California Gold Rush

First we were delivered from the evil health insurance companies by Obamacrap. As originally written and signed in to law, Obamacrap prohibited health insurance companies from excluding pre-existing health insurance conditions from coverage on children under the age of 19.

And the mob was pleased.

But the clowns that wrote the law, which they never read until after it was passed, left the insurance companies an out.

Essentially the way Obamacrap was written, IF a health insurance company issued a policy on a child under the age of 19 they would be required to cover any pre-existing medical conditions.

That was a big "if".

If a condition was overly expensive to treat, creating a situation where the carrier would lose money by issuing a policy, Obamacrap allowed them to just say no.

Enter the chief clown to the rescue.

HHS Secretary Shebullshits issued a decree which applied to all carriers throughout the land. Henceforth, by command of Shebullshits, health insurance companies could not refuse to issue a policy on a child.

In essence, she created a provision by fiat that did not exist in the law.

Carriers again reacted by agreeing to issue policies on children, but only if applied as a dependent of a healthy adult.

Again the mob complained that this was not fair. To deny coverage for sick children was bad, but to require parents as part of the package wasn't right.

Enter the California goon squad to save the day. California declared it was unlawful for carriers to require parents to buy health insurance if they wanted coverage on their children.

Think about the irony for a moment.

A key provision of Obamacrap, and one that has generated the loudest protest, is the individual mandate. Once fully implemented, all citizens of this formerly free nation, will be required to buy health insurance or else pay a tax unto Caesar.

But when an insurance company seeks to apply a mandate that adults purchase health insurance in order to also cover their children, this is also considered unfair.

California officials listened to the mob and henceforth declared a mandate for adults of minor children is unjust and passed a law making the parental mandate illegal.

Just like that, the parental mandate is illegal in CA but the Obamacrap mandate is legal . . . at least for now.

But the fire sale on children's health insurance in California is about to end. When the lefty state declared that carriers MUST cover children they conceded there MIGHT be adverse selection unless a window of opportunity was created.

And that window is about to close.

The LATimes reports Cali lawmakers are urging parents to act responsibly and secure coverage for their sick children, creating, in effect, a new kind of gold rush.

The law, which took effect Jan. 1, allows parents to apply for the coverage during an open enrollment period that runs until March 1, or in the month after their children's birthdays.

"The law is only effective if parents take advantage of it

Well, duh!

So parents of sick children, apply now before it is too late.

The carriers have agreed to comply with this mandate, as if they had a choice, but have come back with their own response.

Blue Shield of California has asked for a 59% rate increase on health insurance plans.

Somehow I doubt they will be the last to ask for a significant rate increase. There is also speculation that Blue Shield will bow out of the individual health insurance market.

And so it goes . . .

ACO's - How They Work

Yesterday we learned how an Accountable Care Organization might be set up. Today we will look at an ACO in practice.

Or maybe not . . .

This Just In: ObamaLied©

Not to put too fine a point on it, of course, but here's what the (ostensibly) non-partisan Medicare Actuary just officially announced:

"[ObamaCare©] probably won't hold costs down, and it won't let everybody keep their current health insurance if they like it."

In other related news, the sun is expected to rise in the east tomorrow, and next month is expected to be February.

That is all.

ACO's - Accountable Care Organization

Accountable Care Organizations will deliver a more affordable health care system, save money, and allow Obama to be re-elected.

Well, maybe . . .

Cavalcade of Risk #123 now online

Notwithstanding blog presents this week's roundup of risk-related goodness. Take a chance and stop on by!

And please note: If your post is included, you are expected to link back.

Another One Bites the Dust

Remember that ObamaPromise© that "if you like your health insurance, you can keep your insurance?" And remember when (just 3 short months ago) The Principal and UHC put the lie to that vow? Well, it just got kicked again:

"Today, Guardian announced plans to withdraw our medical insurance product line from all states, pending regulatory approval. This means we will no longer quote any new medical insurance business and we will work to wind down our existing medical business over the next two years."

[ed: That's from an email we just received; so far, this hasn't shown up at the company website]

Around these parts, Guardian wasn't exactly a major player in the medical insurance arena, so the impact is likely to be fairly small. Still, it's one more notch in ObamaCare©'s belt.

To paraphrase Bob, "Poppa Washington: less choice, fewer carriers."

UPDATE: No sooner did I hit the "go" button on this post than another email arrived, this one from UHC:

"UnitedHealthcare Employer & Individual has entered into an agreement to renew medical insurance coverage for The Guardian Life Insurance Company of America's medical plan customers."

Does anyone else see a pattern emerging here? Is anyone else just a wee bit concerned about it?

1 + 1 = 0

As we've long since noted, one of the (unintended?) effects of ObamaCare© is a shortage of physicians. As we reported last month, "40% of doctors said they would "retire, seek a nonclinical job in health care, or seek a job or business unrelated to health care." Dr Bradley Wertheim, looking at the facts through a slightly different lens, finds that new physician training standards will exacerbate the problem:

"[S]taffing requirements further underpin the argument for 30-hour shifts and 80-hour workweeks. The problem is simple: We have too many patients and too few doctors."

In a related development, FoIB Holly R tipped us to news on the doctor-owned hospital front. Previously, we reported that the "health care overhaul law closes the door on future physician-owned hospitals;" Holly's link expands on that point:

"The construction of physician-owned hospitals, which has been halted or jeopardized due to Section 6001 of healthcare reform, could have provided $200 million in tax revenue and 30,000 jobs to local communities ..."

The point is that it's not just the doc's who are affected by this, but the architects, contractors, carpenters, plumbers ... well, you get the picture. It's a very expensive ripple effect. And it affects us health care consumers, as well: fewer hospitals means less competition, and thus higher prices. And, of course, higher health care costs means higher health insurance costs.

And it's not just those direct costs that matter. According to the Physician Hospitals of America, "physician owned hospitals pour millions into local businesses, collectively spending $4.2 billion per year, or $15 million for every community that has" one. That's a lot of economic impact, now frittered away.

Oprah, Tom and Tiger vs MLR

What do a talk show host, a movie star and a golf legend have to do with Medical Loss Ratios (MLR)? This clever video has the down low:



My only real quibble with the vid is that it continues the conflation of health care with health insurance. For a more detailed explication of MLR, be sure to check out Mike and Bob's take on the subject.

