News from Ms Burntwell

Actually, there are quite a few ObamaTax-related items cluttering the in-box. In no particular order:

■ A dataset which purports to provide "the total number of Qualified Health Plan selections by ZIP Code for the 37 states that use the [404Care.gov] platform." It includes basic plan info about which plans folks in a given area selected during Open Enrollment. It's not clear how many (if any) of these folks actually bought a plan at all.

■ A handy little (one page!) .pdf letting us proles know how much HHS collected from reinsurers in 2014 to offset costs of the Transitional Reinsurance program. Spoiler alert: thus far, less than 75% of target.

■ The death of the insurance agent's role has been more than a little exaggerated. Case in point:

"The drafters of the [ObamaTax] seemed to think that brokers were mostly a waste of money ... For a look at how the new, humbled SHOP exchange system has done since then, read on."

Please do.

The reality is that (competent, professional) agents do far more than just suggest plans designs. They are an integral conduit between the client (individual or employer) and the carrier. Of course, that sales role can't really be underplayed, as witness the fate of the SHOP (Small group insurance exchange):

"HHS has been notoriously reluctant to release any numbers hinting at how many employers or workers might be using SHOP plans"

Any bets on whether that would hold true were it a rousing success?

Thought not.

Now, I happen to be one of those (competent, professional) agents who is authorized to sell SHOP plans. I can tell you that I have yet to experience any employer asking me for a SHOP quote (neither current clients nor prospects). I have suggested to a few current clients that we at least look into it, but when they learn what's involved, well, any interest seems to fade away quickly.

It may be the cumbersome (but intrusive!) data entry process, it may be the confusing requirements, or some combination of these and other factors. But it's certainly not surprising.

And speaking of cost of care....

Yesterday, we noted trends in cost of healthcare over the next decade. But what about the cost of Long Term Care? Well, the folks at Genworth have just released their latest "Cost of Care Survey," including an interactive map and state specific data.

According to the Executive Summary:

■ The National Median Hourly Rate for home ehalth aides is $20
■ Adult Day Care now runs about $69 a day
■ Assisted Living Facilities now north of $3600 a month
■ And full on nursing care is $220 a day (semi-private room)

Now's an excellent time to review your current coverage, or to contact a reputable, independent agent with experience in this market.

In the meantime, you can stop by Genworth for even more in depth analysis and information, including the aforementioned maps and charts,.

[Hat Tip: FoIB Randy G]

What a difference a decade makes...

With the spate of folks expected to retire in the near future, and their (understandable) concern about how they're going to pay for their health care, the folks at LifeHealthPro have put together 5 helpful charts that seek to predict how much that care's going to cost.

Here's the first one, from the perspective of a 65 year old couple:

[click pic to embiggen]

There are a handful more here.

Most Excellent Perm vs Term Review

Over at LifeHealthPro, an insurance agent (and financial planner), eviscerates populist "advisor" Dave Ramsey on the latter's arguments against permanent insurance versus term.

Highly recommended.

Two caveats:

First, I sell a decent amount of term insurance, as it does, in fact have its uses; permanent plans are no panaceas in and of themselves.

Second, I think Michael misses the real problem with the 'buy term and invest the difference" scenario: almost all the folks who buy into this end up spending the difference, not saving it.

An important message from...Brussels?

So this arrived in email:

"Anthem is committed to providing our brokers with best-in-class service, and we are always looking for ways to make it easier for you to do business with us – and to help you better serve your clients. Currently, we’re working with a research firm called North American Testing Organization (NATO) to conduct an online broker satisfaction survey to help us better understand your needs."

I must admit to a bit of a spit-take upon reading that I might be contacted by (that other) NATO, but must settle for these wannabe's.

Be interesting to see what they ask ... I was told there'd be no geography.

How NOT to do Narrow Networks

We've long noted that one of the negative - and completely foreseeable - consequences of the ObamaTax is the rise of so-called "narrow" networks:

"Nationwide, about half of all exchange plans feature narrow networks ... Those narrow network plans cost up to 17% less on average than plans with broad networks."

It also means that you're less likely to be able to keep your doc, or even find one willing to take on new patients.

And it certainly doesn't help when a doctor decides to implement his own version:

"A Long Island cardiologist had the office of another doctor torched, then hired someone who turned out to be an undercover police officer in a failed attempt to have the doctor hurt or killed"

Geeze, doc, have a heart!

Yeah, about keeping your Doc

As we've long documented, increasing the demand for care (more folks with insurance) will of necessity run into the brick wall of supply of said care. That is, when everyone has access to "free" healthcare, who's going to provide it, especially with narrow networks reimbursing providers less and less?

Well, some enterprising Golden State folks have come up with an intriguing (if ill-fated) idea:

"Physician Retraining and Reentry (PRR) an online program designed to give experienced, medically licensed physicians and specialists, retired or otherwise, the opportunity to practice adult outpatient primary care in understaffed clinics across the country."

