Um, about that 3000% decrease

Remember when President Obama promised that, under the ObamaTax, premiums would plummet?

Turns out - and you may want to sit down for this - he wasn't being truthful.

How do we know this?

Well, here's a screencap of a small group renewal that just hit my desk. These folks have had their plan for a number of years, and this is what it would cost to bring it into full compliance:

[click to embiggen]

I'm no mathematician, but I'm thinking that a 200% increase doesn't meet that aforementioned promise.

Stupid Carrier Tricks, Beginner Level version [UPDATED]

Really, Mass Mutual?

In its efforts to "reach out" the the non-insurance community, MM seems to have shot itself in the foot here.

How, you ask?

Insurance 101-level stupidity. On Facebook, no less.

Here's the problem:

"Rebating: Returning a portion of the premium or the agent's/broker's commission on the premium to the insured or other inducements to place business with a specific insurer. Rebating is illegal in the majority of states."

Actually, I am unaware of any state where this is legal [ed: Wrong. See update below]. And the folks at Home Office should know that potential policyholders will see this, and begin asking its agents and representatives about premium breaks. After all, they've just been told to "Haggle Relentlessly."

It's a shame, too, since the carrier has a long history of doing great things:

"In an effort to provide Millennials with the support they need, MassMutual [has] launched a new initiative – “Down with Debt” - aimed at addressing the student debt crisis by providing helpful financial tips and offering a $20,000 reward for the most creative strategy to pay down debt."

Wonder if these folks can get a deal on their college loans.

UPDATE [9/30/14]: Co-Blogger Bob and FoIB Chad N point out that both California and Florida do allow rebating.

I don't think this detracts from my overall point, but we always strive for accuracy.

Making Strides Against Breast Cancer

Recently, a friend of mine went in for her routine mammogram. What happened next wasn't so routine: they saw a shadow. A few tests later, and she was diagnosed with breast cancer. Thankfully, it was caught in the very early stages, and after a few weeks of pinpoint radiation therapy, she's good to go.

Another acquaintance wasn't so lucky, and she's just finished her most recent round of chemo.

And by the way, it's not just women who need to be aware - men are at risk, too.

Fact is, almost all of us know a cancer survivor (or perhaps one who didn't). This year, I'm participating in the American Cancer Society's annual walk to raise money for research. You can help with your pledge. The walk is in a few weeks, and I'd appreciate your help. It's pretty easy - just click here to help make a difference.

Thank You!

Cavalcade of Risk #218: Call for submissions

David Williams hosts next week's edition. Entries are due by Monday (the 29th).

To submit your risk-related post, just click here to email it.
You'll need to provide:

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

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.
We need hosts for Fall Cav's - Please drop us a line to claim yours. It's easy, fun and a nice traffic bump. Thank you!

Adult Autism and The ObamaTax

I was surprised at the number of autism-related posts we've done over the years (here and here, for example). They all seem to have one thing in common, though: they are primarily about autism in children.

But children (eventually) grow up, and of course face additional - albeit different - challenges:

"It’s getting easier for parents of young children with autism to get insurers to cover a pricey treatment called applied behavioral analysis. Once kids turn 21, however, it’s a different ballgame entirely."

Seems that, once you hit that magical age of 21 [ed: Wait, what? According to the ObamaTax you're still a toddler at age 26], those mandates mostly fall off, leaving young adults without coverage. It should be noted that such coverage isn't "free:" its cost (as with every mandated benefit) is built into our ever-increasing premiums.

But it seems to me that, if we're going to pay for life-style choices (*cough* birth control convenience items *cough*), then why aren't we considering conditions which are not under one's direct control? I'm not proposing another mandate, of course, but certainly there ought to be some room for discussion.

L'Shannah Tova: 5775

Tonight marks the beginning of the Days of Awe (well, unless you count Selichot - but that's another post). We welcome the New Year, reflect upon the old, and look inside ourselves to determine where we've fallen short and how we can continue to grow.

May you be inscribed for a blessing in the Book of Life.

If you like your plan...Well, too bad, so sad - Part II

Our good friend (and senior research fellow at George Mason University's Mercatus Center) Bob Graboyes continues to build on the work that he and co-blogger Pat P have done on Actuarial Value. In his newest US News & World Report, Bob warns that there's another wave of cancellations looming:

"Insurance coverage for Americans will remain in permanent turmoil because the Affordable Care Act requires all plans to fit within four cookie-cutter designs called "metallic tiers .. families may have to change plans repeatedly because, as circumstances change, a plan that fits within a tier one year may not fit in any tier a later year."

