Interesting "Solution" (Not For Faint of Heart)

Recently, Co-Blogger Bob clued me into a new (?) strategy some agents are using to help their clients. The idea is pretty simple and straightforward: combine an inexpensive Medishare (healthcare sharing ministry) plan with a commercial Short Term Plan. The Medishare component means one dodges the fine penalty tax, and the STM plan undergirds the Medishare (to be fair, I'm not really clear on how, but that's another post).

Bob then wondered if "a Jewish agent would offer Medishare plans to clients?"

Actually, that's an interesting question. The answer is "yes, but no."

Let me explain:

I have no objection to selling plans available only to Christians. After all, I've sold MediGap plans and I'm under age 65. But that's not why I wouldn't sell them:

I'm an insurance agent, and I hold myself out (semi-)professionally as such. So if I sell a Medishare plan, which is specifically not insurance, I'd be concerned about an E&O claim in-the-making.

Why is that?

Well, what happens when my client has a claim that the Medishare folks decline? He's going to come back to me and ask why I sold him an insurance plan that wasn't insurance. And how do you think the court's going to decide?

So yeah, I'll pass.

Yeah, About Health "Care" and Single Payer

A lot of ink and pixels have been spilled over the years touting schemes like "Medicare for All" and Universal Health Care. All seem to rest on the assumption that government-run delivery of health care will be the greatest, most efficient thing since sliced bread.

As we've long chronicled, of course, this is most definitely not the case.

Here's a recent illustration:

"One Sunday in March this year, I woke up at 2am with a grumbling pain in my right groin ... [Dr] Anson told me I had a minute kidney stone stuck in my ureter ... three weeks later, when nature had failed to take its course, [Dr] Anson decided to operate to remove it."

So far, so good. But then you scroll to the end of the article, and there's this little gem:

"The operation costs £2,500 privately, £1,200 or less on the NHS if done as day surgery."

Note that even with "free" health care available, folks willingly pay over twice as much for private services. Why do you think that is?

Here's a clue:

"Think the ER can treat a ureteral stone? All it can do is give you some pain pills. A urologist has no obligation to remove your stone unless you can pay for his/her services ... Private surgery? Now why would you pay twice as much for private surgery when the UK offers universal healthcare?

 All depends on how long you want to wait."

You get what you pay for. At best.

[Hat Tip: Co-Blogger Bob V]

Agents Behaving Badly

This goes way beyond our Stupid Agent Tricks series. Thanks to FoIB Jeff M, we learn about these two creeps:

"[T]wo retired insurance agents were convicted of targeting senior citizens as part of a multi-million dollar scam that spanned seven years. Milton Hooks, 72, of Rocky Mount and James Mangum, 69, of Tarboro scammed nearly 80 victims out of $11 million from 2004 to 2011."

Touting the benefits of "Fixed Indexed Annuities," these two crooks enticed their victims to raid their 401(k)'s and insurance policies to "invest" in these  products, generating some $600,000 in commissions. In addition, over $300,000 went straight into their bank accounts.

All told, they were convicted of a half dozen counts of "obtaining property by false pretenses" and forced to to repay their victims.

The worst part, though? This:

"The judge ... gave the pair suspended sentences because of the restitution."

Um, no.

If you rob a bank, and subsequently return all the cash you took, do you really think you'd get probation?

Yeah, me either.

#ACAWinning: Part 4,327

Yeah, about that 3000% rate decrease:

"In Anchorage, premiums for a silver ACA plan for a 64-year-old couple making $82K a year = *$50,930* a year. That's not a misprint."

The plan looks like this:

 

[click to embiggen]

So, $50,000 before the $14,300 max out-of-pocket.

That's over $64,000 in potential total annual cost.

But hey, they get free birth control.

Which is nice.

Marty Robbins Life Insurance

We've written pretty extensively over the past dozen or so years about Universal Life, very little of which was complimentary. The design itself, especially the first few iterations, really needed a young person as the insured, and said young person really needed to "over-fund" the plan (ie not be skimpy with the premiums). This to ensure that the policy had enough "oomph" (in the form of cash value) to carry it in the later years.

Recently, I had occasion to work with one of our P&C clients who has a MetLife UL purchased from "a friend" many years ago. Of course, this friend is long gone from the insurance biz, and for some time "Marty" (not his real name) has been trying to figure out why his policy is imploding. In desperation he called us to see if there was anything we could do to help even though we're not MetLife agents.

