Friday, February 28, 2014

My (last) new article is up....


"A professional insurance agent can provide timely, expert advice on both the types and amounts of coverage you may need, and you don't have to pay extra to access or benefit from it."

This is actually my last long-form article: they've changed the role of CEWs. I'm actually grateful for that, as well as the opportunity to "stretch" my writer's muscles.

Cavalcade of Risk #203: Call for submissions

Bob Wilson hosts next week's Cav. Entries are due by Monday (the 3rd).

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, February 27, 2014

'Huis Clos' Updated

Jean-Paul Sartre's 1944 classic "No Exit" described a group of (dead) people, forever locked in a room, trying to ascertain the nature of and reason for their punishment.

Fast forward 7 decades, and FoIB Jeff M alerts us to the story of 64 year old David Carpenter and his 62 year old wife, Sandra, locked in an even scarier scenario: the ObamaTax.

Seems that Mr C made a fateful and (as it turned out) costly mistake: he signed up for an ACA plan at the site. This would prove to be a disaster, since it turned out that he also began to receive his well-earned VA benefits this year. Since there's not supposed to be any "double-dipping," he needed to cancel his ACA plan forthwith.

That's when he turned to his insurance agent, Stephanie Sheffield. As a Marketplace-certified agent, she was prepared to do battle on the Carpenter's behalf, but quickly learned that "[w]hen there is something that needs to be changed on the policy through the marketplace, no one seems to know how to fix it — not people at the marketplace nor their supervisors."

So in addition to being breeding grounds for ID theft, it turns out that Ms Shecantbeserious and her crew have no idea how to actually service their customers' changes. As a result, the Carpenters could end up owing Uncle Sam some major bucks:

"Carpenter’s dilemma is that at year’s end, he’ll have to pay back any insurance subsidy ... $8,160 for the whole year."

That's a lot of scratch for a couple who've been funemployed for the last 14 months.

But remember:

Health Wonk Review: Marchin' like a lion edition

David Harlow hosts this week's round-up of wonky blog posts, with a little trip to the wild side.

What's so great about this edition is how seamlessly David weaves so many different posts together into a very compelling narrative.

Do check it out.

Wednesday, February 26, 2014

Tuesday, February 25, 2014

Dabney Coleman gets...

The last laugh:

Monday, February 24, 2014

TRAGIC Wins Shallow Victory in SHBP Battle

T.R.A.G.I.C, the teacher group we blogged about in January formed to protest #Obamacare changes to the Georgia SHBP (State Health Benefit Plan) won a shallow victory. State and local government groups and school systems that use SHBP as their health plan received an email today, announcing retroactive changes in the health plan.  

Readers may recall the uproar over the loss of copay plans and the announcement that BCBSGA was awarded the contract as the sole claims administrator for the health plan that covers 650,000 Georgia residents.

But Blue Cross was awarded the business in August of 2013 and there were no protests then.

During October SHBP particpants were given details on the new benefit packages. It was obvious there were no copay options. We had three choices, Bronze, Gold and Silver. All were high deductible HRA plans.

Where was TRAGIC then?

Crickets chirping

The state caved and agreed to overlay a doctor copay RETROACTIVELY to January 1, 2014. Yeah, that's going to be fun when Blue has to calculate refunds and then figure out if they restore dollars to an HRA or pay them to the policyholder.

So why is this a shallow victory?

The new copay's only apply to ER and doc visits.

Copay's do not count toward the major medical deductible.

SHBP participants still have the lousy Blue Cross POS limited provider network.

The Rx plan is still managed by Express Scripts. The amounts paid for Rx copay's still do not count toward the major medical deductible or OOP (out of pocket) limit.

Like I said. Shallow victory. The people behind TRAGIC fought to have doc copay's reinstated and completely missed the big picture.

Now that is tragic.

Coming soon to a hospital near you

In case you were (still) wondering about how the ObamaTax would affect your health care, well:

"The Royal College of Surgeons wrote to healthcare inspectors last year warning of “grave concerns” that too many people were dying in the south of the country because of long waits for heart surgery."

No, not Mississippi or Alabama (yet), but the quaint subset of Great Britain called Wales (soon to be Wails?). Turns out that there are (at least) "150 cases in which patients died waiting for life-saving treatment." All part of the grand scheme we call the Much Vaunted National Health System©.

But hey, at least it's "free," right?

Helping Sarah Kliff Solve Her Medical Bill Issue

Former WaPo Wonkblog health policy writer Sarah Kliff is a huge proponent of Obamacare and the expansion of health insurance. She's also been a recipient of excellent employer sponsored insurance benefits. Sarah has a problem. Here is what she tweeted:

2/20 at 11:27am
Sarah Kliff @sarahkliff
Received today an $820 medical bill that I was not expecting nor can I decipher because American health care.
2/20 at 11:35am
Sarah Kliff @sarahkliff
I've never tried to negotiate down a medical bill before, but excited for this new personal and professional adventure! 

