Not Ready for (Sub-)Prime Time

So I spent a great deal of yesterday afternoon on the phone with the friendly - if hapless - folks at 404Care.gov. Turns out, one of my "Grandmothered" Anthem clients may be eligible for a subsidy, which means the (dreaded) Marketplace. We'd already picked out a plan, now we needed to enroll her.

Since her December renewal triggers a Special Open Enrollment, we were looking for a December 1 effective date. She's actually pretty fortunate: as I explained to her, it's not yet Open Enrollment season (that starts this coming Saturday), so there were likely only hundreds, perhaps thousands of folks vying for coverage at any given time today. Come the weekend, and especially next Monday, that will swell into the millions.

And yet, well, what you see at the top of this post is what we encountered multiple times. So we took their advice and called the toll-free number.

And spent the next two hours (really!) speaking with a delightful young lady named Destiny (last name withheld because she isn't the problem). Like us, she was unable to successfully access the system; in fact, she had to ask for my client's information several times as the system gobbled it up and spat out error message after error message. If it spat out anything at all (she was experiencing more hang-time than Michael Jordan).

Ultimately, we had to bag it (my client had another appointment, as did I) and we'll pick up again in the morning. We did ask Destiny if there was a better time to call, and she assured us that the call center is open 24/7, and one time's as good useless as any other.

And remember: this is the off season - still think they'll be up for the real deal?

I'll let you know how it goes today...

Great Expectations

It appears that Exchange enrollment for Obamacare isn't going to be what it was cracked up to be.

Back in 2011 CMS released released their summary forcast showing that in 2014 exchanges were expected to enroll 13.9 million. For 2015 that number was 15.9 million. Now comes word from HHS that actual enrollment as of mid-October there are 7.1 million people enrolled and that they are lowering expectations in 2015 to between 9 and 9.9 million. Why? Because they want it to be "accurate...analytically based."

I always thought meteorologists had the best job security. They could be wrong half the time and we forgive them. Now I'm thinking the best job is forecasting for Obamacare. When HHS/CMS make a mistake they simply "downgrade" expectations. Only in this situation we shouldn't forgive them.

Obamacare Architect: "Call it the Stupidity of the American Voter"

Jonathan Gruber...watch the video.

Nuff said.

Breaking: SCOTUS to hear King

The Supreme Court has just agreed to hear arguments on whether or not folks in states with Federally-run Exchanges are eligible for subsidies.

Hunh.

Cavalcade of Risk #221: Call for submissions

Claire Wilkinson hosts next week's edition. Entries are due by Monday (the 10th).

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.

Health Wonk Review: Post-election edition

Jennifer Salopek at Wing of Zock (which, BTW, would make a great name for a band) hosts this week's round-up of wonky posts, with special focus on the future of O'Care in this new era.

Have ObamaCare, Will Travel (With a Twist)

Tired of reading all those sob stories about folks losing their health insurance? Ready for some good news for a change?

Well, you're in luck:

"According to the Department of Health and Human Services, foreign diplomats... are eligible to participate in an array of medical programs administered by the federal government, including participation in Health Insurance Marketplaces."

WooHoo!

And all you middle-class whiners who make too much for a subsidy will be glad to know that at least someone's making out like a bandit:

"[A] foreign diplomat could satisfy the statutory criteria to be eligible for a premium tax credit and cost-sharing reductions.”

Isn't that great? Who wouldn't want to make sure that foreign visitors here enjoy the same a better level of benefits and access to health care than we simple proles do?

Don't be a hater.

[Hat Tip: FoIB Holly R]

Rubber, Road and Lyft: Insurance Crisis? [UPDATED]

If memory serves, we first addressed the insurance challenges of ride sharing some 3½ years ago:

"When you bought your policy, you agreed to the coverages and exclusions in the policy, and also to your own (minimal) obligations, one of which is to inform the carrier of a "material change" in the risk."

At the time, we noted that hiring out your vehicle, or offering rides therein, made you a commercial insurance risk, and that personal auto policies explicitly exclude this from coverage. Fast forward a bit to this past Spring, and we restated the problem in the age of Uber and Lyft:

"The Nebraska Departments of Insurance and Motor Vehicles are urging caution before people sign up for Internet services that connect drivers, riders and vehicle owners for car-sharing and ride-sharing."

Again, the problem is whether or not one's policy allows for commercial use, and whether or not one had alerted one's carrier to the change (and obtained appropriate cover).

The challenge takes on a new urgency today:

"A spokeswoman for rideshare service Lyft says one of its drivers was involved in a multi-car crash in Northern California that left a man dead"

It appears that the Lyft driver was at fault (swerving to avoid a broken down vehicle), so the question arises: did he have appropriate insurance? We don't know, but one suspects that we'll soon find out. In the meantime, I've reached out to our favorite P&C guru for his thoughts.

Stay tuned....

UPDATE: Thanks to Kevin Sullivan, we have a bit more on this developing story:

"While a driver is providing a ride or on the way to pick up a passenger, Lyft offers $1 million in liability insurance, and $1 million in uninsured/underinsured motorist coverage. That coverage, which once was “excess” — kicking in only after a driver’s personal auto policy had been exhausted — became primary coverage in July."

Here's why this is important: it's possible (perhaps likely) that the underlying coverage - that is, the driver's insurance - will not cover this event. That being the case, it couldn't be "exhausted" and therefore Lyft's plan might not come into play at all.

