Monday LinkageFest

■ Death. Taxes. Health Insurance. New ObamaTax forms are soon to be on their way (most likely):

"If the Internal Revenue Service (IRS) implements the current rules as planned, insurers will have to send 1095-B coverage notice forms for the 2015 plan year in early 2016."

What's that mean? It means that large employers will have to send these forms to covered employees (kind of like W-2's or 1099's), which employees will then need to enclose with next year's tax returns. The ostensible reason is to allow the Feds to confirm that said taxpayer did, indeed, have appropriate coverage.

Exit question: who really believes that these forms won't ultimately result in additional taxes?

■ A few short weeks ago, it was the prospect of UHC eyeing Aetna, and Anthem smacking its lips over Humana. But things are never what they seem:

"Aetna, the second-largest U.S. health insurer by market value, is closing in on an acquisition of Humana"

First, consider me gobsmacked: I coulda sworn that UHC occupied the #2 slot. Second, expect this kind of consolidation to continue as profit margins shrink and companies vie to position themselves as administrators of the coming Single-Payer scheme.

■ Folks in smaller groups ought not be pointing and laughing at Item #1 above:

"Employers in the 51-100 employee size bracket are anxious about the prospect of being added to the “small group” market that under the Affordable Care Act (ACA) currently cuts off at 50 employees."

And why is that?

Well, those considered "small groups" have more stringent coverage requirements than their larger brethren, including the "10 Essential Health Benefits" mandate. Net result: "an immediate impact on premiums due to new rating rules."

And they don't mean "downward."

Narrow Framing vs LTCi, David W responds

David Williams graciously responds to my take of his WSJ LTCi review:

"So I revise my view: long term care insurance has a role to play. But it still doesn’t deliver what I’m looking for."

Progress, surely.

SCOTUScare Fallout

Well, that didn't take long:

"Obamacare Ruling May Have Just Killed State-Based Exchanges"

Indeed. Why would a state - any state - continue to throw money and other resources into maintaining their own HIX? Actually, there's a delicious irony here: Herr Gruber himself maintained that the law was written to encourage states to set up their own Exchanges (in order for their citizens to qualify for subsidies). Absent that bribe, er, motivation, the only rational action is to move your folks to 404Care.gov.

[Hat Tip: FoIB Holly R]

And thus ends the Rule of Law

Words mean nothing:

"[T]he Supreme Court on Thursday upheld ObamaCare subsidies in states that did not set up their own health care exchanges. 

The decision was 6-3."

And thus is born SCOTUSCare.

And BTW: This means that both the (Evil) Individual and Employer Mandates stand. So we have that going for us, which is nice.

Risky Roundup

■ Last month, we mentioned some of the very positive results that would arise from a Plaintiff's victory in King v Burntwell. Today, Cato's Michael Cannon offers even more, noting that "the benefits of a ruling for the challengers would swamp all other effects."

A few:

·  Over 11 million citizens "freed from an illegal tax averaging $1,200

·  A pay raise of over $900 for affected employees

·  Almost 240,000 new jobs

And the list goes on.

■ FoIB Allison Bell wonders about the implications of a failed Palmetto State CO-OP, which left (on average) some $2,400 per enrollee in unpaid claims. Some are covered by their states' Guaranty Fund, but some aren't. It depends on whether or not the plan is considered a MEWA, and thus not eligible:

"South Carolina Health Cooperative was a nonprofit, member-owned MEWA formed outside the PPACA system. Because it was not classified as a health plan under South Carolina law, its members were not eligible for guaranty fund protection"

This could prove to be a major problem as these types of plans continue to fail.

■ Ever heard of Bitcoin? It's a non-government-backed "virtual" currency that's become attractive as both an alternate payment method and an investment strategy. But it's also risky business: with no government to backstop it, what happens if the value collapses? And since it's virtual (that is, completely on-line, with no physical analog), there are added cyber-security risks, as well:

"[G]lobal insurance giant Lloyd’s of London released a report titled *Bitcoin: Risk Factors for Insurance* ...  businesses seeking to enter the virtual currency marketplace—whether by running an exchange, holding bitcoins in secure “wallets” for users, or simply accepting bitcoins as payment—must be aware that Bitcoin’s “security risk will never be reduced to zero.”

On the one hand, I'm not convinced that **any** risk can be "reduced to zero" (else it's no longer "risk") but the point here is that the currency is now ubiquitous enough that it represents a significant risk factor for businesses.

