More Cannon Fire

Cato Institute Director of Health Policy Studies (and FoIB) Michael Cannon summarizes most of ObamaCare's broken promises and failed metrics.

Here's a quick summary, courtesy of Americans for Prosperity:

And now for something....

Completely different:



[Courtesy Ace of Spades]

Chag Chanuka Sameyach!

This evening marks the first night of Chanukah 5777 (2016). To help us get into the spirit, here's inspirational new music from Nefesh Mountain:

The Christmas That Almost Wasn't

Hard to believe, but a Christmas favorite for young and old almost never happened.

Charlie Brown and all the characters of the comic strip Peanuts have been loved by children and adults for years. The complex personalities, dialogue and carefully crafted stories brought to life in a few frames on a printed page are sheer genius.

Charles Schulz, creator of Peanuts, offered this synopsis of the comic strip. “All the loves in the strip are unrequited; all the baseball games are lost; all the test scores are D-minuses; the Great Pumpkin never comes; and the football is always pulled away.” - Smithsonian Magazine

But through all the disappointments there are triumphs and lessons in life. Peanuts offers intriguing insight into the human psyche through the eyes of children.

Until 1965 Christmas themed television shows consisted mostly of old movies with a smattering of cartoon shows aimed at children. The animated "Rudolph the Red Nosed Reindeer" had been a hit for years. But was the TV viewing audience ready for a Christmas show with Charlie Brown, Lucy, Linus, Snoopy and the gang?

When the show aired for executives at CBS they were underwhelmed. The voices weren't right. The story didn't fit their idea of what a children's Christmas cartoon should look like.

And then there was the closing scene.

As Lucy and the gang walk off the stage leaving Charlie Brown to exclaim "Doesn't anyone know what Christmas is about?", enter Linus, stage left. Out of the mouths of babes come wise sayings. Linus' 60 second soliloquy sums up the meaning of Christ's mass, or what we refer to as Christmas.

From our house to yours, we wish you a Merry Christmas. Blessings.

Making a Difference

As I wrap up another year in the insurance industry I would like to share a story with IB readers about why we do what we do in our “real jobs”. The story highlights the highs and lows we go through with our clients. It’s a story that most people never see because it’s the behind the scenes work that doesn’t make headlines or front page news. In fact, the likelihood is slim that this story would even be reported on. So, I’m asking you to please read on. If you enjoy the story, please share it with others.

I am blessed to have strong support staff that I work with every day. They are a huge part of a team that integrates benefits administration, human resource assistance, claims management services, and wellness coordination programs for our clients.

In July, we set up another wellness challenge for a client in coordination with their insurance renewal. These challenges have been very successful in the past and with this challenge we created a competitive environment with teams battling each other for a prize at the end (which I agreed to provide). The challenge ended at the end of August and the winning team of ten employees was looking forward to an evening at a comedy show.

Then came news that nobody could have imagined. One of the employees on the winning team had a family emergency. The employee’s daughter had an apparent emergency gall bladder attack. She was away at college when it began. That night, during the surgery, they found out this young 19-year-old had cancer. That was September 2nd. On September 5th, she was told that the cancer was in her abdomen and extremely aggressive. Treatment began right away. But unfortunately, just 31 days later the young lady passed away.

This is a very close employer with just over 60 employees in a small town. The wellness challenge was put on the back burner. That prize became irrelevant. The focus was now on helping one of their own. And we were there. Helping in ways that most employees didn’t even know.
From the day of diagnosis our team worked with the company ownership and management in guiding them with counsel through the FMLA process. As fundraisers were held during the month she went through treatment, the VP of Operations for the company came to us with a question and asked for our help. The VP wanted to know what financial responsibility the employee would incur under their company health plan. She also wanted to know how claims would process.

