Cavalcade of Risk #207 - Workin' Hard for Risk edition

Rebecca Shafer hosts this week's round-up of risk-related posts. It's particularly interesting to see such a wide variety of topics, including Wounded Warriors and venture capitalists, Aristotle and ERM.

Do check it out.

Told Ya So (Part XIV)

As we've noted for a while now, a plurality (if not a majority) of those signing up through the Public Exchanges have enrolled in Medicaid, not "commercial" insurance plans. This is itself problematic not just for the sustainability of the ObamaTax, but as it turns out, for the newly-enrolled themselves:

"States are working through hundreds of thousands of backlogged applications due to Obamacare’s Medicaid expansion, but the administration is threatening to cut funding for dealing with them."

Since Medicaid is run by the 58 states, this creates somewhat of a dilemma: are the states capable of cutting through the backlog (let alone funding these new beneficiaries) or are their citizens destined to hang in Medicaid limbo for the foreseeable future?

By withdrawing not just active support, but actual financing, how are the states supposed to process this influx?

A partial answer comes from HHS Secretary Shecantbeserious herself, whose grasp of logic (if not common sense) is underwhelming:

"[She] theorized that looming cuts would incentivize states to get their backlogs under control as soon as possible."

Alternate version: the chocolate ration has been increased from 20 grams to 15.

ObamaTax Navigators: What are they hiding?

Y'know, for "the most transparent administration ever," Ms Shecantbeserious and her minions sure do like to keep their little secrets. Problem is, these secrets affect each and every one of us, often in ways we may not even be aware of.

Take, for instance, the care and feeding of Navigators. We've been exposing their potential for massive fraud for quite a while. The folks at Judicial Watch have kicked it up a notch, though:

"Judicial Watch announced a lawsuit ... against the Department of Health and Human Services after officials failed to comply with a November 8, 2013 Freedom of Information Act Request about Obamacare navigators."

According to the Feds, there are some 50,000 Navigators out there preying on innocents plying their trade. That's a lot of unlicensed, unvetted, unaccountable folks with access to your private medical, financial, health and tax information. It doesn't seem unreasonable that we, the public, should understand exactly how (or even if) Navigators are trained, and what safeguards are in place to prevent massive identity theft.

And it's fair to point out that Ms Kathy herself has admitted that many, if not most, Navigators may be felons, as in California, where "at least 43 convicted criminals have worked as navigators and handling sensitive information of private citizens."

Warm fuzzies, no?

Of course, that's not to say that it's all work and no play for these hardworking Navigators:

"On a call outlining its strategy to get people to sign up for Obamacare over the summer, leading Obamacare advocacy group Enroll America said it will get more creative with its outreach tactics – including hitting up night clubs"

Which is ironic, since it's been virtually impossible to actually get through to the 404Care.gov site.

Not to mention, under what scenario will these victims would-be customers be eligible to sign up? The Initial Open Enrollment Period is over, and the next one is many months away. Under what pretext, pray tell, will these folks claim a Special Open Enrollment Period?

Inquiring minds want to know....

Vanilla is Vanilla

My kids love our favorite local ice cream joint. The soft serve isn't what draws them though. It is the fact that they have so many different choices of sundaes and toppings. From a "Mud Sundae" with crushed Oreos, hot fudge, and gummy worms to the quart sized "hot fudge cake" there is something for everyone.

All of that is about to change. Later this week legislation is being introduced on the Affordable Ice Cream Act (AICA). You see, the cost for these heavenly sundaes has been rising lately and the government feels that they need to step in and change the way people purchase the product and make it more affordable for everyone.

In order to make it affordable the government is setting standards for what is available. You will now only be able to choose from chocolate, vanilla, strawberry, and twist. If you are under the age of 12 you can get Neapolitan. The only variation of ingredients can be in the fat content of the dairy products you use. No longer will you be able to have any toppings and all serving sizes will be measured to the ounce. Because of this, every ice cream shop in town would now be the same. Prices will be close and the only difference will be in taste.

Everyone must purchase ice cream or they will pay a penalty. The only people who can qualify for an exemption are those who can prove that they are lactose sensitive (yes, there is a difference from lactose intolerant).

For the sake of "professional development" I told my boys about this crazy new law yesterday afternoon. The reaction from them was priceless. The older two didn't believe it and actually made fun of the thought that anyone would eliminate toppings. The four year old wasn't happy. He really believed that he wouldn't be able to get a twist with sprinkles and smiley face.

The next time you step up to order a Topsy Tervy - or my personal favorite the Buckeye Sundae - think about Obamacare. Because in the health insurance world pretty soon the most creative option left will be the basic cone with twist ice cream.

