A spoonful of sugar...

Perhaps it's all in one's perspective:

"Growing numbers of Americans with health insurance are walking away from their prescriptions at the pharmacy counter, the latest indication that efforts to contain costs may be curbing health-care consumption."

The Journal's thesis is that, because folks have higher co-pays and/or deductibles, they can't afford to pay as much for their meds.

I think it's something else: when 3rd parties are paying the bulk of your expenses, you have no real incentive to cut back. DTC (Direct to Consumer) advertising also plays a role, increasing demand, regardless of whether or not it's justified. Bob wrote about this some time ago, pointing out that "(s)ome studies suggest that newer, more expensive meds are no more effective than older, less expensive drugs."

So there's an increase in demand, fueled by the fact that someone else is footing the bulk of the bill, but what happens when that equation tilts the other way? People make the conscious choice to take a flyer, perhaps understanding that they don't really need that med, after all (not unlike those who choose to go without health insurance). Seems pretty rational to me.

Supporting this thesis is the fact that "(p)atients are deserting prescriptions for the most expensive drugs most often." That makes sense, although one wonders why they even bothered having them filled in the first place. It's not as if the cost, and one's portion of it, is a surprise: the cash register pretty much tells the story. Simple enough to pull an Emily Litella.

To some extent, ignorance of how health insurance works is a factor:

"After switching employers in April, Ms. Brockway said, she chose a high-deductible plan for herself and her 12-year-old son because it took less out of her paycheck ... when she went to pick up asthma medicine for her son and an antidepressant for herself, the pharmacist told her it would cost more than $335."

And?

How much did she save in premiums, and where did that go? How much is her cable bill (if any)? Just once, I'd really like to see so-called "journalists" ask (and report) about what other choices their subjects are making. We have no idea whether Ms Brockway's son has his own cell-phone, for example, and how much that costs. What other discretionary expenses do people make that tells us about their priorities? Why aren't these part of the story, as well?

And there's this: "She returned later and bought a less-expensive prescription for her son." So she did in fact, make the choice to put her son's health first. Why didn't she ask about less expensive medication in the first place? Why didn't the pharmacist (or her doctor) suggest the lower priced alternative? I submit that it's because, until recently, cost wasn't a factor: someone else was paying for it.

The fact is, her high-deductible plan (apparently) worked exactly as advertised, she just didn’t understand how to use it. Once she had "skin in the game," it was to her advantage to begin asking questions, and looking for ways to lower the cost of her (and her son's) health care.

And that's a good thing.

How Will the Insurance Company Find Out?

"If I don't tell the health insurance company about (name any illness), how will they find out?". I always cringe when this question comes up. Got a call like this today from a former client.

I say former because he bought health insurance from me a few years ago, including maternity with no waiting period, so his wife could get pregnant.

She did, she delivered, he dropped the coverage.

Then last week he called again. Just like before, did not want health insurance on himself, nor on his son (who is on Peachcare . . . Georgia's SCHIP plan for low income families), just on his wife.

My spidey senses were tingling.

"Is she in good health?" I asked.

"Oh yes, I just want to get health insurance on her just in case."

I wanted to ask "in case what" but I didn't.

Today he called back and wanted to know which health insurance plan I would suggest. I said the plan from Humana was a good one and the one I would probably buy if I were in the market.

"How soon can we make it effective?" he asked.

"Usually a couple of days. Why do you ask?"

"She is waiting on some tests. The doctor thinks she may have Lupus".

There you go. The cat is out of the bag.

"Well, she won't be able to get health insurance until the tests come back and if confirmed that she has Lupus, she will not be able to buy health insurance then either".

"Why not?"

I hate that question almost as much as the one that followed.

"The carrier will ask on the application if she is waiting on test results and when they find out they will postpone the health insurance application until the tests come back".

"So how will they know if she doesn't tell them?"

"They have ways of finding these things out. If they don't find out before underwriting, they almost certainly will if the tests come back positive for Lupus."

"What kind of ways?"

"I tell you what. Let's just forget about any of the plans I sent you and you should have her apply for PCIP, the Obamacare plan that is designed for this kind of situation."

"How much does it cost? Is it more expensive than the Humana health insurance plan?"

"Probably, but it doesn't matter since, based on what you have told me, she won't qualify for Humana or any other health insurance plan besides PCIP."

"OK, send me the information, I think I will wait until the tests come back before applying."

"Sounds like a plan . . ."

I hate calls like this.

ObamaCare© Travelin': Medical Tourism under PPACA

Steven Lash, President of Satori World Medical, thinks that there's a silver lining in ObamaCare©: it's his belief that it will continue to fuel, and in fact increase the demand for, medical tourism. He bases this belief, in part, on the fact that this train-wreck has already begun to show the stress fractures in our system as a result of increased demand without adequate supply.

With Steven's permission, here's his take:

The changes in legislation [ed: ObamaCare©] will offer both positive and negative impacts to U.S. businesses. One of the benefits of the legislation is that we now know how the future of health care is going to be shaped. There are a specific set of deliverables and timetables that have been set.

With the completion of PPACA, businesses are focused again at looking for measures to save on rising health care costs. Because of this, businesses are starting to see a place in their employee benefit plans for medical travel.

With the addition of 40 million Americans having access to health insurance, there will be increased demand for health care services. Couple that with an existing shortage of nurses and doctors, queuing for medical care will be a natural by-product.

As the time to see a specialist increases, more individuals will seek to get immediate help through medical travel. Employers and employees will come to understand the high-quality health care that is available to them internationally as they look to end pain and ill health.

The PPACA utilizes similar features as the state-wide Massachusetts plan, which was implemented several years ago. In the Massachusetts plan, queuing for primary and specialty care has more than tripled the wait time for appointments and treatment.

As the low cost option, medical travel will be an attractive network option for employer-based medical plans.

Thanks Steven!

Retro Risk Reduction

It's tempting to think that the long, heavy "big metal" cars of bygone eras were safer than today's smaller versions. Take, for example, the venerable '59 Chevy Bel Air, its 211 inches weighing in at an impressive 3225 pounds. At the other end of the spectrum, last year's Chevrolet Malibu which, while actually a bit heavier (by about 200 pounds), is about 20 inches shorter. In a head-to-head (literally!) battle, the survisor might surprise you:



[Hat Tip: FoIB Sam B]

ObamaCare© Dreamin': I've got some questions

Currently, and since the advent of HIPAA, I can go from a group plan to another group plan, or an individual plan to a group plan, on a guaranteed issue basis, and any pre-existing conditions will be covered immediately.

[ed: Yes, there are a variety of hoops through which to jump, but assume those for sake of discussion]

In order to accomplish this, I need but a simple piece of paper, called a Certificate of Creditable Coverage, which "proves" that I've been covered for (at least) the previous 12 months. Absent this Cert, my new employer's carrier can delay covering any pre-existing conditions for a while.

Yes, yes, Henry. What's your point?

Well, as long as I have that little piece of paper, I can prove prior coverage, which is the point of the exercise, and demonstrates that one can, in fact, prove a positive.

But can one prove a negative?

Implicit in the PCIP (ObamaPool©) program is the applicant's assertion that he has not been insured during the previous six months. Which leads us to Question #1:

How does the Pool's© lifeguard prove that I did?