Since Lyft's policy is now considered primary it shouldn't matter whether or not the driver's insurance steps up.

Time will tell.

Renewals vs "Grandma"

A couple of weeks ago, Anthem sent me a list of my clients whose plans renew this December. These are so-called "grandmothered" plans, but because Anthem chose not to participate in the expanded transition program, no changes can be made to them: my clients' only choice is to keep them or ditch them.

So I put together a brief (but informative) email explaining this, and sent it to the folks to whom it applied:

"Good morning!

As you know, there have been (and continue to be) a lot of changes with health insurance. Your current Anthem plan is "grandmothered;" that is, you may keep it as-is, or we can shop it around.

Your current rate is: $xxx
Your December renewal rate: $xxx

Based on recent experience, don't expect great results from shopping for a new plan (sorry!): your current plan doesn't meet all of the new ACA mandated requirements, but a new plan would (and I'm seeing some pretty horrendous rates on those). If you're interested in checking that out, here's a link to our (private) Exchange - it does NOT go to the .gov site:

[link]

There, you can see if you're eligible for a subsidy and get quotes for different plans. Of course, I'm always happy to run those for you if you'd prefer (or even just walk you through).

Thank you so much for the opportunity to be of service!"

As you might imagine, I've had quite a few replies: folks are generally pleased to have been kept in the loop, and most have asked me to see what else is available. Curiously, only one or two seem to be eligible for a subsidy, but we can't get those rates yet.

In the meantime, we started ...

Wait, what do you mean "we can't get those rates yet?" It's less than two weeks until Open Enrollment starts, and the carriers haven't figured out what they're going to charge? How can that be?

Have you not been paying attention? We reported a month ago that carriers were enjoined by Our Betters in DC© from disclosing Exchange-related testing results, which of course would include details such as rates. Makes sense, really: after all, we have to hide the site in order to learn what's in it.

Right?

As I was saying, I began running quotes for my December renewals, and (as expected) they weren't pretty. By way of example:

Client 1 - HSA plan, current rate $241, renewal rate $276, comparable ACA-compliant plan $540

Client 2 - HSA plan, current rate $355, renewal rate $432, comparable ACA-compliant plan $1,020

[ed: Almost all my clients are in HSA-compliant plans. Funny, that]

The point is, there don't seem to be any attractive options for these folks; their best bet is to stay put, at least for the nonce. I'll add that I see no reason to be optimistic about the January 1 rates - when they're finally released.

Hoosier Health Insurance Goes Bye-Bye

Looks like 30,000 Hoosiers really hate their current insurance. After all, the Precedent explicitly promised them that if they liked their plan, they could keep it:

"Notifications have been sent out to 30,000 residents of Indiana informing them their health insurance plans no longer meet the requirements of the Affordable Care Act, also known as Obamacare, and will be cancelled at the end of this year."

Easy come, easy go...

The $958 Fallacy

Randy Essex, editor of the Glenwood Springs (Colorado) Post Independent, has an interesting, if disingenuous, article on a recent health care claim. Briefly, he underwent what he called "routine blood tests" that had previously cost him $45, and for which he was recently dinged $958.

He then proceeds to complain about transparency, pricing and claims, without ever actually demonstrating any knowledge of what actually happened.

So let's deconstruct this for him, shall we?

By his own admission, his previous tests cost him $45 because he had a (presumably generic) co-pay plan. Of course, the tests cost much more than $45, and he pre-paid the balance with inflated premiums (versus a catastrophic, HSA-compliant plan).

Flash forward a few months, and he has a new (catastrophic, presumably HSA-compatible) health insurance plan. As an aside, he laments that he was a victim here: "The only thing that had changed was my insurance, which, like so many other workers’ plans in America, had been switched by my employer to a high-deductible policy."

Here's a new flash, Randy: your employer can't require you to sign up for his group plan. You could always say "no, thanks." Look for that option to go away, though, as employers dump their employees onto the Exchanges.

But I digress.

Next, Randy admits to a very stupid choice: "the doctor wanted to put me on Lipitor, and I acceded. I hated it and stopped." This is called "self-medicating" and is generally a very stupid idea. At the very least, you should discuss this in advance with your physician (for whose services you've paid, by the way).

He goes on to detail his most recent encounter, and it's here that things begin to go sideways quickly:

First, he laments that he needs "to be able to see the prices without spending hours on the phone." Most carriers have made this information available for years (heck, we first wrote about it almost exactly 9 years ago!). Then he "assumed this was a preventive, covered procedure meant to help lower my risk of heart disease" (emphasis added: we all know what happens when we assume). Rather than assume, why wouldn't you ask the purpose, and then check to make sure? Based solely on the article, it sure seems to me that this was diagnostic, not preventive, and thus subject to the deductible.

Generally speaking, even diagnostic items would be eligible for in-network pricing, but that appears not to have been the case here:

"The bill also showed an insurance adjustment that lowered my cost by $1. One. Dollar." After speaking with the plan administrators, he was assured that this was a mistake and that it would be corrected, but that seems not to have happened. Rather than pursue a solution with the insurer, though, he indicts "the clearly ridiculous cost, the complete lack of transparency in medical prices and the lack of any real consumer choice."

