Long Term Care and Life Insurance

Recently the Wall Street Journal had a "Family Value" item on policies combining life and long term care insurance. Often referred to as "hybrids," the premise is that one can avoid future rate increases, and guarantee that someone gets some money out of the insurance company.

The article bothered me, and I couldn't quite put my finger on why that was the case, so I turned to our on-call Long Term Care insurance (LTCi) guru Herman Bruns:

The writer is somewhat confused in her terminology: when the term "hybrid" was coined for LTCi plans, it was more for permanent life plans that would triple, quadruple, etc the death benefit if you ever needed LTC, and give you all your money back if you changed your mind. She does not appear to refer to these at all.

Eventually, some carriers got smart and took the accelerated death benefit feature that has long been around, and tweaked it into a LTC rider that allowed you to accelerate the death benefit if a long term care need developed. This seems to be more what she is referring to. The insurance company is just potentially paying out a death claim early at a predetermined payment schedule.

The latter choice (with the rider), which I do *not* call a hybrid, still gives you a reasonably cost-effective permanent life insurance policy....as opposed to an overpriced life policy in the case of a true hybrid. The hybrids want the big up front, single premium payment, whereas the life plans with the riders can be paid just like any other life plan: as you go.

The general problem with life insurance policies as a LTC solution is that you have to buy two polices to protect a couple; that is, there is no such thing as a "shared" life plan. I have seen no second to die plans that come with LTC riders so far. You have to qualify for the life insurance medically, so sometimes you can get LTC and not life, and vice versa.

Bottom line is that there is a place for all these products.

Thanks, Herman!

Health Wonk Review: Surprise, it's October!

FoIB David Williams presents this week's collection of wonky posts, heavily influenced by the recent Presidential debate. If that's not your thing, though, don't fret - there's lots of other interesting info, as well.

Light Another Candle

under the Obamacare birth control mandate.

The Roman Catholic Archdiocese of Atlanta has joined dozens of other religious institutions to have filed lawsuits seeking to overturn the so-called birth control mandate in the Patient Protection and Affordable Care Act.

The archdiocese’s suit, filed in U.S. District Court in Atlanta, said the institution seeks to vindicate one of the country’s most fundamental freedoms — the right to practice one’s religion without governmental interference. The government is trying to penalize all Catholic entities that refuse to pay for or facilitate access to abortion-inducing drugs, sterilization and contraception, the suit said.

Christ the King Catholic School, Catholic Charities of the Archdiocese of Atlanta and the Roman Catholic Archdiocese of Savannah are also plaintiffs in the litigation. It was filed against the Labor, Treasury and Health and Human Services departments.

“We are undertaking this action because the stakes are so incredibly high,” Wilton Gregory, Archbishop of Atlanta, said. “… The unchallenged results of the [Health and Human Services] mandate would require that we compromise or violate our religious faith and ethical beliefs.”

AJC, "Archdiocese files suit"

Of course the Obama administration would say they required birth control because it was the right thing to do . . .

Unfortunate Agent Tricks

And yeah, that "tricks" is a double entendre. From upscale Kennebunk, Maine:

"[A] local fitness instructor who's been charged with running a prostitution business out of her Zumba dance studio and secretly videotaping her encounters ... her business partner, 57-year-old Mark Strong Sr., pleaded not guilty to 59 counts of promotion of prostitution and violation of privacy."



And what does this have to do with insurance? Well, "[t]he Strong Agency is an automobile, home and commercial insurance business located in Thomaston" whose owner (the aforementioned Mr Strong) has "pleaded not guilty to 59 counts of promotion of prostitution and violation of privacy."

One wonders if his E&O (Errors and Omissions) policy covers that.

Obamacare Pink Slips

If your employer is Blue you may soon be getting a pink slip. Blue Cross Blue Shield of TN is cutting 100 jobs and will not be filling another 100 vacancies due to Obamacare MLR requirements.

"Our sincere hope was to cut costs without impacting people, but this was a tough decision that we could not avoid," said Bill Gracey, CEO-elect for BlueCross. "The health insurance industry is undergoing tremendous changes. It is growing more competitive by the day, and we are facing unprecedented challenges that require us to operate more efficiently."

Specifically, the release cities the Affordable Care Act's medical loss ratio (MLR) restriction and new $200-million-plus annual excise tax that BlueCross will have to pay starting in 2014.

Bizjournals, "Blue Cross TN cutting jobs"

Doesn't that make you see red?