Follow up question: by what mechanism is the new carrier allowed to investigate the veracity of my claim?

Next, we turn our attention to the problem of the child; that is, the fact that one can no longer buy a child-only policy. Carriers which have gone this route (and I'm aware of none that haven't) generally allow a child to be covered if at least one of his parents is also on the policy. Which brings us to Question #2:

What happens when Mom and Junior apply and are issued a policy, and a month later Mom drops coverage on herself?

Follow-up question: by what mechanism would the carrier be allowed to then cancel coverage on Junior?

Well?

Friday LinkFest

■ At Frontpage, Tait Trussell makes the case that ObamaCare© constitutes "Medicare Malpractice" by essentially shafting "millions of low-income folks, minorities, and Hispanics." As we've noted, a lot of seniors covered by Medicare Advantage plans have been thrown under the bus.

■ David Hogberg offers his fisking of the New Republic's Jonathon Cohn's take on efforts at repealing ObamaCare©. He notes that this train-wreck "will force a lot of people to pay higher premiums ... lavish subsidies on the private insurance industry ... [and] put life-and-death decisions in the hands of bureaucrats." Sounds like a hat-trick to me.

■ Finally, the AP reports that the ObamaPools© are off to an underwhelming start (something we've long since noted), including one that we missed: "California, which has money for about 20,000 people, has received fewer than 450 applications."

Enjoy!

The Sad (Real) Faces of ObamaCare©

Yesterday, I had to turn away two prospective insureds. That's happened before ObamaCare© was a gleam in Ol' Nancy's eyes, but it was particularly troublesome because there are fewer choices now on which these folks can "land."

Let me explain:

Steve is a 45 year old gentleman who was laid off from his job last month. He's eligible for COBRA, but his means are (obviously) more limited, and the cost is prohibitive. With ARRA subsidies gone, he's stuck. Compounding his troubles is the fact that he's way to short for his weight, and has a number of other health issues. In fact, but for one "glitch," he'd be a prime candidate for the ObamaPool©.

Unfortunately, he's been insured within the past half-year, so he's outta luck, and outta the 'Pool©.

Then there's Tonya, a young lady in her late 20's, a single mom with a healthy five year old. Her employer offers a very nice group insurance plan, which just experienced a 35%+ rate increase, much (most?) of which comes courtesy of ObamaCare©. She'd like to jump off, but she has a number of problems.

No, her height and weight are within normal guidelines, but she's a Type I diabetic, and therefore uninsurable in the "regular" market. The 'Pool© might be a great option for her, but - you guessed it - no can do. Adding insult to injury, she can't do what we used to do: peel Junior off the group plan and put him on his own, much less expensive, policy. It's really a nasty trick, because even though we could write Junior on a plan with Mom, if Mom doesn't qualify (and she doesn't), Junior's not eligible. Then again, it's doubtful now that they'd save any money if they could get him his own plan.

I guess now that we're seeing what's in the bill....

Irony, Thy name is Cliff Clavin

Let me get this straight: Postal Workers' union elections are on hold because ballots have been lost in the mail?

Yep:

"But the union announced that only about 39,000 ballots were turned in -- and that "a large number of union members had not received their ballots."

You're kidding, right?

Um, no:

"The American Postal Workers Union has extended its internal election after thousands of ballots appeared to have gotten lost . . . in the mail."

As Warner Huston notes, these are the folks that want to run our health care system?

It's a little known fact that...

Shecantbeserious Waivering: You want fries with that?

On the heels of the recent McDonad's/Mini-med kerfluffle, we now learn that over 2 dozen companies have been granted temporary ObamaCare© exemptions. This of course raises a number of -- shall we say uncomfortable? -- questions:

First, under what criteria were these waivers granted? What, if any, quid pro quo was extracted from the corporate coffers of those which benefitted?

Second, what happens next year, when these waivers expire? Will they automatically renew? If not, what process will be implemented to review whether or not such exemptions will continue?

Third, what companies applied for an exemption and were declined, and on what basis?

Fourth, why is it that not only employers and insurers were granted exemptions, but also unions?

One more little time-bomb that was in the bill we had to pass to see.

Obamacare - Is The Public Option Dead?

Is the so-called public option in Obamacare dead? Some don't think so. Left wing blogger Huffington is sporting a post today suggesting there is still hope for those who want a public health insurance option. According to Dr. Abrams who it appears has never practiced medicine nor run a health insurance company, Democrats can still exploit a little publicized provision in Obamacrap to sweep them into office and create even more bureaucracy at the state level.

Apparently no one told Dr. Abrams the states are broke.

Although a federal 'public option' failed to make it into the law, states were granted the power to generate their own public option.

There you have it. Public insurance run by the states. The same states that are complaining about the addition of millions of uninsured's to Medicaid and wondering how care for the masses will be funded without massive tax hikes.

There's your answer.

States, like the federal government, have almost unlimited authority to raise taxes at will. For some reason people seem to think if it comes from the government it must be free. Those are the same people who believe that corporations pay taxes and you can't get pregnant if you do "it" standing up.

If I were running anywhere this year, for governor or state legislature, I would propose that my state enact a public option for itself. Its costs would be negligible, as the federal government provides the necessary subsidies to enable those who cannot afford it to buy it, whether it is from a private insurer or the state.

Costs would be negligible. Gotta love it. 

Raise your hand if you believe in subsidies that will last forever, if they even materialize at all. If you raised your hand you probably live in one of the 57 states and voted for having your health insurance premiums lowered by $2,000 and still believe if you like the plan you have you can keep it.

To paraphrase Mark Twain, according to HuffPo, "Reports of the public option being dead are greatly exaggerated".

The Commish (An InsureBlog Exclusive!)

Although the Whitman-Brown (or is that Brown-Whitman?) race seems to be sucking up all the air in the room, there's another electoral competition going on in the Golden State. In California, the Commisioner of Insurance is an elected position. It's a tough race, but independent insurance agent Rick Bronstein aims to give it all he's got. Rick graciously agreed to an (Exclusive!) email interview with InsureBlog:

InsureBlog (IB): So, Rick, can you tell our readers a bit about yourself (including how long you've been in the insurance business)?

Rick Bronstein (RB): I’ve lived in the Los Angeles area all my life, graduating from UCLA in 1978. I’ve been licensed since August 1977 when I began working in a small P& C agency part time. Ultimately I became the office manager and remained there for 9 years. Since then I’ve worked for a credit union as their insurance department manager, as an outside salesperson for Secure Horizons, and been on my own since 1996.

I enjoy long walks on the beach golf, profitable trips to Las Vegas, and riding my motorcycle [ed: since this is a family-friendly site, no centerfold].

IB: How would you characterize the current state of CA insurance markets? I realize that this is a somewhat loaded question; maybe a little bit about the P&C side, and more on the life/health (especially health) side.

RB: Like most states, mandates and regulations have created more problems than they have solved. Carriers are forced to provide benefits that may not be wanted, and every benefit has a cost.

We have a state run workers compensation company that as part of its mandate is to be revenue neutral to taxpayers. A few months ago our insurance commission sent $5,000,000 to various district attorneys throughout the state to fight fraud. How is that revenue neutral? Insurance companies should fight their own fraud cases.

The insurance commissioner has been holding Anthem Blue Cross “hostage” and has not approved their plans with effective dates after 9/22/10. How is that helping residents of California?