This is one of those “feeling punched in the stomach” moments in our business – one that many never face. The reality of this family saying goodbye to a loved one – especially a child – then facing the heaps of mail from doctors, hospitals, labs, and the insurance company. It’s overwhelming, painful, emotional, and creates stress and anxiety. All things we don’t want the family to face. So, we did what any broker can do. We asked the company if we could assist. We requested that the family send us all the mail they received.

That’s exactly what they did. The employee, after being gone for three weeks to be with her daughter, gathered all the mail and brought it to her employer. They sent a package to us via FedEx with a small stack of insurance company EOB’s and several bills from providers. Our team sorted and consolidated these statements and bills. We spent time on the phone with United Health Care, The James Cancer Center in Columbus, numerous provider offices, and many other places. These calls were made to have claims adjusted and reprocessed to make sure that this family didn’t have to bear any burden of fighting through a complex system. In the end, we came up with a final audit of all bills and patient responsibility. We were able to share with the family exactly what they owed and to whom. It gave them peace of mind in knowing that the insurance was there and would keep them from a financial catastrophe. It allowed them to grieve without additional emotional stress. It provided them with a voice that they could count on that was working in their best interest. In an email we received from the family this is what they had to say:

“Thank you for all your help with everything! Without your assistance, this process would have been a bigger headache on top of the emotional rollercoaster and devastation my family has went through. I just hope you realize how much you are appreciated and all the hard work you have done has helped our family tremendously!”  

“Thank you so much for everything you do!”

Health insurance is important. The help we provide as a broker is essential. It is what we do. It’s the relationship. It’s the feeling of help and support. It’s knowing that we have a unique skill of understanding a complex system full of twists and turns that many of us take for granted.

Tomorrow is Christmas Eve. Next week it will be 2017. I will spend time these next ten days with my friends and family. It’s unlikely that I will spend time with my team. I hope they know how much I appreciate them and will never take them for granted. To Pam, Joan, Michelle, Lindsay, Sanaa, and Cindy, have a Merry Christmas and Happy New Year.

To my co-bloggers, Hank, Bob, Mike, Kelley, and Bill, as well as all of you who read my gibberish here at IB, Merry Christmas and Happy New Year to all of you.

Without your support I would be nothing more than a simple insurance agent. But with you we do great things. This story is just one example of the impact we have.

Euphemism Insurance

So this arrives in email:

"Key Person Failure to Survive"

Now granted, the product itself is kinda cool (high value life insurance plans with no exam and a one page application). But "Failure to Survive"‽

 /sigh

HRA Cure-all's

So, our good friends at Cornerstone sent us this news:

"President Obama Signs CURES Act into Law"

For a while now, small employers (under 50 full-time employees) have been prohibited from helping their employees with unaffordable ObamaPlans by funding their Heath Reimbursement Arrangements with cash for premiums.

This new legislation specifically "enable[s] small employers with fewer than 50 full-time employees to fund qualified stand-alone HRAs. Employees may use the HRA to pay for qualified out-of-pocket medical expenses, including individual polices purchased through the public exchanges."

I reached out to our gurus of all things HRA (and HSA, and FSA) at FlexBank, who confirmed that this does seem to mean that employers can finally go back to throwing premium dollars into tax-advantaged HRAs. There are, of course, some important caveats and restrictions: for example, no subsidies while using HRA funds for premiums, and it's available only to those smaller employers who don't offer group health insurance.

Unfortunately, little actual official guidance is available yet, so we have just the basics. But this is still good news for those smaller employers and their employees.

Stay tuned...

Because of *course* they did

A few months back, we reported on how easy it seemed to be to enroll fake people in the Federal Exchange:

"[F]ederal watchdog office did set up 10 phony insurance coverage accounts with no pushback from those overseeing the applications."

Which was in fact a marked improvement from the previous time we'd looked.

But time marches on, and now that Phase 1 of this year's Open Enrollment season is past, things have improved, right?

Um....

