This month, the American Enterprise Institute, a 75-year old conservative, business-oriented think tank, published its recommendations for a universal health insurance plan. It started from the question: “If we could build from scratch the very best health care system, what would it look like, and why?” AEI’s answer is contained in this 45-page report.
I think you’ll find it worth your while to read at least this summary of AEI’s plan. The entire report is here - if you can spare the time, read the whole thing.
Monday, August 12, 2013
The Down Syndrome Conundrum
Consider, if you will , the following statement:
"If muscular dystrophy were completely cured, the world would lose something from the absence of that culture"
Or, perhaps:
"If celiac disease were completely cured, the world would lose something from the absence of that culture"
Would you agree with either of these?
How about this one:
"If Down syndrome were completely cured, the world would lose something from the absence of that culture"
That's the potential of promising new research being done at the University of Massachusetts Medical School, which claims that "it may be possible to switch off the genetic material responsible for the condition that causes cognitive delays, heart defects and shortened lifespans."
The trade-off for all of these hopeful changes is a loss of what at least a few in the DS community see as "the mechanism that creates people who offer lessons in patience, kindness -- and what it means to be human."
It seems to me that this is a rather selfish - and short-sighted - perspective; what do our readers think? Please take a moment to cast your vote, and we'd love to hear your thoughts in the comments section.
"If muscular dystrophy were completely cured, the world would lose something from the absence of that culture"
Or, perhaps:
"If celiac disease were completely cured, the world would lose something from the absence of that culture"
Would you agree with either of these?
How about this one:
"If Down syndrome were completely cured, the world would lose something from the absence of that culture"
That's the potential of promising new research being done at the University of Massachusetts Medical School, which claims that "it may be possible to switch off the genetic material responsible for the condition that causes cognitive delays, heart defects and shortened lifespans."
The trade-off for all of these hopeful changes is a loss of what at least a few in the DS community see as "the mechanism that creates people who offer lessons in patience, kindness -- and what it means to be human."
It seems to me that this is a rather selfish - and short-sighted - perspective; what do our readers think? Please take a moment to cast your vote, and we'd love to hear your thoughts in the comments section.
Ah, the Much Vaunted National Health Service© strikes again
The doc lied, the patient died:
"A surgeon who told a patient he had successfully removed her brain tumour and urged her not to seek further treatment had in fact not removed it ... By the time she sought private help, her tumour was inoperable."
In fact, he strung the poor woman and her husband along for several years, going so far as to alter a pathology report and even tell the victim's own physician that she was fine.
And in true MVNHS©, he faces "a misconduct hearing."
That'll teach him.
"A surgeon who told a patient he had successfully removed her brain tumour and urged her not to seek further treatment had in fact not removed it ... By the time she sought private help, her tumour was inoperable."
In fact, he strung the poor woman and her husband along for several years, going so far as to alter a pathology report and even tell the victim's own physician that she was fine.
And in true MVNHS©, he faces "a misconduct hearing."
That'll teach him.
ODJFS reminds me why I shouldn't hire workers in Ohio
As we trudge through this mess that the ACA is creating I am reminded of another pseudo-insurance disaster run by the government.
Earlier this year I hired a part time adjuster that was laid off by Anthem when they outsourced the job to the Philippines. A normal adjuster should do 20 claims per hour. This adjuster averaged 1 claim per hour. Give her a couple warnings, no improvement. Catch her padding her time sheet, she does it two more times. Finally terminate her for lack of production and falsifying her time sheet.
And then it starts to get expensive. She files a claim saying she was let go for lack of work. Even though lying on an unemployment application is supposedly illegal, I don't think anyone has ever been taken to task for this. Then the paperwork starts; I have over an inch of filings with ODJFS (Ohio Department of Job and Family Services) of responses to their letters and copies of emails sent to the employee warning her.
Today I get a letter;
"... this agency finds that the claimant is totally unemployed from Employee Benefit Concepts Inc. due to a lack of work."
$1,440.92 of my money was just given to an ex employee fired for not working and padding her time sheet. Not to mention, right after firing her I hired a replacement, a sure-fire defense for any lack of work claims (you would think).
When I call ODJFS they now say the letter was an error and she was not awarded benefits for lack of work, she was awarded benefits because I didn't have her sign the emails warning her about her poor performance. This was a remote employee that lived 3-4 hours away that only came to the office once for training. When asked how remote employees are supposed to sign warnings, we were told that we should have required her to come in (like that would happen). Not to mention, I lost another case where an employee refused to drive 1 hour to the office.
Luckily Anthem is paying the majority of the claim and I am only out $1,440.92 plus a few thousand dollars of my time, but this is a great example of what goes wrong when insurance is misused by government for social causes.
Paying an ex-employee not to work is not an insurable interest, I'm forced to buy a policy that not only doesn't benefit me, it's actually counter to my interest.
ODJFS, who makes the benefit determinations, has no stake in the game. No matter how egregious the determination or riddled with errors, they have no accountability. They can give away employers' money regardless of how bogus the claim and counter to actual policies and they are doing a good thing, helping the poor unemployed.
Fraud is an acceptable part of the process. I have even called the fraud hotline to report ex-employees claiming they were let go for lack of work when clearly that was not the case and was told that is what applicants are instructed to do. Apparently the hours wasted of employers time has no value to ODJFS and fraudulent claims are just potential payments that need massaged.
Anthem found the right solution, outsource the jobs out of Ohio where you pay less, get more, and have no ODJFS giving away your money.
Earlier this year I hired a part time adjuster that was laid off by Anthem when they outsourced the job to the Philippines. A normal adjuster should do 20 claims per hour. This adjuster averaged 1 claim per hour. Give her a couple warnings, no improvement. Catch her padding her time sheet, she does it two more times. Finally terminate her for lack of production and falsifying her time sheet.
And then it starts to get expensive. She files a claim saying she was let go for lack of work. Even though lying on an unemployment application is supposedly illegal, I don't think anyone has ever been taken to task for this. Then the paperwork starts; I have over an inch of filings with ODJFS (Ohio Department of Job and Family Services) of responses to their letters and copies of emails sent to the employee warning her.
Today I get a letter;
"... this agency finds that the claimant is totally unemployed from Employee Benefit Concepts Inc. due to a lack of work."
$1,440.92 of my money was just given to an ex employee fired for not working and padding her time sheet. Not to mention, right after firing her I hired a replacement, a sure-fire defense for any lack of work claims (you would think).
When I call ODJFS they now say the letter was an error and she was not awarded benefits for lack of work, she was awarded benefits because I didn't have her sign the emails warning her about her poor performance. This was a remote employee that lived 3-4 hours away that only came to the office once for training. When asked how remote employees are supposed to sign warnings, we were told that we should have required her to come in (like that would happen). Not to mention, I lost another case where an employee refused to drive 1 hour to the office.
Luckily Anthem is paying the majority of the claim and I am only out $1,440.92 plus a few thousand dollars of my time, but this is a great example of what goes wrong when insurance is misused by government for social causes.
Paying an ex-employee not to work is not an insurable interest, I'm forced to buy a policy that not only doesn't benefit me, it's actually counter to my interest.
ODJFS, who makes the benefit determinations, has no stake in the game. No matter how egregious the determination or riddled with errors, they have no accountability. They can give away employers' money regardless of how bogus the claim and counter to actual policies and they are doing a good thing, helping the poor unemployed.
Fraud is an acceptable part of the process. I have even called the fraud hotline to report ex-employees claiming they were let go for lack of work when clearly that was not the case and was told that is what applicants are instructed to do. Apparently the hours wasted of employers time has no value to ODJFS and fraudulent claims are just potential payments that need massaged.
Anthem found the right solution, outsource the jobs out of Ohio where you pay less, get more, and have no ODJFS giving away your money.
Saturday, August 10, 2013
Harry Reid Predicts Medical Care Welfare System
On Friday August 9th in Las Vegas, Senate Majority Leader Harry Reid said the country has to “work our way past” insurance-based health care. The interestingly-named Steve Sebelius then asked Reid whether he believes that ultimately the country
would have to have a health care system that abandoned insurance as the
means of accessing it, Reid said: “Yes, yes. Absolutely, yes.”
Of course the Democrat Party's ultimate intent to implement a single-payer scheme is no surprise; it has been their intent for decades and this public statement of it is not nearly the first.
A single-payer scheme as Reid describes it would not mean that insurance companies go away; the federales would continue to contract with insurance companies and perhaps other types of administrators to operate the single payer scheme. What it would mean is that the concept of medical insurance largely ceases to exist and would be replaced by a medical care welfare system.
In a medical care welfare system people will, in theory, be entitled to medical care simply because they are citizens (excuse me, that should be: simply because they are present in the room). The government - the single-payer - will finance most of this entitlement thru taxes excepting only amounts that politicians deem appropriate cost-sharing.
An insurance-based system requires a certain amount of personal responsibility so I suppose its demise is inevitable in this country at this time. That troubles me, but not nearly as much as the unstated agenda behind the political posturing: namely, the federales desire to control an additional 18% of the economy. Economic control is political control. Polls continue to show that most Americans remain uncomfortable with all this, and I think most Americans will live to rue the day it happens.
Of course the Democrat Party's ultimate intent to implement a single-payer scheme is no surprise; it has been their intent for decades and this public statement of it is not nearly the first.
A single-payer scheme as Reid describes it would not mean that insurance companies go away; the federales would continue to contract with insurance companies and perhaps other types of administrators to operate the single payer scheme. What it would mean is that the concept of medical insurance largely ceases to exist and would be replaced by a medical care welfare system.
