'Huis Clos' Updated

Jean-Paul Sartre's 1944 classic "No Exit" described a group of (dead) people, forever locked in a room, trying to ascertain the nature of and reason for their punishment.

Fast forward 7 decades, and FoIB Jeff M alerts us to the story of 64 year old David Carpenter and his 62 year old wife, Sandra, locked in an even scarier scenario: the ObamaTax.

Seems that Mr C made a fateful and (as it turned out) costly mistake: he signed up for an ACA plan at the 404Care.gov site. This would prove to be a disaster, since it turned out that he also began to receive his well-earned VA benefits this year. Since there's not supposed to be any "double-dipping," he needed to cancel his ACA plan forthwith.

That's when he turned to his insurance agent, Stephanie Sheffield. As a Marketplace-certified agent, she was prepared to do battle on the Carpenter's behalf, but quickly learned that "[w]hen there is something that needs to be changed on the policy through the marketplace, no one seems to know how to fix it — not people at the marketplace nor their supervisors."

So in addition to being breeding grounds for ID theft, it turns out that Ms Shecantbeserious and her crew have no idea how to actually service their customers' changes. As a result, the Carpenters could end up owing Uncle Sam some major bucks:

"Carpenter’s dilemma is that at year’s end, he’ll have to pay back any insurance subsidy ... $8,160 for the whole year."

That's a lot of scratch for a couple who've been funemployed for the last 14 months.

But remember:

Health Wonk Review: Marchin' like a lion edition

David Harlow hosts this week's round-up of wonky blog posts, with a little trip to the wild side.

What's so great about this edition is how seamlessly David weaves so many different posts together into a very compelling narrative.

Do check it out.

My new article is up...

At Answers.com:

"A Business Owners Policy offers a reasonably priced alternative to buying insurance coverage ala carte. By pre-packaging common benefits, and offering appropriate customization options, BOP's can save companies money and administrative headaches."

Oh, sure - NOW they tell us!

As we've long noted, the ObamaTax Exchange sites are a veritable treasure trove of ID-theft opportunities. Turns out, though, we may have under-estimated the breadth and scope:

"Security experts worried that 35 state health exchange websites were vulnerable to hackers and were rated as "high risk" for security problems before ObamaCare's launch"

Really? That's a tad over 60% of the Exchanges, and they were known to be high-risk? Thanks, Ms Shecantbeserious, for the heads' up.

Dabney Coleman gets...

The last laugh:

Coming soon to a hospital near you

In case you were (still) wondering about how the ObamaTax would affect your health care, well:

"The Royal College of Surgeons wrote to healthcare inspectors last year warning of “grave concerns” that too many people were dying in the south of the country because of long waits for heart surgery."

No, not Mississippi or Alabama (yet), but the quaint subset of Great Britain called Wales (soon to be Wails?). Turns out that there are (at least) "150 cases in which patients died waiting for life-saving treatment." All part of the grand scheme we call the Much Vaunted National Health System©.

But hey, at least it's "free," right?

Helping Sarah Kliff Solve Her Medical Bill Issue

Former WaPo Wonkblog health policy writer Sarah Kliff is a huge proponent of Obamacare and the expansion of health insurance. She's also been a recipient of excellent employer sponsored insurance benefits. Sarah has a problem. Here is what she tweeted:

2/20 at 11:27am
Sarah Kliff ‏@sarahkliff
Received today an $820 medical bill that I was not expecting nor can I decipher because American health care.
 
2/20 at 11:35am
Sarah Kliff ‏@sarahkliff

I've never tried to negotiate down a medical bill before, but excited for this new personal and professional adventure! 

Sarah, please allow me to help you out.

First, you can't blame the American health care system as the reason for not being able to understand the bill. It's probably an issue with the coding - the little thing called ICD-9 soon to be ICD-10 that you wrote about just a week ago. If the coding was incorrect then the insurance company might have pended the claim until additional information was received.

 

Second, since the bill came from the provider my guess is that the $840 probably is retail charges. Having insurance provides you with a discount on the service. There are a few other things that could have caused you to receive the bill.

• Could it be that the service isn't covered under your plan?
• Could it be that you went to a non-network provider?
• Could it be because your plan has a deductible that you haven't met yet? 

You need to find an EOB that matches up to the bill you received. You should also review your SBC to make sure that the healthcare service was covered under the plan. 

These are the questions a professional advisor would be asking you. From there we would take your bill and your EOB and work with your provider and insurance company to have the claim fixed. It is NOT an easy process - something I'm sure you are finding out.

My new article is up...

At Answers.com:

"While viatical settlements are less common now, Accelerated Benefit Riders on new policies serve the same purpose without requiring the insured to give up ownership of the plan."

My new article is up...

At Answers.com:

"Long Term care annuities offer a simple an effective way to avoid paying out-of-pocket for Long Term Care insurance, and protect one from the possibility of future rate increases. They may also multiply the amount available to cover long term care expenses."

The California Push - A Potential Net Negative

Thanks to the "Lie of the Year" Covered California is able to claim victory. According to data released yesterday Covered CA has now enrolled over 825,000 people which is greater than the goal of 700,000 they had set back in September.

But as Lee Corso would say: "Not so fast my friend."

That little blatant lie President Obama told everyone about if you like your plan you can keep it will be the reason why Covered California can celebrate. The Covered California Board voted unanimously in November to not allow policy renewals for the 1,000,000 insured people to be able to keep the plan that they liked regardless of the President using his Executive power to reinstate them.

For those scoring at home, Covered California used their power to cancel 1,000,000 policies and so far has a total enrollment of 825,000. This is what the government calls a win?

Garcon, how much for the insurance?

Here's an interesting idea:

"The owners of Republique on La Brea have added a 3% fee to every bill to pay for insurance for every employee"

The idea is that, instead of paying for or subsidizing employees' insurance costs and reflecting that in the menu prices, the cost is unbundled and there for all to see.

