Tuesday, May 31, 2016

Something You Don't See Everyday

And now for something completely different.

According to the NY Times, the details of Obamacare
were revealed to the IRS in a "by special invitation only" meeting. Here are the bullet points.

  • IRS doubted the Obama administration had legal authority to spend the projected $3.9 billion on health insurance premium subsidies
  • Attendees were given an OMB memo outlining the salient points of the proposed spending
  • Attendees could read and discuss the memo, but could not take notes or copies
  • Then Attorney General Eric Holder signed off on the legality of government subsidies
  • The Obama administration failed to get Congress to sign off on spending $3.9 billion but they went ahead and spent over $7 billion anyway
  • Obamacare premium subsidies are not authorized by  IRS code

For those that want the details, here is the link "In a Secret Meeting ...."

You can file this away in your Obama administration transparency filing cabinet.

#ObamacareFail #TheMostTransparentAdministrationInHistory

Stupid Vendor Tricks

I've always believed that the best way to do business is to look for ways to do business; that is, throw up as few roadblocks as possible (with zero being optimum). Glitches do happen, of course, but a good attitude and a smile go a long way towards smoothing things out.

And then there are the incompetents at ExamOne.

I just wrote a combination case for one of my clients: life insurance with Company A, and disability coverage with Company B (long story, not really relevant here). I double-checked with each to confirm that we could do one exam (so poor Betty only gets stuck once); no worries, they were both fine with that as long as I noted it on the applications.

I've used ExamOne pretty much exclusively for many years, solely from inertia. Never had any real problems (until now). On the other hand, I've never really challenged them before.

So, this morning, I called to place the order. I explained to the gentleman what I needed done, and he asked to put me on hold to see if that the carriers would agree to "share" the information (since we were looking to get by with one needle-stick). Since I'd already pre-cleared this, I knew the answer, but I did understand that he couldn't just take my word for it. So he asked me for the carrier names and then put me on hold while he checked it out.

After a few minutes, he came back to confirm that he had the right name for the DI carrier (hint: it's not exactly obscure). After confirming it with him, he again put me on hold to see if he could ascertain whether or not they would be able to accomplish this very simple task.

After a while, he came back and told me that "I can't find a definitive answer, so I'll just go with no."


Making up our own rules as we go along, are we?

This is absolutely unacceptable.

I thanked him for his time and hung up, seething.

Recently, I'd received an email from our new ExamOne rep (who even knew we had an ExamOne rep?), so I reached out to her to tell her about this experience, and that they had just lost a customer (there were also other issues with the original call that aren't relevant here). She promised to "look into it," and I promised to find another vendor.

Which I almost immediately did: I called both the life and disability carriers for suggestions, and they both recommended APPS - Para Medical Services. Well, I called, spoke with a rep right away, and had everything locked down in under 5 minutes. They understood exactly what I needed and knew which insurance carrier was which, no problem.

So, out with the old and incompetent vendor, in with the helpful new one.

Happy ending.

Monday, May 30, 2016

On this Memorial Day

Thank you.

[Hat Tip: RedState]

Friday, May 27, 2016

InHealth Collapse: Immediate Aftermath

So I reached out (via email) to my InHealth clients today:

"Yesterday afternoon, the Ohio Department of Insurance placed InHealth into receivership. This was not completely unexpected: almost all the Co-Ops nationally have failed; we were hoping that IH would be an exception.

The good news is that the DOI will handle taking care of outstanding bills, etc, and this is a trigger for a Special Open Enrollment period so that you can obtain coverage elsewhere.

I'll be in touch early next week to let you know how we can help with this transition. Meantime, have a GREAT (and safe!) Memorial Day Weekend."

I sent this to all my IH clients, and almost immediately received this reply from one:

"Does this mean that I will be required to meet my deductible again this year with the new company?  I've already met my deductible with IH for this year and have more expected medical expenses scheduled in the next few months (MRI for GI and more testing for the neurosurgeon).  Hopefully they take these sorts of things into consideration. 

Hope you have an enjoyable weekend as well!

Keep me posted..."

Good question.

