Friday, March 29, 2019

So Much For Options and Choice

Association Health Plans, an alternative for sole proprietors and small businesses to avoid the many pitfalls of the Affordable Care Act, have been dealt a mighty blow. In a ruling late yesterday Judge John Bates sided with eleven states and D.C. agreeing that the DOL's definition of what constitutes an employer under AHP's does not meet the employer relationship under ERISA.

Under ERISA there are ways to have a bona fide AHP however the rule set forth by the DOL under President Trump vastly expands this definition.

In a 43 page opinion Judge Bates sided with the plantiffs on several different points including: economic harm and increased regulatory burden.

Yes, the plantiffs are saying they will lose tax revenue from ACA, have increases in uncompensated care, and will also suffer from increased regulatory burden.

While this is a definite hit to AHP's, it should be noted that the DOL is very likely to ask for a stay and to appeal this decision.

As for the 11 states and D.C., well, they feel like winners. By winning they are screwing small businesses and sole proprietors all across the country out of affordable alternatives that limit them to ACA plans that government says are best.

Thursday, March 28, 2019

Offered without comment

Okay, maybe one: Methinks the folks at TriHealth need to lighten up a bit.

What am I talking about?

Well, FoIB Holly R recently sent us this tip:

"TriHealth is suing a company known for sexually explicit gag-gifts after receiving one of their products anonymously."

The 'gift' was sent to a family practice office in Cincinnati.

The best part, though, is imagining the poor law clerk who had to type this into the lawsuit:

"Nothing about the package warned it was a spring-loaded d--- bomb"

No kidding?

Carlos Danger was unavailable for comment.

Promoted from the Comments: ACA #Winning?

Responding to Tuesday's ObamaCare "success" post, co-blogger Mike made some extremely salient points, and I wanted to make sure that they were more easily accessible. Regarding the report's noting that "Among all consumers in the 39 states that use the platform, the average premium before application of the tax credit was $612,” Mike explains:

"The 2019 average of $612 is 1.5% less than the 2018 average number of $621.

It appears the average reduced because fewer people ended up selecting the Silver plan for 2019, and more people selected the Bronze plan.

Click the link to the CMS report, scroll down to the end of Table 2 to find the enrollment by metal plan. You’ll notice that while Bronze selections rose in 2019, Silver selections decreased. These changes are presented as (%) which don’t give the full picture when the base - the overall number of selections - changes. So I converted the (%) to numbers of plan selections in each year.

The result clarifies that in 2019 there were about 76,000 more selections in the Bronze plans and 553,000 fewer selections in the Silver plans. This is evidence of people dropping their Silver plan, or migrating from the more-expensive Silver plan to the less expensive Bronze plan. Both types of selections help explain how the “average” premium before APTC could have reduced from 2018 to 2019.

Keep in mind no one pays a premium that is “averaged” between a Bronze and Silver plan.

But CMS does not provide the year-over-year change in premium for just the Bronze plan and just the Silver plan. Those answers would help to explain why so many people decided to migrate away from the Silver plan - or drop it entirely

In other words:

Wednesday, March 27, 2019

Oy, Canada! Update #3,486

Courtesy of FoIB MisHum, another of our frequent reminders about the wonders of government-run health "care" (eg MedicareForAll):

"The sister of a woman who spent some of her final hours waiting in a New Brunswick emergency room says she believes the wait contributed to her death."

Ya think?

The poor woman sat in the waiting room for almost half a day, even though she had obvious signs of respiratory distress and other symptoms of what turned out to be acute kidney failure.

The 58 year old woman victim, Marianne Porter, leaves behind 3 children, but apparently no outstanding medical bills because: hey, free!

And worth every  loonie.

Nataline, The Lawyer, and *The Other* Lawyer

Regular readers may recall a series of posts we did a decade or so ago about the tragic death of young Nataline Sarkisyan (folks interested in the backstory can find it here). Eventually, her distraught family hired a prominent legal beagle who sued the insurer (tangentially) involved.

Eventually, the story faded from public view, but co-blogger Mike just reminded me that we have a connection to the recent
Avenatti/Nike case: (alleged) unindicted co-conspirator Mark Geragos.