I like this form of transparency.

On the other hand, some folks are concerned that they have "no way of knowing whether the restaurant will use the extra money for the stated cause."

Which is a valid objection.

So, what do IB readers think? An idea whose time has come or not?

In Medicine Teamwork Is an Invention of Administrators and the Government

I recently had the opportunity to give a team-building group exercise to my staff of Medical and Administrative professionals. The focus was on how to build a better team of individuals to better handle our increased patient load. In the beginning of the Seminar, I had everybody fill out an assessment as to how they felt we operated as a team. There were five categories to judge: Trust, Conflict, Commitment, Accountability and Results. The majority of the scores were low, demonstrating that this room full of people, who work with each other day in and day out, some for years, did not feel that they were a team.

Over three hours I discussed trust, conflict, communication, respect, personality types, the ego, how to disagree and how to come together as a group. We did numerous exercises to delve into these areas and discussed them as a team. At the end, when we are supposed to move into being a team, two members stated emphatically that they will never trust an administrator or any superior as long as they carried a license. So after three hours these people were no closer to begin working as a team than before.

Now I do need to make an observation: the Administrative Staff were more willing to work together for the common good than were the medical personnel. They were steadfastly islands unto their own.

So now I have twenty some people who instead of working together for the betterment of the organization, they will work for the betterment of themselves.

And that about sums up medicine.

The government has been attempting to make medicine a team event instead of an individual event. We use the term Provider instead of Doctor. We want to pay for a medical appointment based on how we judge the quality of the work, not for the work that was done.

For example, as an Administrator of an ASC (Ambulatory Surgery Center), I need to gather information on my GI doctors' Colonoscopy Documentation to report back to the government. When it is brought up to the powers that be that, gee,  maybe they should ask the doctors for this information, we are told this is a great opportunity to build a connection with our physician’s office.

In surgeries, there is a Time Out, where someone other than the doctor calls for a pause to review the case, make sure they have the right person, make sure they know what body part they are operating on, if an arm or leg, which side, etc. The doctor has to wait for the Time Out to finish before s/he can begin.

Government and Administrators have tried to pigeon hole medical people into being a team, when in reality medical people are, for the most part, lone wolves. They have been trained to think this way, that if they make a mistake only they will be held responsible and they will go to jail. As such, all medical people have the mindset of “Trust but Verify.” They will not agree to anything they are told, until they see the rule, policy, guideline in black and white, and even then, if they don’t agree with what they are reading, it is disregarded.

So the battle will rage on between the Government that is trying to make medicine into their image and the medical personnel who will leave rather than comply, until medicine in America is fundamentally transformed.

Cavalcade of Risk #202 now online

Jeff Rose hosts this week's round-up of risk-related posts. From insurance riders to self-funding, data breaches and tobacco sales, there's sure to be something to pique your interest.

Aloha State 3600, Beaver State 0

So yesterday, we learned that Hawaii had spent north of $57,000 per to sign up some 3600 victims citizens on their ObamaTax Exchange.

But at least those 3600 folks did sign up (whether or not they'll actually pay up is another matter).

Things haven't gone so well in Oregon, however, where authorities have spent over $300,000,000 (that's 300 million dollars) to sign up ... well:

"...not even one person has yet to enroll online"

What a resounding success story!

They Can't Even Give This Stuff Away - Part 2

As Bob noted last week, a lot of folks may end up balking when it comes time to (literally) pay the piper:

"...roughly 50 percent of consumers who had supposedly enrolled for President Barack Obama's healthcare reform have missed their payment deadline for Jan. 1"

No big deal, right? After all, what's the worst that could happen?

Oh:

"More than 6,400 people in North Carolina did not pay their first premiums for new ACA health insurance plans and, consequently, saw their coverage dropped"

So these folks went through the (not inconsiderable) trouble of wading through the wonky web site, verifying their income and other information, selecting a plan, and "pulling the trigger" on it, only to decide that "hey, it's just not worth it?"

And this is only folks in The Tar Heel State. Now multiply that by the other 57.

Not a pretty sight.

[Hat Tip: FoIB Jeff M]

$57,000 Aloha Fail

Another day, another ObamaTax "success" story:

"The Obama administration gave Hawaii $205 million in grants over the past three years to set up its state-run exchange"

So, one would presume that plenty of uninsured Hawaiians signed up for a shiny new health "care" plan, right?

Well, not so much:

"...so far, only 3,614 Hawaiians have filled out applications"

Remember, filling out an app is not the same as actually buying a plan, so we really have no way of knowing how many Aloha State citizens actually bought coverage (let alone how many have paid for it). But even with the benefit of the doubt, this means that each enrollee cost you and me almost $57 large. That's a lot of health care, no?

But that's still not the best part:

That 3,600 means that their best case scenario was to sign up 9,000 victims souls. Really? Given that about 1.4 million folks live in The Aloha State, and assuming 15% are uninsured, shouldn't their goal have been (at least) 180,000?

Ah, the soft bigotry of low expectations.

[Hat Tip: Ace of Spades]

My new article is up ...

At Answers.com:

"Group Dental insurance plans can be a cost-effective way to pay for both routine and unexpected oral health issues, especially when the premiums are subsidized by one's employer."

So now it's Copper. Can Tinfoil be far behind?

From WSJ February 13th (password protected, sorry):

"Some backers of the 2010 health-care law are pushing to create a new kind of insurance coverage that the measure essentially had ruled out: policies offering lower premiums but significantly higher out-of-pocket costs than those now available . . . dubbed "copper" because they would offer a lower level of coverage than the "gold," "silver" and "bronze" options on the government-run health-care exchanges . . . would be a departure from the minimum level of coverage that is one of the Affordable Care Act's core principles."