There's even a helpful video to demonstrate why these plans were doomed from the start:

ObamaCare Fail in 1,000 Words

US CENSUS BUREAU: 1.25 million MORE Americans uninsured in January to April 2014 than in 2013. pic.twitter.com/TSdSHAWSYB
— Phil Kerpen (@kerpen) September 19, 2014

That is, as of this past Spring, there were 1.25 million fewer insured than in 2013.

The good news: Open Enrollment is coming up.

The bad news: Open Enrollment is coming up.

[Hat Tip: Ace of Spades]

Sinking ship, MVNHS©-style

Think this can't happen here?

"The [MVNHS©] staffing crisis is expected to escalate as ­thousands of doctors seek work overseas."

Almost 5,000 British physicians have filed paperwork that would allow them to practice abroad. And I don't think it's because they want to moonlight; these are doc's looking to escape the stifling reg's and lousy economics that characterize the Much Vaunted National Health System©.

Meanwhile, 4,000 miles away:

"Dr. William Wennen, a plastic surgeon, is closing his Fairbanks practice after 38 years of working in the state. Dr. Wennen blames federal health insurance programs, citing Obamacare, Medicaid and Medicare, for shutting down his practice."

And no wonder: he claims to be writing off something like $750,000 a year in unreimbursed care.

Is he an outlier?

Time will tell.

[MVNHS© story Hat Tip: Co-Blogger Bob V]

RTF Subsidy Q

I was recently asked by an acquaintance whether I knew anything about the ObamaCare "clawbacks" (his term). Seems he had been looking into buying an Exchange-based plan, but was concerned that, if he misstated his income, some or all of his subsidy could be "clawed back" (confiscated) by the government.

We've been blogging about this for a long, long time (here, for example). And I suppose it's gratifying that the Lamestream Media is (finally) also glomming onto it. From yesterday's McPaper:

"[N]ow hundreds of thousands of consumers could owe back some of that money next April."

At issue is the challenge that the subsidy calculator is predicated on one knowing (relatively precisely) how much income one will have in the next year. Guess wrong, and you could be short-changing yourself and your family, or owe some or all of that sweet, sweet subsidy money back to the Feds.

So how to avoid this? Well, the folks at the McPaper advise that one "report changes in income and other changes in one's life, such as a marriage, throughout the year." And where should one report these changes?

You guessed it: the still-dysfunctional 404Care.gov site. Rotsa ruck with that!

But what really caught my eye was the article's headline:

"Tax refunds will be cut for ACA recipients"

But the article itself says no such thing. The only clue it gives is this:

"When you file that 2014 tax return next year, the Internal Revenue Service will compare your actual income for the year with the amount you estimated ... if the income is 400% or more above the poverty line, there is no cap and the taxpayer must pay back the full amount."

Okay, but how does that gibe with the headline?

We know that failure to buy an ACA-compliant plan will result in a fine penalty tax, but the IRS is limited as to how to collect it. Similarly, there's little guidance available about how - or even whether - the IRS can go after these subsidies.

So I reached out to Susan Tompor (the author), and asked her if there was some reason that the article didn't actually address the headline, and if she had any additional light to shed on the topic.

To her credit, she responded almost immediately.

To her shame, here's that response:

"See www.irs.gov or www.healthcare.gov [sic]."

Very helpful there, Suzy.

Oh, here's what I told my acquaintance:

I believe that the potential forfeiture of any subsidies is the least of the ObamaTax's problems. Between the potential for Identity Theft at the 404Care.gov site, the narrowing of networks and tightening of prescription benefits, and the excessive cost (both in premiums and exposure) of ObamaPlans, having an interest-free loan to help pay those premiums seems like a #firstworld problem to me.

Essential Re-Calculating

Feature or bug?

"A flaw in the federal calculator for certifying that insurance meets the health law’s toughest standard is leading dozens of large employers to offer plans that lack basic benefits"

This problem poses several challenges:

First, if your company's health plan is deemed to be ObamaTax-compliant by the calculator, then you're likely not going to be eligible for any subsidy if you opt for an Exchange-based plan instead.

Another issue is that the calculator seems to be approving plans that lack hospitalization coverage, one of the the key essential health benefits (EHBs). That doesn't necessarily mean that employers are actually offering such plans, but it's a bit disturbing to think that they could.