It was Mr G whom Nataline's parents hired to sue Cigna for "emotional distress:"

"It's a win-win for the lawyers and activists: regardless of whether she prevails, this has rekindled the controversy and gotten Mr Geragos and the "Americans for Change" folks free publicity."

Interesting coincidence.

Tuesday, March 26, 2019

In case you were wondering: Open Enrollment v6.0

From Our Betters in DC©:

Some highlights:

* Approximately 11.4 million consumers selected or were automatically re-enrolled in an Exchange plan during the 2019 OEP

(This is a net decrease from last year)

* Nationally, 24 percent of consumers with a plan selection during the 2019 OEP were new to the Exchange

(This is a net decrease of almost 30%)

* Among all consumers in the 39 states that use the platform, the average premium before application of the tax credit was $612

(This is, believe it or not, also a decrease: of $9.00)

The full report available here.

Am I Missing Something?

Entirely possible, of course. Our friend Holly R sent us the link to this story:
'Small Businesses Could See Employees' Health Claims under SB9
Business owners with less than 100 workers would be allowed to see data on employees' health claims under SB9 (M. Huffman), with identifying information made anonymous, which could improve their bargaining position with insurance companies, reports. The bill passed the Senate last week.'

While this is interesting, I'm trying to figure out the point:

After all, for ACA-compliant small group plans, we have the wonderful Community Rating system whereby the overall health of the group (or its individual employees) is irrelevant.

And self-funded and AHP/MEWA-type plans are fully underwritten, so carriers get fresh, up-to-date medical info on everyone.

And since these plans tend to be "off the shelf" anyway, what possible "leverage" would a given employer actually have, with or without this information?

'Tis a puzzler.

Monday, March 25, 2019

Rainy Days and Mondays...

Well, it's a drizzly, gray day here in southwest Ohio, so a perfect time to re-up our post (previously published at the old gig) about the need for a liability insurance umbrella plan:

■ Summary
Insurance is, first and foremost, a risk management tool. That is, it's a way to assign some or all of a financial risk to a third party. One such vehicle is an "excess liability" or "umbrella" policy.

■ Intro
Typically, auto and home insurance policies include a liability portion which pays others whom you have injured in some way (perhaps an auto accident, or someone tripping in your home and breaking an ankle). Liability payments include reimbursing those whom you've injured for their actual medical expenses, as well as lost wages and other out of pocket costs.

Knowing the Risk
Liability payments may also be used to settle court cases when one is found liable for such expenses. For example, perhaps one caused an accident and was sued. The liability portion of one's policy would pick up some or all of any judgment.

The challenge is that judgments often exceed the amount of underlying liability coverage on ones' policy. For example, if your plan has a $300,000 liability limit, and you're found liable for $700,000 of damages, then how are you going to come up with the $400,000 shortfall?

Covering the Risk
That's where an excess liability "umbrella" policy comes in. As the saying goes, "you don't have to be a millionaire to be sued for a million dollars." But increasing your homeowner's and auto insurance policies to a $1 million can get quite expensive. And you'd really have to do both: insuring only your home leaves you vulnerable to a major auto claim, and vice versa.

And umbrella policies, because they cover both your home and your cars (and boat, and motorcycle, etc) offer a cost-effective way to buy a large amount of insurance at a reasonable cost. So a momentary loss of focus on the highway, or the waterway, doesn't have to mean a permanent loss of assets.

Shifting the Risk
Umbrella policies function as supplements to ones regular liability coverage. For example, if one causes a 3-car pile-up on the way to the dentist, one's auto policy's liability coverage might pay the first $300,000 of the other drivers' personal injury claims, and then the umbrella would pay up to (for example) an additional $1 million. And that extra million of coverage costs only a little more than the existing $300,000.

And it's not just about physical injury to others: umbrellas can provide coverage for claims arising out of slander or libel, as well.

Another benefit to an excess liability umbrella is that many carriers offer multi-policy discounts, driving down the net price even further. And many plans include attorney's and litigation fees which can add up pretty quickly.