Seems clear to me the awful truth is dawning on more and more people that Obamacare is not worth its cost.  Just as clearly, it looks like there is mounting disarray within the administration over what to do about it.

My take:  sooner or later Dems must come to realize that their pedals aren’t really to the metal.  The Obamacare insurance tactics are not capable of solving the underlying problem – which is high medical delivery costs. High insurance costs are symptoms of the problem – not the problem. That helps explain why tinkering with insurance has failed to solve the problem for more than 50 years.

What’s perhaps worse is that our politicians and so-called thought leaders have done such a miserable job of educating the public on the nature of the underlying problem. So public attention is focused on symptoms not the disease; the public is told a cure is at hand when it is not; and meanwhile the problem just continues to worsen.

Even Tinfoil won't stop that.

Cavalcade of Risk #202: Call for submissions

Jeff Rose hosts next week's Cav. Entries are due by Monday (the 17th).

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.

My new article is up ...

At Answers.com:

"Americans who are on Medicare due to serious health conditions have limited health insurance choices. For many, a Medicare Advantage plan may be the most efficient means to supplement their Medicare coverage."

Health Wonk Review is up .. and there's a lot to love!

Steve Anderson hosts this week's round-up of wonky posts. Nice job, too: you can never go wrong with Valentine's Day candies!

Do check it out.

We Interrupt This Train Wreck....

This just in from HHS Secretary Shecantbeserious (via email 3 days from the end of the initial ObamaTax Open Enrollment Period):

"From Saturday 2/15, at 3:00PM EST until Tuesday, 2/18 at 5:00AM EST, the Social Security Administration (SSA) will conduct annual systems maintenance activities ...  During this period, verification of Social Security Numbers and other related data that is accessed via the Hub will be unavailable."

Oh, wonderful. But certainly one can at least access the main 404Care.gov site, right?

Um:

"Individuals attempting to complete the application process on HealthCare.gov during this period .... will not be able to immediately receive an eligibility determination/assessment from the Marketplace."

Of course.

How Refreshing!

As regular readers know, agents that want to sell Partnership-compliant Long Term Care insurance (LTCi) plans must re-qualify every two years via a 4 hour "refresher" course. This helps to ensure that we're as up-to-date as possible on the latest LTCi news and policies.

Since my last one was in February of '12, I was due, and so spent this morning under the expert tutelage of Ray Copenheaver, CLTC, LTCP. As always, there was quite a bit to absorb, including news on deductibility of premiums (it just got harder) and on "gifting" to avoid Medicaid eligibility issues (you need to plan sooner).

But we also learned some other more positive tidbits, one of which I'll share here:

Two of the biggest objections folks have to even considering buying a plan is the premium and the (justifiable) fear of rate increases. A lot of the former is dependent on one's age and health, and what level of benefits one chooses. But there is precious little that one can do about the latter: if a carrier is going to increase rates, it's going to increase rates.

But there are a number of plan designs that allow one to bullet-proof one's plan against rate increases, and one of them is made possible by the PPA (no, not the PPACA): the Pension Protection Act that took effect 2 months prior (in January of 2010). One of the key provisions of the PPA is that it made it possible for carriers to offer a special kind of annuity: one that, in addition to tax deferred growth, offers tax-free long term care benefits.

Very cool.

Here's an example:

John and Mary own a non-qualified annuity (that is, it's not tied up in an IRA or other similar vehicle). Their original $50,000 deposit has now grown to a hefty $100,000 (hey. it could happen!). In ordinary circumstances, the $50,000 gain would be taxable. So if one of them needed long term care, they really have only $85,000 available (the original $50,000 plus whatever's left of the gain after taxes). Ouch.

But under PPA rules, they could trade in this annuity for one with an enhanced long term care benefit, and effectively double their long term care funds. In our scenario, the $100,000 "enhanced" annuity includes a $201,000 long term care "pool" from which either could draw to fund long term care, and these are paid out tax-free. Nice.

The downside, such as it is, is that if neither of them ever need long term care, the initial $100,000 (plus interest) is passed along to their beneficiary as a taxable instrument. Still, that's what would have happened had they kept the original plan, so no harm, no foul.

Since the plan is paid in a lump sum, there's no danger of any rate increase. and presuming that this was money that John and Mary weren't living on, it's not a direct out-of-pocket expense like a pay-as-you-go plan would be.

Win-win.

What Fresh Hell is This?

So on the one hand, the Obamastration has magically (and illegally) suspended the employer mandate for medium-sized groups.

On the other, it's adding an onerous new (and also illegal) reporting requirement:

"Treasury officials said Monday that businesses will be told to "certify" that they are not shedding full-time workers simply to avoid the mandate. Officials said employers will be told to sign a "self-attestation" on their tax forms affirming this, under penalty of perjury."

Really?

There's a term for countries that are run this way....oh, yeah.

Introducing the Eventual Care Act

As Nate mentioned yesterday afternoon, the Obamastration has once again kicked the ACA can down the road:

"The Obama administration announced Monday it would give medium-sized employers an extra year, until 2016, before they must offer health insurance to their full-time workers"

Thus illegally postponing - again - the Employer Mandate.

Whoa there, Henry! Did you just call this illegal?

Why yes, yes I did.

And here's why:

"The final words in the section of [the ObamaTax] mandating that employers with more than 50 full-time employees provide their employees with “minimum essential coverage” imposes a specific statutory deadline for doing so. It says: “EFFECTIVE DATE.—The amendments made by this section shall apply to months beginning after December 31, 2013.”

Notice it does not say "shall apply to months beginning after December 31, 2013, or whenever the President feels like it."

And yet, here we are (again).

So here's my question: if the ObamaTax is such a great idea, and if it is so vitally urgent that we insure as many Americans as possible as quickly as possible, then why in the Wide, Wide World of Sports is the President constantly putting it off?