Of course I agreed: he's been an agency client for well over 30 years, and besides, he's a charming older gent who needs our help.

The facts are thus: At age 58, he purchased was sold a Universal Life plan with a fixed, $50,000 face amount, paying just shy of $100 a month in premiums. Now one might think that this would be sufficient to really give the policy that "oomph" that I mentioned, but at age 58, not so much. Seeing as how he's now 86, things have caught up with him.

He called Home Office last year, and was assured that the plan would run to his age 95. Well, that's how he understood it, but the reality is that the plan is designed to end at his age 95 (at the latest). What he was supposed to do at age 96 remains a mystery.

A few weeks ago, he got his annual report, which told him that, contrary to the nice home office lady's claim, the policy was due to expire next year at this time, well before he celebrates that magic 95. And that's when he called us.

Because I'm not the Agent of Record (nor do I currently represent MetLife), I had Marty pop in so we could call Home Office together. This way, they could identify him and he could give them permission to discuss policy particulars with me. Which they did.

The bottom line was that the plan was destined for self-destruction next March, unless we made some significant changes. I asked for a variety of "what if's:"

■ What if we lowered the face amount and kept the same premium?

■ What if we lowered the face amount and increased the premium?

■ What premium would be necessary to carry the policy, at the current $50,000 face amount, to age 95?

Turns out, there is no dollar amount that will take the policy to Age 95 (thanks, Uncle Sam!). Of the other options, the only one that made a modicum of sense was lowering the face amount and doubling the premium. And that suited Marty just fine, so we just sent off the forms to accomplish that (and to name me as Agent of Record so that I can call on his behalf if I have additional questions down the road).

Honestly, I don't know what I would do in that situation. I do know that there were no "good" options.

Just glad I could be of service to a long-time agency client.

Short Term Medical Plans: With a Twist?

We've written before about Short Term Medical (STM) plans as potentially viable ObamaPlan alternatives. They're a lot less expensive than O'Care plans, and offer lower out-of-pocket maximum's, to boot.

On the flip side, they're underwritten (which means that one must be relatively healthy to qualify), they don't cover pre-existing conditions, and (perhaps worst of all) they're not ACA-compliant, That last means that they don't satisfy the fine penalty tax.

Still, a lot of folks do the math and determine that it's worth taking the (negligible) risk.

The other day, though, I got an interesting email offering what purported to be an "ACA Penalty Free & Guarantee Issue" Short Term Medical plan.

Hunh.

I reached out to co-blogger Patrick for his reaction, and he replied:

"Looks like an oxymoron. I don't see how it is possible unless it is somehow tied to a Christian ministry product. Like most "new products" I've seen, these are likely too good to be true."

As usual, Patrick nailed it. When I responded to the email with a request for additional information, the representative very promptly sent me details, and followed up with a phone call confirming that this is, in fact, a sharing ministry-based plan.

I have no particular objections to these, but they do limit the marketability and, of course, they're not really "insurance." Still, they may offer a reasonably-priced ObamaPlan alternative that's acceptable to people in the market for such (which, we now know, is a growing demographic).

Something to consider.

PCIP v2.0?

We were long-time fans of the PCIP (Pre-Existing Condition Insurance Plan), the one part of ObamaCare that actually seemed to make sense. So of course it was designed to sunset after a time, leaving a lot of folks with few choices and less care.

Now, FoIB Dr Val Jones writes about "stability funds," part of the ill-fated AHCA, funded at (gulp) $100 billion over the next 10 years, and which was designed to allow "states to start to repair their individual insurance markets ... With better policy choices, states can make coverage cheaper and more attractive for consumers and coax insurers back into the market, and the stability fund is a powerful tool."

On its face, the idea has merit: the gummint (thee and me) serve as reinsurers, backstopping major claims. This was tried in Maine back in 2011, where an "invisible high risk pool ...  picked up the total cost of claims above $10,000." This seems to me to be a legitimate role of the state (although I could be persuaded, for example, that $10k is too low). If it were included as part of a total reformulation - and of course after O'Care was totally repealed - then I think the concept has merit.

