MVNHS© In The News

Since it's been a while since we've reported on the Much Vaunted National Health Service©, seems like it's a good time to catch up:

1 - Co-blogger Bob alerts us to this alarming news:

"More than 3,000 operations have been cancelled by the NHS in the first two weeks of [December] as an "unprecedented demand" takes its toll."

Here's the deal: When something is "free" (or, more precisely: perceived as free) then more folks are going to want it. After all, why would anyone in their right mind leave money (or health care) "on the table?"

It also points out that nationalized health care schemes do nothing to rein in demand, and by extension, cost.

2 - FoIB Peter K explains why the folks mentioned above may have been lucky to have been put off:

"A six-week-old baby was killed by her bipolar mother after she stuffed pages from the Bible into the infant's mouth, while supposedly in the care of bungling NHS staff."

What difference which book was used seems irrelevant and unhelpful; the important information here is that careless (overworked?) staff allowed such a person unfettered, unsupervised access to a vulnerable patient in their charge.

Could it happen here? Of course, but the difference is that this seems to be a pattern for MVNHS© folks:

"Other fatal errors by the Cambridgeshire and Peterborough NHS Trust included the shocking loss of records detailing an attempt by Lovemore in 2006 to smother her first child."

And that was just this one family.

Oy.

A Timely Reminder

It's 2015, and that means:

"The employer mandate applies to applicable large employers with 50 or more full-time employees and full-time equivalents. It requires applicable large employers to either offer full-time employees and their dependents minimum essential coverage that is affordable and meets minimum value requirements, or risk paying an excise tax (penalty). 

Employers with 100 or more full-time employees and full-time equivalents, and employers with 50-99 full-time employees and full-time equivalents who do not qualify for transition relief, will need to comply in 2015."

Shorter: The (Evil) Employer Mandate is now in effect.

Note that smaller groups (under 50) are (so far) exempt. So again we ask: how would you like to be Employee #51 on the company totem pole?

Bob G vs "Survey Says!"

FoIB Bob Graboyes takes to the pages of US News to explain why judging the success (for certain values of "success") of the ObamaTax, based on ubiquitous and often self-selecting surveys, is destined to be disappointing:

"The phrasing of questions matters a great deal. Individuals surveyed may answer a pollster’s question dishonestly for a variety of reasons, or they may answer incorrectly because they don’t actually know whether they have qualifying insurance coverage."

Or maybe they think their better half took care of it. Doesn't really matter: you know the old saw about lies, damn lies and...

Bob wants to know just one simple thing: Why must we rely at all on these consumer surveys? They are subjective and prone to bias (both intentional and inadvertent). Surely there must be a better way?

And indeed there is. But you'll have to read his article to see what it is.

(It's worth it)

Bucks, Ducks and Luck

Congratulations to The Ohio State Buckeyes for their impressive route of the University of Oregon Ducks last night in Texas. While most of us here in Buckeye country are busy celebrating the win, one regional retailer is licking its wounds:

"Ohio-based Morris Furniture Company is now on the hook for upwards of $1.5 million in refunds to customers ... The promo promised refunds to customers who purchased at least $1,999 in furniture a ... if OSU won the championship game by at least seven points."

Which, by golly, they did.

So the chain is on the hook for an estimated $1.5 million dollars. That's the bad news. The good news is that they took a page from Chicago's World Furniture Mall, about which we wrote some 8 years ago:

"[The store] promised that if the Bears shut out the Packers in the season opener at Lambeau Field in Green Bay, Labor Day weekend shoppers would get their furniture free."

Which is what happened. Fortunately, the owner had purchased a "Special Event" policy for just such an occurrence, and was out only the price of the plan. So, too, the Ashley's folks "did work with a third-party company that underwrote the promotion."

Smart move.

Frustrating Client Tricks

First off, let me be clear that it's the client (and myself) that's frustrated. It's just that kind of situation:

Mary is divorced, and has custody of her teenaged son.She is responsible for his health care expenses, but her ex- is supposed to provide health insurance. Unfortunately, he is not terribly reliable: he is frequently unemployed (and uninsured), and he doesn't always let Mary know whether or not their son's actually covered.

In order to alleviate the stress of that inconsistency, Mary has always kept her son on her insurance. Due to some recent employment woes, she purchased a subsidized ObamaPlan from the Exchange.

A few weeks ago, her ex- contacted her to let he know that he'd found new employment, and that he and their son would become active on the new group plan on February 1. This presents her with something of a dilemma:

Once her son is on the group plan, he is no longer eligible for a subsidized plan. And according to Mary, she will also lose her subsidy (although she can keep the plan itself). Since I came into the picture after she'd already gone through the 404Care.gov subsidy eligibility hoops, I really can't confirm this, so I've just taken her at her word.

She also knows, from previous experience, that she really needs to keep her son on her plan, lest her ex- bail on the insurance requirement (yet again).

She asked her agent about what to do, and he referred her to me (this happens with some regularity).

I turned to my trusted posse (a group of colleagues around the country who are both expert and high integrity) for advice. I had a pretty good idea of what was going to happen here, but really wanted some additional input, especially regarding issues I might have missed.

Colorado Health Insurance Insider's Louise Norris came through in a big way.  Louise confirmed my belief that Mary "can't keep her son on a subsidized exchange plan. You can't get subsidies at all if you're even eligible for employer-sponsored coverage that is deemed affordable under the ACA rules (and unfortunately, because of the family glitch, they only look at the cost of coverage for the employee when they determine whether a group plan is affordable, regardless of whether dependents are being added to the plan or how much it would cost to add them)."