So the first question would be: um, why now, when reimbursements are at an all-time low and headed south? Follow-up: why do you suppose all these folks retired in the first place? (Hint: see Question #1)

But all is not lost, dear readers, because they've come up with a fool-proof way to fill in the gaps:

"The program has also given new hope to disabled surgeons who are no longer able to practice surgery"

To be fair, the folks at PRR aren't (necessarily) advocating that disabled surgeons start operating again, merely "treat patients in a primary care setting." What, exactly, that would entail is left to the imagination of the reader.

(Sorry 'bout that)

While I certainly applaud the group's willingness to think outside the box, I'm just not seeing a path to success here.

[Hat Tip: Gabriela Torres-Soler]

Who is Reading Your Medical File? The more things change (Part 2)

Last week, we broke the story of how some medical records, particularly those stored on off-shore servers, are likely not protected by HIPAA's privacy reg's. I reached out to Dr Rob Lamberts (whom we've previously interviewed) for his thoughts on this as a provider:

Very troubling issues here.  The question of “who has the record” is the most important one.  There needs to be a certainty of who has access to the records unless the patient is made aware of that insecurity and gives consent.  An example of insecurity is the use of Google Spreadsheets for monitoring blood pressure, etc which people sometimes share with their doctors.  They should be aware that there is an insecurity of these records, and their consent to use them can be seen as acceptable in a narrow usage.  Similarly, the tendency of patients in my practice to communicate via email must be covered by some sort of agreement in which the patient agrees that their use of email is “at their own risk” and that our practice will make every effort to only communicate securely.

The  storage of records in an off-site setting where the actual location and potential access to them is unknown to both physician and patient is troubling.  If the vendor is selling the doctor something that claims to “meet HIPAA security requirements” (which many 3rd party vendors do), then the onus is on the vendor.

I told Rob that I wasn't sure I agreed with that last part: It seems to me that, if I'm coming to you as a patient, I'm presuming that you have my records under lock-and-key, or at least in-house. Why is it my obligation to ask if that's the case? Rob replied:

The contract between a provider and an IT vendor is one where they take on the task of IT security (among others) in exchange for payment.  Legally, the physician has gone into that agreement in good faith, and so the vendor would be liable should there be a breach.  That is the same thing the patient does with the physician, overall.  They assume the doctor is acting in a way that is responsible with the medical records.  While I agree that there is a certain right of knowing where the records are stored, in some way we must trust that those making the sausage are being overseen by others who will make sure only reasonable things are being put into that sausage.  There is a reasonable degree of trust we must all have (which is no excuse for naiveté or gullibility).

Okay, that makes good sense from the provider's POV. I'm still not convinced that a doc using a vendor with off-shore servers isn't obligated to notify his patients of such. Now, one might argue "well, Henry, how's the doc to know?" To which I'd reply "simple: ask."

Why not?

And a Special IB Thank You to Dr Rob for his insights and willingness to share them!

The 4% Solution

Heh:

"Only 4% of people who signed up for ObamaCare got the correct subsidy"

Oops.

Expected, of course; actually, I'm surprised the "success" rate was that high. After all, calculating one's subsidy necessarily meant that one was guesstimating the next year's income. Since I've never seen a Ouija board with a $ sign on it, this always seemed...unlikely.

And it didn't help that the IRS sent out faulty forms to over three quarters of a million suckers filers, "nearly all of [whom] are being told they'll have to wait, maybe until Oct. 15, to straighten it out."

Oh goodie!

The good news (for certain values of "good") is that folks will get to repeat this process again in a mere 12 months. One wonders if a) the IRS will finally have the correct forms available and b) significant numbers of suckers citizens will choose to play again.

Time will tell.

[Hat Tip: RedState]

HillaryCare -> ObamaTax

So, who made this promise:

"If you like Blue Cross, you can keep your Blue Cross"

If you guessed President Obama, well: close, but no cigar.

That one comes from a 1994 meeting laying out strategy for the future SoS's health care "initiative:"

[click picture to embiggen]

 Time after time....

[Hat Tip: Ace of Spades]

Dumb Prospect Tricks

So, as I've mentioned before, I'm often the recipient of referrals from other agents. Yesterday, I fielded a call from one such that still has me shaking my head.

The setup:

John is referred to me by a (his?) local State Farm agent for information on signing up for health insurance. Since Open Enrollment season is (finally) over, the first order of business is to determine whether or not he and his family are eligible to even buy a plan.

Turns out, none of the family (2 parents, 4 kids) has been insured for a while: the folks for over 20 years (!) and the kids for several (they had apparently been covered by Medicaid/SCHIP some years back). So, no obvious path there.

Turns out, though, that The Mrs has a job offer in another state, and they'll be moving there. She's been asked to determine the cost of a health insurance plan, to be included as part of the comp (she'd be a 1099 employee). So, John wanted to know how much a plan would cost.