[Video Hat Tip: Avik Roy]

Health Care Reform - Walking Down Memory Lane

Been there, done that.

For those too young to remember, here is a refresher course on health insurance mandates and how it affects small (and large) business.

Godfathers is a large, small business.

Godfather stores are mostly franchises, with about 100 that are company owned. Franchise owners are small business men and women who must balance costs, including payroll, against prices they can charge in a competitive market.

Restaurants have been hit hard during this recession, and increased costs in the form of forced health insurance could very well force those businesses to close down.

Government operates on the basis of spending whatever they wish without regard to balancing a budget and the belief that if they need more money, all that is required is to raise prices (taxes).

The raising taxes part works for them because they do not have competition and they have the power to do whatever they want with impunity (except at election time).

And of course we know how well the balanced budget part is working . . .

Of course Clinton's health care plan never got off the ground, and thank God for that.

Along comes Obamacrap with the same issues as with HillaryCare but an economy that is even less able to absorb the increased taxes and job losses.

Same game, different name.

Stupid Carrier Tricks: Empty Threats Edition

Got this in email from United HealthsCare:

"All Savers will require notification from all groups at renewal, regardless of whether or not a plan change is being made."

AllSavers is UHC's latest rendition of group coverage. At renewal time, groups have several options: stay with the current (or similar) plan, change benefits, and/or shop around. Typically, a group has to respond only if it's going to make changes; absent an affirmative response to the contrary, the carrier will assume that the group wants to "let it ride."

Here, UHC is "requiring" that the group respond, regardless. To which I replied: "Or else what?"

No response is needed, of course, since they can huff and puff all they want, but they can't refuse to renew a group because said group didn't send them a form.

The good news is that this came via email, so all that was wasted were some relatively inexpensive pixels (and my time).

Wherefore art thou, Gramps?

Another ObamaPromise© under the bus:

"After health care reform was enacted on March 23, 2010, we chose to grandfather most of the medical plans in our portfolio ... Since that time, we have seen muted market interest in retaining grandfathered status."

This is from Anthem, but I suspect that other carriers share this experience. It's simple, really: all 'grandfathering" does is tie a group's hands: it can't make substantive changes to bring down rates at renewal, and it adds a whole host of complications to the renewal process itself. And, as we've mentioned, the whole phenomenon will go away in a few short cycles since groups must make changes to rein in costs, thereby "un-grandfathering" their plans.

As a result, Anthem isn't even going to go through the motions any longer. Beginning with April renewals:

"We will release all renewals as nongrandfathered plans."

Sure, they'll still offer groups the option of remaining grandfathered (as opposed to the current "default" position), but that's going to be a bit more complicated going forward, since the carrier, the agent and the group will have to determine whether any changes have already been made that would obviate grandfathered status. In fact, there's a rather extensive "laundry list" of issues that must be addressed in that process.

It's just one more (egregious) example of how ObamaCare© does not, in fact, have anything to do with managing the cost of health insurance, let alone health care.

Benefits Package #4 is up!

Jennifer Benz takes the baton from us, and presents a great roundup of benefits-related posts. Do stop by.

Windmill Tilting?

As tempting as this idea may be on paper, one wonders whether it's the least bit legit:

"Idaho's Republican-dominated Legislature now plans to use an obscure 18th century doctrine to declare President Barack Obama's signature bill null and void.

Lawmakers in six other states -- Maine, Montana, Oregon, Nebraska, Texas and Wyoming -- are also mulling "nullification" bills"

The basic premise of "nullification" is that the states themselves empower the Fed's, and that this power can be "switched off" if the latter oversteps its bounds. Even if one accepts this notion (and it's sorely tempting when it comes to ObamaCare©), it's important to recall that the Supremes swatted it down back in the 50's. That was then, of course, and this is now, but it's hard to imagine that the Supremes would renege on their own precedent.

Meantime, FoIB Holly R informs us that my own Buckeye State has also joined the lawsuit against ObamaCare©:

"Iowa, Kansas, Maine, Ohio, Wisconsin and Wyoming will join the coalition of states that have filed a lawsuit in federal court in Florida."

The plot thickens.

Cavalcade of Risk #123: Call for submissions

Notwithstanding Blog hosts next week's roundup of risk-related blogetry. Submissions are due by Monday (the 24th), and must 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.

NB: The Cav is about risk, but not necessarily or exclusively about insurance. So feel free to think outside-the-box, risk-wise.

About that RepealIt vote...

Regular readers may be wondering why we haven't yet weighed in on this historic occasion. There is no question that it represents an important first step in the abolition of ObamaCare©. Frankly, though, it's something we've been touting all along, so it's surprising to us only that the new Congress fulfilled a campaign pledge.

I do have some concerns about how one begins to undo the damage wrought so far by this train wreck. For example, will all those 20-somethings now be kicked back off mommy-and-daddy's plan? What will happen to groups and individuals who've already renewed, and are (literally) paying the increased price? Will carriers reinstate lifetime maximums and rescind first-dollar preventive care benefits?

And what about the few people that did sign up for one of the ObamaPools©? Will the states keep them in place until the cash cow runs dry, or simply fold up shop?

Mind you, none of these are earth-shattering in implication, but they are potentially messy loose ends that need to be tied up.

One last thing: despite the fact that it's now up to the Democrat-led Senate, this vote was far from merely "symbolic." The very best take on the "symbolism" comes from Cato's Mike Cannon:

"The symbolism of today’s House vote is striking. Within a year of ObamaCare’s enactment, the House of Representatives has voted overwhelmingly to repeal it.

That didn’t happen with Social Security. It didn’t happen with Medicare ...

Today’s vote makes it more likely that someone with the power to scrap ObamaCare will do so"

Amen, brother.

Silly Interweb Insurance Info

So I log off email, and see this link on the home page: "Seven Insurance Policies That Aren't Worth the Money." Intrigued, I click over, curious to see what profound wisdom is to be had.

Turns out, not much.

Here are the 7 policy types, a brief description of each, the author's take, and my own:

1. "Mini-Med" Insurance

The agent quoted here is not a fan of these policies, claiming that "(b)uyers should know that these policies are best used for minor cuts and scrapes." While I know that there are some cases where this is true, I think this brief and arrogant dismissal misses the mark: for some people, this may be the only kind of coverage for which they qualify or that they can afford.