Here's my reply:

"That will depend on the carriers, but my guess would be that yes, everything would reset to zero. I’ll know more as they roll out what options will be available: it’s possible (no idea how likely) that the DOI could make some provision for this. But just don’t know yet."

To which he responded:

"Ugghhhh.....not the answer I was hoping for; however, the one I had expected.  Guess they feel like the working middle class is made of unlimited amounts of money. Rant over.  Lol!"

I can certainly empathize. I'm sure that the coming weeks will bring some clarification, both as to how the transition will be handled by the DOI, and my own choices viz fees.

A dear friend has reminded me that things change, and I do need to be more open to other practice choices (less medical, more life, etc). I know that he's right, and I've been wrestling with this for a while (as regular readers have likely gathered). I do love what I do (mostly), so one supposes that it's natural to sound off on having to adjust course.

But time and tide....

Thursday, May 26, 2016

BREAKING: InHealth Mutual Now Under DOI Control [UPDATED]

[From email just now]

"COLUMBUS - Lt. Gov. Mary Taylor was appointed receiver for Coordinated Health Mutual, Inc. today following the Ohio Department of Insurance (ODI) request to liquidate the company which provides health insurance to nearly 22,000 Ohioans under its InHealth Mutual brand.  The action allows ODI to assure that claims of policy holders, providers and vendors are provided for in an orderly manner while it winds down company operations."

More as this develops.

Really disappointed, had hoped that they'd make it. Take-away? Co-Op model = wishcasting.

UPDATE: Full DOI statement here.

ACA-related Spelling Problems [UPDATED!]

Folks keep misspelling "3,000% rate decrease." For instance:

"Most health insurers in Pennsylvania are pressing for double-digit rates increases for Obamacare plan coverage starting in January"

This is unpossible.

Or this egregious example:

"Health insurance industry lobbyist tells me that Blue Cross Blue Shield of Texas will announce a 59% rate increase today for next year."

Sure wish they'd get this under control.

UPDATE: Check out this post at Bob Laszewski's place for the full story of the Empire State's health insurance market travails. Money quote:

"Let me also suggest that people don't pay rate increases--they pay premiums."


Wednesday, May 25, 2016

Of Belly Dances and Obamacare

Quick update on how our tax dollars are being spent to promote and enroll people in Obamacare.

A recent audit of the Nevada state Obamacare exchange looked at how money was spent on education, training, etc. Among other things they found this .......
Six of the nine navigator organizations offered explanations for the time they weren't at events, saying they were working on social media posts, emails, training or helping with walk-in customers, but auditors said it was still unclear whether those paid hours were spent on exchange-related activities.
Gilbert also took issue with auditors singling out one navigator organization's attendance at the belly dance and lingerie events, saying the exchange needs to target women who are self-employed or operate small businesses and prioritize women's health issues. He said the exchange's success came in part because it appeared at less-traditional events. - Herald Online

Less traditional indeed.

Where to I sign up?

#ObamacareFail  #LingerieShow

O'Care Hall of Shame (Part 367)

So, the McKinsey Center for U.S. Health System Reform has released the findings from its most recent survey of the last Open Enrollment (its 8th such). Those of us who've been following along at home are not surpriosed, but one suspects that folks who haven't been paying attention (and those with their eyes willfully closed) may well be.

For starters:

"Over half of QHP-eligible uninsured individuals have been uninsured for over three years." [ed: QHP = O'Care compliant]

This dovetails perfectly with how long we've been going through this charade. The very obvious conclusion is that the scheme is not working, period. The whole point was to get people insured, and that's clearly not happening.

"While awareness of penalties and subsidies continues to rise, fewer consumers understand their personal eligibility or are shopping."

Um, d'unh! People do understand quite well that even if they could afford the outrageous premiums, how do they afford the additional out-of-pocket costs?

As an aside, I find it interesting that it's quite difficult to determine how many people actually paid the ObamaTax: there are plenty of articles of how many were subject to it, and how many had the amount dinged from their tax refunds. But what about folks who were due no refund? How many of them actually ponied up?

'Tis a mystery.