■ Conclusion
Litigation and medical costs keep rising, and quickly. An umbrella plan offers a relatively inexpensive way to protect oneself from the risk of loss from high dollar liability cl

Friday, March 22, 2019

Happy Anniversary!

For certain values of "Happy:"

Thursday, March 21, 2019

Policy Loans: The Dark Side

One of the benefits of cash value life insurance plans (eg Whole Life, Universal Life, etc) is the ability to "borrow against" it. That is, as the cash value (equity) increases, it's available as a loan, with the death benefit as the collateral.

This can be very handy when sudden, unexpected expenses rear their ugly heads. For example:

"Unable to secure a large enough bank loan, Walt Disney borrowed against the cash value from his life insurance policy to help finance the creation of his new theme park, Disneyland."

Other famous folks with similar stories include James "JC" Penney and Ray Kroc.

Of course, there's a balance here: while these loans can be quite helpful, they have the potential to be very dangerous, as well.

How's that, Henry?

Well, generally speaking, if one borrows from a policy and fails to pay it back, then the company merely subtracts the balance due from the death claim. No harm, no foul, no taxes. But what happens if one borrows from the policy, and it dies before the insured? That is, if it lapses while the insured is still alive?

Well, in that case, the borrower (and potentially his/her heir) are in for a nasty surprise: Form 1099-R.

Such was the case for a recently deceased client:

In January of '18, she let her Whole Life insurance policy lapse with a substantial loan balance. This January, she passed away. Yesterday, I got a call from her widower asking why he had received a tax form from Acme Life. I asked for the policy number to which it referred, and advised him that when the policy lapsed last year it created a taxable event, and that the balance due is being treated as taxable income (which would have also been the case if my client was still with us).

I always advise clients who take loans against their plans to at least keep up with the interest each year, to avoid the loan balance snowballing until the policy is unrecoverable.

Now you know.

Wednesday, March 20, 2019

Wednesday Roundup: International edition

We've written before about the so-called 'Secondary Market' for life insurance:

"And so, as part of HIPAA, a new word entered the popular lexicon: viatical. Basically, one can sell one's plan to a 3rd party with little (or no) tax consequence."

But of course, the good ol' US of A isn't the only place on Earth where this type of sale takes place. Our Neighbors to the North also have this available, but it's getting a little more 'iffy' as to the buyer's benefits. According to FoIB Allison Bell:

"Manulife Financial Corp. and other Canadian life insurers won a legal battle against hedge funds that contended the insurers should be compelled to take unlimited deposits into high-yielding investment policies."

This basically serves to limit the tax-advantaged growth available to certain plans, and re-focuses on the death benefit itself. Will be interesting to see if these restrictions wend their way here.

One of our most enduring memes here is that coverage ≠ care; that is, insurance doesn't guarantee that actual care will be available, either quickly or even at all. And so we look again at CanuckCare© as a warning to those who advocate MedicareForAll:

Be careful what you wish for.

And piling on, we look Across the Pond to Britain's Much Vaunted National Health Service©:

"HIP replacements, cat­aracts, varicose veins and tonsillectomies are among a string of surgical operations that will no longer routinely be carried out on the NHS "

[Hat Tip: Sally Pipes]

Since even (especially?) socialized medical care schemes have proven unsuccessful at reining in the cost of care, the only viable alternative is to ration deny it.


Tuesday, March 19, 2019

Monday, March 18, 2019

MVNHS© Winninng: A Story in Two Parts

Part 1:

This is what happens when a country turns its medical care over to government bureauweenies. As a result of consistent and increasing budget cuts, the Much Vaunted National Health Service© is "push[ing] more patients towards paying for treatment privately."

Wait, what?

"paying for treatment privately"

It's a not-so-closely guarded secret that even countries with government-run health "care" have huge markets for private insurance. As we reported 7+ years ago:

"Private Medical Insurance ... allows you to have complete reassurance of knowing that, should the need arise you and your family can receive medical treatment privately, without waiting for the NHS to treat you."