Louise also mentioned that Mary shouldn't lose her own subsidy just because Junior came off, but again, I  came in after she'd done that calculus, so I'm going to leave that lie (I have no idea how she completed the process).

Ultimately, it appears that the only way that Mary can resolve her dilemma is to drop her ObamaPlan and buy a new policy off-Exchange, one that will cover both her and her son. I pointed out to her that this solution has its own challenges; for example, having two plans in place often leads to Coordination of Benefits issues between the two carriers. She told me that she's done this before (where she kept him on both the ex-'s and her own plans) to no ill effect.

I am not satisfied with this solution, yet it appears that it's the only viable one if she wants to know that her son always has some insurance in place.

Still, better than nothing, one supposes.

Paying Medical Bills

A recent blog post by health care business consultant and policy expert David E. Williams suggests that medical bills are not paid because people do not understand them (as cited in a recent report by the Consumer Financial Protection Bureau). He then admits that “[e]ven though I’ve been working as a healthcare business consultant for more than 20 years, I don’t understand my bills either” and then lists several reasons for this misunderstanding. With all due respect to David, let's dissect this:

1) Providers send bills while insurance claims are still pending, so I don’t understand whether I’m being asked to pay the right amounts

In today’s modern medical offices, even those without EMR (electronic medical records), practices have Practice Management software which electronically bills insurance companies through organizations called clearing houses. When the provider receives the Explanation of Benefits (EOB) from the insurance carrier, the payment or if the patient owes is entered into the software and then a bill for the patient is generated based on the information from the insurance company. A provider would not bill while an insurance claim is pending as the software is not designed to generate a bill before the insurance information is entered. When you are billed by the provider, it is the correct amount.

2) Explanations of benefits from my health plan aren’t timely and aren’t informative. The services described sound completely generic and are hard to trace back to the provider bill

Your EOB should match the bill you receive from your physician’s office. Also, after the visit you the patient should receive a statement detailing your services, both the ICD-9 and CPT codes you were charged, the amount of money charged by the physician and any payment you made, such as a co pay or co insurance.

3) We now have a high-deductible plan and are being asked to pay more by our providers, but I’m not confident that providers are correctly taking into account our out-of-pocket maximums on an individual and family basis

As a medical practice manager, I am astounded that someone that purports to be a health care advisor would make such an inflammatory statement about medical providers. Going back to point one, the provider bills only after receiving the information from the insurance company on the patient’s portion. It is not any provider's responsibility to keep track of a patient’s deductibles, that is the patients responsibility and it is between the patient and the insurance company.

4) Providers aren’t coding claims in line with the Affordable Care Act or insurance company rules, resulting in incorrect out-of-pocket amounts

Mr. Williams then cites another post in which he discusses the “free” services to be offered by the provider, such as preventive care annual physical or the “free" screening colonoscopy. This is an oft misunderstood aspect of medical care: these services *can* be paid at 100% *provided that* the exam is purely a review, and there are no diagnostics, tests, labs etc. The minute you say, “by the way doc, my arm hurts when I do this”, it is no longer a preventive exam, it is now diagnostic and your deductible and/or co-pays will apply. Now, the logical question is, isn’t talking to the doctor about things that hurt the whole reason for seeing a doctor? Yes it is, but hey I didn’t make up the rules, I only follow them. So providers are not incorrectly coding, we are coding what actually happened.

5) Few providers (at least around here) allow online payments. I have to either call the office during work hours or mail in a check –both a hassle

Really, David? Many (most?) banks now allow for on-line bill-paying, no reason you can't set that up to pay for health care, as well. Heck, if you're on an HSA-compliant plan (as it appears you might be), you could even pay those bills from your HSA account.

This article is a rehash of every complaint I have heard in my 15 years working in health care. Why is paying your doctor any harder than paying your cable bill or your credit card bill? It is an expense you incurred of your own free will when you went to see your doctor. You know that you will receive a bill, especially with the average deductible north of $2500, and yet each patient is always surprised when the bill arrives in their mail box: “Is this the correct amount?” or “Have you billed my insurance company?” or “The doctor said he wasn’t going to bill me. My favorite is “I don’t think I should have to pay: 1) for my healthcare, or 2) such a high amount”. I have heard every excuse and reason not to pay a medical bill, and in my experience the provider is correct 90% of the time.

OPM @ HHS

Hey, it's a great gig:

"HHS executives spent $31 million taking 7,000 first class and business class flights between 2009 and 2013, including 253 trips for which a one-way ticket cost more than $15,000."

Which comes as less-than-great news for us proles.

Kill the 40 Hour Bill

Today the House of Representatives will vote on a bill to repeal the definition of full time employment status from Obamacare. Under the law, employers with 50 or more employees are now required to provide health insurance benefits to their employees who work more than 30 hours per week. The House bill (and accompanying Senate bill) would increase the threshold to the traditional full time definition of 40 hours per week. Passing this bill would be a huge mistake.

By passing this legislation, Republicans are providing supporters of the law with cover and ammunition. It allows them to claim that Republicans are pro-big business and anti-middle class while also accusing them of wanting more people to be uninsured.

It also will reduce the number of people who oppose the law. Every time Republicans chisel away a piece of Obamacare it makes an anti-Obamacare group less likely to oppose the law (hint: device manufacturers). The Obama Administration knows this - It's why many of the unpopular provisions of the law didn't begin until 2014. Even then the administration has continued to delay unpopular provisions time and time again.