In a medical care welfare system people will, in theory, be entitled to medical care simply because they are citizens (excuse me, that should be: simply because they are present in the room). The government - the single-payer - will finance most of this entitlement thru taxes excepting only amounts that politicians deem appropriate cost-sharing.
An insurance-based system requires a certain amount of personal responsibility so I suppose its demise is inevitable in this country at this time. That troubles me, but not nearly as much as the unstated agenda behind the political posturing: namely, the federales desire to control an additional 18% of the economy. Economic control is political control. Polls continue to show that most Americans remain uncomfortable with all this, and I think most Americans will live to rue the day it happens.
Friday, August 09, 2013
Ah, *there's* the catch!
As we've previously discussed, the opportunity to choose an "early renewal" date is pretty attractive for healthier (and/or younger) groups. Likewise, less healthy (and/or "older") groups may see some substantial benefit from the implementation of Community Rating (CR); one of mine is scheduled to take a 30% decrease next year.
So one might believe that it's all to the good for those groups who look to benefit from CR.
But maybe not.
From email this morning:
"In regards to groups that will benefit from the community rates and want to change to a 1/1/14 renewal. Please keep in mind that these are projections and they will be moved to an ACA plan and we do not know what that plan will look like. The projections shown do not include essential benefits, which will be included on all ACA plans. It is thought that essential benefits will add approximately 8-10% onto the premium."
What this means is that:
1 - Contra The President, these groups will not be able to "keep their current coverage"
2 - At least some (and perhaps most or all) of the anticipated savings from CR will be eaten up by the new Minimum Essential Benefits
3 - Groups that currently enjoy their Health Savings Account contributions are out of luck
4 - The whole "early renewal" issue does not take into account "regular" renewals based on medical inflation, claims and the like
Easy come, easy go.
[Hat Tip: FoIB Beth D]
So one might believe that it's all to the good for those groups who look to benefit from CR.
But maybe not.
From email this morning:
"In regards to groups that will benefit from the community rates and want to change to a 1/1/14 renewal. Please keep in mind that these are projections and they will be moved to an ACA plan and we do not know what that plan will look like. The projections shown do not include essential benefits, which will be included on all ACA plans. It is thought that essential benefits will add approximately 8-10% onto the premium."
What this means is that:
1 - Contra The President, these groups will not be able to "keep their current coverage"
2 - At least some (and perhaps most or all) of the anticipated savings from CR will be eaten up by the new Minimum Essential Benefits
3 - Groups that currently enjoy their Health Savings Account contributions are out of luck
4 - The whole "early renewal" issue does not take into account "regular" renewals based on medical inflation, claims and the like
Easy come, easy go.
[Hat Tip: FoIB Beth D]
Sprechen sie ObamaTax?
Because Ms Shecantbeserious and her minions have been soooo successful implementing the Exchanges, looks like they have some spare time to add fuel to the (metaphorical) fire:
"Now [Ms Kathleen] is seeking to fill another need relating to the operation of the exchanges: translation services ... Effectively provide 24x7 oral over-the-phone interpretation services in any language (supporting at least 100 languages)"
Yeah, that's gonna work out just fine.
"Now [Ms Kathleen] is seeking to fill another need relating to the operation of the exchanges: translation services ... Effectively provide 24x7 oral over-the-phone interpretation services in any language (supporting at least 100 languages)"
Yeah, that's gonna work out just fine.
Thursday, August 08, 2013
Runnin' on empty
In news that should surprise exactly no one who's been paying attention, Ms Shecantbeserious' minion has now publicly acknowledged that "[m]ost of the 24 health care co-ops created under Obamacare are in danger of running out of money before they even begin offering health insurance to consumers."
And why is this non-news to regular IB readers?
Well:
"CO-OPs are high-risk ventures: the Office of Budget and Management has projected a default rate for them as high as 43%. Through 2012 over $2 Billion had been distributed by HHS to these start up insurers."
Patrick published that prescient post almost two months ago (and tipped us to the latest news), and Mike had a related one a week earlier. The take-away is that, when one considers how much money has been thrown at these, and what they were expected to do, it would have been news if they'd succeeded.
And why is that?
Well, CO-OPs (short for Consumer Operated and Oriented Plan, which is both funny and creepy) were designed to funnel federal dollars to favored lobbying groups. Whether or not these organizations actually "delivered the goods" was irrelevant. Indeed, based on the the OBM's analysis, it was highly unlikely that that was even in the mix.
And how do we know this?
Follow the money:
"Half the co-ops the IG reviewed said they had no private support at all. The other half said their private funding amounted to less than 2 percent of their federal startup loans."
If these were really supposed to be serious and competitive players, then where were the big dollar private donors (eg Soros, Buffett, et al) to prop them up? Or, if you prefer, where were the private sector dollars and venture capitalists who really believed this was a viable business model in the ObamaTax environment?
Money talks, no?
And why is this non-news to regular IB readers?
Well:
"CO-OPs are high-risk ventures: the Office of Budget and Management has projected a default rate for them as high as 43%. Through 2012 over $2 Billion had been distributed by HHS to these start up insurers."
Patrick published that prescient post almost two months ago (and tipped us to the latest news), and Mike had a related one a week earlier. The take-away is that, when one considers how much money has been thrown at these, and what they were expected to do, it would have been news if they'd succeeded.
And why is that?
Well, CO-OPs (short for Consumer Operated and Oriented Plan, which is both funny and creepy) were designed to funnel federal dollars to favored lobbying groups. Whether or not these organizations actually "delivered the goods" was irrelevant. Indeed, based on the the OBM's analysis, it was highly unlikely that that was even in the mix.
And how do we know this?
Follow the money:
"Half the co-ops the IG reviewed said they had no private support at all. The other half said their private funding amounted to less than 2 percent of their federal startup loans."
If these were really supposed to be serious and competitive players, then where were the big dollar private donors (eg Soros, Buffett, et al) to prop them up? Or, if you prefer, where were the private sector dollars and venture capitalists who really believed this was a viable business model in the ObamaTax environment?
Money talks, no?
What if they gave an Exchange and nobody came? [UPDATED]
Lest it be lost amid the noisy crash of the Data Hub, here's news that should cheer up folks who despair that - once all these pesky "security issues" are settled - life on the Public Exchanges will be a bowlful of cherries and choices.
Wait, did I say "cheer up?"
So sorry - I meant to say 'discourage:'
"Major health insurance companies--Blue Cross, Aetna, United, Humana--have decided not to participate in various states in the Obamacare health-insurance exchanges ... Aetna, a fortune 100 company with $34.2 billion in revenue, has pulled out of the government-run exchanges in three states"
And of course we've documented plenty of other examples. The net result is that these Exchanges - literal oligopolies - will offer little (if any) choice and much higher prices, irrespective of any anticipated subsidies. But it's so superior to the system we leave behind....
UPDATE: And co-blogger Patrick just sent along this news:
"Aetna has reversed course on plans to participate in Ohio’s federally-mandated health insurance exchange next year ... Aetna has withdrawn its individual exchange filing in Ohio for 2014 but plans to continue offering its Coventry individual product on the exchange"
While we haven't been privy to details of the Coventry (a recent Aetna acquisition) product, it's a safe bet that it will feature a "skinny network" (and most likely higher rates than folks have been led to believe).
Wait, did I say "cheer up?"
So sorry - I meant to say 'discourage:'
"Major health insurance companies--Blue Cross, Aetna, United, Humana--have decided not to participate in various states in the Obamacare health-insurance exchanges ... Aetna, a fortune 100 company with $34.2 billion in revenue, has pulled out of the government-run exchanges in three states"
And of course we've documented plenty of other examples. The net result is that these Exchanges - literal oligopolies - will offer little (if any) choice and much higher prices, irrespective of any anticipated subsidies. But it's so superior to the system we leave behind....
UPDATE: And co-blogger Patrick just sent along this news:
"Aetna has reversed course on plans to participate in Ohio’s federally-mandated health insurance exchange next year ... Aetna has withdrawn its individual exchange filing in Ohio for 2014 but plans to continue offering its Coventry individual product on the exchange"
While we haven't been privy to details of the Coventry (a recent Aetna acquisition) product, it's a safe bet that it will feature a "skinny network" (and most likely higher rates than folks have been led to believe).
Navigators vs Agents: Told Ya So
Earlier this week, we noted the intensive training through which insurance agents will have to go in order to be certified to advise folks regarding (and ultimately selling policies through) the Exchanges. We also noted that this would not necessarily be true of Navigators. Now, I'm all for accountable, well-educated professionals being as knowledgeable as possible about the various ins and outs of these products and the subsidies that may (or may not) help to pay for them.
What is completely ridiculous, though, is that Ms Shecantbeserious and her minions have now "cut back on the number of training hours required for the Obamacare "navigators," federal workers who under the health care law are tasked with helping consumers purchase insurance through the state exchanges."
To be clear, this is not an issue of "fairness" (hey, life ain't fair), it's an issue of accountability. And it's also an issue of gross negligence:
"Grants to hire and train the workers aren't expected to be released for another two weeks ... That leaves just 32 business days to hire and train thousands of helpers in these states."
And I'm sure that the mad rush to cram in as many of them as possible - trained or not, qualified or not, honest or not - won't result in even more confusion and opportunity for identity theft and fraud, not to mention potentially catastrophic results when folks learn that the person on whose advice they relied were grossly under-trained.
But hey, it's only $54 million, right?