We wondered at the time about why this was necessary, given the free and widely available health care that is the MVNHS©. Now we know.

Part B):

One of our most enduring memes here at IB is the fact that health care ≠ health insurance. That is, what good is the coverage if there's no one to provide the care?

Well, our British Cousins are learning this lesson good and hard. From FoIB Rich W:

A lesson to be learned as we rush headlong toward #Medicare4All: Be careful what you wish for.

Friday, March 15, 2019

*True* Junk Plans: A Retrospective

So big news on Capital Hill:

What they really need to be reviewing are the true junk plans:

"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"

Hint: They're not talking about STM's....

Thursday, March 14, 2019

Blue Cross: Word Salad edition

So this morning, FoIB Jeff M emailed this item about the planned merger of Blue Cross Blue Shield of North Carolina "with Portland, Ore.-based insurer Cambia Health Solutions. The two not-for-profit organizations with combined revenue of $16 billion and more than 6 million customers said the alliance will make health care "simpler, better and more affordable."

Wait a minute: what does "simpler, better" actually mean?

Well, it depends. According to the official email announcement:

It might mean "Each company retains its current assets, such as its reserves and capital, and there is no change to the underlying business in our states."

On the other hand, it could be that "The companies will share services, which will cause some resources to shift."

On the gripping hand, perhaps it notes that "Our long-term goal is to make health care more affordable for the individuals and families we serve ... Our expertise, common management and increased resources will allow us to better address rising costs in the health care system by reinvesting shared savings, enhancing price transparency tool."

Okay, but why does all of that remind me of this?

In the end, one suspects that it means "business as usual," only with a bigger footprint.

And as Jeff notes, a look at their website seems to indicate that "they still think healthcare and health insurance are the same."



[click to embiggen]
So, FoIB Holly R sent us this:

"Just had a doctor's office tell me the doctor couldn't discuss test results over the phone because of HIPAA. This is false, and another reminder that medical facilities constantly use HIPAA as a bogus excuse for being opaque and difficult."

Interesting take, and one I've heard before. But is it true?

I reached out to co-blogger Kelley B, herself a medical office manager, for her reaction. She replied:

"The reality is that the doctor will be paid nothing to tell the patient his test results over the phone. Since this requires medical decision making on the doctor's part, he/she is entitled to be paid and that means that the patient has to come in for an appointment. The patients hate this because it costs them money.

Is it a HIPAA violation. It could be as you cannot confirm that the person on the other end of the phone is the patient. It is in the doctor's best interests not to give out results over the phone and have the patient come in."
That makes sense, although I would point out (before others do) that under the nascent DPC (Direct Care) model, that first point would be moot, since the doc's already been paid.


Wednesday, March 13, 2019

The (New, Improved?) ACA is Working

Regular readers may recall that the current administration loosened a lot of the rules surrounding Short Term Medical (STM) plans, and the ensuing hue and cry from 'the usual suspects' about the world ending (or worse!) as a result.

Well, preliminary results are in, and guess who comes out standing tall (hint: it's not the naysayers):

Turns out, folks who bought these plans are, for the most part, completely satisfied that they worked as promised; in fact, over 80% of buyers who actually had claims were either satisfied or even very satisfied.


And most of the folks who had claims also "said their policies covered what they thought the policies would cover."

Imagine that.

Would that ObamaPlan victims insureds were so satisfied.

Meantime, Colorado becomes the latest state to ban sales of STM plans altogether:

"The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has amended the regulation governing short-term limited duration health benefit plans, requiring these plans to provide many of the same protections afforded by Affordable Care Act (ACA) qualified plans."

In other words, no more short term plans for Centennial Staters.

Wonder why their leaders hate choice.

[Hat Tip: FoIb Lynne]

Tuesday, March 12, 2019

Outstanding Vendor Tricks: Dental edition

Over the years, we've detailed any number of really stupid vendor tricks; the list of terrific ones is, unfortunately, much shorter.

Well, that latter list just grew a little larger today, as Superior Dental Care joins that august group.

And why is that, you ask?

