The Flip Side of Halbig/King/Burntwell

The goal of The ObamaTax was to extend health insurance (and thus, presumably, health care) to the minority of Americans without it. It's been an article of faith that the subsidies are what will drive that goal. The Supreme Court has yet to rule on Halbig (etc), but that hasn't stopped the chattering class from opining on what a tragedy it will be if they strike down the government's (illegal) extension of subsidies to residents of states using the 404Care.gov Exchange.

But there's another side to this, one which has thus far gone unremarked: is there a potential upside to folks whose subsidies go away? Turns out, there likely is. In fact, the case for enforcing the law train-wreck as written is pretty strong:

"Nearly 8 million people currently enrolled in 37 states through the HealthCare.gov site would lose their health insurance [by] losing their subsidies. Premiums would spiral out of control as the only ones left in the exchanges would be the sickest and most expensive patients."

Okay, making the defendants' case, so what's that "flip-side?"

"[A] new report ... says that these critics are looking at only one side of the equation ... the claim [is] that 8 million will lose insurance assumes that everyone who loses subsidies in the federal exchange would cancel their health plans."

While it's likely that many - perhaps most - would, in fact, opt for the (toothless) penalty fine tax, it's by no means certain that all of these folks would bail. After all, as IBD points out, most of these folks were already paying for insurance before the ObamaTax. It seems reasonable, then, to presume that a good portion of them would suck it up and continue paying unsubsidized premiums.

But wait, there's more:

"[P]eople in [the affected] states would be eligible to enroll in low-cost catastrophic plans, something that they can't do now without also paying the individual mandate penalty."

This is key: many folks really just want/need catastrophic cover, without unnecessary (and expensive) bells-and-whistles.

As an aside, this would be a perfect opportunity to expand HSA eligibility to these types of plans. Hint, hint.

Perhaps the greatest benefit is the one least discussed:

"Getting rid of the subsidies has benefits, too: Namely, both the individual and employer mandates would get flushed away with them."

How's that, you ask?

Well, if getting rid of the subsidies renders coverage "unaffordable" (an ACA "term of art"), then the penalty no longer applies, thus saving consumers even more money. In fact, the "study finds that 11.1 million people will be free of the individual mandate, and more than a quarter million businesses will be liberated from the employer mandate" if the plaintiff prevails: "No subsidies, no mandate."

Four words I can get behind.

Oh, and the other upside?

That would be the north of 230,000 new jobs, plus higher pay for both full- and part-time workers.

So what's the rub?

Well, all of these goodies likely go away if the rocket surgeons in Congress decide to "fix" the ObamaTax instead of deleting it. What are the odds of that?

A Quarter Trillion here, A Quarter Trillion there...

And pretty soon, you're talking real dollars:

"Obamacare is set to add more than a quarter-of-a-trillion—that's trillion—dollars in extra insurance administrative costs to the U.S. health-care system"

Keep in mind, these costs will be borne by insureds; that is, carriers will simply increase premiums to cover them. Remember: companies don't pay taxes or premiums.

And at "a whopping 22.5 percent of the total estimated $2.76 trillion in all federal government spending for the Affordable Care Act," it's just one more example of the way that the ObamaTax continues to hurt the very folks it was ostensibly passed to help.

BONUS: The rocket surgeons that wrote the report itself continue to buy into the long-since-debunked idea that Medicare "has overhead of just 2 percent." They then use this faulty "data" to justify the move to single-payer.

Of course.

[Hat Tip: Co-Blogger Bob]

Unfortunate Client Timing

Got  a call this morning from the daughter of one of our agency's long-time clients. In addition to his auto and home, my long-since-retired colleague had written a life insurance policy for him. As the official "Life/Health guy," it fell to me to get the ball rolling on the claim, so I called the carrier's home office to get that started.

The first question I always ask is "is the policy in force?" That is, is it still active and thus able to be paid out. The answer is almost always "yes," and then I start asking about beneficiaries, face amounts and the like.

So I was a bit startled when the customer service rep said "no, that policy was cancelled at the insured's request."

Whoa.

In fact, the cancellation request came in almost exactly a year ago. Of course, unless he was being treated for a terminal illness at the time, it seems unlikely that the insured knew that this was, perhaps, premature. I have no idea why he cancelled the plan; perhaps he had adequate coverage with another agent, or it had grown unaffordable, or some other reason. All I know is that it's now my sad duty to let his daughter know that there's going to be no payout from that policy.