Really, Randy? I don't think so: you have no idea what drives those "ridiculous costs," such as malpractice and other liability insurance, lab fees, the actual costs to run the various tests, and of course the experts to analyze the results. The lack of transparency is on you: why didn't you check the carrier's site, or ask the tech? Most likely he (or she) wouldn't know, but could direct you to someone who did. And finally, you had your choice of any number of facilities where this work could be done (Google and/or your carrier's site come to mind).

No, it's much easier to blame others for your own lack of foresight. On the flip side, congrats on your lower lipid level.

[Hat Tip: FoIB Holly R]

1,000 Words on the ObamaTax

[Hat Tip: FoIB Jeff M]

Halloween: P&C Claims Style

[Hat Tip: FoIB Amanda A]

SHOP - Not as "Easy as Buying a Plane Ticket"

Ohio is one of five states with early access to the Small Business Health Options Program (SHOP). The SHOP is the only place where an employer can receive a small business tax credit and offer multiple insurance companies and plans. With early access we have the green light to quote plans and rates for 2015 right now. Yesterday was my first "experience" in the system.

One of my clients believes they will receive a substantial tax credit for health insurance. Their accountant told them it would be advantageous to take it - if they qualify. Last year they dropped employer sponsored insurance but are looking to go back because they are having difficulty retaining employees and are worried about the individual plan rate increases.

Here is how the process went.

First, you create an account using the same platform as an individual does. This is where we encountered our first issue. The CEO had created an individual account with his email address and even though we were in the SHOP it wouldn't allow him to create another account with the same email.

After creating another email we finally established the account. Then we had to verify that the CEO was the CEO. The same personal questions from the individual market were asked of my client. Before committing to answer he asked a very good question that I'm sure nobody has an answer to yet:  "What if I leave the company? Is there a transfer of this account to the new person in charge?" We couldn't get an answer from the call center.

He reluctantly completed the verification and we hit enter. Then this occurred...

Back at it again this morning we were finally able to verify and began (again!) entering all of the employer information. While redundant, it seemed like we were going in the right direction. Success is achieved. Next step.

It asked us to begin entering information for each employee. We could either do that or download an excel document and populate it into the system. We elected to view the excel document and see what all is needed to complete the process.

Oh boy, this isn't going to be fun. The spreadsheet has 20 columns to complete for each employee. Each dependent has an additional 8 columns to complete. You must provide date of birth, social security number, date of hire, address, employee code, and a preferred method of contact for each employee and their dependents.

We are stopped once again. The employer needs to have someone complete the spreadsheet with the proper format. Cut and paste are great tools and hopefully will make transposing easier. But the company still has to get dates of birth and social security numbers of spouses and dependents.

At this point the employer is stopping the process. Without knowing the rates and benefits it doesn't make sense to waste productivity gathering all of the data. Instead we will wait until the insurance companies are allowed to quote the plans directly. When will that be? I'm not sure but I'll bet it won't be until after next Tuesday.

From Bad to Worse...

The 2015 Open Enrollment begins in a couple of weeks, and carriers, agents, HHS and all the rest are busy gearing up for it.

That's the good news.

Sort of.

Here's the reality: if you're thinking about buying on the ObamaTax Exchange, be sure your LifeLock plan is paid up:

"IRS Warned about Protecting Taxpayer Information on Health Exchanges ... The IRS must do more to ensure that federal tax information submitted to the ACA exchanges is protected and prevent its unauthorized disclosure"

Or else ... what? It's not like the current administration has a track record of going after its own (cf: Secret Service, Benghazi). And it's also not like there's an alternative: if you qualify for - and wish to use - a subsidy, you're going through the Exchange. For better or worse.

But mostly worse.

On the other hand, once you have that brand new subsidized health insurance plan, you'll have plenty of opportunity to use it.

Or maybe not. As FoIB Jeff M tips us:

"Over 214,000 doctors won't participate in the new plans under the [ObamaTax] ... Reimbursements under Obamacare are at bottom-dollar - they are even lower than Medicare reimbursements"

As we've noted, doc's can't afford to keep eating their losses, and there's no Doc Fix for the ACA. It's possible, bordering on likely, that more providers will opt out than actually participate.

Welcome to the future of American "healthcare."

Cavalcade of Risk #220: Tricks and Treats edition

Louise Norris has a real bag of goodies for us this week, with risky posts from drones to (metaphorical) tsunamis. And not a marshmallow peanut in sight.

A Holly Jolly LinkFest

Our good friend Holly R sends us some interesting links:

■ We've written before about how carriers have gotten, erm, imaginative in their efforts to rein in costs under the ObamaTax regime. In addition to rx limitations, another neat "trick" is to unbundle the cost of care:

"The therapist worked out of a local hospital ... he was surprised when the bill for each visit contained two charges: the approximately $100 he expected to see for the therapist — and a similar fee for the room, which was not covered."

Making it that much more challenging to predict the actual cost of care, and increasing that cost. Nice job, O'Care!

■ One way to cut costs, of course, is to encourage consumers to pick and choose their care with an eye toward efficiency and price. That's the premise behind Health Savings Accounts, and it's also the foundation of a new startup called Vitrals, which offers "a direct cash incentive to have your procedure at the health facility preferred by your employer and plan."

Thereby putting its money where your mouth (or other body part) is.

Very cool.