2. Accidental Death and Dismemberment

I agree with the article that these are - at best - a waste of money. I'd also add that the AD&D rider on life insurance policies has never made sense to me, either: dead is dead, regardless of cause. And how does it make sense that your wife needs more cash if you're hit by a bus than if you die of cancer?

3. Divorce Insurance

The article's agin it; I've never even heard of it. Of course, I hadn't heard of virginity insurance before, either. The idea is that a couple buys the policy and, if they get divorced after 4 years, they get some quick cash. Uh-hunh.

4. Comprehensive or Collision Coverage for Old Cars

I'm not a P&C guy, so I asked my friend Bill M for his take. Bill's a 30+ year industry veteran, a CIC and independent agent. Here's his take:

"I advise customers to consider dropping comp and collision when the value of the vehicle hits $ 3,000 or less. At that point a minor fender bender can total your car. You also need to look at the premium charged versus the potential benefit in that decision."

5. Car Rental Insurance

Again, we turn to P&C guru Bill M:

"As far as the car rental insurance goes, you need to check your rental contract to see if you are responsible for loss of use or diminished value, two items not normally cover by your own auto insurance.

If you are going out of the country you need to check that your coverage extends to where you are going.

All of these items should be discussed with your insurance agent about your specific policy."

6. Term Life Insurance

Is term insurance really a "big waste of money" as the article claims? No more than auto, home or health insurance are: none of those pay off if you don't have a claim, either. I agree that it's often not the best choice ("permanent needs require permanent solutions" as my own mentor used to say), but if you think it's really just money down the rat-hole, consider a Return of Premium plan.

7. Mortgage Insurance

First, there is no such thing as "mortgage insurance." That's simply a marketing wrapper for folks who don't want to buy "life insurance." Second, there's no industry-standard definition of what one means by the term. The article uses it to describe a term plan that's payable to the lender. But you can make any insurance policy payable to pretty much anyone you want to. Back in the day, "mortgage insurance" was a euphemism for "decreasing term life;" that is, the face amount ostensibly declined along with one's mortgage. The premium stayed the same, though, meaning the coverage got more and more expensive with each passing year.

As they say, YMMV.

Godwin's Law and "Representative" Steve Cohen

Godwin's Law is a well-known (if often misquoted) internet meme that says:

"As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches."

Today, Democrat Representative Steve Cohen of Tennessee broke it in the real world, managing also to ignore President Obama's request for rhetorical civility:

“They say it’s a government takeover of health care, a big lie just like Goebbels ... You say it enough, you repeat the lie, you repeat the lie, and eventually, people believe it. Like blood libel. That’s the same kind of thing, blood libel. That’s the same kind of thing.”

I hereby invoke my own Absolute Moral Authority and soundly denounce the heated, hateful, fact-free and decidedly uncivil rhetoric spewed by the "Representative." It is exactly the same as left-leaning pundits comparing global warming skeptics to Holocaust deniers: it trivializes the real Holocaust and its millions of innocent victims.

It is beyond the pale that the ignorant and self-hating Mr Cohen would liken foes of ObamaCrap to those who actually killed innocents. Recently, a (non-Jewish) politician used the term "blood libel" precisely as it should have been used, both in context and in meaning. Rep Cohen, who should know better, uses it to smear political opponents who recognize that ObamaCrap is, in fact and demonstrably, a government take-over of our health care system.

Rep Cohen, you owe us an apology for this brutal and spiteful shanda.

[Hat Tip: RedState]

Doc's On ObamaCrap

A (moving) picture's worth...

[Video courtesy The Heritage Foundation]

More BS from ShecantBeSerious

What to make of this:

"The Department of Health and Human Services study ... concludes that somewhere between 50 million and 129 million non-elderly Americans have a pre-existing condition."

And?

First, way to laser in on the actual numbers there, Kathy! The forces of ObamaCare© have now given up all pretense of rational, fact-based debate and are resorting to just picking numbers out of their Pelosi's.

More critically, why is this even an issue? Either they they have such a condition or they don't. If they do, then how come, in 2000+ pages, you couldn't have given them all immediate coverage? After all, it'd be the right thing to do, wouldn't it?

But wait: you did!

Then why is it that all of these uninsured - and ostensibly uninsurable - folks aren't flocking to the ObamaPools© that have been online since last summer? After all, these wonderful new plans are guaranteed issue and cover pre-existing conditions.

Part of the answer is that, as noted above, there are no "129 million" uninsurables. It's just another example of ShecantBeSerious BS:

"While the title shouts that 129 million people could be denied coverage, the so-called study defines preexisting conditions to include those “that would result in an automatic denial of coverage, exclusion of the condition, or higher premiums.”

Catch that little sleight of hand?

Here it is in slo-mo:

"... the so-called study defines preexisting conditions ... “that would result in an automatic denial of coverage, exclusion of the condition, or higher premiums.”

An exclusion is not a denial, and in the real world, an increased premium is called "pricing the risk." So they're not even competent at making it up. And we're supposed to trust these clowns to actually run our health care system?

What could go wrong?

Avik Roy has his own tremendous takedown of this ShecantBeSerious BS, including this must read insight:

"Sebelius and her HHS colleagues try to morph the definition of “preexisting conditions” into “conditions.” Take this random sample of Sebelius’ assault on the English language:

An analysis of a survey that follows people over time found that, among healthy people—reporting very good or excellent health with no chronic conditions—today, 15 to 30 percent (depending on their age) will develop a pre-existing condition within the next eight years.

So, let’s get this straight. Fifteen to 30 percent of Americans will, in the future, develop a preexisting condition. This only makes sense if the HHS has also invented time travel.

A person who has health insurance, and later becomes ill, does not have a preexisting condition. He has a condition of the plain old “existing” kind—one that his insurance will help pay for. This is exactly how insurance is supposed to work."

Read the whole thing.