I recently had a conversation with NYT reporter Reed Abelson, and mentioned that I was a fan of PCIP, and that I'd like to see something like it incorporated into whatever new scheme our congresscritters managed to cook up. The idea is that it encourages carriers to take on some additional risk without breaking the bank. I'd also like to see it coupled with some kind of assessment, so that that carriers are incentivized to spread that risk amongst themselves.

I know: Wishes in one hand....

Dutch Digging Deeper

We've posted before on how the folks in the Netherlands really like them some euthanasia:

"The number of Dutch people killed by medical euthanasia has more than doubled in the 10 years since legislation was changed to permit it, rising 13 per cent last year"

Now granted that was almost 5 years ago, so certainly the country's found a better path to healing, right?

Right??

Not so much, apparently:

"A Dutch woman doctor who asked an elderly patient’s family to hold her down while she administered a fatal drug dose has been cleared under Holland’s euthanasia laws ... as the doctor tried to administer the injection, she began to struggle and the doctor had to seek the family’s help to complete the procedure.”

The poor woman, suffering from dementia, had previously expressed "a desire to have her life ended when she felt the ‘time was right.’" The time wasn't right, however, and she began to fight for her very life while being administered the lethal concoction.

She lost.

Coming soon to an IPAB near you?

Does it make sense?

Last week, we noted the curious case of Joaquin Shadow Rams, who seems to have made a habit of collecting on life insurance policies he took out on family members (one hesitates to use the phrase "loved ones"). Last we heard, he was on trial for the murder of his year old infant son, on whom he had purchased a sizable ($500,000) life insurance policy.

Now, as then, we're going to focus on the underwriting aspect of this case, specifically:

"What rocket surgeon underwriter approved a half million dollars of life insurance on a toddler?"

Since that post was published, I've had a fruitful conversation with my underwriter at our primary life carrier, whose bottom line observation provided the title of this post.

In addition to the various issues we discussed previously, he explained that, if the father was, in fact, applying for multiple policies on his son's life, this would (likely) generate an "excessive applications" hit at the MIB (Medical Information Bureau), which tracks these over the course of several years (let alone one). This alone would have set off a red flag or three.

Alternately, if Mr Rams had purchased just the one $500,000 policy on his infant son, this too would have raised some eyebrows. As FoIB Jeff M noted in comments to the previous post:

"Every life insurance company that I have ever used required an amount of life insurance on the parents to be at least 2x that which was being applied for on a child."

My underwriter confirmed that, for the most part, this is true, but that New York has recently ruled that the child's death benefit amount allows at certain ages a face amount equal to the parents'. Still, there's a floor. We also discussed my observation that, if this was Bill Gates, Jr there might very well be justification, and my underwriter added that there may be other extenuating circumstances.

For example, he mentioned a case where the parents had no life insurance, but were applying for a large amount on their son (who, it should be noted, was not an infant, but a teenager at the time). When queried, it turned out that Dad didn't have coverage because he was uninsurable, and the primary reason they were seeking coverage on the progeny was to protect his future insurability. So it made some sense in that case.

Of course, the MSM can't be bothered to do even that much rudimentary fact-checking, so we have no idea how much - if any - life insured Mr Rams had on himself (there's no mention of a Mrs Rams).

The bottom line, it seems to me, continues to be that there were some highly questionable actions taken by whichever insurer is left on the hook for this tragedy, which apparently failed to ask "Does it make sense?"

[Many Thanks to FoIB Rob P]

ObamaCare #Winning Updates

Our good friend Holly R tips us to some interesting, if obvious, ACA-related news:

■ Ohio Senator Rob Portman points out that, under The ObamaTax, not only was the claim that "if you like your insurance you can keep it" a lie, but that as a direct result of its implementation, 20 counties in Ohio (almost a quarter) have only one health insurance carrier still in the individual market:

■ From the "D'unh! Department" we learn that higher premiums in The Grand Canyon State led to, get this, "a 3.3 percent enrollment decline in marketplace plans."

Hunh.

■ "New PBM programs bypass insurers to offer drug discounts directly to consumers"

On the surface, this seems like good news, and it may well be. But as we've noted before, this is really a double-edged sword: encouraging drug use by offering pricing incentives distorts claims experience:

"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."

So, may well be no "right" answer here, but certainly not an open-and-shut case, either.

Health Wonk Review: AHCA Aye or Nay Edition

Louise Norris once again lends her deft touch to crafting an interesting, issue-centric Health Wonk Review, this time focused on TrumpCare, er, the AHCA.