Interesting stuff.

Generous Carrier Tricks

Our on-going Stupid Carrier Tricks series is generally over-represented, so it's nice to be able to add one on the positive side. Medblogger Lisa Emrich daily chronicles her thoughts and strategies as she battles MS; she also reports significant events on Facebook, where she recently posted this:

"Some readers doubted my description of an insurance company who pays much more than hospital charges for an infusion. See details from the EOB."

Turns out, her Grandfathered health insurance plan (from Carefirst BCBS) allows for very generous benefits, especially when it comes to treating her MS.

How generous, you ask?

This generous:
 

That's right, they actually allow a greater amount than what her provider ended up charging her, and this was in turn reflected in her balance due. And, of course, the amount she pays in co-insurance helps reduce the balance for the rest of the year.

Reason I mentioned her Grandfathered status is that this plays a role in the overall scheme of things. Lisa tells me that "I absolutely appreciate the 10% coinsurance which is why I've kept this grandfathered plan. After Carefirst processes the 2nd infusion (in June), I will have fulfilled my max OOP (for medical) for the year." Nice.

Bottom line: it's nice to know that some carriers really do try to help out their insureds whenever possible. Chalk one up for the good guys.

Narrowly Framing LTCi (Part 2)

In Part 1, we took a detailed look at a recent WSJ piece on Long Term Care insurance and "narrow framers." Our friend David Williams has asked us to review his take on that article, and so we shall.

I have only a few quibbles with his analysis:

"Insurance is useful when it covers rare events that could be financially ruinous. But long-term care is a common need ... and the benefit structure doesn’t protect against catastrophic expenses."

I think this is overly simplistic: as I mentioned in Part 1, insurance as risk-management tool has more to do with the severity of the potential loss rather than the frequency (although that’s certainly a factor). This explains, in part, the popularity of co-pay health insurance plans vice HSA's: few of us would go broke paying for a simple doctor's visit or common prescription, but we've been conditioned to "let the insurance pay for it." Regular readers will spot the fallacy there.

More disturbing, though, is his contention that "the benefit structure [of LTCi} doesn’t protect against catastrophic expenses." This is a common misconception of how LTCI works and what it's really designed to do, and for that I blame not David, but my industry. The story we've been told to tell is that you buy LTCi to pay for care. This is correct, but misleading: there is no realistic way to buy a plan that will completely cover the costs of a major claim (or series of claims). Anyone that could afford to buy such a plan would be much better off self-insuring.

No, the role of LTCi is to supplement one's assets (and a Partnership-compliant plan is a terrific ally in that quest), and to buy "choice."

What does that mean, Henry, "choice?"

It means that having the ability to pay for care oneself opens up a lot more doors (as regards facility and resource availability) than folks dependent on Medicaid will see. Is that fair? Doesn't matter. Is that real? Yes.

David then writes about his own experience in considering a plan, and noted that what he was shown had very little in common with what he wanted. This is a failure of either David (for not sharing his vision with his agent) or the agent (for not listening to David). I don't know his agent, but I have a very difficult time believing that David was less than forthright and explicit in his request. On the other hand, I know from experience that clients are generally less knowledgeable about these plans than they might think (which is no indictment: they've been served a long line of carrier and industry propaganda). My very first step when asked about LTCI  by a client (or potential client) is to point them to our primer on when one should consider buying a plan, and what to look for.

David does describe his ideal plan: "a policy with a 5 year elimination period and no cap on the benefit period." Such a configuration does not, to my knowledge, exist, but it seems to me that there ought to have been some common ground between what the agent had available and what David wanted; unfortunately, that doesn't seem to have been the case (or so I inferred from the post). Does that make David a "narrow framer" (in the context of the WSJ post)? Hardly: in fact, he seemed crystal clear in what he wanted and not distracted by the minutiae.

Where I think he veered off course is in not considering other reasons to buy a plan, and I hope that he takes the opportunity to revisit that decision. I'd be happy to refer him to a pro.

CO-OPs: That flushing sound you hear...

Last month, we again noted that CO-OP's (Consumer Operated and Oriented Plans) were in financial trouble:

"[O]nly one Co-op, Maine Community Health Options, reported both favorable underwriting and net income at $10.9 million. All other Co-ops reported both underwriting and net losses"

As the saying goes "that which can't go on, won't." And so we find ourselves (unsurprisingly) at the edge of a cliff:

"Ominous signs are proliferating among 22 Obamacare health insurance co-ops of imminent financial collapses that could leave more than a million Americans without coverage"

So, while everyone's eyes are on SCOTUS, another major piece of The ObamaTax is facing its demise. And of course, that means all those taxpayer dollars down the terlit.

