An Update on The Risk Corridor - Death Spiral Edition

I've written about Obamacare's Risk Corridor provision many times. From the Rubio Amendment to Suing for the Slush Fund we have learned that not only was government funding this leg of the 3R's likely illegal but it was also never going to be budget neutral. In fact we can conclude from the year-to-year view that the losses insurers are incurring through Obamacare marketplaces are on an expedited death spiral.

Recently (and quietly) released payment and charge amounts show just how far off of budget neutral this mess really is. More concerning, what every insurer thought was bad last year is even worse this year. And. It's. Not. Even. Close.

In two years this temporary program that was budget neutral (allegedly) has lost a total of $7,871,900,000. Payments due to insurers have more than doubled from 2014 to 2015 and revenues have been reduced by almost 75%. With numbers like this how much longer can insurers remain before they are put on life support?

Tuesday Morning HealthyLinks

■ The folks at Cigna tell us that the IRS has extended the reporting dates for 1095's (these are the forms carriers and employers use to demonstrate that individuals have abided by the tax penalty Mandate). They were originally due out by January 31st of next year; that's been moved back over a month, to March 2nd.

Yay.

■ FoIB Holly R tips us to this interesting story about how a Cincinnati-area doctor "uses jet engine knowledge to fix woman's vocal cords."

At age 13, Anna Kessler was diagnosed with asthma, which kept getting progressively worse over time. She finally met with Dr Sidd Khosla, who had studied at MIT and was able to combine his knowledge of how jet engines work with Anna's condition.

Pretty cool.

■ And finally, a two-fer on lifesaving healthcare trends:

"1. Focus on people first ... getting patients actively engaged in managing their health and working with the physicians and technicians who treat them."

And "2. Why you need to go wireless ... a move toward continuous home monitoring and an effort to bring care to patients rather than requiring them to travel long distances to see specialists."

This, I think, is related to the burgeoning and ubiquitous use of telemedicine. I'm not completely told that it's a panacea, but it certainly has its place.

MVNHS© and Medicaid vs Babies

The Much Vaunted National Health System© continues its war on children. This time, a preemie was "left to die alone in a sluice room at an NHS trust plagued by clinical errors and bad staff attitudes."

In case you're wondering, a "sluice room" is "where used disposables such as incontinence pads and bed pans are dealt with, and reusable products are cleaned and disinfected."

For the MVNHS© "disposables" now includes babies, apparently.

Great system over there.

And lest we forget, our own version leaves much to be desired, based on this cautionary take from Florida:

"Kim and Richard Muszynski love Florida ... in September, the couple left the Sunshine State ... because they think Abby's health insurance was killing her."

The kicker?

"Like nearly half of all children in Florida, Abby has Medicaid"

Leaving aside for the moment that appalling statistic, it may be instructive to note that, as with the Much Vaunted National Health System©, Medicaid is not not insurance (after all, who pays premiums?) but taxpayer-funded health care. And, again as with the MVNHS©, who pays the piper calls the tune.

[Hat Tip: Holly R]

Thanksgiving 2016

Please remember everyone deployed away from their families this Thanksgiving. pic.twitter.com/w9Pv3UTHUQ

— Meoso (@MeosoFunny) November 24, 2016

Pre-Thanksgiving Heads' Up

It's time once again to break out Captain Kirk William Shatners wise words of warning about frying your fowl:



Have a great (and safe) Thanksgiving!

From the P&C Files: Easy Peasy, Yeezy

We've blogged before about Special Event policies for things like hole-in-one contests, special product promotions based on sports scores or political conventions. Here's another example:

Rap star Kanye West has been on tour recently, and was just hospitalized; he's since cancelled the balance of his tour, at a cost of at least $30 million. That's a lot of scratch even for a successful musician, which is why he (reportedly) has an insurance policy that likely covers this kind of situation.

Assuming that it ends up paying out (there may be specific exclusions, for example), his wallet will be grateful.

Wow, Pre-Existing Claims

With 2017's Open Enrollment in full swing, lots of folks are calling in for quotes and explanations, hoping to get their coverage in place for January 1. By now most of us know that, for better or worse (but mostly worse) ObamaPlans cover pre-existing conditions. This means that if one has, say, asthma, the new plan will cover it right away.

Some people, though, are less clear on the subject.

For example, 29 year old Megan Tice-Royea, is a grocery store manager in Newport, Vermont. Last year, she she decided she couldn't afford health insurance, despite making what appears to be enough to qualify for a healthy subsidy (or just buying a Cat Plan).