What is completely ridiculous, though, is that Ms Shecantbeserious and her minions have now "cut back on the number of training hours required for the Obamacare "navigators," federal workers who under the health care law are tasked with helping consumers purchase insurance through the state exchanges."
To be clear, this is not an issue of "fairness" (hey, life ain't fair), it's an issue of accountability. And it's also an issue of gross negligence:
"Grants to hire and train the workers aren't expected to be released for another two weeks ... That leaves just 32 business days to hire and train thousands of helpers in these states."
And I'm sure that the mad rush to cram in as many of them as possible - trained or not, qualified or not, honest or not - won't result in even more confusion and opportunity for identity theft and fraud, not to mention potentially catastrophic results when folks learn that the person on whose advice they relied were grossly under-trained.
But hey, it's only $54 million, right?
Wednesday, August 07, 2013
Flip Flopper
Key PPACA
proponent and "health law" expert Timothy Jost is once again coming to the defense
of President Obama. This time it is to save Congress Critters and their
staffers from being thrown to the wolves by having to get their insurance AND
PAY FOR IT through Federal and State Exchanges Marketplaces. If you didn’t
read Bob’s post on Monday, this super special group of people will not be able
to "keep the plan they currently have" but will still receive the
generous Federal Government contribution.
What's so wrong with that? Well
according to an article in Health Affairs Mr. Jost wrote back in January doing
this would be illegal and may violate large employer rules on adequate and affordable
health coverage. In that article Mr. Jost states:
"The problem is that section 2711 of the Public Health Services Act, added by the ACA, prohibits annual dollar limits on health plan coverage, and HRAs are by definition limited in the dollar amount they offer for coverage…That conclusion, however, left open the question of “stand-alone” HRAs. In some instances HRAs are not integrated into a group health plan, but rather simply offered to employees to allow the employee to purchase conventional insurance in the individual, non-group, market with pre-tax dollars. Some employers had hoped that with the advent of the exchanges in 2014, they would be able to offer their employees a fixed dollar contribution through an HRA, which would permit the employee to take advantage of the tax subsidies currently available through HRA coverage but get the employer out of the health insurance business…Large employers, who must offer adequate and affordable health care coverage to their full time employees (and dependents) or pay a penalty if an employee ends up receiving premium tax credits, would probably not have been able to use this strategy, as it is hard to see how a stand-alone HRA could meet the “adequate and affordable test,” but it could be an attractive strategy for small employers who wish to move to a defined contribution approach to health benefits. The FAQ clarifies that this approach is not possible under section 2711."Fast forward to a Reuters article today where he has this little gem:
"It was probably never Congress' intention to take away federal benefit contributions from Capitol Hill employees, just to push them into them into the exchanges. There is nothing in the health law that prohibits private companies from contributing to employee health insurance premiums for plans purchased on the health exchanges. This clarifies what they really intended to do all along. Congress had subjected itself to a requirement that applied to nobody else in the country."So tell me Tim, as a law professor which quote of yours is correct?
Security to the Bridge!
And the hits just keep on comin'. This morning, we noted that there seem to be some major issues facing the income verification process for folks who'd like some of that sweet, sweet subsidy money:
"An exchange will have some flexibility when it comes to asking for extra documentation from individuals"
Turns out, it may not be "flexibility" so much as "vulnerability." Co-blogger Bob tips us to this rather disturbing news:
"The federal government is months behind in testing data security for the main pillar of Obamacare ... The missed deadlines have pushed the government's decision on whether information technology security is up to snuff to exactly one day before that crucial date [October 1st]"
There's so much at stake here, and so many things that could go wrong, that it's hard to really pin down the worst of this. The Reuters folks think it's identity theft, and we've also discussed that threat. But the sad fact is, the project itself is so vast, and with so much of it being thrown together at the last minute, one can't help but wonder "what were they thinking?"
And there's this:
"A [crucial information technology] test was to have been performed between June 3 and 7 ... is now set for this week and next."
Meanwhile, the Countdown Clock continues its inexorable measure, as E-Day approaches. Contra Reuters, this may be the scariest thing:
"The delays mean that the ruling by CMS's chief information officer certifying the Obamacare IT system as secure will be pushed back from September 4 to September 30"
Who wants to bet that - no matter the true results - the Official proclamation will be that "all is well?" Yeah, that's what I thought, too.
"An exchange will have some flexibility when it comes to asking for extra documentation from individuals"
Turns out, it may not be "flexibility" so much as "vulnerability." Co-blogger Bob tips us to this rather disturbing news:
"The federal government is months behind in testing data security for the main pillar of Obamacare ... The missed deadlines have pushed the government's decision on whether information technology security is up to snuff to exactly one day before that crucial date [October 1st]"
There's so much at stake here, and so many things that could go wrong, that it's hard to really pin down the worst of this. The Reuters folks think it's identity theft, and we've also discussed that threat. But the sad fact is, the project itself is so vast, and with so much of it being thrown together at the last minute, one can't help but wonder "what were they thinking?"
And there's this:
"A [crucial information technology] test was to have been performed between June 3 and 7 ... is now set for this week and next."
Meanwhile, the Countdown Clock continues its inexorable measure, as E-Day approaches. Contra Reuters, this may be the scariest thing:
"The delays mean that the ruling by CMS's chief information officer certifying the Obamacare IT system as secure will be pushed back from September 4 to September 30"
Who wants to bet that - no matter the true results - the Official proclamation will be that "all is well?" Yeah, that's what I thought, too.
Cavalcade of Risk #189: What in the world edition
R J Weiss makes his
hosting debut today with this outstanding collection of risk-related posts. From Worker's
Comp to Morningstar Reports, R J's got ya covered.
You made HOW much??
Here's a conundrum: if the Data Hub isn't online come October (or even January) 1st, and since the (Evil) Employer Mandate is delayed, then how will Capital City's right hand know about its left when it comes to Exchange subsidies?
Well, the folks in charge seem to think that's not going to be a problem:
"Obama administration officials have been telling Congress the exchanges will have ways to check consumers' income information in 2014."
Uh-hunh.
And how might that be?
Turns out, the "normal" data on which the Exchanges would rely comes from the IRS, Social Security and Equifax. But what if these agencies can't actually provide the verification? No problem:
"[T]he exchange will cut off access to the tax credits"
Really?
Are these the same bureauweenies that arbitrarily (and illegally) extended subsidies to states with Federally-run Exchanges? Or the ones who unilaterally (and illegally) delayed the Employer Mandate?
It is?
Then this becomes troublesome:
"An exchange will have some flexibility when it comes to asking for extra documentation from individuals"
Yeah, I'm sure that won't be abused.
Well, the folks in charge seem to think that's not going to be a problem:
"Obama administration officials have been telling Congress the exchanges will have ways to check consumers' income information in 2014."
Uh-hunh.
And how might that be?
Turns out, the "normal" data on which the Exchanges would rely comes from the IRS, Social Security and Equifax. But what if these agencies can't actually provide the verification? No problem:
"[T]he exchange will cut off access to the tax credits"
Really?
Are these the same bureauweenies that arbitrarily (and illegally) extended subsidies to states with Federally-run Exchanges? Or the ones who unilaterally (and illegally) delayed the Employer Mandate?
It is?
Then this becomes troublesome:
"An exchange will have some flexibility when it comes to asking for extra documentation from individuals"
Yeah, I'm sure that won't be abused.
Tuesday, August 06, 2013
Mid-Afternoon Info Break
First, the National Federation of Independent Business (NFIB) has posted a webinar covering many of the key questions employers are asking about their responsibilities under the ACA. Click on over to "learn what the delay means, what you still need to do and what changes are yet to come."
If you own (or manage) a small business, then this is pretty crucial knowledge, available gratis.
Second, not really insurance-related, but very cool nonetheless. As a recent convert to the world of smart-phones, I hadn't realized just how critical they can be.
Case in point:
"Ricky Dean's memory problems are so severe he has to be told to do just about everything, from eating to brushing his teeth."
As an infant, he was starved of oxygen, and then later diagnosed as autistic. It was during testing to determine exactly what was wrong when a memory scan "revealed the full extent of his memory loss."
He has no sense of time passing, which makes cooking or drawing a bath impossible, but with the help of his friends, family and smartphone, he's leading a relatively independent life:
"Until three years ago, Ricky rarely left his family home, because he could never remember where he was going, but now relies on his iPhone"
If you own (or manage) a small business, then this is pretty crucial knowledge, available gratis.
Second, not really insurance-related, but very cool nonetheless. As a recent convert to the world of smart-phones, I hadn't realized just how critical they can be.
Case in point:
"Ricky Dean's memory problems are so severe he has to be told to do just about everything, from eating to brushing his teeth."
As an infant, he was starved of oxygen, and then later diagnosed as autistic. It was during testing to determine exactly what was wrong when a memory scan "revealed the full extent of his memory loss."
He has no sense of time passing, which makes cooking or drawing a bath impossible, but with the help of his friends, family and smartphone, he's leading a relatively independent life:
"Until three years ago, Ricky rarely left his family home, because he could never remember where he was going, but now relies on his iPhone"
ObamaTax News
While we watch the anticipated implosion of the Data Hub, we should also be keeping our eyes on some of the ways we're expected to interact with it.
Example the First:
"[A]dministration officials announced Monday that the [ObamaTax] is a step closer to reality for millions of uninsured Americans ... consumers can now go online to healthcare.gov and create personal accounts by establishing a username and password"
Well, goody! Must mean we're really close to open access to hundreds of new plans and going-out-of-business rates (so to speak).
What?
Oh:
"[S]erious shopping will have to wait until sometime in September, when details on insurance plans and premiums offered in local areas will become available."