Death and Taxes (But Mostly Taxes)

As might be expected, we tend to look at the insurance (and health) aspects of ObamaCare©, but as Bob's pointed out, there are some pretty significant tax issues, as well. Some are hidden, of course, but two readers, Bob D and Sam B, have drawn our attention to some of the more overt tax increases contained in the bill we had to pass to see. As we've discussed before, the (Evil) Individual Mandate is a tax, as is the (Stupid) 1099 Rule. But these are only two examples of the tax perfidy to which we're about to be treated. Here's a handy cheat sheet to many others:

Last year saw a $2.7 billion tax on indoor tanning, and a $22 billion hit on drug innovation companies.

This year will see the implementation of a $5 billion "Medicine Cabinet Tax" (on generic med's under HSA, FSA and HRA plans) coupled with a $1.4 billion spike in HSA withdrawal penalties. We'll also be treated to the new Employer reporting requirements (more on this issue here).

In '12, we'll see the roll-out of much-despised and derided "Corporate 1099-MISC Information Reporting" requirement, expected to cost over $17 billion.

2013 looks to be a "banner year" for ObamaTaxes©: we'll see the $123 billion Surtax on Investment Income [ed: which has to do with healthcare, how?], an $86.8 billion increase in the Medicare Payroll Tax, a new cap on Flexible Spending Accounts as they relate to special needs kids (why does Barry hate the children?), a $20 billion tax on manufacturers of medical devices (why does Barry hate sick people?), an increase in the itemized deduction requirements that's expected to cost taxpayers an additional $15 billion, along with the elimination of the deduction for employer-provided prescription med benefits that looks to cost $4.5 billion.

Looking ahead to 2014, we see the much anticipated (and Evil) Individual and Employer Mandates in full swing, along with a new tax on certain insurers. That last little goody's looking to cost insurers $60 billion. Wait, did I say "cost insurers?" Just kidding! It looks to cost insureds $60 billion.

And waaay down the road - 2018, to be exact - we have a shiny new, $32 billion Excise Tax to look forward to.

Isn't it grand that we had to pass it to learn all this?

Grand Rounds is up...

George Van Antwerp hosts an engaging 'Rounds, focusing on patients' access to and understanding of health care.

You say that like it's a *bad* thing!

Quick, who said this:

"(P)romising fundamental changes to the country's expensive and over-stressed ... health care system ... the reforms would cut red tape and improve treatment, but critics claim they will cause chaos ..."

Nope, not BarryNancyHarry. This is "The New MVNHS©" and it's the rallying cry of Prime Minister David Cameron. The primary issue seems familiar: who's in charge of health care decision-making, the docs or the bureaucrats? Currently, it's the latter, but that could change:

"(B)y giving control over management to family practitioners rather than bureaucrats, and allow private companies, charities and social enterprises to bid for contracts within the public health service ... Making health care more efficient ..."

Heh.

So at a time that many here want to see us adopting a British-type system, the Brits themselves are seriously considering scrapping it? Wow!

Worse yet (from our own statists' perspective) is that Mr C is taking direct aim at those self-same bureaucrats:

"Cameron promised to get rid of "topdown, command-and-control bureaucracy and targets."

Whoa there, fella, that's some dangerous rhetoric.

For those who continue to deplore the (alleged) 17% of our GDP that goes to health care, keep this little number in mind:

"The health service is Britain's biggest employer, costs more than 100 billion pounds ($158 billion) a year." [emphasis added]

Looks like that ostensibly superior health care scheme hasn't been any more successful at reining in health care costs (or demands) than we have.

The MVNHS© Strikes Again. And Again.

No, these aren't the opening sentences of a bad prose contest, they're for real:

"It was a bitterly cold night in January when Geraldine Weller gave birth in the car park of a London hospital. Three hours earlier, the maternity unit had sent her away."

The good news is that Mrs Weller (the article points out that this isn't her real name) and her baby survived the ordeal, no thanks to the understaffed facility. Her story is just one of thousands in similar straits, though, all because the "world class" health care scheme is ill-prepared and ill-equipped. And it's getting worse:

"(A)n investigation by The Sunday Telegraph discloses widespread fears among health professionals that maternity services are sliding into crisis, as small units close, and funding fails to keep up with a decade-long baby boom."

Ooops.

As mentioned, the baby survived (no thanks to the MVNHS©), but it's not all sunshine and lollipops. Heaven forfend that the poor child catch a nasty germ; as we pointed out last month, the Brits' health care "safety net' has some rather conspicuous holes:

"The NHS Direct helpline is at ‘breaking point’ as parts of Britain experience the worst flu outbreak in a decade."

But that's okay, the system's first response is "to do no harm." Right?

Thanks to Mike, we know the answer and it's "um, not so much:"

"Healthy people buying the flu jab have compounded shortages in the NHS and left those at greatest risk struggling to get the vaccine, claimed Dr Clare Gerada, the chairman of the Royal College of GPs."

Their solution? Well, regular readers know what's coming next:

"Dr Gerada said that allowing those who could afford it to buy the jab had upset the “delicate balance” of availability and contributed to shortages ... healthy individuals who had paid to have the jab on a private patient basis at pharmacies shared some of the blame for the shortages."

See, if you're not part of the solution, you're the problem.

And if you are part of the solution, you're still the problem.

Exit question from Mike: "Say, wasn't UK all worried about not enough people getting vaccinated?"

Blues vs Shecantbeserious: The Plot Thickens

Last week, we reported that the California Blues were playing a bit of "chicken" with their rate hike request. To wit, an astounding 59% increase in premiums. The Golden State's Department of Insurance responded by asking the carrier (and others) to delay their proposed increases for two months, but lacks any enforcement powers to make them comply. Which turns out to be a good thing, given this:

"The company said it expects to lose $20 million to $30 million this year on individual policies."

Ouch.

But how could that be, since ObamaCare© promised to lower health care costs?

Well, not so much:

"In the past three years, the company said, its costs for hospitals, physicians and prescription drugs have risen by an average of 15 percent annually."

That's 45% right there; add in another 10 or 15 points or so since the advent of ObamaCare© last September, and Bob's your uncle. It's not a stretch, then, to see how these numbers make sense. The ball is now in Ms Shecantbeserious' court: does she have the will, let alone the means, to derail these increases?

Time will tell.