Which was a fine, rational decision, until it wasn't:

"In September, she was admitted to the hospital with a gallbladder infection. The surgery left her $32,000 in debt."

Ouch.

But here's the very best part:

"Now she’s considering signing up for an insurance plan through Obamacare, but only if it will help pay off her earlier medical bills."

Good luck there, Megan.

Now let's rewind the tape a bit, and take a look at "what might have been:"

Megan's 29, makes $14 an hour, and we'll assume that she doesn't smoke. Had she taken (literally - I timed it) 3 minutes, she could have visited her state's Exchange, where she would have learned that she qualified for a $347 per month subsidy, and then purchased a Bronze level plan for less than $60 a month (that's about $2 a day).

[ed: all rates and plans based on 2017 Exchange info, YMMV]

Her maximum out-of-pocket (including deductible) would have been $7,150 plus the $720 in premiums, meaning that the $32,000 claim would have cost her less than eight grand (about 25% of the actual bill).

Expensive 3 minutes.

[Hat Tip: FoIB Dr Dino]

LifeLock News

So this happened:

I reached out to our friend Steve Geis (VP at Cornerstone) for his thoughts. Steve's the one who basically put our LifeLock discount program together; he replied:

"In my opinion, this will only make LifeLock stronger.  I’m sure it will lead to new advancements in Cyber Crime/ Data Breaches using Symantec’s resources.

It’s too soon to tell if this will impact on brokers (and clients) but my guess is it will be business as usual.  We still have to wait for regulatory approval before the deal is done.

We’ll just have to wait and see what comes to us from LifeLock and we’ll communicate upon notice."

Thanks, Steve!

As a reminder, you can get a 10% discount on LifeLock services (15% is available for most employer groups).

[Hat Tip: Holly R]

Yeah, About That Cost Curve

We were promised from the outset that The ObamaTax would "bend the cost curve down;" that is, reduce the costs of both providing and paying for health care.

Here at InsureBlog, we've also blogged extensively about Medical Tourism, where folks go across the border (or the ocean) in search of cheaper health care.

Reason I bring these up is because our friend Holly R tipped me to this interesting piece at CNBC:

"Here's where you can get health care a lot cheaper than in the US"

The article gives several examples of care purchased in France versus here. For instance:

"[A] single day in a hospital in the U.S. costs, on average, $1,514 (up to as much as $12,537), while in France it costs $853."

And:

"Hip replacement surgery costs an average of $25,061 (up to $87,987) in the U.S., but just $10,927 in France."

Of course there are various travel expenses involved, but depending on the time of year, and how far ahead one booked, it seems likely that the total cost would still be a (significant?) net savings.

To be sure, this really only works for elective (non-emergency) procedures, and it's also only available to those with the resources to pay for flights and lodging, plus the fact that one's going to have to front the money (no insurance billing back to Blue Cross or Humana). And follow-up care may be an issue, as well.

But what really piqued my interest was that the author focused on why costs here in the US varied so widely from area to area, city to city, and the role insurance companies play in negotiating prices. It does acknowledge the role that tort-reform could play in reducing the cost of (for example) malpractice insurance.

But it completely missed the elephant in the room (and to be fair, that's perfectly understandable: it is about the advantages medical tourism, after all). So what goes unsaid here?

"Remember the President's assurances that his ACA would finally “bend the cost curve”?"

That is, one of the explicit promises of ObamaCare was that not only would insurance rates go down, but so would the overall cost of health care itself.

So how's that working out?

From the P&C Files: Freeze!

It may not seem like it now (at least here in southwest Ohio), but sub-zero weather is around the corner. And that means a lot of folks will be in danger of severe damage from their home's water pipes freezing and bursting.

The Cincinnati Insurance Company has thoughtfully provided this helpful video to share with our readers about how to prevent this from happening:


Prevent Frozen Pipes from The Cincinnati Insurance Company on Vimeo.

Thanks, CIC!

Bye, Bye Grandma!

We've written about Grandmothered plans (most recently here), focusing primarily on individual major medical policies. But these rules also apply to group plans, and the clock's ticking on them, too.

Grandmothered plans are those which were issued after ObamaCare was established, but were given a "hall pass" from many of its mandated "benefits." Much like the Doc Fix that kicked Medicare's provider reimbursement cuts down the road, Transitional Relief was ObamaCare's safety valve that allowed these plans a temporary reprieve. For the past several years, group clients have been able to re-cast their renewal date to continue to take advantage of it.

