Illegal Immigrants Lose Obamacare Coverage

Just in case you have been following the Obamacare scorecard of who is losing and gaining coverage,

you might have missed this tidbit.

The Centers for Medicare and Medicaid Services said Wednesday that the 200,000 people will be dropped from plans at the end of February. They are in addition to the 112,000 who lost coverage late last year.

"These are individuals who have gone through the process of attempting to confirm their citizenship or immigration status for their 2014 coverage and (despite) repeated outreach we've not received that documentation," said Andy Slavitt, CMS' principal deputy administrator. "So our requirements of enforcing the law will require us to remove these people from our coverage." - USA Today

Did you catch that?

Some 200,000 immigrants got Obamacare health insurance (presumably with taxpayer subsidies) but now are losing it because they can't prove they are here legally.

My question is, why were they given coverage to begin with? Aren't LEGAL residents already in the system somewhere? Employers are required to verify legal resident status or face fines, but the folks who hand out Obamacare like they were Obamaphones apparently aren't subject to the same standards.

Immigrant advocates, who have had some of the biggest successes in enrollment on the federal health care exchange, said it was unfair. 

Yes it is unfair.

If you don't qualify you should not receive the coverage from the start.

Stupidest Idea of the Year: An Early Frontrunner

Long Term Care insurance (LTCi) is arguably the single most complicated product we sell (tied perhaps only with Disability Income plans). It has a lot of moving parts, a very specific market niche, and is easily misunderstood. Underwriting is particularly involved because, unlike, say, life insurance, there can be multiple claims of varying degrees. The tax implications can be confusing and complicated, particularly for business owners. There are different ways that carriers count off their elimination periods, and how they price and define shared plans. And so on.

So naturally, Rocket Surgeon Paul Forte, CEO of some outfit called Long Term Care Partners L.L.C, thinks it would be a grand idea to market LTCi plans through Exchanges modeled on the ever-so-successful 404Care.gov site.

Really!

One can see why he'd like that to happen: his company is the admin for two major Federal insurance programs, and one can never have too much of that sweet, sweet gummint largesse. That they would no longer feel the need for, oh, agents or underwriting is just icing, really.

Wait, what?

No, seriously:

"Allowing some medical underwriting could hold down costs without leading to a rate spiral, and keeping costs low could help make a big exchange sustainable even without the help of a mandate."

Yes, he's proposing the "Affordable Long Term Care Act" - because we've seen just how successful the ACA has been in reducing costs, not to mention folks' access to actual care.  And did you notice that interesting little turn of phrase: "help of a mandate?"

Remember when we were warned, during the initial SCOTUS fight, that if the government can force us to buy health insurance, they can force us to buy anything? That was dismissed as silly then.

Still sound silly now?

Didn't think so.

But wait, there's more:

"Forte would further reduce costs by putting the LTCI exchange system under the jurisdiction of the federal government, not state governments"

Yes, because Lord knows that the Feds are well-known for reining in costs and keeping to a tight budget. Heck, I bet he could reduce the cost of Long Term Care insurance by 3000%.

And what about that whole direct-to-the-public marketing scheme? Let's unpack that a bit:

"Those objecting to what they think will be lost by foregoing the services of live agents should recognize that the ALTCIP would not be geared to high-net-worth individuals, but rather to moderate-income persons seeking better value"

Well first, Mr Genius, high net worth folks already have plans in place, and many can afford to self-insure. They're also likely to have easy access to loads of expert advisors and financial planners. Long Term Care coverage is specifically geared towards middle class folks who don't have that kind of access, and to whom, for example, the Partnership Program is a real boon (does he seriously think that high net worth individuals worry about Medicaid spend-down?). These are exactly the kinds of folks who need agents to help them understand the difference between, for example, service and calendar days.

There is literally nothing positive or useful in this proposal; it is simply an embarrassingly naked attempt to grab a few more DC dollars, and to further damage the middle class.

Wonder if he thanked Ms Bell for the free advertising.

Health Wonk Review: VD edition is up...

VD as in Valentine's Day. Peggy Salvatore has a new blog (WooHoo!), and this week's eclectic round-up of health care policy and polity.

It's chock full of great posts - Sweet!

I can't wait!