'Tis a shame.

Potentially Stupid Customer Tricks [UPDATED]

[First posted @ 5-26-15. Please scroll down for Update]

We first blogged on the insurance issues associated with ride-sharing services (eg Uber, Lyft) back in 2011:

"Seeing a business opportunity in millions of cars that sit idle at office parking lots or on weekends, several start-up companies have introduced "peer-to-peer" car-sharing services ... Likewise, renting out your car to someone you've never met (and will probably never even see!) is a dramatic change in the nature of your insurance policy's risk."

Fast forward 4 years, and despite the success of these ventures, and the swelling population of drivers and fares customers, many of the same issues remain. In fact, the very first sentence of this post contains an egregious error: it ain't "ride sharing," which sounds more like car-pooling than what Uber, Lyft, et all actually comprise, which is ride selling (and buying).

These transportation networking companies (TNCs) are, for purposes of insurance, pretty much taxi (or livery) services, and your personal auto policy isn't designed (or priced) to reflect that. The TNCs may offer some protection through a corporate liability policy, but that may apply only when a driver is actively engaged in transporting a customer.

And that's just one of the many insurance challenges facing both drivers and passengers:

■ How much coverage is actually available when the driver does have a fare?
■ How will your insurer react if you have a claim?
■ What happens if you don't tell your agent?

And more. Unsurprisingly, I tend to fall in the "better safe than sorry" camp.

[Hat Tip: P&C Guru Bill M]

UPDATE: Home Office friend of mine sent me this:

"Just saw your post. We've been discussing this issue (Uber, etc); currently our view is that there are 3 stages of Uber: 1) you are listed as available, 2) you accept a pickup request, and 3) you pick up the customer and take him/her to the destination. If an accident occurs during #1, there is coverage. If an accident happens during #3, no coverage. During #2, very grey area."

Thanks! Color me (still) skeptical, though: seems to me that stages 1 and 3 still make one a taxi/livery service (else why advertise "availability?"). But hey, I'm a simple unfrozen caveman lawyer life and health guy.

Life Partners back in the news

We first started blogging on this monumentally bad idea in 2010:

"So who really loses here?  [I]t would have to be the poor saps who bought into this idea, and forked over $50,000 (minimum!) to do so."

In 2012, we noted that "Life Partners Holdings, Inc. has been cleared of allegations by Texas state securities officials that it did not register life settlement transactions as securities under state law."

So, bullet dodged, right?

Not so fast there, pardner:

"The bankruptcy trustee for Life Partners Holdings Inc. is seeking to control the proceeds of life insurance policies held by its customers after his own investigation revealed a number of new ways he said the company committed fraud."

Yeah, the ol' shock meter seems busted right now.

And my 5 year old prediction seems pretty much confirmed:

"Artificially shortened life-expectancy figures supplied by the company convinced investors that their returns would be greater ... [LP] charged massive undisclosed fees and misrepresented the company’s business practices."

And the list goes on.

Look for this to get even messier, and we'll keep you posted.

Health Wonk Review at Julie's Place

HWR co-ordinator Julie Ferguson steps up to host this week's 'Review (your scheduled host, moi, is dealing with end-of-life issues with the canine member of our family).

Please drop by for some great insights.

Unalienable Insurance?

Via co-blogger Bob:

Dear HHS, Will You Share My ACA Success Story?

March 23, 2010 was an historic day for health insurance in America. It was on this day when we all rejoiced knowing that Obamacare was going to reduce the average premiums for a family of four by $2500. It was going to help small businesses find affordable options to offer employees. It was going to eliminate "junk" insurance policies. Employees were told that if they liked their plans they could keep them.

So how has this Obamacare thingy helped my small company:

• We have seen an overall decrease in benefits since 2010.
• From November 2010 to our current plan year premiums have increased 58.7%.
• If we would have been forced to an Obamacare compliant plan the increase would have been 116.7%

Numbers don’t lie. Click on the picture to see the real impact.

Blue Grass State HIX Blues

So this happened:

"[T]he Kentucky Health Cooperative, an ObamaCare creation funded initially by federal dollars and then bailed out with tens of millions of dollars more last year, is insolvent."

Ooops. And of course, the bureauweenies behind this massive #fail appear to be circling the wagons. Which is not unexpected, but a shame, nonetheless.

And why is it a shame, you ask?