Plan cancelled! Understanding The Full Ramifications of "If You LikeYour Current Plan"

I've written extensively on the broken promise of "if you like your plan you can keep it" yet over and over again it keeps surfacing throughout media outlets. The most recent edition comes to us from a study done by Benjamin Sommers at Health Affairs. In his findings he shares that churn, turnover in the insurance market, is so high that policy cancellations "aren't out of the norm" for people who purchase individual health insurance.

There is no doubt that turnover occurs in this segment of the market. Most of these people are in between jobs and use individual products as a bridge back to employer coverage. Based on Sommers' data in 2012 there were 10.8 million people in the individual insurance market. 6.2 million leave this form of insurance annually. So we all need to calm down about the insurance cancellations as it only impacts 4.6 million people. That's his logic and, as many liberal media outlets are reporting, is the whole argument.

But. It's. Not.

Those of us who understand insurance markets know that this is much more widespread than what is being reported. The individual market isn't alone. It also hits small employer sponsored insurance plans which represent more than 23 million people. Every small employer will lose their current plan (unless grandfathered) over the next two years. This is guaranteed because of the strict requirements under Obamacare. These requirements include a provision called Actuarial Value (AV). AV is the amount of the average claims an insurance plan must pay under a policy. If a plan falls outside of one of the four narrow bands it must be eliminated.

Which brings us to another key problem - less choice. Government believes they know what is better for you than you do. By restricting the AV bands (Bronze, Silver, Gold, Platinum) they are eliminating a large number of insurance choices. What was available in 2013 is no longer the case in 2014. This chart explains how choice is restricted and where plans are being cancelled.

In 2013 employers and individuals could purchase insurance from insurers that had any AV. Every dot represents an insurance plan. You will see very good plans to very poor plans. Now that 2014 is here insurers must conform to the four narrow bands of AV. What this does is eliminate all of the red insurance plans. For many small employers they are having very comprehensive plans cancelled and are being forced to either better or lesser plans.

This is how Obamacare works. Insurance companies are forced to cancel plans outside of the four metallic bands which eliminates consumer choice. It also hinders an insurance company's ability to price products at various levels and suppresses creative plan designs.

The results are less plans, less variation in plan design, less variation in premiums, and less innovation in plan administration. Worse yet, the formula used to determine the four metallic bands will change every year. So, even if you like your new Obamacare plan don't count on keeping it.

My Karma Ran Over My Dogma

In case you needed a laugh:

"General Electric is telling its investors that Obamacare is to blame for recent losses in the company’s health care division"

GE, you may recall, was an early, vociferous proponent of the ObamaTax. It now cites the very real problem of market uncertainty resulting from a law both carelessly and cavalierly written and enforced.

There's a word for this....

Deadline? WHAT Deadline?

Only in DC could this concept make any sense:

"The Obama administration said Thursday that sick patients in the temporary, federal [PCIP] program now will have until June 30 to select an exchange health plan."

Let's consider this for a moment, shall we?

We've always considered the PCIP (Pre-Existing Condition Insurance Plan) as one of the very few (if not the sole) good things about the ObamaTax. It allowed those with severe and/or chronic conditions to purchase reasonably effective, reasonably priced health insurance, and covered their pre-existing conditions from the get-go. Unfortunately, it was designed with a built-in "sunset clause" that (ostensibly) closed down the program on January 1, based on the (naive) idea that it would no longer be necessary.

At that, the reports of its demise were somewhat exaggerated, as the phase-out was pushed back to the end of March.

And even that was pushed back in a last-minute, under-the-radar announcement that "Enrollees in the federally-run [PCIP], who have not yet found new health insurance coverage through the Marketplace, can purchase an additional month of PCIP coverage through April 30, 2014, while they continue their search."

All well and good (one supposes), but now we learn that, again with little fanfare, the program has been extended an additional 2 months.

Which raises some questions:

First, why would we believe that even the new-and-improved June 30th deadline will be enforced?

Second, and perhaps more critically, just how is this extension being funded? The money originally set aside for it is long-since spent, and I've seen no Congressional activity authorizing additional funding.

Finally, if the ObamaTax folks can't get even those who value such coverage to sign up, why would they believe that healthy folks would be interested in an ObamaPlan?

Cavalcade of Risk #207: Call for submissions

Rebecca Shafer hosts next week's Cav. Entries are due by Monday (the 28th).

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.

Again???

You'd think that this would have been fixed...

Embarrassment of (Link) Riches

■ Say it ain't so! Seems that the Silver State's Health Exchange has a few problems, not the least of which is that it's intent on hiding its problems:

"Confidential documents which appear to be from a Nevada Health Link employee may reveal huge problems within the state health exchange."

See - I told you so!