In theory, this will be last time (since no one really knows what's going to happen under the next administration). But, carriers are soldiering on; I received this in email today from United Healthcare:

"For many customers, there are significant cost implications in the change from Transitional Relief to ACA compliant plans ... you may be interested in changing your renewal to Dec. 31, 2017 ... This allows you to take advantage of the extension of Transitional Relief and keep the coverage you like for the maximum period currently allowed by law"

'Course, I'm old enough that I remember this.

In the event, UHC (and, of course, other carriers) is contacting its group clients to offer them a bit of relief.

Based on recent quotes I've seen, this is definitely an offer they shouldn't refuse.

MVNHS©: "We could tell you, but then..."

You can't make this stuff up (well, you could try, but then reality's still going to trump you):

"NHS chiefs are trying to keep plans to cut hospital services in England secret ... Managers were even told how to reject freedom of information requests"

Of course, now this particular cat's out of the bag, so it'll be interesting to see how successful MVNHS© bureauweenies will be in fighting off those FOI requests. And just what are they trying to cover up?

Well, according to leaked information, the cuts include the closure of at least one hospital in London, maternity and stroke services country-wide, and the forced merger of four hospitals in Merseyside, to name a few.

There are actually quite a few services and facilities on the chopping block, which is interesting because we've been told that nationalized health care schemes deliver better care than ours at a fraction of the cost, effectively bending the cost curve down.

How's that working out for the Much Vaunted National Health System©?

[Hat Tip: Ace of Spades]

Rx Ch-ch-changes

Interesting news from Medical Mutual of Ohio (via email):

"Ensuring Members’ Specialty Drug Costs Are Accurately Reflected in Benefit Accumulations

Beginning January 1, 2017, only the amount a member truly pays out of pocket for specialty drugs, when filled through one of our contracted specialty pharmacies, will accumulate toward the member’s annual deductible and/or maximum out of pocket (MOOP)."

Now, this applies only to ACA plans (on- and off-Exchange), but I'm guessing that these make up the bulk of MMO's current individual book of business. The impetus for this new process is the use of those ubiquitous manufacturers' coupons for pricey meds.

The example they gave was a drug that cost $500 but the insured had a manufacturer's coupon for $450, bringing their actual out-of-pocket cost for that scrip to $50. In that case, the insured's "balance" would be credited the actual amount paid.

MMO also pointed out that these coupons, while essentially disguising the true cost of a given med, may actually be leading to over-utilization:

"Over the past five years, the use of manufacturer’s coupons for high-cost brand-name drugs contributed to an additional $700 million to $2.7 billion in drug spending. We believe the amount of financial assistance received for specialty drugs by the Medical Mutual ACA plan population could exceed $3 million in 2017."

Hence, finally applying some brakes to this runaway train.

And I get that. As I mentioned to co-blogger Patrick:

"I have no problem with this.

1 – If they only spent $50, they only spent $50.

2 – I do wonder how much over-utilization results from mfrs sending out these coupons. OTOH, I 'get' that there are folks who couldn’t afford the med otherwise, and that gives me pause. On the gripping hand, there are no perfect solutions."

And Patrick agrees:

"I think of it this way, under a PPO plan with $25 copay the member pays only that amount. The difference between negotiated and copay don't go toward the MOOP just the copay does. I know it's not exactly the same due to a "coupon" but the reality is not everyone gets the coupon. Members who do receive them should rejoice that they aren't paying the whole amount. Members who don't receive them have a greater expense and therefore should get credit toward the MOOP for what they pay."

Point being: you don't (shouldn't) get credit for expenses that you don't, in fact, incur.

Kudos to MedMutual. 

Why can no one spell?

Apparently, the folks at the Washington Free Beacon can't spell "$2,500 premium savings:"

"Obamacare premiums will increase by 27 percent next year ... the government’s increase of 22 percent “can be misleading” because most of the 2017 Obamacare plans will be new"

That's because carriers have been deleting plan after plan in order to find some way to staunch the flow of claims dollars. And of course, carrier after carrier has been leaving the market completely, to the point that "one-third of the country will only have one insurer to choose from in the exchanges."

Regardless of what the new administration does (or doesn't do) come inauguration day, the die has been cast - for at least a while - for folks signing up now.

Talk about train-wrecks.

#ObamaCareWinning

[Hat Tip: FoIB Holly R]

Car Insurance That Pays For Routine Maintenance

Wouldn't it be nice if our car insurance covered the cost of routine maintenance?