Don't miss it!

Affordable Insurance thru a National Single-Employer Plan

A National Single-Employer Plan would end unemployment, enable universal, affordable medical insurance, promote broader coverage, leave employees with more take-home pay, and make American goods more competitive in world markets.  All at the same time.   

The key concept is “single-employer” i.e., a national employment system.

At present, this does not exist in the U.S. Instead, we have hundreds of thousands of separate employers, each with its own employment practices, business practices, payrolls, and other overhead. For example, every grocery store has its own employees, stock supply chain, pricing, and purchasing arrangements, etc. This is why in the separate-grocery business model, we have grocers in some neighborhoods who don't offer fresh produce while grocers in other neighborhoods stock an ample supply of fresh, healthful groceries. More generally, the separate-enterprise model for every businesses is the cause of most problems involving duplication of service in some places, inadequate access in other places, and irrational pricing.  This affects manufacturers, retail outlets, banks, insurance companies, medical offices, schools and colleges, and thousands of other enterprises. 

Economics and common sense both tell us that consolidation reduces unit costs, usually called "economy of scale".  So it's logical that consolidation of the separate-enterprise business model should be the goal. And that ultimately leads to a national, single employer.

The single-employer would be the federal government, which would be the sole national purchaser of labor. Government single employer would eliminate duplicative and needlessly expensive overhead of our present independent and poorly-coordinated employers. The cost of business administration and related payroll costs would plunge by easily 50%.

The trillions saved would permit the single employer system to employ everyone age 16 and above

No one would be denied a job. In fact, everyone would be compelled to work under penalty of law.  Not just junk jobs, mind you, but meaningful, high-paying jobs. The government would assign all jobs fairly, using modern, efficient government planning processes without regard to gender, race, national origin, education, or ability to work. Every working-age American will have a job, and earn a decent living wage paid from public funds. Result: the curse of unemployment is gone forever, financed by savings from the change to single-employer.

This means everyone would have medical insurance through their employer – the federal government.  Our medical insurance would cost much less than today because our medical care would cost much less.  That's because all workers in the medical fields, and those who supply the medical fields, as well as all workers in the insurance field, would be salaried employees of the government, and their salaries would be under strict control.  With lower-cost medical care, it would no linger be necessary for insurance plans to contain high deductibles, copays, coinsurance, and benefit limits.   All this would result in more financial security for Americans, higher take-home pay - and would make American goods more competitive in world markets.

The benefits of a Universal Single-Employer Plan are remarkable.  It's even more remarkable that no one thought of it, until now.  

What Do Doctors Think About Gun Violence?

Gun violence is a polarizing topic that seems to come up following violent crimes that make national headlines. They also creep into the discussion during political races.

But what is gun violence and can we really change things by legislation?

While this detours from our normal subject matter at InsureBlog it is still relevant to the substance of this blog because gun injuries usually also involve health care.

I recently came across an article in The Good Life, a Dr. Oz magazine. From a professional perspective, I try to avoid conversations about religion, abortion, politics (well maybe not all the time) and things like gun violence. But this piece was quite interesting because of the subjects who were interviewed.

In spite of the inflammatory lead in, I decided to press forward.

NINETY-TWO PEOPLE A DAY TIMES 365…THAT’S MORE THAN 33,000 AMERICANS WHO ARE KILLED BY GUNS EVERY YEAR.
More than double that, about 84,000, is how many are injured by guns annually. 

That certainly get's your attention. But it also begs the question, why are guns violent? Did they have a terrible time early on in their development or was the problem always then and then one day they just snapped?

The lead interview is with Dr. Milly Turakhia who is quoted as saying "You cannot tear down this problem just by taking away people's guns".

She goes on to address another public health issue, obesity. "We don't talk about locking up refrigerators" (in an effort to reduce obesity). Instead "We focus on wellness, education and prevention".

Her next comment is telling. She comes from Baltimore where the gun violence rate continues to rise despite the fact more guns are being seized.

More violence with fewer guns. Interesting paradox.

The article is a mix of moral, political and emotional comments. Overall it is balanced and a good read for those who are interested.

Feel free to read and offer your own comments. What doctors think about gun violence.

#gunviolence

Becoming a Christian Nation Because of Obamacare?