And just how many tax dollars?

Well:

"[A]n Obamacare co-op that defaulted earlier this year, suffering $163 million in operating losses in a single year ... net losses for the co-ops reached a record $614 million in 2014"

Yes, yes: petty cash to the DC bureauweenies, but actual, hard earned dollars to thee and me.

What's particularly troubling is that "[t]he figure is nearly three times the $234 million in losses suffered through the first three quarters of 2014 ... It means that the burn rate for the experimental Obamacare co-ops is quickening."

Maybe that's a good thing, though: the faster it burns up, the sooner we can start having a serious discussion about alternatives (and reality).

Narrowly Framing LTCi (Part 1)

Our good friend David Williams has written a blistering review of a recent WSJ article on why people aren't buying Long Term Care insurance (LTCi). Before addressing his concerns, I'll offer my own thoughts on the piece:

■ Based on the results of their study, Drs Olivia Mitchell and Daniel Gottlieb "found that many people regard long-term-care insurance as having no real value if ultimately the payouts aren’t needed.”

It's said that people rarely buy insurance: it must be sold (to them). This would certainly hold true regarding LTCi; as agents, we do a terrible job of selling it, which seems to validate this particular conclusion.

■ The article goes on to note that "instead of looking at long-term-care insurance primarily as financial protection, many people think of it as an investment—and a bad one at that." And they're right, of course: it is a terrible investment. But then, a dump truck is a lousy commuter vehicle, and my oven does a terrible job of washing my dishes (well, there was this one time I inadvertently left a plate in on the "self-clean" cycle, but that's another story).

Insurance is a risk-management tool, not an investment. No one expects to make a profit on their homeowner’s policy, either, but we still insure our homes. That's because, as David points out, the downside of a catastrophic loss far outweighs the cost of a policy.

■ The real meat of the article, though, and the part with which David seems most frustrated, is this:

"[O]ur research suggests that some consumers’ rejection of long-term-care insurance is based on what psychologists call “narrow framing,” or people’s tendency to exclude key factors when making decisions."

As the authors point out, this is often the case when faced with making a decision about something as complicated as LTCi. It is much easier to convince oneself that "if I can't understand it, I must not really need it." Something about "the path of least resistance" comes to mind.

Where I think the conclusions fall apart is this rather innocuous-sounding sentence: "[W]e believe that insurers could better position their products in the marketplace by providing more information to consumers regarding the high probability of needing care, and the high costs of such care."

Bullcrap.

For one thing, we already do that: look at any product brochure or marketing piece, and the stats are right there in big bold letters, charts and graphs. It seems to me that piling on would simply reinforce the "narrow framer" mindset.

The authors do get this one right: "focus more marketing toward adult children whose parents will likely require nursing-home care;" the idea being that they will pay for their parents’ policy as a means of preserving their parents' estate (and thus their own inheritance). The problem with this strategy is that you still have to get the parents' buy-in, and who's to say that they're not "narrow framers" themselves?

Finally, the article suggests that insurers should "emphasize policies that provide benefits in addition to protection for long-term-care costs. For example, more policies could include retirement income payouts or life insurance"

This skirts the issue, because the more benefits you throw on a plan, the more expensive it's going to be (whether broken out as riders or simply "baked into the cake"). Making LTCi more expensive seems counter-productive.

Interestingly, the article fails to mention one of the most valuable, easily understood benefits of LTCi, one which addresses pretty much all of their concerns: the Partnership Program. Pointing out that a properly constructed plan will help keep the Medicaid folks at bay makes for a very compelling argument that even "narrow framers" would find hard to resist.

Okay, so that's the WSJ; what about our friend David? Well, seeing as how this post is up to almost 700 words already, click here for Part 2.

UPDATE: David has graciously linked back to this post. Thanks, David!

Aetna exiting small group arena?

Well, how else to explain this:

"A new producer service fee arrangement introduced by Aetna looks to eliminate broker commissions on small-group business ... The Producer Service Fee model requires brokers and their clients to negotiate a service fee that will be paid by the customer/employer to Aetna, and then paid out by Aetna to the broker."