Get new tires for a small copay. Free oil changes, every time.

Radiator flush?

No problem. Send the bill to my auto insurance carrier.

But it doesn't work that way. And that is a good thing. If all you had to do for routine auto expenses was have the bill sent to you car insurance carrier I doubt many of us could afford car insurance.

Since your car insurance does not pay for routine services, there is a price chart on the wall when you take your car in for work. If what you need isn't on the wall you can ask and the service manager will quote you a price.

But it doesn't work that way for health care. And it probably never will.

Enter Trumpcare 

Some agents I know have been debating suggestions for Trumpcare which is expected to be a much improved version of Obamacare. When the new model is available in the show rooms, and whether people will want to trade in their old Obamacare plan for a shiny new Trumpcare plan is subject to speculation. When it happens we will see. Until then, suggestions for Trumpcare are simply fodder for discussion.

Price Transparency

One of the hotly debated items is price transparency. More than one member of our roundtable wanted to know why we don't have price transparency when it comes to health care.

If I need to get my car repaired, I know exactly how much it will cost before  I have the work done.

True.

But who will pay the bill?

The person who owns the car.

And who pays the doctor or hospital when you get sick?

The lions share, typically 80% or more, of your medical bills are paid by the insurance carrier.

Networks

There is no transparency because of provider networks. That's why 5 people can go to the doctor for the exact same procedure and pay 5 completely different amounts.

Networks can be frustrating but they also save us money.

Without network pricing we would never know if we were being overcharged or not.

Without networks we could be balance billed for amounts over and above what the carrier says is a reasonable charge.

No matter what your doctor or hospital charges for treatment, almost invariably someone will say they have been overcharged. Who are we (as patients) to say that $12,000 is too much to pay to take out a bum appendix? Does it really matter, as long as the pain stops and you are once again fully functional?

Networks set the pricing for removing an appendix. You may still think the doctor and hospital are overcharging but so what? You are paying 20% (or less) of that cost of your care.

Network pricing results in a pre-determined cap on how much you pay for the procedure. There is no balance billing.

And that is a good thing.

#Obamacare  #Trumpcare

Promising Health News

Some potential good news for fans of the Much Vaunted National Health System©: they may be able to move on from using maggots to treat MRSA.

How's that, you ask?

Well:

"A 25-year-old student has just come up with a way to fight drug-resistant superbugs without antibiotics."

The greatest challenge in treating these "superbugs" is that we keep throwing stronger and stronger anti-biotics at them (with who knows what effects on ourselves) and pretty soon they become inured to them (think Borg). Now, Ms Lam (a 25 year old Australian PhD student) has developed what seems to be a microscopic shuriken that literally rips the bugs to shreds.

It's still early days, so we likely won't be seeing this in use on humans soon, but very cool.

Kudos, Ms Lam!

[Hat Tip: Ace of Spades]

Another ObamaCare Success Story

For certain values of "success" (via Dr John Goodman):

"The IRS demanded John payback the subsidies he had already received which amounted to $6,900 hit on his taxes. In order to pay back what he owed John took out a 2nd mortgage on his home."

The victim citizen (called "John" in the post to protect his identity) found, through a series of unfortunate events, that his previously "affordable" coverage was no longer such a deal, and as a result of clawback was forced to cough up almost $7 large. Adding insult to injury [ed: do ObamaPlans cover those?] their insurance plan now costs over $7,000 a year, and then another $12,000 in out-of-pocket.

But hey, Mrs John gets free birth control convenience items.

So, success.

On Veteran's Day 2016

[Jennifer Agnello, President of Cornerstone, has graciously granted us permission to share her profound, heart-felt thoughts on this day honoring those who've served]

"In honor of Veterans Day...

After a big week in our country, (no matter how you voted), tomorrow is a day where we should all be especially thankful.  In honor of Veterans Day, please take some time to remember that it is because of our veterans we all enjoy the freedom to express our own opinions and choose to vote however we individually see fit.  Please pause to recall the sacrifices that our Soldiers, Sailors, Airmen, Marines, and Coast Guardsmen have and will continue to make, serving our Nation where and whenever they have been called upon. These courageous and brave individuals have sacrificed family life, their careers and potentially their lives by willingly taking on the greatest responsibility, upholding our freedom.  They have voluntarily joined the ranks of America's Armed Forces, fully aware of their obligations as citizens and the risks they are taking in order to stand for what our country believes in and what it was founded upon.  They serve and have given their lives for the USA with courage and unquestioned commitment, for all of us.