And what, exactly, are these problems? Well, to start with, there's the case of Lawrence Basich. Regular readers may recall Mr B as the gentleman who's been trying - unsuccessfully - to sign up for an ObamaPlan since last Fall. Turns out, he (and upwards of 10,000 others in similar circumstances), may have been the victim of the Exchange itself, which was apparently miscalculating subsidies and premiums.

The scary part is that administrators apparently knew of these problems and, rather than fix them, chose to hide them.

But according to their state's senior Senator, they're all lying.

■ We've written pretty extensively on the Death Panel IPAB controversy, but as FoIB Holly R tips us, that may not be the worst of it:

"The Center for Medicare and Medicaid Innovation has flown below the political radar. That's due to its seemingly innocuous mission: promoting new and more efficient "payment systems" and "models of care."

As Bob pointed out almost two years ago, the CMMI may sound anodyne - it is anything but:

"Obamacare’s Center for Medicare and Medicaid Innovation will conduct payment and delivery reform demonstrations with a goal of changing Medicare from fee-for-service to “capitated” or salaried payments. Unlike a pluralistic system of competitive plans, Medicare patients will have little or no control over whether or not they will be subject to these changes."

Shorter version: bye-bye, Grandma.

■ Up is down and left is right:

"Actuary Jac Joubert, along with a pair of Oliver Wyman analysts, say a big new federal risk-management program could pay carriers too much for covering consumers with health problems and too little for covering low-risk people."

That's the take-away from a study of how the ObamaTax is faring thus far. Ms Shecantbeserious (well, for now) and her minions are using a "risk adjustment model" originally designed for  Medicare Advantage plans, which are vastly different than ObamaTax-compliant major medical policies.

The result: decreased profit margins and a faltering - or even failing - carrier.

Perhaps Ms Kathy sees this as a feature, not a bug?

Health Wonk Review: ACA "Improvement" edition is up

Louise Norris always does a great job hosting, but this week's edition is arguably her finest work. It's full of great posts and helpful context, just a really terrific job. Definitely worth clicking over to read the latest and greatest on ObamaCare.

Alphabet Soup News

From our friends at FlexBank:

■ "The IRS announced [last October] the ability to permit employees to carryover up to $500 of an unused health FSA balance. IRS Notice 2013-71 now offers an employer the option to amend their Section 125 plan to allow up to $500 of unused funds remaining at the end of a plan year to be carried forward into the following plan year."

This is significant because these plans have traditionally been "use it or lost it," and now participants may have the opportunity to roll-over unused dollars.

 ■ "The IRS released a memorandum on March 28, 2014 that confirms that employees participating in a general purpose health FSA, and who have carryover from a prior year, cannot contribute to an HSA for the entire following year."

General Purpose Flex Spending Accounts are those which cover any so-called 213(d) expenses (a laundry list of eligible expenses) as opposed to a Limited Purpose FSA which covers only those specifically stated in the plan document. This is significant because it may severely limit one's participation in a Health Savings Account.

 ■ "Section 125 Plans (also known as a Cafeteria Plan or Premium Only Plan (POP), must follow the general principle that employees' pre-tax elections are irrevocable for the plan year, except under certain conditions"

Generally speaking, you only get to change your "cafeteria plan" choices once a year - at Open Enrollment. But there are exceptions to these rules, although they're quite limited. These would include a "Change in Status" (eg marriage, adoption, etc), as well as a few others. The fine folks at FlexBank offer you this link for an overview of the permitted election changes.

Look out below! [UPDATED]

Such a success:

"[A]n intriguing analysis of Covered California’s state-run exchange found that up to half the 1.2 million new enrollees might actually drop their coverage."

To be fair, some of these folks will find new jobs with employer-sponsored insurance plans. On the other hand, a lot will find themselves now eligible for (taxpayer funded) Medicaid coverage. And some will take a look at their high premium, high expense, low benefit plan and decide to chuck it.

Sounds like a plan.

UPDATED: Perchance there's an even simpler explanation:

"California Obamacare customers are expressing outrage after finding out that nearly 1,000 California doctors were listed on the Covered California website as accepting Obamacare plans when in fact they do not"

As we've mentioned numerous times, "narrow networks" are one of the more insidious ways in which the ObamaTax tries to rein in costs. This is, in fact, a fairly obvious method of rationing health care: "sure, here's an insurance plan that guarantees your insurability, but good look using it to actually access, you know, care."

Dying of Thirst (Literally)

One of the major problems of the ObamaTax is that it does not, in fact, save health care dollars. This problem plagues similar regimes as well, most notably the Much Vaunted National Health System©.

Never fear, though, the MVNHS© has a solution:

"At least 1,000 hospital patients are dying needlessly each month from dehydration and poor care by doctors and nurses."

A perfectly sensible way to deal with runaway health care costs, don't you agree?