"Healthcare.gov and its state marketplaces approved health care coverage and subsidies for nine fake applicants in another Government Accountability Office sting"

Which is actually not so bad, when one considers that ObamaPlans are themselves pretty much fake insurance. Now, nine "people" out of the (presumably) tens of thousands who signed up doesn't seem like a lot, but here's the rub: that's just the ones we know about because they were essentially a controlled experiment undertaken by the Feds themselves.

How many others were enrolled for less honorable reasons we'll likely never know, but it seems unlikely that there aren't at least some. So what's the big deal? Isn't this basically a victimless crime? Not really: how many providers will be duped into performing services for which they'll never get paid, since the insured doesn't actually exist?

Well?

Of all the flipping stupidity...

Would someone please give me an intelligent reason why not submitting this page would interrupt the processing of an application?

Faxed in, at the request of the gnomes at Anthem.

As they used to say in the army, "Mine is not to wonder why.  Mine is but to do and die..."

Proud to be of service

Once again, the folks at Healthline have named InsureBlog as a Top Men's Health Blog:

"Your blog has made Healthline's list of the Best Men's Health Blogs of 2016! Healthline's editors selected each winner based on their reach to educate, inspire, and empower their readers with frequent updates and high quality information."

Thank you!

Less really *is* more

Here's a thought experiment:

If eggs sell for $1.00 a dozen, and the government gives you a voucher for 40¢, how much do the egs cost?

If next year eggs cost $1.50 a dozen, and the government gives you a voucher for 60¢, has the price of eggs increased?

Reason I ask is this:

"Taxpayers will fork over nearly $10 billion more next year to cover double-digit premium hikes for subsidized health insurance under [ObamaCare] ... the cost of premium subsidies under the Affordable Care Act will increase by $9.8 billion next year"

This is supposed to demonstrate that the cost of ObamaPlans really hasn't increased, because those who buy subsidized plans saw those subsidies increase. Of course, that's simply financial 'legerdemain' - remember, the government has no money of its own, all of that comes from thee and me. So of course as the actual cost of plans increased, so did our financial burden in the form of increased taxes.

Chicken, eggs, ObamaCare.

[Hat Tip: HotAir]

Shanda or no? [UPDATED]

[Scroll down for update]

So FoIB Holly R tips us to this potentially scandalous story:

"Sales were sluggish that year. So the company looked south ... the New York-based company encouraged Southerners to buy insurance to protect their most precious commodity: their slaves."

And?

Here's the thing: at the time, slavery was perfectly legal, and slaves were a valued (and valuable) asset to those who owned them. This is, by the way, a purely legal and economic argument: I'm certainly not condoning the "peculiar institution" as moral or ethical. But as a specifically financial arrangement, it would make sense to insure one's assets, including slaves.

We still have these kinds of policies, by the way: we call them Key Man life insurance policies, and employers take them out on valued employees all the time.

“We profoundly regret that in the 1840s our predecessor company, Nautilus Insurance Company, insured the lives of slaves for a brief period of time"

So says New York Life's spokescritter in a vapid display of "mea culpa." The reality is that, at the time, it was a perfectly legal and sensible application of basic life insurance principles. Eventually, slavery was outlawed, and thus the need for (and attraction of) these plans no longer existed.

As a purely historical phenomenon, I agree that this offers a fascinating glimpse into the early days of the life insurance business here in America. But I see no particular lessons to be drawn, or amends to be made.

Interestingly, the Gray Lady fails to note that these experiences eventually led to the founding of Pilgrim Life, which was founded in 1898, and which:

"[B]ecame the first insurance provider for African Americans in Georgia. A black-owned and -operated company, Pilgrim was one of the largest employers of African Americans in Augusta and issued tens of thousands of policies in the first decades of the twentieth century."

And why do I bring this up?

Because it demonstrates that my industry is capable of learning from the past, and (eventually) making things right.

Again, no one's condoning the circumstances that led up to either of these, but to impute some evil motive to the former is unsupportable.