Medicare :: ObamaTax

One of the major problems with government-run healthcare schemes (such as, say, Medicare or the ObamaTax) is that the bureauweenies running them have so little accountability or motivation to ensure that things run fairly and effectively.

Last week, for example, almost 100 people were arrested and charged in one of the biggest Medicare fraud cases to date. Attorney General Steadman and HHS Secretary Shecantbeserious were quick to pounce on this major bust as a turning point. But it's the culture of the system itself which encourages - nay, facilitates - these kinds of crimes.

And it's not just erstwhile providers on the line:

"More than a quarter-million Medicare beneficiaries are potential victims of identity theft and hampered in getting health care benefits because the government won't issue new IDs"

Medicare officials' excuse will surprise exactly no one who's been paying attention: "it's too expensive and too many agencies are involved to reissue" the cards and numbers. So all those "potential victims" are outta luck. Sure, they can call Medicare's equivalent of 9-1-1, but instead of a dispatcher sending a squad car, Ms Kathy will send a "so sorry" letter (at best). This is the perfect illustration of why government-run health care provides neither health nor care.

And it's this system writ large which is responsible for implementing much of the ObamaTax. Which means that it's not just those poor 284,000 medicare beneficiaries at risk, but you, too.

Death Panels take Cannon Fire

As in Cato's Michael Cannon, who heads up a special Cato forum at noon tomorrow (Thursday). Michael is joined by Len Nichols, the Center for Health Policy Research and Ethic's Director (whom we've met before), and a few other "friends."

The forum will discuss the ObamaTax's Independent Payment Advisory Board (IPAB) Death Panels, and takes place at the Institute. For those of us who can't be there in person (and thus will also miss out on lunch), the event is being livestreamed, as well.

Cost Cutting Obamacare Style

From the land of unintended consequences . . .     

Darden Restaurants, which owns the Red Lobster, Olive Garden, LongHorn Steakhouse, and Yard House chains has stopped offering full-time schedules to hourly workers, the Orlando Sentinel reports. The company plans to offer a maximum of 28 hours per week per employee.

Newsmax, "Restaurant chain cuts hours to avoid Obamacare costs"

Restaurants typically are not known for paying high wages, so combine low wages with reduced hours and it sounds like Obama won't be able to balance his budget. It also won't do much to help the middle class.

Under a section of President Barack Obama's Affordable Healthcare Act due to go into effect in 2014, large employers face fines of up to $3,000 per employee if they fail to provide insurance for employees who work an average of 30 or more hours per week.

Sounds like a "loophole" to me.

But then, Congress never considers human behavior when they write these laws. Of course in this case, they also failed to read it before passing it.

Darden said it offers health insurance to its 185,000 employees nationwide but many are on a limited-benefit plan which will be phased out under Obamacare.

Limited benefit plans, unless granted a waiver, are considered illegal under Obamacare rules. Bazinga!

The Orlando Business Journal reported that Darden plans to open 500 new restaurants in the next five years, adding an estimated 50,000 new jobs.

50,000 newly employed taxpayers who will not have employer provided health insurance.

Emergency Cash

Emergency room visits are traumatic enough, now you'll need cash if you want treatment. Hospitals are losing money on emergency room patients and in an effort to stop the bleeding, in a manner of speaking, they are demanding cash payments up front from ER abusers.            

Last year, about 80,000 emergency room patients at hospitals owned by HCA, the nation's largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency.

Led by the Nashville-based HCA, a growing number of hospitals have implemented the pay-first policy in an effort to divert patients with routine illnesses from the ER after they undergo a federally required screening. 

Kaiser Health News, "Hospitals demand up front payment from emergency room patients"

Patients who visit the ER are triaged as required by EMTALA rules. If they are truly experiencing a life or death emergency, or are in severe, debilitating pain, they are admitted to the emergency room and treated accordingly.

But if they are using the emergency room for a routine exam and treatment they are expected to make an up front cash payment before treatment.

Hospital officials say the upfront payments are a response to mounting bad debt caused by the surge in uninsured and underinsured patients and to reduced reimbursements by some private and government insurers for patients who use the emergency room for routine care.

In the past year, for instance, Iowa, Tennessee and Washington state reduced or eliminated Medicaid reimbursements for those visiting ERs for specified non-urgent conditions, such as sore throats or warts.

Of course in 2014 under Obamacare the uninsured issue will no longer be a problem.