Through their sacrifices they have secured for millions of others the blessings of freedom, democracy, and the unmatched opportunity that we enjoy in the United States today.

Please thank and/or remember those special folks.  Cornerstone has several employees who have served (Eric Pouncy, Hal Demmerle and Miles Massey) and many more have family members currently serving or whom have served in the past and they deserve to be recognized and respected.

We have chosen to give our own Veterans ½ day off on Friday afternoon to show our appreciation corporately.

Thank you to our employees and families for making this sacrifice.  We are grateful to you for allowing us to continue to live in a thriving, peaceful, FREE country.  Have a safe Veterans Day, and as always, God bless the United States of America.

...Please take the time to THANK A VETERAN."

[Thank you, Jennifer. HGS]

Omens & Portents, Part Two

Via email an hour or so ago:

"Important Notice: Discontinuance of Individual LTC Insurance Sales

To our LTC Distribution Partners and Producers:

After a recent analysis of the macro-economic trends facing the long-term care (LTC) insurance industry, we have made the difficult decision to discontinue sales of our individual LTC insurance policies in all states.  As many of you well know, the distribution landscape for LTC insurance has shrunk significantly since the peak of the industry in 2002.  Today, there are far fewer outlets through which individual LTC insurance is sold, impacting the growth potential of the product.  In addition, consumer demand for individual LTC insurance has fallen and remains stagnant. These trends, combined with the significant capital requirements of the LTC insurance business, are the primary reasons for this decision, which was not taken lightly."

Hancock has been an 800-pound gorilla in the Long Term Care insurance market for as long as I can recall.

So I reached out to our friend and LTCi guru Ray C for his thoughts, and he reminded me that "several years age, ManuLife purchased John Hancock.

I believe this change is now saying, they wanted Hancock for life and annuity - investments and not long-term care.

We stopped doing John Hancock three years ago.

So, we see no negative impact on our business - but another black eye on the industry."

I'm glad he reminded me of this, because I then went back and saw this in a post from '13:

"Executives at Manulife Financial ... think the benefits of staying in the private long-term care insurance (LTCI) market outweigh the benefits of getting out."

Looks like they've had a change of heart.

Omens & Portents

I haven't commented on the fate of ObamaCare in the wake of Tuesday's election, nor do I currently have any plans to do so. But I was intrigued by one specific electoral result:

"Amendment 69, the ballot measure known as ColoradoCare that would have created a universal health care system in Colorado, was soundly defeated Tuesday night."

On the one hand, I've always championed the 58-state laboratory model; that is, rather than the one-size-fits-very-few ObamaCare debacle, that each state should be free to try out its own proposed solution(s). So I was actually rather happy to see Colorado put it on the ballot.

On the other hand, many of us have said all along that Single Payer was the ultimate goal of ObamaCare in the first place, so the results of this ballot measure are telling: it went down in flames 4:1 (~80% to 20%). That's a clear repudiation in a state that went pretty solidly for Mrs Clinton.

So what message should one take from this?

Well first, it seems to vindicate the state-by-state laboratory model (as if it needed vindication). And second, the end-game of ObamaCare might not be as  inevitable as its proponents may have believed.

Election Day Special

[Originally published March 3, 2009, re-posted today in honor of this "very special" election]

The Americans With No Abilities Act
Washington , DC - (Dateline March 3, 2009) President Barack Obama and the Democrat controlled Congress are considering sweeping legislation that will provide new benefits for many Americans. The Americans With No Abilities Act (AWNAA) is being hailed as a major legislative goal by advocates of the millions of Americans who lack any real skills or ambition.

"Roughly 50 percent of Americans do not possess the competence and drive necessary to carve out a meaningful role for themselves in society," said California Senator Barbara Boxer - Democrat. "We can no longer stand by and allow People of Inability (POI) to be ridiculed and passed over. With this legislation, employers will no longer be able to grant special favors to a small group of workers, simply because they have some idea of what they are doing."

In a Capitol Hill press conference, House Majority Leader Nancy Pelosi – Democrat, and Senate Majority Leader Harry Reid – Democrat - pointed to the success of the U.S. Postal Service, which has a long-standing policy of providing opportunity without regard to performance. Approximately 74 percent of postal employees lack any job skills, making this agency the single largest U.S. employer of Persons of Inability.

Private-sector industries with good records of non-discrimination against the Inept include retail sales (72%), the airline industry (68%), and home improvement warehouse stores (65%). At the state government level, the Department of Motor Vehicles also has an excellent record of hiring Persons of Inability (63%).