Pause.

The good news, I explain, is that since they're moving to another state, they'll be eligible for a Special Open Enrollment. The bad news is that I'm not licensed in that state, don't know the market or the plans, nor do I know if he'd be subsidy eligible, so there's no way to know rates, let alone best options. I explain all this, and offer to hook him up with a local agent, but John's insistent, really wants to lock down a number. So I told him that it would likely range between $2,000 and $50,000 per year.

He didn't like that.

So I explain - again - why I can't just give him a number, and he abruptly hangs up on me. What to do?

Of course, "the sticker" provides a quick answer, so I hopped over to the NAABC site to find a few agents in the Austin, Texas area, and emailed those to him (along with the site for determining subsidy eligibility).

I do understand that he needs this information, but it really isn't as simple as he'd like to believe. And since he's essentially asking for me to provide my services for free, I'm not really clear on why he thought his attitude was going to be all that helpful.

Dumb.

One step forward, two steps...

So, even as the 2105 Open Enrollment season was (illegally) extended and expanded, turns out all was not a bed of roses, especially for Tar Heel State residents:

"North Carolina had a higher attrition rate out of Obamacare exchange plans than many other states."

North Carolina uses the Federal Exchange (like 36 others), and saw only about three quarters of its ObamaTax enrollees re-up this year. There doesn't seem to be any clear-cut explanation for the large discrepancy between different states' attrition rates.

That last observation may, in fact, be key: what, exactly, drives folks in different areas to either sign up or forgo coverage from year to year? Be interesting to see the rate differentials between the various states; cost would obviously be a major factor.

[Hat Tip: FoIB Jeff M]

Who is Reading Your Medical File? The more things change...

So, 9 years ago, Bob wrote an eerily prescient post on the future of health records:

"In a time zone 17 hours ahead, a radiologist in Australia, working for a company called NightHawk Radiology Services, had been sitting before the same images ... In an effort to hold down costs, hospitals and other medical practices are outsourcing certain functions half way around the globe."

Turns out, one of those functions is patient record-keeping.

About a month ago, we wrote a long term care insurance policy for a very nice couple. Sam and Sally are relatively young, and in good physical shape, but pretty much every case requires an APS (medical records). Generally, the carrier sends a request (and a check) to the doc, who then instructs his clerical folks to get the records together and faxed/emailed over to the carrier. This can take a couple of weeks, but it's not usually a major roadblock.

Until now.

Seems that Sally's doc uses an off-site electronic records keeping outfit, which relieves the doc of certain administrative costs and burdens. But according to the way the contract is written, the vendor may specify that it will only fulfill these kinds of requests once a month. Here's the first problem: let's say that Sally's doc's vendor’s contract specifies that requests are fulfilled on the 15th of each month. So Doc Smith sends the request on the 13th, no problem.

But if he sends it on the 16th, we've now just lost one month. And this is significant, because the underwriter can't finish...underwriting…without the records, and so that app just went to the bottom of the pile.

Not a pleasant thought.

Here’s the next problem (they keep getting "better"): Sally had no idea that her doc was using such a service. When she called to find out why the doc hadn't sent her records, she was told that the doc had, in fact, requested them over two weeks ago. Unfortunately, no one told the carrier, which has been waiting patiently, and the vendor hasn't returned phone calls asking about status.

And to add further insult to injury, Sally also had no idea that her records were being stored not just off-site, but on a vendor's cloud server.

Why is this a problem?

Well, let's skip down a bit in Bob's 2006 post:

"Most are aware of the privacy laws that come as part of HIPAA but few stop to think about how much of that law is lost once your medical information leaves the shores of the United States."

That is, HIPAA stops at the border. So here’s a question: exactly where is the vendor's cloud server physically located? Denver? Or New Delhi? Makes a difference: if the former, HIPAA applies, if the latter...

So here's a question: does the doctor have the obligation to notify his patients that he is, in fact, using such a service? Does he have a further obligation to determine whether or not his patient’s PHI (Private Health Information) is, in fact, protected by HIPAA?

In Part 2, we discuss these issues with Dr Rob Lamberts.

[Hat Tip: FoIB Randy G]

Life Insurance Snapshot

Hard to believe, but it's been almost 7 years since we blogged about Progressive Insurance's (then) new "Snapshot" program, a "high-tech monitoring device [which] makes it possible to reduce insurance premiums for drivers who avoid jackrabbit starts and slam-on-the-brakes stops...The catch? Bad drivers who take a chance on the program may wind up paying a surcharge instead."

Insureds merely "snap" (get it?) the widget into their cars, and their speed, distance, etc are then uploaded to the carrier, and rates adjusted accordingly.

Now, what would you say to applying that tech (or something very much like it) to humans?