“Pay No Attention to the Man behind the Curtain”

The government, this time the State of California, has decided that maybe it should ensure that the plans it has been selling to unsuspecting the general public will be accepted by the patient’s choice of physicians.

“A little too little a little too late,” but I digress.

So they came up with a brilliant plan to find out if doctors are taking the insurance by setting up “secret shoppers” to check the provider networks. Seems like I have heard this song and dance before:

“U.S. Plans Stealth Survey on Access to Doctors.” The article discusses how the United States Government is going to use mystery shopping techniques to assess the wait times for new patients to get into a primary care physician’s office"

But that was then (June of 2011, almost 3 years ago), and this is now:

“The secret shoppers would call or visit the providers in a plan provider directory and see whether the providers would take new patients with coverage from that plan, or whether the providers would let patients use that plan to pay for care.”

This is the latest rocket surgery dreamt up by the Covered California folks, who appear to have learned nothing from previous experience.

The short answer is that, IF the doctor is contracted with the insurance plan, then YES the doctor will see the patient and accept payment. IF the doctor is not contracted with the insurance plan and IF the patient agrees to pay the doctor, then YES the doctor will see the patient.

But, it appears that the problem is not the doctors seeing patients, but a “narrow provider network.”

So in answer to the first IF, it seems that there are not enough doctors in the network. So move to the second IF: if not in-network, then will the patient pay and accept it being applied to the out-of-network deductible? Let’s look at the article for an answer:

“Priscilla Myrick, a Berkeley, Calif., activist and plan enrollee, wrote to the board to say she was surprised to find  her providers are no longer in her  network, even though she replaced a pre-PPACA plan with a plan from the same carrier. She said her plan issuer increases the deductible to $20,000 for out-of-network, from $10,000 for in-network care, and increases the annual out-of-pocket maximum going to $12,700, from $6,350.”

It seems that Ms. Myrick's out-of-network deductible is a little high - like stratosphere high - which can be a detriment to seeing her provider.

“If you like your doctor, if you like your insurance company….”

So it seems that the insurance plans have incredibly high deductibles, a narrow physician network, and the reason that patients cannot find doctors is ... drum roll please ... the doctor’s fault. And when you cut off all legs of a frog and yell jump, the frog goes deaf.

My Bleeding (404Care.gov) Heart

By now, IB readers are presumably fully aware of the dangerous Heartbleed virus (well, major internet security flaw). Some may recall that a week or so ago, the folks in DC assured us that users of the 404Care.gov site weren't at risk there.

But that was then, and this is now:

"Healthcare.gov users told to change passwords following Heartbleed flaw ... People who have accounts on the enrolment website for President Barack Obama's signature healthcare law are being told to change their passwords following an administration-wide review of the government's vulnerability to the confounding Heartbleed internet security flaw."

Actually, this is potentially very bad advice: unless and until a site has been demonstrated to be HB-negative, changing one's password may simply open one up to even more shenanigans:

"If you find that a site is still vulnerable, don’t enter any passwords or data that it doesn’t already have."

To determine whether a particular site will leave you vulnerable, **here's a simple test* you can use.

In the meantime, use extreme caution when visiting the 404Care.gov site (if you must visit it at all).

[Hat Tip: John Hayward]

We’re lost, but we’re making good time

Today's Wall Street Journal reports President Obama saying that eight million people had picked health-insurance plans through the Affordable Care Act.  “The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working..."

Well yeah, it's a start, but it's still at most only 20% of America’s uninsured, leaving aside what this obsessively word-smithing president might mean by "picked".

The insurance underwriter in me knows what Obama said is sales talk.  His are not the words of a knowledgeable experienced salesman, or an experienced executive, or even a realistic person. They are the words of someone trying to persuade me with weak logic, scant evidence, and a story contrary to what I can see with my own eyes.  They are the words of a man trapped inside some Mary Poppins fairy tale in which “Well begun is halfway done.”  In short, it's sales talk.

And the problem with the president's sales talk is that he is selling a fantasy world, not the real world.  The real world sets a higher bar for "it's working":  people who have enrolled must be able to obtain services they need when they need them; their personal costs counting premiums, deductibles, co-pays, and wait times must be truly affordable; after first enrolling, people must be willing to re-enroll for the next year.  Not only that, but in the real world, almost all the remaining 30+ million uninsured Americans must soon also enroll.  In the real world, physicians and hospitals must be able to accommodate millions of additional patients without harming quality or accessibility. In the real world the insurance companies must be able to set premiums with confidence based on hard facts about the covered populations.  In the real world, the feds must actually, you know, get around to building the back-end systems needed to transmit enrollment info and premiums to the insurance companies.  And of course, in the real world, our president promised back in 2009, “I will not sign [The ACA] if it adds one dime to the deficit, now or in the future, period.”  And yes, he really did say “period”.