Under AWNAA, more than 25 million mid-level positions will be created, with important-sounding titles but little real responsibility, thus providing an illusory sense of purpose and performance.

Mandatory non-performance-based raises and promotions will be given so as to guarantee upward mobility for even the most unremarkable employees.. The legislation provides substantial tax breaks to corporations that promote a significant number of Persons of Inability into middle-management positions, and gives a tax credit to small and medium-sized businesses that agree to hire one clueless worker for every two talented hires.

Finally, the AWNAA contains tough new measures to make it more difficult to discriminate against the non-abled, banning, for example, discriminatory interview questions such as, "Do you have any skills or experience that relate to this job?"

"As a Non-abled person, I can't be expected to keep up with people who have something going for them,"said Mary Lou Gertz, who lost her position as a lug-nut twister at the GM plant in Flint , Michigan , due to her inability to remember rightey tightey, lefty loosey."This new law should be real good for people like me," Gertz added. With the passage of this bill, Gertz and millions of other untalented citizens will finally see a light at the end of the tunnel.

Said Senator Dick Durbin (Democrat-IL), "As a Senator with no abilities, I believe the same privileges that elected officials enjoy ought to be extended to every American with no abilities. It is our duty as lawmakers to provide each and every American citizen, regardless of his or her inadequacy, with some sort of space to take up in this great nation and a good salary for doing so."

Life to the Max, Opportunity Missed

We've blogged on Pension Maximization before (most recently here); briefly, it's using life insurance to cover the shortfall if one chooses the "no period certain" option at pension decision time.

In that case, the gentleman in question was able to retroactively resolve a potentially disastrous situation.

Today, I learned of a situation with a much sadder ending:

Susie, my longtime client, asked if I would help her recently widowed mother with her health insurance. Even though I've sent the bulk of my clients to Cornerstone for assistance, Susie and I determined that this case needed a more personal, hands-on touch, and so I met with them this morning. As I expected, Nancy (her mom) is every bit as lovely and bright as her daughter, and we started discussing her needs. What I had not known prior to this morning was that Nancy's husband (Susie's dad) had passed away, unexpectedly, in July.

This caused Nancy some major collateral damage: when Joe had retired 18 months before, he'd chosen the pension option with the greatest monthly payout, which stopped when he did. To further compound the problem, this also meant that she was no longer eligible to keep the health insurance. And adding insult to injury, while Joe had told her that he had $200,000 in life insurance, the policy was actually only $25,000, a good chunk of which went to pay for his funeral.

The good news (for certain values of "good") is that she qualifies for a pretty substantial health insurance subsidy next year. The bad news is that she never replaced her health insurance, which ended in early August. Now it's too late (she missed the window for a special open enrollment opportunity). She likely qualifies, however, for a hardship exemption from the ObamaTax.

Still, had she and Joe sat down with a professional agent (*cough*) when they were getting ready to pull the retirement trigger, perhaps she could have avoided this unfortunate situation.

Food for thought.

SHOP Sweat

How desperate are the rocket surgeons in DC to make something - anything, really - of the Small Business Health Options Program (SHOP)? This desparate (via email from CMS):

"Do you know that from November 15 through December 15, small businesses can enroll in SHOP Marketplace coverage without meeting a Minimum Participation Rate (MPR) requirement? Think about your new and existing clients who may not otherwise be able to meet the minimum participation requirement."

Now why is this a big deal?

Well, let's just say that the response to the program has been underwhelming:

"After nearly two years in operation and millions of dollars spent in development ... about 85,000 people, from 11,000 small businesses, have coverage through the [SHOP]."

So now we know why the gummint would (illegally, natch) lift its own requirements. But then one is faced with the dilemma of Chesterton's Fence:

Carriers require certain participation levels because of "adverse selection;" that is, if only those with health problems sign up, then the carrier is going to be losing money very quickly since there's no corresponding offest from healthy employees.

But then, understanding basic insurance principles was never a strong suit of O'care proponents in the first place.

"In the end, there can be only one"

In email from our friends at Cornerstone:

"In 2017, the Centers for Medicare and Medicaid Services (CMS) will automatically re-enroll individuals of discontinued “on exchange” plans into similar plans offered by other carriers still selling in the marketplace."

To be sure, with so many carriers ditching the marketplace for the 2017 plan year (and, perhaps, beyond), such a streamlined process makes a certain amount of sense. And as we're also seeing, Blue Cross seems to be the one carrier still left standing in state after state.