[Hat Tip: FoIB Brian D for the "ECA"]

It doesn't pay to plan if you own or run a business

I am going to go broke if I keep planning ahead on how to assist clients in meeting their needs and ACA requirements.

"The Obama administration announced Monday it would give medium-sized employers an extra year, until 2016, before they must offer health insurance to their full-time workers. Firms with at least 100 employees will have to start offering this coverage in 2015"

Good news if you're a business with 50-99 workers

Self Funding and Community Rating

The early results look very promising for self funding: if you are among the 80% of groups that were average or good health looking at a bad renewal under ACA, self funding rates are providing some relief.

Not all is smelling roses though; while worst case self funded is coming in better than ACA rates, they are not as low as current rates before the ACA renewal. While only 3% or so of groups with Agg have that worse year, employers are still having to get comfortable taking on risk and potential cost higher than a normal renewal.

They are also having to quickly learn the basics of self funding and be aware of some tricky fine print. Many of the self funded products offering to protect small groups from ACA have some traps of their own. They return only a portion of the savings, often as a credit only after renewal.

This means if they come in $60,000 lower then worst case, and what the group funded, they only get $40,000 back. That $40,000 credit also requires they renew with the carrier regardless if they feel the renewal offer is fair. There were carriers in the past that knew they could stick groups with a bad renewal because the cost to leave them was so exorbitant. For example, assume a 40 employee group came in $120,000 under max and thus was entitled to a $80,000 credit. If another carrier beat the current carrier by $60,000 on the renewal rates it would cost the employer $20,000 to change due to the lost credit. The in-force carrier obviously knows this, so they can pad the renewals for any case that had meaningful savings.

Still better than paying guaranteed higher ACA rates but some unlucky employers are going to lose a lot of savings if they aren't careful what self funded solution they go with....out of the pot and into the frying pan!

Medical ID Theft Rampant

We first started covering this phenomenon almost 8 years ago, when Bob noted  that one problem arising from theft of your medical data is that "you could end up being treated based on someone else's medical history"

It may be difficult to overstate the problem:

"Most identity theft in the United States is medical-related ... In 2012 alone, medical identity theft increased by nearly 25 percent, affecting 1.85 million Americans"

Ms Melchior notices something else we've pointed out, namely:

"... as many as 31 states do not conduct background checks on Obamacare navigators, who have access to enrollees’ names, Social Security numbers, financial records, and health information" [emphasis added]

And of course, this also doesn't include the hacktastic nature of the 404Care site.

Perhaps we need to more aggressively market ID Theft insurance.

Out of the frying pan and into the Exchange

Last month, we reported that Ms Shecantbeserious had unceremoniously dumped the Exchange website's Canadian contractor CGI for the winsome folks at Accenture. It was hoped that bringing in "new blood" would staunch the metaphorical hemoraging caused by CGI's apparent incompetence.

Ms Kathleen chose poorly:

"Accenture, the contractor hired to fix ongoing problems with the federal health exchange website, has been heavily criticized by some of its largest clients, including federal agencies ... the U.S. Postal Service Inspector General's Office recommended this past June that the agency consider terminating more than $200 million in contracts with Accenture"

When even the notoriously inefficient Post Office is calling you out, then you have a problem.

The Problem with Grandpa [UPDATED]

Well, Grandfathered policies. These are the plans that ostensibly fulfilled the empty promise that "if you like your current insurance, you can keep your current insurance" As we now know, this applied only to folks who made no substantive changes to their existing health insurance plans.

I'm fortunate to have a handful of clients who did not, in fact, make any such changes and whose plans are "grandfathered in."

Unfortunately, they won't be for long. Last week, one of my grandfathered clients received his 2014 renewal, along with a 28% premium increase. And there's nothing he can do about it because if he chooses to, for example, increase the deductible in order to rein in the premium, he loses grandfathered status.

So his only real choice is to pull the trigger on a new, ACA-compliant plan. In his case, this could actually save him substantial dollars versus his renewal. And because he's fortunate enough not to qualify for a subsidy, he can avoid the misbegotten Exchange. Of course he'll have higher out-of-pocket costs, and the knowledge that he could not, in fact, keep his current plan.

And he has to make his decision in the next few days if he wants a March 1st effective date.

Nice little policy you have there; be a shame if something were to happen to it....

UPDATE: In the comments, Nate points out - quite correctly - that a viable alternative to the challenge of grandfathered plans is to self-fund. Not sure how that works? Never fear, Nate has the answer here.

My new article is up...

At Answers.com:

"Single Pay Long Term Care insurance plans remove the risk of future rate increases, while providing comprehensive long term care benefits. These plans multiply the dollars available for long term care should the need arise while providing access to cash values if necessary."

Covered CA and Accountability

Got a laugh out of this today:

Dana Howard of Covered California admitted it was responsible but said, “It really isn’t feasible for Covered California or any entity to check thousands upon thousands of doctors to make sure that the information that they are providing is accurate.”

 Actually it is: just about every insurer and TPA in the country has been doing it for over a decade. Granted, there will always be an error here and there but nowhere close to the level of incompetence Covered California has achieved.

Open Wide ... Take 2

Late last summer, we discussed one of the ObamaTax's "Essential Health Benefits," Pediatric Dental. At the time, we noted that, if nothing else, it represented a major windfall for orthodontists.

Fast forward 6 months or so, and we have this rather uninformed update on how Pediatric Dental coverage is being implemented here in Ohio. As FoIB Holly R tips us:

"...like other pieces of the Patient Protection and Affordable Care Act, it’s not so simple. That’s because the federal government ruled that dental coverage for kids can be left out of medical plans sold in most states, including Ohio and Indiana."

The author of the piece seems to imply that carriers will use this "loophole" - which is, in fact, specifically encouraged by the ObamaTax itself - to avoid including Pediatric Dental coverage.