The 44th president of the United States proclaimed more than once that we are not a Christian nation. Whether his point was valid or not is subject to debate, but his claim will not be discussed in this post.

One thing that is clear, the plan that promised "If you like your plan you can keep your plan, and if you like your doctor you can keep your doctor" is also a divisive issue. #Obamacare has been, still is, and will be one of the health care hot points dating back to the backroom Missouri compromise and continuing through "repeal and replace".

My personal opinion is that Obamacare did more harm than good and we may never recover from this train wreck. I see no reason to repeal a plan that will most certainly be dead by the end of 2017. If the folks in DC had any sense they would craft a replacement plan and have it ready for roll out in 2018. Keep Obamacare in place, or at least what is left of it. And roll out Trumpcare/Ryancare as a competitor.

Let the people choose the option they want.

But then, no one ever said the folks in DC that make our laws had good sense.

Rather than DC picking winners and losers based on their interpretation of voter viewpoint, let the public decide.

About that opening question. Are we becoming a more Christian nation because of Obamacare?

Hard figures on enrollment in Christian health care sharing programs are difficult to come by but this report from US News offered up their findings.

Since Obamacare’s passage, health sharing membership has more than doubled, from about 200,000 to about 530,000, according to the Alliance of Health Care Sharing Ministries. The law exempts health sharing members from having to abide by its “individual mandate,” which obligates people to buy health insurance or pay a penalty.

While some may argue that covering 300,000 new members is a small number in the big scheme of things, the fact remains, something is causing people to abandon traditional health insurance and seek out a non-insurance solution. As a percentage, the ranks of Christian sharing programs grew more than any other health care financing options, including Medicaid. A 265% increase in members is nothing to make fun of.

And the better news is, no taxpayer dollars were involved.

Not just anyone can join these plans. You must sign an affidavit attesting to your religious beliefs and accept the lifestyle tenants of the bylaws. Some of the sharing ministries require an affirmation of your character while others do not.

This not-so-impartial site comes up in searches and can serve as a guide to those seeking refuge from Obamacare and into the waiting arms of sharing ministries. We are not endorsing the site, nor do we believe it is a substitute for your own vetting. Medical Cost Share is a slick marketing site to steer visitors toward enrolling in Liberty Healthshare. That program, or any of the competing programs may or may not be right for you but they are all considerably less than Obamacare premiums which look more like mortgage payments than health insurance premiums.

Caveat emptor.

#Obamacare #ChristianHealthcareSharingMinistry

New Final Expense Plan: KickStarter-style

Co-blogger Bob V tips us to this interesting new effort initiated by the folks at Legal and General America Life (corporate parent to Banner Life and William Penn Life), which "officially launched last week ALittleHelp.com, its new crowdfunding website dedicated solely to memorial funds."

Turns out, a lot of folks either don't buy or can't afford life insurance to pay final expenses, leaving families desperate for funds at their most vulnerable time. This led exec's at L&GA to launch this new crowdfunding program:

"We recognize that not everyone has gone through financial planning ... We deal with families every day that have gone through the planning. We just wanted a way to be there for those who haven’t."

Unlike established online crowdfunders like GoFundMe, L&GA's ALittleHelp.com won't be skimming off the top to cover overhead; it's worth noting, however, that funds do go through PayPal, which does charge transaction fees (although these are likely nominal).

There's even a way for folks to set up memorial funds for others who may not be as tech-savvy, or who don't have internet access themselves. The one thing that might be a turn off for some is that there's no anonymity for the beneficiaries:

"The person who is receiving the funds is disclosed on the website, so donors know who they are paying and that person can receive the money."

Nice to see carriers spearheading these kinds of efforts.

Kudos to Legal & General America.

Anthem's Top 20 (Percent, that is)

This is interesting: Ohio law requires health insurers to publish a "list of the top 20% of services based on use" as well as how much each insured has to pay for each of them.

Last year, that top 20% of health care services covered by Anthem were:

■ Primary care office visits
■ Lab and Pathology services

To be frank, this surprised me: I would have bet money that prescription med costs would have broken into the top two.

Which is not to say that they didn't play a major role, but apparently far less than primary care and lab services. Which is also, perhaps, a decent argument in favor of Direct Primary Care.

We shall see.