In email from HHS:

[click picture to embiggen]

And because I'm a giver, here's the link to register. Have fun, and try not to trash the place, m'kay?

Another 1,000 Words on ObamaCare

Hello, This is Peggy

Do you ever wonder who is actually on the other end of the line when you call hc.gov? What kind of training

do they have? Am I getting the right answer? If not, can I call back and ask for Peggy?

"You can call HealthCare.gov three different times and get three different answers," - USA Today

Well that's refreshing. At least they are honest about it.

Being locked out of one's account can be extremely frustrating, especially for some of the low-wage workers who have very limited time to deal with their insurance, navigators said. But some of the problems — such as lapses in insurance coverage for sick relatives — can infuriate people.

Call-center workers have become much more proficient at unlocking consumers' accounts this year, which remains an issue because many people forget their passwords, user names or both, said Cardenas. Last year, the workers would tell people to just create new accounts, which tended to create more confusion and is a particularly bad idea this year for those re-enrolling, she said.

Considering you can't get a subsidy without going through goodluck.gov I would say getting locked out of your account is a major concern.

So, who you gonna call when you have a problem?

Ronnell Nolan, who heads Health Agents for America in Baton Rouge, said she and some of her members long suspected call-center workers weren't giving them their own names. Nolan recalls dealing with someone who went by what sounded like the same name as actress Halle Berry. Turns out, they don't use their own names — and it's with good reason, said CMS spokesman Aaron Albright,

Representatives use aliases and won't disclose their location .

So much for transparency in government.

Buckeye Medicaid Dumping

Glancing into his crystal ball in 2009, co-blogger Mike had some harsh words for the folks running Medicaid:

"Why has Medicaid failed to protect the poor? Medicaid is the government program expressly established to provide adequate medical insurance for the poor. Why is it not doing so? Why has our government left so many of the poor without access to medical insurance?"

Flash forward 5 years or so, and we find that not much has changed:

"Medicaid could dump 500,000 Ohioans in 6 months ... All are poised to lose benefits for failing to submit information needed to confirm that their household income falls within Medicaid eligibility guidelines."

And of course, this redounds negatively on Gov Kasich's (foolish) decision to expand the program, multiplying the effects.

So what's the problem?

There are several, actually:

First, all of these folks are required to "re qualify" annually; that is, to prove that their economic woes haven't let up. That they failed to do so is, ultimately, on them. But the state, having initially approved them does have an obligation to remind them of this requirement. The traditional method is via snail mail, but some of these "Some problems ... may have been caused by apartment numbers being placed above recipient’s names on envelopes, preventing them from being delivered."

Oops.

And the notices, written (as is appropriate) in English, went to at least some folks who "speak other languages." I would say that's their problem, not the taxpayers'. And up to a third of the notices were returned as "undeliverable."

Lovely.

Talk about burying the lede, though:

"About 2.9 million poor Ohioans receive Medicaid."

Given that the state is home to just shy of 12 million people, has it occurred to someone in charge that having 25% of your population on Medicaid might indicate just a wee little problem?

Way to go, Guv.

[Hat Tip: Co-blogger Bob V]

Anthem Hacking - Perspective

In comments to one of our previous posts on this topic, Co-Blogger Bob makes a terrific point:

"Not taking anything away from Mandiant as they are the "A team" when it comes to tracking down hackers ... Most companies do very little when it comes to cybersecurity and many (mo st?) have probably been hacked and just don't know it."

This morning, the Wall Street Journal reported that "Anthem Inc. stored the Social Security numbers of 80 million customers without encrypting them." On the face of it, this seems pretty unconscionable.

But is it?

I reached out to several of our carriers, and to AHIP (America’s Health Insurance Plans), which represents (most of) the carriers. I had but one question:

"Is this an egregiously unusual oversight, or industry standard?"

That is, is Anthem an outlier here, or do most carriers leave that kind of information unencrypted? The folks at AHIP were kind enough to send me a copy of the HHS regs on the subject, but also told me that they'd not surveyed their members on it, so can't tell me whether or not this is SOP.

I'm still waiting to hear back from my carriers, and will update this post as appropriate.