Right after they skim off their vig, I'm sure. But what's behind this?

Well:

"They are specifically angling to say that we do not represent them, that we would be engaged by the customer and that therefore they have absolutely no obligation to pay us"

Sounds about right.

Of course, it's Aetna's prerogative to do pretty much anything it likes, but there are always those pesky consequences. For one thing, it's possible (likely?) that this violates MLR requirements.

How's that?

Well, premiums are calculated based on a group's demographics, location and the like, but they also include the commission. Nothing in the announcement indicates that premiums will be reduced based on the carrier's lower cost (perhaps they're emulating the old Blue Cross model?).

I haven't received my copy yet, so I'll withhold judgement until then. But I'm pretty sure I know my response should this prove out.

Completely Asinine Carrier Trick

So, Medical Mutual of Ohio sent me a new Broker Agreement form (essentially the contract that allows me to sell their products and receive a commission for doing so). Very standard, very simple, no big deal.

Except:

The form is 13 pages long, and only 3 of them require any input (name and contact info, signature). So, I print off and complete those 3 pages, scan them back in (and could somebody explain the rocket surgery in emailing an electronic form which then needs to be printed out, then scanned back in?) and hit the send button.

Easy peasy lemon squeazy.

Or so I thought.

This morning, I'm greeted with this:

Good Morning
Our legal department requires at all  13 pages are returned .

I have attached a new blank document for your use

Please complete
Page 1 – List your name  
Page 11 – your contact information
Page 13 – Sign and print your name and added your NPN Number

Return all  13 pages please

Thank you

Um, Einstein's? Those were the three pages I sent you; the rest is boilerplate. But I'm now supposed to print out 10 more pages of your idiotic verbiage? How bad is it when I'm complaining about killing trees?

Sheesh.

Health Wonk Review: Tinker's Ready edition

Boston Health News blogger Tinker Ready hosts this week's roundup of of wonky posts, with an emphasis on the upcoming King/Burwell SCOTUS case. As usual, the posts are interesting and thought-provoking (and don't miss the roll-out of a new term: "horrendoma").

Great job, TR!

An embarrassment of riches linkage

■ Who says crime doesn't pay? Oh, I guess that would be "Tracie Yvette Clay, 46, chief executive of N.C. Behavioral Health and Counseling Services" who's just been sent to the slammer for the next half-dozen years.

Why, you ask?

Well, as FoIB Jeff M tips us, Ms Clay admitted that she's "submitted claims for services for at least 56 clients – none of whom received the services."

And the value of those not-actually-provided services? A cool million dollars. Easy come, easy go.

■ For those following the Halbig/King/Burntwell saga, here's some perspective: "Only 1 out of 5 whose insurance costs grew because of obamacare got subsidies."

That is "the subsidies also served to mask the significant health insurance premium increases that would inevitably result from the law’s new insurance benefit requirements and regulations."

Of course, the current meme-of-the-day is that current rate hikes are "modest." Try telling that to my clients facing double-digit increases, and essentailly no options if they want to maintain comparable coverage.

■ And in Blast-From-The-Past news, the home of RomneyCare continues to embarrass itself:

"MassHealth squandered more than $500M ... The state’s Medicaid program squandered more than $500 million over a five-year span ... the state paying twice for the same service on nearly 1.5 million occasions"

Could be worse, of course.

Red fish/Blue fish, Big fish/Gulp!

Well, it used to be a dog-eat-dog world out there, but lately the prevailing metaphor would seem to be big fish eating smaller ones. There's always been a certain amount of consolidation in the insurance biz, but that appears to be heating up of late as The ObamaTax kicks into high gear. Cases in point:

■ Anthem eyeing Cigna and/or Humana: "Anthem Inc. has explored a takeovers of smaller health-insurance rivals Cigna and Humana ... Humana has also drawn interest from Aetna Inc."

I believe this is known as "jockeying for position."

■ United Healthcare pursuing Aetna: "UnitedHealth and Aetna on Monday night joined the list of health giants said to be exploring a potential merger"

Given that Anthem and UHC are the two 800# gorillas in the room, it no longer seems improbable that someday, in the perhaps not-too-distant future, we'll be down to two mega-carriers. On the one hand, this would be good for stockholders of both (and, one supposes, those of the smaller companies they swallowed up).

On the other hand, this doesn't bode well for fans of a competitive, free market. Competition breeds innovation and helps push down costs, but it's not clear to me that having two such behemoths left as the last ones standing would be to society's benefit.