Here's something quite interesting:

Almost 40% of those eligible for an ObamaPlan have opted not to sign up. Not exactly a ringing endorsement of this train-wreck, is it?

Not much of a surprise, either.

[Hat Tip: Allison Bell]

Tuesday, May 24, 2016

Subsidies vs Rate Hikes

ObamaTax architect Herr Jonathon Gruber famously quipped that "the stupidity of the American voter ... was really, really critical for the thing to pass.” Confusing go-along-to-get-along as "stupidity" may have been his arrogance speaking, but he wasn't wrong:

"86 percent of the people who use the marketplaces get health insurance subsidies” to buy coverage, a point repeated by policy shops and advocates who want to downplay the effects of possible rate increases"

That's the popular press' spin on the impact of continued premium increases - some higher than 45% - and fewer carriers with narrower networks. If only there were a term for this.

Oh, yeah.

Regardless, the point is that trying to gloss over significant rate and out-of-pocket increases by touting potential subsidies is not just wishful thinking, it's delusional:

"Subsidies diminish in value the more money a family has ... Higher premiums matter a lot to those receiving smaller subsidies and could potentially force some of them to drop their coverage."

It also touches on something we've observed before:

"One's premium and subsidy (if applicable) are based in part of where one lives (zip code, county), but the penalty is simply a flat percentage of income regardless of one's location."

And, finally, roughly the same number of people buy unsubsidized plans as subsidized ones, but few in the press seem the implications of this. That is, an awful lot of folks don't enjoy the benefit of fellow tax-payers footing significant portions of their health insurance tab, amplifying the effect of these rate and out-of-pocket increases.

But we had to pass it to....

[Hat Tip: Charles Ornstein]

"Winning," O'Care Style

Gosh, what a complete surprise:

"Obamacare Poll: Most Enrollees Hate Their Plans"

According to the (not exactly right-leaning) Kaiser Family Foundation, "just over half (54 percent) now rate the value of their coverage as ‘only fair’ or ‘poor.’”

And of course they throw in the lie that rates - and out of pockets - have increased.

What has increased is that dissatisfaction trendline:

"[In]n 2014, the percentage of enrollees who rated their coverage “only fair” or “poor” was 39 percent."

This new result indicates a 40% increase [ed: Gee, what else has increased over 40% the past few years, health insurance-wise?]. Adding insult to injury, a recent Gallup poll shows that a majority of Americans favor repeal of the train-wreck.


Monday, May 23, 2016

Death (Panel) Comes a'Calling

We first wrote about the IPAB (Independent Payment Advisory Board) almost exactly 6 years ago:

"A stealth, 15 member panel appointed by the king, I mean president, to make sure Medicare doesn't spend too much money on health care."

At the time, the idea that the IPAB was in reality a Death Panel was mocked and derided as hopelessly over the top. But was it?

Turns out, not so much:

"ICER [Institute for Clinical and Economic Review] portrays itself as being independent when it is nothing of the sort, as it was founded and is being run by people with strong ties to the insurance industry ... ICER is set to review new therapies for small cell lung cancer."

So what, you ask?


"It recently reviewed a drug for another type of cancer, Multiple Myeloma, and, not surprisingly, it found the drug too expensive."

When insurance companies (and Medicare) pay the piper, they call the tune, and if the price is deemed too high, then the music stops. Britain's Not So Vaunted National Health System© bases care on quality-adjusted life years (QALY), and "seldom endorses treatments costing more than [$43,000] per additional year gained." No matter how one spins this, it is rationing.

Now, there's a case to be made that this is for the public good: after all, we all most of us pay premiums and taxes, and therefore have a horse in the race. But what's insidious about this method is that, unlike the one used by the NSVNHS©, ICER is not transparent. And so one is left wondering when one's spigot will ultimately be turned off.

Second look at a cancer policy?

[Hat Tip: FoIB Holly R]

A Cancer Story

Full disclosure: I have yet to sell a cancer policy myself, but I've been told by more than a few colleagues that I'm remiss in this.