Of more than 6 million emergency room visits to HCA hospitals last year, 314,000, or about 5 percent, were determined not to be emergencies, Fishbough said. About 230,000 of those patients paid and remained in the emergency room for treatment. The other 80,000 or so left. The HCA payment policy excludes children 5 and younger, pregnant women and those 65 and older.

This seems fair to me.

"These policies are beneficial because they help patients understand their financial responsibilities and make informed decisions about where to utilize services," said Tomi Galin, a spokeswoman for Community Health Systems. "These practices help reduce costs for both the patient and the hospital."

Personal responsibility. What a novel idea.

In December, Skaggs Regional Medical Center in Branson, Mo., began asking emergency room patients to pay $40 or their insurance co-payment before receiving a prescription.

"If they don't pay . . . they won't be given their prescription," hospital spokeswoman Michelle Leroux said.

The strategy is designed to help the hospital deal with spiraling, unpaid ER bills. About a third of the 120 patients treated daily in the hospital's ER are uninsured. The change was implemented after the emergency room reported $1.3 million in bad debt for August.

"This amount of bad debt is unsustainable for our operation," Skaggs chief executive William Mahoney said.

Unpaid emergency room bills impact all of us. When freeloaders skate on their bills the hospitals must raise their prices which result in health insurance carriers raising premiums.

Stupid Government Tricks

The latest nail in the coffin of personal responsibility (and common sense) just got pounded in:

"Unclaimed property probes by states have escalated to now include mid-sized insurance companies ... The cost of these settlements are not insignificant."

This past Spring, for example, MetLife paid off settled with regulators in 22 of the 58 states, to the tune of $40 million. And for what? Allegedly, they used different methods to track down annuitants than life insurance beneficiaries.

Here's a clue, "insurance regulators:" of course they used different methods, they're different kinds of policies which promise different things.

Presumably, one buys a life insurance policy to help defray funeral costs, pay off a mortgage, help one's progeny through college, whatever. But if it was important enough to motivate one to buy the insurance, doesn't it stand to reason that it's also incumbent upon one to let people know you bought it in the first place?

Sheesh.

There are really two questions here: is it really the insurer's responsibility to track down its dead policyholders? And exactly how are they supposed to do this? As to the first question, do we really want to give insurers access to our every movement? Because that's the only way they can track us. No one has a problem with that?

As to the second, even the government admits its own record-keeping of deceased citizens is damaged goods.

By the way, MetLife didn't pay that $40 million: its policy- and share-holders did. But does anyone really expect government bureauweenies to "get" that?

The ObamaTax vs The Economy

A year and a half ago, we noted that the ObamaTax specifically encouraged employers to find ways to discontinue (or avoid offering) group health insurance plans. At the time, we predicted a "preference cascade" among employers; that is, once one large company started down that road, others would soon follow.

Are we beginning to see this in action?

You tell me:

"Orlando-based Darden Restaurants has stopped offering full-time schedules to many hourly workers in at least a few Olive Gardens, Red Lobsters and LongHorn Steakhouses ... one of the many things we are evaluating to help us address the cost implications health care reform will have on our business."

The company is quick to point out that there's been "no decision made about expanding" the program, but really, what else can they say at this point?

Something about unringing a bell?

Monday Morning LinkFest

Have you ever driven by a car wreck just as it's happening? Time seems to slow down, everyone and everything appears to be moving in slow motion. Well, that seems to be happening with the ObamaTax. FoIB Elena Marie notes this little gem:

"Five insurers, including two of the nation’s largest, already decided to stop selling health insurance in Indiana, mainly because of the [ObamaTax] edict ... And the American Enterprise Group, citing the medical loss ratio and other regulatory burdens, will stop offering individual insurance in more than 20 states, causing 35,000 people to lose their coverage and create a less competitive insurance market."

But remember, "if you like your health plan..."

Meanwhile, in our nation's capital, the local politicos think they've stumbled on the health insurance panacea:

"A board has required D.C. small businesses and individual buyers to purchase health insurance through the newly minted health exchange."

There's some question as to that Board's authority to enforce the new regs, but it's interesting to note that its chairman, Dr. Mohammad Akhter (doctor of what is left unspecified) opines that "[i]f you have a business license here in the District of Columbia, then you participate through the exchange."

Looks like some folks have a problem grasping that whole "pro-choice" concept.