JUST IN from Anthem:

Members who may have been impacted by the cyber attack against us should be aware of scam email campaigns targeting current and former members.  These scams, designed to capture personal information (known as “phishing”) are designed to appear as if they are from a health plan and the emails include a “click here” link for credit monitoring. These emails are NOT from us.

• DO NOT click on any links in email.
• DO NOT reply to the email or reach out to the senders in any way.
• DO NOT supply any information on the website that may open, if you clicked on a link in email.
• DO NOT open any attachments that arrive with email.

We are not calling members regarding the cyber attack and are not asking for credit card information or social security numbers over the phone.

Friday LinkFest

So, several items that, while blogworthy, don't seem to merit their own dedicated post:

■ As we've already seen, the future of health care CO-OPs is, at best, rocky. At the Employee Benefit Advisor, Bruce Shutan looks under the hood, and notes that "it captured nearly a quarter of the total enrollment for all 23 consumer-operated and oriented plans known as CO-OPs operating in 24 states," all on a "shoe-string" budget. Bruce has some thoughts on how this will play out as we go forward..

■ FoIB Holly R tips us to this tidbit of tantalizing info:

"The White House cyber czar may have had personal information leaked in the recent Anthem data breach."

That breach, news of which is still evolving, may end up "touching" a lot more folks than originally believed.

■ As we've noted many times, wine (especially the reds) have been linked to several positive health effects. Turns out, that IPA you were drinking last Sunday may also help:

"[B]eer also confers some health benefits, according to a new study, which found a compound within can ward off dementia and other cognitive decline."

L'chaim!

Obamacare Enrollment Update

The folks that brought us Obamacare and a non-working website like to keep those who are interested up to

date on the latest score. The latest installment for week 10 of the Obamacare open enrollment saga goes like this.

Since Open Enrollment began on November 15, almost 7.3 million consumers selected a plan or were automatically re-enrolled through the HealthCare.gov platform, which includes the Federally Facilitated Marketplace (FFM), State Partnership Marketplaces and supported State-Based Marketplaces. - HHS

7.3 million selected a plan or were re-enrolled.

Sounds a lot like the stimulus reports about jobs created or saved.

Selecting a plan does not mean actually applying for coverage. Nor does it mean the premium was paid. In DC-speak it means window shopping.

The same is true for the automatic re-enrollment.

Until you actually PAY for your policy you don't have coverage.

Isn't it odd how they fail to count the number of people that actually LOST health insurance because of Obamacare?

Anthem Hacked [UPDATED]

Picking up on where Bob left off ...

As you've no doubt already heard, hackers were able to gain access to Anthem's systems, and access the personal information of both clients and employees (it's not clear whether "employees" include independent agents/brokers who represent the carrier). All told, it appears that over 80 million folks were affected.

To its credit, Anthem sent out an email last night addressing the problem:

To our valued business partner:

Safeguarding your clients’ personal, financial and medical information is one of our top priorities, and because of that, we have state-of-the-art information security systems to protect your data. However, despite our efforts, Anthem was the target of a very sophisticated external, cyber attack. These attackers gained unauthorized access to Anthem’s information technology (IT) system and have obtained personal information from our current and former members such as their names, birthdays, member ID/Social Security numbers, street addresses, email addresses and employment information, including income data. Based on the information we know now, there is no evidence that banking, credit card, medical information (such as claims, test results, or diagnostic codes) were targeted or compromised.

Once the attack was discovered, Anthem immediately made every effort to close the security vulnerability, contacted the Federal Bureau of Investigation (FBI) and began fully cooperating with their investigation. Anthem has also retained Mandiant, one of the world’s leading cybersecurity firms, to evaluate our systems and identify solutions based on the evolving landscape. [ed: emphasis added, see below]

Anthem’s own associates’ personal information was accessed during this security breach. We join you in your concern and frustration, and we assure you that we are working around the clock to do everything we can to further secure your clients' data.

Anthem will individually notify current and former members whose information has been accessed. We will provide credit monitoring and identity protection services free of charge so that those who have been affected can have peace of mind. We have created a dedicated website (www.AnthemFacts.com) where members can access information such as frequently asked questions and answers. We have also established a dedicated toll-free number that both current and former members can call if they have questions related to this incident. That number is: 1-877-263-7995. As we learn more, we will continually update this website and share that information with you.