But I think that Kaiser buries the lede here. It's only when you scroll down that you see this little gem:

"HHS is aware of potential problems with the calculator but has not changed it"

Now, there could be several innocent reasons for this. For example, based on their top-notch efforts rolling out the 404Care.gov site, they may not be competent to even address the issue. But I wonder what will happen to employers who rely on the calculator, offering "sub-par" plans to their employees. If and/or when this issue is resolved, what kinds of penalties will they face (if any)? And how many employees will have substantial and unreimbursed hospital expenses while this gets sorted out?

It's just one more example of the real-world consequences of incompetent government over-reach.

Of Gas Lines and Med's

Those of us of a certain age recall the gasoline shortages of the early 70's. Oil prices had jumped considerably, and so the government (in its infinite wisdom and keen understanding of market forces) put in place price controls, basically telling the oil companies how much they could charge for their product.

As one might expect, these companies, faced with the reality that they were going to lose money on each sale, began to limit availability of their product. This lead to the infamous "gas lines," where folks lined up to purchase their 10 gallon maximum, every other Thursday between 9:00AM and 1:00PM.

I'm reminded of this because of a rather silly piece in yesterday's New York Times, with the deceptive title "How Insurers Are Finding Ways to Shift Costs to the Sick."

First, the Grey Lady gets the premise exactly wrong: by purchasing insurance, consumers shift their risk to the carrier, not the other way around. All that a carrier can do is to limit the amount of risk it's willing to assume.

In the event, the point of the article is that some carriers, chafing under the restrictions placed on them by the ObamaTax but still needing to turn a profit, necessarily have to find ways to limit their exposure. One way is by the use of "narrow networks," whereby fewer and fewer providers are actually in-network.

But that only goes so far: a lot of people are on some form of prescription, often a "maintenance" one (for chronic conditions). Many of these are of the generic variety, which used to be the most efficient way of reining in out-of-control med costs. Unfortunately, this has proved to be insufficient for the task. So what's a carrier to do?

Well, if they're smart (and they generally are), they'll do what Shell and Sunoco did 40 years ago, and cut their losses. Limiting how much they'll pay for generics, or even which generics they'll cover at all, is simply their version of a gas line. To categorize it, as the NYT does, as "trying to skirt the spirit of the [ObamaTax]" is not only pernicious, but irrelevant: they are doing what they need to do to stay in business. It's perfectly understandable, perfectly legal, and it's what happens when the heavy hand of government meddles in the market.

[Hat Tip: David Harlow]

Exchanges, Carriers and Ch-ch-changes

Just because the Federal Exchange is a hot, hacktastic mess, there's no reason to think that those run by individual states are in such sorry shape.

Right?

Ummmm:

"Maryland officials are planning a gradual rollout of the state's health insurance website to avoid problems"

Oh? And what kind of "problems" are we talking about?

Oh, those kinds of problems:

"... glitches can be worked out and the system won’t be overwhelmed with requests"

Yeah, one could see where that might be a problem. After all, there'll likely be tens (hundreds?) of thousands of Old Line State citizens eagerly shopping for their new - or replacement - ObamaPlans. Would be kind of embarrassing if they crashed the system.

Again.

Meanwhile, the folks behind the Green Mountain State Exchange have actually shut it down, albeit only temporarily [ed: uh-hunh]:

"Anyone clicking on the Vermont Health Connect website sees a message in bold black letters on a pale green screen that advises the site is down for maintenance."

Must be pretty heavy duty, since the closure is set to last for "weeks before health insurance customers would be able to resume buying plans, check accounts or pay electronically on Vermont Health Connect."

Interesting choice of words, that: "weeks."

It doesn't take long for "weeks" to become "a month." Or months.

And it's not just the folks Back East who are in for some potentially unpleasant surprises. FoIB Jeff M alerts us to this alarming development in The North Star State:

"PreferredOne, the insurer that sold nearly 60 percent of all private health plans on Minnesota's Obamacare exchange, on Tuesday said it would leave that marketplace."

Unsurprisingly, P1 offered the lowest rates on that Exchange.

No way there could be a connection between these two facts, though,

Right?

Cavalcade of Risk #217 is up!‏

Rebecca Shafer turns in another great roundup of risky posts, from Dopey Audacity to Your Mama's WC (Worker's Comp):

Do check it out!

La plus ca change, 404Care.gov-style

Another week, another 404Care.gov security scandal. The latest iteration come to us courtesy of the General Accounting Office:

"HealthCare.gov [sic], President Barack Obama's health insurance exchange, has security and privacy protection vulnerabilities ... despite steps taken by [CMS] for security and privacy protection, weaknesses remain in the processes used for managing information security and privacy."

No kidding.