On the other hand, it looks like actual health care providers are none too pleased with the ObamaTax:

"A new survey shows Mitt Romney with a commanding lead over President Barack Obama among doctors, with Obamacare helping to sway their votes."

Well over half of the doctors surveyed say they favor repeal of the train wreck.

Our last item this morning also comes to us courtesy of Elena Marie.

Seems that the Much Vaunted National Health System© is continuing its crackdown on folks who want to, you know, stay alive:

"Forty-three hospital patients starved to death last year and 111 died of thirst while being treated on wards ... There were 558 cases last year where doctors recorded that a patient had died in a state of severe dehydration in hospitals."

Remember, this is the model for the ObamaTax that we'll soon be living dying under.

UPDATE: Looks like the ObamaTax may have another potentially damaging challenge:

"Tucked inside the Supreme Court's lengthy list of orders ... was an indication that the fight over President Obama's health care law soon could be back before the high court ... Liberty University, a Christian college in Virginia, has been fighting the employer mandate since the law was enacted ...  the Supreme Court ruled that the Anti-Injunction Act did not serve as a barrier to lawsuits challenging the health care law."

Earlier, the 4th Circuit had turned down the case as "premature" since no one had yet been penalized for not paying the Employer Mandate fine tax. The Supremes, though, have just re-opened the door for Liberty to re-file.

We've written before about the ill-conceived Employer Mandate; this seems to indicate that it'll be back on the radar soon.

Georgia Medicare Doctors Say No

Georgia Medicare doctors are saying no to new patients. If you are turning 65 and going on Medicare, you may be shocked to know many Georgia Medicare doctors are not accepting new patients.                      

A wave of aging baby boomers will soon join the estimated 1.2 million Georgians currently on Medicare, but fewer Georgia Medicare doctors are taking new patients, according the American Medical Association.
“They're going to find it much harder to find a physician that will accept the low payments that Medicare is giving, because they can't afford to,” American Medical Association Chair Dr. Robert Wah said.

WSBTV, "Doctors rejecting new Medicare patients"

If Georgia Medicare doctors are not accepting new patients, what is a person to do?

You could purchase a Medicare Advantage plan from an HMO such as Kaiser. The structure of the KP HMO is such that finding  Georgia Medicare doctors is much easier than other MA plans or those with original Medicare and a Medigap plan.

“They're going to find it much harder to find a physician that will accept the low payments that Medicare is giving, because they can't afford to,” American Medical Association Chair Dr. Robert Wah said.
The payment formula used to fund Medicare has come up short for the past decade, forcing congress to pass short-term fixes to avoid cutting reimbursements to doctors. But doctors are getting tired of the threat of cuts, so more are choosing not to accept new Medicare patients.
    
“Physicians are dedicated to their patients. They want to take care of their patients, so they'll probably stay with their current patients, but the new patients will have trouble,” Wah said.

Georgia Medicare doctors cannot afford to lose money on new patients. Don't expect Congress to do anything until January when they reconvene after the election. The economy and middle east are hot election topics but seniors on Medicare are also keeping a watchful eye on how DC will implement cuts in Medicare funding.

Neither presidential candidate will eliminate Medicare, but Obamacare does gut funding for Medicare. This means fewer Medicare Advantage choices, higher premiums, and higher copay's.

“We will improve health care only if and only to the extent that the federal government backs away from micromanaging the health care sector,” said the Cato Institute’s Michael Cannon.
The current Medicare fix runs out at the end of February. Unless Congress acts, Georgia doctors will lose an average of $31,000, according to the American Medical Association.

How do you find Georgia Medicare doctors that are approved by Medicare and accepting new patients? You can FOLLOW THIS LINK to find Georgia Medicare doctors

Shecantbeserious Flails

Well, continues to flail is probably more accurate.

She and her minions still haven't found time to delineate specifics for the "Essential Health Benefits" portion of the ObamaTax. This is a set of core "benefits" that must be included in health insurance plans that want to participate in the Exchanges (yeah, we know) come 2014.

Badger State insurance commissioner Theodore Nickel "now has written to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius to say that the state needs at least 60 days after HHS issues the final PPACA essential health benefits (EHB) regulations."

While she's dragging her feet on actually doing her job, Ms Shecantbeserious has found time to spread government largesse (ca$h) around to her buddies in the private sector, inking a "deal worth more than $3 million to promote [ObamaTax] “exchanges.” And yes, these are the same Exchanges that she can't be bothered to actually, you know, provide guidance for.