UPDATE: Co-blogger Bob points out that this is perhaps more akin to STOLI (Stranger Owned Life Insurance) than Key Man, and I tend to agree:

Like slavery, STOLI plans were eventually outlawed. And, like STOLI, it's likely that the insureds didn't even know they were insured.

Still, I don't think it changes the basic point that this is, in fact, much ado about nothing.

Even more Headlines, Shmedlines

You have GOT to be kidding me:

Truth Squad: The Video

From ACA signups to drone coverage to long term care insurance, the value of a professional, independent agent:

 

Holiday heads' up: Drone insurance to-do's

As we head into the Christmas (and Chanukah) gift-giving season, lots of folks have drones high up on their wish lists (SWIDT?). But before you fire up and fly your new gizmo, there are some important insurance-related issues you'll want to consider.

As we blogged at this time last year:

“Almost no one is thinking about insurance coverage when they’re opening the box,” says Jeff Antonelli, a Chicago attorney who specializes in federal regulations for unmanned aerial systems."

But that was then, and this is now, and there's been some progress. Our Guru of all things P&C, Bill M, tips us to this recent article in an insurance trade journal:

"[Here] are insurance coverages and how they are likely to apply. Keep in mind all claims are handled on a case-by-case basis, and there may be more exclusions and conditions that apply as drone technology evolves."

These include homeowners and renter's policies, auto and even commercial plans, too.

Have fun, but speak with your agent about how to protect your financial well-being if things take a dive.

Deadlines Schmedlines

HHS blames the website. I blame Bush.

Either way, you have four more days to #getcovered.

Last Minute O'Care PSA

As pretty much everyone knows, today is the final chance for folks to enroll in a 2017 ObamaPlan with a January 1 effective date.

So that means if you miss out, you miss out, right?

Well, not necessarily:

If you miss today's deadline, you can still apply for a plan with a February 1 effective date, so long as you apply by  January 15. And if you miss that one, all is not lost: you still have until the end of January to sign up for a plan that starts March 1, which still means you avoid the penalty fine ObamaTax.

Of course, that also means that you'd be uninsured for up to two months, in which case you could take your chances, or look into a Short Term Medical plan.

Good luck!

Open Enrollment Heads' Up

From HHS:

Tick, tock...

Going Bare: Making the Case

As we've long noted (here, for example), some (many?) folks have made the perfectly rational decision to forgo ObamaPlans (or health insurance of any kind). For one thing, the fine penalty tax is nominal (particularly in comparison to non-subsidized premiums). Recently, FoIB Dr Gerard Gianoli tipped us to this well-researched and written article expanding on the idea:

"There are necessities of life, but insurance is not one of them."

That's Dr Jane Orient's opening salvo, and it gets even better from there:

"It might be a ticket to get you into certain medical facilities, but in these days of narrow networks, it will keep you out of others."

This in reference to how restrictive networks have become; I'd add that there's another dimension, as well: HMO vs PPO models.

Until this year, many (most?) plans were built on the PPO (Preferred Provider Organization) chassis. That is, one got the best bang for their premium bucks by staying in-network for care, but there was still a safety net for out-of-network claims. This is no longer the case: all the plans I've seen (in this market) are for HMO model plans; that is, zero coverage for non-emergency non-network expenses.

So what's the big deal? Well, what if your oncologist is out of network?

I particularly appreciated this observation:

"If most bills were paid directly instead of through a third party, medical care would cost far less. Wouldn’t that be better for everybody?"

This comes as she makes the case for a return to truly catastrophic coverage, which she favors as the best O'Care alternative.

As they say: Read the whole thing. You'll be glad you did.

Wing, Prayer, Healthcare

It's long been my belief that there's a direct, intrinsic connection between prayer and healing. Although the healing prayer group in which I'd participated for so many years is now defunct, I continue to believe in the healing power of those prayers. And of course I'm far from alone in this.