RepealIt Update [UPDATED & BUMPED]

The House vote to repeal ObamaCare© is back on track:

"As the White House noted, it is important for Congress to get back to work, and to that end we will resume thoughtful consideration of the health care bill next week"

Meantime, the forces of the 10th Amendment continue to march on the judicial front:

"That brings the number of states on the Florida suit to 23 and the total number of states suing to stop Obamacare (which includes Virginia and Oklahoma) to 25."

The misleading headline is most likely due to a rounding error (after all, 25 is less than half of 57).

UPDATE: And now Dorothy, Toto and the gang are joining in the fun, too:

"The state of Kansas recently asked to join the lawsuit challenging the constitutionality of the Obama health care plan filed by 20 state governments ... That brings the total number of state governments litigating against the plan to twenty-six."

Granted, that's still less than half of the 57, but it's getting closer.

And, oh yeah: "Ohio, Wisconsin, and Wyoming are also seeking to join the multistate lawsuit, while Virginia and Oklahoma have filed separate challenges to the law."

Isn't that called "piling on?"

California DOI: FAIL!

This is hysterical:

"Dave Jones, the new California insurance commissioners, is asking big carriers to refrain from increasing premiums for at least 60 days after the effective dates of their most recent rate filings."

Remember, it was folks like Mr Jones who rushed ObamaCrap through Congress, and now he wants to slow things down? Hey Davey: Why don't you approve the rate hikes so you can see what's in them?

Heh.

Good on the MVNHS©!

It appears that the Much Vaunted National Health Service© has learned a lesson from us Colonials:

"The lives of more than 5,000 cancer sufferers will be saved each year under an £800 million [about $1.25 Billion] government drive to make England’s survival rates among the best in Europe ... Under the plans, GPs will be given the power to order a range of cancer tests direct from hospitals without having to refer the patient first to a consultant."

It's true that there are still a few plans here in the States that require such a referral, but a) they're few and far between and, b) one isn't forced to buy such plans (yet). It's also true that our cancer survival rates soar above our Cousins Across the Ponds'. On the downside, that 5,000 survivors apparently represents about one third of 1% of those who might otherwise succumb. Baby steps and all that.

In the event, about $15 million of that total will go towards encouraging folks to "see their doctor sooner if they develop symptoms." Sounds sensible.

Cavalcade of Risk #122 now up!

David Williams presents this week's roundup of risky posts. Take a chance and stop on by! And please note: If your post is included, you are expected to link back to the Cav in a timely manner.

On the Oregon Trail

FoIB Holly R forwarded the link to this story, about which I can only ask "on what planet is Hannah Wallace living?" It is so full of inconsistencies and outright misinformation, one wonders how The Onion could possibly do better.

Let's start at the beginning, shall we?

"For a writer living in New York state, there were plenty of reasonably priced plans"

Really? The actual numbers tell a different story.

Ms Wallace continues apace:

"That’s largely because in Oregon, “medical underwriting”—during which insurance companies cherry-pick healthier customers ... it’s one of five states with so-called “guaranteed-issue” laws that mandate insurance companies cover anybody regardless of health status."

(See above)

“The last thing we want to be doing as a state is hampering that sector with high insurance costs. It’s exactly the wrong way to stimulate the economy ... Yet this is precisely what Oregon is doing by not providing affordable health insurance options."

We've written about Oregon's insurance situation before; they have a very effective (if lethal) way of dealing with increased health care costs (which, of course, drive health insurance costs).

But wait, there's more!

"The only plan I can find here that would cover my pre-existing condition costs more than half my rent"

This is another of those little "throwaway" canards that's never made any sense to me: what does one's rent have to do with one's insurance? If Ms Wallace lived with her parents, then her insurance would be infinitely higher than her rent, yet that is no more meaningless (or meaningful) than her comparison.

She continues:

"I don’t want just so I don’t become one of the 51 million Americans who are uninsured."

And again with the oft-debunked number of uninsured (anyone else notice how that number keeps growing, despite the advent of wonderful ObamaCare©?). It's a bogus number to begin with; that it keeps growing is itself a wonder.

Are we done yet? Of course not:

“What really needs to happen for you is that it needs to be 2014 ... when the new Patient Protection and Affordable Care Act ... will eventually force insurance companies to cover everyone, pre-existing conditions or not. They have had to cover sick children since September; adults, however, have to wait until January 1, 2014—three long years away."

Except they haven't; healthy kids hardest hit. And if you want to see what's in store for '14, you need look no farther than the current ObamaPool© programs. These are guaranteed issue plans which cover all pre-existing conditions (sound familiar, Hannah?), yet their reception has been, well, underwhelming. Why would any rational person believe that's going to change in 3 years?

Bu the very best (well, funniest) line comes near the end:

"For freelancers ... Massachusetts is mecca"

Oh, absolutely, it's just been so successful! If that's Mecca, then one shudders to think what Armageddon looks like.

Grand Rounds: It's (Not Really) Complicated

Tony Chen presents an outstanding edition of Grand Rounds. It's obvious that he's read every submission, and worked hard to make them flow together (no mean feat when you consider subjects from diabetes to autism). Best of all, it's not overly long (as these things can grow to be), so it's easy to read through.

ObamaCare© Repeal Update

The vote on the (aptly named) "Repealing the Job-Killing Health Care Law Act" has been postponed due to Saturday's tragedy in Tucson.

There is no question that the events over the weekend were horrific, but I have to question whether this is an appropriate response. I'd be very interested in our readers' take on this:

Should Congress postpone the vote to repeal ObamaCare©?

• 
  
  Yes


• 
  
  No

view results
Free vote poll

Ohio Department of Insurance News: Update

FoIB Holly R just dashed my hopes....er, alerted us to this new development:

"In his first official acts as governor after the inauguration, Kasich named Lt. Gov. Mary Taylor director of the Ohio Department of Insurance..."

Mazel Tov, Mary!

The Blues play chicken with Shecantbeserious

The term "neener-neener!" comes to mind:

"Another big California health insurer has stunned individual policyholders ... this time it's Blue Shield of California seeking cumulative hikes of as much as 59%."

But, but, but:

"HHS will require that health insurance companies “disclose and justify any rate increases of 10 percent or more.”

What to do, what to do.