A Puzzling Crime [UPDATED & BUMPED]

[Scroll down for Update]

We've posted before about folks who concoct elaborate schemes in order to profit from another's death. It's against public policy (and, of course, the law) to profit from one's crimes. So if you're caught burning down your house, your insurance isn't paying off, and if you kill someone and get caught, you're not getting that sweet life insurance cash.

But there's another facet to this, and it has to do with underwriting.

Here's what I'm talking about:

In this story, tipped to us by FoIB Holly R, we learn about Joaquin Shadow Rams, who seems to have a habit of buying, and then collecting on, life insurance policies for his intended victims, including (allegedly) his mother and his girlfriend. And he might still get away with his most recent adventure:

"Prosecutors say Rams drowned his son after taking out more than $500,000 in life insurance on the boy."

Of course, Mr Rams is still entitled to his day in court, and that's fine, because I really want to focus not on the (alleged) murder itself, but on a much more curious item (from an insurance agent's viewpoint):

What rocket surgeon underwriter approved a half million dollars of life insurance on a toddler? Perhaps if the family name was Gates or Rockefeller, but here? I just don't see it. That just screams moral hazard.

I don't get it.

UPDATE: A Twitter buddy asked me "is it possible though he took out a whole bunch of smaller policies?"

Which is a really good question, because if there were a series of smaller plans, then theoretically the underwriter wouldn't necessarily know.

Here's where that falls apart, though:

When applying for insurance, one must list other plans already applied for or in-force, and then that particular plan is underwritten based on the sum of all those others, as well.

For example, Johny owns a $100,000 policy with Acme Life, and applies for $150,000 with Mutual of Podunk Life. The agent would have to use Podunk's underwriting requirements for $250,000.

Let's say, though, that the agent didn't know about the Acme plan, and the client didn't disclose it. That's called a material misrepresentation, and Podunk could deny the claim when Johny passes.

It gets better, though (for certain values of "better"): the Incontestibility Clause in a policy limits the amount of time that an insurer can contest a claim to the first two years. So it's possible that Mr Rams "jumped the gun" (so to speak) by not waiting until his son was at least 2 years old.

Oh what a tangled web...

(I've also reached out to my underwriter at our primary carrier to see if there's any circumstance where they'd approve $500,000 on a baby. I'll update again as appropriate)

Spring Break Beckons. Are You Covered?

From our friends at Global Underwriters:

Students and Families are getting ready to embark on Spring Break travel and study abroad programs.  Many students and families don't realize that their health insurance will not provide adequate coverage while traveling and living outside of the United States or in many instances, that they have no coverage at all. This is a terrible financial burden for anyone. Several countries and study abroad programs, also require health and medical evacuation insurance, in order to obtain a visa or participate in their program.

We have travel medical plans available (in the sidebar), or contact your own favorite local, independent agent.

Heads' Up, Nor'easters!

Our friends at the Property Casualty Insurers Association warn folks: Before a winter storm, know what to do “When the Sky Turns Gray."

And they back it up with this helpful video:

The Stupidity of The GOP Congressman

AHCA. Another acronym that falls short on facing the real problem with our health care system.

Republicans' latest attempt to change Obamacare is nothing more than misdirection. It replaces "subsidies" with "tax credits", continues Medicaid expansion until an election year (when nothing gets done), and keeps the most costly items such as guaranteed issue, community rating, and no pre-existing conditions exclusion in place.

It eliminates the individual mandate and creates a new continuous coverage rule allowing insurers to charge 30% higher premiums for up to 12 months to those who have a break in insurance coverage greater than 63 days. The new rule, like the mandate tax, has no teeth.

Speaking of taxes, it eliminates almost $600 million over ten years - which is a good thing. Except for the fact that over half of that amount does nothing to reduce or influence costs of health care or health insurance. More than half ($275 million) is going back to high income earners who are currently paying more in taxes for Medicare and investment income. We should also note these two taxes aren't indexed so as incomes rise more of us would pay these over time.

For Medicaid, it would roll back the enhanced matching rate for the expansion population. This has serious implications for states who fell hook, line, and sinker for the bait of government funding that they knew wasn't financially sustainable.

Think about it: traditional Medicaid funding for those the program was intended to help is paid at roughly a 63%/37% federal to state ratio. By law the range is set at 83% all the way down to 50%. Under expansion the funding started at 100% federal and will reduce to no lower than 90%. Not only is the expansion paid at a higher level, it is also paid to fund able bodied, working adults.