Recently, FoIB Holly R sent along this interesting article that discusses the link between health care and spirituality:

"Dr. Christina Puchalski is familiar with death ... Several years ago, [she] went into a checkup with a patient previously diagnosed with a terminal illness ... We’d gotten to the heart of the visit, and it wasn’t about the medication or the pain. The real issue was the bereavement and the fear of losing each other.”

And it's not really about religious faith, per se: the focus is primarily on one's “search for ultimate meaning.”

I recall a few years ago, a dear friend (who, perhaps not coincidentally, was the founder of our own healing prayer group) was scheduled for a procedure. Like me, he was also Jewish, and his Christian doctor asked if it would be alright if they could pray together. Of course my friend immediately agreed, and everything went well (which may or may not have had anything to do with the prayers, but they certainly did no harm).

In fact, this practice appears to be more widespread than one might believe:

"In 1998, the Association of American Medical Colleges (AAMC) published a report called the Medical School Objectives Project, which included sections on spirituality."

Kudos (and prayers sent).

About Those ACA Signups (GIGO)

As the first phase of Open Enrollment v4.0 winds down, it may be helpful to get a sense of how successful the whole effort's been thus far (for certain values of "success"). ObamaCare proponents like to boast that the train-wreck insured some 20 million Americans.

But is this really accurate?

It will come as no surprise to IB regulars that the answer is a resounding 'No:'

"The Department of Health and Human Services claims that 20 million people have gained health coverage ... 17.7 million people gained health insurance from Obamacare’s first open enrollment period."

Which is all well and good, except that these numbers are based entirely on survey data, not actual, verified enrollment numbers. When one examines those, a very different picture emerges:

"Just over 14 million people gained coverage from the end of 2013 to the end of 2015. Of those 14 million, 11.8 million gained their insurance through Medicaid."

So roughly 85% of those being counted are not, in fact, insured: they're enrolled in Medicaid, which is not insurance. So less than 15% of the folks who ACA proponents claim became insured under the ObamaTax actually did so.

Of course, they'll never admit this, because: #Narrative.

Another One Bites the Dust

Last we looked, there were only a handful of Co-Ops still fogging a mirror (metaphorically, of course). And that list just got shorter:

"Evergreen Health Cooperative Inc. (“Evergreen” or “company”) will not be issuing or renewing individual health benefit policies ... Evergreen Health plans are not available on Maryland Health Connection for the 2017 plan year"

This means that folks currently insured by the faltering carrier will have to choose a new one, and they have just about a week to do so (if they want to remain insured come January 1). Now, if they'd purchased their current plans through the Old Line State's Exchange (Maryland Health Connection), they'll be automatically "transitioned" into a comparable plan with another carrier. If they don't wish that to happen, then they'd best get crackin'.

Those who bought off-Exchange are on their own.

Still, I'm a bit puzzled as to how this can be happening. After all:



[Hat Tip: FoIB WeirdDave]

Obamacare Conflict: Losing The Personal Touch

I've been fielding a lot of questions from individuals looking for health insurance lately. They wonder why I tell them up front that it's unlikely I will have time to personally meet with them on their needs - especially considering many of them are losing their plans. So, in an effort to explain my situation here is what I'm sharing. 

Hi Jane, 

I'm sorry our affiliate isn't able to suit your needs. Unfortunately the ACA forces everyone to renew their plan January 1st which makes a personal touch almost impossible to achieve. Also unfortunate is most of my professional colleagues that have true knowledge and understanding of the industry aren't willing to work in this market. This is because they are astute business people and know that most of the insurers participating don't value our personal touch. We know this because many of them have completely eliminated our compensation and others have dramatically reduced our compensation. I hope you understand that we simply can't work for free.

If you are looking for a personal touch I can tell you that you do have options available. 

The first are Navigators. Navigators are unlicensed people that have been hired by non-profits who received government funded grants to help you through the process. Unfortunately these folks aren't able to advise you on specific plan choices or make any recommendations. Of course why would you take their advice since they are not licensed to sell insurance and haven't had any formal training. Not to mention, they are unable to service your account throughout the year.