Not so fast there, Lisa B-K. Turns out, quite a few carriers continue to offer PediaDent cover:

Anthem requires PD whether or not there are any children actually on the plan, and include a $5.20 charge for this cover regardless. Which seems seems as fair as charging single men and post-menopausal women for birth control convenience items.

Medical Mutual of Ohio says that those with adult only (no children) coverage can waive PD cover, buit those with children are required to enroll. They may, however, unenroll from this cover if they have valid comparable other dental insurance coverage.

Humana's PD coverage, like Anthem's, is "baked into the cake;" that is, it's included whether or not you want it (or need it). Same with United Healthcare/Golden Rule. There is no "opt out" provision, so one is charged for a benefit that one cannot ever use.

How nice.

[Thanks to Kelly V for her clear and concise explanation]

Harbinger of things to come?

FoIB Jeff M tips us to this interesting story out of North Carolina:

"Montgomery County employees are facing a change in regard to medical insurance coverage ... their recommendation to discontinue providing medical insurance to employees and to assist employees in pursuing insurance though the Marketplace"

As we've repeatedly mentioned here at IB, this is, in fact, the wave of the future: employers dumping their group plans and shunting their employees off to the Exchanges.

So much for "if you like your current plan, you can keep your current plan." We've already seen this playing out in the individual market, and group is on deck.

But it's the last line of the Herald story that piqued my interest:

"This assistance will include navigational, choice information and financial assistance" [emphasis added]

Here's the problem: under the train-wreck, groups can no longer use Health Reimbursement Arrangements (HRA's) to subsidize premiums. Jeff asked whether or not the employer could provide a "stipend" to each employee to help with the cost of insurance and, if so, what effect that would have on said employees' taxes.

I suspected that I knew the answer, but sought confirmation from my HRA gurus at FlexBank, who did not disappoint. Years ago, we used to fund some key employees' life insurance plans through something called an Executive Bonus. This was simply a fancy way to give the employee the money to pay for a personal life insurance plan, and it was (of course) included on their W-2's.

This seems to be the only legitimate arrangement open to the folks running Montgomery County; one suspects that the employees being unceremoniously dumped from their current health plans will be none too pleased to see the extra tax liability.

Talk about adding insult to injury (neither of which, apparently, are covered under the ObamaTax).

Stupid Theoretical HHS Tricks

On the one hand, Ms Shecantbeserious relies on licensed (and trained, and who have been background checked) agents to "push" Exchange policies. On the other hand, she's an idiot:

"[Ms Kathy] strongly suggests that agents and brokers not use 'Marketplace' or 'Exchange' in the name of their businesses or websites ... QHPs cannot discriminate based on disability, age or health needs."

As to the first: why the heck not? Far be it from me, a lowly insurance agent, with a measly 30+ years of sales experience, to edumacate The Fair Kathleen on how to market insurance, but that is exactly the kind of product identification you want to encourage. After all, would-be Exchange victims customers are looking for, you guessed it, the term "Exchange."

As to the second, well, that's pretty dumb, too. Here's a dirty little secret, Kathy: as agents, we don't care who buys a plan from us - old, young, fat, skinny, healthy or sick - we want to, you guessed it again(!), sell insurance. Last I looked, no carrier pays us commissions on plans we don't sell.

Perhaps the best part is that these are currently cast as "suggestions." Who wants to bet on their codification?

Anyone?

Cavalcade of Risk #201: Understated edition

Russell Hutchinson hosts this week's round-up of risk-related bloggetry, with a soft voice and interesting context. Plus, he's come up with a great logo for the CoR, which I am shamelessly pilfering from him.

Thanks, Russell, for hosting and for the logo!

The Affordable Golf Club Act

[If you have old golf clubs, you can keep your golf clubs....until April 2014.]

Until now, typically only the wealthy or financially responsible have been able to purchase new golf clubs without the assistance of their government.

This new law ensures that every American can now have "affordable" golf clubs of their own, because everyone is equally entitled to new golf clubs. And if you want to keep the golf clubs you already have, you can do that, until April 2014.

These affordable golf clubs will cost from $1,000 to $3,000 each depending on your income level. This does not include taxes, pull cart, electric cart fees, green fees, membership fees, balls, tees, gloves, range finders, storage fees, maintenance, or repair costs.

In order to make sure everyone participates and purchases their affordable golf clubs, the costs of owning golf clubs will increase 50% each year up to 400% by year 2018. This way, wealthy people will pay more for something that other people don't want or can't afford to maintain. People who can't afford or refuse to maintain their golf clubs will be fined. However, children under the age of 26 can use their parents’ golf clubs until they turn 27 at which time they must purchase their own golf clubs.

If you don't want or think you don't need golf clubs, you are still required to buy them. If you refuse to buy a set or make claims that you can't afford them, you will be fined $800 until you purchase a set or face imprisonment.

People living in farming areas, ghettos, inner cities, Wyoming, or areas with no access to golf courses are not exempt. Age, health, prior experience or no experience are not acceptable excuses for not buying, maintaining, and using your golf clubs.

A government review board that doesn't know the difference between a hook and a slice will decide everything. This includes when, where, how often and for what purposes you can use your golf clubs along with how many people can ride in your golf cart. The board will also determine if participants are too old or not healthy enough to be able to use their golf clubs.

They will also decide if your golf clubs have outlived their usefulness or if you must purchase specific accessories, like a range finder with slope adjustment or a newer and more expensive set of golf clubs.

Those that can afford memberships at expensive golf country clubs will be required to buy memberships. If you are already a member and you like your  membership you can keep your membership. After April 2014, a different country club will be assigned for you to purchase a membership.
Government officials are exempt from this new law as they and their families and some of their friends and a few of their friends friends can obtain golf clubs at taxpayers expense.

[Hat Tip: FoIB Sandy M]

Public Enemy or Navigator?