  • Could it be that you went to a non-network provider?

These are the questions a professional advisor would be asking you. From there we would take your bill and your EOB and work with your provider and insurance company to have the claim fixed. It is NOT an easy process - something I'm sure you are finding out.

Friday, February 21, 2014

Taxpayer Give Away

If you want free money, where do you go? Not the lottery. Not lost and found. Jackson
Hewitt and H & R Block.
The store-front firm Jackson Hewitt is probably the most enthusiastic about the model.  Its staffers will complete and even mail the Medicaid paperwork for clients who are eligible for expanded coverage.  They are not licensed brokers so can’t sell insurance directly, but the firm has created a partnership with the commercial online insurance marketplace Getinsured which will help Jackson Hewitt customers buy coverage.
For no extra fee, Jackson Hewitt will figure your subsidy (and your penalty) when it prepares your taxes. And, if you want, it will send that information directly to Getinsured, where you can buy a policy.
Tax preparers participating in the largest wealth redistribution  scheme in the history of the United States.
Jackson Hewitt isn’t alone: H&R Block HRB +0.35% is partnering with the commercial online health exchange GoHealth to help people enroll through Block-branded online chat and phone support. In a pilot program, Block also will have insurance agents located in some Arizona tax offices.
Get your R.A.L. and #Obamacare at the same place. Why not food stamps and voter registration too?

Thursday, February 20, 2014

My new article is up...


"Long Term care annuities offer a simple an effective way to avoid paying out-of-pocket for Long Term Care insurance, and protect one from the possibility of future rate increases. They may also multiply the amount available to cover long term care expenses."

The California Push - A Potential Net Negative

Thanks to the "Lie of the Year" Covered California is able to claim victory. According to data released yesterday Covered CA has now enrolled over 825,000 people which is greater than the goal of 700,000 they had set back in September.

But as Lee Corso would say: "Not so fast my friend."

That little blatant lie President Obama told everyone about if you like your plan you can keep it will be the reason why Covered California can celebrate. The Covered California Board voted unanimously in November to not allow policy renewals for the 1,000,000 insured people to be able to keep the plan that they liked regardless of the President using his Executive power to reinstate them.

For those scoring at home, Covered California used their power to cancel 1,000,000 policies and so far has a total enrollment of 825,000. This is what the government calls a win?

Wednesday, February 19, 2014

Garcon, how much for the insurance?

Here's an interesting idea:

"The owners of Republique on La Brea have added a 3% fee to every bill to pay for insurance for every employee"

The idea is that, instead of paying for or subsidizing employees' insurance costs and reflecting that in the menu prices, the cost is unbundled and there for all to see.

I like this form of transparency.

On the other hand, some folks are concerned that they have "no way of knowing whether the restaurant will use the extra money for the stated cause."

Which is a valid objection.

So, what do IB readers think? An idea whose time has come or not?

In Medicine Teamwork Is an Invention of Administrators and the Government

I recently had the opportunity to give a team-building group exercise to my staff of Medical and Administrative professionals. The focus was on how to build a better team of individuals to better handle our increased patient load. In the beginning of the Seminar, I had everybody fill out an assessment as to how they felt we operated as a team. There were five categories to judge: Trust, Conflict, Commitment, Accountability and Results. The majority of the scores were low, demonstrating that this room full of people, who work with each other day in and day out, some for years, did not feel that they were a team.

Over three hours I discussed trust, conflict, communication, respect, personality types, the ego, how to disagree and how to come together as a group. We did numerous exercises to delve into these areas and discussed them as a team. At the end, when we are supposed to move into being a team, two members stated emphatically that they will never trust an administrator or any superior as long as they carried a license. So after three hours these people were no closer to begin working as a team than before.

Now I do need to make an observation: the Administrative Staff were more willing to work together for the common good than were the medical personnel. They were steadfastly islands unto their own.

So now I have twenty some people who instead of working together for the betterment of the organization, they will work for the betterment of themselves.

And that about sums up medicine.

The government has been attempting to make medicine a team event instead of an individual event. We use the term Provider instead of Doctor. We want to pay for a medical appointment based on how we judge the quality of the work, not for the work that was done.

For example, as an Administrator of an ASC (Ambulatory Surgery Center), I need to gather information on my GI doctors' Colonoscopy Documentation to report back to the government. When it is brought up to the powers that be that, gee,  maybe they should ask the doctors for this information, we are told this is a great opportunity to build a connection with our physician’s office.

In surgeries, there is a Time Out, where someone other than the doctor calls for a pause to review the case, make sure they have the right person, make sure they know what body part they are operating on, if an arm or leg, which side, etc. The doctor has to wait for the Time Out to finish before s/he can begin.