Well:

"The Kentucky Hospital Association outlined its concerns in a report released Friday called “Code Blue,” saying payment cuts to hospitals are expected to reach nearly $7 billion through 2024. “Kentucky hospitals will lose more money under the Affordable Care Act than they gain in revenue from expanded coverage”

It's almost as if the system itself is imploding. The bigger question, of course, is whether this is by happenstance or design.

You be the judge.

Another 1,000 Words on O'Care

Courtesy FoIB Jeff M:

(Not So) Shocking O'Care news

Last week, we reported on the latest Volunteer State health insurance premium woes:

"BlueCross BlueShield of Tennessee has filed to increase its health insurance premiums for 2016 individual plans by 36 percent, on top of a 19 percent increase approved last year"

Never fear, though, 5 other states are next in line:

"[E]xchange insurers in six states where 2016 rate requests have already been filed are seeking to raise rates an average 18.6% next year."

That 36% hike in Tennessee was the high water mark this time 'round; Beaver State carriers are seeking a more modest 24% increase. Folks in Connecticut get a break, with average rates increasing just shy of 8%.

Now, there are some that would argue that this is to be expected, and can't be totally the fault of The ObamaTax.

These folks would be wrong, it is 100% attributable to the train-wreck:

Gender Bender Preventive Care

So, the kind folks at Ballard Spahr (a well-known benefits law firm) passed along info on the efforts by Our Betters in DC© to more stringently enforce the so-called Preventive Care requirements in ObamaPlans. There's the usual litany of "free" (cf: TAANSTAFL) items, and then this particular turn of phrase caught my eye:

"In applying preventive service recommendations that are sex-specific to particular individuals (for example, a transgender individual)"

Regular readers know that the exhaustive list of preventive care requirements contain exactly ZERO male-specific benefits. So here's a conundrum: folks undergoing female-to-male "transitioning" will be giving up valuable coverage, with no corresponding decrease in premium.

Is this fair?

When can we expect to see the first lawsuit?

Will there be popcorn?

Cover Cali sputtering

As Bob pointed out last month, The Golden State's health exchange (Covered California) continues to burn through tax-payer dollars at an alarming rate. That wouldn't necessarily be a bad thing if, say, they had something - anything, really - to show for it.

But alas:

"After using most of $1 billion in federal start-up money, California's Obamacare exchange is preparing to go on a diet"

And why is that?

Well, it's actually pretty simple:

"[A] reduced forecast calling for 2016 enrollment of fewer than 1.5 million people."

You'll recall, of course, that the primary purpose of The ObamaTax was to increase the roles of the insured. Adding insult to injury, that pesky first 'A' in PPACA continues to remain out of reach, even with subsidies:

"[H]ealth policy experts said that some uninsured folks still find health insurance unaffordable"

The problem, of course, is that folks who qualify for subsidies still find it difficult to come up with the scratch to cover mega out-of-pocket maximums, and that's when they're successful even finding a provider who takes ObamaPlans.

So, the state is tightening its metaphorical belt:

• Spend $58 million less compared with the current fiscal year, a 15% reduction.

• Devote the largest portion, $121.5 million, to outreach, sales and marketing. That's down 33% from the current year.

• Maintain the monthly $13.95 fee for each individual policyholder, which would raise $233.2 million in revenue.

I find #2 to be the most ludicrous: sell all you want, if folks can't afford what you're selling, well...

So, who's next?

Breaking: Silver State HIX Plot Thix

LifeHealthPro's Allison Bell tips us to this interesting news, thus far flying under the radar:

"The #Nevada exchange, @NVHealthLink, has canceled a meeting that was scheduled to take place tomorrow"

Last time we checked in, Nevada's Exchange was having trouble paying commissions on policies written through it by agents.

Was that a portent of things to come?

Your Genes vs Your Job

Every once in a while, the question of genetic testing in the workplace - and especially as relates to employer-based health insurance - rears its (ugly?) head.

We've covered this several times over the years; in fact, our very first year we reported that "40 percent of people already undergoing genetic testing are worried that participation might affect their future insurance coverage.”

At the time, this seemed kind of a stretch, inasmuch as health insurance companies were forbidden to use these results in their underwriting process (and since group insurance has been guaranteed issue for almost 20 years, it was moot to begin with).