By the way, this is the second such deal for her friends at PR firm Weber Shandwick; back in 2010 they scored a cool $3.4 million contract ostensibly for promotion of Medicare fraud prevention and reporting.

Nice gig if you can get it, right Kathy?

Um, about that 3000% Premium Decrease (Redux)

As we've pointed out before (most recently here), the mythical decrease in health insurance premiums was always a fantasy, concocted by those who pushed to pass the ObamaTax (in order, of course, to find out what was in it). Now, FoIB Holly R tips us to the latest from my own neck o' the woods:

"Workers in Greater Cincinnati and Northern Kentucky will pay an average $4,775 out of their own pockets for health care in 2013, about $400 more than this year and nearly $2,000 more than 2007."

Ooops.

I can't help but notice that Mr Peale joins his journalistic brethren in continuing to conflate health care with health insurance. On the other hand, he at least tries to differentiate between them by noting that "payments include health care premiums through their employer, plus office co-pays and deductibles."

I give it a B-.

A star is born!

Our very own Kelley Beloff was part of an NPR roundtable last night, watching and commenting on the debate:

"Kelley Beloff, who works in the health care industry and leans right, says tax rates are impacting her vote, "I am totally middle class...and the big thing for me was hearing Mr. Romney talk about bringing down our taxes. My husband owns his own business, and we pay those individual taxes, and it is very difficult at times to make those tax payments."

Here's audio:

Musings: An Interview with Dr Rob

Dr Rob Lamberts, one of my very favorite med-bloggers, is making a major career change. He'll still be doctorin', of course, but in a new practice, based on a cutting-edge model of health care delivery. If you've never read any of his work, I heartily recommend that you do so.

After his residency at Indiana University in 1994, Dr Rob went into private practice with another physician (who subsequently went to Africa to do missions work). Their practice was initially owned by a hospital, but by 1996 they'd decided that it was better to leave and do "their own thing."

InsureBlog: What made you decide to chuck it all and re-boot?

Dr Lamberts: I had been frustrated as the other doctors in the practice grew more and more resistant to change. The more partners we had, the more inertia we gained. Since I am not a person to sit still when I think there are solutions to problems, I found it increasingly difficult to stay put because of others' personalities. This created conflict, which led to me looking at my options. Going solo in a practice that dealt with the insurance game and had the same limitations as the old practice was not a good solution for me, so when I found the Direct Primary Care (DPC) model it really appealed to me. In the end, my (now former) partners and I saw this as an irreparable split between us and the decision to split was mutual. They have worked it out so I don't have to draw a paycheck for up to 6 months, which gives me time to build my new practice right. They also gave me access to my patients to tell them about the new practice, which is a really generous thing on their part.

IB: You've mentioned that you may have patients that can't (or won't) follow you to your new practice, can you expand on that?

RL: The DPC model is one in which the patient pays the doctor directly for their care, usually in the form of a monthly "subscription," plus or minus a fee for visits. DPC usually limits the size of the patient pool as well, so I will only be able to take 1/3 of my total patient population even if all wanted to come (I had between 3 and 4 thousand patients in my old practice and will limit it to around 1000). Plus there is the fact that some patients are not going to be willing to pay what they see as an extra fee for care they already could get. Since nobody else in the area is doing this, the only way I can show that the value of the service will be worth the cost is to make it work. Some people will trust me in this, while others won't.

IB: I know a lot of practices are being gobbled up by hospitals eager to grow their ACO's [ed: Accountable Care Organizations]. Was this ever an option for you?

RL: Not really. If we were able to work out our differences in the old practice I would have been part of a primary care ACO that is being formed by a local IPA (group of independent primary care physicians who have allied together to do this). Primary care is quite independent in Augusta, and has recently done quite well in organizing and working together for their best interest (without risking collusion, despite what the hospitals may say). I could be part of an ACO in that setting if I wanted. In truth, however, I have grown less and less enamored with these models, as they are more driven by data and processes built around meeting care standards than they are built around good patient care.

We had been working on "Patient Centered Medical Home" in our practice, and I found that it was anything but patient-centered; it was data-centered, and took my attention away from the patients. Finally, I simply don't think the hospitals are the means to truly affect meaningful change in health care. They are the businesses that have been built on over-spending on health care, on unnecessary procedures, and on consumption of medical resources. The goal of most hospitals for my patients is 180 degrees from mine: their financial gain is built on people getting procedures, going to the ER, and being hospitalized, while mine is to help them avoid all of the above. [Continued below the fold]

Quote of the Day

"Fathom the hypocrisy of a government that requires every citizen to prove they are insured... but not everyone must prove they are a citizen."