All of that and more is how the real world will decide if “it’s working.”  Clearly, despite what the president wants me to believe, this administration still has promises to keep, and miles to go before it sleeps.  Those promises cannot yet be counted as kept.  That's why I think it's misleading to say The Affordable Care Act "is working."

For right now at least, it's much closer to the truth to say, as Yogi Berra once said, “We’re lost, but we’re making good time.”

Friday Spindle-Clearing Time

Each of these may well deserve their own post, but alas, 'tis not to be:

■ The Obamastration's touting the latest (fake) number of sign-ups at 29 gazillion (or 8 million - I've heard it both ways). Thing is, that seems to include thousands of actual prison inmates.

Kudos, Kathy!

■ From the MVNHS© Files comes this unfortunate statistic:

"Majority of foreign doctors in the UK, including from India, would fail Britain's health service exams if they were held to the same standard as their British colleagues."

But hey, it's free!

■ More ObamaTax lies:

"A New York woman suffering from a neurological disease that has required four brain surgeries has been dropped by all of her doctors and denied medications due to her Obamacare plan."

According to Harry Reid, though, this woman is lying:

Lose Your Husband, Insurance [UPDATED]

Apparently, the ObamaTax is all about the "glitches:"

"More than two dozen widows who were married to retired Madison county employees, lost their health insurance coverage earlier this year."

That's Madison County, Alabama (no, not that Madison County), which had been self-insured. It's not really clear to me why that would preclude them from offering coverage of some kind, but according to county commission chairman Dale Strong, "new regulations in Obamacare would amount to an extra $25 million dollars per year."

Yikes.

UPDATE: Okay, turns out that (of course), there's more to the story. Yes, the county was self insured, and yes, the ObamaTax would have made it too expensive to continue covering these poor widows. So the county "instead joined a statewide network that dozens of county governments already are in. That plan, though, does not offer coverage to husbands and wives when their government employee spouses die."

That makes a lot more sense than just dropping deceased employees' spouses. And, of course, it reinforces the truth that, dead or alive,  you can't keep your plan..

Cavalcade of Risk #206: Work in Progress edition

Dennis Wall hosts this week's roundup of risky posts. One risk, of course, is that one may encounter various technical glitches, which is why you'll need to check back from time to time to see what's new.

HSA and LTCi: What a match!

Long term readers know that we're big fans of both Health Savings Accounts (HSAs) and Long Term Care insurance (LTCi). What a lot of folks may not know, though, is that these two seemingly unrelated risk-management tools can actually work together to help you stretch your health care dollars.

How that, you ask?

According to FoIB (and LTCi Guru) Randy Gallas:

"If you're not eligible to deduct your LTCi premiums through self-employment or as an unreiumbursed medical expense on your federal income tax return, HSA funds may be an attractive option. Since LTCi premiums are considered a qualified medical expense, folks who who meet the criteria may withdraw money tax-free from their HSA to pay premiums."

Go on....

"Consider this example: you're 52 years old and looking for a tax-advantaged means of paying your LTCi premium (and good for you for buying at an early age!). You don't own a business so, so you can't deduct premiums as a self-employed person. Your accountant told you that you can't deduct the premiums as unreimbursed medical expenses. But if you own an HSA (or are eligible to open one),you may be able to use tax-advantaged funds from that account to pay that LTCi premium."

Randy also points out that there are are some limitations and considerations for people who have HSA accounts or those who are eligible, and provides this link to a more complete explanation of those.

Thanks, Randy!

Pesach 5774 / Passover 2014

Tonight marks the first evening of Passover, and the first of the two traditional meals called "seders" ("seder" means "order"). It's a ritual and a meal, and commemorates the end of the Israelites' 400 year stint as slaves to the Egyptians.

I use the term "Israelites" because there is a significant school of thought which holds that we didn't really become "Jews" until the Covenant at Sinai.

The ritual itself, at least as practiced today, dates back about 1000 years or so, so it's actually a rather recent addition to our history. Still, it's by far my favorite "Chag" (holiday). This year, as most, we will host seders both nights, with a great (and different) mix of folks at both.

Chag Pesach Sameyach!

(PS Click here for a detailed and interesting deconstruction of so-called "Christian Seders")

Goodbye Shecantbeserious, Hello Burntwell

While I realize that it's not a "done deal," the latest from DC tells us that the ObamaTax is in the very best of hands:

"[Burntwell] testified “in laborious detail about what she had found in Mr. Foster’s garbage on the night he died.”

Dumpster-diving Diva Burntwell seems to be eminently qualified to continue the ObamaTax.

Cavalcade of Risk #206: Call for submissions

Dennis Wall hosts next week's Cav. Entries are due by Monday (the 14th).