■ As we head into the midterms next week, the ObamaTax is sure to be on voters' minds:

"Americans who hold private health insurance spent more on medical services in 2013 even though they used fewer of them."

So much for the promise to lower both premiums and the actual cost of care.

L'Chaim - To Life!

Ebola. ISIS. Enterovirus. Scary stuff, and sure to get one considering one's own mortality. Not to mention the state of one's life insurance. Life Happens, "a nonprofit organization dedicated to helping Americans take personal financial responsibility through the ownership of life insurance and related products," has a new video out covering the basics.

If you already own this invaluable coverage, perhaps it's time to review it: is it enough? Are my premiums and beneficiaries up to date?

If you don't own a policy, have you considered whether you need one? What do your loved ones think about that?

Food for thought.

[Hat Tip: Bill Coffin]

Cavalcade of Risk #220: Call for submissions

Louise Norris hosts next week's edition. Entries are due by Monday (the 27th).

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.

Apples To Oranges? Try Rotten Bananas

Fourth quarter GRANDMOTHERED small employer health insurance renewals have been rolling out. Many of them here in Ohio are in the 7%-15% range with few exceptions. These aren't easy for employers to swallow. Until I show them the ACA compliant alternatives.

Benefits are Apples to Oranges

Strict actuarial value guidelines are causing plans to be canceled. The plans replacing them must have a more cookie cutter benefit structure. There is little to no room for creativity or innovation from the insurance companies as they are bound by these new rules. The new benefits have different copays, deductibles, maximum out-of-pocket limits (MOOP), prescription drug coverage, and provider networks.

For most ESI plans the benefits are a reduction from what they were. Supporters won't tell us this. Instead they point to the fact that plans must now cover a few "new" benefits that impact a small portion of our population.

Rates, well...they are Rotten Bananas

Whoever believes that "rate shock" isn't going to occur hasn't spent a day in the trenches of health insurance. This is because ACA compliant plans must follow community rating guidelines. Regardless of health status everyone's rates must be the same (exceptions: age, tobacco use, location). If you have a vibrant healthy workforce congratulations. You are now subsidizing the unhealthy workforce.

Kudos to the companies who found savings through community rating. These folks all made the transition last year when they had an advantage. Note that we didn't hear very much cheerleading from this group because it was extremely small. How many small businesses do you know who went to ACA compliant plans and said "This is GREAT!!!"?

Fortunately here in Ohio the Legislature, Department of Insurance, and insurance companies took advantage of our weak-kneed President's "If you like your current plan" transitional relief gesture. For the short term my clients and other small businesses have the ability to renew their old plans for a couple more years. This is comparable to putting a Band-Aid on a jugular wound.

When the ACA option is looking at lesser benefits and a 50% or more increase it doesn't matter if my client likes their current plan or not, they are definitely keeping it.

Saving the MVNHS©

On Facebook, Doc Emer asks "What's wrong with the NHS?" and links to a story about the service's "own answer to whether it can survive as a unique system of healthcare."

I suggested that the more important question is whether (and why) the MVNHS© should be saved.

After almost 10 years of blogging on the Much Vaunted National Health Service©, it seems to me that the problems are endemic, and systemic. One of the biggest challenges is that, contra its supporters, the folks who run it have had no more success in reining in health care costs than any other system, the Liverpool Pathway notwithstanding.

The linked story begins propitiously enough: titled "How to save the NHS in just 50 pages," it sets forth a kind of Five Year Plan [ed: how ironic] the purpose of which is to "make the case for some of the changes we’re going to need.” And what are these changes?

That's a good question.

Unfortunately, the answer's a bit vague: "It’s not a one-size-fits-all blueprint for every part of the country, let alone a detailed plan for everything that needs to happen."

So, a typical government white paper, long on rhetoric and short on substance. No real surprise there. What I do find startling, though, is that the article explicitly sets forth the real problems facing the service:

"And as no political party wants the NHS to visibly decline on its watch, this is a not-so-subtle public warning that without extra billions, bad headlines and public discontent will follow."

Short version: "It sucks, we can't justify its continued existence,but I can't be the one to pull the trigger."

Which is pretty much where we'll be with a few more years of the ObamaTax under our belt.

Health Wonk Review: All the leaves are brown edition

Louise Norris hosts an outstanding edition of the Health Wonk Review. What's so outstanding about it, you ask? To begin with, it's a diverse group of posts, covering the ObamaTax to Ebola, virtual wards to healing prayer.

Kudos, Louise!

Can I Charge Interest?

One of my clients dropped their employer sponsored insurance plan effective May 1, 2014. This forced 21 of their employees (including the owners) to find individual coverage. We met and worked with all of them to secure coverage either off the exchange or through goodluck.gov.

In another month we will perform this exercise in patience once again. To really do a good job for our clients this process is frustrating, complex, and time consuming.

It's even more frustrating for me though when one of the insurance companies still hasn't paid my commissions yet.

For the last six months we have continued to help with service questions for the employees I enrolled with this particular insurer and have spend an inordinate amount of time trying to get paid. We knew there would be problems with this whole process and I understand that the initial issues could be a result of mistakes from all parties. However, those items were fixed a couple of months ago.

When will I get paid? Who knows. Its too bad I can't charge them interest though.