Now add this, "Many of those who refuse, or are unable, to prove they are citizens will receive free insurance paid for by those who are forced to buy insurance because they are citizens."

[ed: incorrectly attributed to the great Ben Stein - but spot on nonetheless]

[Hat Tip: FoIB Debbie C]

Know Your EOB

EOB. Explanation of Benefits. A document that is mostly ignored and misunderstood by way too many people.

      

Your EOB is just as important as your bank statement or credit card bill. Yet far too many people never bother to read them.

Most health insurance EOB's are laid out well and relatively easy to decode. The billing codes and carrier explanations usually appear at the bottom of each page, or on the back if you get a paper EOB. Most plans also have online versions that can be viewed and printed.

Like your credit card statement, the EOB does you no good unless you check it each month.

Compare your Explanation of Benefits statement against your medical bills for each service. Doctor, lab, hospital, pharmacy, etc. Every medical provider that has your insurance information is required to file claims on your behalf with your insurance carrier. Par providers have time limits in which they must file or forfeit their right to collect from the carrier or patient.

A common health insurance complaint on consumer forums deals with "mysterious" medical bills showing up a year or more after service was rendered. Often the individual finds out about it when applying for credit and discovering a black mark on their report, or when they get a collection notice.

Really?

What happened to the bills from the medical provider? Do you ever open your mail?

Sometimes the patient bill is never generated by the provider's office due to an oversight. The shortfall is discovered during a routine audit.

This is where you need to get cozy with your EOB. If the provider was in network, and they never filed the claim with your health insurance carrier, you are probably not liable for the bill.

Regardless of whether the provider is par or non-par, or even if the provider filed the claim or not, YOU, the patient, are ultimately responsible for the bill. Failing to pay can impair your credit. Failure to pay could mean a denial of services in the future.

Check your EOB on a regular basis, especially if you frequently use medical services. The more you see a doctor, have lab work or diagnostic services, the more diligent you need to be in checking your EOB.

Retiree Plans Go Poof!

Retiree plans are dropping like flies. Johns Manville, American Airlines, 3M and Kodak are just a few corporations that have either discontinued retiree plans or have plans to do so.                    

Did you know there are sites on the internet that show CEO's how to maximize profits by terminating retiree plans?

Large employers continue to drop retiree health care plans – just 24 percent offered coverage to retirees under 65 and 16 percent to Medicare eligible retirees, compared to 29 percent and 21 percent the year before.

Chief Executive, "Control Health Care Costs in 2012"

What is causing this movement?

Much of the blame lies with Obamacare.

The increased direct costs that impact health insurance premiums plus additional oversight and compliance mandates are already causing many employers to consider dropping health insurance. Employees under age 65 will be able to purchase health insurance (possibly with a subsidy) through an exchange.

Retirees over the age of 65 can return to original Medicare and enjoy a GUARANTEED RIGHT to purchase a Medigap plan. 

When employers terminate retiree plans you may actually be better off than before. With original Medicare you can use any doctor, any hospital and never have to worry about networks, referrals or claim forms.

Many employers are subsidizing the cost of your Medigap coverage which means you may actually pay less than you did for the retiree plans and have more coverage.

Former employees of Johns Manville got this letter back in July that announced the cost cutting move cancelling retiree plans.

Johns Manville is moving from the current group health plan to providing a subsidy that you and your eligible spouse can use to enroll in any individual plans that supplement your original Medicare (Parts A and B) coverage, including Medicare Supplement, Medicare Advantage and Medicare Part D (prescription drug coverage), as well as for reimbursement of Medicare B premiums.

No longer will the cost of your insurance be deducted from your pension check or paid separately.

Rather, Johns Manville will provide a tax-free subsidy that will be available to you January first of each year through a ‘Health Reimbursement Arrangement’

Sounds like a workable plan to me. You have the freedom to choose any plan, including those that allow you to see any doctor. The cost of your health insurance plan will be subsidized through a "voucher" type system by way of an HRA.

As retiree plans become a thing of the past seniors age 65 and older will enjoy more flexibility.

Cavalcade of Risk #167: Now online!

Russell Hutchinson presents this week's Cavalcade of Risk and, as usual, does an outstanding job. As he notes, "whatever the conditions, I usually find at least one writer in each Cavalcade offers something interesting that is written well."