We’ve gone from oversight to over-regulation.

IB: Why run for insurance commissioner instead of, say, letters to the editor, that kind of thing?

Letters to the editor are almost impossible to have published, and if so, are rarely more than one or two paragraphs. While I know it’s unlikely that I will receive more votes than the establishment candidates (Democrat and Republican), at least I can get out the message of allowing a free market to actually be free.

What are your Top 3 goals should you become elected? Or, if you prefer, the first 3 things you plan to address?

The most pressing issue right now is the ObamaCrap that the brain surgeons in Washington passed. So the first 3 things I would do is to encourage the state to do everything possible to have this overturned. Among all the other unconstitutional provisions, the entire bill violates states’ rights.

Since I do not believe the insurance commissioner’s job is to make it more difficult for insurance companies to do business in California, I would reduce the regulations that thwart competition and lead to higher prices.

The third item is to once again allow for gender rating for Medicare Supplements. Several months ago the state required unisex rates which had the effect of raising prices for women on many plans by 20% or more. Once again, regulation where none was needed.

IB: One last question: With all the news out of DC, what do you think about ObamaCare, and specifically as it might effect Californians?

RB: This is a family site, right?

Thanks, Rick, for your forthright answers, and your commitment to fight the good fight. Hopefully, at least some of your ideas will find their way to implementation.

[This interview is not intended as an endorsement of any candidate]

Movin' on up... (An IB Exclusive)

In the Wikio Health Blog rankings. The new numbers are out, and we've moved up quite a bit, all the way to the (lucky) 13 spot (pretty good for an insurance blog!).

Thanks to Wikio's Oliver Orlik for the heads' up, and for the (exclusive!) opportunity to post this before the official publishing date:

1	Well
2	Respectful Insolence
3	Science-Based Medicine
4	Kevin, M.D. - Medical Weblog
5	Dr. Wes
6	Health Beat
7	The Health Care Blog
8	In the Pipeline
9	Pharmalot
10	White Coat Underground
11	Better Health
12	John Goodman's Health Policy Blog
13	InsureBlog
14	The Last Psychiatrist
15	Health Care Renewal
16	Managed Care Matters
17	Healthcare Economist
18	Disease Management Care Blog
19	DB's Medical Rants
20	The Happy Hospitalist

Ranking made by Wikio

Foreign Serendipity

My better half has long cautioned me that "there are no coincidences," but what am I to make of this?

First, my office email brings word from Golden Rule (Health) Insurance outlining "3 Reasons You Should Add International Health Insurance to Your Portfolio."

Among these are the opportunity to provide "an additional service to your current clients, and attract new ones, when you offer international health insurance ... International health insurance is a growing market and ... you can add a quoting link to your website that practically does all the work for you!"

WooHoo!

But where would these droves of new (international) clients go for medical care?

The King and I know (no, not that King):

"The Tourism Authority of Thailand’s Medical Tourism Blog Contest kicks off with cash and prizes worth nearly US$20,000 up for grabs, including a seven-day all-inclusive medical tour of Thailand for 12 finalists."

Yep, the Thai Tourism agency is sponsoring a blogging contest, with many valuable prizes. Me, I'd settle for a nice dish of pad thai , but I'm a simple guy. But say I was interested (or maybe Bob, Bill or Mike would like a round-trip to an exotic foreign land); what's the deal?

"In order to win, finalists must write the best blog post and attract the highest number of unique visitors."

Hmmm. Could you be more specific?

"The competition is open to anyone who has experience writing blogs related to tourism or medical tourism in English language or containing English language."

Ah hah! Thanks for clearing that up.

So, any takers?

AIG Update: Good news?

Yeah, sorta:

"The Treasury Department says it expects the total cost of Troubled Asset Relief Program (TARP) aid to American International Group Inc. (AIG) and other federal aid to AIG to be about $30 billion."

I know, how's that good news?

Wait for it....

"The Treasury Department invested about $40 billion in helping AIG ... and the Federal Reserve System invested about $182 billion"

So according to Washingtonian-style advanced financial calculations, there's a "savings" of $192 billion, which is a good thing.

Of course, in the real world, we don't look at it as "saving" almost $200 billion, we look at it as wastefully spending $30 billion.

As Bob says: Smaller cars, bigger debts, Papa Washington.

Cavalcade of Risk #115 now online

Wenchy outdoes herself with this week's outstanding roundup of risky posts. Come for the Open Enrollment, stay for the RTFM (if you have to ask...).

Still looking for a host for the November 17th edition - take a risk and sign up!

Timing is everything...

Remember the health care "crisis" that necessitated that we had to quickly "pass the bill to learn what's in it."

Remember that?

If you do, then you're a few steps ahead of HHS Secretary Shecantbeserious and her minions of bureauweenies:

"A new report from the non-partisan Congressional Research Service ... finds astounding proof of the total administrative failure of the administration in implementing Obamacare. According to the report, HHS has missed one-third of the deadlines contained within the legislation for the first six months under Obama's new health care regime."

Ooops.

Up to 11 (eleven!) key deadlines were missed, including a number of state ObamaPools© and Medicare/Medicaid provider screening guidelines.

On the other hand, perhaps we should be grateful for their incompetence: anything that slows this train-wreck down has got to be a good thing.

[Hat Tip: RedState]

Ahoy, mateys! (From the P&C Files)

When Somali pirates [ed: did they actually swash their buckles?] forcibly captured Captain Richard Phillips and his crew last year, the primary concern was, of course, for their safety. But what of the ship's cargo? About a third of the 17 thousand metric tons was "relief supplies bound for Somalia, Uganda, and Kenya."

The other two-thirds, one supposes, were commercial; one further supposes that most, if not all, of that cargo was insured. Regular readers may recall our story from three summers back, detailing how (since-disgraced) insurance carrier AIG put together a veritable A-Team to fight fires threatening their clients' high-end homes.

Taking a page from AIG's fire-fightin' heroes, a "group of London-based insurance companies ... is planning to create a private navy to protect commercial shipping passing through the Red Sea and the north-western Indian Ocean."

These are big-dollar (or pound sterling) losses, too: at an average of $4 million a pop, pretty soon you're talking about real booty. The insurers have been thus far underwhelmed by the prowess of their respective countries' official military forces, and have decided to go full Chuck Bronson.

Or not:

"Instead, this private navy would operate under the direct control of the international naval force that is already in the area, with "clear rules of engagement valid under international law."

Then what's the point?

And it seemed so promising.

RELATED: Speaking of fire fightin', what do you think of this?

"Each year, Obion County residents must pay $75 if they want fire protection from the city of South Fulton. But the Cranicks did not pay ... Because of that, not much is left of Cranick’s house."

On the one hand, fair's fair: the Cranick's knew the potential consequences, and made their choice.

On the other hand: how big a deal would it have been for the firefighters, already on the scene to protect the neighbor's property, to turn the hoses on the Cranick's house?

On the gripping hand: it's a fire service; what's the incentive to prepay if you know that you'll be rescued anyway?

So here's an IB poll:

"Should the fire department have tried to put out the house fire once they were on the scene?" As always, comments on this issue are welcome.