Government and Administrators have tried to pigeon hole medical people into being a team, when in reality medical people are, for the most part, lone wolves. They have been trained to think this way, that if they make a mistake only they will be held responsible and they will go to jail. As such, all medical people have the mindset of “Trust but Verify.” They will not agree to anything they are told, until they see the rule, policy, guideline in black and white, and even then, if they don’t agree with what they are reading, it is disregarded.

So the battle will rage on between the Government that is trying to make medicine into their image and the medical personnel who will leave rather than comply, until medicine in America is fundamentally transformed.

Cavalcade of Risk #202 now online

Jeff Rose hosts this week's round-up of risk-related posts. From insurance riders to self-funding, data breaches and tobacco sales, there's sure to be something to pique your interest.

Tuesday, February 18, 2014

Aloha State 3600, Beaver State 0

So yesterday, we learned that Hawaii had spent north of $57,000 per to sign up some 3600 victims citizens on their ObamaTax Exchange.

But at least those 3600 folks did sign up (whether or not they'll actually pay up is another matter).

Things haven't gone so well in Oregon, however, where authorities have spent over $300,000,000 (that's 300 million dollars) to sign up ... well:

"...not even one person has yet to enroll online"

What a resounding success story!

They Can't Even Give This Stuff Away - Part 2

As Bob noted last week, a lot of folks may end up balking when it comes time to (literally) pay the piper:

"...roughly 50 percent of consumers who had supposedly enrolled for President Barack Obama's healthcare reform have missed their payment deadline for Jan. 1"

No big deal, right? After all, what's the worst that could happen?


"More than 6,400 people in North Carolina did not pay their first premiums for new ACA health insurance plans and, consequently, saw their coverage dropped"

So these folks went through the (not inconsiderable) trouble of wading through the wonky web site, verifying their income and other information, selecting a plan, and "pulling the trigger" on it, only to decide that "hey, it's just not worth it?"

And this is only folks in The Tar Heel State. Now multiply that by the other 57.

Not a pretty sight.

[Hat Tip: FoIB Jeff M]

Monday, February 17, 2014

$57,000 Aloha Fail

Another day, another ObamaTax "success" story:

"The Obama administration gave Hawaii $205 million in grants over the past three years to set up its state-run exchange"

So, one would presume that plenty of uninsured Hawaiians signed up for a shiny new health "care" plan, right?

Well, not so much:

" far, only 3,614 Hawaiians have filled out applications"

Remember, filling out an app is not the same as actually buying a plan, so we really have no way of knowing how many Aloha State citizens actually bought coverage (let alone how many have paid for it). But even with the benefit of the doubt, this means that each enrollee cost you and me almost $57 large. That's a lot of health care, no?

But that's still not the best part:

That 3,600 means that their best case scenario was to sign up 9,000 victims souls. Really? Given that about 1.4 million folks live in The Aloha State, and assuming 15% are uninsured, shouldn't their goal have been (at least) 180,000?

Ah, the soft bigotry of low expectations.

[Hat Tip: Ace of Spades]

Saturday, February 15, 2014

So now it's Copper. Can Tinfoil be far behind?

From WSJ February 13th (password protected, sorry):
"Some backers of the 2010 health-care law are pushing to create a new kind of insurance coverage that the measure essentially had ruled out: policies offering lower premiums but significantly higher out-of-pocket costs than those now available . . . dubbed "copper" because they would offer a lower level of coverage than the "gold," "silver" and "bronze" options on the government-run health-care exchanges . . . would be a departure from the minimum level of coverage that is one of the Affordable Care Act's core principles."
Seems clear to me the awful truth is dawning on more and more people that Obamacare is not worth its cost.  Just as clearly, it looks like there is mounting disarray within the administration over what to do about it.

My take:  sooner or later Dems must come to realize that their pedals aren’t really to the metal.  The Obamacare insurance tactics are not capable of solving the underlying problem – which is high medical delivery costs. High insurance costs are symptoms of the problem – not the problem. That helps explain why tinkering with insurance has failed to solve the problem for more than 50 years.

What’s perhaps worse is that our politicians and so-called thought leaders have done such a miserable job of educating the public on the nature of the underlying problem. So public attention is focused on symptoms not the disease; the public is told a cure is at hand when it is not; and meanwhile the problem just continues to worsen.

Even Tinfoil won't stop that.

Friday, February 14, 2014

Cavalcade of Risk #202: Call for submissions

Jeff Rose hosts next week's Cav. Entries are due by Monday (the 17th).

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, February 13, 2014

Obamacare Fraud Connection

The hits just keep on coming. You can't make this stuff up.
The director of Colorado’s health exchange has been placed on administrative leave after the state discovered she had been indicted for stealing from a non-profit,
National Review

In fairness, the indictment is not related to her current position as director of the CO exchange.