VaderCare? "Pray I don't alter it any further"

As the Halbig saga slogs on, the industry itself is moving forward:

"[I]nsurance companies offering plans on HealthCare.gov this year had a new clause inserted into their contracts ... that allows them to cancel plans if federal premium subsidies are eliminated."

Hunh.

Now why do you suppose that Ms Burntwell and her minions might agree to that?

It isn't very difficult to connect the dots.

Another Ebola Insurance update

Well, the more the merrier! This latest comes to us via email from Medical Mutual of Ohio:

"All fully insured and self-funded health plans administered by Medical Mutual Mutual and Mutual Health Services will cover treatment for Ebola as if it were any other illness, subject to terms and conditions of the member’s plan."

This is crucial language: it means that items like isolation and special travel arrangements are likely covered. On the other hand:

"[W]e do not have specific information about treatments considered “unproven,” experimental or investigational, such as plasma transfusions from recovered patients or the medication Zmapp."

They do go on to note, though, that they would "likely" be covered. I understand this: no one really knows what we're getting into here. And if this does in fact become pandemic, well, all bets are off.

Blue Cross Wrist Slap

Received this via email:

"The ruling confirms last year's judgment by a federal court in Detroit, which found that BCBSM collected millions of dollars in hidden fees over a nearly 20-year period from the  employee health plan for Hi-Lex Controls, Inc. and Hi-Lex America, Inc."

Over the years, we've blogged on the Blues' various legal travails more than once (most recently here). It's nice to see one that's actually "gone the distance," though.

The case at hand actually took 3 years to wend its way to SCOTUS, but it's apparently not the last:

"The Hi-Lex matter is the first of nearly fifty cases filed by Varnum [law firm] over the fraudulent fees."

It seems that BX was acting as the claims payor for self-insured plans, and reporting different amounts than were actually being charged. Even more egregiously, managers apparently knew of the practice, but discouraged employees from mentioning it, making them unwitting accomplices.

It appears that BX has since discontinued this practice, perhaps as a result of the litigation.

[Hat Tip: Tyler Lecceadone]

Have Faith (and Insurance)!

For the past 14 or so years, I've participated in a healing prayer group with some friends. We meet weekly and pray for the health of folks running the gamut from broken limbs to terminal illnesses. The one hard-and-fast rule we have is that the person for whom we're praying must know that we are praying for him (or her) and must have given us explicit permission to do so (there are exceptions, of course: someone in a coma is unlikely to meet those criteria for a while).

That rule is because we believe that the key to our efforts is that we are connected to and with the folks on the list. To that end, we also endeavor to get regular, timely updates from them on their progress (If any). We acknowledge that we don't know - can never "know" - whether or not our efforts have been successful, but we continue to meet week in and week out because we believe that we are making a difference in these people's lives.

Which may explain why my interest was immediately piqued by this item:

"I was parked in front of a patient’s home before my visit, running through my checklist. Patient’s diagnosis and prognosis. Any known family members or friends supporting the patient. Religious affiliation, if any. Patient’s name – you should always recheck the patient’s name. It’s good to know little about a patient’s medical concerns, but as chaplain, my concern is not what the patient’s illness is, but who the patient is. I want to address their spiritual needs and see how their spiritual health affects their overall health."

Turns out, the (anonymous) author works for an ACO (Accountable Care Organization - healthcare companies that are paid as a percentage of the money saved through their care management) called MissionPoint Health Partners. The folks in my healing prayer group were also intrigued,and urged me to connect with the firm to find out more.

So I reached out via their site's contact form, and even sent a LinkedIn invite to whom it appears is their media outreach person.

Days later: /crickets.

That's a shame, too, since this concept shows real promise, and there are some key questions that we'd like to see addressed.

For assistance: how do they deal with atheists who express an interest in this service?

And what metric do they employ to measure "success?" That is, they claim that this service reduces expenses, but how do they know this?

Oh, well, they missed an opportunity.

Double Whammy, ObamaTax-style

First the bad news:

"ObamaCare shoppers in search of the lowest-cost plan may come down with a mild case of rate shock when 2015 exchange enrollment begins next month ... the cost of the cheapest bronze plan will jump an average of 13.9%"

Remember when we were promised that we'd have 3000% rates decreases?

Good times, good times.

But wait, it gets better worse:

Turns out, the folks who actually buy these plans can't afford to use them:

"[E]ven among those who receive enough subsidy money from the rest of us to offset the high premiums, killer deductibles make their coverage much more expensive in practice, to the point of rendering them virtually useless."

It's simple mathematics, after all: thousands (perhaps tens of thousands) of dollars in premium plus thousands ((perhaps tens of thousands) in out-of-pocket costs means that a lot of folks now can't afford to use the insurance they scrimped and saved to buy.

But hey: so much better than the old system, no?

Cancer Walk Thank You [Updated!]

So, the Making Strides Against Cancer walk took place this morning, and I'm happy to report that we all made it through the grueling 3.1 mile course. Thankfully, the rain held off until we'd finished (Yay!); some 10,000 people took part in ours.

Our team finished a very respectable 21st out of 539 (top 4% - WooHoo!), and my terrific contributors donated $800 as of this morning. But don't feel left out: you can still donate here.

Thank You!

I'll post our team picture shortly.

ICYMI: We already *had* an Ebola Czar

Prior to appointing political hack well-regarded activist Ron Klain to the position, actual Dr Nicole Lurie was the official frontman .. er, woman for this important post.