Well, thanks to FoIB Holly R, we learn that John Hancock is proposing to do just that:

"Once you sign up, John Hancock sends you a Fitbit monitor as one way to track your fitness. You earn Vitality Points for your activities. As you accumulate points ... the more you save each year on your life insurance premiums." [emphasis in original]

And those savings could be substantial: up to 15% off your premium. The downside, of course, is that if one starts to slip, premiums creep back up (maxing out at the original rate).

Of course, privacy advocates aren't necessarily thrilled by this, and I have to admit that it's got a whiff of Big Brother going on. But - and this is key - it's completely voluntary, so I'm not really too put out by it.

Another objection is that "the plan will raise insurance costs for lower-income people juggling two jobs who don't have as much time to get to the gym." Which is, of course, a valid point, but it's exactly backward: their costs don't necessarily go up because someone else's goes down; it's not a static value.

It'll be interesting to see how many folks take advantage of the program, and how it ultimately pans out.

ADHD and Mortalit ... Hey look, a squirrel!

So, one of my favorite medbloggers, Dr Kevin Pho, has an interesting post up at his blog about ADHD and early death. Written by Dr Claudia Gold, it's about a recent study that purports to show that "diagnosis with ADHD doubles the risk of early death." Dr Gold then goes on to discuss the clinical issues involved (although not clinically - it's actually a very fascinating article, and well worth the read).

I had an immediate, visceral reaction though: as always when reading these kinds of articles linking Condition X to increased mortality risk, I tend to say "show me the money." That is, the folks who have the most to lose (or gain) from this type of information are those whose actual money is at risk: life insurance carriers.

I quickly checked a couple different life insurance apps; none of them mentioned ADHD by name or acronym. Of course, they all ask about meds, so if one was on Ritalin, for example, then that condition would likely show up.

So, I reached out to one of our esteemed underwriters to see what affect, if any, such information would play in determining insurability. After all, the insurance company stands to make (or lose) a lot of money if they misunderstand the underlying issues.

The good news is that, in and of itself, ADHD is not generally a disqualifying condition, although depending on severity, one's rate may be better or worse than someone without the condition. What was interesting, though, and echoed Dr Gold's take, is that there are often other conditions, such as anxiety or depression, that are often associated with an ADHD case, and that these could very easily affect an underwriters decision.

Folks whose ADHD is well controlled, and who are stable as a result, have little to worry about, especially as adult. Where it gets dicey is in children (and, one presumes, especially teens, although I didn't specifically ask about them).

The bottom line, then, is that the ADHD iteslf is unlikely to be much of a challenge, it's the associated conditions that could cause an underwriter to balk.

Something to consider next time you're shopping for life insurance.

Explosive Renter's Coverage?

Last week's terrible explosion claimed 2 lives (so far) and left scores homeless. Jeanne Salvatore, of the Insurance Information Institute, explains how renter's insurance helps in these circumstances:



My Answers.com article has a more detailed explication of this valuable coverage, as well.

Tuesday Potpourri

Interesting items for your early week perusal.

■ Item 1 - Not exactly a surprise:

"[A] survey of 743 personnel executives by the Society of Human Resource Management ... Nearly 14% of firms have cut part-time hours for workers ... and another 6% plan to do so."

But hey, free health care.

■ Item 2 - And some more good news (for certain values of "good"):

"The death spiral isn’t just a theory. Eight states learned this the hard way in the 1990s when they enacted two policies known as “community rating” and “guaranteed issue ... Obamacare includes both community rating and guaranteed issue"

Three guesses where this is heading (and the first two don't count).

■ Item 3 - As we head into the tax season home stretch, the IRS has "put out a plea for consumers and their tax preparers to look on HealthCare.gov for advice about exemptions from the [ObamaTax]."

Of course, since they ask for zero documentation, one wonders how many folks will just go ahead and check "yes." Trying to figure out the downside of that.

Happy Tuesday!

Face-Palming HIX Tricks

Regular readers may recall Bob's post a week or so ago lambasting the folks running the ObamaTax for shortchanging citizens by effectively locking out their agents and brokers:

"[T]there is also a concern for the lack of informed advice available to the consumer that dialogues with a navigator who has barely a few weeks of training (if that) buys through the exchange. What kind of counsel are they getting? Do the navigators understand the nuances of a PPO plan vs. HMO? And what about drug formularies?"

Of course not, but because the "agents are unnecessary (if not evil)" meme was fully entrenched, it seemed that folks who could truly benefit from having access to a knowledgeable, accountable agents were outta luck.

The good news is that at least one state, Washington, has seen the light:

"If you want to get people insured, you go to agents and brokers ... the board notes it is working to increase broker participation, and therefore increase enrollment participation."

And it gets even better: the folks running the beleaguered Maryland Exchange "said they were looking to brokers to reach those remaining uninsured. That including rotating brokers into their call centers." [ed: not sure how well that'll work, since agents work best independently, but perhaps time will tell].