[Hat Tip for the Cranick's story: Hot Air]

Real Life ObamaCare@ Consequences: Buckeye Edition

At the risk of beating a dead horse, here's the current state of Ohio's individual health insurance market:

Aetna, Assurant, Anthem, Humana and Medical Mutual of Ohio (MMO) will no longer write any child-only policies (where "child" is defined as "under age 19"). MMO had not made this decision final until after the 23rd, so any such applications submitted have been returned. In addition, MMO is opening itself up to major adverse selection, er, uh....has announced that "dependents under the age of 19 who apply as new business and part of a family plan will be eligible for coverage year-round." In other words, no "Open Enrollment" necessary.

It actually gets a bit more convoluted, but that's the gist.

Anthem also addressed the grandfathering issue pretty much head-on, as well. Parents with grandfathered plans will be able to add their under-19 aged kids; they'll still need to submit an application for underwriting (to assign the proper risk category and price), but won't be subject to decline for medical reasons, and (disclosed) pre-existing conditions will be covered.

I predict that's going to be the next major battle-ground (or at least one of them), by the way. The new rescission rules are pretty clear-cut, so carriers are going to have a very real incentive to pay close attention to these "minor" apps.

How's that, you ask?

Simple:

"Rescission is permitted only for an act, practice, or omission that constitutes fraud, or an intentional misrepresentation of a material fact, as prohibited by the terms of the plan or coverage. Rescission is not permitted in the case of inadvertent misstatements of fact." [emphasis added]

Who makes the call as to what was "inadvertent" and what was "deliberate?" Methinks that the application will be even more important for carriers going forward. This is another example of why having to "pass the bill to learn what's in it" is so fraught with danger.

[Hat Tip: FoIB T Shook]

Post This, Obamacare!

Retiree's of 3M, makers of Post-It Notes and Scotch tape will see their retiree health insurance go away courtesy of Obamacare. As more companies weigh the cost of providing health insurance against the predicted rise in health insurance premiums and additional government reporting requirements, dropping health insurance becomes a foregone conclusion.

When it is less expensive and less painful to drop health insurance benefits than it is to maintain, companies large and small, as well as individuals, will make the obvious choice.

Problem is, the drafters of Obamacrap anticipated most people who get health insurance through their employer would continue to do so.

Given that almost no one in Washington, from Obama on down through the Cabinet and Congress have no clue how the business world works, it is not surprising that they did not anticipate the backlash of resistance to more government interference in the private sector.

"Health care options in the market under the health care reform law became better," said spokeswoman Jackie Berry, adding that taking retirees off the 3M group plan would save money for both 3M and retirees.

The move is part of a longer-term trend by employers to get a grip on the ballooning costs of retiree benefits. Most employers already have done away with the rich pension plans of the past and switched to 401(k) plans, under which they limit their exposure to future costs.

When ERISA imposed new rules on retirement plans in 1974 almost no one in government anticipated the mass cancellation of traditional retirement plans that followed. 

Just like Obamacrap, the idea behind ERISA was to impose "consumer protection" rules on businesses that offered retirement plans. Employers dropped defined benefit plans like a hot potato in the years immediately after ERISA and never looked back. The PBGC which was created to provide insurance for underfunded retirement plans has struggled ever since to cover benefits from terminated retirement plans that were underfunded.

The recent recession would have most likely torpedoed the PBGC if not for the fact very few publicly traded companies offer traditional retirement plans.

3M may be one of the first large employers to take this step in response to health reform, but it's not likely to be the last.

"I suspect they're ahead of the game in terms of arriving at this decision," said Henry Van Dellen, who heads the health and benefits practice at Aon Consulting. "Practically speaking, this likely will happen with a lot of employers."

Will Obamacrap transform employer group health insurance into a sequel to ERISA?

If Obamacrap is not repealed or gutted you can count on it.

Medicare Advantage Plans Go Poof!

Roughly 21,000 seniors will lose their Medicare Advantage Plans (Medicare Part C) in 2011. According to the Chicago Tribune:

A state agency says insurers have notified about 21,000 Iowans that they will no longer provide the Medicare Advantage plans in 2011.

Under the plan, Iowa seniors get their health care insurance through a private company, not the government Medicare program. The plans provide prescription drug coverage as well as medical and hospital coverage.

Seniors in Georgia will be facing similar issues. Cut backs in funding under Obamacare plus restrictive rules CMS has applied to insurance companies offering Medicare Advantage and PDP's have resulted in many companies opting to withdraw from the market rather than deal with government bureaucracy.

People who lose their Medicare Advantage Plan have the option of returning to traditional Medicare and picking up a Medigap (Medicare supplement) plan to pay for things not covered by Medicare.

Grand Rounds: Minimalist Edition

Sharp Brains blogger Alvaro Fernandez hosts this week's roundup of interesting medblog posts. It's done list-style; each entry is a helpful summary.

Obamacare Delivers Silent Tax Increases

[Welcome NRO readers!]

The Patient Protection and Unaffordable Care Act (Obamacrap) is delivering silent tax increases to fund this mess. In truth, the $1 trillion law is a giant tax increase and that figure doesn't include hidden taxes or those that will follow at the state level to fund Medicaid coverage for roughly 15 million people over the next few years.

The snake oil peddlers sold the public on the idea that their elixir would cure all your ailments.

The folks at Kiplinger report "13 Tax Changes are on the Way". Sounds like politician speak.

Tax changes.

Not tax increases, changes.

Tax number 1 on tanning services is obvious. Unless you are John Boehner it probably doesn't affect you.

Tax number 2, a small business tax credit sounds nice but very few companies will actually qualify. Even left wing NPR acknowledged few businesses will ever see a dime of the tax credit.

Most of the taxes listed in Kiplinger numbered 4 - 13 are sneaky unless you think about them.

Elimination of a deduction employers now take for providing Medicare Part D prescription drug coverage to their retirees to the extent that the federal government subsidizes the coverage

Doesn't sound like much but it is. Many large employers have already announced they will be dropping the Part D benefit for retirees. When that happens, those who want to continue Part D coverage must secure coverage from the few health insurance companies that are still offering the plan.

While not a direct tax, it does mean retirees will have to use their own money (which for many is limited any way) to purchase coverage on their own. Factor in the closing of the donut hole in Medicare Part D which will result in higher premiums for Part D, seniors get a double whammy.

Corporations that drop that benefit will pay more in taxes unless they find another write off.

6. A limit on the amount that employees can contribute to health care flexible spending accounts to $2,500 a year, but the cap won’t take effect until 2013. This was previously left to the employer's discretion, with many firms choosing a limit of $4,000 to $5,000 or so

7. A ban on using funds from flexible spending accounts, health reimbursement arrangements or health savings accounts for the cost of over-the-counter medications, starting in 2011.

If you have an FSA or HSA the new limits mean you can shelter less income from taxation. The result is higher taxes. Item number 7 fails to inform readers they can still use FSA/HSA/HRA funds to pay for OTC meds but only if they have a doctors prescription.

That means a trip to the doc that is a hidden tax because it is money you would not have spent if not for Obamacrap.

Beginning in 2013 if you don't have health insurance and/or and HRA/HSA/FSA to cover out of pocket medical expenses you will have to spend 10% of your AGI before you can claim a partial write off on Schedule A of your income tax form.

