cost of being a provider in an Exchange-based network.

Big Brown Says Goodbye to Spouses

Atlanta based UPS is pulling the plug on health insurance benefits for an estimated 15,000
working spouses. In a cost saving move caused at least in part by Obamacare, many will lose their UPS coverage.

Rising medical costs, “combined with the costs associated with the Affordable Care Act, have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost,” UPS said in a memo to employees.
According to Kaiser, UPS told white-collar workers two months ago that 15,000 working spouses eligible for coverage by their own employers would be excluded from the UPS plan in 2014.
So what does the Obama administration have to say about this?
"The health care law will make health insurance more affordable, strengthen small businesses and make it easier for employers to provide coverage to their workers," said Joanne Peters, spokeswoman for the U.S. Department of Health and Human Services.
The big lie continues.

Cavalcade of Risk #190: Late summer edition

Jacob Irwin hosts this waning days of summer round-up of interesting risk-related posts, including lightning strikes and cyber strikes. Not to be missed (well, you don't want to get hit by either of those).

NB: We're scheduling Fall Cav's, just drop us a line to claim yours. It's easy, fun, and a nice little traffic bump.

Tuesday, August 20, 2013

LTCi - Ch-ch-changes (NOT good news)

As we noted last Fall, Long Term Care insurance rates for the fairer sex have been artificially flat for quite a while, and were due for some "adjustment" (read: increase). Recently, my good friend (and home town LTCi guru) Chris van B emailed that "actuarial data shows that 67% of LTC insurance claims go to females. As a result, two of the largest carriers, Genworth Financial and John Hancock, have introduced gender based rates."

In English, this means that unisex rates (where males subsidize females) are on the way out, at least for these two carriers (although thus far Hancock is the only carrier to have these new rates approved in Ohio). It seems no stretch that they are but early adopters, and that other carriers will soon follow suit.

And speaking of John Hancock and LTCi, they're about to bail on the Golden State's long term care Partnership Program. And of course, they explained this in the simplest of terms:

"Sales of the California partnership program policy have been modest, and "we have found that the strategic direction of our LTC products and markets no longer synchronizes with California partnership regulatory requirements," the company said in a memo to producers."

Uh-hunh. That's insure-speak for: "we haven't been selling enough of these policies to make it worth our while to continue even trying." One hopes that this is an outlier, because the Partnership Program is a great deal for seniors and wannabe-seniors.

Life Imitating A News Article, Imitating Life

While having lunch the other day, I was talking with two physicians, one retired from active practice and the other having practiced for close to 30 years. The conversation turned to physicians today and the financial difficulties they face. Retired Physician was a Cardiologist. With steady decrease to medical reimbursements over the years, Retired Physician made less money each year he practiced, while his skill and expertise increased. Since medicine is paid by a piece meal basis, payment is for each patient served and the only way to make more money is to see more patients, physicians are burning out and going broke.

This isn't a big secret; a recent CNN piece noted that  “[t]his quiet reality, which isspreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

As our conversation continued, Retired Physician lamented that as his practice grew (at one point there were 49 employees), his pay and his partners' pay continued to decline as more money went into payroll, benefits, malpractice and overhead. Even though he had never been sued, his malpractice insurance premiums continued to rise each year. What finally made him retire was when he had to make a decision about which long-term employees to let go (some had been with the practice for 20 years) in order to stay in business, or what benefits to cut in order meet other financial requirements.

Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year.  "And we still barely made payroll last paycheck," he said. "Many of us are also skimping on our own pay."

What we all agreed on was that with the low reimbursements and growing federal regulations, medicine is not the once-lucrative business that had attracted our best and brightest. Today’s physicians will face a lower standard of living due to higher debt to pay back and lower incomes.

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat.  "Many are too proud to admit that they are on the verge of bankruptcy," she said. "These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them."”

Medicine in America, motivated by success, had become the stalwart in the world. Our physicians, considered to be the leaders in medicine, had breakthroughs that have increased our life spans and our quality of life. Diseases, once life sentences, have been conquered and others have treatments that allow individuals to continue to live productive lives. How have these men and women been rewarded? By facing constant cuts to their very livelihood, they may not be able to continue to practice their chosen profession.

On average, there's a 10% to 15% profit leak in a private practice," he said. Much of that is tied to money owed to the practice by patients or insurers. "This is also why they are seeing a cash crunch." "The economics of providing health care in this country need to change. It's too expensive for doctors," he said. "I love medicine. I will find a way to refinance my debt and not lose my home or my practice."