From the "Told Ya So" Department:

"Health and Human Services secretary Kathleen Sebelius [sic] said today that Obamacare navigators don't need to undergo criminal background checks ... "So a convicted felon could be a navigator and could acquire sensitive personal information from an individual unbeknownst to them?"

And what do you know?

"At least 43 convicted criminals are working as Obamacare navigators in California, including three individuals with records of significant financial crimes."

And that's just in the Golden State. What about the other 57?

In case it's not obvious, here's the issue:

These folks may well be completely rehabilitated, morraly upstanding and good to their mothers. But why would the state take the chance that one or more of these previously convicted felons would see a pretty lucrative opportunity here? And of course, you can't sue the state for foisitn these potential identity thiefs upon its citizenry.

Just another reason to avoid the Exchange - and especially Navigators.

[Hat Tip: FoIB Holly R]

Medicare for Young Folks: A Case Study (Part 2)

In Part 1, we met a young lady who suffered a tragic medical setback, and is now unable to live on her own, and whose medical care is paid for by Medicare. We also began to learn about what alternatives or supplements might be available to her and her family to help fund her care.

The Medicare Advantage plan seemed promising. One immediate challenge is that the most recent regular Open Enrollment period ended last month, and the next one doesn't start until the Fall. The good news, according to my personal Medicare Advantage guru Roger D, is that folks on the Extra Help program are pretty much always in Open Enrollment, so she may be able to hop on to an Advantage Plan.

So we'd now identified 3 potential avenues: an Exchange plan, her father's retirement medical plan, or a Medicare Advantage plan. It was now time to do a little more digging, and then to meet to review the results:

As it turns out, folks on Medicare can not (easily) buy an ACA Exchange policy. As the folks at CMS explain:

"It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan."

But what if you really, really want one?

Well:

"[T]here are some situations where you can choose Marketplace coverage instead of Medicare ... if you’re eligible for Medicare but haven’t enrolled in it ... If you’re paying a premium for Part A, you can drop your Part A and Part B coverage and get a Marketplace plan"

Oh. Well, our young lady is already enrolled, so the first "out" won't work. And the second alternative didn't seem very promising, since she wouldn't be eligible for a subsidy.

So much for that.

Adding her to my friend's plan has some attraction: it's a known quantity (and is itself a Medicare Advantage plan with some great benefits) and offers the convenience of having one plan (and carrier) for both.

I had, however, a concern: what happens if/when my friend passes away - can his daughter stay on the plan? After poring over the written materials he had brought with him, and several frustrating phone calls to the carrier, we still don't have a definitive answer. This is troubling, but not necessarily a deal-killer.

So we called Roger (my guru) and had a very frank and helpful discussion about a separate Medicare Advantage plan for the daughter. First, we confirmed that she is, in fact, an Extra Help participant, so the Open Enrollment issue is moot. Second, we learned that there are several $0-premium Advantage plans available here, saving my friend several thousands of dollars in extra premiums. These plans also cap her out-of-pocket exposure to about $4,000 a year, which is well within my friend's means to cover.

One thing that still needs to be done before a final decision is made is to confirm that her doctors and other providers are in-network, and to check her meds against the carriers' formulary lists.

My friend was delighted that a good plan is available at a very affordable cost ("free"), and was very impressed with Roger's depth of knowledge about not just the Advantage plans but also the Extra Help and other programs. He even suggested some other places for my friend and his daughter to look for additional resources and help.

It's such a blessing to have access to folks on whom I can call to ask for help and advice, and who I know will take care of my clients. It makes me look good (no mean feat in itself), and they get quality advice and service.

And there's this: I try to learn from every interaction I have, whether or not I make a sale. There is no doubt that I'll have the opportunity to use what I've learned on this case down the road. And that, too, is no small thing.

Cavalcade of Risk #201: Call for submissions

Russell Hutchinson hosts next week's Cav. Entries are due by Monday (the 3rd).

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.

Happy Blogiversary!

Hard to believe, but today marks the 9th anniversary of InsureBlog. As always, I find it helpful - and humbling - to revisit my very first post, and to contemplate with pride how far we've come.  This past year, we welcomed new co-blogger Pat Paule, who brings still another interesting perspective to our pages.

Words can't express how fortunate I feel to be working with Bob, Mike, Nate, Kelley, Bill and Pat. As I often brag, I am blessed with the very best co-bloggers on the 'Net.

Most important, of course, are our loyal readers (and followers) who visit us each day - Thank You!

The (Un)Affordable Care Act: Film at 11:00

[Hat Tip: Ace of Spades]

Medicare for Young Folks: A Case Study

A friend of mine recently reached out to me for some advice about his disabled daughter. Years ago, while an Honor Student at a prestigious Midwestern university, she needed emergency surgery, and while under anesthesia, an accident occurred: oxygen was cut off to her brain for many minutes, resulting in permanent brain damage.

She is still able to converse for brief periods of time, but unable to earn a living or live on her own. Even though she's only in her early 30's, she does qualify for Medicare and for the "Extra Help" program that substantially reduced her out-of-pocket for necessary medications.

Her father - my friend - is retiring soon, and asked for my help in researching health insurance alternatives for his daughter. What he was looking for would be a pre-65 Medicare supplement (MedSupp) for her. He already knew of one potential source: for a monthly premium of $300, he could add her to his post-retirement health plan (provided by a former employer). He asked me if there were others, and I agreed to research this (mostly because I think this is a very interesting scenario, plus I get to help a friend).

I identified several potential avenues, and began to determine their viability:

First, I recalled that - years ago - the 'Medicare And You booklet' put out by our state Department of Insurance (DOI) used to include a list of the handful of carriers that sold pre-65 MedSupps. I clicked over to the site and downloaded the latest version, and began to search through it for that list.

It was nowhere to be found.