The second option is to head on over to your local WalMart. You will need to find the person standing up by the checkout lines behind a table with a "health care" banner next to it looking bored out of their mind. This person is licensed to sell health insurance and can walk you through the process. I'm sure they will have time to meet with you.

If you would still be interested in a phone consultation and my recommendations please let me know. I'd be happy to assist you - if I can.

Attaboy, ObamaCare Style

So you've just spent several hours helping a client navigate Open Enrollment v4.0, sifting through the various options, checking to see which (if any) of his doc's are in-network, helping to determine whether or not he's eligible for a subsidy, helping him set up an account and verifying his identity at 404Care.gov. How do you think you should be compensated? Well, co-blogger Bob V tells us that the Rocket Surgeons in DC© have just the thing:

"[T]he Centers for Medicare and Medicaid Services (CMS) is offering health insurance brokers who enroll 20 or more individual consumers or 20 or more employers through the marketplace the opportunity for a “gold star” in the form of membership in the Healthcare.gov Circle of Champions."

Gosh, who wouldn't prefer this kind of recognition to icky commission dollars?

As we've pointed out, many agents have bailed on this season because carriers have drastically reduced or, in some cases, done away with agent compensation. As Ronnell Nolan, president/CEO of Health Agents for America points out, it's really just "throw ‘em a bone but not pay any money.”

And stay tuned: Co-Blogger Patrick has a very personal experience to share coming up shortly.


#ObamaCareWinning!

Tomayto, Tomahto

Potayto (via FoIB Jeff M):

"Newly issued federal data shows that North Carolina has among the highest health insurance costs under the [ObamaTax] ... North Carolinians covered by the ACA receive some of the nation’s highest subsidies per person."

Here's the thing: prices get distorted as soon as the government steps into the equation. Tar Heel State ACA insureds provide ample proof of this; by insulating them from the actual cost of plans, our Betters in DC© are able to gloss over the devastating effect that the ACA has had on health insurance rates.

Potahto:

The folks at HotAir point us to what's happening on the macro scale:

"Steven Lopez has gone without health insurance for 15 years, and the Affordable Care Act hasn't changed his mind. Once again this year, he will forgo coverage, he said, even though it means another tax penalty."

Mr Lopez is a 51 year old IT pro; last year, he and his family coughed up almost $1,000 to cover the fine tax penalty. It was either that, or 4 or 5 times that much in premiums, plus actual out-of-pocket for any healthcare they inadvertently received.

For all the talk of how many folks have signed up for ObamaPlans, some 28 million of our fellow citizens have taken a pass. And that's not counting the tens of millions on Medicaid (which, as we've repeatedly pointed out, is not insurance).

#ObamaCareWinning!

Up, up and away!

As we inch closer to Winter Christmas break, many students are planning international journeys. Some will be strictly for fun (think ski trips in the Alps) while others will begin studies abroad. Our friends at Global Underwriters remind us that, either way, they'll need to plan for the unexpected:

"Many students don't realize that their health insurance will not provide adequate coverage while outside of the United States or in many instances, they have no coverage at all. This is a terrible financial burden for any young person. Several countries and study abroad programs, also require health and medical evacuation insurance, in order to obtain a visa or participate in their program."

So where to begin? Well, a quick phone call or email to your favorite professional insurance agent is a good start. There are any number of plans available to help "close the gap;" some include not just medical coverage, but even medevac and war risk cover.

Perhaps best of all, these plans are generally inexpensive, and easy to acquire.

Safe travels!

UnAffordable Health "Care"

Years ago, my parents bought a small piece of property. I don't recall the particulars, but it was part of a larger parcel which was divvied up. The idea was that property always increases in value, so it was a "safe" investment.

Problem was, the whole thing was kind of "landlocked" such that it was pretty much unusable and undevelopable. Nevertheless, the folks had to keep paying the property taxes on it or it would be forfeit (which I'm not altogether sure wouldn't have been just as well).