Well, as Mike pointed out in his post, "rate hearings will also remind people in every state what a fraud the government has perpetrated in claiming to have "reformed" health care." And hearings there will be:

"[Newly elected CA Insurance Commissioner Dave] Jones said the Blue Shield move underscored the need for the Legislature to give the insurance commissioner legal authority to regulate insurance rates the same way he does automobile coverage.

At present, the commissioner can block increases only if insurers spend less than 70% of premium income on claims. Jones' office said Blue Shield's March 1 increase was under review."

There we go again, comparing health insurance and auto insurance. They are not the same, and their rate structures are based on very different methodologies. Not to mention the fact that auto policies aren't (currently) required to cover oil changes and tune-ups. What do you think would happen to auto rates if (when?) they do?

The bigger issue, of course, is "why?" The Blues claim that "the increases were the result of fast-rising healthcare costs and other expenses resulting from new healthcare laws." But of course that can't be true: after all, the folks who passed the bill so that we could see what's in it promised us that it would result in lower, not higher, insurance costs.

The wheels on the bus go thump-thump-thump.

The Benefits Package: New Year's Edition

Welcome to the first Benefits Package of the new year (and, indeed, of the new decade). We're grateful to Evan for the opportunity to be the first "non-Evan" hosts, and to this week's participants for sharing their insights and ideas.

I'm also pleased to help launch a new "niche carnival;" that is, one with a more narrowly defined focus. It seems to me that these smaller versions are less intimidating for hosts and readers alike. Certainly, it's a lot easier to edit and post a carnival with 8 or 10 (or a dozen!) entries than some of the "big boys." So if you're even remotely interested in hosting a future edition, please drop Evan a note: I guarantee you you'll find it a simple, yet rewarding, experience.

And now, on with the show:

■ David Kerrigan looks under the hood at what, exactly, drives the decision to keep or change group insurance carriers. You may be surprised at the role played by network size.

■ The Cato Institute's Michael Cannon wonders if the administration is perhaps playing fast and lose with their numbers-crunching, at least regarding how it deals with expenditures and the private sector. Great food for thought.

■ Anne Freedman combines some (scary) statistics with good old-fashioned common sense as she explores the growing problem of an aging work-force. Specifically, older workers may be playing an outsized role in keeping out "new blood." This doesn't bode well for our current unemployment situation.

■ Only David Williams could combine coupons, bullets and FuzzBusters and come up with an intriguing post on why it's bad policy for drug companies to make your co-payment for you.

■ Benefits Package founder (and uber-wonk blogger) Evan Falchuk shares some important lessons he learned from a group of Longhorn business folks. He's careful to point out that it's less prediction than recognition.

■ Another great health policy wonk, David Harlow, takes aim at Jeff Goldsmith's recent article on Accountable Care Organizations (ACO's). While acknowledging that Mr G makes some valid points, David's convinced that the basic ACO model is still salvageable.

■ Jennifer Benz and Ed Bray provide us with a handy two-minute overview of PPACA (known around these parts as ObamaCare©); just the ticket when the boss asks "what's this all about?" It's handy, brief and timely.

■ There's no question that prescription drug prices play a key role in how much we pay for health benefits. George Van Antwerp lays out the case for efficient innovation in how PBM's (Pharmacy Benefits Managers) market themselves to demonstrate the value they bring to the table.

■ Just as pharmacy benefits impact the cost of health care, so may improved utilization of Information Technology (IT). Blogging at Action for Better Healthcare, Kester Freeman reports on a new IT initiative currently underway by IBM and Premier Health Alliance that hopes to effectively address the issue.

■ As Keith McMurdy explains, pension benefits are also affected by the current economic downturn, and could lead to a "withdrawal liability" problem.

■ In our own contribution, we discuss how some employers are going mental over mandates.

And that wraps up the Benefits Package, Third Edition. Be sure to stop by Jennifer Benz's place on the 24th for the next exciting installment!

CBO Yo-Yo

Have you ever watched a game of Ping-Pong? Your head constantly swivels back-and-forth, following the ball as it (hopefully) passes over the net. That's kinda how it feels watching the Congressional Budget Office (CBO) whipsaw over how much repealing ObamaCare© will cost.

Er, save:

"The Congressional Budget Office, in an email to Capitol Hill staffers... has said that repealing the national health care law would reduce net spending by $540 billion in the ten year period from 2012 through 2021 ... Repealing the bill would also eliminate $770 billion in taxes."

The email comes in response to a request from Rep Paul Ryan (R-WI) that the CBO "score" the bill without all the double-counting of revenue and taxes that marked its initial take on the Repealing the Job-Killing Health Care Law Act on which we reported yesterday.

Anyone know if ObamaCare© covers whiplash?

ObamaCare©: "Wait" for it....

Courtesy of the "evil" folks at Anthem, we learn about a few more gotcha's in the bill we had to pass to see. In health insurance, there are two very important, and different, uses of the term "waiting period." One refers to how long a carrier can put off covering pre-existing conditions, and the other to how long an employer can put off adding a new employee to an existing plan.

First, regarding pre-ex, we already know that policies with plan years that begin (or renew) after last September can no longer apply a waiting period for "the children" (under age 19). Insureds 19 years or older may still be subject to such a wait.

Beginning in '14, of course, no such waiting periods are allowed. I'm sure that will lead to reduced premiums, right?

As to those waiting periods for group eligibility, also beginning in '14, the waiting period is capped at 90 days (this is currently the law in Ohio, anyway, so no change here). Interestingly, the "employer fine" calculation isn't applicable during that waiting period (so long as it's no more than 90 days).

Frankly, this provision doesn't really strike me as too onerous: after all, either the new guy's going to work out in 3 months, or he's not. Extending the waiting period beyond 90 days doesn't seem critical.

Benefits Package due to arrive here on the 10th [BUMPED]

We're pleased as punch to host the next edition of the new Benefits Package blog "carnival," conceived and developed by our friend Evan Falchuk. Look for it here next Monday (the 10th).

What's the Benefits Package all about?

Glad you asked!

It's a bi-weekly round-up of the best posts in health-benefits blogging. Participation is encouraged, so if you're a benefits blogger, here's the scoop, via EPS (Evan's Package Service):

Your Benefits Package is scheduled for delivery on Monday, January 10, 2011. In order to ensure proper contents, please check the packaging material for the
following:

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

Please email your package's contents [Sorry, the deadline for BP#3 has passed] no later than today (January 7th) to ensure timely delivery.