10. A new 40% excise tax, beginning in 2018, on high-cost health plans, levied on the portion that exceeds $10,200 for individuals and $27,500 for families. The provision is aimed mostly at gold-plated plans offered by employers, although it can affect individual policies

11. A new tax on individuals who don't obtain adequate health coverage by 2014 -- this is often referred to as the individual mandate.. The tax is to be phased in over three years, starting at the greater of $95, or 1% of income, in 2014, and rising to the greater of $695, or 2.5% of gross income, in 2016.

This is what you call damned if you do, damned if you don't.

If you purchase health insurance that meets Obamacrap guidelines most everyone will be subject to the 40% excise tax, but if you don't buy health insurance you will pay a tax.

They've got you coming or going.

A tax Kiplinger missed is the one imposed on anyone in business that spends more than $600 with a vendor in 2011 and later. Business owners are required to generate a 1099 for any vendor where they purchase more than $600 in goods or services. That means if you own a business and buy more than $600 in gasoline, electricity, telephone, internet, cell phone, natural gas or water you must generate a 1099 for those businesses. Buy more than $600 from Office Depot or Staples?

Generate a 1099.

Do you pay a cleaning service to empty the trash in your business? Pay a landscaper? Provide a coffee service for employees and guests?

1099. 1099, 1099.

It will cost you money to generate those 1099's. Money that could have been used to create jobs.

This is one of the most ill conceived pieces of legislation to come down the pike in a long time and it is a jobs killer that will further stall the recovery.

Just another stupid government trick from the folks who gave us Government Motors.

Monday morning "Told ya so!"

As we've previously pointed out, ObamaCare©'s impact on the delivery of health care is likely to get ugly, and here's another piece of evidence supporting this:

"The U.S. healthcare reform law will worsen a shortage of physicians as millions of newly insured patients seek care"

Says whom?

Says the Association of American Medical Colleges in a statement released late last week. And they don't mean "someday," they mean "right around the corner:"

"While previous projections showed a baseline shortage of 39,600 doctors in 2015, current estimates bring that number closer to 63,000, with a worsening of shortages through 2025"

Ooops.

And it's not just those wing-nut doctors. Left-of-center NPR reports that:

"In the latest episode, Obama's health officials published a sweeping amount of information on 4,000 individual insurance plans ... The data include plans' prices, descriptions of benefits, and — to insurers' consternation — estimates of how many applicants each plan rejects. It's all on HealthCare.gov."

Bob's already pointed out just how drain-bramaged this "tool" actually is, but the folks at NPR tell us that the information it kicks out is, at best, misleading. For example, the site tells prospective applicants the percent of applicants a given insurer rejects, without explaining the basis for the rejections (e.g. incomplete forms, mismatched identification information ,etc).

So not only don't we (or they) know what's in the bill (cf: McDonald's) but they can't even implement a simple website.

[Hat Tip for the NPR link to FoIB Holly R]

Principal Out, UHC in... [UPDATED!]

[Scroll down for update]

From today's email (9/30/10):

"UnitedHealthcare has entered into an agreement to renew medical insurance coverage for The Principal®'s commercial medical plan customers."

The $64,000 Question, of course, is why? They've scheduled a conference call for tomorrow (Friday) afternoon, from which I hope to learn whether or not ObamaCare© played any role in this. While it's tempting to believe so, the nHealth kerfluffle demonstrated that it's not necessarily the case.

We'll keep you posted.

UPDATE [Oct 1]: Well that was interesting. Just got off a conference call with "teams" from Principal and UHC, and have several pages of notes. Here are some first impressions:

Principal's apparently been shedding medical business for a while; that line currently makes up something like 15% of its business. So this is not exactly "unexpected." As a result, they're transitioning their health business to UHC; this process is anticipated to be complete within the next 36 months.

Second, the Principal's team was adament that this decision was not driven primarily by ObamaCare©; if one accepts the prior point, this makes sense. They did acknowledge that, again due to their diminishing book of business, they are ill-equipped to handle the onslaught of ObamaCare©-driven changes.

Another key point is that as a result, all of their groups will (eventually) be "un-grandfathered." While both teams acknowledged this reality, they did try very hard to downplay its significance. Make of that what you will.

Finally, and consider this an IB "scoop," we were told that the Mayo Clinic will be in-network with UHC as of November 1.

I'll be happy to share more, just ask away in the comments.

What's Gold Got To Do With It?

Quick: What do Kinko's, Ft Knox and Century 21 have in common?

Answer: They're all instruments of ObamaCare©.

Hunh?

Thomas Sowell points out that, among other silliness, ObamaCare© includes "a provision ... regulating people who sell gold." As Dr Sowell concludes, this has "nothing to do with medical care but everything to do with ... government's power over gold."

And therein lies the problem (well, not really the problem, but a major one) with the idea that we had to "pass the bill to see what's in it." Because no one (least of all the rocket surgeons who voted for it) really knows "what's in it," we keep finding things like new 1099 requirements, new taxes on certain home sales, and now increased government power over the private sale and ownership of a precious metal.

None of these things has to do with medical care (or even health insurance), but they have everything to do with increasing government control of our lives. And they come at a huge cost: increased government oversight means increased government bureaucracy, which means increased government spending, not less. Could someone please explain to me how regulating the sale and ownership of gold, or increased tax-prep paper shuffling, or new taxes on the sale of only certain homes will lower my premiums by 3000%?

I'm waiting....

Cavalcade of Risk #115: Call for Submissions

The inestimable Wenchy hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 4th). Please remember to include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

You can submit your post via Blog Carnival or email.

Did Retirees Go "Thump?" [UPDATED]

As in this little ditty. Some folks believe so, others (myself included) aren't so sure. Here's the "problem:"

Nearly all plans in force as of September 23, 2010 will be subject to certain ObamaCare© provisions, whether or not they're deemed to have been "grandfathered." These include:

■ Extending coverage to "kids" up to age 26, regardless of their student, marital, financial or residence status (although this does not apply if "Junior" is eligible for coverage at his job)

■ No caps on "essential health benefits" (including ambulatory patient services, hospitalization, and maternity and newborn care, among others).

■ No lifetime maximums on plans (grandfathered plans may still impose annual caps)

Notice that "Nearly all" caveat above: it doesn't apply to retiree-only plans. This is important, because it's not clear whether this is a slap in the face for retirees, a sop for their former employers, or something else entirely. Recall also that many of these same retiree plans benefitted from some $5 billion of our tax dollars to offset costs.

In the event, retiree-only plans are exempt from the list cited above. This is something of a two-edged sword: on the one hand, such plans may be spared (for now) some of the major rate hits, er, hikes that will come about as a result of implementing these additional benefits. On the other hand, a lot of these folks have children in the affected demographic, and at least a few aren't at all happy that they can't keep their kids on (or add them back onto) the plan.

It's not clear to me that either side has a legitimate beef; or, perhaps, both sides do. The end result is that these plans are exempt from the new rules, and will have to live with the consequences. The only real question is whether or not that's a "good thing."

MIKE ADDS: If PPACA is a huge benefit to insureds, and simultaneously a meaningful relief to the budget, why exempt anyone, especially retirees who are the most expensive to cover ?

[Including retirees under PPACA would capture those retiree expense savings which would be highly beneficial to the federal budget. Isn't that so? Or maybe the savings are not so certain after all? Which is it?].

How likely an explanation is "politics" when 65% of the country opposes the whole law?