Take his advice and check it out.

Obamacare vs. God

The battle over forced birth control just won't go away. This should not be surprising. Government intrusion in to our life is creating a nanny state.      

Eat this, don't eat that. Warning labels. Calorie counts. You can buy two 16 ounce drinks but not one 32 ounce drink.

Yeah, that makes sense.

Tyndale House is a religious publishing company. You might think they could get a free pass on the Obamacare mandate requiring employers to include "free" contraceptive devices and medication in their group plan.

Apparently not.

Attorneys have filed suit against the HHS Secretary (Tyndale House Publishers v. Sebelius) demanding an exemption.

“To say that a Bible publisher is not religious is patently absurd. Tyndale House is a prime example of how ridiculous and arbitrary the Obama administration’s mandate is. Americans today clearly agree with America’s founders: the federal government’s bureaucrats are not qualified to decide what faith is, who the faithful are, and where and how that faith may be lived out.”

ADF Media, "Bible Publisher Isn't Religious Enough"

Put me down as undecided on this.

On one hand, I really do believe government has overstepped their role and needs to back off. The Bible tells us Adam and Eve only had one law.

Then  Moses received 10 new laws from God that seemed to work well for centuries.

On the other hand, just because a company prints Bible's and other religious literature doesn't mean they are a religious entity. Using that argument you could also say companies that manufacture pews and pulpits should also be exempt. Or companies that produce wine (or grape juice for the Baptists), or shot glasses (used for communion).

The list is almost endless.


Thanks to Henry Stern for this tip

Alzheimer's News

It's been a little while since we've written about Alzheimer's; two recent news items on the subject caught my attention.

First, it appears that researchers at the "Barcelona Biomedical Research Institute have hailed a natural hormone linked to the sleep cycle as an important new weapon in the fight against" Alzheimer's. Combined with an active lifestyle (exercise), melatonin seems to be effective in slowing deterioration of the brain.

Nothing conclusive yet, but it seems promising.

The second item relates more to those providing care to folks already suffering from the disease. As we've noted, a major problem for family members as caregivers is that they can "cost themselves major chunks of their own nest-eggs; giving up their ability to contribute to 401(k)'s and the like means that there's less available to them when they need it."

That's the financial side, which is pretty important, No less important, though, is the physical toll this can have on these selfless folks. And that's where "the Hebrew Home at Riverdale's ... ElderServe at Night" comes in. The program offers "a structured series of singalongs, crafts and therapy sessions that lasts until dawn." and is available to folks suffering from dementia. That's the good news.

Here's the bad:

"While many nursing homes offer temporary "respite care" so caregivers can catch up on sleep or go on vacation, the overnight-only program at the Hebrew Home fills a niche. But costs are high, and such programs are rare. An official at the Alzheimer's Association said she knew of no other."

Here's hoping that the phenomenon takes off.

ObamaDentalTax

Dr Kim Henry is a dentist (and friend of Bob's) who practices in Hapeville, Georgia. He's also a veteran (Navy) who served alongside Marines in Lebanon in 1983. Having been in practice for over 3 decades, he's seen a lot of changes in health care. Recently, he penned this post for his own FaceBook page, and has graciously allowed us to re-post it here:

"We were told by the former House speaker that we should “Pass the health care bill so we could find out what is in it.” Slowly we are finding out what is in it, and much of it really stinks.

Beginning January 1, 2013, a new 2.3% federal excise tax will be added to all dental lab work- crowns, dentures, bridges, everything. Bet you thought something called the “Affordable Care Act” was supposed to make health care cheaper, not more expensive, right? Well, I am sure it’s not the first time you have been lied to by politicians.

In June, our US House of Representatives voted to kill this provision, by 270 to 146. Unfortunately, there is not the interest in the more liberal US Senate to back up the House action.

When government makes operating costs of dentists go up, guess what happens to dental fees? Think they will be more “affordable?”

I could write a whole book on how government raises the cost of health care. Unfortunately, class envy demogogues want you to believe it is greedy health care professionals who are responsible.

There will be more Obamacare surprises to come, I guarantee you."

Thanks, Dr Henry, for sharing your succinct - and spot on - thoughts with our readers.

Will Obamacare figure in the debates that start this week?

I think not much. Why not? 

Obama may not want to bring up this law because, despite the Supreme Court decision, it remains widely unpopular.