But still . . .
The 12-page indictment alleges that, while serving as executive director of the federally funded Housing Montana, McClure, between 2008 and 2010, paid herself “significant sums” for consulting services, although she was already on the payroll as a full-time employee.
She also made payments to her family and used federal money for personal travel, to pay family bills and to buy consulting services, the indictment alleges.
She also is accused of charging homeowners for a $750 warranty that did not exist, converting a laptop for personal use, inflating the hours she was to be compensated and writing herself a $21,000 check to which she was not entitled.

Her pre-employment background check turned up nothing, but it seems she should have disclosed her past history.

My new article is up ...


"Americans who are on Medicare due to serious health conditions have limited health insurance choices. For many, a Medicare Advantage plan may be the most efficient means to supplement their Medicare coverage."

They Can't Even Give This Stuff Away

The latest #ObamacareFail numbers are in and it isn't pretty. Just when you think it couldn't get worse, it did.
The White House has been dealt a stunning new blow on Obamacare sign-up numbers with reports showing that only about half of the people "enrolled" at healthcare exchanges in various states have actually paid their premiums.

With the March 31 deadline for enrollment just seven weeks away, the number of sign-ups in federal and state marketplaces has slowed down to an alarming figure since the sudden surge in the latter part of December and early January.

But wait. There's more.
But the bigger problem for the Obama administration is that roughly 50 percent of consumers who had supposedly enrolled for President Barack Obama's healthcare reform have missed their payment deadline for Jan. 1, according to Investor's Business Daily's website

Community organizer fail.

Health Wonk Review is up .. and there's a lot to love!

Steve Anderson hosts this week's round-up of wonky posts. Nice job, too: you can never go wrong with Valentine's Day candies!

Do check it out.

Wednesday, February 12, 2014

We Interrupt This Train Wreck....

This just in from HHS Secretary Shecantbeserious (via email 3 days from the end of the initial ObamaTax Open Enrollment Period):
"From Saturday 2/15, at 3:00PM EST until Tuesday, 2/18 at 5:00AM EST, the Social Security Administration (SSA) will conduct annual systems maintenance activities ...  During this period, verification of Social Security Numbers and other related data that is accessed via the Hub will be unavailable."
Oh, wonderful. But certainly one can at least access the main site, right?


"Individuals attempting to complete the application process on during this period .... will not be able to immediately receive an eligibility determination/assessment from the Marketplace."
Of course.

How Refreshing!

As regular readers know, agents that want to sell Partnership-compliant Long Term Care insurance (LTCi) plans must re-qualify every two years via a 4 hour "refresher" course. This helps to ensure that we're as up-to-date as possible on the latest LTCi news and policies.

Since my last one was in February of '12, I was due, and so spent this morning under the expert tutelage of Ray Copenheaver, CLTC, LTCP. As always, there was quite a bit to absorb, including news on deductibility of premiums (it just got harder) and on "gifting" to avoid Medicaid eligibility issues (you need to plan sooner).

But we also learned some other more positive tidbits, one of which I'll share here:

Two of the biggest objections folks have to even considering buying a plan is the premium and the (justifiable) fear of rate increases. A lot of the former is dependent on one's age and health, and what level of benefits one chooses. But there is precious little that one can do about the latter: if a carrier is going to increase rates, it's going to increase rates.

But there are a number of plan designs that allow one to bullet-proof one's plan against rate increases, and one of them is made possible by the PPA (no, not the PPACA): the Pension Protection Act that took effect 2 months prior (in January of 2010). One of the key provisions of the PPA is that it made it possible for carriers to offer a special kind of annuity: one that, in addition to tax deferred growth, offers tax-free long term care benefits.

Very cool.

Here's an example:

John and Mary own a non-qualified annuity (that is, it's not tied up in an IRA or other similar vehicle). Their original $50,000 deposit has now grown to a hefty $100,000 (hey. it could happen!). In ordinary circumstances, the $50,000 gain would be taxable. So if one of them needed long term care, they really have only $85,000 available (the original $50,000 plus whatever's left of the gain after taxes). Ouch.

But under PPA rules, they could trade in this annuity for one with an enhanced long term care benefit, and effectively double their long term care funds. In our scenario, the $100,000 "enhanced" annuity includes a $201,000 long term care "pool" from which either could draw to fund long term care, and these are paid out tax-free. Nice.

The downside, such as it is, is that if neither of them ever need long term care, the initial $100,000 (plus interest) is passed along to their beneficiary as a taxable instrument. Still, that's what would have happened had they kept the original plan, so no harm, no foul.

Since the plan is paid in a lump sum, there's no danger of any rate increase. and presuming that this was money that John and Mary weren't living on, it's not a direct out-of-pocket expense like a pay-as-you-go plan would be.