What, you didn't know that?

Don't blame yourself:

"Nicole Lurie, M.D., M.S.P.H., has been completely M.I.A. ... She's the Assistant Secretary for Preparedness and Response"

What, now she's in isolation? Hunh.

Econ vs Engineering: A Case Study

Uber-wonk John Goodman has an outstanding piece at Forbes contrasting the perspectives of various players in the health care arena, focusing specifically on the (mis-)handling of the Ebola crisis at the hands of the CDC.

Basically, he argues (persuasively) that engineering-oriented folks focus primarily on planning as a function of organization, and that self-interest is largely unimportant. They believe, he argues, that "incentives don’t matter [very much]."

Economics-oriented individuals, on the other hand, believe that incentives matter a great deal; that "people find that when they pursue their own interests, they are also meeting the needs of others."

You can see the problem.

His thesis is fairly simple, and therein lies its elegance:

"[M]ost people in health policy take the engineering approach. That is why there have been so many mistakes and so many failures of policy – ranging from Obamacare to Ebola control."

Read the whole thing for his explication of this unfortunate truth. You'll be glad you did.

Friday LinkFest

■ The Bay State's Medicaid explosion, er, expansion looks to be growing at a much faster clip than originally anticipated. Wonder why?

Wonder no longer:

"[A]nalysis of financial filings indicates that the subsidized Medicaid program known as MassHealth has for the past four years incurred $500 million in deficits that have been hidden by a quirk in the state’s budget process."

Ooops. And this has been going on for quite a while, racking up "billions in cash shortfalls."

■ While we've been focusing on the financial implications of The ObamaTax, the impact on the delivery of health care is equally critical. And equally in shambles:

"Doctors are ramping up our protests against the government's expanding role into health care ... We are instead protesting silently through our practice decisions."

And the "practice decision" being made by an increasing number of doc's is: we're outta here.

■ We've posted before on the fact that the Exchanges are quick to take folks cash, not so quick to pay out commissions to those who actually helped people navigate (heh) the onerous 404Care site. That may be changing:

"The long-awaited fix to the National Producer Number (NPN) is expected to be in place by Nov. 15 and will allow brokers to enter their identifiable information and receive commissions"

What's stupid is that we've been using the NPN numbers for a long time now - in fact, it's the only acceptable form of identification for many states' Continuing Education requirements. Why am I not surprised that the Feds are so far behind on this simple piece of infrastructure?

Life imitates The Onion

Bob posted on this earlier, but I wanted to add my $.02, as well.

It seems we've been down this road before, but this time with a twist:

"FTC cracks down on a health insurance scam ... Consumers were charged $50 up to several hundred dollars initially, the FTC said, and then a monthly fee of $40 to $1,000 for the purported health insurance."

You're forgiven if you thought "gee, musta been a heckuva subsidy," but in this case, it's simpler: the perps were passing off medical discount cards as true insurance. We've actually blogged on this practice before; back then, various state insurance departments were cracking down on these outfits. Now they've made an honest-to-goodness Federal case out of it.

Now, you're probably asking yourself: "how did the Fed's know that these were scam sites?"

Simple: They worked.

And speaking of frauds, the Feds are fairly nonplussed at pulling their own little scam, at least according to the legal eagles at Judicial Watch:

"At a Wednesday press conference to announce the filing of a lawsuit challenging health insurance coverage for members of Congress through the District of Columbia’s small business exchange, Judicial Watch President Thomas Fitton called the arrangement “fraud.”

Turns out, our Betters in DC© have been buying coverage off the Capital's Small Business (SHOP) Exchange site [ed: even more evidence of their recklessness, no?]; the JW folks argue that this avenue is open only to small businesses, of which Congress isn't one. Even better, at least a few of these rocket surgeons seem to have applied, and been approved for, a subsidy.

Your tax dollars at work.

From the Mailbag: Now you see it, now you don't

FoIB Jeff M, commenting on the curious case of the missing renewal numbers, wonders:

"Our most transparent administration ever has announced that ACA plan renewal rates won't be released until after election day. But don't renewal rates have to be released 60 days prior to renewal?"

Great question.

Our own Pat Paule has your answer:

"The 60 day written notification applies to grandfathered plans in the individual market, as well as grandfathered and non-grandfathered plans in the small group market. Non-grandfathered coverage in the individual market doesn't have to receive their written notice until "BEFORE THE FIRST DAY OF THE NEXT ANNUAL OPEN ENROLLMENT PERIOD." Insurers in this market are not allowed to send written notices of renewal until the QHP (Qualified Health Plan) Issuer Agreements for the plan year have been signed, "to ensure that the correct information is included."

It is my understanding that a few states have approved rates available to view - without benefit summaries - and others are still waiting on their Compliant Issuer Agreements to be approved. Any guess where these agreements are at? Also, none of the plans take into account the beloved subsidies. Without that information we really have no idea how much more these plans will cost people until they have the ability to enroll beginning on 11/15"

Thank, Pat!

Making Strides Against Breast Cancer

Recently, a friend of mine went in for her routine mammogram. What happened next wasn't so routine: they saw a shadow. A few tests later, and she was diagnosed with breast cancer. Thankfully, it was caught in the very early stages, and after a few weeks of pinpoint radiation therapy, she's good to go.