And here's a perfect illustration of why:

"When Shirley Tully was just starting her career ... in 1993, she had a number of reasons to buy cancer coverage. When she bought the policy, she wasn’t even eligible for some of the benefits, such as mammogram wellness benefits, because of her young age."

One day, that all changed:

"In September 2008, however, her life changed forever. When she visited the doctor for the follow-up appointment, she got the news: “Shirley, the test did not come back as well as we had hoped.”

Please click through for the rest of this incredibly moving, and ultimately uplifting story.

And maybe ask your agent about a cancer plan.

Friday, May 20, 2016

The Doctor Won't See You Now

No doubt you have heard about the long lines in the airport due to TSA understaffing and poor morale. But have you tried to find a doctor willing to see you and accept your Obamacare health insurance plan?

The folks in DC are discovering their plan isn't exactly the gold, silver or bronze coverage they expected.
The average wait in the District to see a psychiatrist is almost three weeks, showing a glaring deficiency in mental health treatment in the city. The D.C. health care network, who’s mission is to, “implement a health care exchange program in the District of Columbia in accordance with the Affordable Care Act,” serves roughly 200,000 residents, reports NBC Washington - Daily Caller
Between skinny networks and high deductibles those who need care the most can't afford it.
“This study shows us that many people are not able to access needed care and people are paying for mental health care they cannot access,” 
Add to the mix the enormous paper work and requirements Obamacare places on doc's and you have a real mess.
A staggering 86 percent of psychiatrists in D.C.’s Health Insurance Exchange Network said they were unable to take on new patients or were completely unreachable.
How is that Obamacare working for you?


Thursday, May 19, 2016

Cause & Effect, ACA-style

This morning, Bob posted on Highmark's lawsuit seeking to compel the Feds to actually cough up the money as promised. On the one hand, it's nice to see some pushback, but on the other ... well, the industry made its pact with the devil, and so earns little sympathy from yours truly.

On the gripping hand, it seems that more eyes are opening about the future of this train-wreck:

"Insurer participation in ObamaCare exchanges declined 27 percent since law took effect"

That is, over a quarter of the carriers initially counted on to make up the market (for certain values of "market") are now gone, leaving consumers with fewer choices and higher rates.

And how much higher?

You may want to sit down for this:

"PPACA public exchange plans in New York seek to raise premiums by 17% ... UnitedHealth ... is seeking to boost New York state premiums by 45.6 percent — the second-highest request in the state."

"2nd highest"


If these rate hike requests are rejected (as they may well be), look for that 27% dropout rate to be the low watermark going forward as carriers continue to get hammered. Alternately (or, perhaps, also), look for more carriers to drop out.

Mad as Hell

Readers may recall the 1976 film "Network" where Howard Beale (Peter Finch) encouraged viewers to get off their butts, go to the window and shout  "I'M AS MAD AS HELL, AND I'M NOT GOING TO TAKE THIS ANYMORE!"

At least one of the Obamacare health insurance carriers is mad as hell and not going to take it any more.
Highmark is suing the government demanding payment of almost $223 million, the full amount to which the health insurer says it is legally entitled for 2014 under an Obamacare program designed to limit the business risk of selling plans. - CNBC
Highmark, like all the other rubes that bought into the administrations lies about Obamacare, is owed bribe money.

Money that was promised in order to mitigate their anticipated losses from Obamacare.

Money that, like all the other Obamacare lies, never played out as promised.
 Highmark's suit, filed in the U.S. Court of Federal Claims in Washington, effectively rejects the government's position, announced last year, that it would pay Obamacare insurers only 12.6 percent of what they were claiming under the health-care law's "risk-corridor" program 
Because of that policy, all eligible Obamacare insurers are being paid just $362 million out of the $2.87 billion they had claimed for 2014. Highmark itself has gotten about $27 million. 

That's a lot of money.

This, on a much grander scale, is comparable to the lie that consumer premiums would be reduced by $2500 per year.


Just another lie.

And we are all mad as hell.


Health Wonk Review: Potpourri edition online

Tinker Ready (isn't that a GREAT name‽) hosts an eclectic collection of health care bloggetry, covering the gamut from insurance to LGBT and cancer. Do stop by for some interesting (and provocative) posts.