[And by the way, where was AARP on this? Doesn't AARP claim to be the retirees advocate? What was AARP advocating all this time? I'd say AARP seems to be quietly sneaking away to hide the knife they stuck in the backs of retirees!]

Excluding retiree plans from PPACA requirements can be seen as consistent with

1. Siphoning off $500 billion from Medicare, much of which will come from benefits and the rest from

2. Medicare Advantage - which is under all-out assault. (eg Harvard-Pilgrim Health Plan in Massachusetts exiting from the Medicare Advantage business entirely? H-P has about 22,000 Medicare Advantage subscribers. It seems likely that more plans--particularly smaller ones--will do the same.)

I think the treatment of Medicare is a clear retreat from the social contract expressed when Medicare was born--i.e., Americans agreed to be taxed when young so that we will have protection from medical costs when old. Uh, I guess that meant "unless it gets too expensive." Now, in reality this may be the only reasonable course and it may be inevitable, but it is being dishonestly presented. There is no admission that this administration intends to reduce Medicare cost by reducing benefits as a deliberate strategy. Older Americans are just not worth keeping alive beyond a certain point--a certain price point, I guess. And there is no one explaining (or even asking!) how "fraud and waste" will be reduced when the CMS budget for fraud detection is about the same as in prior years. Instead this administration asserts with a straight face that the new law "preserves and strengthens" Medicare.

Obamacare - You Deserve a Break Today

The McDonald's restaurant chain wants to have it their way when it comes to Obamacare.

McDonald’s told federal regulators that it may drop health insurance for almost 30,000 hourly restaurant workers unless a requirement in the law is waived, the Wall Street Journal reported yesterday, citing a company letter to the U.S. Health and Human Services. The story isn’t correct, said Jessica Santillo, a spokeswoman for the department in Washington.

Seems to be a conflict here. So what is the real story?

One thing is known, the cost of implementing Obamacrap at the consumer level is significant. The cost of Obamacrap to employers is so substantial that many large companies have conducted studies and learned it will be less expensive for them to drop health insurance for employees and pay the fine.

The folks who crafted Obamacrap assumed those with employer provided group health insurance would keep those plans. But if there is a wholesale dumping of group health insurance Obamacrap starts to implode.

The government may allow some low-cost plans like those offered at McDonald’s, which have limited benefits, to get waivers from the health law’s insurance requirements, according to a Sept. 3 Health and Human Services memo. Those requirements were waived for McDonald’s on Sept. 24, Santillo said.

“In order to ensure that individuals with certain coverage, including coverage under limited benefit or mini-med plans, would not be denied access to needed services or experience more than a minimal impact on premiums, the interim final regulations contemplated a waiver process,” the Health and Human Services Department said earlier this month.

If McDonald's and other large corporations are not allowed to keep their limited benefit plans one of two things will happen. Either workers will lose coverage, or McDonald's may opt to drop health insurance coverage altogether.

Looks like the Obama administration could have an egg McMuffin on their face . . .

Health Wonk Review: "Live long and prosper" edition

Peggy Salvatore takes this week's news about the UN appointing a "space ambassador" into grand orbit, as she presents a star-studded array of interesting posts from the wonkosphere.

It's obvious that she's read each and every post, and she offers them up with a hint of humor while treating each one respectfully.

Bravo, Peggy!

Another ObamaCare© Myth Debunked

Please, people: there's enough "red meat" in the ObamaCare© debacle without having to "make stuff up." In emails and on-line, there's a growing chorus of folks who believe (erroneously) that there's actually a "hidden sales tax" on the sale of people's homes.

No, there isn't:

"(T)here is no "sales" tax on home sales in the health care bill. The bill would impose capital gains taxes on some home sales made by a limited number of taxpayers." [emphasis in original]

Only a few people would even be hit by this capital gains tax: there's a floor on both income and home value. As the Tax Foundation's Tax Policy Blog notes, there's the potential for more homeowners to eventually be affected, based on increasing home values (although there's little evidence that incomes are rising).

Now, if you want to ask “what the heck does selling your home have to do with health care?” Now there’s a great point.

[Hat Tip: FoIB Joe Kristan]

Shecantbeserious vs The Truth

NRO health-blogger Avik Roy has a terrific fisking of yesterday's Wall Street Journal "op-ed" by HHS Secretary Shecantbeserious. He refutes each and every one of her "arguments" with compelling and documented evidence.

A must read for anyone remotely serious about the truth.

Fixed or Not: Ohio Kids' Insurance

Bob just sent me this little tidbit:

"[Ohio] has issued new guidelines aimed at enticing health insurers to reverse decisions to halt offering child-only policies to avoid federal requirements."

The DOI (Department of Insurance) just set forth new rules which they hope will clarify the ObamaCare© provision for so-called "Open Enrollment." The DOI says carriers must hold a one-off Open Enrollment "through Nov. 15 and, following that period, each January and July."

It will be interesting to see if this actually works: as I mentioned to Bob, there are some carriers which are not currently offering child policies, from which I infer that they would be exempt from this provision. If that's true -- and it's a BIG "if -- then I can't see other carriers being all that enthused about taking up the slack.

And lo and behold, the DOI itself acknowledges just this problem:

"Not all health insurers offer these policies, so please check with an agent or insurer to determine where to purchase this coverage."

Faced with this information, how long will it be until there are no carriers offering such coverage?

Any takers?

LTCi Rate Hikes: Outrageous or Responsible?

When sold properly, Long Term Care insurance is a terrific risk-management tool. One thing that sometimes gets overlooked is that (generally speaking) premiums on this product are not guaranteed. That is, although carriers can't single out a particular insured, they can increase the premium for a given "block" of business. John Hancock, one of the "Big Boys" in this market, has just announced that they will, in fact, be seeking a 40% rate increase. There are a lot of (thus far) unanswered questions, chief among them being: which plans, exactly, are affected? There are other questions, as well, which is why we've turned to our "on-call" LTCi Guru, Herman Bruns:

My understanding is that the rate increase will NOT apply to the Custom Care II, Custom Care II Enhanced, or Leading Edge product lines. The older Custom Care product, the Fortis plans, as well as their group offerings will be impacted. Obviously these plans were under-priced at the time.....so it is likely that a 40% rate hike would probably not even bring these plans up to today's level of LTC premiums. The steeper rate hikes will affect the plans with the more robust inflation clauses.....so they will simply be offered things like cutting from 5% compound to 4% compound to maybe keep the premium level.

If the plan was dirt cheap 10 years ago, and it goes up by 25-40%, is it still dirt cheap? Compared to the alternative of not having LTC coverage at all, you still have a decision to make. If the plan had a contingent non-forfeiture clause in it (a standard offering today), and the rates go up by more than a specified percentage based on your age, you get to walk away from your policy and all the money you paid in is held in reserve should you ever need care. Try that with a health plan that you could not longer afford!!!!

[But what about those 10-Pay plans which promise a shorter premium payment time?]

10 pay plans only reduce the payment to 10 years....they don't guarantee the rate for 10 years. If you want a rate lock guarantee, buy a single premium pay plan, or buy a 10 pay with a 10 year rate lock. Happy to sell you either one. Once the plan is paid for, it is paid for. Nothing can be simpler.

[Okay, that makes sense, but what about folks who now find their plans unaffordable?]