Romney may not want to bring it up either.  That’s because the Obama campaign would very likely not respond on the issue, but instead would respond by claiming "Romneycare" in Massachusetts was the model for Obamacare.  That’s false; Romney’s actual proposal was less intrusive and less expensive than the law that was ultimately enacted in Massachusetts.  But, nevertheless:

(1) the explanation is complicated, and would not sway many votes.  That’s because most voters would ignore it just because it’s complex.

(2) Worse, it would be a diversion, taking limited debate time away from focusing on Obama’s main governing failures – his wretched economy and his wretched foreign policy.

For these reasons, neither candidate may see much use in bringing up Obamacare; in fact both candidates may see potential harm in doing so. That’s why I think Obamacare will not figure importantly in the debates.

Additional info is here and here.

Among other things, the first linked article reports

The Romney proposal included an employer mandate that required only catastrophic coverage, not the comprehensive and expensive "Cadillac plan" coverage that was ultimately included in the Massachusetts law, and in ObamaCare. 

So, clearly, the Obama plan did not follow the Romney “model” in this feature – a feature important enough that it was disputed all the way to the Supreme Court.  There's more:

Romney's successor, Governor Deval Patrick, greatly increased the mandated level of coverage while implementing the law

Deval's tinkering resulted in much higher costs not contemplated in the original law, and those costs still adversely affect the state’s finances.  Yet the whole thing is tagged as “Romneycare”.  Go figure.

A further insight, which both the linked articles report:  On the day that Romneycare was signed into law, Romney line-item-vetoed eight elements changed in or added into the final draft of the bill . . .  After the signing ceremony, though, the Democrat legislature returned to the State House and overrode all eight vetoes. (in fact, during 2006 alone, Romney's last year as Governor, Romney issued 250 vetoes, every single one of which was overridden.)

. . .  see how easily an Obamacare discussion leads away from the economy and foreign policy?  My bet -  Romney won't go there - and neither will Obama.

Assinine Industry Tricks

Back in the day (2 months ago), I could get competitive quotes from several carriers using the application of just one. Apparently, the carriers think the new ObamaTax Exchanges are preferable to (icky) agents, though, because that's now a thing of the past.

Professional agents "pre-screen" groups so that the quotes have some basis in reality. If a carrier has no medical (underwriting) information, then they're just going to use their "book" rates without adjusting for folks who are, for example, pregnant or diabetic (or both!). These quotes are worse than useless, because they will never reflect what the actual rate will be. By using one carrier's application to obtain quotes with several carriers, we could provide meaningful quotes to our clients.

Well, that used to be the case.

Now, if I want (need) competitive quotes, I can no longer use just one carrier's application. Sure, some carriers will still accept (for now) another carrier's application for rating purposes, but this number is quickly dwindling.

Of course, I can pay an extra fee to a 3rd party to collect that information for me, which is (one supposes) convenient. But what with MLR and carriers looking to cut costs, this is hardly an economically viable alternative to those of us in the (soon to be gone anyway) small group market.

It's almost as if the carriers want to be marketing through the ObamaTax Exchanges.

Gee, I wonder why?

Sarah P and The MVNHS© [UPDATED]

If you want to see how the system on which the ObamaTax was modeled really works, you have only to pick up a British newspaper:

"Cost-cutting NHS chiefs are routinely assigning just one family doctor to districts that stretch over hundreds of square miles ... Patients are still put at unacceptable risk by apparently negligent practices.’"

As we've pointed out before, such provider shortages are looming on our own horizon, as well. And no wonder: more folks with insurance seeking care from fewer and fewer doctors results in the text-book definition of rationing.

It's ironic that former Vice Presidential candidate Sarah Palin made this call years ago. It's even more ironic that her banner's been picked up by erstwhile auto bailout maven Steven Rattner:

“We need death panels ... unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget."

Gee, ya think?

UPDATE: Turns out, it's not just us laypeople who are worried. The folks on the front lines, who will be called upon to actually render care to all these extra 10's of millions of new "patients" aren't exactly thrilled, either. Dr. Marc Siegel, an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center, weighs in:

"President Obama and Congress should have checked with the country’s physicians before passing a law that relies on our efforts to handle health insurance expansion to more than 30 million more people ... Perhaps most disturbing, more than half of doctors surveyed by The Physicians Foundation revealed that they will cut back on patients (including Medicare) or reduce patient access to their care over the next three years."

So, more demand, fewer resources, what could possibly go wrong?