Tuesday, February 11, 2014

What Fresh Hell is This?

So on the one hand, the Obamastration has magically (and illegally) suspended the employer mandate for medium-sized groups.

On the other, it's adding an onerous new (and also illegal) reporting requirement:


There's a term for countries that are run this way....oh, yeah.

I Hear the Train a Coming

Introducing the Eventual Care Act

As Nate mentioned yesterday afternoon, the Obamastration has once again kicked the ACA can down the road:

"The Obama administration announced Monday it would give medium-sized employers an extra year, until 2016, before they must offer health insurance to their full-time workers"

Thus illegally postponing - again - the Employer Mandate.

Whoa there, Henry! Did you just call this illegal?

Why yes, yes I did.

And here's why:

"The final words in the section of [the ObamaTax] mandating that employers with more than 50 full-time employees provide their employees with “minimum essential coverage” imposes a specific statutory deadline for doing so. It says: “EFFECTIVE DATE.—The amendments made by this section shall apply to months beginning after December 31, 2013.

Notice it does not say "shall apply to months beginning after December 31, 2013, or whenever the President feels like it."

And yet, here we are (again).

So here's my question: if the ObamaTax is such a great idea, and if it is so vitally urgent that we insure as many Americans as possible as quickly as possible, then why in the Wide, Wide World of Sports is the President constantly putting it off?

[Hat Tip: FoIB Brian D for the "ECA"]

Et Tu Brute Lauer?

The secret is out. #Obamacare is no longer a train wreck. It is a sinking ship. 

Gary Lauer, chairman and CEO of Internet-based health insurance broker eHealth, said he no longer has confidence Obamacare can work in its current state. "We're stuck in this kind of abyss where it's all being left to government to do this. And just it's not going to work that way."
Consumers can come to eHealth for insurance, but Lauer's company is unable to process subsidies.
"If you're lower income right now, you can only go to a government-run exchange," 
That would be the same exchange that was designed by a Canadian firm with suspicious ties to FLOTUS, stumbled out of the starting gate, and still hasn't worked out a system to pay subsidies to carriers.
"It's much like saying, 'If you're low income, you can only ship a package through the Postal Service. If you're higher income, you can use FedEX or you can use UPS,'" he added. "We're working with the federal government to change that, and trying to get a few states to come around."
I wonder if the captain will go down with this ship or be on the lifeboat with the women and children.

Monday, February 10, 2014

It doesn't pay to plan if you own or run a business

I am going to go broke if I keep planning ahead on how to assist clients in meeting their needs and ACA requirements.
"The Obama administration announced Monday it would give medium-sized employers an extra year, until 2016, before they must offer health insurance to their full-time workers. Firms with at least 100 employees will have to start offering this coverage in 2015"
Good news if you're a business with 50-99 workers

Self Funding and Community Rating

The early results look very promising for self funding: if you are among the 80% of groups that were average or good health looking at a bad renewal under ACA, self funding rates are providing some relief.

Not all is smelling roses though; while worst case self funded is coming in better than ACA rates, they are not as low as current rates before the ACA renewal. While only 3% or so of groups with Agg have that worse year, employers are still having to get comfortable taking on risk and potential cost higher than a normal renewal.

They are also having to quickly learn the basics of self funding and be aware of some tricky fine print. Many of the self funded products offering to protect small groups from ACA have some traps of their own. They return only a portion of the savings, often as a credit only after renewal.

This means if they come in $60,000 lower then worst case, and what the group funded, they only get $40,000 back. That $40,000 credit also requires they renew with the carrier regardless if they feel the renewal offer is fair. There were carriers in the past that knew they could stick groups with a bad renewal because the cost to leave them was so exorbitant. For example, assume a 40 employee group came in $120,000 under max and thus was entitled to a $80,000 credit. If another carrier beat the current carrier by $60,000 on the renewal rates it would cost the employer $20,000 to change due to the lost credit. The in-force carrier obviously knows this, so they can pad the renewals for any case that had meaningful savings.

Still better than paying guaranteed higher ACA rates but some unlucky employers are going to lose a lot of savings if they aren't careful what self funded solution they go with....out of the pot and into the frying pan!

Medical ID Theft Rampant

We first started covering this phenomenon almost 8 years ago, when Bob noted  that one problem arising from theft of your medical data is that "you could end up being treated based on someone else's medical history"

It may be difficult to overstate the problem:

"Most identity theft in the United States is medical-related ... In 2012 alone, medical identity theft increased by nearly 25 percent, affecting 1.85 million Americans"

Ms Melchior notices something else we've pointed out, namely:

"... as many as 31 states do not conduct background checks on Obamacare navigators, who have access to enrollees’ names, Social Security numbers, financial records, and health information" [emphasis added]

And of course, this also doesn't include the hacktastic nature of the 404Care site.