On the other hand, you really can't be too careful, and so we got the Genetic Information Nondiscrimination Act of 2008 (GINA), "which prohibits genetic information discrimination in employment" (the law went into effect the following year). In fact, the law goes even further, in that it also forbids the use of this information as regards benefits (including insurance).

And yet:

"Big companies are considering blending genetic testing with coaching on nutrition and exercise to help workers lose weight and improve their health before serious conditions like diabetes or heart disease develop."

At first glance, this specific use seems to skirt the letter of the law, so it's probably "kosher."  As long as the results aren't used to, for example, determine premium contribution or subsidy levels (ie how much of the premium the employer pays*), this seems to be a legitimate use of the data.

Now, the efficacy of using the information in the manner being proposed may indeed be questionable:

"[E]mployee benefits experts have doubts that such a novel approach will gain momentum. It first has to conquer steep challenges like ... employer skepticism about its effectiveness."

That is, whether or not there's actual value there, and whether it's worth the cost of implementation (these tests aren't necessarily cheap, and one presumes that the employer will be footing the bill).

A potentially more serious concern arises as to who will have access to this information, and how secure it will be. But that's another post.

[*For illustrative purposes only; regular IB readers know that employers actually pay 0% of the premium]

ObamaCare Aloha

Here's co-blogger Bob almost exactly a year ago:

"Hawaii Medical Services Association posted losses of $30.1 million in the first quarter and said it recorded $46.1 million in fees related to Obamacare."

Fortunately, the success of O'Care has helped immensely...

Wait. What?

"The Hawaii Health Connector has prepared a contingency plan to shut down operations by Sept. 30 after lawmakers failed to pass legislation to keep the state's troubled Obamacare insurance exchange afloat."

Looks like ObamaCare #Fail from sea to shining sea.

Under the plan, Aloha State residents will be cut off from enrolling in new plans at the end of this week, and be completely shuttered by the end of next February (costing another 73 hard-working Americans their jobs). It appears that Island citizens will be transitioned to the 404Care.gov site for Open Enrollment Season v3.0 beginning this fall.

Chalk up another one to the Unaffordable "Care" Act.

MassCare unraveling

We've been covering the Massachusetts health insurance Connector since it was merely a gleam in Johnathan Gruber's eyes. So it comes as less than a surprise to us that it continues to implode under the new ObamaTax regime. Thanks to the intrepid Josh Archambault (senior fellow at the Foundation for Government Accountability), we learn that the noose is tightening. Turns out, Bay State Brahmins:

■ Failed to execute a contract with CGI, the vendor hired to build the site, that would track the progress of the project and ensure on-time delivery of a product that included all required features

■ Failed to implement a governance structure that would ensure ongoing quality of the project

[And worst of all:]

■ Attempted to conceal these shortcomings by misrepresenting the progress of the health insurance exchange to a number of stakeholders including the Centers for Medicare and Medicaid Services [among others]

Major no-no there. In fact, their behavior was so egregious that the Feds "have subpoenaed records related to the commonwealth’s ‘connector’ dating to 2010.”

In other words, this is now a criminal matter, with actual fines and (hopefully) jail time potentially on the table.

One wonders which of the other 57 states will be next...

Bob G on O'Care

Our good friend Bob Graboyes (senior research fellow for the Mercatus Center at George Mason University) has some key insights into the failed ObamaTax roll-out. Among them:

"Other than “more people with insurance,” the law’s goals were never clearly stated, so there are few objective metrics on which to judge it. More are insured, but there’s no increase in supply of health care to meet any new demand."

As our own Bob Vineyard pointed out some years ago, this is an utterly predictable result of inelasticity:

"The economics of goods and services can be reduced to simple demand and supply. Health care is no different. It follows economic theory just like every other consumer good.At either extreme you have inelastic price curves and elastic curves. Most consumer items track a bell curve but some things are totally elastic or totally inelastic."

That is, more people may have insurance (although this remains unproven), but the supply of actual health care remains steady (or is, in fact, falling). So how valuable is your ObamaPlan if you can't find a provider who accepts it?

Then there's the little problem of administering your plan if you're fortunate enough to be able to afford and are successful in actually buying one:

"[T]he back end is still dysfunctional. It’s very difficult for a consumer to conduct a transaction as you would with, say, Amazon.com, that results in verifiable coverage. Pen, paper, and processing time are still required"

And how does one track changes made this way?

There's lots more, all of it good, all of it important.

Read the whole thing.