Are eyes being opened at long, long last?

Yeah, 'bout those ObamaTax Sign-ups

Saw an interesting comment at another blog I frequent:

"Did [my taxes] early, with TurboTax. If I explained why, you would definitely not suspect I was some kind of overachiever. I was expecting a bunch of paperwork to prove I had health insurance, but all there was was some sort of affirmation and no further hassle.

Which tells me that the stats about who has health insurance and who does not will be lies."

And then I thought back to ours, and remembered I was surprised that no documentation was required (nor was there any indication that it could be attached).

I'm mildly disappointed in myself for failing to make the connection the commenter did.

But it's spot on, no?

More March (Open Enrollment) Madness

As we noted a few weeks ago, Our Betters in DC© have (illegally) extended Open Enrollment season for those who flaunted the (evil) Individual Mandate last year:

"The Centers for Medicare & Medicaid Services (CMS) announced today a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment”

Aetna has emailed a helpful "message for the brokers" to let us know that "[t]his Special Enrollment Period is for on-exchange business only and all applications must go through the Marketplace." That's actually a helpful bit of info: it means that one can only satisfy the requirement this way by going to the buggy, security-challenged Exchange.

The carrier also "expects premiums to be paid prior to the member’s specified due date. Exchange rules require a payment grace period. Although this is not a new term, the grace period for Exchange premium payments will differ between non-subsidized and subsidized members."

Which is a rather long-winded way of saying that some insureds are more equal than others. You'll also note that they don't specify exactly how some are more equal, presumably to avoid giving folks any ideas about gaming the system (heh). The bottom line is that, if you're eligible for and take a subsidy, your grace period is 3 times greater than the rest of us proles.

Isn't that special.

Oh, and ICYMI, only those who meet these criteria are eligible at all:

• Are not already enrolled in a 2015 plan.
• Were unaware or did not understand the implications of the fee for not enrolling for 2014 until after the end of open enrollment (February 15, 2015).
• Owe a fee for not having coverage in 2014

Outstanding Carrier Trick

A few months ago, I "inherited" a small group from a colleague transitioning out of that side of the business. One of the challenges with this process is that the new agent doesn't have any of the original paperwork (applications, etc) to refer to should the need arise.

Yesterday morning, I received a frantic call from the employer: one of her employees had recently changed doctors, and needed to have a prescription filled. For some reason (I'm still unclear on the specifics), the pharmacist couldn't get the okay from the insurer because the employee's birth date didn't match what the carrier had on file.

The employer called me to see if there was anything I could do to resolve this as quickly as possible, preferably by the end of the day. I explained that insurance companies (very) rarely move that fast, but that I'd see what I could do.

Fortunately, I had the contact info for the carrier's rep. Even though this wasn't his area (he toils on the individual side), he was able to access the original application to confirm that the records didn't match. He quickly helped me get to the proper department, where I explained the problem to a very nice lady, who told me that all she needed was an email with some basic info (group and ID number, and correct date of birth) and that we needed this resolved ASAP. I immediately fired that off, and let the employer know that we'd at least gotten a good start, I also advised her that she should urge the employee to wait until (at least) today to try getting the scrip filled, since it generally takes a while for these things to resolve.

Oh me of little faith!

About an hour later, I got an email telling me that "[t]he correction has been made to the drug system.  She can pick up her Rx now."

Wow!

So, kudos to Medical Mutual of Ohio, and especially Mike B and Nancy K for a job (very) well done.

Health Wonk Review: We're not really in Daytona edition

Over at Wing of Zock (which, as we've noted before, would make a great name for a band), Jennifer Salopek hosts this week's outstanding round-up of health care wonkery, covering a panoply of topics from who owns our health records to the recent travails at California Blue Cross (about which our own Bill Halper has written).

It's a grand edition, and worth perusing.

Medicaid & Long Term Care: An Update

FoIB Holly R tips us to this from the folks at NPR:

"The Morgans live in Stockton, California. They are in their early 60s and are retired, aside from Rod’s occasional construction jobs ... In 1993, Congress passed a law requiring states to recover the costs of long-term care services spent on Medicaid recipients over the age of 55 after they die, the exact burden the couple was hoping to avoid."

No kidding.

In fact, we've noted this issue many times (most recently a few months ago). Unlike the ObamaTax clawback problem, this one's entirely reasonable: if your fellow taxpayers are footing your long term care bills, then we have a right to be reimbursed from your remaining assets. Fair's fair.

Of course, some folks don't see it that way:

"Pat McGinnis, the executive director of California Advocates for Nursing Home Reform, says estate recovery hurts the people who need inheritance the most."

No doubt, but that's where planning and risk management come into play: Partnership-compliant Long Term Care plans help defray the cost of long term care and preserve part (maybe most) of your estate.

Something to think about.