So I called the DOI to see if I was just looking past it, and was told that it wasn't me: there are currently no longer any carriers that market these plans (at least not here in the Buckeye State). So much for that.

But the nice gentleman at the DOI did mention that Medicare Advantage plans are available to serve this market, although the young lady would have to be in an Open Enrollment period. I turned to my own Medicare Advantage guru, Roger D (I long-ago decided against selling these myself), who kindly offered his expertise. One thing he suggested I do is to determine whether or not the young lady was participating in the Extra Help program.

Extra Help enables qualifying Medicare beneficiaries to purchase their meds at greatly reduced prices, with the government (well, fellow tax-payers) picking up the cost. According to the Social Security Administration (which oversees the program), Extra Help "is estimated to be worth about $4,000 peryear." Nice!

I also started looking into whether or not she could buy an ACA-plan from the Exchange.

In Part 2, we discuss the results.

Health Wonk Review is up...

Brad Wright hosts this week's round-up of wonky health-related posts. It's quite an effort, with lots of great posts and helpful context. Do check it out.

Thursday Morning LinkFest

■ From the Stupid Carrier/Government Tricks File:

"State insurance regulators have reached a settlement with the Genworth Life Insurance Company over the insurer’s use of the Social Security Administration's Death Master File database."

The carrier has agreed to more aggressively utilize the Social Security Administration's Death Master Files (DMF) to search for potential claimants.

Only one thing wrong with this whole (stupid) idea:

As we reported almost 2 years ago, "the DMF is itself rife with potential errors and misinformation" and there's no indication that this has been addressed.

Garbage in, garbage out - but hey, at least the states' insurance departments get to nick GW's policy- and other stake-holders for some quick cash.

■ Deadlines? What deadlines?

"The IRS [has unilaterally decided that] it will wait at least until 2015 to enforce the nondiscrimination rules, at the earliest, because defining terms such as “highly compensated employee” and “discrimination” has been difficult."

Math is hard? Who knew?

More importantly, under what authority is the IRS declining to enforce the law? 

■ And speaking of IRS malfeasance, turns out they're having no problem defining how to enforce the Evil Mandate ObamaTax on ordinary citizens:

"The Internal Revenue Service has drafted a collection of proposed regulations that could determine whether some taxpayers will owe fines for failing to get health coverage ... The IRS assumes many enrollees are confused"

Gee, whatever gave them that idea? 

■ This is kind of scary (if unsurprising): International Medical broker Global Underwriters has provided a "brief Travel Alert Update and Product Overview for all of our brokers and agents that have clients traveling internationally."

Specifically, there are significant concerns about the upcoming Olympics, since "[a]cts of terrorism, including targeted bombings, hostage taking, suicide bombing continue to occur in Russia particularly in the North Caucasus Region."

Is this destined to be a repeat of Munich '72?

Educating Obama on Pre Existing Conditions

In case you hadn't heard, last night was the State of the Union Address. In the hour plus speech President Obama mentioned health care reform for roughly two minutes. The focus during that time was on how nobody could be denied coverage now because of a pre-existing condition. Here is the script taken right from the teleprompter:

Now -- a pre-existing condition used to mean that someone like Amanda Shelley, a physician's assistant and single mom from Arizona, couldn't get health insurance. But on January 1st, she got covered. (Applause.) On January 3rd, she felt a sharp pain. On January 6th, she had emergency surgery. Just one week earlier, Amanda said, that surgery would've meant bankruptcy. That's what health insurance reform is all about, the peace of mind that if misfortune strikes, you don't have to lose everything.

I'm glad Ms. Shelley #GotCovered. But a pre-existing condition is one that a person has prior to purchasing insurance. Her emergency surgery and sharp pain happened after she had purchased insurance.

This was not a pre-existing condition. It would have been covered before Obamacare. Likewise, under Obamacare, if Ms. Shelley wouldn't have purchased insurance on January 1st her emergency surgery would not have been covered on January 6th.

Either President Obama and his speechwriters don't understand their own law or they simply choose to lie about it. If past history is an indicator, my guess is it is the latter.

PPACA - governing arbitrarily rather than lawfully.

Via the indispensable Overlawyered comes  this article published in the Journal Regulation:

You’ll find it well worthwhile to read the entire article, but here are its concluding paragraphs:

"In his classic 1964 book The Morality of Law, Harvard legal philosopher Lon Fuller listed several criteria that mark the break-down of the rule of law. They include the lack of rules, leading to inconsistent decisions; rules that are secret or unintelligible; the use of retroactive legislation; commands requiring citizens to do the impossible; edicts that change unpredictably; and a gap between the rules and the way government actually operates. A society suffering from those maladies is likely to be governed arbitrarily, rather than lawfully.

"Sadly, even in its early stages, PPACA already manifests many of those symptoms.  It left many crucial terms unexplained; even “minimum essential coverage”—i.e., what kind of insurance the law requires Americans to purchase—was left for HHS bureaucrats to define later, outside the reach of the ballot box. The employer mandate was unilaterally extended by administrative fiat beyond the statute’s clear command—yet Republican demands for a similar extension of the individual mandate were turned away, only to be granted in a modified form weeks later when HealthCare.gov proved a failure.

"Those and other aspects of the legislation’s halting and unpredictable implementation reveal serious flaws in PPACA. But they also demonstrate a deeper crisis.
"In the pursuit of progressive goals, the Obama administration and its congressional allies have done long-lasting damage to a constitutional order that was meant to preserve individual liberty by cabining government power along clear, predictable, and democratically accountable lines."

Shall Americans accept such assaults on the Constitution and the rule of law, by following this increasingly tinpot President down the rabbit hole of unilateral government thru arbitrary enforcement and Executive Orders?  Sadly, this remains an open question.

My new article is up...

At Answers.com:

"Homeowners' and business insurance policies don't cover losses caused by floods, and many home and business owners don't even realize this. Up top 25% of all flood insurance claims come from low or moderate risk areas, where premiums may be very reasonable because of the smaller risk."