As we ended our lunch - a retired physician, a still practicing physician and a health care executive - we hoped that the business and profession of medicine would not end, but continue to grow and prosper.

Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy. That law says rates should be cut every year to keep Medicare financially sound.

Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary "patch," this dilemma continues to haunt doctors every year.”

Monday, August 19, 2013

New York Time comment section shows just how uninformed the public is

If you can somehow get past Krugman and how ignorant of basic facts he is, the comment sections are somehow even worse. What you have to wonder are people just being this dishonest or are they really this clueless?

"VikramPhatak,Austin, TX

I am also the owner of a rapidly expanding busines. (Mine is in computer security and I have 48 employees.) Average salary is $90K+ and we already offer health benefits.

I am having the exact opposite experience. Health insurance premiums are set to go DOWN by nearly 50% in October, saving the company $35K/mo ($420K/yr). That savings will enable me to hire 4 more people, while increasing profits for investors.

Apparently my savings are due to no longer having to pay for freeloaders. As a proud Texan and entrepreneur I am happily surprised by Obamacare."

Where to start;

Rates going down in October means this is a pre-community care  rating renewal. The only ObamaCare feature that could account for any savings is MLR reform which is already in its second year so that didn't cause a 50% decrease.

Saving 35K per month means they were paying close to 70K per month for a 48 life group. All states have small group reform, the only policy I have ever seen close to $1500 per emlployee were $0 or very rich plans for very old and sick groups. Which would be helped, but not till January.

No longer having to pay for freeloaders is the give away this entire comment is BS, ObamaCare does the exact opposite. It guarantees coverage when people need it freeing then to wait till then to buy it. It also allows those with unhealthy lifestyles to stick the rest of use with a large portion of their expenses.

The last comment in the thread was a gem;

"I did have an associate atty who is not technically an employee (she is "Of Counsel") of the firm, but who has been on our health care policy for 15 years. She was unceremoniously kicked off as of Sep 1 and has been forced to find individual coverage, but she has health issues, the reason why she was kicked off in my opinion. She is not eligible for COBRA due to this stupid employment rule of the ins companies. This is a very serious matter for her, and her family. So our broker has been able to write her some kind of temporary coverage to "...get her to Jan 2014" when she cannot be denied coverage, though the matter will probably still not be a favorable as her current (former) coverage is. Talk about your "death panels."

Disgraceful. We need universal, single-payer coverage for all American citizens."

This is a law firm, complaining they can't cover a non employee on their EMPLOYEE benefit plan. Notice the call for single payer, but no offer from the law firm to you know actually hire the individual which would solve the problem right away. 

Ja, ve haff der insurance

As we move inexorably closer to a nationalized, single-payer health care system, it may be worth noting that another such system is fading, quickly:

"The German government abolished the three-year waiting period for an individual to move from state-regulated health insurance to private health insurance. This has lead to more Germans purchasing private cover."

But why would good German citizens turn up their noses at "free" health care? Pretty simple, really: they've "started investing in private health insurance products to gain access to better medical treatment, without having to pay expensive medical costs."

Remember when we had such a system?

Good times, good times.

Forever 21 no more

Forever 21, a store that caters to young people on a budget, is one of my daughter's favorite places to shop. And who can blame her? Great selection of fashion forward clothes and accessories at terrific prices.

But as with so many other businesses, especially those employing those same young people, the ObamaTax has bitten them on the tush, too:

"Popular clothing company Forever 21 is the first of what might be many companies to limit its non-management workers’ hours to 29.5 a week"

[ed: "first" ?! Au contraire!]

So what does this mean for those "non-management" employees? Well, the obvious affect is a smaller paycheck. But it's about to get smaller, since these innocent victims of the ObamaTax will now be forced to purchase health insurance, at an inflated cost, from the Exchanges.

Or pay a nominal fine penalty tax.

Gee, which do you suppose they'll choose?

If you like your current plan...So sad, Too bad

Much like Health Savings Account plans will be phased out under the ObamaTax, Garden State B&E (no, not that - "Basic and Essential") plans are on the chopping block:

"The bare-bones health insurance policy that’s been the plan of choice for New Jerseyans who can’t afford something better is set to go away next year ... B&E plans were meant to help young families get coverage and stanch the drop of enrollment in the individual health market, their relatively low price ... made them the most popular option for those who don’t get insurance through an employer or a government program."