We want to personally apologize to you and your clients for what has happened, as we know you expect us to protect your information. We will do everything in our power to make our systems and security processes better and more secure, and hope that we can earn back your trust.

Sincerely,

Ken Goulet
President, Commercial and Specialty Business

Erin Hoeflinger
Ohio Plan President
 
Regarding Mandiant and cyber-remediation: on the one hand, this seems very much like closing the barn door. On the other, at least they recognize their vulnerability, and are seeking to mitigate and minimize it. One suspects that Mandiant (and its competitors) will be very busy going forward, as other insurers take stock of their own potential weak spots.

UPDATE: FoIB Holly R catches this from Bloomberg:

"... hackers obtained data on tens of millions of current and former customers and employees"

And asks: "How former?"

Good question, disturbing implications.

Blue Attack

Anthem Blue Cross policyholder data hacked. Possible 37 million affected.

The information accessed during the "very sophisticated attack" did include names, birthdays, social security numbers, street addresses, email addresses and employment information, including income data, the company said. - Yahoo News

Taxes, Shmaxes

Thanks to Moe Lane, we have this little gem:

"Consumers who received too much in federal tax credits ... got a reprieve of sorts from the Internal Revenue Service this week. Although they still have to repay ... excess subsidies, the IRS won’t ding them with a late payment penalty if they don’t repay it by the April 15 tax deadline."

Which is nice for them, but creates a problem:

"The Equal Protection Clause of the 14th amendment of the U.S. Constitution prohibits states from denying any person within its jurisdiction the equal protection of the laws."

So what's the problem?

Well, suppose you owe taxes on something (other than the subsidy clawback), and fail to pay on time: you're still subject to fines and interest. But for the special snowflakes that "miscalculated" their subsidies, well, no worries, mate.

Of course, it's not really a problem at all, at least according to the Obamastration:

"White House Press Secretary Josh Earnest described reports that millions of Americans would be getting tax bill because of Obamacare as "inaccurate" just days after the Treasury Department estimated that 6 million Americans will pay about $2 billion in individual mandate taxes this year."

Left hand meet right hand.

Sheesh.

Guest Post: The Force(d) is with You

From time to time, we host guest posts from esteemed colleagues and other bloggers. These are typically for insurance-related matters that fall outside our own particular wheelhouse. Today, we're pleased to bring you this post from Dennis Wall,  an elected member of the American Law Institute, author of several legal and risk-related books, and proprietor of the Insurance Claims And Issues blog.

If you've ever bought a house, you know that the lender requires you to insure it. Sometimes, folks let their coverage lapse, and the lender then obtains its own coverage, "forcing" it onto the property (and the homeowner). Today, Dennis explains the implications in this economy:

The “Great Recession” of 2008-2009 has caused a lot of harm. No harm has been felt more keenly than by people involved with residential mortgages and home loans.

During the six years leading up to the Great Recession, or from 2002-2007, mortgage debt rose nearly as much as it had since the United States was founded. Household mortgage debt rose an average of $60,000.00 during those same six years, or about $10,000.00 each year for each home in the United States. That is also the time when the once-standard 30-year fixed rate mortgage with a 20% down payment was no longer the mortgage loan of choice. [Findings from report of the Financial Crisis Inquiry Commission. THE FINANCIAL CRISIS INQUIRY COMMISSION FINAL REPORT, January, 2011].

A forensic investigation over three years, including research into publicly available federal court electronic filings, reveals clearly that many business practices have deliberately been kept secret concerning the sale, maintenance and monitoring of mortgages. In particular, the practices of a small number of insurance companies offering force-placed insurance to lenders has dramatically driven up the price of lender force-placed insurance or LFPI.

LFPI is insurance which protects the lender’s interest in the borrower’s collateral. It is “collateral protection insurance” in the sense that it is insurance which protects only the collateral.

Kickbacks and other alleged premium add-ons drive up the price of lender force-placed insurance. Some call the process “reverse competition” or “pay to play.” LFPI premiums are paid by the borrowers and not by the lenders. That is, the premiums for LFPI are paid by homeowners and not by the banks. A three-year review of federal court files reveals that the only complaints which survive in court are the complaints in which the homeowners complain about the extra charges added on to the monthly premiums they pay.