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

Dennis would specifically like to see posts about residential mortgages, force-placed insurance, the participants in the mortgage process, the participants in securitization of mortgages.
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.

Patrick's in The Federalist (Again)!

For the second time in as many months, co-blogger Patrick has penned a post for The Federalist. This time, he discusses O'Care's impact on Employer-based (ie group) health insurance plans:

"Now that there is a tax for not having it many have simply added on to their employer’s plan. As shown in the Kaiser Employer Sponsored Benefits Survey from 2013, small employers foot a significant portion of the premium."

Definitely read the whole thing.

Is your healthcare different today than it was yesterday?

The Center for Medicare services has released how much it paid doctors in the year 2012. The big news is that one doctor in Florida made a lot of money:

“Medicare paid a tinygroup of doctors $3 million or more apiece in 2012. One got nearly $21 million.”

Let’s take a look at these doctors based on CMS own data: “a small sliver of the more than 825,000 individual physicians in Medicare's claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.”

So if only 344 physicians earn the top dollar out of 825,000 physicians how much did the other 824,656 physicians make?

“The median payment — the point at which half the amounts are higher and half are lower — was $30,265.”

While we don’t know what the other physicians made, we do know that the median amount paid to all physicians was $30,265. Medicare makes up about 30% of the payer mix for an average physician’s office. So what we can concur from this information, from the most transparent administration in the history of America, is that 30% of a physician’s revenue was approximately $30,000. Does this information in any way change how you choose a doctor?

“Employers, insurers, consumer groups and media organizations pressed for release. Together with other sources of information, they argued that the data could help guide patients to doctors who provide quality, cost-effective care”

An argument for releasing this information is so consumers can be better educated on choosing their doctors based on how much Medicare pays the doctor for the service provided. One piece of insight already data mined from all this information is that Medicare pays for cataracts and cancer treatment.

“In the $3 million-plus club, 151 ophthalmologists — eye specialists — accounted for nearly $658 million in Medicare payments, leading other disciplines. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments.”

So using the rationale that this data will allow consumers better decision-making on choosing physicians, are we shocked that Medicare -  insurance for the elderly - pays out a significant amount of money for cataracts and cancer treatment, both illnesses of the elderly?

Having been both a provider and an administrator in the medical field for close to 15 years, what this information tells me is that doctors are for the most part underpaid by Medicare. If the median amount is $30,000 that any one physician makes in treating Medicare patients and the Medicare population is rising, then it is obvious that the reimbursement rates are lowering. This is exactly what is been happening since the year 2003 with a Medicare fee schedule that, while it does not cut, it does not give raises. As a medical administrator, all this information has done is prove to me that Medicare is not adequately paying for the work performed by physicians.

When failure is achievement

To remind us how little they really know about health insurance the Obama Admin decided to brag about a failure thinking they did well;

"White House officials were quick to point out the many successes during Ms. Sebelius’s tenure: the end to pre-existing conditions as a bar to insurance"

In the dark ages prior to ACA an individual could buy an insurance policy any time they like. No matter the month if you wanted insurance you could buy it. If you waited till you were sick you might pay more. A very small group of people were denied or had to enroll in high risk pools. But 85 to 90% of the population could buy any time they liked.

Now that ACA is in place and open enrollment closed unless you have a qualifying event you can't buy insurance no matter what, and that applies to 100% of the population.

That is progress under the Obama Administration.

Breaking: Oy!

HHS Secretary Shecantbeserious is resigning:

"Sebelius leaves the administration after the tumultuous launch of the Affordable Care Act exchanges last fall. Despite calls for her ouster from Republicans at the time, she stayed on until the enrollment period ended at the end of March."

That;s the good news.

Now the bad:

"White House budget office director Sylvia Matthews Burwell [will] replace the outgoing secretary"

Hmmm.

Burwell.

What to do, what to do....

Ms Kathy has Sgt Schultz Syndrome

Just a reminder that, two weeks after the (ostensible) end of Open Enrollment, Ms Shecantbesrious still can't (or won't) say how many of the "billions and billions" who signed up were simply victims of the ObamaTax "You Can Keep Your Plan" Hoax.

Imagine that.

Health Wonk Review: Not So Foolish (Early) April edition

Billy Wynne hosts this edition of the Health Wonk Review, and you'd be foolish to miss it. And definitely check out Julie Fergosun's take on Workers Comp and GoogleGlass.