With Medicaid expansion running significantly over budget already it's amazing that the GOP hasn't pushed this financial disaster to the forefront. They should be putting pressure on the other side of the aisle to address how Obamacare gives more to fund those who can work while penalizing states for trying to care for those who need help most. Instead these clowns roll out cuts to the program without explaining why they might be necessary or focusing on who the cuts are geared towards.

We should have known this was going to be a poo-poo platter. Anything short of full repeal - which takes 60 senators to accomplish - is nothing more than lip service.

Going forward my advice to Congressman Ryan, Secretary Price, and President Trump is simple: Stop pretending you can do something that we know you can't. Be truthful. Democrats own Obamacare. They used a supermajority to pass a bill on a party line vote. They then used the Nuclear Option to push it through. Retaliation isn't the answer. Instead it ensures an endless cycle of political warfare that leaves constituents in the crossfire.

You owe it to the people who elected you to stand up and say that because Democrats are being obstructionists there is nothing you can do to make our health care and health insurance systems better. While you would like to see things change for the positive it falls on Democrats to come up with solutions that can come as a compromise. The compromise can't include their go-to move of throwing more money or expanding an entitlement program that is already financially unsustainable.

It must be the opposite, which is coming up with a solution to the real problem: how do we control costs of care and what ways are best to utilize insurance to help protect us from health issues that we can't control or predict.

An Alternate Viewpoint

Our friend Rich W offers a different perspective on PubbieCare©:

"I had an epiphany: This new bill creates wage growth and cost control. You just have to use leftists' logic:

The $5,000 tax credit encourages employees to leave the non-group (ESI) market to chase the credit. Employers will recompensate employees with taxable wages to adjust for healthcare savings (new tax revenue/ wage growth). Employees will choose High Deductible plans so they can bank as much of credit into HSA (Health Savings Accounts) as possible.

These High Deductible plan buyers presumably use the system less because of out of pocket costs (cost control). It's all the same theory used to sell ACA Cadillac Tax to American people. How can the left deny the conclusions? They've already used this methodology.

And now we even have a detailed analysis of how indexing to inflation impacts the credit, the exact same math as happens to current Cadillac tax. Sad!"

Thanks, Rich, for sharing this with us.

Health Wonk Review: Interesting Times edition is up

Peggy Salvatore presents this week's lively roundup of interesting health care-related posts, with a major emphasis on the pros and cons of Repeal/Replace.

Replacement Wish List - Part 1

As I mentioned yesterday, I'm pretty underwhelmed by the newest iteration of PubbieCare©. For one thing, it's much longer than it needs to be, which means it's more complicated and top-heavy than it should be. And I noticed that they simply swap insurance carriers for The Tax Man for mandate compliance [ed: what else would you call the 30% surcharge?].

And, of course, they switch out subsidies for tax credits.

Here's a clue, fellas:

If you have to subsidize it, it's too expensive to begin with. One reason is that, like ObamaCare, it seeks to keep the government's hands in the financing of health care at the retail level.

So what would I like to see?

Well, since you asked....

Let's do away with this notion that health insurance needs to cover every little nick, bruise and routine expense (physicals, pap smears, prostate exams - that kind of thing). Maternity and sex-change coverage is also a no-go. These are all either budgetable or lifestyle choices.

On the other hand, there ought to be a way to make these expenses more easily affordable, and that comes through competition, and that comes about through personal accountability: let's expand Health Savings Accounts to anyone that wants one (regardless of what kind of plan one owns, or even if one is insured at all).

Is this a panacea? Of course not, but it's a start. By restricting coverage to things that are medically necessary, we cut out a large swath of expenses that need to be covered, thus forcing premiums down. And that means that plans can be truly affordable, and usable.

I have zero objection, of course, to carriers choosing to offer these kinds of "benefits" as options - hey, that's what a free market should be about.

Obviously, this is simply a place to start; the problems created by ObamaCare loom large: narrow networks coupled with HMO model coverage, fewer carrier choices offering ever more expensive plans and higher out-of-pockets, the whole Medicaid expansion issue fiasco.But there needs to be a first step, and PubbieCare© isn't it.

We'll have more over the coming days.

About "Repeal & Replace"

Because people have been calling and emailing about the new Republican plan:

My initial reaction is that anything over 10 pages is a non-starter (and this one clocks in at 60+, let alone what the final product will actually look like). Still, it's a start, and I'm sure we'll have any number of posts about it over the coming days, weeks, whatever.