Still, doesn't it seem a bit...presumptuous for a government entity to so brazenly (and without much fanfare, really) automagically assume that citizens prefer that the choice be taken from them?

Or, as FoIB Allison B so wryly observes, "Anthem gets everybody."

Indeed.

Obamacare Gaming Edition

Obamacare is almost 3 years old and an even bigger mess than ever. The billion dollar website still crashes and is not fully functional. Navigators and "enrollment assistants" are nothing more than phone jockey's trained (in a manner of speaking) on how to key in questions and read answers off a computer monitor.

Most have no clue about the difference in a PPO, POS or HMO plan. Of course with most of the PPO/POS plans going away that will make their job easier.

Drug formularies are another story.

But this is to be expected when health insurance agents with years of experience are forced out of the market only to be replaced by former minimum wage workers who have gone through 2 weeks of training and are now earning a "livable wage" of $17 per hour.

Savvy consumers who are not subsidized and are now facing monthly insurance premiums higher than mortgage payments and STILL required to shoulder tens of thousands in out of pocket expenses before the carrier pays a single dime are saying ENOUGH!

Consider the case of Will Denecke.

Will Denecke, a self-employed urban planning consultant in Portland, Ore., said he planned to skip buying health insurance for 2017 because the premium had shot up to $930 a month. Instead, the 63-year-old man said if he developed a medical issue sometime during the year, he would go to the Affordable Care Act marketplace and buy a plan outside the open-enrollment window, which he's aware he's not supposed to do. 

He said the ACA rules sharply limiting such midyear enrollment are easy to get around. Last time he simply claimed a change of income. “I've done it before, and my broker helped me - Modern Healthcare 

Obamacare is three years old and DC still hasn't closed all the loopholes. Agents, the few that have not left the business, are sticking it to the government and carriers every day.

Too bad Obama and company pissed off some of the most talented people this industry has ever known.

#ObamacareFail

If you like your doctor...

Remember this:



Ah, good times, good times.

Reason I ask is this:

"The number of physicians who say they’re accepting health insurance plans offered on Obamacare’s federal and state marketplaces has plummeted nearly 20 percentage points"

Now, we've blogged on this for a long, long time, but as we head into Open Enrollment v4.0, it's not enough to make sure your plan is affordable, but that it's actually useable. That is, all those "freebies" (colonoscopies, mammograms, routine physicals)? Well, they're not going to be free if your doc doesn't take your plan. And good luck finding a new provider:

"[O]nly about 57 percent of doctors said they'll be taking new patients insured by the plans next year"

That's less than two-thirds, and may be even worse in some areas.

#ObamaCareWinning

[Hat Tip: HotAir]

Game 7 Health Wonk Review is up

Brad Wright hosts this week's World Series (and election) themed collection of the best health care wonkery on the 'net.

And, like the Cubs this year, a winner indeed.

Heads' I win...

There's a popular meme circling the 'net that says the rate increases really won't affect most people because their subsidies will cover the spread:

"Yet most Obamacare participants won’t feel the full price hike or anything near it. Nationally, 85% of those enrolled receive a tax credit"

This is why I get so frustrated with the media, which seeks to isolate the Marketplace (Exchange) from the big picture: all ACA-compliant plans are ObamaPlans, not just those on the Exchange. That is, if it's ACA-compliant, then it's ObamaCare. By trying to split "ACA compliant" from "bought on the Exchange" these oh-so-clever "journalists" seek to put daylight between the two that doesn't actually exist.

The reality is that yes, most folks who buy on the Exchange are going to be getting subsidies (aka "a several hundred dollar health insurance gift card from taxpayers"), which is the only reason one should even consider buying there. But this completely misses the point that most folks don't buy on the Exchange or receive subsidies, and thus feel the full brunt of these fully operational Death Stars rate hikes.

And these same reporters also ignore the fact that even those "shielded" from rate hikes are still going to feel the MOOP pinch.

What's "the MOOP pinch," you ask?

That's the newly increased Maximum Out of Pocket limit. Care to see how this works in the real world?

Well, FoIB Jeff M has graciously forwarded his own plan rates and specs for this year and next:

So not only does he have the privilege of paying almost $3,000 a year more in premium, but his out-of-pocket increased by $300.

One supposes he doesn't feel "shielded."

[Hat Tip: HotAir]

O'Care Implosion (Anecdotal)

So got a call yesterday from a very nice lady who was looking for information on health insurance, and specifically an HSA plan. Seems she and her husband have been uninsured for several years, paid the tax penalty fine, but were thinking maybe it's time. She'd apparently been calling around, and no one was returning her calls.