A better solution would be to let employers and their employees "feel the pain." An employer who chooses to offer insurance and avoid the penalty can do so and play within the legal requirements of the law. Offering the minimum coverage and charging the maximum allowed under the law is a good start. Employees need to understand what Obamacare defines as affordable and good insurance under the law. For the employer who doesn't offer insurance they would then be subject to the tax imposed on them by the law. Make no mistake, the result here is that in many cases the employer will simply pass along this tax to their employees in the form of lower wages.

Republicans will be better served by focusing on how this will financially impact people when it's fully implemented. They should point to all of the unpopular provisions that the Obama Administration delayed. They should ask the constituents they serve what the financial impact would be if they had to pay 9.5% or more of their income for insurance. They should ask what impact employers will face if they can't afford to offer insurance. They should ask employers where the $2000 per employee penalty will come from.

Allowing this atrocity to run its course isn't the ideal solution. But for the average American the only way to understand just how bad this law really is means that they must feel the pain - and that is best felt when it hits their pocketbook.

If you like it, you can('t) keep it

Healthcare economist Robert Book has a very personal tale of ObamaTax woe:

"I am self-employed, and I have several significant pre-existing conditions ... who was supposed to be able to get insurance under the new system."

Turns out - surprise! - that he was lied to. That is, he relied on the word of ObamaTax proponents, including that of the President himself, that he could simply go to the 404Care.gov site, punch a few buttons, and be enrolled.

I heartily recommend reading the whole thing, but the takeaway is breathtakingly simple, and alarming:

"A few days later I got a letter from “The Marketplace” ... congratulating me for selecting a plan, and reminding to to pay my premium as soon as I got a bill from the insurance company."

Problem is, he never received the bill, because his newly-chosen insurer never received notice that he had, in fact, signed up. In theory, HHS sends a notice (ANSI 834 form) to, say, Anthem that Bob Smith has chosen them as his carrier, and needs to add him to their records, send out a bill and an ID card, etc. What seems to be happening is that this last, crucial step is either delayed or, in many cases, not happening at all.

So you have any number of folks who think they've signed up for insurance who really haven't. And since this is the gummint, good luck holding those (ir)responsible to account.

Just another broken promise, apparently.

And More 404Care.gov Tricks

And the hits, they just keep on coming. From email:

[click to embiggen]

Warm, fuzzy.

The more things change...

The more they stay the same. From email today:

[click to embiggen]

Hallowed Halls of Harvard: Grubered!

Too funny:

"Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care ... vote came too late to stop the cost increases from taking effect"

Couldn't have happened to a more deserving bunch.

[Hat Tip: Ace of Spades]

UPDATE: From FoIB Robert G:

More Unintentional Medical Tourism

This past November, we discussed the (poorly reported) story of a Canadian woman who, while on vacay in The Aloha State, gave birth (prematurely) and was "stuck" with a rather large bill.

A million dollar one, in fact.

Well, turns out that a British couple has just joined their exclusive little club:

"Brits Katie Amos and fiance Lee Johnston didn't expect to become a family of three until 2015, but at just 29 weeks pregnant, Amos went into labor—while walking through Central Park during "a last getaway" to the Big Apple."

And once again a nationalized health care scheme - the MVNHS©, this time - has failed to live up to its promise:

"Dax's medical bills are expected to total $200,000 before their stay is up. While insurers reportedly cleared Amos to fly, "we aren't sure if our insurance covers the medical bill."

Sounds familiar, no?

And, once again, the couple had apparently purchased a travel medical policy which is unlikely to cover any of the expenses, seeing as how, at 29 weeks, Ms Amos most definitely had a pre-existing condition.

A number of questions arise:

First, if the MVNHS© plan is so good, why would one need supplemental coverage (as if IB readers didn't already know)?

Second, why doesn't the media bother to explore and/or explain how travel medical plans work, and especially why said pre-existing conditions are excluded?

Third, why don't people read their policies, especially considering that the couple in question would be traveling halfway around the world, to a foreign country, while pregnant? Wouldn't this be cause for at least some concern?

The good news is that Dax seems to be doing well (all things considered). And since will be "registered as an American citizen," one presumes that he is eligible for an ObamaPlan that should cover at least some of his expenses.

But that's another post, and perhaps an interesting one, at that.

Put on a Happy Face

Late last summer, we reported that the Oregon health insurance Exchange (HIX) had enrolled exactly 0.0 suckers citizens. This past fall, we learned that, based on this underwhelming performance, Beaver State honchos were "pulling the plug on the site and switching over to the federal exchange and [404Care].gov," but exactly how and when that would happen was anyone's guess.

But that was then, and this is now:

"Oregon officials are pledging to avoid 2014’s enrollment nightmare ... Deloitte Consulting was hired ... to help transition the initially conceived state-run exchange to [404Care].gov"

Apparently something went right, because just north of 400,000 Oregonians managed to sign up in the last quarter or so. This despite the myriad problems still facing the fledgeling effort:

"[T]he new arrangement may still create “some potential disconnects” and confuse consumers with three different websites."

Gee, ya think?

Totally Terrific TomTom Tricks

Over the years, we've owned a number of GPS devices, the most recent one a TomTom unit we purchased about 4 years ago. It came with "Lifetime Maps and Traffic," which means we get new maps to install a few times a year (and the traffic feature is great for alerting us to potential bottlenecks up ahead, and usually at least one alternate route to avoid them).