Well, because they are an absolute joy to work with. Case in point:

Recently, I was privileged to write a brand new small group (as in, they'd never had group health insurance before). A month or so later, they asked about adding voluntary dental ("voluntary" in this context means employee paid, no employer contribution). I don't do a lot of dental, but Superior Dental (SDC) is one of my two go-to's for it. Superior especially is a delight, because they just make things so easy. In this case, we were going for a March 1 effective date, and the employer emailed me the forms on February 27.

Except I never received that email. So I presumed that they had decided to either change their minds, or were opting for an April 1 start date. So last week I followed up to see if they were still interested. They replied "of course, we sent you the paperwork last week!"


So I called our SDC rep to see if there was any chance we could still get that March 1 effective date, even though it was already the 7th. And the answer was "of course, just send us the forms right away and we'll get that done for you."

So I called the client and they re-sent the forms, which I dutifully forwarded to SDC.And this morning, I received confirmation that the plan was activated on March 1, and that ID cards would be on the way shortly.

Doesn't get any better than that.

Kudos to Superior Dental Care.

Monday, March 11, 2019

More MVNHS© #Winning

Saturday, March 09, 2019

#Winning: Socialized Health "Care" edition

Friday, March 08, 2019

Friday O'Care Reminder


Thursday, March 07, 2019

A (Timely) Blast from the Past

I had completely forgotten this post from co-blogger Mike, but it is incredibly relevant today. For one thing, it echoes a longstanding principle here that health insurance health care. And it presciently touches on the (Evil) Individual Mandate and the Death Panel that have been ObamaCare hallmarks. Finally, it seems to be an early, distant warning about what lies in store for us if (when?) Medicare4All is actually implemented.

Oh, what's it called?

"Why isn't health care compulsory?"

Here's a taste:

"I’m not talking about health insurance. I’m talking about health care. Health insurance is not the same as health care. Who calls their insurance agent when sick or injured? Who calls an actuary? Don’t real people call their doctor or go to the emergency room?"


And there's this:

"First, all health care professionals become employees of the Federal Government, paid a living wage from public funds. Second, hospitals, clinics, labs and other facilities are nationalized and their staffs also become employees of the Federal Government ... it is illegal to seek or receive health care from anyone except a Federal health care professional."

Yes, yes it is rather scary.

And that's the point.

Read the whole thing here.

Wednesday, March 06, 2019

The More Things Change: 2019 edition

So, FoIB Steve Downey alerted us to this item at CNN:

"A woman received nearly $375,000 from her insurance company over several months for treatment she received at a California rehabilitation facility. A man received more than $130,000 after he sent his fiancée's daughter for substance abuse treatment."

Okay, that's (very) nice for them, but what's that got to do with the price of tea in China, or insurance, well, anywhere?

Well, these folks got these checks as a result of Anthem's (alleged) strong-arm tactics being brought to bear on non-network providers to join up. Generally, carriers pay even out-of-network providers directly (although at less than in-network rates, natch). This has the non-network providers unhappy...

What? So what's the big deal,  you ask?

Well, if you're General Hospital and your patient just got the $375,000 from Anthem, how quickly do you think said patient's going to run it down to your business office to sign it over? Or even bother to do so? And yes, you can sue the patient, but that adds to your own wait time, as well.

Yeah, that's the big deal.

What will be interesting is to see whether the plaintiffs prevail. I doubt it, since Anthem's actions don't seem to be illegal. To the contrary, it could very easily be argued that the carrier has a higher duty to the insured, since there, at least, is a contract (the insurance policy). Not so with the non-network provider.

Oh, and lest one thing that this is some crazy new tactic: well, it's not. As I replied to Steve:

"We blogged on something like this *years* ago (will take a while to dig up), so nothing new under the sun, But *does* point out the lengths to which some carriers will go to get their way."

Well, I eventually did find that (very) old post, and I was right:

"When Premier's network contract with Anthem expired on Jan. 1, Anthem stopped paying Premier directly ... Anthem sent reimbursement checks of four and five figures to enrollees instead.”

We'll keep you posted on this latest attempt.

Tuesday, March 05, 2019

Anthem/Peach State Update

Whew boy!