Wednesday, May 18, 2016

MidWeek LinkFest

Item 1: What if they gave an insurance market, and no one came? FoIB Holly R tips us that:

"3 states are down to one Obamacare insurer. What if they fall to zero?"

Actually, that's no problem.

A lot of us have been saying that this has been the endgame all along.

Looks like we were right.

Item 2: Holly also alerted us to this little gem, which has a direct link to Item 1 above. See if you can spot it:

"[W]oman killed by doctors because she was obsessed with cleaning: Just one of growing numbers of Dutch people given the right to euthanasia because of mental, not terminal, illness."

When resources are free, and thus become scarce, then there are only a few ways to handle the shortage. The NSVNHS© relies primarily on waiting times, while their Dutch counterparts take a more, um, proactive approach.

And in case you were wondering, the connection is to the recent Golden State initiative to make it even easier for patients to self-euthanize.

Seems like a trend, no?

Item 3: This last piece is courtesy FoIB Dr Rob Lamberts, who tipped us to this article explaining that more is
better when it comes to medical care:

"[T]oo much medical care has its own risks. It can be smart to avoid certain tests or treatments and opt for second opinions instead of more visits, and a good provider can help you make that decision thoughtfully."

This is of a piece with consumercentric health care, but has been given short shrift as we seek to expand the definition of health "insurance."

No real surprise there.

Tuesday, May 17, 2016

Trouble in Rx City

FoIB Jeff M tipped us to this interesting (baffling?) development:

"It turns out her insurance company may be overcharging her for the prescription, clawing back money ... United HealthCare, makes customers pay a premium on some prescription drugs, charging them more than the actual cost – clawing back money from the pharmacy and customer."

There are, of course, many levels here, and I'm only going to address a few.

First, we've talked about PBM's before (here's a good primer); briefly, they're a way for carriers to rein in runaway prescription drug expenses (which are a disproportionally large driver of health insurance rates). On the other hand, they're by no means the only available way to purchase meds:

"[A]s more folks access alternative delivery options (such as from Canada or other exotic locales), these kinds of processes will need to be implemented."

Which brings me to the question that this really elicits: why is it that consumers will spend hours, sometimes days, on Amazon to save $25 on a new TV, but can't be bothered to do a little shopping for their meds, especially those they'll be taklng for a while and which can really add up? I realize that this doesn't apply to the antibiotics one takes to get over an illness, but for things like insulin, or lipitor or the like, why would you not shop around?

Jeff pointed out that some friends of his are prime examples: "I've quit talking with them about the need for life insurance outside of the paltry amount they have through their employer and the need for a will given they have 3 children.  For him, it's more important to have the latest iphone and fancy wheels/tires for his truck."


Most Americans Want Medicaid

When Obamacare was still on the drawing (and quartering) table two options were tossed out for consideration.

Public option.

Single payer.

Cutting through the rhetoric, public option and single payer are two sides of the same coin. Both plays would restrict health insurance carriers to a TPA (third party administrator) role.

Most don't realize it, but carriers are involved in Medicare and Medicaid as TPA's. The folks that adjudicate and pay Medicare and Medicaid claims work for insurance carriers or independent TPA's.

And the people that answer the phone at 1-800-MEDICARE?

They are General Dynamics employees.

The federal government farms out the day to day operation of Medicare and Medicaid to private contractors.

What does this have to do with the title of this post?

A lot.

According to the Washington Post, many Americans would like to see Obamacare replaced with single payer.
Well over half of Americans want to replace Obamacare with a single-payer system. That figure, amazingly, includes 41 percent of Republicans and Republican-leaning independents — even though the wording of the question specifies that the program would be "federally funded." - Washington Post
Federally funded.

The federal government doesn't have any money other than what they take from us.

Federally funded = taxpayer funded.

And there is this.

Single payer = Medicaid.

I wonder how many of those polled would have the same answer if the question was worded this way?

"Would you like to see Obamacare replaced with Medicaid that is paid for through higher taxes on everyone, including you?".

My guess is the answers would change dramatically.