The other day, I was alerted that a new map was available, and proceeded to install it. Before doing so, however, I continued my practice of separately copying the "Favorites" file so that I wouldn't have to re-enter a bunch of addresses.

This proved prescient.

In the event, something went very wrong with the install (this is the first time that's happened, by the way, in 4 years of use): the map became corrupted, rendering the device unusable. Over the next few days, I called tech support a number of times, and they could not have been more helpful, professional or courteous. They walked (and emailed) me through a number of trouble-shooting steps before determining that we had to format the device (Yikes!) and start with a clean slate. This took some time, of course, but in the end, I had a virtually new, clean unit, and because I had saved my Favorites, we were able to copy those in seamlessly.

Oh, did I mention that all these phone calls and emails didn't cost me a dime? And no, I had purchased no extended warranty or service plan, and this was for a unit that was 4 years old and cost less than $200.

Pretty good deal, I'd say.

As an aside, I learned something new about these units: mine has a built-in 2MB "hard drive" that currently holds a map of the US, Canada and Mexico. At some point, however, this map will become too large for my unit's on-board memory. What then?

Well, the folks at TomTom have that figured out, as well: they'll break the map into "zones;" one just loads whatever piece is needed and heads on out. And newer models come with a micro-sd slot to provide virtually unlimited memory, obviating the need for zones at all.

Pretty nifty.

And a special Thank You! to Amol P. and Raj R. for their help, patience and sense of humor.

Tuesday Afternoon Linkage

■ The good news (such as it is) is that just shy of 2 million suckers Americans have signed up for ObamaPlans so far during this year's Open Enrollment season.

The bad news is that this represents less than 15% of the expected number of sign-ups, and even then, most of these are simply re-enrollments, not "new blood."

Also on tap for a less-than-happy New Year:

"Most renewals are on autopilot, creating the risk of 'rate shock' when re-upped Americans get their bills in January"

Ouch.

■ Here's some actual good news for at least one family:

"A Seattle baby is home in time for Christmas after local doctors bet on a last-chance, once-discarded treatment that uses liquid, not air, to inflate the collapsed lungs of fragile newborns."

Seems that little Tatiana Saiaana had inhaled some of the meconium, resulting in an unusual but not unheard-of condition called Meconium Aspiration. This can lead to severe breathing problems. In Tatiana's case, doc's were able to come up with an out-of-the-box solution, and she seems to be on the mend.

■ FoIB Holly R alerts us to some disquieting news that's affecting not-for-profit hospitals that - get this - want to be paid for services rendered.

How gauche.

In the event, the rocket surgeons at the IRS plan to impose strict new rules that seek to prevent these providers from actively collecting payments from these they serve.

I'm sure this will have no affect on the ability of those most vulnerable among us to access vital health care services.

WC Kudos

One area of insurance that we really don't blog about is Workers Compensation. It's a highly specialized field, and there are already a number of very good, readable, expert WC bloggers. Among them are a few that I consider friends, and I am pleased as punch to inform IB readers that these fine folks have been honored by Lexis Nexis as the Top Workers' Comp blogs for 2014:

First up, the witty (and sometimes whacky) Bob Wilson, who hosts the eponymous From Bob’s Cluttered Desk. Always fun, always insightful, never dull.

Next comes my very good friend Julie Ferguson, co-blogger at Workers Comp Insider. Julie blogs constantly, and (along with Joe Paduda) founded the bi-weekly Health Wonk Review (which she still coordinates). She's a gracious, knowledgeable expert with a ready word of encouragement.

And speaking of Joe Paduda, his Managed Care Matters blog pre-dates IB by about 3 months, and I'm pretty sure we've included him on our blogroll from the git-go. Joe's got the inside track on health care policy, and writes from the heart.

Mazel tov to three hardworking bloggers that are making a difference.

SHOP Chop

As Bob reported last week, "CoOportunity Health, a fledgling Iowa health-insurance company ... has been taken over by by state regulators and could soon go under."

Our good friend (and fellow blogger) Joe Kristan, who lives and works in The Hawkeye State, has some on-the-ground news about the fate of the co-op, and of the state's Small Business Health Insurance Market (SHOP) in general. It ain't pretty, but it may be a bellwether:

"In our coverage area, CoOportunity was the only SHOP provider ... This makes life complicated for small businesses that don’t currently have “grandfathered” coverage"

Since most probably don't, there's bound to be some broken hearts (and bank accounts). Joe's included a helpful round-up of related posts from around the 'sphere.

Recommended.

Deck chairs. Unsinkable ship. Some assembly required.

So here's an interesting case of deja vu. Years ago, we reported on the efforts of Minnesota Blue Cross to standardize the way benefits are described, making it easier to compare plans and understand one's coverage. At the time, this was considered cutting edge.

Fast forward eight(!) years, and the Feds are busy touting - and tweaking - their own take on this idea:

"Federal agencies want to change the standard "nutrition label for health plans" in a way that could make it more appealing for young, healthy insurance buyers."

Aside from the obvious similarities, I find it amusing that anyone thinks that young people really find anything about health insurance "appealing." It may be "necessary," or even "helpful," but appealing? Please.

Do Ms Burntwell and her minions really believe that lack of "scenarios" is what's behind the abysmal sign-up numbers we're seeing? In fact, almost all of the enrollments are simply mindless, zero effort re-enrollments. One wonders why.

Cavalcade of Risk #224: Swan Song edition

"The Swan song is a metaphorical phrase for a final gesture, effort, or performance given just before death or retirement."