Tangled Webs

Maybe it's the troubled economy, or perhaps folks are really pressed for funds to pay their ObamaTax, but it seems like there's been a spate of fraudulent life insurance death claims of late. A few months ago, it was a "widow" filing for $2 million worth of life insurance; turned out, her "late" hubby was very much alive. That one was truly a family affair: "Her son ... was charged with actively concealing the fraudulent scheme." That one included another nice touch: "At her request ... the body was cremated."

One way to get rid of evidence.

But even that well-planned scheme pales in comparison to the intriguing case of The Gorman and The Fox:

"When a man was found dead in a Houston-area motel room of apparent natural causes in January, police figured it would be an open-and-shut investigation ... the man — whose fingerprints identified him as Gerard Joseph Gorman — was suspected of murder in Colleyville."

And it just gets worse from there; it appears that Mr G and his son "stalked and killed Anita Fox, an elderly Alvarado housekeeper."

Grisly, yes. Tragic, of course. But what has any of this to do with life insurance, let alone fraud?

Well, ya see, Danny boy, the Gorman's were Irish Travelers, "a secretive and nomadic ethnic group whose members often garner their wealth by doing dubious repair work and executing scams — and by taking out exorbitant life insurance policies on one another."

In this case, it appears that the late Anita Fox was no stranger to these schemes, even as she fell victim to one.

Here's my question, though: Mrs Fox is described as "an elderly Alvarado housekeeper;" how, exactly, did someone convince the carrier to issue a million dollar policy on a maid? Generally speaking, a policy that large is going to require at least some "financial underwriting;" that is, one's income and/or assets have to justify such a large (even by today's inflated standards) amount.

As an aside, I really hate it when reporters just take their subject's word for something, as if either one of them had an actual clue:

"In America, there’s a clause which allows you to insure anyone with a blood connection"

This is simply wrong: no such "clause" exists, and it doesn't even pass the smell test: Really? An insurance company will let me buy a $1 million insurance policy on my second cousin, in another state, no questions asked? So "insurable interest" is trumped by blood?

I don't think so, Deanna. Next time, do a bit more research.

Something just doesn't add up.

The Best Laid Plans [Updated]

From the "No D'unh!" Department:

"A special enrollment period to obtain health insurance for millions of uninsured people who owe a tax penalty under the Affordable Care Act is off to a slow start ... Only 12% of uninsured people would buy policies if informed of the penalty"

In other words, a lot of folks with even rudimentary math skills have figured out that paying the fine penalty tax and "going bare" is a much more cost-effective choice than buying coverage.

No kidding.

UPDATE: Rubbing salt in the ObamaTax wound, we also learn that (surprise!), the overall enrollment picture ain't exactly rosy:

"Of the 8 million people who signed up for a marketplace plan last year, 6.7 million actually enrolled"

Shocker.

Top. Men. An IRS Story...

The folks in charge of your health care now:

"The IRS sometimes uses old software without key security patches that leave its computer systems vulnerable and could endanger taxpayers’ private information ... Part of the problem is that the IRS hasn’t even always followed its own guidelines for assessing risks and creating information security plans"

Here's the best part: as a broker who sells on-Exchange plans, we have to take annual re-certification training, part of which is an extensive section on security and privacy, including computer security issues.

Which apparently don't apply to the folks enforcing the rules.

Nice double-standard there, guys.

Yeah, about that *Affordable* Care Act

Contra the President's explicit promise to lower health insurance premiums by 3000%, the reality is that average premiums rose 23% from last year, and that's after subsidies.

Yes, those wonderful gimme's designed to (artificially) reduce premiums actually didn't.

Shocking, I know.

One big reason is that the subsidies themselves actually decreased at the same time that, due to medical inflation and other factors, premiums increased. So the net result is that the ObamaTax is less "affordable" than ever. And it's not likely to get any better:

"Next year is likely to bring more premium pain, if the Congressional Budget Office is right. It says insurance costs will climb 8.5% in 2016"

And let's also not forget the other elephant on the table: MOOPs. But hey, we had to pass it to...

Another Potential Alzheimer's Break-through

An alert reader tips us to this potentially outstanding news:

"[A] team of researchers have discovered a new non-invasive ultrasound technology that could be used to treat it and even possibly restore memory."

While we usually think of ultra-sounds at the other end of the life cycle, it appears that the tech could hold promise for folks at the far end suffering from dementia. It does this by attacking "neurotoxic amyloid plaques;" as we've previously blogged, "beta-amyloid, a protein fragment that accumulates in the brain of Alzheimer's sufferers to form the disease's signature plaques." In that post, we noted that some research seems to indicate that prolonged cell-phone use could actually be a way to break those down; this sonogram-type process seems a lot safer.

What's really exciting about this process is that it appears to actually restore memory, not just halt progression of the disease.

Research is still in the embryonic stage (SWIDT?), so only time will tell. Still, some really great news for those for whom this disease has been so horrible.