But here's something that seems to be under the radar, and which I think may prove to be another major problem for those of us who continue to sell health insurance:

Yesterday, a very nice gentleman called, referred to me by another agent, looking for help and advice on purchasing health insurance. His COBRA plan is due to expire soon, and he needed help figuring out what to do. As is typical in these interactions, I took some basic information (age, tobacco use, etc) and asked about his current plan. Eventually, we got to the part about subsidies; like so many people, he really had no idea what that was all about.

So we discussed how the program works, the criteria for qualifying, that kind of thing. And then I explained to him that, if he qualified for a subsidy, and wanted to take advantage of it (not necessarily a no-brainer), then he would eventually find himself interacting with the government's website, and potentially exposing his personal, financial and medical information to hackers.

Which got me to thinking: if I assist a client in enrolling through the 404Care.gov site, and their information is hacked, am I culpable? After all, I was the one that sent them there, and perhaps helped them complete the necessary steps. But for my efforts, said client may never have visited the site, let alone participated in the information-gathering process, and thus not become hacker-bait.

Kind of a scary thought, no?

It's a dog eat dog (insurance) world

It was marginally amusing when Baxter Smith was successfully enrolled in an ObamaPlan. After all, the 14-year-old Yorkie was simply an innocent bystander:

"Smith ... had to sign up for coverage through the state exchange because his health insurance plan was cancelled under ObamaCare. He isn’t sure how Baxter wound up getting enrolled instead, but he ... did give Baxter’s name as a security question as part of the registration process."

And perhaps it wasn't a total waste. The Medical Device Tax impacts vet's offices, too:

"Some vets say they can’t afford it ... “I’m extremely concerned how this is going to be a hidden tax to our consumers that is going to be passed on.”

So, what to do?

Well, we've recently partnered with Hartville, one of the oldest - and largest - pet insurance programs, to offer readers a reasonably-priced plan that could reimburse up to 90% of your pet's health care costs. There are three benefit levels available, but they all cover exams, meds and even MRI's.

Click here for a brochure and here for a quote.

Life is short...

About two years ago, we took a gander at the cost of end-of-life-care:

"$33,382 for one hospital stay. $43,711 for the next. And a final $14,022 for the last three days of life. This is the cost of dying in America"

One imagines that these figures haven't changed much, and certainly that they haven't gone down. Still, it's something many of us have faced or will face, whether for ourselves or (often) a loved one. When to "pull the plug" is rarely an easy decision, but a company called Vital Decisions may be on to something:

"Imagine you're at home. Maybe that's in Florida, Wisconsin, Rhode Island, wherever. You have cancer. You just had another round of chemo, and the phone rings ... This is no telemarketing call - it’s about the end of your life."

Vital Decisions employs 50 social workers who reach out to folks to offer counseling and other assistance, even offering to reach out to the patient's health care provider or other family members.

The service is paid for by the insurer.

It's an interesting article, and a fascinating story, but there are a few details that remain unclear to me:

First, although it mentions that the service is provided and paid for by insurance companies, it doesn't say how Vital Decisions gets looped in./ One imagines that a participating carrier has a set of criteria, and once an insured hits a certain point (discernible from their claims history), the file is forwarded to Vital Decisions. According to the article, this practice is permissible, but I'm a little wary of that. I also wonder how amenable the health care providers are to discussing case details with the service, regardless of the patient's approval.

One can see why an insurer would want to bring in a 3rd party: it would seem, well, a bit self-serving for the carrier itself to suggest less-than-heroic measure, however rational that may actually be. By subcontracting this out to another party, there's a sort of arms-length quality to the discussion.

And there's this:

"By Daitz’ own rough estimate, the company’s services have resulted in about $10,000 less in health care spending per patient, “$100 million to the health care system in 2014.”

That's a lot of health care dollars not being spent, which may well be a good thing. But I'm also wary of looking at one's life as a series of calculations. No question that many folks would suffer a great deal less if they moved from acute to palliative care, and Vital Decisions claims that this is at least partly because "critical conversations about end-of-life care just aren't happening enough and the company's goal is to foster them."

That in and of itself seems pretty admirable. On the other hand, I can't help but think that insurance companies are not hiring companies like Vital Designs in order to just spend more money: they have a real incentive to cut costs. And that's also not a bad thing: again, look at those numbers from 2012. Since health care costs drive health insurance costs, it's to everyone's benefit to look for meaningful, justifiable ways to rein in spending.

What say you? Is this a good way to encourage end-of-life-care decision-making, or simply another way for carriers to cut costs?