Let me be clear at the outset: the above refers to the Cav, not your humble host. When I started it back in Ought 6, my goal was to offer fellow bloggers an opportunity to share their thoughts on risk:

"The purpose of the C of R is to offer insights into the world of risk management; generally, this will be insurance-related, but that’s not a requirement. Our goal is to help folks understand what risk is, and how to manage it. It's about business and finance, of course, but it's also about risks in our everyday lives and personal relationships."

And of course, rotating hosts each edition helped to spread the load, and for those who stood up I am eternally grateful. It's been a great 8+ years.

And now, on with the show:

I'm going to lead off with David Williams and Julie Ferguson, because their blogs were among the select group included in the Cav's debut edition. This week, David writes about the challenges facing the FDA as it assesses - and attempts to minimize - cardiac risks in the evaluation of new meds.

Julie Ferguson (whose co-blogger John Coppelman also graced our first Cav) has a very clever entry: a  carnival-within-a-carnival. This one's actually a great two-fer: it's got a jolly, red-suited big-guy (Merry Christmas!!) and the most recent edition of the Health Wonk Review (a sort of sister-carnival to the CoR which Julie untiringly coordinates every other week).

Another long-time participant and host, Nina Kallen, writes about a very special kind of insurance called business interruption coverage, which helps pay an employer's overhead after a loss. Her post deals with how the courts look at how that overhead is actually calculated.

Jason Shafrin has been my favorite health care economist for as long as I can recall; he, too, has been a long-time participant and host. In this week's entry, he reinforces one of my all-time favorite memes (and one which we at InsureBlog have been expounding for many, many years): health insurance is NOT health care . Seems obvious, no? Well, it often isn't, and Jason does a great job of explaining why they shouldn't be conflated.

And speaking of long-time contributors and hosts, Claire Wilkinson is the brains behind the Insurance Information Institute’s blog, and is a powerhouse of interesting insurance info (see what I did there?). This week's post on cyber risk is quite timely (and the folks at Sony should be following her blog).

Another frequent participant is Rebecca Shafer, whose posts on worker's comp are always interesting and on-point. In her final Cav post, she writes about a new EEOC initiative regarding new interactive requirements that must be implemented from the day an employer knows there's a serious health issue. If you're an employer, don't miss this one.

Talk about a "blast from the past:" Ironman (proprietor of the Political Calculations blog) pops in with his post on how O'Care's lack of transparency is costing us taxpayers a pretty penny, and the risk that not a few of the newly-insured may face come tax time.

Bob Wilson also writes on Worker's Compensation issues, and this week's offering from his cluttered desk includes a visit from Cthulu. Okay, not really, but do try to get that image out of your head while you read his take on the tentacles of employer fraud in the WC arena.

Louise Norris has been a terrific supporter of the Cav from its earliest days (as has her husband, Jay). This week, she's gone above and beyond to write a post specifically for this final edition: Open Enrollment has been much in the news, but the new auto-renewal rules have been mostly under the radar. Louise examines the risks of not paying attention.

Occasional contributor Jason Fisher pops in this week with his informative post on some ways that diabetics (and their agents) can help themselves when applying for life insurance.

And, finally, our own final Cav contribution laments the death of Vermont's brief foray into Single-Payer health care (really!).

Thanks to all the folks who contributed to this final Cavalcade of Risk, and my heartfelt gratitude to all of those along the way who've participated and hosted. Be well!

Anticipated Government Tricks

This particular story has been making the rounds lately:

"New rules being proposed by the Centers for Medicare and Medicaid Services will give that agency enormous new powers ... the government will choose and force you to pay for a policy that they think works best for you."

At issue is the fact that many (most?) folks who use the Exchange are going solo, or relying on the "expertise" and/or good will of the anonymous folks on the other end of the phone line. So when renewal time rolls around, they may (or more likely, may not) pay any attention to the notice from the insurance carrier, and be "renewed" into a completely different plan.

So what?

For one thing, this has been SOP in the health insurance market for as long as I can remember: plans come and go, and carriers transition their insureds to what they they consider the closest alternative. If the client doesn't like it, they're free to choose a different plan, or even - gasp! - shop around for another carrier altogether.

It's called "Personal Responsibility," and it means paying  attention to things like renewal notices and plan changes. Now, it's likely that these kinds of changes will become more commonplace as the Actuarial Value rules mandate the limitation or deletion of certain plan designs. Not to mention, carriers themselves seeing the writing on the wall:

Recently, one of my clients, who had a Medical Mutual of Ohio "Gold" plan learned that it was no longer being offered, and he was being transitioned to a "Silver' level policy (MMO has discontinued all of their Gold plans in this area, no doubt due to horrendous claims experience). We took the opportunity to shop around and compare prices and plans, and he was able to find a new one that fit his needs and budget. And notice, this wasn't an Exchange-based plan at all, and yet the experience matches what's being anticipated on it.

There's just no there, there.

Chemin d'Liverpool

The Brits have their Liverpool Pathway, and we (now) have the ACA Death Panels, and it appears that the French are well on their way, as well:

"Doctors in France will have the right to put terminally-ill patients into a deep sleep until they die, under plans unveiled [recently]that reignited a national debate on euthanasia."

Of course, when the government pays for your healthcare (as they do in France), it gets to call the shots (so to speak). And it also gets to say when said shots stop. Such is the nature of a socialized health care scheme: who pays the piper calls the tune.

Of further course, killing off your patients is a great way to cut costs and, of further course, there's no recidivism. So, win-win. Well, except for the patient.