On the gripping hand, it would certainly make the transition to single-payer (the true goal of the ACA) that much easier.

On "Losing" Subsidies

No one yet knows how SCOTUS will rule in King v Burntwell, but that hasn't stopped the doomsayers from claiming that a gazillion people will "lose their subsidies" should Plaintiff (King) prevail.

No, they won't.

That's because you can't lose something to which you were never entitled.

The fact of the matter is, should SCOTUS insist that the law be applied as it was written, then folks in states using the 404Care.gov site were never eligible to receive subsidies in the first place.

It's really not that complicated:

Here in Ohio, we have a very cool program called the Golden Buckeye card:

"All Ohioans age 60 or older ... are eligible for a free Golden Buckeye card ... Merchants of all types (e.g., restaurants, retail, auto care, medical and more) voluntarily offer special savings or deals for older Ohioans who carry [it]."

Now let's suppose that I (who have not yet reached that august age) do, in fact, patronize a store that offers a GB discount. Am I "losing" that discount (aka subsidy)? No, since I don't qualify for it. It really is that simple.

What's frustrating (albeit not surprising) to me is the wailing and gnashing of teeth, as if the evil folks who dare to upset the subsidy applecart are somehow the villains. No, they are not; that would be the bureauweenies (primarily the IRS) who granted them to ineligible folks in the first place.

Really.

Transjenner Insurance

Bruce Jenner may be the celebrity-du-jour of the transgender set, but he's certainly not the only member of it. While he and his extended family can most likely afford to pay for the procedure(s) out-of-pocket, most folks lack the requisite funds to do so.

And just how much does this process cost? Well:

"The total typical cost of a transition usually includes: expenses incurred in the year before surgery, during which hormone therapy, counseling and living full-time as the target sex are recommended; the cost of the surgery and follow-up care; and ongoing costs after the surgery, including hormone therapy for life and continued doctor visits."

All told, a successful (for certain values of "success") transition seems to run between $40,000 and $50,000. That's a lot of scratch for a non-celebrity, so to what other source might one turn for help?

If you thought "health insurance," give yourself a cigar (preferably a candy one: tobacco use results in higher insurance rates). Now, you may be thinking "Henry, I understood that health insurance covers only medically necessary procedures; how can this possibly fit that bill?"

And you'd be right again.

Sorta:

My initial reaction was "no way a health insurance policy covers this."

But then alert reader and FoIB Jeff M sent me this gem:

"Obamacare to cover majority of transgender woman's sex reassignment surgery costs ... with the help of Obamacare, Larson says she is looking at paying $5,000 out of pocket for the surgery."

Surely that can't be right: what carrier in its right mind would cover such a thing?

Turns out, more than a few: Aetna, Anthem Blue Cross Blue Shield, Cigna and several others cover the surgery (or surgeries), subject to a very specific definition of medical necessity. Interestingly, UHC generally doesn't.

And those plans that do offer coverage treat it the "same as any other illness;" that is, subject to deductibles and co-insurance, as well as any network pricing issues. So depending on what plan one has, out-of-pocket could be as little as a few thousand dollars. Reason #4,835 why premiums are skyrocketing.

Ah, what brave, new world.

BX in the Crosshairs

Surprised only that it took this long:

"Blue Cross and Blue Shield (BCBS), along with the Blue Cross Blue Shield Association, was sued across all states in a class action brought by two types of plaintiffs ... BCBS is able to buy services as a cartel and is not passing savings on to consumers."

This would be news, of course, only to those who haven't been following along, or who don't understand the true role of Blue Cross/Blue Shield (BX):

"In the insurance world, MFN (no, that's not an acronym for something dirty) means "Most Favored Nation," a term usually reserved for international trade agreements. In this case, it's an agreement between an insurer and a provider (or many providers) which grants the insurer exclusive and substantial discounts on medical services."

Back in Aught 10, we noted how BX had (seemingly) abused this status, but the sad truth is that they are the 800 pound gorilla in (virtually?) every market.

The challenge here is that as premiums increased, there was no concomitant rise in provider reimbursements. And in true vicious cycle fashion, these savings weren't then funneled back to the insureds.

Now, the lawsuit covers the period from 2000 to 2007, so it pre-dates the ObamaTax and thus MLR (Medical Loss Ratio) requirements. The fact that the case is still going forward is interesting, inasmuch as the underlying problem seems to have been resolved. Still, one supposes that those (allegedly) harmed by it deserve their day in court.