Down to the wire...

From Anthem email:

"Reminder: January 31 is payment deadline for individual plans effective January 1

Consumers who purchased an individual health plan with a January 1 effective date have until January 31 to submit payment for their first months premium. This applies to individual plans bought on or off the exchange."

One wonders how many will comply, and what happens to those who don't. Recall, also, that the original deadline was the 1st. How many more extensions will Ms Shecantbeserious approve?

When you've lost Jim Moran...

Congresscritter Jim Moran (D-Va) is concerned:

"I’m afraid that the millennials, if you will, are less likely to sign up [for the ObamaTax] ...  don’t think we’re going to get enough young people signing up to make this bill work as it was intended to"

Here's the point, to which Rep Moran passingly alludes: in order for the numbers to properly crunch, there has to be a mix of both healthy and young people (not necessarily the same thing). Absent one, or both, the system will quickly fall apart, since it's on the shoulders of those two demographics that the premium structure relies.

How's that, you ask?

It's pretty simple, really: since the ObamaTax limits the premium differential between young and old, the former are needed to subsidize the costs of the latter. This means that young people will pay disproportionately higher premiums in order to artificially lower the folks in their 40's and 50's.

And since the law now requires that insurers take everyone whop comes a-callin' - and the sicker the better, really, for the photo ops - the healthiest are now subsidizing their less fortunate fellows to an even greater extent than under our previous system.

What's that word I'm looking for? Oh, yeah.

Timing is everything

This past Fall, I had the opportunity to help one of my long-time clients - who's also a good friend - buy some additional life insurance. My friend, we'll call him Ted, is a bit, um, portly, so he didn't qualify for the best rates. Still, he was satisfied with the offer that the carrier tendered, and we secured the coverage.

One evening recently, Ted called me at home with some scary news: he was calling from the hospital, where he had just been admitted because they had found what appeared to be a brain tumor. Surgery was scheduled for the next day, and he didn't want me to hear the news from a third party.

Of course, I wished him well, and asked if there was anything I could do for him or his family. Mostly, he said, send good thoughts and prayers that the surgery would be successful, and that it would turn out to be something treatable. Of course I agreed.

He did have the surgery, and we're still waiting on the results. In the meantime, though, I immediately went back and reviewed the recent application and coverage binder to be sure that all the i's were crossed and t's dotted. This is especially critical in a case such as this: life insurance policies have a one- or two-year "contestability" clause (often erroneously referred to as a "suicide clause"). Briefly, the contestability clause allows the carrier to review a recently approved policy to see if there were any misstatements or misrepresentations, or if relevant information was omitted (such as a history of cancer).

Thankfully, none of that appears to be the case and, since I've known Ted for over 20 years, I think I'd have a pretty good idea if he had skipped anything important on the application.

Here's why I'm so grateful that he agreed to the final rate: for at least the next few years, Ted isn't going to be able to buy any additional life insurance and will likely never qualify again for even these rates.

Sometimes, it pays to listen to your agent.

MVNHS© vs Seniors

This is the future of the ObamaTax, as well:

"Pensioners with cancer are being written off as too old to treat ... survival rates for British patients aged 75 and over are among the worst in Europe."

And younger Brits with cancer aren't faring so well, either:

"Young lung cancer sufferers are only 10 per cent more likely to die within five years than their continental counterparts"

Gotta love that "only" qualifier.

Today, I spent three hours listening to Anthem's on-hold music...

Somewhere, in one of the deepest circles of Hell, Anthem's over modulated, distorted, horrible music is playing...for eternity.  Be good.  Or else....

Over the cliff? [UPDATED]

[Please scroll down for update - HGS]

We've maintained for a long time that the actual intended result of the ObamaTax was, in fact, Single Payer. And the evidence making that case continues to pile up:

"Aetna CEO Mark Bertolini told CNBC on Wednesday that Obamacare has failed to attract the uninsured, and he offered a scenario in which the insurance company could be forced to pull out of program ... He said that so far, Obamacare has just shifted people who were insured in the individual market to the public exchanges where they could get a better deal on a subsidy for coverage"

Let's unpack this a bit, shall we?

First, I think it is rather frightening - and instructive - that the CEO of a publicly traded company, let alone a major player in the health insurance market, is signaling that his company may willingly walk away from its individual policy market. That represents a major portion of its core business, and he's saying that it may well go "poof."

Second, the news - and most of our readers already know this, of course - that the majority of the "new" business coming into the Exchanges is, in fact, folks whose previous coverage was cancelled despite the President's explicit and repeated promise that this would not happen. So we're not talking about "newly" insured here. As Yogi Berra, CLU might opine, "the uninsured are staying away in droves."

Not exactly what we were promised, either.

UPDATE: In the comments, John F and Bob H make the point that this may be much ado about, well, nothing much. Upon reflection, I think I have to agree with them. On the other hand, it's probably worth at least noting that Aetna is signalling their concern over the viability of the individual market. Is this concern over-stated? Perhaps. It will be, um, interesting to see how this plays out.

It's a Green Thing

What with all the winter white covering the ground, it's easy to forget that there's green underneath, as well. FoIB Bob Graboyes, senior research fellow at the Mercatus Center at George Mason University, has a slightly different take on the color, though:

"The battle for the soul of American health care is not really one of Democrat versus Republican or liberal versus conservative. Rather, it is between competing visions we can call the Fortress and the Frontier."

And what, you may ask, is "the Frontier?"

Well, as Bob explains it:

"The Frontier believes elites overestimate the capabilities of insiders and underestimate the abilities of outsiders. Innovation is the imperative."

And he then explains exactly how innovation and lateral thinking can drive down health care costs while maximizing effectiveness.

And make sure to check out the green plastic fingers.