Thanks, and Happy New Year!

Um, about that CBO blogpost

A number of polibloggers have seized on this claim by the Director of the Congressional Budget Office (CBO) regarding appeal of ObamaCare©:

"(W)e expect that repealing that legislation would increase budget deficits."

Of course, they leave out the back-pedaling and obfuscation part:

"The administration's chief actuary predicts that the federal government and the country will spend $310 billion more under Obamacare than we would have without the new law"

Fine, but what strikes me as most interesting is this: the previous Congress, lead exclusively by the Democrat party, managed to rack up more debt than all the previous Congresses, combined!

And now they're worried about deficits?

There's your new definition of "chutzpah."

[Hat Tip: FoIB Holly R]

Cavalcade of Risk #122 Call for submissions

David Williams hosts next week's CavRisk. welcoming in the New Year with new risks. Submissions are due by Monday (the 10th). David asks that you 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.

NB: The Cav is about risk, but not necessarily or exclusively about insurance. So feel free to think outside-the-box (e.g. driving and texting, the environment, vaccination, etc).

ObamaCare© Overreach

Once again, this administration just doesn't seem to understand its own limits. At a time when "(n)early half of voters with health insurance do not believe President Obama’s promise that they will be able to keep it under the new healthcare reform law," the rocket surgeons behind ObamaCare© think it's a good idea to not only expand federal regulation of health insurance (a blatantly unlawful move), but to exacerbate that awful decision by folding the "health reform office charged with overseeing the insurance ... into the federal Medicare agency."

Brilliant!

But of course they've tapped someone with a deep and exhaustive knowledge of insurance principles and the impact this could have on our ability to manage our care, right?

Sure they did:

"The Office of Consumer Information and Insurance Oversight was created to guide the implementation of key parts of the health overhaul law. Its director, Jay Angoff, a class-action litigator who took on insurance companies..." [emphasis added]

Oh goody: we get the love-child of HHS Secretary Shecantbeserious and John Edwards.

What could go wrong?

Health Wonk Review: Auld Acquaintance edition

The Apothecary's Avik Roy hosts this week's outstanding edition of the HWR. As fellow blogger David Williams puts it, " this is exactly the way to host a blog carnival: well-organized classification of the posts, synopsis of each, thoughtful commentary and context, not too cutesy."

Ditto!

Heh: We get results!

Less than two weeks ago, we blew the whistle on the new Medicare Death Panels. Well, FoIB Holly R tips us that "(t)he Obama administration ... will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations."

The Gray Lady is spinning this like a whirling dervish, but the bottom line is that this ghoulish program has been busted. You're welcome.

And speaking of spinning, here's more of your tax dollars at work shilling for ObamaCrap:

"Try typing "Obamacare" into Google, and you'll find that the first entry is now the Obama administration's www.healthcare.gov ... You'll get the same paid-for result if you type in "Obamacare facts," "Obamacare summary," "Obamacare info ..."

And the list goes on. These people have no shame: whether it's spending tax dollars for Matlock to pimp for Medicare cuts, or this waste of taxpayer dollars, HHS Secretary Shecantbeserious and her henchmen just don't care.

AARP Waivermania

We've long noted AARP's disingenuous (some would say hypocritical) support of ObamaCare©. Well, on a tip from FoIB Bob D, we learn about the quid-pro-quo:

"While other health policies must go through a rigorous rate review under ObamaCare and justify any premium increases of more than 10 percent, AARP's Medigap policies are to be exempt from the federal review and restriction."

[ed: For an explication of that "more than 10%," see Mike's excellent analysis here]

One presumes that 10% is equal to 30 pieces of silver.

Brett Baier has more:

65 Outstanding Words

When we (virtually) cornered incoming Speaker of the House John Boehner (R-OH) last November, we asked him a rather pointed question:

"Mr. Speaker ...Did you really mean what you said about rolling back the toxic Democrat agenda, do you get what the Tea Party movement is really about, and if so, what will be your very first agenda item to defund and declaw ObamaCare? "

Little did we know that he'd answer us (and Sen Reid, et al) so unequivocally:

"Senators Reid, Durbin, Schumer, Murray and Stabenow:

Thank you for reminding us – and the American people – of the backroom deal that you struck behind closed doors with ‘Big Pharma,’ resulting in bigger profits for the drug companies, and higher prescription drug costs for 33 million seniors enrolled in Medicare Part D, at a cost to the taxpayers of $42.6 billion.

The House is going to pass legislation to repeal that now. You’re welcome."

Nice.

[Hat Tip: RedState]

Ohio Insurance News Update

No surprise here, really, but current DOI Director Mary Jo Hudson is bailing effective next Monday (the 10th). In Ohio, the DDOI is an appointed position (Hi, John! Sure, I'd love that slot!); MJ, a Miami University grad (just like me!) was named to her current position by then-Governor Ted Strickland.

No word yet on who will take her place, but knowledgeable sources tell me that keeping the MU-grad tradition going is considered paramount (did I mention that I'm an alum?), as is well-rounded experience in the field (such as, but not limited to, continuing education provider, veteran agent, outstanding blogger).

We'll keep you posted.

STOLI Ooops!

A few weeks ago, we wrote about the newest "twist" in Stranger Owned Life Insurance (STOLI). One of the conclusions we drew was that the only real "losers" in these schemes were "the poor saps who bought into this idea, and forked over $50,000 (minimum!) to do so."

We stand corrected:

"New investor lawsuits are emerging amid the wreckage of an investment boom in life-insurance policies that spectacularly collapsed ... Since the bust in the market, insurers have portrayed themselves as the victims."

[ed: the rest of the story is behind a $link]

And, having played the victim card, they're raising the stakes: over the past couple of years, insurers have filed hundreds of suits and agitated state regulators to clamp down on these after-market sales. Their rationale is that the actuarial assumptions on which these plans were based are somehow negated by the change in ownership of the plans.

I call BS: the nature of the risk hasn't changed one iota; John Doe is still John Doe, and his health and mortality risk is what it is regardless of who owns the policy. The idea that he'll meet an untimely demise at the hands of an unhappy investor is silly; the law's very clear that one can't profit from one's crimes in that way.