On the other hand, who do they think is going to actually pay should plaintiffs prevail?

It's official (Assurant waves buh-bye)

As we predicted a month-and-a-half ago, Assurant is saying adios to health insurance:

"Assurant Inc. said today it will exit the health insurance market and sell some small group business lines ... Assurant Health will cease sales of its individual major medical, small group fully insured and short-term medical health insurance policies on June 15 and will not participate in open enrollment under the Affordable Care Act for 2016."

No reason was given for this shocking development.

Just kidding!

It was The ObamaTax:

"Approximately half Assurant’s projected 2015 losses are attributable to a reduction in 2014 estimated recoveries from the ACA risk mitigation programs"

That would be the highly suspect touted Risk Corridors.

And what about the other half?

Well:

"The remainder reflects elevated claims on 2015 ACA policies."

Hey, remember that promise?

Front!

We first took a substantive look at (so-called) "Concierge Medicine" over 7 years ago, noting that "[p]rimary care physicians are battling to save their practices by looking at new ways to increase revenues ... a few have gone to concierge services."

So it was with some bemusement that I read this piece, sent to us by FoIB Jeff M, lauding a Tar Heel State physician purportedly at the forefront of this phenom:

"It turns out that a physician from North Carolina was one of the trailblazers who adopted early this type of practice. Dr. Brian Forrest is a family practitioner who owns and operates Access Healthcare Direct in Apex, NC."

His practice's website doesn't indicate when it was founded, but another article refers back to a 2009 "Cardiovascular Centers of Excellence" award, so I'll give him that mulligan.

More important, he recognizes that both political parties are heavily invested in "mak[ing] insurance-based medicine extraordinarily burdensome." We see this with HI-TECH and EHR regs, and the lowball reimbursements from Medicare and Medicaid, which also drive non-governmental providers' revenues (via insurance).

About 2½ years ago, we interviewed Dr Rob Lamberts, who at the time had just  set up his own version. He noted at the time that an overarching motivation was being able to walk away from the administrative costs and overhead of dealing with multiple carriers, each with their own rates and rules. This tracks very well with Dr Forrest's experience.

Of course, signing up with one of these practices doesn't obviate the need for some kind of catastrophic coverage: hospitals and oncologists don't use this model. Still, it seems to be a growing trend, and I think that may well be a good thing.

Yeah, about that promise...

You know, this one:



Sitting down?

Good, because this is shocking (not):

"Due to changes for 2015 requiring H S A deductibles be a minimum of $2600/$5200 for embedded deductible plans, plans E51, E52, and E1 with copays are no longer eligible as an H S A plan. These plans will be removed from the quoting tool around 6/12. We have added E58, E59, and E5 with copays to replace those plans." [ed: from Anthem email]

Got that? Folks who were perfectly happy with their existing Health Savings Account compliant plans have just been forcibly moved into new ones with different (perhaps unwanted/unneeded) "benefits."

[Hat Tip: FoIB Beth D]

Centennial State HIX Hiccups

The latest news from Colorado reinforces the fact that state-run Exchanges are no panacea, either (as if further confirmation was needed - Aloha!):

"Colorado’s health exchange board today approved a final budget for the next fiscal year that requires aggressive sales growth and higher fees, but still doesn’t bring in enough cash."

Shorter: we're losing money hand-over-fist, but we'll make up for it in volume.

A big part of the problem is that a disproportionate population of folks are being added to the Medicaid rolls, which bring in zero premium dollars, and exacerbate an already-overwhelmed health care delivery system.

But they certainly have their priorities in order:

"Kevin Patterson, the new interim CEO, pledged that his primary goal is to improve customer service"

Yeah, because that's the most pressing issue.

Top. Men.

Fellow insurance agent John Luhman notes that a key problem (aside from, you know, customer service) is that the Exchange itself is plagued with technical problems. In response, the rocket surgeons tasked with maintaining it claim that "that’s the case about 10 percent of the time and they are trying to build a better shared IT system with state Medicaid officials."

"10%" Sure, sure.

But the best quote comes from board member Davis Fansler, who said he’s "concerned about the projected losses. There’s a gap here (between revenue and expenses) no matter how we slice it ... We’re ultimately going to have to take a look at what some ancillary revenues might be."

No kidding. And what are these "ancillary" revenues of which he speaks?

Good question.