Over 100,000 Garden State residents currently on these plans will now be shunted off to more expensive Exchange-based policies. While this may not seem like a big deal (NJ is home to almost 9 million souls), it's a big deal to folks who could barely afford even the minimal premiums ("as little as a couple hundred dollars a month for some people"), let alone removing even more choice from their health care financing menu.

And speaking of the ObamaTax, our friend Avik Roy has found an unpublished memo from the Congressional Research Service which notes that Ms Shecantbeserious and her minions have missed  about half of the scheduled deadlines mandated by the train-wreck. These include a "requirement for the Secretary to “develop requirements for health plans to report on their efforts to improve health outcomes” and "rules that would safeguard the privacy of medical records."

Must have given themselves a waiver.

Friday, August 16, 2013

Still Finding Out "what's in it" - Even More Controversy in the Abortion Controversy

Yahoo reports - and consider the source here:

"Under the health care law, insurance plans in the new markets may cover abortion unless a state passes a law prohibiting them from doing so. Plans offering coverage for abortion, however, may not use federal funds to pay for it."

By law Senators, Representatives, and their staffs must buy insurance thru an Exchange.  In Exchange plans, the government thinks it can force plan sponsors and insurers to provide abortion coverage.  But also by law, the OPM cannot use federal funds to pay for any plan that provides abortions.

So will members of Congress and their staffs have abortion coverage?  

Yes.  Unless, no.

Still Finding Out "What's In It" - Obamacare Navigators take precedence over Disease Prevention

This helps us understand the administration's true priorities with Obamacare.

"In a sign that HHS secretary Kathleen Sebelius is worried about Obamacare, she transferred some 20 percent of the money for the “navigators” from programs earmarked for disease prevention."

Well of course The Fair Kathleen is worried.  She can hear the onrushing train whistles, too.

But . . . notice she scraped up the extra funding from money appropriated for disease prevention.

I think this is yet more evidence to support criticism that has been present from the very beginning: the top-priority goals of  Obamacare are achieving maximum possible enrollment as a means of gaining maximum possible political control over the medical care delivery and financing system.  The goals of improving public health and reducing medical cost are clearly subordinate to the top-priority goals.

And this maximum possible political control would last until the end of time, or until the federal bureaucracy decides to give back that control to the people . . . whichever comes first.

Still finding out "what's in it" after 3 years - and counting.

Investors Business Daily posted this story online August 13 that suggests “If a charitable hospital treats a homeless person who staggers into the emergency room without insurance, it may be punished with taxes and fines."

IBD explains this is because a federal law known as EMTALA requires charitable hospitals to treat a minimum number of patients who can't pay.   If a hospital does not comply the EMTALA penalty is loss of tax-exempt status.  Yet ObamaCare requires everyone to have health coverage so in theory, after January 1, 2014 there won’t be any more patients who can’t pay.  This means charitable hospitals may have a hard time avoiding an EMTALA violation after January 1, 2014.   How will they keep their tax-exempt status?

The obvious way is for Congress to amend EMTALA.  But as a practical matter, I don’t think the federales will enforce the EMTALA penalty even if it’s not amended.

Why not?

Because if a charitable hospital treated only “a homeless person” i.e., some meaningless handful of non-paying patients, is it reasonable to believe IRS would act?  I think not.

On the other hand, I also doubt IRS would act if a charitable hospital treated a meaningful number of non-paying persons.  A public dispute over this puts IRS squarely on the side of denying treatment.  That would embarrass the IRS and the administration.  Even worse, it would reveal the continuing existence of a large number of uninsured people.  That of course would (1) discredit Obamacare, and (2) politically embarrass Obama . . . because he has promised America for years that his signature health plan will fix the uninsured problem.

So I doubt the conflict between EMTALA and Obamacare will have any material affect on any particular charitable hospital.

One other observation about the information reported by IBD:

Obamacare requires each charitable hospital to file a report to IRS once every 3 years "to prove that the charitable hospital is still needed in their geographical area."  And if IRS deems the hospital not needed?  Will it be forced to close?  As a matter of fact, no.  It will be forced to convert to a for-profit status.  That;s because it's not needed as a not-for-profit but still very much needed as a for-profit.  See?