And of course, it's not just the insurers playing that card, "suits also have been filed by relatives of some of the deceased elderly, alleging that death benefits belong to the family members."

No, they do not. The death benefit belongs to the named beneficiary, which may well have been a family member (or members), but the owner of the policy makes that call, not his kids. Yes, an "irrevocable beneficiary" would have those rights, but then if there was such, the transaction couldn't have been completed in the first place.

And then there's this egregious misstatement: "State insurable-interest laws require an insurance buyer to have a bigger stake in the insured person's continued well-being than in his death."

No, they don't: "insurable interest" is only relevant at the time of application. Once the policy is issued, it is no longer relevant, or applicable. It's Insurance 101 stuff, and the media can't even get that right.

Now, as to the propriety and/or appropriateness of these schemes, I'll leave that to our readers' sensitivities. But the bottom line is that there's nothing inherently illegal, immoral or fattening about them.

[Hat Tip: FoIB Holly R]

MVNHS©: "Hello, Tech Support?"

Behold the new face of the Much Vaunted National Health System©:

"The NHS should move more call centres and offices to India if it wants to beat the spending cuts, a key government health adviser has claimed."

Leaving aside all the inevitable tech support jokes, the move would have the benefit of potentially lowering the cost of health care delivery under the financially-strapped MVNHS©. According to that "key advisor," the problem isn't the quality of the sub-continent's workers, but a reluctance among the Brits to discuss personal health issues, and make doctor appointments, with "foreign operators." The upside, though, is a projected savings of over $30 billion.

Such moves are nothing new on this side of The Pond: as Bob noted over 4 years ago, "In an effort to hold down costs, hospitals and other medical practices are outsourcing certain functions half way around the globe." Aside from privacy and HIPAA concerns, there's the potential for security breaches. But these are, perhaps, offset by cost savings and efficiencies of scale. Of course, a key difference here is that, should such a security problem arise, our legal system is available for remedies. The Brits', though, are stuck with a government-run system which is much more difficult to prosecute.

Have a nice day!

Are ya ready for some Grand Rounds?!

Glenn Laffel has the play-by-play of great year-end medblog posts. Grab a dog and a brew, and root for your favorite teams, er, bloggers.

It's On (ObamaCare© Repeal)! [UPDATED]

I'll leave it to the polibloggers to dissect the partisan aspects of this (not to mention its viability), but a few thoughts strike me. That it will pass the House, I have little doubt. Once it hits the Upper Body, however, it faces (at least) two significant parliamentary hurdles:

1) 61 votes to invoke cloture

2) 50+1 votes to pass

If the first is accomplished, what doubt is there of the second?

But as to that second, the calculus is, um, interesting:

There are now 47 Republicans in the Senate. If one assumes (and this is, perhaps, a leap of faith) that they vote en bloc, they're still 4 shy of the required 51 votes to pass. So the question becomes: are there perhaps 4 Democrat Senators, facing re-election either 2 or 4 years hence, who can be persuaded to vote for repeal?

ADDED: Saw this at one of the aforementioned polibloggers:

"Eliminate the exemptions. That will make them squeal."

Yup.

COURTESY OF MICHELLE MALKIN: The "ObamaCare© Waiver For The Rest Of Us" bill:



HR__-Repeal -

What the heck is VBID?

Caution: extreme wonkery ahead. Which is not to say that that there's extreme clarity ahead: after all, on what planet does this phrase make sense:

"Value-based insurance design (VBID) has emerged as an important tool for tamping down health care spending by lowering consumer cost-sharing."

Get that? Spend more, cost less.

But that's the kind of mental gymnastics in which the folks behind ObamaCare© must engage. It's basic economics: make something more available and cheaper, and demand will rise. When demand rises, one of two things will occur:

One, prices will continue to decline (e.g. e-Books, flat-screen TV's), or

Two, prices will increase (e.g. insurance, health care)

Which path a given product will follow is a function, as Bob's pointed out, of its "elasticity:"

"Sugar has price elasticity. As the price of sugar rises, demand decreases since there are substitutes for sugar ... Gasoline is inelastic ... At this time, there really is no substitute for gasoline."

Same for health care: there is no "substitute" for it, like Equal or Truvia (or honey, for that matter). When you remove an insured's "skin in the game," their own share in the cost, then there's no reason for the consumer to refrain from accessing the benefit. The problem is that there is a finite, and steadily shrinking, supply of providers who can, well, provide these services. Short of capping physicians' wages (and who believes that this is beyond the pale when it comes to HHS Secretary Shecantbeserious?), how does increasing the demand for health care translate to lowering its cost?

And so I would propose a somewhat more accurate translation for the aforementioned acronym: Very Bad Idea, Dimwits.

Ringing in the New Year

Upon opening my email this morning, I was greeted with the following. A young lady had visited my site a few days ago and ran rates on health insurance. We were unable to connect by phone but she wanted to make sure I was aware of her interest, therefore her email.

I'm 30 need health INS but I have asthma and a hyper thyroid, so no INS will cover me fully, I would need everything to be mostly covered

Asthma comes in various forms and can be very expensive to treat. As such, carriers that are still able to issue exclusionary riders for the condition usually will do so to keep the premium affordable.

Those who do not offer riders will calculate the maximum rate up and determine if the new premium is sufficient to cover the risk. If so, they will make an offer. If not, they will decline the application.

Sometimes people tell me they have hyperthyroid when in fact it is hypothyroid, a distinctly different condition. Normally I would ask which they have, but under the new Obamacrap reduced compensation levels, I no longer have the luxury of taking the time for an extensive dialogue.

Plus, I assume this is her illness, so she should know which she has.

Hyperthyroid can lead to a host of symptoms and related conditions including muscular weakness, considerable weight loss and rapid heart beat.

Because of the complexity of hyperthyroid, the range of treatment protocol and potential side effects of a "run away thryroid", most carriers will decline the application and I told her what she would encounter.

Her response follows:

Which is why I will die young from heart disease like my mom did at 49 yes old. cause this country doesn't care! thanks anyway'

This type of response is somewhat typical and I usually just ignore it and block their email. No sense in ruining my day, or year.

Instead, I simply sent her a link to the Obamacrap risk pool . . . and then blocked her email address.