[Hat Tip: Co-Blogger Bob]

Cavalcade of Risk #224 - Swan Song edition: Call for submissions

We'll be hosting next week's Swan Song edition right here at IB. After 8 1/2 years, the Cavalcade of Risk is folding its tent, so don't miss your last opportunity to send in a post.

Entries are due by Monday (the 22nd).

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.

Green Mountain State Blues [UPDATED]

No sense burying the lede:

"Vermont Gov. Peter Shumlin on Wednesday dropped his plan to enact a single-payer health care system in his state"

This will come as no surprise to regular IB readers, since we've already seen how Vermont has had major issues just running its own Exchange. Selling health insurance is child's play, though, compared to actually delivering health care, and Governor Shumlin (D-VT) - to his credit - acknowledged that, given the current state of the Obamaconomy, "[t]his is not the right time” for enacting single payer ... citing the big tax increases that would be required to pay for it."

What was perhaps even more interesting is that the plan wasn't even "true" Single Payer, since ERISA (self-funded) plans would have been given a pass. So if Single Payer can't fly in a deep blue state like Vermont, one wonders where can it?

UPDATE: Actually, this saddens me.

Why? Well, we've long supported the idea of 58 state laboratories, each one trying out new (or old) ideas to see what works, and what doesn't. Would have been quite interesting to see if Single Payer would work in Vermont (95.2% white, median income $54,000), and then whether or not that experience was transferable to other less pale, less wealthy states.

Alas, 'tis not to be.

Ho, Ho, Ho: Health Wonk Review has been delivered

Julie Ferguson presents (SWIDT?) a holiday-themed round-up of wonky posts, all ready to be unwrapped and savored. So pull up your easy chair, pull on your cardigan and reading specs, and enjoy.

Another 1,000 words on the ObamaTax

Chanukkah 2014/5775

Tonight, we begin the 8-day long celebration of The Festival of Lights, Chanukkah. As everyone knows, this holiday commemorates the time, in ages past, that a candle with but one day's oil burned for over a week.

Except, it doesn't and it didn't.

The true story of Chanukkah is far more about culture and faith than Harry Potter:

"The Apocrypha's texts make it clear that the battle against Hellenization was in fact a kulturkampf among the Jews themselves ... Armed Hasmonean priests and their comrades from the rural town ofModi'in attacked urban Jews, priests and laity alike, who supported Greek reform, like the gymnasium and new rules for governing commerce  ... So the miracle-of-the-oil celebration of Hanukkah that the rabbis later invented covers up a blood-soaked struggle that pitted Jew against Jew"

And they weren't fighting over latkes.

Oh, and Chag Chanukah Sameyach!

Nothing like a hard and fast deadline...

At 1:51 this afternoon, an email arrived from CoveredCA keeping enrollment open until Midnight, December 21.  I'm not really surprised, given the number of error messages I saw while trying to enroll people. 

URGENT! You Have Extra Time to Help Consumers Complete Enrollment for January 1^st! 

Given the high volume of Californians interested in enrolling in health coverage, we’re pleased to announce that Covered California has decided to give our service partners additional time to help consumers get across the finish line and complete enrollment. Service partners will have until midnight on Sunday, December 21, 2014 to assist consumers with enrollment. This applies to both new and renewing consumers enrolling for coverage effective January 1, 2015.

Please note that while the Agent Service Center will now be open this Sunday, Dec. 21st (see below for hours), the Covered California Service Center for consumers will be closed this Sunday. You are encouraged to assist consumers with completing their applications as early this week as possible to ensure you receive the assistance you may need from our service center representatives.

While you and your consumers are given the extra time, we would appreciate your help in communicating expectations: completing enrollment after December 15th may delay invoices and proof of enrollment from the health plan the consumer has chosen.  We encourage all consumers to make a binder payment when possible to facilitate faster enrollment in their chosen plan. 

We will be providing further information about payment deadlines as soon as possible. 
In order to accommodate this change within the system, we will be taking the online system down starting midnight tonight until approximately 7 a.m. tomorrow, Tuesday, Dec. 16. 

If you should need immediate assistance, please call the Agent Service Center at (877) 453-9198. This is the most effective way to reach a service center representative for an urgent need related to enrollment. If you should receive a busy signal when calling, please hang up and try again.   

I can only imagine what the faces look like inside the various carrier's service departments.

The Gift of the MAGI (and the 1%)

This time of year affords us the wonderful opportunity to put aside petty differences, and to focus on what really matters:

Free money.

That's right, free money, as in ObamaTax subsidies for the poorest richest among us. Hark, they passed the bill so we could learn what's in it,  and boy, it's just good news all around for those with a big nest egg and no real income.

What the heck are you babbling on about, Henry?

Well, it's like this:

As I mentioned the other day, I tend to get a number of referrals from other agents. Recently, one such referral called for an appointment, and we got together to consider her family's options. This delightful and engaging lady was recently downsized from a prestigious (and lucrative) position with a Fortune 500 company, with a generous severance package and some major bucks in the bank.

As a result of the way that they're calculated, we quickly discovered that her family was eligible for a $1,000+ per month subsidy, bringing the family's net cost (for a fairly decent plan) to about $250 a month. They're very nice, gracious, warm people, and of course I don't begrudge them their free bucks - heck, they should be thanking Nancy, Harry and Barry - but are they really the kind of people we should be subsidizing?

Apparently so.

Audits, Audits Everywhere!