If you like your plan...Well, too bad, so sad

Alert reader Jeff M sends along this timely reminder of the upheaval the ObamaTax has had on those most vulnerable:

"Two of Pattie Curran’s three sons have rare bone marrow failure syndrome combined with a secondary mitochondrial disease ... this Piedmont-Triad family “has witnessed their family’s insurance coverage slip away as premiums, deductibles, and medication co-pays have drastically increased"

And that's just for things that are covered. It actually gets worse.

Much, much worse:

"Pattie has now been notified that her sons’ life-saving compounded medications will be dropped from coverage all together as of September 15"

September 15 - hey, that's today!

And this despite her son's doc, who diagnosed the Mitochondrial Disease in the first place, actually wrote a letter to the carrier explaining why the med was so critical, and that there's really no substitute for it.

The challenge with ObamaPlans is that which plagues any "one size fits all" program; it's only half the sentence: "... but not very well." In order to comply with ObamaTax regs, carriers have had to re-write their plans to fit a band of specific benefits - no more, no less.

It's probably not much consolation to Ms Curran that her son's policy does cover birth control pills.

Here's more:

Observable results

Years ago, my youngest had a particularly painful episode which necessitated a trip to the ER at the local Children's Hospital. She actually stayed there overnight, but was not technically admitted.

I never really understood that, but was told it had to do with billing and insurance issues. Fortunately, she responded quickly and was sent home 23 hours after we arrived.

That 23 hours is the key: had we stayed just 60 more minutes, it would have been considered an "admission,": and additional costs involved. On the other hand, no one ever asked me what we wanted to do; apparently, my opinion about my daughter's care was unimportant. In fact, I didn't actually put 2+2 together until after we were home, and I had spoken with others more knowledgeable than I on these matters.

Reason I bring this up is because of this little doozy from Kaiser Health News:

"An increasing number of seniors who spend time in the hospital are surprised to learn that they were not "admitted" patients -- even though they may have stayed overnight in a hospital bed and received treatment, diagnostic tests and drugs."

So far, this sounds eerily familiar.

In the case of Seasoned Citizens, though, there may well be a very good reason for the 23 hour cut-off:

"Seniors must have three consecutive days as admitted patients to qualify for Medicare coverage for follow-up nursing home care"

That is, Medicare will only pay for follow-up care in a nursing facility if you've been admitted to, and stayed at least 3 days in, a hospital.

[By the way, this may be why so many folks believe - erroneously - that Medicare will cover their Long Term Care expenses.]

And, of course, different insurance plans may treat a 23 hour stay very differently than an actual admission:

"Because observation care is provided on an outpatient basis, patients usually have co-payments for doctors' fees and each hospital service"

There may be additional expenses for needed medications, as well.

So, what to do?

Well, first of all, make sure you understand what your specific plan says about "observation stays" versus actual admissions. And where possible, ask your attending or other staff how they're going to code this particular claim. There may be little or nothing you can do about that, but knowing how it's likely to be billed may at least give you an idea of what your out-of-pocket's going to be.

And knowing is half the battle.

Lyin' liars gonna lie...

Due to the ObamaTax, nearly a quarter of a million Virginians will lose their current healthcare plans.

So says NBC's Sharon Gregory.

To which Harry Reid replies:

So, who ya gonna believe?

[NBC clip Hat Tip: FoIB Holly R]

Cavalcade of Risk #217: Call for submissions

Rebecca Shafer hosts next week's edition. Entries are due by Monday (the 15th).

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

You'll need to provide:

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

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

We need hosts for Fall Cav's - Please drop us a line to claim yours. It's easy, fun and a nice traffic bump. Thank you! 

Get a Life!

The fine folks at MassMutual remind us that September is Life Insurance Awareness month. And they've even come up with a quick, easy and helpful widget to help you figure out how much you are worth (well, financially speaking, anyway). Click here for that.

And believe it or not, the LifeSpan calculator that we posted on 5 1/2 years ago is still, well, live.

So what are you waiting for?

Health Wonk Review is up....

David Williams hosts this week's collection of posts on health care policy and polity. As usual, he has a great selection and helpful context. Do check it out.

Want to Save 25% on Obamacare Insurance?

A couple of small known facts about Obamacare could provide a savvy (though not necessarily smart) purchaser of health insurance with a way to save 25% on their annual premiums.

1. The grace period for not paying premiums until an insurer cancels an insured is 90 days (on exchange).
2. The amount of time one can be uninsured before they are subject to the individual mandate tax is 90 days.

Couple these two items above along with open enrollment that includes no pre-existing conditions, guaranteed issue, and community rating and consumers can take advantage of the following loophole.