So, readers may recall our post from a month ago regarding a class action lawsuit brought by a large Georgia law firm "on behalf of thousands of Georgia healthcare consumers misled by Anthem's “deceptive marketing scheme.” The story is that these insureds were (allegedly) promised that "if you like your doctor, you can keep your doctor" [ed: ISWYDT]. This turned out to be, wait for it .... not the case, which left these poor folks with a lot of out-of-network issues. We promised to update this story as it developed.

There are developments:

It wasn't clear at the time just what relief these clients sought, turns out to be out of left field: instead of (or, perhaps, in addition to) monetary damages the firm "is asking a federal court to allow thousands of consumers victimized by multiple false marketing claims to be granted a “special enrollment period” to switch to a new health insurance company."

If the request is granted, it would be a first, and could set an interesting precedent.

Oh, and it's not just that the providers are out-of-network, but the carrier has also "revers[ed] its marketing promise that consumers would not be required to seek referrals before seeing specialists."

Still, I don't see how Anthem's (alleged) bad faith has anything to do with the ACA, nor that the Feds have the authority to make such an accommodation.

As before, we'll keep you posted.

[Hat Tip: Whitney D]

Monday, March 04, 2019

Monday Morning LinkFest

We've posted fairly often about Health Care Sharing Ministries, most recently here:

"After some online research Mazie, who lives in Miami, found something he thought was a godsend: United Refuah HealthShare, a Jewish alternative to traditional insurance ... He was thrilled by the bargain-priced plans."

This was news because this model of health care financing is typically offered with a Christian slant (NTTAWWT). Regardless, they're gaining in popularity (sort of: there are about 1 million folks on these plans, which makes it a rounding error), and the movement wants a seat at the table as we look for ACA alternatives:

"The health sharing plan movement made itself felt recently at the Inter-Company Marketing Group’s 2019 annual conference."

Good for them!

It's true that we spend a lot of time dissing on Britain's Much Vaunted National Health Service©, and with (very) good reason. For example, FoIB Sally Pipes alerts us to this latest news:

"NICOLA Sturgeon has admitted she is not “surprised” that NHS waiting times are still getting worse despite bringing in a legal guarantee to prompt treatment seven years ago ... [Last] week, official figures showed a record 27.3 per cent of patients waited longer than 12 weeks in the last quarter of 2018, the equivalent of 200 breaches each day."

But hey, it's free!

And on its way here, if the M4A folks have their way.

Even with ObamaCare's actual body count, we're still doing pretty darned well in the health care results metric. From FoIB David Balat:

"The world’s leading medical journals report the U.S. has superior results, including for cancer, heart disease, high blood pressure, diabetes, and high cholesterol."

The Tweet links to an article behind WSJ's paywall, so...

Friday, March 01, 2019

Meanwhile, at the MVNHS© [UPDATED]

[Scroll down for update]

So about that bending the cost curve down by way of nationalized health "care:"

"Friday’s report by the public accounts committee into the cost of clinical negligence in hospital trusts reveals that the bill has quadrupled in 10 years to [~$2 billion] and is expected to double again by 2021."

So why are these expenses climbing so high and so rapidly? Well, there seem to be a couple of factors in play:

"As well as increasing damages for a small and stable number of “high value” ... there is a growth in the number and cost of “low value” claims."

The vast majority of those "high-value" claims, by the way, are maternity-related.

But why the increase in claims themselves?

Apparently, there's a mysterious connection between "steeply rising demand and chronic staff shortages." I mean, who could have foreseen that in a government-run system? And this in turn has led to "endless examples of deteriorating patient safety."


#Unexpected #MedicareForAll

UPDATE: And just when you thought things couldn't get worse under this mess:

"NHS 'backs plans to scrap four-hour A&E maximum waiting target'"

Because it had been working out so well previously. From 2 years ago:

"Nearly a quarter of patients waited longer than four hours at A&E last week with just one hospital hitting its target."

Hey, at least they're admitting that they can't meet their own (rather modest) goals.

[Hat Tip: FoIB Sally Pipes]