#RepealObamacare #HigherTaxes #MedicaidForAll

Monday, May 16, 2016

Breaking: TransAmerica UL Lawsuit

This will be very interesting to follow:

"Universal life insurance policyholders behind a multimillion-dollar class action are asking a Miami federal judge to stop Transamerica Life Insurance Co. from drastically raising their monthly charges."


Because the carrier has taken a major beating on investment income [ed: no kidding] and is raising the internal costs of its Universal Life insurance policies to make it up.

I've never written a TA UL, so I can't speak for that carrier, but I suspect that this lawsuit will gain exactly zero traction.

Why's that, you ask?

Because the nature of the UL beast is such that the carrier has a built-in CYA clause in the form of a published table of maximum rates which they're allowed to charge. Depending on how TA's plans are written, it's likely that this gives them all the "permission" they need to increase rates to that maximum. And they really have no choice: these contracts promise a minimum interest rate that is likely much higher than what the company's currently earning.

Why's that, you ask? After all, the market's been doing pretty well of late, no?

I suppose it has, but that's not terribly relevant: carriers are statutorily restricted on the kinds of investments they may make, and these tend to be very low risk (and thus low reward/interest).

It's interesting that a lot of the plaintiffs bought their plans in the 80's and 90's; one wonders about the last (or even first) time they actually read their policy's annual reports.

La Plus Ca Change: Fraud Edition

One of our very first posts highlighted some creative attempts at defrauding insurance carriers. That was over 11 years ago, and we're sorry to report that not much has changed:

[Click link in post for full version]

[Hat Tip: Consul Insurance]

Friday, May 13, 2016

Compliance for Compliance

Attention employers who offer group insurance: the phone police might be calling.

CMS released an initiative this week where they may be asking for you to confirm an employees' eligibility for employer-sponsored coverage in 2016. Between April and June a contractor to CMS may be calling and asking employers "to attest that either a specific employee or a sample of employees are offered insurance that meets the affordability and minimum value tests".

Never fear employers, CMS stated that they are conducting this study to check what individuals are stating on their exchange applications - not to determine whether or not you should be paying the employer "shared responsibility" tax mandates.

Which brings us to this: if CMS is calling employers to verify affordability and minimum value of the employer plans for employees,
then why are employers being required to complete the whole 1094/1095 reporting requirements?

Strokes - Can They Be Prevented?

Over the past few years I have become more acquainted with what happens when someone has a stroke. Some of my friends, people I grew up with, have had strokes.

Most have recovered to the point they function reasonably well. But one has had more than one stroke that has confined him to a hospital bed, wheel chair, respirator and requiring 24 hour care.

I recently discovered an informative piece in the Washington Times that addresses the impact of having a stroke can have in your life. The piece discusses stroke prevention, diagnosis and treatment.

The Washington Times article is summarized and expanded in this post on my website. You may follow and read more about Can Strokes Be Prevented.

#Strokes  #Medicare

Thursday, May 12, 2016

Does Medicare Cover Cataract Surgery?

Does Medicare pay for cataract surgery? Are there restrictions on what they cover?  How much will I owe? Is my coverage different with original Medicare and a supplement plan vs. a Medicare Advantage plan? Can I use any doctor or hospital for the surgery? Does Medicare also cover routine eye exams?

Last year one of my clients was facing cataract surgery and had questions similar to those above. He had already found a surgeon he wanted to use and had talked with the office nurse about options and out of pocket costs, but he wanted additional insight into how Medicare worked.

Earlier this week that same nurse called me and asked if I would be willing to provide her information that could be shared with patients. Something that explains how Medicare handles cataract claims.

Here is a link to the post I penned in response.

#Medicare #CataractSurgery

Wednesday, May 11, 2016

Midweek Linkathon

■ First up, in email from Aetna:

"Ohio eligibility changes take effect on September 1, 2016. Moving from eligibility definition to total average employees (TAE)"

This is an effort to more clearly delineate the definition of "large" (51+) from "small" groups for rating purposes. Be interesting to see what, if any, effect this will have.