I explained to her that if this had been a few short years ago, I would have been surprised, but that times have changed. Nevertheless, I was willing to see if we could help her out.

First, I completed a referral form to send to Cornerstone. She was concerned that, due to their ages, she and her husband would find premiums, even for an HSA-compliant plan, unaffordable. I think she was expecting me to pooh-pooh that, but of course I did not (could not). All I could say was that the fine folks at Cornerstone would do the best they could for her.

She had mentioned that they were self-employed, and that her husband was the minister of a small congregation. So I asked if they'd looked into a health care sharing ministry; she said they'd had a very bad experience with one such, and so I dropped that and asked if she was aware of the Direct Primary Care model.

She was intrigued.

So I offered to see if  we could help connect her with a DPC provider in her area, which was fine with her. I reached out to Dr Rob, of course, but also others I know in that field. Within a few hours I had a handful of leads for her, which I of course passed along.

I've asked her to keep me apprised of what she ends up doing; she's under no obligation to do so, of course, but I'm really curious to see how this turns out. Developments here as they occur.

1,000 Words on Open Enrollment v4.0

You can't make this up:

Open Enrollment v4.0: A Preview

No, I don't really think it takes a crystal ball to predict an abysmal showing for this year's Open Enrollment. For one thing, there are a lot fewer plans available, but they're up to 116% higher, which is nice.

For another, it's likely that fewer agents will be helping folks sign up for on-Exchange (ie subsidized) plans. As FoIB Allison B reports:

"Managers of HealthCare.gov continue to put barriers in front of consumers who want help from agents or brokers with buying, and using, public exchange plan coverage"

These include providing more agent information up-front, as well as requiring consumers to "call the HealthCare.gov call center at the beginning of the open enrollment period." And good luck with that: based on previous experience, those hold times become epic.

But that's not all.

Noted ACA proponent (and yet FoIB) Charles Gaba rues that "there were about 10.5 million people still enrolled in effectuated QHPs via the ACA exchanges. As I noted at the time, this was about 300,000 fewer people than I had assumed would be enrolled at that point."

And it just gets better (for certain values of "better") from there:

"Third-quarter earnings reports from Aetna and UnitedHealth showed that their combined exchange enrollment totals fell by 113,000 to 1.6 million from the end of June through September, a decline of 6.6%."

And why is this significant? Well, because these two carriers "account for nearly one in six exchange enrollees" (that's about 16% of the total market). So if enrollment fell off so dramatically last year, imagine what a bloodbath this year has in store.

#ObamaCareWinning!

[Hat Tip: FoIB Rich W]

Speak Softly and Carry a Big Stick

Elimination. This is what government is about when it comes to dealing with competition. The latest example comes via a new rule for Obamacare. If government speaks quietly enough you won't notice when they try and slip a fast one by you. If you do notice, they have that big stick ready to go so when competition doesn't fall in line they can smack the crap out of the competition with it.

That is what HHS did today when they issued a proposed new rule on short term medical insurance plans. The rule revises the definition of a short-term plan and will limit these plans to only three months and not be renewable.

On the surface this isn't a big deal to consumers. Primarily because short-term medical plans were never actually renewable. They are medically underwritten and don't meet the criteria of being Obamacare compliant. So when the policy ends it must be medically underwritten again before being issued. And, because they aren't Obamacare compliant people who purchase these plans are also subject to the individual mandate tax.

Therein lies the government's problem. Because these plans aren't compliant and include medical underwriting they are much less expensive than the Obamacare plans one is being coerced to buy through the marketplace. In some cases they are so much cheaper that a healthy person can pay the premiums plus the tax and it's still financially better for them than buying an Obamacare plan.

This leads us to the real reason government wants these plans gone. They see the death spiral of the individual market accelerating. Costs of insurance are exploding - including those cheap high deductible Bronze plans. Logically the only way government knows how to try and reverse this course is to force the healthy into the pool. By eliminating short-term plans and forcing consumers to the marketplace they believe they will strengthen the Obamacare risk pool.

Obamacare is a crap sandwich. Right now there are other sandwiches out there. Among them are limited benefit plan sandwiches, Christian Ministry sandwiches, and short-term medical sandwiches. One by one the government will eliminate your choices of sandwiches. Pretty soon all you will have left is the crap sandwich - and once you take a bite you'll find that it will leave a bad taste in your mouth.