Another acquaintance wasn't so lucky, and she's just finished her most recent round of chemo.

And by the way, it's not just women who need to be aware - men are at risk, too.

Fact is, almost all of us know a cancer survivor (or perhaps one who didn't). This year, I'm participating in the American Cancer Society's annual walk to raise money for research. You can help with your pledge. The walk is this Saturday (the 18th),  and I'd be very grateful for your help. It's pretty easy - just click here to help make a difference.

Thank You!

Cavalcade of Risk #219 now online

Hosted by Russell Hutchinson, who once again presents a terrific collection of risk-related posts. Come for the drones, stay for the moms and kids.

Kudos, Russell!

Ebola Insurance - Update?

Interesting email from the folks at United Healthcare:

"UnitedHealthcare Responds to Ebola Concerns ... The health and wellbeing of our members is a top priority ... Diagnostic testing and associated care will be covered in accordance with the terms of your health plan."

Notice that they're neither confirming nor denying that your plan will cover Ebola-related expenses. And of course, UHC offers many different plans - individual and group - so coverage is likely to differ among them. So some plans may include that endemic disease exclusion, some (most? all?) may not. The only way to know for sure is to check your SPD (Summary Plan Document) for the list of exclusions.

You might also call the customer service hotline, but be warned that you're then taking the word of an anonymous CSR who may (or may not) know what you're talking about.

Interesting times.

New Hope for Naughty Navigators?

We've long chronicled the troubled history of the unlicensed, unvetted Navigators (here for example), but hope may be on the way for potential victims customers in The Sooner State:

"Commissioner Doak Adopts Emergency Rules for Navigators ...  The rules ensure that all registered navigators are properly trained and obeying Oklahoma laws."

Which is most certainly a step in the right direction. But what does that mean, exactly?

"Navigators must be approved by the federal government, undergo a background check and pay the required fees before operating in the state of Oklahoma."

That first one's not all that impressive. The second is problematic: "undergo" doesn't necessarily mean "pass;" that is, just because someone underwent a background check doesn't mean that they're inherently honest. All it means is that their "record" (if any) is noted in their file. This does not inspire much confidence.

Still, it's better than nothing, and perhaps some of the other 57 states will adopt these - or even more stringent - standards.

High Tech (P&C) Carrier Trick

Hurricanes, tornadoes, and wildfires, oh my. In the Property/Casualty business, these often evolve into so-called "cat [catastrophic] claims." When that happens, carriers mobilize adjusters from all over to handle the massive influx of claims, often in the immediate aftermath, when infratsructure is compromised and housing difficult to come by.

Now comes one carrier with some outside-the-bun thinking:

"[USAA] ... asked the Federal Aviation Administration for permission to test unmanned aircraft last week, becoming the first insurance provider to seek an exemption."

No, they're not talking about firing off checks via drone:

"Area imagery provided by drones would be used in collaboration with reports from adjusters on the ground."

So a carrier could actually make do with less personnel on the ground while still providing necessary and timely claims service. USAA is still waiting for the all-clear to get started, but this looks very promising.

MVNHS© and CanuckCare Update

Speaking of socialized medicine, here are two items from systems upon which The ObamaTax is modeled, in case you were wondering what our own health care will work:

"A premature baby who was given little chance of survival when he was born at 23 weeks has celebrated his first birthday."

That's the good news. His parents had been advised that he most likely wouldn't survive birth. And there's where things went sideways:

"The couple also claim that they were told they would receive no medical support if the baby weighed less than 1lb."

Such is life under government-run healthcare.

Another great feature of socialized medicine is the shortage of timely care. We're seeing this already under O'Care; it's only going to get worse from here.

But all is not necessarily lost - perhaps we can take a lesson from our Neighbors to the North©. Having to live with their own version, they've developed some interesting work-arounds. For example:

"Since 2003, Timely Medical Alternatives has been developing a network of over 20 facilities throughout Canada & the U.S., to help our clients access timely surgery at affordable prices."

Basically a medical tourism travel agency. No word yet on when they're opening their US branch(es).

[Hat Tip: FoIB Peter K]

Say it ain't so

Can't say as this comes as a surprise:

"California's health insurance exchange has awarded $184 million in contracts without the competitive bidding and oversight that is standard practice ... including deals that sent millions of dollars to a firm whose employees have long-standing ties to the agency's executive director."

The good news is: it's not just the DC Grandees making coin off the ObamaTax Exchanges.

The bad news is: it's not just the DC Grandees making coin off the ObamaTax Exchanges.

Sweet gig, no?

The Health Wonk Review is up!

This week's Health Wonk Review is up - and another great round-up by co-founder Joe Paduda.

Hit me again!

So folks in the Sunshine State aren't the only ones feeling the premium pinch coming up on Open Enrollment v2.0:

"State regulators approved significant premium hikes on Louisiana’s and Iowa’s Obamacare exchanges this week, with each state seeing average hikes reaching the double-digits."

Yes, that's double-digit increases (as opposed to the 3000% decrease we were promised. Bayou State Blue Cross insureds will see on-Exchange premiums rise by almost 20%; folks in the Hawkeye State are in for a drubbing, as well, also clocking in at about 20%.