[Hat Tip: DoIB HS]

Blue Shield of CA has its state tax-exempt status revoked...

I guess you can't have $4.2 Billion surplus in the bank, pay your CEO $5 Million/yr. and still call yourself a non-profit.  Bummer.

California's Franchise Tax Board apparently revoked the non-profit last August and ordered the company to file State taxes for 2013 forward.  The news is just now coming out.

More information is in the LA Times article.

And the Hits Keep Comin'

It seems like only weeks ago that Anthem suffered a catastrophic security breach of sensitive, private customer info.

Wait, it was just weeks ago, and now sister (?) company Premera Blue Cross reports that it, too, has been hacked:

"[I]nformation on 11 million people may have been exposed in a cyber attack uncovered six weeks ago."

Wait, what?

Six weeks to report it? According to Evergreen State insurance commish Mike Kreidler, it took Premera officials that long to notify his office. What could possbly justify that kind of lag-time?

Stolen info seems to include the usual: names, social security numbers, bank and private health information. The good news (for certain values of "good")  is that this represents a much smaller database than Anthem's, which topped off at just under 80 million clients affected.

The Public Option Lives!

Co-blogger Mike was eerily prescient last summer when he wrote about the Public Option as it relates to Medicare Advantage plans:

"Medicare has not chosen to respond to its Medicare Advantage competition by improving its own product. Instead, Medicare chose to respond to its competition by using its power to kill its competitor, rather than compete with it.  That illustrates pretty well how governments tend to "compete" and we all need to keep this in mind when the "public option" idea again surfaces."

Indeed.

But what does that have to do with the price of tea in China?

Well, as Our Betters in DC© continue to "streamline" ObamaTax alternatives, they've (perhaps unwittingly) turned the spotlight once again to the Public Option, which for so long has been presumed dead.

So, what's the "Public Option," you may ask?

Well:

"The "Public Option" is a euphemism for Single Payer, the obvious end-game for the ObamaTax from the get-go.

And how do we know this?

"The administration still intends to control medical costs by ... a single payer mechanism"

That is, the government sets up its own health insurance racket scheme to "compete" with the private sector. Of course, the private sector is made up of commercial carriers that are enjoined from collaborating in a way that the government is not. The government, of course, has the lawful power of force, which it can use to ensure an unfair and insurmountable market advantage. Thus, the end of the private insurance business.

So, why bring this up now? The Public Option is dead, right?

Maybe so, maybe not:

"The BHP [Basic Health Program] system could appeal to states that would have liked to see Congress offer a government-run, "public option" health insurance throughout the country, in addition to or in place of the PPACA exchange system"

In fact, the power of the government's purse is so strong, there's no "maybe" about it. Seems to me that this alone dwarfs the current Halbig/King/Burwell kerfluffle: by definition, the Public Option is itself simply one big subsidy.

Sweet.

Time Lord, CLU

Dalek coverage optional:

Yeah, about that "If you like your plan..." Dealio

Residents of the The Centennial State are about to get a rude wake-up call:

"Colorado Sen. Cory Gardner (R) said he’s “utterly appalled” by the Colorado Division of Insurance decision to cancel 190,000 health plans that don’t comply with Obamacare regulations"

Colorado is one of 14 state-based HIX (Exchanges); as an aside, these are the states with legitimate subsidies. The plans at issue had been "Grandmothered" in, meaning that they could continue to be sold as long as the state's insurance department allowed. Colorado's insurance commish justified the cancellation because "by delaying it, it doesn’t give us a good pathway into full implementation of the ACA.”

Which is an eminently reasonable rationale.

The problem, of course, is that it's part of why The Obamastration's explicit promise about keeping your plan was always a lie: under the ObamaTax, all plans would eventually have to come into compliance, an impossibility given how they're structured.

But hey, they had to pass it to...

Insuring Pi

In honor of Pi Day tomoorow, we have this great infographic courtesy of our friend Claire Wilkinson at III:

[Click on pic for details]

Health Wonk Review springs forward

Brad Wright hosts this week's refreshing collection of health care wonkery from around the 'net.

'Tis a breath of fresh air!

And another thing...

In yesterday's Linkfest, I included a link to United Healthcare's informative booklet on Special Open Enrollments. Turns out, though, that it's a lot easier to game the system than UHC or I had thought. The folks at CMS have thoughtfully (and, of course, illegally) opened up another Open Enrollment Period. From the horse's, erm, mouth:

"The Centers for Medicare & Medicaid Services (CMS) announced today a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM)"

That's right, flout the law one year, get rewarded the next. Sweet.

Bonus question: What with Halbig/King/Burwell hinging on "Five Little Words," isn't this tacit acknowledgement by CMS that plaintiffs are correct? After all, if there's really no difference between Federal and state-run Exchanges (as argued by the Obamastration), then why does this new extension make the distinction? Doesn't this unfairly punish folks in states that run their own Exchanges?