Let's say I purchased my Obamacare plan last year and paid my premiums on time from January through November. I just got my invoice for December but have decided that I'm going to roll the dice for the short term. December and January pass and I have yet to pay either premium. It's now February 28th - my 90th day without paying for insurance. I've had zero claims and went into goodluck.gov between February 1st and February 15th and enrolled in the exact same plan I had last year for 2015. The new plan takes effect on March 1st.

No premiums. No penalty. Perfect cancellation date. Obamacare!

An Embarrassment of (Link) Riches

The Inbox is filling up with interesting linkage: many of interest, few really blogworthy on their own.

So, in no particular order, some (hopefully) interest-piquing links:

■ "By February, CMS had spent an average of about $92 per HHS exchange QHP enrollee"

That is, they'd spent almost $100 per (successful?) ObamaPlan victim enrollee. That may not seem like much, but if the numbers HHS is touting are true [ed: uh-hunh], then we're talking hundreds of millions of IT dollars.

■ Does the ObamaTax actually contain wording that contains the seeds of its own destruction?

"The Patient Protection and Affordable Care Act (PPACA) contains a provision — Section 1332 — that states can use to turn it inside outside"

The little-known Section 1332 allows state Departments of Insurance the opportunity to solicit waivers for certain plan provisions, including Qualified Health Plan requirements. Something to keep in mind, though:

The verbiage in question is actually called "Sec. 1332. Waiver for State innovation," and allows states to "apply to the [HHS] Secretary for the waiver of all or any requirements described in paragraph."

But it's not open-ended; rather, it's an opportunity for a given state to experiment a bit, while requiring of the state a "10-year budget plan for such plan that is budget neutral for the Federal Government."

Sweet deal for the Feds.

■ As if confirmation was needed that the ObamaTax has lead to provider shortages, and at least a suspicion that rationing is just around the corner (if not already here):

"5 ways insurers can limit care access in this brave new world ... Insurers are not sitting back with open arms and welcoming all of the poorest, sickest and most costly patients"

No kidding. When increased demand (in the form of newly insured, both on ObamaPlans and Medicaid) meets static (or perhaps even shrinking) supply, something's gotta give. 

■ Here's a new twist on the ol' Three R's: reinsurance, risk corridor and risk-adjustment. These also happen to comprise some underlying reasons why insurers' own financial health may face some challenges.

According to Steve Zaharuk, a senior vice president at Moody’s Investors, "although exchange qualified health plan (QHP) enrollment has been strong, insurers have given few details about QHP underwriting results ... At best insurers were predicting a break-even scenario, but most were anticipating losing money on the business for the full year.”

Not a great long-term business strategy. Which actually ties in nicely with... 

■ FoIB Jeff M tips us to this news out of The Tarheel State:

"Carolinas HealthCare System has eliminated roughly 100 jobs and is looking to cut its 2015 budget by $110 million"

Which seems to me to be a combination of the four previous links. One wonders how many more such reductions we'll see as we enter the next Open Enrollment season, and even more folks jump in (or don't).

MVNHS© vs Cancer

Spoiler Alert: Cancer's winning.

"[A] report by Cancer Research UK said that ‘cracks are beginning to show’ in NHS cancer diagnostic and treatment services ... Specialists have been struggling to keep up with the rising demand for care at the same time as their budgets have shrunk amid the NHS's £30bn efficiency drive"

Once again, we need to point out that nationalized health care regimes are no more successful at reining in costs while maintaining (let alone improving) health care delivery than our previous system.

My Project Manager Better Half often speaks of "resource starved" organizations. That is, businesses that, rather than spending the necessary funds to fully staff a given project, instead rely on fewer and fewer personnel to handle the tasks. This creates a strain on both the company and the folks that are left, exacerbating the problem even further.

That seems to be the case in Britain, where "[t]he abolition of scores of NHS bodies ... such as the scrapping of the highly regarded National Cancer Action Team and cancer clinical networks, has produced an unhelpful "vacuum" and loss of leadership in cancer delivery."

No kidding. Previously, the Much Vaunted National Health System© relied on several key coordinating groups, including "NHS England, NHS Improving Quality and the 211 GP-led local clinical commissioning groups." Not that these folks were any great shakes when it came to, for example, caring for elderly cancer patients.

Of course, the answer always seems to be "throw more money at it," when, in fact, it's not so much a funding problem as it is a structural one. Of further course, the powers that be don't see it that way.

They never do.

[Hat Tip: Co-blogger Bob V]

In case of Emergency...