Cavalcade of Risk #190: Call for submissions

Jacob Irwin hosts next week's Cav. Entries are due by Monday (the 19th).

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.

NB: We're starting to schedule Fall Cav's, so please consider hosting an edition yourself. It's easy, and it's fun, just drop us a line to claim yours.

Thursday, August 15, 2013

Pick a Plan - Any Plan at All

According to the president and his minions, this fall you will be able to pick a health insurance
plan from any number of offerings on the #Obamacare exchange. The pitch is, it will be just like shopping on Travelocity or Amazon.


Do either of those sites require full disclosure of prior income and tax information as well as a "best estimate" of future earnings? Am I required to invest 45 minutes of my time (according to CBO) to undergo a financial colonoscopy before I even BEGIN to shop for an airline ticket or book?
Mr. Nowak, a 48-year-old Indianapolis medical-spa owner, likes WellPoint. But he has been seeing an Indiana University-affiliated physician for five years, and "when you get a trust with a doctor, you want to stick with them," he said.
WSJ Online

If Mr. Nowak buys a policy from Anthem Blue Cross (his current insurance carrier), doctors affiliated with Indiana University Health system and their 19 hospitals will not be in network for exchange based policies. The Blue plan will be an HMO which means no coverage for non-emergency services administered outside the network.

Early estimates are that roughly HALF the plans offered on the exchange will be HMO contracts that severely limit the number of available par providers imposes severe financial penalties when consumers voluntarily use non-par providers.

Translation - you pay for everything out of pocket for non-par services.
Insurers are betting that consumers who buy plans on the exchanges will be willing to trade some choice and flexibility in order to get cheaper premiums. Smaller networks of providers generally translate to lower premiums, because insurers can negotiate discounts with health-care providers who will then have less competition for patients within the network.
In other words, price sells.

At least that is the game plan.

If you live in Los Angeles don't count on using UCLA Medical Center or Vanderbilt if you are in the Nashville area.

In some parts of Georgia, your only plan choice will be Blue Cross if you buy on the exchange. That may mean driving 100 miles or more to see a doctor or receive treatment in a par hospital.

Sound like a #trainwreck yet?

Or you can buy OFF exchange and have a greater choice of plans and providers.

So buying on the exchange is like buying an airline ticket online?


Don't like the hand you are dealt? Too bad. Time to ante up or fold.

Truth hurts

It isn't often that we praise insurance companies for intellectual honesty, but every once in a while one comes through. Case in point: Blue Cross Blue Shield (NC). The Tar Heel State's largest carrier "is warning potential patients about rising premiums and other problems."

While this may seem self-evident to anyone who's been paying attention to the train wreck, there are apparently still people who don't understand that adding millions of previously uninsured with no underwriting and using Community Rating models to set premiums is a recipe for disaster.

BCBS notices something that we've been saying for a while: that younger, healthier folks will likely choose the nominal fine penalty tax over the exorbitant premiums for a product they likely don't believe has much value.

And then there are the dim-witted folks who "call it fear mongering aimed at changing aspects of the law the insurance industry doesn't like, like the $100 billion in new taxes the industry will have to pay over the next 10 years."

Um, guys? The "industry" doesn't pay any taxes. They never have and they never will. No business pays taxes, ever. Sheesh.

[Hat Tip: FoIB Jeff M]

Health Wonk Review: Dog Daze (of August) edition

David WIlliams hosts this late summer round-up of interesting, provocative and always informative posts of health care wonketry. It's so hot, it's cool.

Wednesday, August 14, 2013

So, about those convenience items

Via email, UHC has informed us that Ms Shecantbeserious has (finally) settled on rules for the birth control convenience item mandate, which include four (4) substantive changes:
1.Modification of the Religious Employer Exemption (REE) definition.
2.Extension of the current Temporary Enforcement Safe Harbor (TESH) through Dec. 31, 2013.
3.Replacement of the TESH with an Eligible Organization designation for plan years starting on or after Jan. 1, 2014, including a new self-certification form for Eligible Organizations.
4.Requires that a health insurance issuer providing fully insured coverage or a third-party administrator that receives certification from an Eligible Organization provide direct payment for contraceptives services at no cost to the plan or its members.
With regard to the religious exemption issue, instead of having to meet 4 criteria to be eligible, an organization must meet only one:

"A “religious employer” now must only be organized and operated as a non-profit organization and referred to under Code section 6033(a)(3)(A)(i) or (iii), which refers to churches, other houses of worship, their integrated auxiliaries and conventions or association of churches, as well"

And if that's not clear enough for you, The Fair Kathleen has also introduced the "Eligible Organization Designation," which seems simple enough:

"An Eligible Organization is a non-profit religious organization with religious objections to covering contraceptive services. Those organizations that self-certify as an Eligible Organization may exclude coverage for some or all contraceptive services."