Perhaps we need to more aggressively market ID Theft insurance.

Out of the frying pan and into the Exchange

Last month, we reported that Ms Shecantbeserious had unceremoniously dumped the Exchange website's Canadian contractor CGI for the winsome folks at Accenture. It was hoped that bringing in "new blood" would staunch the metaphorical hemoraging caused by CGI's apparent incompetence.

Ms Kathleen chose poorly:

"Accenture, the contractor hired to fix ongoing problems with the federal health exchange website, has been heavily criticized by some of its largest clients, including federal agencies ... the U.S. Postal Service Inspector General's Office recommended this past June that the agency consider terminating more than $200 million in contracts with Accenture"

When even the notoriously inefficient Post Office is calling you out, then you have a problem.

The Problem with Grandpa [UPDATED]

Well, Grandfathered policies. These are the plans that ostensibly fulfilled the empty promise that "if you like your current insurance, you can keep your current insurance" As we now know, this applied only to folks who made no substantive changes to their existing health insurance plans.

I'm fortunate to have a handful of clients who did not, in fact, make any such changes and whose plans are "grandfathered in."

Unfortunately, they won't be for long. Last week, one of my grandfathered clients received his 2014 renewal, along with a 28% premium increase. And there's nothing he can do about it because if he chooses to, for example, increase the deductible in order to rein in the premium, he loses grandfathered status.

So his only real choice is to pull the trigger on a new, ACA-compliant plan. In his case, this could actually save him substantial dollars versus his renewal. And because he's fortunate enough not to qualify for a subsidy, he can avoid the misbegotten Exchange. Of course he'll have higher out-of-pocket costs, and the knowledge that he could not, in fact, keep his current plan.

And he has to make his decision in the next few days if he wants a March 1st effective date.

Nice little policy you have there; be a shame if something were to happen to it....

UPDATE: In the comments, Nate points out - quite correctly - that a viable alternative to the challenge of grandfathered plans is to self-fund. Not sure how that works? Never fear, Nate has the answer here.

Saturday, February 08, 2014

No Third Party Checks

Just like at the liquor store, you can't use third party checks to buy health insurance either.  No Schlitz Malt Liquor. No Obamacare.

Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage under President Barack Obama's healthcare reform are in danger of being thrown out of the insurance plan they selected in a dispute over federal subsidies and the interpretation of federal rules about preventing Obamacare fraud.
Some healthcare advocates see discrimination in the move, but Blue Cross and Blue Shield of Louisiana says it is not trying to keep people with HIV/AIDS from enrolling in one of its policies under the Affordable Care Act, also known as Obamacare.
The state's largest carrier is rejecting checks from a federal program designed to help these patients pay for AIDS drugs and insurance premiums, and has begun notifying customers that their enrollment in its Obamacare plans will be discontinued.
The carrier says it no longer will accept third-party payments, such as those under the 1990 Ryan White Act, which many people with HIV/AIDS use to pay their premiums.
No more fraud, right?
But this is much more. It is the right hand not knowing what the other hand is doing.
In September, CMS informed insurers that Ryan White funds "may be used to cover the cost of private health insurance premiums, deductibles, and co-payments" for Obamacare plans.
In November, however, it warned "hospitals, other healthcare providers, and other commercial entities" that it has "significant concerns" about their supporting premium payments and helping Obamacare consumers pay deductibles and other costs, citing the risk of fraud.
So which is it?
You can't have it both ways.

Friday, February 07, 2014

My new article is up...

Covered CA and Accountability

Got a laugh out of this today:
Dana Howard of Covered California admitted it was responsible but said, “It really isn’t feasible for Covered California or any entity to check thousands upon thousands of doctors to make sure that the information that they are providing is accurate.”
 Actually it is: just about every insurer and TPA in the country has been doing it for over a decade. Granted, there will always be an error here and there but nowhere close to the level of incompetence Covered California has achieved.

Open Wide ... Take 2

Late last summer, we discussed one of the ObamaTax's "Essential Health Benefits," Pediatric Dental. At the time, we noted that, if nothing else, it represented a major windfall for orthodontists.

Fast forward 6 months or so, and we have this rather uninformed update on how Pediatric Dental coverage is being implemented here in Ohio. As FoIB Holly R tips us:

" other pieces of the Patient Protection and Affordable Care Act, it’s not so simple. That’s because the federal government ruled that dental coverage for kids can be left out of medical plans sold in most states, including Ohio and Indiana."

The author of the piece seems to imply that carriers will use this "loophole" - which is, in fact, specifically encouraged by the ObamaTax itself - to avoid including Pediatric Dental coverage.