Let's head to the Wayback Machine, and set the dial for June of 2011:

"Two reports from Boston.com, one in 2010 the other today show ER visits are on the rise, not decline."

Boston, one may recall, is in Massachusetts, home of ObamaTax progenitor RomneyCare. Proponents of the latter touted its ability to reduce costly Emergency Room visits, and thus drive down the "cost curve."

[ed: Funny how we don't seem to hear much about that "cost curve" thingy any more. Wonder why?]

Of course, it did no such thing:

"MIT economist Jonathan Gruber, who helped legislators draft the law, said some people who avoided emergency rooms because they were too expensive in the earlier period may be using them more, now that they have coverage"

Hold the presses!

Jonathan Gruber, you say? That Jonathan Gruber?

Hunh.

In the event, we knew well over three years ago that schemes like RomneyCare and ObamaCare do not, in fact, reduce ER visits.

Why bring this up now, you ask?

Well:

"More people newly insured by Medicaid under ObamaCare are seeking treatment in hospital emergency rooms — one of the most expensive medical settings, a study released Monday concludes"

Deja vu all over again.

So we knew - conclusively - over three years ago that increasing access to health insurance would necessarily lead to increased use of "free" services (like the ER). Which are, of course, decidedly not free.

As newly-insured folks are finding out. Two years ago, we noted:

"[A]bout 80,000 emergency room patients at hospitals owned by HCA, the nation's largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency."

ObamaPlan customers may be in for a rude awakening.

With chemo you get egg roll?

Here's an interesting twist on medical tourism:

"When Lin Tao was diagnosed with a lethal spinal tumor in 2012, doctors in Hangzhou told him he had one option in China—surgery that would replace two sections of his vertebrae and might leave him paralyzed"

Not particularly enamored with the prospect of permanent paralysis, Mr Lin did what any reasonably affluent and rational person would do in such circumstances: he "flew to San Francisco and paid $70,000 UCSF Medical Center,  where doctors recommended that Mr. Lin try radiation therapy," instead.

This despite the fact that China has its own version of the MVNHS©, guaranteeing "free" health care to its citizens. Of course, that care is often (usually?) substandard - when it's even available. Thus, smart Chinese folks with more than a few yuan to rub together are increasingly turning to other sources:

"The Mayo Clinic, in Rochester, Minn., said the number of ts patients from China has more than doubled over the past year."

Which, by the way, accepts only one kind of ObamaPlan, so if yours isn't a Blue Cross/Shield Silver plan, then you're SOL. Unless, of course, you've got that extra $70 large laying around collecting dust.

As it is, hospitals in mainland China aren't exactly models of efficacy:

"[They] struggle to make money. Low-paid doctors are paid for each service and commonly receive kickbacks for drug prescriptions, which can lead to exploitation of patients."

Talk about pay-to-play medicine.

And there's this:

"China ramped up health-care spending more than 13% last year to 820 billion yuan, or around $133 billion ... But the funding barely scratches the surface for a population increasingly plagued by
chronic diseases"

That is, another nationalized health care system fails at reining in runaway health care costs. Quelle surprise.

Glad we don't have such problems here.

Hacktastic 404Care.gov: Geese and Ganders

Last week, Bob posted on the July hacking of the 404Care.gov site, noting that "they are just now telling us about it."

This struck me as more than a bit problematic, and here's why:

Readers may recall that I recently underwent Marketplace re-certification training. This annual exercise is required for agents who wish to sell on the Exchange (and, increasingly, even off-Exchange). One major module was on "Privacy and Security Standards," which outlined all the various systems and protocols agents must have in place for dealing with potential clients. For example, I must encrypt any emails that include Personal Health Information (specifically, Personally Identifiable Information), and, more importantly, the "procedures required for incidence handling and breach notification."

And these were extensive.

"Accountability" is paramount, requiring that the "principles [of information safekeeping be implemented, and adherence assured, through appropriate monitoring."

Which brings us to the reason for this post: the double standard levied on agents versus those required of the folks who actually run the Exchanges.

To wit:

"A security incident occurs when there has been an attempted or successful unauthorized access ... in an information system." [emphasis added]

What would you call July's "incident?"

And what is required of agents - but not, apparently, of the Feds - in the event of such an occurrence?

I'm glad you asked:

"Agents and brokers must report any incident involving the loss or suspected loss of PII or PHI ... Provide details ... Require reporting of any incident or breach of PII to the CMS IT Service Desk" [emphasis added]

And what about when that incident or breach is aimed directly at that CMS IT infrastructure? Well, it certainly appears that these rules don't apply.