If you are concerned about buying a plan and having to bail, buy a plan that lets you walk away from it and get 80% of money back if you need it and can still fog a mirror. Some carriers offer these. Else, buy a linked benefit plan with a single pay, money back guarantee.

Either way, let's not go out of our way to scare people from buying what could be their best protection from catastrophic financial ruin when their $80/month premium jumps to $112/month 10 years after they bought it. My goodness people, we all know how cheap health insurance was a mere 10 years ago, and now we are all upset about what amounts to trivia by comparison.

Maybe John Hancock simply never should have bought Fortis' block, or perhaps they should have tightened their underwriting a little more. If you are big in the group business like Hancock, and you take the majority of people with little or no questions asked, do you think you will have more claims issues than a carrier who focuses more on the individual market? Maybe a lowly A rated carrier like Genworth, who has little group presence, and no substandard health classes to offer, will hang in there better. I'll bet Penn Treaty had more claims than they thought.......but we all know why.

Lets not scare the general public any more than we have to......or do you want the government to take control of LTC insurance too. The Class Act should give you an idea already of the stupidity of government run LTC.

Thanks, Herman!

Life and/or Death under Medicare

Two seemingly unrelated items come to our attention. FoIB Bob D tips us that " (m)illions of seniors face double-digit hikes in their Medicare prescription premiums next year unless they shop for cheaper coverage."

The article refers to so-called Medicare Part D plans (ostensibly, the "D" stands for "drugs;" IB readers know that it actually stands for "debacle"), which are due to change in January. These plans are necessary evils for seniors, who must decide not only whether or not to buy one but also which one among the myriad of choices available.

Well, best scratch that "myriad of choices available," since the market is shrinking:

"Medicare "is really reshaping the market ... There are a lot of plans that are shutting down."

Ooops.

For example, AARP's "MedicareRx Saver" plan (actually issued by United Healthcare) has some one and a half million subscribers, but it's about to be shelved in favor of the more expensive "MedicareRx Preferred" plan. And get this: "Seniors who are already in the AARP Preferred plan ... will see their premiums fall 11 percent on average," subsidized by the folks coming from the erstwhile "Saver" plan. How's that for fair?

And speaking of fair, Medicare isn't just about premiums, it's about coverage. As we saw with the recent Avastin kerfluffle [ed: you really like that word, don't you?], there's more than a little controversy about how end-of-life issues will be treated going forward. FoIB Jeff M points us to news that "Provenge, a first-of-a-kind therapy approved in April ... costs $93,000 a year and adds four months’ survival, on average, for men with incurable prostate tumors."

There are, of course, a number of questions which arise from this. The first, obviously, is the efficacy of spending nearly a hundred thousand dollars for an additional few months of life. Who gets to make this call? The patient? His family? Unaccountable government bureauweenies?

The second is how, or even if, these kinds of medications will continue to be covered. One option, of course, would be for Insurer A's Part D plan to cover it (meaning higher premiums) and Insurer B's to exclude it. That seems like a rational, free-market solution, but is that how it will unfold?

Of Gift Horses and Fine Print

"Never look a gift horse in the mouth" goes the old saw, meaning "when given a present, be grateful for your good fortune and don't look for more by examining it to assess its value." And that's often good advice. But not in the case of the little "present" given by Blue Cross of North Carolina to some of its insureds:

"Insurance Commissioner Wayne Goodwin and Blue Cross and Blue Shield of North Carolina President and CEO Brad Wilson ... a unique, one-time refund that will return $155.8 million to more than 215,000 individual BCBSNC customers as a result of the Affordable Care Act."

Now, on the surface this seems like a great deal: overpay for insurance, receive an unanticipated refund of that overpayment, and pocket the "found money."

But it's not that simple. You see, there's an interesting little caveat in that announcement, one whose long term implications seem to have flown under the radar:

"The funds come from active life reserves, which are portions of the premium set aside in the early years of a policy to pay future claims and keep rates stable as customers' medical expenses rise during the life of the policy."

Let's step back a moment, and consider the nature of insurance company "reserves." This is money that carriers are required to put away as a sort of "rainy day fund" in case their morbidity and claims estimates fall short of reality. These are generally considered very long term, since plans can theoretically stay on the books for many, many years. And as these plans age, they become less and less stable, with more and more claims arising from the shrinking pool of folks who don't "jump ship."

But ObamaCare© essentially "gifts" these plans with an exit date:

"(P)olicies purchased or substantially modified after March 23 of this year [i.e. "un-grandfathered"] will end in 2014 under the new health care reform law"

Ooops.

If your plan is one that has not been grandfathered, or has become "un"-grandfathered, it's going away in 2014. Think about the implications of that: for one thing, what happens, exactly, if you're on claim? As we saw with the nHealth kerfluffle, such circumstances don't fall under states' Guaranty plans. Theoretically, plans offered in the as-yet undefined Exchanges will be guaranteed issue, which means that one will be able to simply transition to one of those.

Theoretically. The more immediate issue, though, is noted by the Cato Institute's Mike Cannon:

"(E)very BCBS customer who is sick or becomes sick in the future will have less protection against their insurer skimping on care. Competition used to discourage insurers from providing lousy access to care, but under ObamaCare competition will reward skimping."

Still want to send Blue Cross a Thank You note?

[Hat Tip: FoIB Jeff M]

ObamaCare© for Docs

For the past week or so, Mike and I have been participating in an online ObamaCare© "event," sponsored and hosted by LexisNexis' Martindale-Hubell. It's been an opportunity for us to "strut our stuff" for a select audience of legal eagles; the "capper" was a 2-hour webinar on Wednesday, covering ObamaCare© from the perspectives of not just insurance folks, but providers as well.

It is truly scary stuff.

Surprisingly, the most important thing I learned was that it's not just the insurers that are in a tizzy. Providers are in a very bad situation: the "reform" rules hit them as much as they do the carriers. Unlike the insurers, though, many (most?) providers are small (often very small) businesses that are going to have some major tech and other expenses in short order.

My guess is that a lot of them are going to be forced to sell out to the hospitals and/or larger provider "umbrella" organizations. And look for a lot of them to drop out of all insurance networks. I'm also thinking that a lot of them - especially specialists - are going to be shedding Medicare/Medicaid patients.

Hey, a lot of folks wanted "change."

Time for a break from ObamaCare©

We'll continue to bring our readers the latest news and implications, but we certainly don't want to be seen as "All ObamaCare©, All The Time." In that vein, then, consider this:

■ Most wage earners - and even many trusted advisors - simply don't think about disability or its impact.

■ Most wage earners are not prepared for an income limiting event; nearly 40% [say] they could only pay their expenses for 3 months or less if income ceased.

■ Regardless of health and behavior, disability can happen to anyone at any time - plain and simple.

[Courtesy CDA - Council on Disability Awareness]

Concerned yet? You should be. And if you'd like to know just how concerned you should be, the CDA has posted a printable Personal Disability Quotient (PDQ) test that you can take in the privacy of your own home.

Take it for yourself, take it for your family, but take it.

Obamacare Roll Out - Good or Bad?

Today is the first day of a major change in the way health insurance is offered to the market place. Two big changes include "free" preventive care and children under the age of 19 can no longer be rejected when they apply for health insurance.

Well, kind of . . .