Not so fast there, Lisa B-K. Turns out, quite a few carriers continue to offer PediaDent cover:

Anthem requires PD whether or not there are any children actually on the plan, and include a $5.20 charge for this cover regardless. Which seems seems as fair as charging single men and post-menopausal women for birth control convenience items.

Medical Mutual of Ohio says that those with adult only (no children) coverage can waive PD cover, buit those with children are required to enroll. They may, however, unenroll from this cover if they have valid comparable other dental insurance coverage.

Humana's PD coverage, like Anthem's, is "baked into the cake;" that is, it's included whether or not you want it (or need it). Same with United Healthcare/Golden Rule. There is no "opt out" provision, so one is charged for a benefit that one cannot ever use.

How nice.

[Thanks to Kelly V for her clear and concise explanation]

Thursday, February 06, 2014

Harbinger of things to come?

FoIB Jeff M tips us to this interesting story out of North Carolina:

"Montgomery County employees are facing a change in regard to medical insurance coverage ... their recommendation to discontinue providing medical insurance to employees and to assist employees in pursuing insurance though the Marketplace"

As we've repeatedly mentioned here at IB, this is, in fact, the wave of the future: employers dumping their group plans and shunting their employees off to the Exchanges.

So much for "if you like your current plan, you can keep your current plan." We've already seen this playing out in the individual market, and group is on deck.

But it's the last line of the Herald story that piqued my interest:

"This assistance will include navigational, choice information and financial assistance" [emphasis added]

Here's the problem: under the train-wreck, groups can no longer use Health Reimbursement Arrangements (HRA's) to subsidize premiums. Jeff asked whether or not the employer could provide a "stipend" to each employee to help with the cost of insurance and, if so, what effect that would have on said employees' taxes.

I suspected that I knew the answer, but sought confirmation from my HRA gurus at FlexBank, who did not disappoint. Years ago, we used to fund some key employees' life insurance plans through something called an Executive Bonus. This was simply a fancy way to give the employee the money to pay for a personal life insurance plan, and it was (of course) included on their W-2's.

This seems to be the only legitimate arrangement open to the folks running Montgomery County; one suspects that the employees being unceremoniously dumped from their current health plans will be none too pleased to see the extra tax liability.

Talk about adding insult to injury (neither of which, apparently, are covered under the ObamaTax).

Hitler Can't Keep His Doctor Either

Wednesday, February 05, 2014

Stupid Theoretical HHS Tricks

On the one hand, Ms Shecantbeserious relies on licensed (and trained, and who have been background checked) agents to "push" Exchange policies. On the other hand, she's an idiot:

"[Ms Kathy] strongly suggests that agents and brokers not use 'Marketplace' or 'Exchange' in the name of their businesses or websites ... QHPs cannot discriminate based on disability, age or health needs."

As to the first: why the heck not? Far be it from me, a lowly insurance agent, with a measly 30+ years of sales experience, to edumacate The Fair Kathleen on how to market insurance, but that is exactly the kind of product identification you want to encourage. After all, would-be Exchange victims customers are looking for, you guessed it, the term "Exchange."

As to the second, well, that's pretty dumb, too. Here's a dirty little secret, Kathy: as agents, we don't care who buys a plan from us - old, young, fat, skinny, healthy or sick - we want to, you guessed it again(!), sell insurance. Last I looked, no carrier pays us commissions on plans we don't sell.

Perhaps the best part is that these are currently cast as "suggestions." Who wants to bet on their codification?


Obamacare Non-Help Line

Did you buy an #Obamacare plan through the #exchange? Have you received your policy or ID
cards yet? Washington, we may have a problem.
Thousands of Americans who have asked the federal government to fix errors on their Obamacare applications aren’t likely to get solutions anytime soon, according to internal government data obtained by The Washington Post.
Some 22,000 Americans have filed appeals over errors made while applying for health coverage on, the website for Obamacare’s federal exchange, the newspaper reported. Those errors have included being pushed into the wrong program, receiving incorrect subsidies or insurance payments, and being denied coverage entirely.
Hey. Mistakes happen. Should be easy to correct, right?
But’s system won’t allow federal workers to go into enrollment records and make any changes to the applications. Washington Post reporter Amy Goldstein wrote. “The Obama administration has not made public the fact that the appeals system for the online marketplace is not working,” the story said, noting that the administration is more focused on other parts of that don’t work, such as the payment processing system.
Sounds like the Russians built the system.
Maybe they did . .
U.S. intelligence agencies last week urged the Obama administration to check its new healthcare network for malicious software after learning that developers linked to the Belarus government helped produce the website, raising fresh concerns that private data posted by millions of Americans will be compromised.
The intelligence agencies notified the Department of Health and Human Services, the agency in charge of the network, about their concerns last week. Specifically, officials warned that programmers in Belarus, a former Soviet republic closely allied with Russia, were suspected of inserting malicious code that could be used for cyber attacks, according to U.S. officials familiar with the concerns. 
As my friend Henry says, Oy!