Health Wonk Review - Grumpy Cat edition

Steve Anderson hosts this week's compendium of health care policy and polity, channeling negative vibes into positive outcomes.

Kudos!

ObamaCare ka-boom

As if we needed them, two more reasons why the ObamaTax is imploding. One we've already covered:

"Almost half of the insurance exchanges set up by states are struggling financially"

Again, this should surprise exactly no one.

But the Daily Caller article then posits an interesting possibility:

"[O]fficials are considering raising fees on insurers, asking the state for more money and working with other states to improve their exchange. Connecticut plans to sell advice and strategy to struggling states."

Given its history, seems like the only bit of Connecticut's advice of any value would be on how not to set up or run an Exchange.

But what's remarkable to me is how many folks still don't 'get' that insurers don't pay these fees, and that states don't have money: customers pay the fees, and tax-payers provide the funds.

So the only thing they're going to accomplish is higher premiums (so fewer folks buying or keeping plans) and raising taxes (same same). Where do they think all this money's coming from?

Oh yeah, us proles.

[Hat Tip: FoIB Holly R]

Three sides of a coin

When one considers insurance, the majority of claims are paid to 3rd parties. For example, life insurance proceeds are paid to one's beneficiary, auto claims to the body shop, medical claims to a doctor or hospital, and so on.

But three types of plans, all of which are fairly similar, actually pay benefits to the insured. These are  (in no particular order) critical illness (CI), long term care (LTCi), and disability insurance (DI).

We've blogged on LTCi many times (most recently here). Thanks to FoIB Sandy M, we learn that Fidelity (of investment fame) has produced "a pretty cool chart of US and various sorts of health care" including a very useful interactive map of how much long term care costs around the US.

We haven't blogged much on Critical Illness coverage, which is a shame, because these plans also pay the insured cash benefits for things like heart attacks and cancer. These plans can be particularly useful if one has a high deductible (HSA) plan or one of the newfangled ObamaPlans with sky high out-of-pocket exposures. By providing a quick injection of cash, these plans can mitigate a lot of financial pain.

Finally, the fine folks at the Council for Disability Awareness remind us that May is Disability Insurance Awareness Month. To that end, they're sharing the results of their 2014 consumer survey. Among the key findings:

• 57% of working adults report having no private disability insurance
• One third would consider buying disability insurance if they knew more about it
• 41% would consider buying it if it were less expensive, but perceptions about costs vary considerably

That last is important: many (most?) folks think disability coverage is unaffordable, but seldom check to confirm that by asking for a quote. So if you're one of the 57%, why not check with your employer about a short or long term disability  group plan or - better yet - ask your professional, independent agent for a quote.

You may be surprised by just how affordable coverage can be.

Assuring Clarification

We're not generally in the habit of carrying water for insurance companies, but last week's news about Assurant Health has engendered some confusion. Briefly, Assurant Health is (was?) a subsidiary of a larger company that also owns Assurant Employee Benefits (which sells group non-medical coverage, such as dental and disability).

Unlike its sister company, Assurant Employee Benefits continues to enjoy robust growth and financial stability. According to the carrier:

"Assurant Employee Benefits (AEB) is not exiting the benefits market ... By approaching the sale of Assurant Employee Benefits in this public manner, it allows for us a faster process.  The public announcement allows us to be transparent and control the process.  We expect to know within a few short months who our new parent company will be."

I've been fortunate to work with some great folks there over the years, and know them to be a solid company. Someday I'll have to tell you about my first death claim with them....

Who'da thunk it?

As Bob reported a week or so ago, the Golden State's health exchange is fast approaching room temp. But they're not alone:

"Nearly half of the 17 insurance marketplaces set up by the states and the District under [the ObamaTax] are struggling financially ... wrestling with surging costs, especially for balky technology and expensive customer call centers"

That's right: the much-touted call centers don't work, but we'll keep throwing money at them anyway.

Makes sense (if you're in DC).

On the other hand, even Ms Burntwell (et al) may have begun to see the value that professional agents bring to the party:

"The agency that runs the public exchange system in the HealthCare.gov states has given navigators, certified application counselors (CACs) and other nonprofit assisters a webinar on how to work with insurance agents and brokers."

Unlike these "counselors," agents must be vetted for prior criminal activity, licensed by their state, have strict continuing education requirements, and carry malpractice (Errors & Omissions) insurance.

Nice that DC finally got a clue.