Free Contraceptives aren't that important after all

Interesting fact among a few;

"The top 10 therapy classes by claims volume for exchange enrollees and those in a commercial health plan were largely similar, with a few notable exceptions. The proportion of pain medication was 35% higher in exchange plans; the proportion of anti-seizure medications was 27% higher in exchange plans; the proportion of antidepressants was 14% higher in exchange plans; the proportion of contraceptives was 31% lower in exchange plans." [emphasis added]

As major an issue as Saundra Fluke and free birth control was, those actually buying the plans don't seem to need it. By the time you're signed up for ObamaCare you have already been screwed so they don't need it?

Quelle surprise!

To the surprise of only those who haven't been paying attention, the latest ObamaTax "enrollment" numbers are in, and they're not pretty:

"People who signed up early for insurance through the new marketplaces were more likely to be prescribed drugs to treat pain, depression and H.I.V. ... early enrollees face more serious health problems and are older than those covered by their employers"

They also tend to use more expensive meds, further driving up costs for healthier folks who may have been suckered in signed up.

But don't worry, they'll make up for it in volume.

And speaking of which (volume, that is), rotsa ruck to all those "newly insured" folks who think they've successfully signed up for "health care:"

"As a proud new beneficiary of the Affordable Health Care Act, I’d like to report that I am doctorless. Ninety-six. Ninety-six is the number of soul crushing rejections that greeted me as I attempted to find one"

Hope and change, indeed..

The ObamaTax Domino Effect

While we've all seen the horrendous rate increases caused by the ObamaTax (including on our 1040's), there are other victims. According to a recent RAND Corporation study:

"The expansion of health insurance accomplished under the Affordable Care Act may alter costs for several major types of liability insurance ... Automobile, workers’ compensation, and general business liability insurance costs may fall under the Affordable Care Act, while costs for medical malpractice coverage could be higher"

It makes sense, of course, once one stops to consider it. Workers' Comp is, after all, essentially a government-run health insurance scheme. Auto insurance liability and med pay coverage is basically health insurance, as are comparable homeowners' coverages.

On the one hand, the study posits that the rate increases will likely be "modest" - in the 5% range. But we really don't know, since the full effects are still to come.

Recently, my P&C colleague across the hall was complaining about homeowners' insurance rate increases, and I jokingly suggested that he do what I do, blame the ObamaTax.

Little did I know...

Winning!

Well, for a certain value of "win:"

"The number of Americans who were enrolled in Medicaid at any time during fiscal 2013 exceeded the entire population of the United Kingdom"

Thanks to The ObamaTax, many (most?) of these are folks who've "benefited" from Medicaid expansion, and access to the program through the Exchanges.

Of course, each of these folks represent a net drain on the system, since they pay no premiums while gobbling up services.

A Pyrrhic Victory, no?

CCW, Guns and Insurance

Just because you've done the training, passed the test and obtained your Concealed Carry permit doesn't mean that you're covered if you ever need to use it. In fact, you should probably assume that if you injure or kill someone, even if you're eventually exonerated by law enforcement, your worries may be far from over.

What prompts this insight is an article by insurance expert and instructor Ted A. Kinney, writing in this month's PIA (Professional Independent Agents Association) newsletter. It's rather eye-opening stuff, because it addresses something that's been under the radar for a while.

Lots of attention was given, in the aftermath of the Newtown tragedy, to liability issues when a gun is used in a crime. And almost exactly a year ago, we discussed the proposal put forth by retired business owner Tom Harvey to compensate victims of illegal gun violence.

But what about the legal use of a weapon in self-defense? The rate of concealed carry permits has risen dramatically the past few years, and most folks have either home or renter's insurance. What part might these policies play if one were to injure or kill someone else in self-defense?

[ed: we'll deal here only with homeowners' policies - as always, we urgently suggest that you consult with your own agent about your specific policy]

The typical homeowner's policy follows a fairly predictable pattern: "we give you coverage, we take it away, then we give some of it back to you." The relevant policy section in this instance is "Coverage E - Personal Liability." This coverage protects one's assets if one is sued for injuring someone else. The policy extends coverage for this type of claim, but then excludes those claims that arise due to intentional acts. In this case, it's pretty clear that you intended to shoot your attacker, so it seems as if you're on your own.

Right?

Not so fast there, pardner:

Mr Kinney points out that newer policies will generally have an "exception to an exclusion;" that is, a policy clause that gives us back some coverage. In this case, it is for intentional acts that result from the use of "reasonable force." Unfortunately, as Mr Kinney also points out, the policy doesn't actually define "reasonable force."

So is there coverage, or not?