Well, perhaps Carly Simon had it right, after all.
Which brings us to Example the Second:
"A federal health insurance exchange agency has come up with advice about how its exchanges will manage relationships with one type of consumer helper — the "certified application counselor."
So what's a CAC?
So glad you asked:
"[F]ederally facilitated exchanges" run by CCIIO will designate CACs, and how the FFEs will fire CACs violating privacy standards or breaking other program rules."
Clear as mud.
Actually, a "CAC will be like a navigator, but without necessarily having the ability to provide "culturally and linguistically appropriate" help."
M'kay.
Example the First:
"[A]dministration officials announced Monday that the [ObamaTax] is a step closer to reality for millions of uninsured Americans ... consumers can now go online to healthcare.gov and create personal accounts by establishing a username and password"
Well, goody! Must mean we're really close to open access to hundreds of new plans and going-out-of-business rates (so to speak).
What?
Oh:
"[S]erious shopping will have to wait until sometime in September, when details on insurance plans and premiums offered in local areas will become available."
Well, perhaps Carly Simon had it right, after all.
Which brings us to Example the Second:
"A federal health insurance exchange agency has come up with advice about how its exchanges will manage relationships with one type of consumer helper — the "certified application counselor."
So what's a CAC?
So glad you asked:
"[F]ederally facilitated exchanges" run by CCIIO will designate CACs, and how the FFEs will fire CACs violating privacy standards or breaking other program rules."
Clear as mud.
Actually, a "CAC will be like a navigator, but without necessarily having the ability to provide "culturally and linguistically appropriate" help."
M'kay.
Breaking News....
Remember that state-of-the-art Data Hub that's going to enable lightning-fast, hyper-accurate, real-time exchange of information to facilitate the wildly successful ObamaTax?
Ummmmm:
"PPACA data hub testing incomplete ... One huge hurdle will be connecting so many different federal and state agencies ... The hub also will have spokes reaching out to agencies with less obvious health insurance relationships"
So, speaking of hubs, are the wheels coming off?
Ummmmm:
"PPACA data hub testing incomplete ... One huge hurdle will be connecting so many different federal and state agencies ... The hub also will have spokes reaching out to agencies with less obvious health insurance relationships"
So, speaking of hubs, are the wheels coming off?
Monday, August 05, 2013
Insult to Injury
So let me get this straight: I have to waste 'invest' 2+ hours in "training" and "certification" , followed by a (no doubt intrusive) identity verification process, but these jokers get to just set up sites and throw out any info they please?
First, the "AARP announced Monday that it has launched two websites ... ahead of the enactment of the healthcare reform's major provisions." About the only thing I believe from these guys is their admission that "the law is confusing."
Keen insight there, Nicole.
And then some other folks, playing cutesy with an "Embargoed News Release" (as if anyone really cares when they roll out their own toys) promising "its Health Care Reform Center for consumers and the ACA Resource Center for physicians."
And this is TOP SECRET, why?
Somebody's taking themselves way too seriously.
And there's this: Co-Blogger Patrick wonders "how much government funding they got for these sites."
Great question!
First, the "AARP announced Monday that it has launched two websites ... ahead of the enactment of the healthcare reform's major provisions." About the only thing I believe from these guys is their admission that "the law is confusing."
Keen insight there, Nicole.
And then some other folks, playing cutesy with an "Embargoed News Release" (as if anyone really cares when they roll out their own toys) promising "its Health Care Reform Center for consumers and the ACA Resource Center for physicians."
And this is TOP SECRET, why?
Somebody's taking themselves way too seriously.
And there's this: Co-Blogger Patrick wonders "how much government funding they got for these sites."
Great question!
and another one bites the dust
From AP about an hour ago:
"Hartford-based Aetna Life Insurance Co. has informed state insurance officials that it has withdrawn from Connecticut's health insurance exchange . . . three insurers will now offer individual coverage through [the exchange]. They include Anthem, ConnectiCare and the nonprofit HealthyCT . . . Aetna has also withdrawn from offering individual plans in Maryland and Georgia, said Susan Millerick, an Aetna spokesman . . . "
It's still fair to say the implementation of Obamacare continues to be a slow-motion train wreck.
But news like this increases the odds that it's becoming another Alice's Restaurant Mass-a-cree.
"Hartford-based Aetna Life Insurance Co. has informed state insurance officials that it has withdrawn from Connecticut's health insurance exchange . . . three insurers will now offer individual coverage through [the exchange]. They include Anthem, ConnectiCare and the nonprofit HealthyCT . . . Aetna has also withdrawn from offering individual plans in Maryland and Georgia, said Susan Millerick, an Aetna spokesman . . . "
It's still fair to say the implementation of Obamacare continues to be a slow-motion train wreck.
But news like this increases the odds that it's becoming another Alice's Restaurant Mass-a-cree.
Oh frabjous day!
So this arrived in my in-box this morning:
"Agent/broker training for the Federally-facilitated Marketplace (FFM) is now available.
All training will occur online. ... The certification is a two-step process, with the first step now available, the training. The second part of the process is completing the agent/broker registration, which will be available later in August. At that time, agents/brokers will be able to obtain an active FFM User ID by completing an online identity verification."
After successfully completing the process outlined above - which we are advised will take over 4 hours - we will be made privy to "the Individual and/or the SHOP Marketplace Agreements."
That is, only after investing valuable time in "training" will we be allowed to see what our own responsibilities and boundaries will be. Oh, and we'll also (eventually) receive certificates (suitable for framing!) and confirmation of our "active FFM User ID," after we've completed an "online identity verification."
Which last, by the way, is something which apparently will not apply to Navigators.
Doesn't that make you feel all warm and fuzzy?
That is, only after investing valuable time in "training" will we be allowed to see what our own responsibilities and boundaries will be. Oh, and we'll also (eventually) receive certificates (suitable for framing!) and confirmation of our "active FFM User ID," after we've completed an "online identity verification."
Which last, by the way, is something which apparently will not apply to Navigators.
Doesn't that make you feel all warm and fuzzy?
Saturday, August 03, 2013
Maryland's strategy to ensure low cost insurance in their Exchange?
Reuters reported on August 2 that Aetna Inc will pull out of Maryland's
health insurance exchange under ACA. Apparently that's after the state told Aetna to
lower its proposed 2014 rates by up to 29 percent.
Which reminds me - I was a bartender at Busch Stadium back in the late 60's. One oppressively hot St Louis afternoon we ran out of beer. (Not for long, but we did run out.) A thirsty fan asked me how much for a beer. I told him we were temporarily out. He then insisted to know how much for a beer. I told him "Mister it's free. We give it away whenever we run out."
Is that Maryland's strategy too? Let's see how that works.
Meanwhile, I think I hear two trains coming this way. Don't you?
Which reminds me - I was a bartender at Busch Stadium back in the late 60's. One oppressively hot St Louis afternoon we ran out of beer. (Not for long, but we did run out.) A thirsty fan asked me how much for a beer. I told him we were temporarily out. He then insisted to know how much for a beer. I told him "Mister it's free. We give it away whenever we run out."
Is that Maryland's strategy too? Let's see how that works.
Meanwhile, I think I hear two trains coming this way. Don't you?
Friday, August 02, 2013
Me, too
Color me shocked:
"I'll offer a perspective as a federal employee myself and a federal employee at the IRS ... we have right now as employees of the government, of the IRS, affordable health care coverage ... you're probably in a better position to stick with that coverage than go through the change of moving into [the ObamaTax]"
Ditto here, Mr Werfel.
"I'll offer a perspective as a federal employee myself and a federal employee at the IRS ... we have right now as employees of the government, of the IRS, affordable health care coverage ... you're probably in a better position to stick with that coverage than go through the change of moving into [the ObamaTax]"
Ditto here, Mr Werfel.
Well, maybe this one little bitty exemption won't hurt
"The White House has approved a deal that will exempt members of Congress and their staff from some of the provisions of the Affordable Care Act, Politico reported late Thursday [August 1] . . . the Office of Personnel Management now plans to rule that the government can continue to make a contribution to the health-care premiums of the lawmakers and their staff, [Politico] said, citing unnamed congressional sources and a White House official. "
And here.
Except of course that this is not just one little bitty exemption - instead it joins the hundreds of previous exemptions, exceptions, delays, interpretations, and political paybacks that this administration has made using the incredibly broad discretionary authority written into ACA - and enacted with not a single Republican vote in either the House or Senate.
As we all learned in our high-school civics classes, America is a government of laws.
Sure it is.
And here.
Except of course that this is not just one little bitty exemption - instead it joins the hundreds of previous exemptions, exceptions, delays, interpretations, and political paybacks that this administration has made using the incredibly broad discretionary authority written into ACA - and enacted with not a single Republican vote in either the House or Senate.
As we all learned in our high-school civics classes, America is a government of laws.
Sure it is.
Cavalcade of Risk #189: Call for submissions
R J Weiss hosts
next week's Cav. Entries are due by Monday (the 5th).
To submit your risk-related post, just click here to email it.
You'll need to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.
To submit your risk-related post, just click here to email it.
You'll need to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.
Thursday, August 01, 2013
41%
Breaking news from the Ohio Department of Insurance!
Just wait, soon you will be hearing about how it doesn't take into account subsidies.
Just wait, soon you will be hearing about how it doesn't take into account subsidies.
Genworth LTCi in the crosshairs
Genworth, one of the last remaining "players" in the Long Term Care insurance (LTCi) market, is about to drop the hammer on some of its long-time policyholders:
"We're conducting an intense, very broad and deep review of all aspects of our [long-term care] insurance business ... believe the company has to increase the price of products sold before 2002 to bring them closer to the break-even point"
Yikes!