The notion that lenders force-place insurance only when borrowers do not meet their obligations, is largely a myth. It is far more likely that lenders will force-place insurance and let the homeowners oppose it if the homeowners can. To the contrary, homeowners make their monthly mortgage payments for the most part – until they no longer can make the payments including the added burden of premiums for “pay to play” force-placed insurance. Then the lenders and their agents foreclose, and the mortgage machine starts all over again.

Thanks, Dennis! And look for his new book, “Lender Force-Placed Insurance,” due out this Spring.

One Decade Down, Next to Go

It is humbling to consider that today marks our 10th Blogiversary. Well over 7,000 posts and millions of views, numerous awards and links from the New York Times, Wall Street Journal, Forbes, Fox and others.

And, of course, the very best co-bloggers on the 'net.

But most important: our terrific, engaging and interested readers.

Thank you all for 10 great years - and now on to 20!

And speaking of Medicaid...

As Bob recently noted, Indiana has become the 28th state to climb on board the  Medicaid expansion train (wreck). He also pointed out that there's already a shortage of providers willing to take on Medicaid patients.

Wonder why?

Well, our friend Dr Val has a pretty graphic answer:

Click on over to read the whole story (and definitely check out the comments).

Another Installment of: That's NOT how it works

It seems like only a  week ago that we referenced our 2nd ever post - wait, it was a week ago that we did that! And here we are again, talking about insurance fraud. And this one's a doozy:

"Irina Vorotinov has been charged by ... with defrauding Mutual of Omaha Insurance Company of more than $2 million in life insurance proceeds by falsely claiming that her former husband had died."

Turns out - Spoiler Alert! - the ex- was, in fact, very much alive, and caught on film years after his alleged death.

Ooops.

Super(bowl) Health Wonk Review is up

Our favorite health care economist, Jason Shafrin, hosts this week's festive round-up of health care policy and polity. It's cold outside, so come in and warm up with some great reads.

Popcorn State Expansion

On February 1, 2015 Indiana will become the 28th state to expand Medicaid. Good news (I suppose) for

those under 138% of the FPL. No more insurance premiums.

But you may have trouble finding a doctor. This is nothing new nor indigenous to Indiana. Medicaid participants in all states have trouble finding doctors willing to take them as new (or even old) patients.

About 765,600 Hoosiers lacked insurance in 2013, according to the Kaiser Family Foundation. The state has estimated more than 300,000 Hoosiers — or 56 percent of those newly eligible for Medicaid — could enroll in the first year and more than 400,000 would sign up during the second year. - Indy Star

Agents that wrote Obamacare subsidized plans on those under 138% of the FPL can probably expect to lose those clients ....... and the revenue.

How is the expansion funded?

The federal government pays for 100 percent of the cost through 2016. That declines gradually to 90 percent by 2020, assuming Indiana's waiver is extended past three years. Indiana's share — estimated to be about $1.6 billion between 2015 and 2021 — will be paid for through the state's existing cigarette tax and from a tax on hospitals.

Funded by the federal government, which doesn't have any money.

And funded by smokers and hospitals.

Increasing the cost of cigarettes probably isn't bad in the big scheme of things but taxes on hospitals will increase the cost of health care. How is this a good thing?

So, what is a Hoosier any way? I have heard it comes from "Hoosier mama" which I suppose is a version of "Yo mama".

Regardless, I wonder if this is a good thing or not.

Some thoughts on subsidies

So, been having a bit of a Twitter-tussle with a well-regarded friend and colleague. At issue is the future of ObamaTax subsidies as we look forward to the resolution of Burwell/King/Halbig.

Which got me to thinking: Why we're having this discussion at all? After all, President Obama explicitly promised us that, under the ObamaTax, premiums would decrease 3000%, and that we would have comprehensive, affordable coverage.

If this were truly the case, then why would we need bribes subsidies in the first place? After all, who wouldn't want cheap, useful insurance coverage? Why would we need to be cajoled, nay, forced into buying it if it was such a great bargain?

And if, as Mike pointed out years ago, the folks in DC actually did their jobs, would we need to be expanding Medicaid?

Thought not.