Fresh on the heels of the Colorado Exchange debacle, and from the home of RomneyCare, comes this news:

"The Massachusetts Medicaid program spent $35 million on questionable claims for health care provided to low-income immigrants"

But Henry, you may object, that's Medicaid, not the ObamaTax. Unfortunately, the two will forever be conflated, as The Bay State  expanded Medicaid under the ObamaTax umbrella.

The review flagged over a quarter million questionable claims, and what's worse, it appears that most of the folks filing them are here in the US illegally. So while you take a last-minute stab at signing up for an ObamaPlan (Phase of one Open Enrollment v2.0 ends today), rejoice in the fact that folks here illegally get their healthcare for free, without having to deal with that pesky 404Care.gov site.

[Hat Tip: Josh Archambault]

Tis the Season for Open Enrollment...

Happy Holidays from goodluck.gov!

 

Stress-relieving Agent Tricks

Long-time readers may recall the sticker I've mentioned over the years, adhered to my phone, reminding me about how to conduct myself. Yesterday, I was privileged to experience a wonderful payoff.

Many agents have opted to take a pass on the rigorous and (unnecessarily) difficult process of becoming certified to sell Exchange-based health insurance, and as a result, I've been getting more referrals than ever (my doc told me I wasn't getting enough stress, recommended selling more health insurance). Yesterday afternoon, I received a call from a young lady whose agent (a friend and colleague) had recommended that she contact me for help. Seems her current (non-grandfathered) plan was getting too expensive, and she 's pretty sure she qualifies for a subsidy.

So she went online to do some shopping, and inadvertently ended up at what I'll call a "lead-farm." This kind of site looks like the 404Care.gov one, but instead of enrolling in a plan, one is basically giving out contact info to hundreds of agents who pay the site's proprietors for access to it.

As a result, she's already received hundred of calls and emails, and become so confused and upset that she can't sleep.

Can't have that.

I began by asking her some questions, and confirmed that she had not, in fact, actually been to the official gummint site. I further determined that her existing plan is with a reputable carrier, and is still affordable (at least for the nonce). She also mentioned that she was due to go out of town in the next few days, meaning that the looming December 15th cut-off for a January effective date was adding to her stress.

So I asked her a question: "What's the absolute worst thing if you simply went for a February 1 start date, instead?"

Silence. And then a sigh of relief.

"I can do that?" she asked.

Yup: and then I told her that the only real downside was paying an extra month of the new, higher premium on her old plan, and missing out on a month's subsidy for the new. She agreed that her sanity and peace of mind was worth far more than the few hundred dollars at stake here. and then she thanked me profusely, telling me that she could already feel the stress draining away, and actually looking forward to her road trip. We agreed to re-connect when she gets back next week.

Sometimes we forget, in the press of analyzing and commenting on the ObamaTax train-wreck, that these are real people, whose real lives are impacted, and it's such a great feeling to be able to help at least one person gain some relief from the attendant anxiety.

I, for one, am grateful for the opportunity to have done so.

Cavalcade of Risk #223, Loud & Proud edition

The inestimable Bob Wilson presents this week's rockin' and rhymin' risky roundup. Clever and informative - that's what I call win-win.

Thanks, Bob!!

Centennial State Blunders

This past summer, we learned that "... the Connect for Health Colorado Board of Directors voted for a $13 million increase in taxes for those insured under the Colorado health exchange to help the exchange make up for a budget deficit."

Hard to believe it, but even that baker's dozen of millions was merely a butterfly bandage on a gaping wound:

"A devastating state audit released Monday found a rash of problems with the Colorado health-care exchange’s handling of $32 million in taxpayer funds as well as possible violations of federal law."

Keep in mind, the Colorado Exchange is set to receive almost $180 million in taxpayer funds from all 58 states. But it's rife with (alleged) corruption, cost overruns, bookkeeping errors galore, and more.

In short, a perfect microcosm of the ObamaTax itself.

Kind of fitting, one supposes.

And it's made even more interesting by the #GruberGate hearings going on now in DC: if (and that's a big if) the Halbig/King cases stymie the Federal Exchange subsidies, folks in state-run exchanges (like Colorado) would still be entitled to theirs. Ka-ching!

Stupid is as Stupid does... [UPDATED]

Via Co-Blogger Bob:



[Video courtesy Breitbart]

A Friendly (Employer) Reminder

A colleague recently called me for some advice. Seems one of his clients (a small dental practice) is considering deleting their group plan and offering to pay for (or at least subsidize) employees' individual health plans. He wanted to know if that would fly, legal-wise.

The short answer, of course, was "no," but given that we're in the midst of Open Enrollment season [Reminder: only 6 days left if you want a January 1 effective date - the cut-off is next Monday], it may be helpful to review the issues.

First, there's nothing immoral, illegal or fattening about deleting a group plan. In fact, that may be the smartest, most cost-effective move an employer could make (or not, YMMV). But if you own (or advise) a small business, you need to know that employers can't use a Health Reimbursement (or any other similar) Arrangement to allow employees to pay for individual plan premiums pre-tax. You can, of course, give them a raise to cover some (or all) of the premium, but remember that this will be taxable income for them [ed: insurance industry old-timers might be thinking about gross-up bonuses about now].

And, of further course, some of these employees may be eligible for a subsidy/cost-sharing on the 404Care.gov site.

Food for thought.

It's in the Genes (A Moral Dilemma)

It's been a while since we've addressed the issue of genetic screening; last time out we discussed the ethical issues of a young woman who elected a double-mastectomy on the basis of a genetic predisposition towards breast cancer.