Something interesting, though, in that Louisiana news: "Blue Cross Blue Shield isn’t hiking rates on customers with narrowed networks." This is something we've been yelling from the rooftops for quite a while: increased demand will always lose out to diminished supply.

Econ 1.0 wins again.

[Hat Tip: PowerLine]

Ebola insurance? (An InsureBlog Exclusive)

Our good friends at Global Underwriters recently sent out an email about cover for church (and other) groups on missions abroad. The primary focus of the email was about the risk of terrorism, but it occurred to me that there's another pretty significant exposure, as well:

Ebola has been much in the news of late, and I wondered how (or even if) a travel medical policy might cover that. Believe it or not, we first covered insurance for folks undertaking a mission overseas in our very first year:

"Once such gentleman – my client, in this case -- is headed over to Tanzania later this month. He’s part of a medical supply effort undertaken by the Rotary Club. They’re delivering over 400,000 doses of medication, donated by one of those evil, greedy, profit-driven pharmaceutical companies, obviously in direct violation of said company’s pact with Satan. My client and his daughter are accompanying the life-saving medications as distribution auditors."

Fast forward 9 years, and here we are again. This time, though, the stakes may be much higher.

First, though, a quick review: generally, Medicare coverage "stops at the border," so seasoned citizens often buy medical plans that cover them overseas. Likewise, most group and individual major medical plans offer limited (or no) coverage outside the country, and of course, that hospital in Nigeria (or Liberia) is unlikely to be in-network. Then there's the little matter of getting you back to the States for more advanced treatment - medevac flights ain't cheap (up to $75,000 or more!), and which is also unlikely to be covered by your regular insurance (or at least capped at a fraction of the actual cost).

[ed: click here for a more detailed explanation of Travel Medical plans and how they work]

So, you're on a church-related mission to Sierra Leone, and you contract Ebola. What happens next will depend in large part on whether you (or your organization) purchased a Travel Medical plan before you left.

So what are the issues here? We turn once again to Peter Schulteis, GU's Executive Vice President, who graciously lent us his expertise:

As always, the devil is in the details; Peter reiterated that any and all coverage (and exclusions) will be found in the policy. And that exclusion list may be critical in this case, since some plans exclude claims arising from endemic diseases. Then again, those that do so may offer a rider allowing one to "buy back" that cover.

And don’t forget to check your own individual or group plan for such an exclusion, either.

Something I hadn't considered, but which Peter mentioned, is that there might also be Workers Comp issues in play. So if your employer is sending you off to head up the new Freetown office, you might want to check with your WC carrier about how they might handle an Ebola-related claim.

The key issues, though, are local, on-site facilities and medical evacuation costs. Places like Sierra Leone and Liberia aren't exactly known for their cutting edge medical establishments, which are now becoming even more overwhelmed as the latest outbreak worsens. But if you do find yourself being treated at Saint Joseph´s Catholic Hospital in beautiful downtown Monrovia, be aware that you're going to be out of Anthem's network (and Humana's, and all the rest). And heaven help you if your plan does have that endemic disease exclusion.

So now you're stabilized, and ready to get out of Dodge (or Freetown). You can't just hop on the next 747 for LAX; you need specialized transport, which means a Medevac plane and crew. As we noted above, this can run into the tens of thousands of dollars (and they don't take American Express). Fortunately, plans like the ones Global Underwriters sell cover these costs for you (up to $500,000 in GU's plan). So again, worth checking the plan you're considering to see what emergency evacuation benefits are available (or even if they're covered at all).

You might also want to check with your disability insurance carrier (you do have DI coverage, right?) to see if there are any issues there. After all, you're likely to be out of the office for a while.

Bottom line is: don't assume you have coverage. It may well be available, but you need to read the fine print, and ask the right questions. Have a great trip!

Cavalcade of Risk #219: Call for submissions

Russell Hutchinson hosts next week's edition. Entries are due by Monday (the 13th).

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.

We need hosts for Fall Cav's - Please drop us a line to claim yours. It's easy, fun and a nice traffic bump. Thank you!

And the hits just keep on coming...

It's getting more and more difficult to keep track of the multiple ObamaTax implosions, and the lie that was "If you like your plan..."

This morning brings news that "[m]ore than a dozen states plan to cancel health care policies not in compliance with ObamaCare." At issue are so-called "grandmothered" plans: these are plans that HHS had allowed to stay on the books, even though they were "sub-par." It was up to the 58 departments of insurance to determine whether or not to go along with this. Some did, but have now reneged.

For example, a quarter of a million Old Dominion State policyholders will soon be receiving cancellation letters. Insureds in a dozen other states will, as well.

And great timing, too:

"[B]ecause federal law requires a 60-day notice of any plan changes, voters will be notified no later than November 1, right before the Nov. 4 midterms."

Heh.

If you like your plan....

Um, about that promise:

What are they hiding?

So this year's Open Enrollment season is well-nigh upon us, and of course the rocket surgeons/IT clowns in DC are testing the portal, (unrealistically) hoping to avoid a repeat of last year's debacle.

Given the stakes, and how desperately they want to show off their success, the results of all this testing will be made immediately available to the folks paying for it (that would be thee and me).

Right?

Um...not so much:

"The administration reminded insurers that their confidentiality agreement with the Obama administration means that insurance executives “will not use, disclose, prescribe, post to a public forum, or in any way share Test Data with any person or entity, included but not limited to media…”