Actually, this is far from unexpected, and arguably overdue: as we've seen over the years, the current long term pricing models just aren't sustainable. For one thing, too many folks have kept their policies (not a bad thing, per se, just that carriers count on a certain amount of attrition), so both claims and reserves continue to mount.
And, of course, as the LTCi business itself matures, it becomes more and more obvious that earlier plans were substantially under-priced. While that may have been a good deal for early adopters, over time it's a problem.
Which is not to say that the LTCi market is 'kaput;' indeed, more folks than ever seem to be taking a serious look at these plans. But it's important to keep in mind that, with few exceptions, rates will continue to climb for at least a while.
"We're conducting an intense, very broad and deep review of all aspects of our [long-term care] insurance business ... believe the company has to increase the price of products sold before 2002 to bring them closer to the break-even point"
Yikes!
Actually, this is far from unexpected, and arguably overdue: as we've seen over the years, the current long term pricing models just aren't sustainable. For one thing, too many folks have kept their policies (not a bad thing, per se, just that carriers count on a certain amount of attrition), so both claims and reserves continue to mount.
And, of course, as the LTCi business itself matures, it becomes more and more obvious that earlier plans were substantially under-priced. While that may have been a good deal for early adopters, over time it's a problem.
Which is not to say that the LTCi market is 'kaput;' indeed, more folks than ever seem to be taking a serious look at these plans. But it's important to keep in mind that, with few exceptions, rates will continue to climb for at least a while.
Wednesday, July 31, 2013
Aetna Touch-N-Go, and the Big Picture
A couple of days ago, we reported on Aetna's apparent change of heart regarding the sale of individual medical insurance here in Ohio. Today, they're back in the news:
There are three essential differences between the Public (FFE) and Private Exchange models:
First, only plans purchased on the Public Exchange will be eligible for subsidies (maybe: the subsidy rules keep changing);
Second, plans available on the Public Exchange are expected to have much smaller ("skinnier," in the vernacular) provider networks;
And third, fewer carriers are expected to participate in the Public Exchanges (limiting competition and choice).
It's that third item that's key: absent a robust marketplace, even subsidized plans are likely to remain out of the financial reach of many folks. That's due partly to premiums, and partly to plan design. The least expensive ObamaTax-compliant plans ("Bronze" level) have potential out-of-pocket maximums much higher than many plans available today, further exacerbating the (un)affordability issue.
If (when?) major players like Aetna take a pass on the Public version in favor of the Private, it will cause an even greater strain on the former's sustainability. The Private Exchange model, on the other hand, looks poised to be reasonably successful: for the most part, these will offer more choice (and thus competition) and better service.
Wait, what's that about service, Henry?
Well, it's like this: agents (you know, the folks who are trained and experienced in the actual business of health insurance) are effectively shut out of the Public Exchanges. But a lot of us have signed up for the Private Exchanges. So when a consumer needs an accurate, knowledgeable and credible answer, to where do you think he will turn?
On the other hand, we know that a lot of agents have already thrown in the towel (and/or are planning to do so in the near future), so that may not be a realistic assessment, either.
Yeah, I'm just full of warm fuzzies today.
Wednesday Potpourri
■ While you're busy planning that end-of-summer trip to Rome or London (or Istanbul, for that matter), you should know that your health insurance works a bit differently overseas. One way to help protect yourself is with a Travel Medical plan.
■ As if the ObamaTax train-wreck wasn't causing enough damage to the health care and insurance sectors, its broad "appeal" has rippled through the whole economy:
"This letter was written by the three of the nation's largest labor unions ... Right now, unless you and the Obama Administration enact an equitable fix, the ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40-hour workweek that is the backbone of the American middle class."
Ooops.
■ Earlier this month, the (Evil) Employer Mandate was put (temporarily) on hold. Before we start singing and dancing for joy (Hi, Joy!), though, here's some sobering news. According to the Congressional Budget Office:
"The Obama administration's move to delay a mandate on businesses to provide health coverage will mean $12 billion in lost tax revenue and additional costs ... one million fewer people will get employer coverage in 2014 as a result of the postponement"
So we get higher costs and fewer people insured. Yup, sounds like a plan!
[Hat Tips to Holly R and Gail S]
■ As if the ObamaTax train-wreck wasn't causing enough damage to the health care and insurance sectors, its broad "appeal" has rippled through the whole economy:
"This letter was written by the three of the nation's largest labor unions ... Right now, unless you and the Obama Administration enact an equitable fix, the ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40-hour workweek that is the backbone of the American middle class."
Ooops.
■ Earlier this month, the (Evil) Employer Mandate was put (temporarily) on hold. Before we start singing and dancing for joy (Hi, Joy!), though, here's some sobering news. According to the Congressional Budget Office:
"The Obama administration's move to delay a mandate on businesses to provide health coverage will mean $12 billion in lost tax revenue and additional costs ... one million fewer people will get employer coverage in 2014 as a result of the postponement"
So we get higher costs and fewer people insured. Yup, sounds like a plan!
[Hat Tips to Holly R and Gail S]
Rakin' in the ObamaTax Bucks
As Patrick noted last week, the ObamaTax Medical Loss Ratio (MLR) provision seems to have been a wonderful gift to the health insurance industry:
"So, thanks to MLR, insurance companies took in an additional $50 Billion in 2012 and paid out $800 Million less in rebates"
Lest our readers think that this is an exaggeration, we learn today that at least one carrier, WellPoint, is making some serious coin off of the ObamaTax:
"[N]ewly minted CEO Joseph Swedish said the company expects a windfall of sorts from the [ObamaTax] — as much as $20 billion by 2016."
While that's only partially due to the MLR (other factors include increased market share and more folks buying coverage through the Exchanges), it's certainly looks to be "berry, berry good" for the folks at Blue Cross.
By the way, take a look at your renewal and let us know how well you're faring.
"So, thanks to MLR, insurance companies took in an additional $50 Billion in 2012 and paid out $800 Million less in rebates"
Lest our readers think that this is an exaggeration, we learn today that at least one carrier, WellPoint, is making some serious coin off of the ObamaTax:
"[N]ewly minted CEO Joseph Swedish said the company expects a windfall of sorts from the [ObamaTax] — as much as $20 billion by 2016."
While that's only partially due to the MLR (other factors include increased market share and more folks buying coverage through the Exchanges), it's certainly looks to be "berry, berry good" for the folks at Blue Cross.
By the way, take a look at your renewal and let us know how well you're faring.
Tuesday, July 30, 2013
Insurance as a loss leader
It's often asked how long carriers will put up with low margins and tight regulations. It's not a very attractive market to be in right now. Unless insurance isn't your primary business. If you're a hospital or health system breaking even but driving more business to your facilities would be a good deal. Making an extra couple points on insurance operations would just be gravy.
Even better is having your competitors or taxpayors subsidize any loses while your hospital runs up charges.
Even better is having your competitors or taxpayors subsidize any loses while your hospital runs up charges.
Lucy (Peanuts fame) found working in Maryland
Lucy would be called an inflation-denier for her never-ending demand that it cost $0.05. Even today hocking life insurance she is set on five cents being the price. I have to wonder if officials in Maryland aren't giving their price setting just as little thought:
"The Maryland Insurance Administration is telling some carriers that want to sell coverage through its individual exchange program to make deep cuts in their premiums. "
"In the bare-bones, “bronze level” of coverage, for example, the monthly premium rates originally requested for a 25-year-old nonsmoker living in Baltimore ranged from $136 to $350.
The rates approved in that category of coverage range from $124 to $237.
The rate reductions demanded range from 1.1 percent for a QHP to be sold by a unit of Kaiser Permanente to 32 percent for a QHP to be sold be a unit of UnitedHealth Group Inc." [emphasis added]
It is important to remember that if the actuaries for United are wrong they don't get to keep the money, it would go back to the policy holders; thus they don't have any incentive to be that far off.
I have to wonder where $237 came from. That doesn't sound far off for a healthy person policy today with maternity. Guaranteed issue with community rating and $350 even sounds aggressive.
"The Maryland Insurance Administration is telling some carriers that want to sell coverage through its individual exchange program to make deep cuts in their premiums. "
"In the bare-bones, “bronze level” of coverage, for example, the monthly premium rates originally requested for a 25-year-old nonsmoker living in Baltimore ranged from $136 to $350.
The rates approved in that category of coverage range from $124 to $237.
The rate reductions demanded range from 1.1 percent for a QHP to be sold by a unit of Kaiser Permanente to 32 percent for a QHP to be sold be a unit of UnitedHealth Group Inc." [emphasis added]
It is important to remember that if the actuaries for United are wrong they don't get to keep the money, it would go back to the policy holders; thus they don't have any incentive to be that far off.
I have to wonder where $237 came from. That doesn't sound far off for a healthy person policy today with maternity. Guaranteed issue with community rating and $350 even sounds aggressive.
Gov tries to circumvent ACA in way HHS clearly tells employers not to
How sweet this would be if not for the inevitable consequences:
Representative Henry A. Waxman, a California Democrat who helped write the 2010 law, said, “The federal government, as our employer, should provide the same contributions it makes to our current health plans.”
HHS has made it very clear to the rest of us though that we dare not even consider such an arrangement.