Cavalcade of Risk #201: Understated edition

Russell Hutchinson hosts this week's round-up of risk-related bloggetry, with a soft voice and interesting context. Plus, he's come up with a great logo for the CoR, which I am shamelessly pilfering from him.

Thanks, Russell, for hosting and for the logo!

Tuesday, February 04, 2014

You Won't Believe Obama's Response

During a Google Hangout session on Friday, fry cook Darnell Summers told
President Obama that his hours were cut due to the Affordable Care Act. 
If you are expecting the president to be sympathetic and responsive, well, you won't believe this.

The president responded by urging states to increase the minimum wage. “I am working to encourage states, governors, mayors, state legislators to raise their own minimum wage,” Obama said.
Out. Of. Touch. 

The Affordable Golf Club Act

[If you have old golf clubs, you can keep your golf clubs....until April 2014.]

Until now, typically only the wealthy or financially responsible have been able to purchase new golf clubs without the assistance of their government.

This new law ensures that every American can now have "affordable" golf clubs of their own, because everyone is equally entitled to new golf clubs. And if you want to keep the golf clubs you already have, you can do that, until April 2014.

These affordable golf clubs will cost from $1,000 to $3,000 each depending on your income level. This does not include taxes, pull cart, electric cart fees, green fees, membership fees, balls, tees, gloves, range finders, storage fees, maintenance, or repair costs.

In order to make sure everyone participates and purchases their affordable golf clubs, the costs of owning golf clubs will increase 50% each year up to 400% by year 2018. This way, wealthy people will pay more for something that other people don't want or can't afford to maintain. People who can't afford or refuse to maintain their golf clubs will be fined. However, children under the age of 26 can use their parents’ golf clubs until they turn 27 at which time they must purchase their own golf clubs.

If you don't want or think you don't need golf clubs, you are still required to buy them. If you refuse to buy a set or make claims that you can't afford them, you will be fined $800 until you purchase a set or face imprisonment.

People living in farming areas, ghettos, inner cities, Wyoming, or areas with no access to golf courses are not exempt. Age, health, prior experience or no experience are not acceptable excuses for not buying, maintaining, and using your golf clubs.

A government review board that doesn't know the difference between a hook and a slice will decide everything. This includes when, where, how often and for what purposes you can use your golf clubs along with how many people can ride in your golf cart. The board will also determine if participants are too old or not healthy enough to be able to use their golf clubs.

They will also decide if your golf clubs have outlived their usefulness or if you must purchase specific accessories, like a range finder with slope adjustment or a newer and more expensive set of golf clubs.

Those that can afford memberships at expensive golf country clubs will be required to buy memberships. If you are already a member and you like your  membership you can keep your membership. After April 2014, a different country club will be assigned for you to purchase a membership.
Government officials are exempt from this new law as they and their families and some of their friends and a few of their friends friends can obtain golf clubs at taxpayers expense.

[Hat Tip: FoIB Sandy M]

Monday, February 03, 2014

How Obamacare Impacts Healthcare in Southwest Georgia

If you live near Albany, Georgia health insurance has never been cheap but for most it was
affordable before #Obamacare. The community rating requirements lumps citizens into 16 geographic regions for rating purposes. If you live in southwest Georgia your rates are some of the highest in the country.

But only if you buy on the healthcare exchange, and only if you buy from Blue Cross of Georgia.
All the dynamics that drive up health costs have coalesced here in Southwest Georgia, pushing up premiums.  Expensive chronic conditions such as obesity and cancer are common among the quarter million people in this region. One hospital system dominates the area, leaving little competition. Only one insurer is offering policies in the online marketplace, and many physicians are not participating, limiting consumer choice.
Kaiser Health News

Community rating, which did not exist in Georgia prior to Obamacare, requires health insurance carriers to factor in the total health of the community along with the cost of health care in that area. 

Further complicating this Obamamess is the principle hospital in the area, Phoebe Putney.
Phoebe's dominance has also grown as it has purchased more physician practices. "Doctors you thought would never work for Phoebe are now Phoebe employees," said Sue Luckie, an insurance agent in nearby Leesburg. 
Phoebe Putney and BCBSGA have never been friends, but it is much worse under Obamacare. 

If you bought a Blue Cross plan, on or off the exchange, and lived in the Albany area, there are no participating hospitals in their network for 100 miles.

But when you search plans outside of the exchange you will find several plans that include Phoebe Putney and their premiums are much lower than Blue Cross.

Sounds like time to change your insurance, but you need to do so before March 31, 2014. After that you won't be able to buy health insurance until the next open enrollment beginning November 15, 2014.

That's something else you probably didn't know about Obamacare.