This time out, the subject promises a far broader impact:

"If you agree to participate in a genome research study, what happens if the researchers find a risky gene in your sequence? Do they have an obligation to tell you? What if you don't want to know? And what about your family members, who might share that problematic gene with you? Do they have a right to know?"

Whew, a lot of questions, and each one potentially fraught with peril. We've previously addressed the first three, but the last two - do family members who may share the trait have a right to know? - is unexplored territory here. On the one hand, it's family. On the other, they didn't pay for the testing and, besides, this is very personal information indeed.

I'd be interested in learning what IB readers think of this possible conflict of familial interest:

Do family members have a right to know the results of your genetic testing?

Yes

No

pollcode.com free polls

And feel free to leave additional thoughts in the comments here.

[Hat Tip: FoIB Holly R]

Cavalcade of Risk #223: Call for submissions

Bob Wilson hosts next week's edition. Entries are due by Monday (the 8th).

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.

Moving Goalposts (Again)

So it appears that erstwhile Senate Majority Leader Harry Reid has conveniently forgotten the President's explicit promise to lower health insurance costs by 3000%. Today, Mr Reid was thrilled that:

"Spending on healthcare grew in 2013 at the lowest rate ever recorded."

Which, while nice, rather misses the point: growing slower ≠ decreasing. Shame on you, Mr Reid.

Health Wonk Review: Post-Turkey Day edition [UPDATED]

As we count down the days from Thanksgiving to Christmas, there's always this incredibly exciting sense of anticipation in the air. This is no less true of us health care wonks, as you can see from this eclectic assortment of bloggetry:

Mea Culpa Update: In the rush to get this put together, I inadvertently left out two great contributions, from HWR regulars, no less (I've put them in the top two spots).

Please make sure to click on through, you'll be glad you did:

■ Jason Shafrin (my favorite econ-blogger) wonders about the curious phenomenon of provider networks converting freestanding urgent care centers to emergency departments. It's not as obvious as one might think.■ The NCPA’s Health Policy Blog's John R. Graham takes a look at the skyrocketing cost of developing new drugs and what’s changed to cause the increase (according to Mr G, it costs $2.6 billion to develop a new med, more than twice what it cost in '03).
 

■ First up, Kip Piper wonders if undocumented illegal immigrants are in line for ObamaCare subsidies, not to mention abortion coverage and the Halbig/King cases [ed: um, you just mentioned them...].

■ Next, the folks at Wing of Zock (which, I'll repeat for the umpteenth time, would make a great name for a rock band)  present a post by two co-founders of a scholarly collaborative that promotes and shares best practices on medical student scholarship across institutions. In it, they describe the benefits of, and barriers to, undergraduate medical student research. As a great poet once observed, the children are our future.

■ Uber-wonk Roy Poses takes a look at PR, medical errors and the Great Texas Ebola fustercluck mismanagement/debacle. His (eminently reasonable) conclusion is that the interests of hospital management appear to conflict with those of public health. Not exactly confidence inducing.

■ And speaking of Uber-wonks (and all in a very good way!), David Williams takes on the very real problem of providers getting clobbered financially if they take on too many Medicaid patients. On the other hand, David observes, there are policy solutions at hand if we are willing to discuss them. In particular, the disparities between Medicaid, Medicare and commercial payments should be reduced, and we should move away from fee-for-service toward risk-based models [ed: risk? Isn't that the purview of insurance?]

■ Peggy Salvatore has a tale of mystery, intrigue and data (but mostly data), as she examines changes at the top echelon of CMS. Seems they have a new First Chief Data Officer, Niall Brennan, who understands how effective data usage can be in achieving value and accuracy.

■ Our good friend and colleague Jay Norris takes on the oft-misunderstood CSR (Cost Sharing Reduction) component of certain Exchange-based ACA plans. For example, if a family with kids and a CSR-eligible income is shopping for coverage, they’re not going to see CSR plans in the browsing tool nor will they see CSR plans in any quotes.  That makes it tough to compare plans prior to enrolling, since the CSR plans offer such a good value and definitely need to be considered by anyone eligible for them. This makes shopping at "The Marketplace" even more exciting challenging.

■ Chris Fleming, proprietor of the Health Affairs Blog, sends along a Contributing Voices post by the executive director of the Catalyst for Payment Reform, Suzanne Delbanco. In it, she summarizes lessons learned, comparing and contrasting different payment models (eg Pay for performance, “payment for non-visit functions”).

■ Count on the folks from healthinsurance.org Blog to come through with a timely (it is, after all, Open Enrollment season) and cautionary post on ACA "benchmark" plans and renewals. The story of a low-income family in Philly who, if they renewed a plan they were told would cost  “pennies per month,” could pay almost $200 a month helps illustrate the dilemma [ed: um, that is "pennies per month:" 20,000 of them].

■ HWR co-founder - and all-around good egg - Julie Ferguson looks at the seismic impact that the executive order related to immigration is likely to have on workers’ compensation. Here’s a hint of the scope: “…one-fifth of work injuries are likely sustained by foreign-born workers, 10% by undocumented workers, whether or not they are reported.” Yikes!

■ And last, but (hopefully) not least, our own small contribution: Even (especially?) in Jolly Olde, the Much Vaunted National Health System© proves inadequate for the task, this time missing key targets for critical cancer care.

Thanks to our great contributors, and to you for dropping by! Please join us next time at Julie's place.