In Ohio, the law says that "a person is presumed to have acted in self-defense ... when using defensive force that is intended pot likely to cause death or great bodily harm ...  if the person against whom the defensive force is used in in the process of unlawfully ... entering ... the residence or vehicle occupied by the person using defensive force"

[ed: contra Mr Kinney's characterization, this is an expression of "the Castle Doctrine," not "Stand Your Ground"]

Let's take a real-life example: George Zimmerman was (famously) found 'Not Guilty' of murder. But what if Trayvon Martin's parents sued him in civil court? Would his homeowner's policy have picked up that tab? Unfortunately, the answer is "it depends:" just because a jury said it was justified doesn't necessarily mean that your insurer will pick up the tab from a civil verdict, or even cover your defense costs (which can be quite expensive). That's determined by the policy wording, and it's possible, bordering on likely, that your policy does not, in fact, afford this coverage.

So what to do.

Mr Kinney offers some suggestions for "stand alone" policies that will (purportedly) offer legal and liability coverage. It's a good idea to check with your own carrier to see if such coverage is available, and to stay as up to date as possible on the changing law (I heartily recommend Andrew Branca's  "The Law of Self Defense" which covers both federal and state laws and issues).

The bottom line? Don't assume that, just because you've dotted all the i's and crossed all the t's in order to get your concealed carry permit, that your insurance policy is going to cover you. You have a lot to lose.

[Many Thanks to FoIB Bill M for vetting this post]

Another Cup o' Joe, Please

We've been touting the health benefits of coffee for a while (most recently here). And the good news just keeps on rollin' in:

"...  a new study has linked drinking more than two cups of coffee a day to a 66 percent decrease in the likelihood of dying from cirrhosis, particularly in non-viral hepatitis."

Sweet (or, unsweetened).

Most surprising? That regular coffee drinkers significantly cut their risk of dying from cirrhosis and non-viral hepatitis.

A caveat: the article does not specify whether this was all coffee or just hi-test (no decaf), so it's not clear whether it's something in the coffee itself, or the caffeine.

Wills and Won'ts

A little over four years ago, we pointed out how important it is to periodically review one's life insurance beneficiary designations. Today, the Wall Street Journal has a similar warning for folks with 401(k) or similar retirement plans:

"If you haven’t updated that paperwork to reflect how your life has changed, you might not be able to leave your wealth to your heirs as you wish. Instead, you could bequeath them a bureaucratic nightmare."

They cite the case of a recently deceased executive who had the bulk of his wealth tied up in his 401(k), but failed to coordinate the beneficiaries with his will. The result was that his wife (widow) of two months stands to gain a great deal, while his kids are left holding the (empty) bag. As the article points out, one's will does not control one's retirement funds' ways.

The lesson? Go review your plans, and update them as appropriate.

Your loved ones will someday appreciate that.

My goodness, how helpful you are!

So it turns out that one doesn't need an agent, a Navigator, a computer or a phone to "enroll;l" in the ObamaTax. Just drawing a breath while on American soil should do the trick:

"Health and Human Services was mailing out letters notifying certain Americans that they had already started a healthcare coverage application on their behalf"

The twist: Ms Shecantbeserious had already started completing the process for them.

Fries with that?

Mission Accomplished! [UPDATED]

For a certain value of "accomplished:"



[Thanks to Bob V for the video link]

UPDATE: If Centennial State sign-ups are indicative (and there's no reason to believe that they're atypical), then The Kraut is really on to something. According to the Colorado Springs Gazette, about a quarter of a million Coloradans have enrolled through the state's Exchange.

That's the good news.

Here's the bad:

Most of these folks signed up for taxpayer funded Medicaid, not private health insurance. And of the less than 120,000 who did sign up for insurance, there's no information yet on how many are subsidized, let alone how many have actually paid for their new "coverage."

Way to go!

[Hat Tip: Ace of Spades]

Tea and (Dark) Chocolates

We've been reporting for a while that chocolate (particularly dark chocolate) has some major health benefits. But have you ever wondered why that is?

Turns out, the sweet treat actually works with the microbes in our stomachs to promote specific health benefits. Specifically, "beneficial bacteria that reside toward the end of our digestive tract ferment both the antioxidants and the fiber in cocoa."

Neat!

Also neat?

Earl Grey tea may actually be better at reducing your cholesterol than oft-prescribed (and much more expensive) statins:

"Researchers from Italy’s University of Calabria explained that the tea contains extracts of a Mediterranean citrus fruit called bergamot, which is made of enzymes known as Hydroxy Methyl Glutaryl Flavonones (HGMF)."

Yes, that's a mouthful, but it seems that this HGMF helped to increase "good" cholesterol and reduce the "bad."

Now about those scones....

Cavalcade of Risk #205: Mistake avoidance edition

Nancy Germond hosts this week's terrific roundup of risky posts, from employee safety to school shooting drills, you're sure to find something of interest.

IB SAYS OBAMACARE IS WORKING!

Premiums are lower by $2500 a family, 100% of people have insurance, Medicaid has been expanded in all 57 states, and most important we believe single payer is the answer to all of our problems. 

Happy April Fools Day!!!