"FAQS About Affordable Care Implementation (Part XI)” (FAQ) available here issued by the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Agencies) on January 24, 2013 sends a clear message to employers that trying to escape ACA or other federal group health plan mandates by replacing their traditional insured or group health plans or policies with health reimbursement arrangements (HRAs) or other arrangements under which the employer agrees to provide a fixed defined contribution to be used to buy or reimburses employees for buying individual health insurance generally won’t pass legal muster. The FAQ also indicates that employers sponsoring HRAs that only reimburse medical expenses, not individual health insurance premiums also need to review their arrangements to verify that those programs also comply with ACA and other applicable rules." [emphasis added]
It has been prohibited to use Section 125 unreimbursed medical funds to reimburse insurance premiums. Outside those two mechanisms I'm not aware of any way to reimburse individuals for premiums and not run afoul of any other law. The one exception being giving them a raise and taking the tax it. Would love to see Congress pass out $10,000 raises to everyone and how that would go over.
Like any true Democrat, Rep Waxman doesn't think they should be bothered by any actual law.
Representative Henry A. Waxman, a California Democrat who helped write the 2010 law, said, “The federal government, as our employer, should provide the same contributions it makes to our current health plans.”
HHS has made it very clear to the rest of us though that we dare not even consider such an arrangement.
"FAQS About Affordable Care Implementation (Part XI)” (FAQ) available here issued by the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Agencies) on January 24, 2013 sends a clear message to employers that trying to escape ACA or other federal group health plan mandates by replacing their traditional insured or group health plans or policies with health reimbursement arrangements (HRAs) or other arrangements under which the employer agrees to provide a fixed defined contribution to be used to buy or reimburses employees for buying individual health insurance generally won’t pass legal muster. The FAQ also indicates that employers sponsoring HRAs that only reimburse medical expenses, not individual health insurance premiums also need to review their arrangements to verify that those programs also comply with ACA and other applicable rules." [emphasis added]
It has been prohibited to use Section 125 unreimbursed medical funds to reimburse insurance premiums. Outside those two mechanisms I'm not aware of any way to reimburse individuals for premiums and not run afoul of any other law. The one exception being giving them a raise and taking the tax it. Would love to see Congress pass out $10,000 raises to everyone and how that would go over.
The Rate Game
Patrick's post yesterday about small group renewal rates seems to have touched a nerve, and I think it's worthwhile spending some time on the whole "early renewal" issue. The premise of early renewal is that some groups may benefit from moving their renewal dates back from (say) early 2014 to late 2013. To that end, carriers have begun offering this service to existing groups.
Yesterday, Anthem sent me a list of my eligible groups, along with what they anticipate will happen to those groups' rates once community rating (and all the rest) kicks in.
As with Patrick's experience, some of my groups would actually see significant rate reductions come next year, while others would see substantial rate hikes. What became immediately obvious is that the "sicker" (and/or older) the group, the better they will fare come January 1. And, of course, the converse is also true.
As a practical matter, then, those sicker/older groups will most likely stay put, since they have nothing to gain from renewing early. But the healthier ones will most likely pull that trigger in an effort to stave off those hefty renewal rates for as long as possible.
And I'm just a very small fish in a very large pond. Imagine this scenario playing out across the country, with many (most?) of the sicker groups staying put, and the healthy ones renewing early. The practical - and obvious - result will be that rates for everyone will skyrocket as carriers seek to find a way to balance these competing forces. It's just not a sustainable model.
One of our commenters also observed, based on his own experience, that "this leads to healthier groups dropping out, and eventually the unhealthy groups are paying even more than they used to." And since the (Evil) Employer Mandate is currently on hiatus, there's really very little that can be done to stop this from happening.
Now, there is one potential reason for those older/sicker groups to take the plunge: Health Savings Accounts (HSAs). That's because, under the ObamaTax, these plans are effectively outlawed (or at least rendered much less effective) after this year. So depending on how important a given group deems its HSA to be, they may well consider keeping it (vs a lower premium) a good trade-off. We shall see.
Yesterday, Anthem sent me a list of my eligible groups, along with what they anticipate will happen to those groups' rates once community rating (and all the rest) kicks in.
As with Patrick's experience, some of my groups would actually see significant rate reductions come next year, while others would see substantial rate hikes. What became immediately obvious is that the "sicker" (and/or older) the group, the better they will fare come January 1. And, of course, the converse is also true.
As a practical matter, then, those sicker/older groups will most likely stay put, since they have nothing to gain from renewing early. But the healthier ones will most likely pull that trigger in an effort to stave off those hefty renewal rates for as long as possible.
And I'm just a very small fish in a very large pond. Imagine this scenario playing out across the country, with many (most?) of the sicker groups staying put, and the healthy ones renewing early. The practical - and obvious - result will be that rates for everyone will skyrocket as carriers seek to find a way to balance these competing forces. It's just not a sustainable model.
One of our commenters also observed, based on his own experience, that "this leads to healthier groups dropping out, and eventually the unhealthy groups are paying even more than they used to." And since the (Evil) Employer Mandate is currently on hiatus, there's really very little that can be done to stop this from happening.
Now, there is one potential reason for those older/sicker groups to take the plunge: Health Savings Accounts (HSAs). That's because, under the ObamaTax, these plans are effectively outlawed (or at least rendered much less effective) after this year. So depending on how important a given group deems its HSA to be, they may well consider keeping it (vs a lower premium) a good trade-off. We shall see.
Monday, July 29, 2013
Death of Small Group Insurance - One Chart
January 1, 2014. Community rating, narrower age banding, guaranteed issue, and other fun parts of the law will begin on this date. In preparation, our agency has been meeting with major health insurance carriers on the impact PPACA will have on our employer sponsored plans with less than 50 employees. For my accounts the results have been staggering:
49 employer groups, 4 with decreases of 20%-30%, 4 with 0-10% increases, 20 employers with 30% or more increases. How will businesses absorb/pass on the cost increases? Drop coverage. With no penalties for not offering why wouldn't they?
Flawed thinking on ObamaCare, giving it a shot has consequences
Reading the comments to an article in the NYT on the Obama Admin's implementation of ACA, I came across a very common response:
What I never see mentioned or discussed by these individuals is the consequences or aftereffects of giving it a shot. They make it sound like giving it a shot is a free sample. That is not in anyway accurate. If it doesn't work we are looking at:
"Corkyjon it seem to me that you speculate in the negative; the best thing that we can do for ourselves is to let Obama care play itself out. It's meant to work by getting all the uninsured to get coverage or suffer a penalty id they don't, and to offer coverage despite pre-existing conditions, Sounds good . . . will it do what's expected of the program ? that's to be seen"
What I never see mentioned or discussed by these individuals is the consequences or aftereffects of giving it a shot. They make it sound like giving it a shot is a free sample. That is not in anyway accurate. If it doesn't work we are looking at:
- Hundreds of billions (if not trillions) of additional debt.
- Individuals being kicked off insurance with no place to go
- Employers having exited the market and possibly not willing or able to get back in
- Shopping habits and expectations for insurance altered
- Carriers having exited the market and possibly never returning
The ObamaTax Subsidy Cheat
As we noted almost 2 years ago, the ObamaTax specifically forbids folks in states with Federally-run Exchanges from receiving any subsidies (and this would include those hybrid State/Fed models, as well). Of course, a little thing like the law is of little consequence to the folks in Capital City, and so the IRS has stated unequivocally that "it determined that Congress intended for subsidies to be available in both state- and federally-run marketplaces," thus greatly expanding the scope (and, of course, the cost) of the subsidies.
Now come two House committees (finally) looking into this egregious decision:
"Two House committees sent a letter to Treasury Secretary Jack Lew ... the law explicitly allows the subsidies to only be applied to purchases made on an exchange “established by the state"
As we were saying (seven months ago).
Since only 16 of the 58 states would legally be eligible for these subsidies, this represents a pretty significant chunk of ObamaChange. The Sooner State (one of those with a state-run Exchnage) "is now the plaintiff to a lawsuit arguing that the federal government cannot legally provide subsidies to federally run exchanges."
Here's wishing them well.
ADDENDUM: Meanwhile, Motor City seems intent on further exacerbating the ObamaTax Subsidy budgeting challenge:
"[T]he city is proposing a controversial plan for paring some of the $5.7 billion it owes in retiree health costs: pushing many of those too young to qualify for Medicare out of city-run coverage and into the new insurance markets that will soon be operating under the Obama health care law."
Yup, hundreds (thousands?) more unemployed folks hitting the Exchanges. And remember, thanks to the now-delayed roll-out of the Data Hub verification system, most if these folks will be climbing on board the subsidy gravy train.
Your tax dollars hard atretirement work.
Now come two House committees (finally) looking into this egregious decision:
"Two House committees sent a letter to Treasury Secretary Jack Lew ... the law explicitly allows the subsidies to only be applied to purchases made on an exchange “established by the state"
As we were saying (seven months ago).
Since only 16 of the 58 states would legally be eligible for these subsidies, this represents a pretty significant chunk of ObamaChange. The Sooner State (one of those with a state-run Exchnage) "is now the plaintiff to a lawsuit arguing that the federal government cannot legally provide subsidies to federally run exchanges."
Here's wishing them well.
ADDENDUM: Meanwhile, Motor City seems intent on further exacerbating the ObamaTax Subsidy budgeting challenge:
"[T]he city is proposing a controversial plan for paring some of the $5.7 billion it owes in retiree health costs: pushing many of those too young to qualify for Medicare out of city-run coverage and into the new insurance markets that will soon be operating under the Obama health care law."
Yup, hundreds (thousands?) more unemployed folks hitting the Exchanges. And remember, thanks to the now-delayed roll-out of the Data Hub verification system, most if these folks will be climbing on board the subsidy gravy train.