Reason I bring this up is that sometimes owning something isn't really that beneficial, especially when one has to keep pouring more money down the hole, with only the vague promise that it would one day be utile.

And so it is becoming [ed: has become?] with ObamaPlans: as we've pointed out before, just because you buy an ObamaPlan doesn't mean that you can afford to actually use it.

Case in point:

"Twenty percent of Ohio adults reported that they or a household member go without medical care because of the cost even though more than 90 percent of them have health insurance"

The problem is that the steep "barrier to entry" that is the deductible (and then co-insurance) renders plans pretty much unusable (well, except for free birth control convenience items and the like). This is really just an extension of something we've been saying for many years here at IB: health care ≠ health insurance. That is, just because one has purchased a health insurance plan doesn't mean that one can then afford to actually use it.

Quite the conundrum.

[Hat Tip: Jennifer A]

Some more anecdata

Another in our informal series chronicling the sad state of ACA as it relates to previously insured ("grandmothered") folks:

First up, Ben and his family have been clients for many years. His current plan isn't fully ACA-compliant, but he's being "allowed" by the Rocket Surgeons in DC to keep it another year. It boasts a $3,000 per person ($6,000 family) deductible, then pays 100% for covered expenses. The plan just renewed, and the premium for his family of four is increasing by 45%(!), from $705 a month to just over $1,000.

But fear not, it's open enrollment season, so a great opportunity to shave some costs.

Right?

Um...

The cheapest alternative I could find has a $7,150 per person deductible, and clocks in at $926 a month. So they’d save about $1,200 per year in premium, but face an additional potential out-of pocket increase of over $4,000 each.

On the other hand, a comparable plan with a $2,500 per person deductible is over $1,200 a month, and includes 10% co-insurance, meaning an out-of-pocket exposure of over $6,500 per person (more than twice their current plan).

Sweet.

Meantime, Patty's plan (which is identical to Ben's) includes herself and her husband, and is increasing by "only" 12%, from $885 a month to just under $1,000.

The least expensive alternative I could find for them has a $7,150 per person deductible, and clocks in at $1,410 per month. So, an additional $4,800 a year in premiums plus $4,000 in potential additional out-of-pocket.

How's that old saying go again?

Friday LinkFest

Odds-and-ends from the past couple of weeks:

■ Continuing to defy the "death by attrition" model of Long Term care insurance, almost 97% of federal employees participating in government-sponsored LTCi plans opted to keep them, despite rate hikes averaging 83%.

What does that tell you?

■ Regular readers may recall the frustrating story of Martin Shkreli, who "jack[ed] up the price of a life-saving drug more than fiftyfold."

Well, FoIB Holl R tips us to some motivated and talented students from "Down Under" who have just "recreated the drug's key ingredient for just $20."

Good on them!

■ And from other FoIB Jeff M comes this heart-warming tale of greed and redemption punishment:

"Federal prosecutors say a Charlotte woman has been sentenced to 16 years in prison for orchestrating an $11 million Medicaid scam involving false medical claims and identity theft."

Seems that Ms Cynthia Harlan must also "reimburse Medicaid $3.1 million."

That's a lot of license plates.

News from the Front

Regular readers know that I've decided to sit out this Open Enrollment season. I'm far from alone in this, but got email yesterday from good friend and colleague Scott M with a first-hand report of what he's experiencing, and he's graciously allowed us to share it:

"I was talking with a client earlier today and I found an old renewal for him.  It was a $5,000 deductible and the premium (prior to renewal) was $345.72 for him, his wife and three kids.  The plan he is going with for 2017 is a $5,500 deductible and the premium is $1,317.90.  I sent the attachment to him and he said, “the funny thing is I was just as pissed back then as I am now”.  I told him I made more when his premium was $345 than I do at $1,300.

Yep, those were the good ole days."