■ A handful of Blue Cross affiliates will stop accepting credit cards for premium payments. I know that a number of my own clients really appreciate the opportunity to turn exorbitant premiums into bonus cash or travel miles. On the other hand, they're apparently a significant expense for merchants, including The Blues.

Oh well.

■ As a public service for those suffering from low blood pressure, we present this informative video on the "thinking" behind The ObamaTax:

Tuesday, May 10, 2016

Ft Mac & Insurance Losses

First, our thoughts and prayers are with the families and firefighters dealing with the horrendous fires in Alberta. One can only imagine their heartache and fear.

Many (most?) of those affected will be insured. This includes home and business owners, those with private passenger cars and large commercial vehicles, and everything in between. Hopefully, there won't be too many life insurance claims.

In a surprising (to me, at least) development, it turns out that the insured losses from these fires will likely hit Canada's economy even worse than Katrina affected ours:

"Intact Financial Corp. may post insured losses of as much as C$1.1 billion ($850 million) from the wildfires in Alberta, which could dent the Canadian economy harder than Hurricane Katrina hit the U.S."

Canada's economy is, of course, smaller than ours (at least for now), so this makes sense. It also occurs to me that a lot of Katrina's losses were flood-related, and not everyone had flood insurance (which, unlike fire, isn't built into the typical homeowner's policy).

A sad reminder of Mother Nature's capabilities.

[Hat Tip: III]

Blabbin' the HWR

David Harlow hosts this week's on-air analysis of the most recent Health Wonk Review. Tune in at 1:00PM (Eastern) for the livestream, or listen in later for the recorded version.

Self-awareness & PPACA

It's no surprise that the so-called "Marketplace" is a disaster. Whether it's missing enrollment goals or drastically underestimating claims, there've been very few positives.

But this article may have inadvertently summarized all that's truly wrong:

"In fact, the exchanges are quickly turning into toxic pools of surprisingly expensive patients who seek coverage when they need treatment and then drop out."

It's only a "surprise" to folks who blindingly and uncritically accepted that removing underwriting from insurance was always going to result in a disproportionate population of sickly folks. The only "surprise" here is that anyone truly believed otherwise, specifically after its chief architect specifically admitted bragged about it..

Self-awareness: how does it work‽

[Hat Tip: Ʀєfùsєηíκ

Monday, May 09, 2016

More Tar Heel State Blues [UPDATED]

It's apparently not enough that North Carolina's Blue Cross franchise has been taking major poundings; it now appears that the reverberations are affecting providers in an even more direct way:

"[T]he many medical practices and clinics not getting paid by the insurance giant. Some of them are on the brink of shutting down."

When you have a virtual monopoly in terms of insurance coverage, and you stop paying the bills (whether by design or not) then providers are left holding the bag. After all, their creditors don't care a whit about whether or not Blue Cross has computer and/or personnel issues. They want to be paid.


And it's not just "the little guys." One major surgicenter is on the hook for over three quarters of a million dollars, with no end in sight.

Me thinks it's going to get uglier still.

UPDATE: It occurs to me that, ultimately, these providers can will just go back to the patients themselves for the missing funds. Granted: blood, turnip, some assembly required. But even a few shekels may make the difference between staying open and shutting down.

[Hat Tip: FoIB Jeff M]

DIAM '16: Week 2 Factoids

As Disability Insurance Awareness Month continues to roll out, the Council for Disability Awareness points out that: 

  • Less than 20 percent of millennials have more than $5,000 in emergency savings.
  • College-educated millennials face the highest student loan burden of any generation – according to Edvisors, the average 2015 graduate faced a whopping $35,000 of debt.
  • In a recent CDA study, 40 percent of millennials said they would consider disability insurance if they knew more about it.
  • In that same study, more than a third of millennials said they couldn’t last three months without their income.
What's perhaps even scarier is that this is far from limited to millenials:

"47 percent of Americans "can’t pay for an unexpected $400 expense through savings or credit cards, without selling something or borrowing money."

That's a minor fender bender or medical procedure, let alone a major wreck or cancer. And if you can't pay for that, where are the groceries and rent coming from?

Something to think about.