Your tax dollars hard at
Friday, July 26, 2013
Promoting the ObamaTax
We've been wondering for a while now, why - if the ObamaTax is such a grand bargain - is it necessary to advertise it so heavily, and to enlist everyone from Sheriff Andy to Michael Jordan to shout its praises from the rooftop. Not only have we received no answer, but Ms Shecantbeserious and her minions insist on doubling - nay, tripling - down.
Item the first: A gorgeous, impeccably designed ObamaTax bumper sticker (to compliment the Co-Exist one on your Prius). We've provided our take on this work of art above.
Item the Second: In keeping with the whole "community organizing" spirit of the Obamastration, Ms Kathy has enlisted folks like "Nahla Kayali ... among the first wave of 2,000 community organizers in California getting trained to persuade more than 1 million uninsured people in the state to sign up for [the train wreck]." Since the success of the whole risky scheme seems to rest on the shoulders of young people (whose lower expected utilization is deemed essential in offsetting the costs of older folks), this seems a no-brainer [ed: I see what you did there].
Item the Third: One of the biggest challenges to those first two may be this little tidbit:
"IRS employees have a prominent role in Obamacare, but their union wants no part of the law."
Ooops.
Turns out, even the folks tasked with enforcing the (Evil) Mandates aren't keen on participating. And who can blame them? After all, they're used to getting gold-plated (and low-to-them-cost) coverage through the Federal Employees Health Benefits Program. Wouldn't want to lose that, now, would we?
Item the first: A gorgeous, impeccably designed ObamaTax bumper sticker (to compliment the Co-Exist one on your Prius). We've provided our take on this work of art above.
Item the Second: In keeping with the whole "community organizing" spirit of the Obamastration, Ms Kathy has enlisted folks like "Nahla Kayali ... among the first wave of 2,000 community organizers in California getting trained to persuade more than 1 million uninsured people in the state to sign up for [the train wreck]." Since the success of the whole risky scheme seems to rest on the shoulders of young people (whose lower expected utilization is deemed essential in offsetting the costs of older folks), this seems a no-brainer [ed: I see what you did there].
Item the Third: One of the biggest challenges to those first two may be this little tidbit:
"IRS employees have a prominent role in Obamacare, but their union wants no part of the law."
Ooops.
Turns out, even the folks tasked with enforcing the (Evil) Mandates aren't keen on participating. And who can blame them? After all, they're used to getting gold-plated (and low-to-them-cost) coverage through the Federal Employees Health Benefits Program. Wouldn't want to lose that, now, would we?
How Much Did That Rebate Cost You?
President Obama has made another exaggerated speech regarding the insurance rebates that are being issued under PPACA. While "insurance premium savings" sounds admirable, there are a few facts we must point out to show the relative ignorance of Obamacare backers.
MLR was designed to leverage insurance company profits and administrative expenses. Reality is all we have seen from MLR is an increase in profits and expenses. Here are the facts:
2011 total premiums: $710 Billion
2011 rebates issued: $1.3 Billion
2012 total premiums: $760 Billion
2012 rebates issued: $500 Million
So, thanks to MLR, insurance companies took in an additional $50 Billion in 2012 and paid out $800 Million less in rebates.
Only in Washington is this "savings".
MLR was designed to leverage insurance company profits and administrative expenses. Reality is all we have seen from MLR is an increase in profits and expenses. Here are the facts:
- From the US Census Bureau: for 2011 to 2012 the number of people purchasing private insurance has remained flat at roughly 197,300,000.
- According to ehealthinsurance and The Kaiser Family Foundation average premiums in 2011 were around $3600 per person (from group and individual policies by family and single I came up with this very conservative number)
- According to Aon average increases in premiums from 2011 to 2012 were 7% (conservative again)
2011 total premiums: $710 Billion
2011 rebates issued: $1.3 Billion
2012 total premiums: $760 Billion
2012 rebates issued: $500 Million
So, thanks to MLR, insurance companies took in an additional $50 Billion in 2012 and paid out $800 Million less in rebates.
Only in Washington is this "savings".
The danger of polling the masses...Employee Choice in Carriers
Journalists, a term used loosely as few actually practice the craft any more, love polls. Easy to create, easier to write stories off of, and if you put even a little thought into the questions your guaranteed to have the narrative you want to push.
Which brings me to this tidbit;
ebn.benefitnews.com/-Employees-want-Choose-Their-insurer-
"A new survey out this week from insurance researcher HealthPocket corroborates that idea, with 65% of employee respondents saying they’d like to select their health insurance company rather than have their employer choose."
I think first we need to remember who we are talking about, over-generalizing here but employees are the same people that:
Properly run insurance should be a commodity anyways, a $2500 HSA from Anthem should have minimal differences than one from United. What are you choosing then if you're picking carriers? Website? Customer Service quality? Contract Negotiation? Do we think employees would actually be adept at measuring any of these and making informed decisions, or would we quickly end up with marketing gimmicks? Carrier with the biggest star endorsement. Freebies and add-ons. Funniest Super Bowl commercial. Do we really need more advertising in insurance? Do we not see how that has worked in Pharmaceuticals?
What employees should be picking are more cost effective and higher quality providers, physician and hospital. They should be shopping for cheaper drugs and lower cost MRIs instead of worrying about the paper pusher at the end. 80-85% of cost goes to care, let's fix that and then worry about the insurance.
Which brings me to this tidbit;
ebn.benefitnews.com/-Employees-want-Choose-Their-insurer-
"A new survey out this week from insurance researcher HealthPocket corroborates that idea, with 65% of employee respondents saying they’d like to select their health insurance company rather than have their employer choose."
I think first we need to remember who we are talking about, over-generalizing here but employees are the same people that:
- Will pay four times as much for a brand name instead of the generic
- Will pay ten times as much for the new heavily advertised combo pill instead of taking two generics
- Will go to the hospital for a non emergency MRI paying $2400 instead of getting one outside the hospital for $600
Properly run insurance should be a commodity anyways, a $2500 HSA from Anthem should have minimal differences than one from United. What are you choosing then if you're picking carriers? Website? Customer Service quality? Contract Negotiation? Do we think employees would actually be adept at measuring any of these and making informed decisions, or would we quickly end up with marketing gimmicks? Carrier with the biggest star endorsement. Freebies and add-ons. Funniest Super Bowl commercial. Do we really need more advertising in insurance? Do we not see how that has worked in Pharmaceuticals?
What employees should be picking are more cost effective and higher quality providers, physician and hospital. They should be shopping for cheaper drugs and lower cost MRIs instead of worrying about the paper pusher at the end. 80-85% of cost goes to care, let's fix that and then worry about the insurance.
Thursday, July 25, 2013
MVNHS© for Thee, but not for Me
First, a belated Mazel Tov to William and Kate on the birth of their son, and may he enjoy a long, happy and healthy life.
Would that it were so for most of their fellow Brits, who - unlike the happy royal couple - have to endure the agony that is the Much Vaunted National Health System©:
"According to the Daily Express, a suite at the private Lindo Wing of London’s St. Mary’s hospital costs £6,265 per night — and this “excludes consultants’ fees ... 37 per cent of the British public think that she should be having her firstborn on the National Health Service"
Which begs the question: why do over a third of their fellow countrymen hate the Royal Couple and their newborn son?
Closer to home, how many rational folks believe that this is not going to be the case for our own "Royalty" once the ObamaTax is fully implemented?
Thought so.
Would that it were so for most of their fellow Brits, who - unlike the happy royal couple - have to endure the agony that is the Much Vaunted National Health System©:
"According to the Daily Express, a suite at the private Lindo Wing of London’s St. Mary’s hospital costs £6,265 per night — and this “excludes consultants’ fees ... 37 per cent of the British public think that she should be having her firstborn on the National Health Service"
Which begs the question: why do over a third of their fellow countrymen hate the Royal Couple and their newborn son?
Closer to home, how many rational folks believe that this is not going to be the case for our own "Royalty" once the ObamaTax is fully implemented?
Thought so.
Dr Jerry Maguire?
About 3 years ago, our own Certified Medical Office Manager (and now co-blogger) Kelley Beloff put some major holes in the Myth of the Rich Doctor:
"I recently received a report stating that the average reimbursement of the average office visit code (99213) for physicians is $65.49. Yep, $65.49. That is all your physician gets for seeing you in a normal 15 minute appointment."
And out of that comes his overhead, including staff salaries, office rent, malpractice insurance premiums and, presumably, a little vig for himself.
Fast forward a bit, and we learn that not much has changed except, perhaps, a certain perception:
"What physicians are trying to tell us is that they don’t see themselves as necessarily any more responsible for health care costs than all of those stakeholders"
Which stakeholders include patients (among others) who are used to virtually immediate and unlimited access to health care. One wonders if there may be a correlation there with the cost of health insurance.
One problem, of course, comes immediately to mind: the only insurance product that effectively addresses this issue is about to be ObamaTaxed out of existence:
"Now, co-blogger Nate points out that "an HSA with anything short of max deductible and no contribution would pass," and that's a fair cop. But without the ability to sock away tax-advantaged dollars in anticipation of future claims, you're not talking "HSA" at all."
Kinda wish they'd read the thing, before they passed it.
"I recently received a report stating that the average reimbursement of the average office visit code (99213) for physicians is $65.49. Yep, $65.49. That is all your physician gets for seeing you in a normal 15 minute appointment."
And out of that comes his overhead, including staff salaries, office rent, malpractice insurance premiums and, presumably, a little vig for himself.