Now, how is it possible that a premium one third the size of the renewal actually generated more income (commission) to the agent? Well, Scott explains that, too:

"I’m writing very little.  And only with BCBS.  The on-exchange folks around my area are completely screwed as none of their doctors nor the local hospital is in network of the on-exchange plans.  Plus, Blue Cross is really the only one paying anything ($10 Per Member Per Month if you have a total of 10 members or more).  I’ve been preparing quotes for my existing clients in the Blue Cross system and having them emailed with the instruction to enroll using the link if you want one of these plans.  If not, you’re on your own.  Can’t waste any time on it.  Especially for the single folks.  $10 per month for that headache?  No thanks.  At least the one I sent you guys is a 5 person household where I’ll make $50 per month.  For him I’m willing to do a little work."

Remember, agents make their income from commissions (both new business and renewals). And why should you care? Because a professional agent is uniquely positioned and qualified to help you figure out the best, most cost-effective plan available.

Which is kinda the point, no?

Health Wonk Review: Puppies and Kittens edition

After a contentious election season, where my preferred candidate didn't even show up, I thought it'd be nice to focus on something a bit more pleasant. And nothing quite brings the smiles like pics of our little furry friends [ed: bonus points to anyone able to guess the significance of the first one].

And so, without further ado, this week's hectic, eclectic, fur-bally HWR:

■ HWR co-founder Joe Paduda  offers the first two entries in his new series The Flash vs Spiderman "Getting Serious About Health Reform" (Part 1 here, Part 2  here), wherein he offers his own suggestions about where we go from here. As usual, interesting stuff.

■ One of our favorite wonks, David Harlow is actually traveling quite a bit lately, most recently to an innovation in healthcare convo in The Big Apple. He graciously took time out to send in his take on how the election will likely affect not only the ACA, but what the various pols are likely to propose.

■ It's been a while since Adam Fein's participated in the HWR, but he's back and in fine form with this post on "The 2025 Payer Market for Prescription Drugs" (wait, Adam's the new Dr Who?). 
 

■ The Health Affairs blog's Karen DeSalvo and Georges Benjamin offer their thoughts on what the future of public health will (should?) look like, including how to compete in a global economy.

■ Our good friend David Williams sends in this post on  legalizing marijuana, both for recreational and medicinal purposes. Considering how well pot-related ballot issues did this year, it's likely to be a hot topic for a while. In his post, David interviews a "marijuana entrepreneur" about implementation.

■ Another HWR favorite, Louise Norris, looks past the election results to dispel some misinformation currently making the rounds: she thinks it's likely that the mandate/tax will still be in force for 2017, and explores what that means to thee and me.

■  Uber-wonk Roy Poses submits his take on the "Bio Telemetry Settlement" (see, I told you he's an uber-wonk 😊), wherein he continues his long-standing exploration of ethics (and/or the lack thereof) in healthcare, this time specifically about physician kickbacks and medical devices.

[ed: And pay special attention to the sidebar pic for that post]

■ Dr Jaan Siderov, still another long-time 'Review regular, takes a respectful (and insightful) look at the potential winners and losers in the upcoming ACA battles, focusing specifically on "organized medicine" and mHealth.

■ Our very favorite Healthcare Economist, Jason Shafrin, talks about "Precision Medicine" and how it potentially offers both vast benefits for patients and challenges for providers (and government regulators).

■ Peggy Salvatore waxes philosophical about the "Healthcare Industry in an Age of Uncertainty;" her concern about special interests is quite thoughtful, especially when we really don't know how things will ultimately shake out.

■ Our dear friend Julie Ferguson asks "what's in store for OSHA and the Department of Labor under the new administration?" Reading the tea leaves in her crystal ball [ed: heh], she takes the President-elect at his word about the ACA being on the chopping block, and what that may portend for OSHA and worker's comp.

■ Our own post explores the changing landscape of specialty prescription meds, specifically the effect of   manufacturers' coupons on claims and balances.

And please tune in again on the 15th, when Julie Ferguson works her own Health Wonk Review magic.

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?