In the meantime, I recommend watching and reading what Michael Cannon, Avik Roy and David Harlow have to say. Each brings a unique perspective and political bent, and each of them are serious thinkers whose writing is nevertheless accessible and understandable to experts and laypeople alike.

Truth Bomb

 
[Hat Tip: FoIB Brian D]

Good news, Bad news Monday

First the bad news:

"ObamaCare's Popularity Is A Myth — Satisfaction Craters To 22% As Law Continues To Collapse"

Ooops.

Now the good:

"ObamaCare's Popularity Is A Myth — Satisfaction Craters To 22% As Law Continues To Collapse"

Hunh.

Of course this is just a poll of anti-ACA activists, so no need to get worked up, right?

Um....

"[J]ust 22% of the 44,200 ObamaCare enrollees polled rate their health plan as good to excellent. That's down from 77% who gave their ObamaCare plans high marks last year"

So why the sudden sea change? Well, that one's kinda hard to determine, right?

Um...

"The reason for the sharp decline was higher premiums, worse service and lack of choice."

That comes from narrower networks, fewer carriers left in the market, and ever higher premiums and out-of-pockets.

What's not to love?

Singin' the Blues (Cross, that is)

FoIB Jeff M tips us to a pair of stories about our "friends" at Blue Cross/Shield of North Carolina. Regular readers may recall our recent reports on this bunch.

Turns out, they're still pushing the boundaries:

"North Carolina’s largest health insurer says it turned a $185 million profit in 2016 by cutting its exposure to the sicker-than-usual customers who bought [ObamaPlans] ... last year had 26 percent fewer ACA customers after increasing premiums by 32 percent"

Looks like they've found the magic combo:

Increase Prices
Decrease Insureds
Profit!

But that's not all!

Remember last fall, when they got dinged for over $3.5 million for billing and other issues?

If you thought that would deter their highest execs from cashing in, well:

"Blue Cross and Blue Shield of NC execs get $1 million-plus bonuses despite technology fiasco"

Nice gig.

Be nice if they'd pay the folks that actually generated that income for them, though.

Penn Treaty: Epilogue

This past October, we reported that the long, sordid Penn Treaty saga was winding down, leaving behind it a trail of financial devastation:

"Penn Treaty and its affiliates are so broke that their unpaid obligations for Pennsylvania are expected to top $500 million"

Well, it looks like we're finally at the end of this particular journey:

"After eight years of legal struggle among state regulators, investors, and policyholders, Commonwealth Court Judge Hannah Leavitt signed off on a plan Wednesday to liquidate Penn Treaty"

That's nice, of course, but at what cost?

Well, it looks like that October estimate of some half a billion dollars was, um, a bit short:

"The decision leaves solvent insurers, their owners, and customers to pick up the cost for more than 70 percent of the up to $4.6 billion in projected long-term-care claims" [emphasis added]

That's $4.6 billion* (with a B), or just shy of 10 times what we thought it would be just a few months ago. About two-thirds of that will come from the state's Guaranty Fund (which money comes from all life and health insureds); the balance will be funded by an extra surcharge for other life and health insureds for the foreseeable future.

So the story may be over, but the impact will ripple on for years.

Oh, and exactly why did they go under? Wonder if it had something to do with this:

[Hat Tip: Co-blogger Bob V]

Show us the money

As we've previously noted, "off-Season" Special Enrollment Periods are fraught with challenges and contradictions. Perhaps the most egregious is the fact that no one in government seems to care about the massive fraud being perpetrated right under their noses during this time.

I speak, of course, of this:

"To Our Valued Broker Partners ... we have decided we will no longer pay SEP commissions effective 04/01/2017."

This from John Molina, CFO of Molina Health Care. Conspicuously missing (as usual) is the statement that policyowner's rates will be decreased to reflect the fact that agents aren't being paid. That's because they're keeping this extra cash for themselves, with zero legal justification for doing so. Carriers' cost of doing business is directly and positively affected, and yet they don't have the corporate decency to acknowledge their greed.

To be fair, neither do any of the other carriers benefiting from this unethical sleight-of-hand, so there's that.

Would be nice if our legislators (and DOI bureauweenies) actually did something about this.

Riiiight.