Fast forward a bit, and we learn that not much has changed except, perhaps, a certain perception:
"What physicians are trying to tell us is that they don’t see themselves as necessarily any more responsible for health care costs than all of those stakeholders"
Which stakeholders include patients (among others) who are used to virtually immediate and unlimited access to health care. One wonders if there may be a correlation there with the cost of health insurance.
One problem, of course, comes immediately to mind: the only insurance product that effectively addresses this issue is about to be ObamaTaxed out of existence:
"Now, co-blogger Nate points out that "an HSA with anything short of max deductible and no contribution would pass," and that's a fair cop. But without the ability to sock away tax-advantaged dollars in anticipation of future claims, you're not talking "HSA" at all."
Kinda wish they'd read the thing, before they passed it.
Exchanges offer cash back bonus!
Exchanges in DC just got a little more attractive, around 2-3% or a free trip to your sunny local of choice that is.
http://www.benefitspro.com/2013/07/23/credit-cards-causing-headaches-for-exchanges
"The exchange managers would consider taking SHOP premiums via credit card and debit card in 2015, if interest in that option appears strong."
If you had the option to pay your insurance premiums with credit card and receive cash back or points to use, what smart business owner wouldn't jump all over that? It is sort of ironic with government's push to squeeze every penny possible out of administrative cost they willingly add 2-3% in administrative costs for payment convenience.
Spending money on brokers or customer service reps, not acceptable; spending more than that on credit card fees....no problem. On an average family premium of $700 the credit card fees are roughly $20. The cost of an ACH around $0.10.
http://www.benefitspro.com/2013/07/23/credit-cards-causing-headaches-for-exchanges
"The exchange managers would consider taking SHOP premiums via credit card and debit card in 2015, if interest in that option appears strong."
If you had the option to pay your insurance premiums with credit card and receive cash back or points to use, what smart business owner wouldn't jump all over that? It is sort of ironic with government's push to squeeze every penny possible out of administrative cost they willingly add 2-3% in administrative costs for payment convenience.
Spending money on brokers or customer service reps, not acceptable; spending more than that on credit card fees....no problem. On an average family premium of $700 the credit card fees are roughly $20. The cost of an ACH around $0.10.
Wednesday, July 24, 2013
Aetna back in the Game?
A month ago (to the day!) we noted that Aetna had suspended sales of its individual major medical products here in the Buckeye State.
This just arrived in my email inbox:
This just arrived in my email inbox:
"We are pleased to announce that effective immediately, you may quote and sell new business for Aetna Advantage Plans for Individuals, Families and the Self-Employed in Ohio.
As a reminder, as of June 24 any Ohio applications that had already been submitted were processed by our underwriting team."
Hunh.
Wednesday WroundUp
■ The future is a lot closer than you might think. We know that Star Trek presaged cell phones, tablets and holograms; now we may actually get tricorders, too:
■ If you're not regularly reading Avik Roy's Apothecary, you're missing a lot. Here's a sample:
- The NY Times Tries — And Fails — To Protect Obamacare From Health Insurance ‘Rate Shock’
- The Devastating Obamacare Tax On Low Income Workers At Large Firms
- Labor Unions: Obamacare Will ‘Shatter’ Our Health Benefits, Cause ‘Nightmare Scenarios’
Lots more at Avik's place.
■ FoIB Holly R sends us this interesting item on life insurance and single folks:
"Single people are often responsible for parents or grandparents, and they want to make sure those dependents will still be cared for."
More at the link.
■ If you're not regularly reading Avik Roy's Apothecary, you're missing a lot. Here's a sample:
- The NY Times Tries — And Fails — To Protect Obamacare From Health Insurance ‘Rate Shock’
- The Devastating Obamacare Tax On Low Income Workers At Large Firms
- Labor Unions: Obamacare Will ‘Shatter’ Our Health Benefits, Cause ‘Nightmare Scenarios’
Lots more at Avik's place.
■ FoIB Holly R sends us this interesting item on life insurance and single folks:
"Single people are often responsible for parents or grandparents, and they want to make sure those dependents will still be cared for."
More at the link.
Cavalcade of Risk #188: Tech & Mech edition
Nina
Kallen presents this week's round-up of risky posts, with an emphasis on
"their technical and detailed nature." Have you ever wondered about health
insurance in China? How about how to overcome pre-existing conditions when
applying for insurance? All this - and more! - at this week's Cav.
Tuesday, July 23, 2013
Exchange Security Breach.....who pays?
There have been a lot of discussions this past week or two on the potential of ID theft in the exchanges. While people getting their ID stolen is bad, as a business owner my bigger fear would be losing my business because the exchanges allowed someone's ID to get stolen.
When I trade protected info with other firms we have Business Associate Agreements (BAA) and other written contracts that protect me if they fail to protect the data I provide them. If they screw up I would still get sued, which is just as bad or worse than actually losing, but hopefully would have some recourse. Cover my cost and any damages if it is proven to be their fault.
When CMS, IRS, or others require by law I send them data they sign no such agreement. Nor for the most part are they liable or susceptible to individual lawsuits from citizens.
Assume you're an employer who purchases your company health plan through the exchange. In doing so you provide them SSNs, health details, and other PHI. That info becomes compromised and ends up in the public and the hands of criminals. Who do you think gets sued? How much assistance would you expect from Washington in proving it was in fact them that exposed the data and thus your not responsible? How much in Attorney fees to prove it wasn't you and will you ever see that money back?
When I trade protected info with other firms we have Business Associate Agreements (BAA) and other written contracts that protect me if they fail to protect the data I provide them. If they screw up I would still get sued, which is just as bad or worse than actually losing, but hopefully would have some recourse. Cover my cost and any damages if it is proven to be their fault.
When CMS, IRS, or others require by law I send them data they sign no such agreement. Nor for the most part are they liable or susceptible to individual lawsuits from citizens.
Assume you're an employer who purchases your company health plan through the exchange. In doing so you provide them SSNs, health details, and other PHI. That info becomes compromised and ends up in the public and the hands of criminals. Who do you think gets sued? How much assistance would you expect from Washington in proving it was in fact them that exposed the data and thus your not responsible? How much in Attorney fees to prove it wasn't you and will you ever see that money back?
Just say no?
Here's a thought: what if they gave an Exchange and nobody came?
That's the premise behind a group calling itself the Citizens' Council for Health Freedom, which has rolled out a campaign to dissuade folks from buying plans on the public Exchanges. CCHF offers four rationales:
That's the premise behind a group calling itself the Citizens' Council for Health Freedom, which has rolled out a campaign to dissuade folks from buying plans on the public Exchanges. CCHF offers four rationales:
1.No private insurance – Obamacare is “Medicaid for the middle class” – or as CBO director Douglas Holtz-Eakin calls exchange coverage: “a second Medicaid program.”
2.No privacy – Data enters federal database accessible by IRS.
3.Limited choice – Coverage is “narrow network” policies.
4.High-cost premiums – Income redistribution to pay for exchange operations and subsidizing high-cost individuals.
While we certainly applaud their efforts, someone really needs to debunk some of their premises.
That would be me:
1. While the ObamaTax certainly encourages (and subsidizes) the expansion of Medicaid, the Exchanges themselves are a separate initiative. Conflating the two seems, well, confusing.
2. Anyone who's been paying attention to the news the past few months and still believes they have any privacy left is fooling themselves. The Data Hub doesn't care whether or not you've enrolled via an Exchange: all of that info is shared across agencies [ed: well, supposed to be shared might be more accurate].
3. Agreed: there is little doubt left that Exchange-based plans will employ "skinny" networks in an effort to rein in costs. A futile effort, of course, but an effort nonetheless.
4. This one's a maybe, and based on how one perceives the role of the government in what should be private transactions. On its face, I'd have to agree that the subsidies are simply robbing Peter to pay for Paul's insurance. Others might take a more charitable view.
CCHF also claims that "people still will be able to buy coverage outside the public exchange system, and that PPACA does not impose penalties on individuals simply because they buy coverage outside the public exchanges."
This is simply not true: only folks buying coverage on the public Exchange will be eligible for subsidies; I'd call that a pretty steep penalty for taking a pass.
In any case, it'll be interesting to watch this play out.
ADDENDUM: Bob has a slightly different take on privacy, the Exchanges and the Data Hub.
That would be me:
1. While the ObamaTax certainly encourages (and subsidizes) the expansion of Medicaid, the Exchanges themselves are a separate initiative. Conflating the two seems, well, confusing.
2. Anyone who's been paying attention to the news the past few months and still believes they have any privacy left is fooling themselves. The Data Hub doesn't care whether or not you've enrolled via an Exchange: all of that info is shared across agencies [ed: well, supposed to be shared might be more accurate].
3. Agreed: there is little doubt left that Exchange-based plans will employ "skinny" networks in an effort to rein in costs. A futile effort, of course, but an effort nonetheless.
4. This one's a maybe, and based on how one perceives the role of the government in what should be private transactions. On its face, I'd have to agree that the subsidies are simply robbing Peter to pay for Paul's insurance. Others might take a more charitable view.
CCHF also claims that "people still will be able to buy coverage outside the public exchange system, and that PPACA does not impose penalties on individuals simply because they buy coverage outside the public exchanges."
This is simply not true: only folks buying coverage on the public Exchange will be eligible for subsidies; I'd call that a pretty steep penalty for taking a pass.
In any case, it'll be interesting to watch this play out.
ADDENDUM: Bob has a slightly different take on privacy, the Exchanges and the Data Hub.
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