So here's a question: why are agents (and brokers) held to a higher standard then the folks who actually run the Exchanges?

I think we already know the answer to that one.

Headline Chuckle of the Day…Firm Date for ICD-10 Switch Still Not Raising Urgency

Since 2003 I have heard that the ICD-10 switch is “FIRM”. No wishy-washy, dilly-dally for the ICD-10, no sir, the date is set in stone. Well, maybe soft concrete. Would you believe chalk on concrete in a rainy climate?

So I got quite a chuckle when I saw an article with the statement of a firm date:

“Now that there is a firm date for the transition to the new ICD-10 coding system -- and it's little more than a year away -- you'd think physician practices would be rushing to get ready, but that doesn't seem to be the case.”  Shocked, shocked I say.

Earlier this year, I had the privilege of sitting through several webinars about ICD-10 and how it would work, and two things became evident. First, that the ICD-10 is so dramatically different from ICD-9 coding that physicians will explode en mass if asked to adopt it,  and seconf, that no one on any webinar believed that it would be implemented in October of 2014. The first question always asked on these webinars is “Will implementation be delayed again?” The answer was always a definitive NO. But it was delayed …

“The new ICD-10 coding system was originally set to take effect this October, but was then pushed back at least a year in a bill -- the Protecting Access to Medicare Act of 2014 (H.R. 4302) -- which was signed into law in April.

However, the bill didn't specify an exact date for the switch -- saying only that the Department of Health and Human Services "may not, prior to Oct. 1, 2015, adopt ICD-10 code sets," meaning that it could be later than that date. This left physicians in limbo, without a definite date for a switch.”

Now CMS is complaining that doctors are not getting ready:

“Physicians have been pushing back on their practices' efforts to get ready, "saying, 'Why should I invest because they're moving the date every year,'" said Robert Tennant, senior policy adviser for the Medical Group Management Association.” And there's this: the vendors aren't ready, either. And why not? Well, they "don't want to invest much either, thinking the date may never stick. It's a terrible situation."

The reality is that medical offices spend hours on developing protocol, attending Webinars, and training, only to have the date of implementation pushed back time and time again. It is not only ICD-10, but the many and various government initiatives that are very poorly designed, pushed to be implemented and then, when there is pushback from the medical community, it is delayed, but only after these offices have invested time and money to get ready. I recently discovered that a program that was to go into effect on April 1 of this year, after being pushed up from January 1, 2014, was instead suspended. I spent hours on training for this initiative and developing the data gathering process, only to discover that, as the manager who told me the news stated, “I wasted my time.”

Why would any doctor or manager, already working 50 to 60 hours a week, want to spend even more time on a government program that has been pushed back so many times that it's now an industry joke? The answer is that they will not waste their time, regardless of any strongly worded guideline from the government.

Oh and how is that metric initiative going?

Refusing Government Health Insurance - A Twist

Earlier this week, Bob reported on the egregious case of the British parents arrested for daring to save their son's life. He noted at the post that "[i]t is a good thing this can't happen here."

Regular readers will recognize the sarcasm, but it turns out that it's no laughing matter:

"Maine Gov. Paul LePage reversed state bureaucrats and vowed to defy a state Supreme Court court ruling if necessary to back a teen mom seeking to lift a "Do Not Resuscitate" order from her one-year-old baby, who was allegedly shaken into a coma but miraculously recovered."

Little Aleah Peaslee, in a coma since being shaken and abused by her father, "unexpectedly regained consciousness not long after being placed in the arms of her mother." The challenge is that she's likely suffered significant brain damage as a result of the abuse and the coma, and the state child welfare bureauweenies care only about that part of the equation.

Budgets are sacrosanct, don'tcha know.

So, the case now heads to the Maine Supreme Judicial Court, where proceedings will, well, proceed beginning on the 23rd. In a twist, the court's actual decision may itself be moot: "[Governor] LePage told FoxNews.com he will not allow state child welfare officials to usurp a parent’s rights regardless of what either court says."

Which may also set up some interesting legal fireworks.

Meantime, Baby Aleah continues to live, despite the child "welfare" agency's best efforts. We'll keep an eye on this one.

The ObamaTax in 4 Sentences

1. In order to insure the uninsured, we first have to uninsure the insured.

2. Next, we require the newly uninsured to be re-insured.

3. To re-insure the newly uninsured, they are required to pay extra charges to be re-insured.

4. The extra charges are required so that the original insured, who became uninsured, and then became re-insured, can pay enough extra so that the original uninsured can be insured, which will be free of charge to them.

[Hat Tip: FoIB Joe B]