First let's look at a partial list of preventive care benefits that must be covered under health insurance plans issued on or after 9/23/2010 and made available at no charge to the insured.

Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked

Aspirin use for men and women of certain ages

Colorectal Cancer screening for adults over 50

Fluoride Chemoprevention supplements for children without fluoride in their water source

All totaled, the list exceeds 70 different kinds of tests or treatment that must be paid for by health insurance companies without requiring the insured policyholder to pay anything at all.

Think about this.

Over 70 items at no charge to the patient.

But Obama and his buddies expect the public to believe all of these services are not only free but will result in LOWER health insurance premiums, not higher premiums.

What blows me away are the gullible people in the media and general population that actually buy this line.

Suppose for a moment Obama had signed a law 6 months ago that requires auto insurance  companies to cover routine maintenance at no charge to the insured car owner. Think about this. If such a law existed, starting today you could get the following at no charge to you by simply showing your auto insurance card.

Routine oil changes, tune up's and wiper blades.

Tires and brakes.

Car washes.

All diagnostic testing including engine and transmission.

Shock absorbers, radiator flush, fan belts and hoses.

All at no charge to you.

Now suppose Obama told you all these things are not only available for free, but your auto insurance premiums will go down, not up, because of this.

How many would believe that line?

If you find such a claim to be incredulous, why would you believe new services will be covered under your health insurance AND your premium will drop?

Today starts another new provision. Children under the age of 19 cannot be denied health insurance coverage under Obamacrap.

Sounds good, but here is  the catch.

Try finding a health insurance company that will issue a policy on a sick child under the age of 19. Almost without exception, health insurance companies are requiring children under 19 to apply as a dependent on their parents plan. No "child only" health insurance plans.

No problem, right?

Not so fast.

Health insurance companies can and will reject the entire family application if they are not allowed to charge an adequate rate to cover the risk.

That means no one in the family can find coverage.

Think it only affects really sick kids?

Think again.

Yesterday I submitted a trial application on a father and 2 children under age 19 based on rules that go into effect today. The father takes Lipitor to control cholesterol, one child takes no medication and has no health issues,  the second child has ADD and takes Adderall.

I submitted this information to several carriers and am waiting on a response but so far two have provided an answer.

Add 20% to the fathers rate and 100% to the child rate or decline the entire application. Another said +50% on the two individuals that are taking medication or decline the entire application.

Yeah, this Obamacrap thing is working real well.

Keepin' it clean (Or not)

With few exceptions, we try very hard to keep InsureBlog "family friendly." Sometimes, though, events overtake us; as vocal (and vociferous) opponents of ObamaCare©, we strenuously object to the characterization attributed to us by Ohio Democratic Party Chairman Chris Redfern [warning: foul language]:



Soap + mouth. Some assembly required.

Obama Wants God to Sell Health Insurance

Desperate times call for desperate measures.

"With nothing else working, President Barack Obama is asking religious leaders to help him sell the public on health care reform. "

Is this guy losing it or what?

"Obama instructed faith leaders to treat the new law as settled fact and use their perches of power to convey that message to congregants and friends."

I have been under the impression that churches that use the pulpit to make political speeches are in danger of losing their tax free status. Are the rules different if the Confuser in Chief makes the request?

And you have to wonder, if his plan is so great why does he have to keep selling the public on it?

Surprise! Surprise! Surprise!

In Gomer Pyle fashion, the folks in Washington that designed Obamacrap are feigning surprise that the monster they created has unintended consequences. The L. A. Times reports:

Major health insurance companies in California and other states have decided to stop selling policies for children rather than comply with a new federal healthcare law that bars them from rejecting youngsters with preexisting medical conditions.

Anthem Blue Cross, Aetna Inc. and others will halt new child-only policies in California, Illinois, Florida, Connecticut and elsewhere as early as Thursday when provisions of the nation's new healthcare law take effect, including a requirement that insurers cover children under age 19 regardless of their health histories.

Readers of InsureBlog have been told of this issue on several occasions in the last few weeks. Perhaps if the ones who drafted this piece of junk law had been more concerned about REALLY lowering the cost of health care rather than attacking health insurance plans they would have seen this coming.

Almost everything in Obamacrap has the effect of creating less competition, not more. Higher premiums, not lower, and less affordable health insurance not more affordable health insurance plans.

The change has angered lawmakers, regulators and healthcare advocates, who say it will force more families to enroll in already strained public insurance programs such as Medi-Cal for the poor in California.

But wait!

Moving folks to Medicaid and similar programs was part of the grand design. As Mike told us a few days ago in "so you can find out what is in it", when Obamacrap completely rolls out in 2014, 89% of the uninsured will go on welfare health insurance (Medicaid).

Why the concern now, right before elections, about putting kids on SCHIP (Medicaid for children)?

Some White House officials, however, noted that families who can't find policies might be able to sign up for high-risk pools being set up around the country as part of the new healthcare law.

Kids with serious pre-existing medical conditions can sign up for PCIP as long as they go without health insurance for 6 months.

But if they are healthy they can't qualify for PCIP.

Sgt. Carter would know exactly what to say about Obamacrap.

Move it, move it, move it!

Cavalcade of Risk #114 now online Down Under

Russell Hutchinson presents this week's glorious round-up of risky posts. You'll be glad you took the chance.

Real Life ObamaCare©: A Tale of Two Clients

This past week, we've been looking at the macro; that is, some of the changes about to be wrought by ObamaCare© from a "big picture" perspective. As we head into the mini-Armegeddon that is 9/23/10, it may be instructive to now consider the micro:

Yesterday, I fielded a call from a long-time client who had some tough questions about grandfathering. He had just received a letter from his insurer offering him the one-time opportunity to re-grandfather his plan.

[ed: under ObamaCare© rules, any changes that were made between March 23rd and June 1st that "un-grandfathered" a plan could be reversed - once! - to reestablish grandfathered status]

My client asked me to explain to him why he received the letter, what it meant, and what he should do. That's one of my roles, by the way: any monkey can sell a policy, professionals understand that it's a much deeper relationship, and part of that means some hand-holding. His plan had become un-grandfathered because he changed his deductible to lower the premium after receiving his renewal in April. At the time, no one knew about this whole "grandfathering" business (hey, we had to "pass it to learn what was in it," and at 2000+ pages, it takes a while for things to become crystallized). That simple change was enough to render his plan un-grandfathered. Who knew?

I explained to him that he had two choices, neither of which was particularly attractive: he could "repair the damage," but then have to cough up the additional premium he would have paid for the intervening 6 or so months. The benefit would be that, theoretically, he would be spared some of the major rate hikes that are about to hit new ObamaCare©-compliant plans. Or he could stick with the plan as is, to which will now be added additional "benefits" he may not want or need, and the next renewal will reflect that reality.

I also spoke with a nice young single mother, whose group plan will be changing significantly on October 1 [ed: one wonders if her employer understands all the ramifications of the changes he's okayed, but he's not my client]. This young lady was underwhelmed by the new plan and its premiums, and wanted to avoid it by purchasing her own plan on the individual market. It was quite disheartening to have to tell her that she was out of luck: there are no carriers currently writing new business for families such as hers (that is, in Ohio and Georgia; YMMV). So much for "more choices and lower rates," not to mention that old saw about keeping the plan you already have.

Hope and Change, Washington style.