There's even a handy self-certification form that needs to be submitted by the end of the year.

You just knew there'd be a "but" in here somewhere, didn't you?

Well, here 'tis:

"Under the final rules, a health insurance issuer providing fully insured coverage that receives an Eligible Organization certification form must provide direct  payment for contraceptives services at no cost to the plan or  its members."

Why is it so difficult for the folks in Capital City to understand that nothing is "free?" All that happens here is the usual sleight of hand as insurers pad everyone else's premiums to pay this tax (and that's what this is, whether Ms Shecantbeserious calls it that or not). Or do they truly believe that pills and condoms grow on trees?

Wouldn't surprise me if they did, at that.

HumpDay LinkFest

■ Will they or won't they? Back in May, Patrick quoted Ron Pollack, Founding Board Chairman of Enroll America (EA), who told him that "Enroll America  has not filed to serve as navigators and has no intention of doing so."

Fast forward a bit, and we learn that EA is still a bit less than forthcoming about its role in the train wreck:

"Jessica Barba Brown, national communications director at Enroll America, says the exchange promotion team now has a staff of 130 and about 3,000 registered volunteers ... The campaign organizers said the Get Covered America campaign is a "metric-focused" organization but declined to discuss numerical goals for their outreach efforts."

So what, exactly, are those "tens of millions of dollars" doing? Inquiring minds want to know.

The Gem State, which had initially opted to design and run its own Exchange, has run into a spot of trouble:

"Idaho will be relying on the federal health insurance exchange for at least a year while it develops its own"

Turns out that they took a little too long in getting their Exchange planned out, let alone implemented.

Most folks love their chocolate, and now there's another reason to rejoice in the confection:

"In a study published [recently] in the journal Neurology, researchers reported that chocolate may help improve brain health and thinking skills in the elderly"

Some words of caution, though: the benefits appeared to accrue only to those who were already at higher risk of dementia, and it's not clear how long the affects actually last. But hey, it's a tasty way to potentially decrease one's risk of dementia.

FoIB Jeff M tips us to this news from the Tar Heel State:

"Triad Adult and Pediatric Medicine, Inc. will close its adult practice on S. Eugene St. in Greensboro on Aug. 30"

Now this might seem like a "local news story," but it's actually more significant: it affects some 20,000 patients, who will now have to find new health care providers. The bulk of these folks (70% or more) are currently uninsured. his means that, once they've bought their shiny new, government-mandated policies, they'll need to spend some quality time trying to find someone with whom to use them.

Good luck with that.

Tuesday, August 13, 2013

This is Another Fine Mess . . .

The comedy team of Stan Laurel and Oliver Hardy reigned supreme for years during the early
years of "talkies". Something that started out as a seemingly good idea often ended up going wrong which led to Hardy's admonishment of Laurel using the line "This is another fine mess you have gotten us into".

One could say the same of #Obamacare.
Now comes word that another costly provision of the health law—its caps on out-of-pocket insurance costs—will be delayed for one more year.
Obamacare contains a blizzard of mandates and regulations that will make health insurance more costly. One of the most significant is its caps on out-of-pocket insurance costs, such as co-pays and deductibles. Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for the any participant or beneficiary.”
In an effort to minimize the financial burden of Obamacare the administration has eliminated or delayed many provisions of the law that promised to lower the cost of health care.
The truth is, almost nothing in the law lowers the cost of health care but does manage to significantly increase the cost of health insurance.
Most of the provisions in Obamacare have only a nominal impact on insurance premiums and many that do have already been implemented. Annual caps and eliminating lifetime benefit maximums have already been applied to existing plans with a barely noticeable effect on premiums.
Frankly I have no idea why this latest announcement is news, nor do I understand how delaying this section of the law will have an impact on premiums.
The coming wave of cost increases, especially in the individual health insurance market, is due to a combination of "guaranteed issue" and community rating.
Obamacare is in reality, another fine mess.