Tuesday Afternoon Linkfest

■ Item 1: Now that Open Enrollment v2.0 is behind us, I'm still getting calls from folks who want to buy new coverage or change their current plan. For the most part, I have to tell these folks that they're out of luck until the Fall. But some lucky (for a given value of "lucky") individuals will experience a life change that triggers a Special Open Enrollment opportunity. Click here for a run-down of how that works.

■ Item 2: Our friends at FlexBank (resident gurus for all things HSA/FSA/HRA) have some news for folks paying their disability premiums pre-tax: if you do, your benefit is likely going to be taxed if/when you have a claim. I like to advise people thusly: would you rather pay tax on the seed, or the harvest?

In any case, here's their take:

• If premiums are paid entirely with pre-tax dollars (through the Section 125 plan), then the benefits an employee receives upon becoming disabled are taxable; or

• If premiums are paid entirely with after-tax dollars, then the benefits are not taxable. This includes employee post-tax contributions as well as employer paid premiums reported as income on the employee's Form W-2; or

• If premiums are paid with a combination of pre-tax and after-tax dollars, then the benefits are taxable on a pro rata basis, calculated using a three-year look-back period for group disability plans and a one-year look-back period for individual disability policies.

The more you know...

■ Item 3: For the most part, the ObamaTax outlawed so-called "mini-med" plans, but that doesn't mean that their completely dead in the water. Evidence of that comes from an unlikely source: Our Betters in DC©:

"Regulators want to keep insurers or other parties from using cleverly designed excepted benefits products that would create a new class of limited-benefit medical insurance plans that would be exempt from the PPACA [regs]"

The challenge is that many of the applicable rules also affect more traditional lines like dental. On the other hand, they may have found an interesting new life for mini-meds as "limited wraparound products." I've long believed that this was a great use for these plans: since ACA-compliant policies often come with outsized deductibles and out-of-pocket costs, having a "supplement" (ala MediGap plans) might make sense.

That is, if there's any money left over in the budget after paying the hefty ACA plan premiums.

We get it. Now stop doing that.

In the course of working in Medical Administration for over 15 years, I am always amazed at what people will do to circumvent the policies of seeing a doctor. One of the basic policies is to present an  insurance card to confirm identity (the presentation of a valid photo ID, at time of service). So I was a bit perplexed when not once, but twice in the past few months, I had patients who presented a photocopy of their Medicare Card with their billing number (which is their social security number) blacked out. Each time I gave the “card” back to the patient and said I could not accept a photo copy, I needed the original card with all the information visible. You see, the only way I can get my doctor paid is to bill Medicare for your service and I need that number to bill. Then I ran across this article and it became clear:

”Why you shouldn't give your doctor your Social Security number”.

According to the article, doctors do not need your social security number to bill. That is correct; however, we do need your social security number if you choose not to pay your bill and we have to turn you over to collections. You see, when you go to a doctor, we are becoming a creditor, and we are accepting your word that you will pay us whatever your insurance company says you will pay after we've billed them. Surprisingly, many of you decide, after the fact and for a variety of reasons, not to pay us:

1) I shouldn't have to pay that much.
2) My insurance company said you billed wrong and you need to recode.
3) I thought it was free (preventive/well visits).
4) I do not believe in paying for medical care.
5) And many more that I have heard over the years.

So, if you do not want to give your doctor your social security number, then pay for your appointment in full, at the doctor’s fee schedule, and then wait for any refund after the doctor bills and receives notification from your insurance company.

The article makes suggestions about how to get out of giving your social security number, but alas, your social security number is your Medicare number, so this is suggested:

“CR’s advice: If you're on Medicare, you still have to share your Social Security number with your health care providers (in the form of your Medicare card), so they can get paid by Medicare. But you can get some protection by making a copy of your original card and, after the first visit, blacking out all but the last four digits of your Social Security number. That way you won’t have to carry around your original card, with your complete Social Security number, at all times.”

Okay so why is this so wrong? Simple: because of identity theft and the ability to change insurances during the open enrollment each year (and sometimes more often), the physician has to confirm each time you visit that you do, in fact, have insurance, and that insurance is, in fact, yours. This is done by confirming your Insurance Number and Name with outside entities that assure your doctor that, yes, the insurance is active and you are you. Thus, you can never bring in a photocopy, as each visit is its own self contained event which must be verified. So with all due respect to Consumer Reports: this advice is wrong, so please stop doing it.

Everything Old...

About a year ago, we wrote about a Tar Heel State municipality considering dumping its group coverage altogether. While we've long predicted that employers in general might find this attractive, the folks who run Montgomery County (NC) proposed an alternative based on an old life insurance standby, the "Executive Bonus" (EB) arrangement.

Briefly, an EB arrangement is used when an employer offers to buy life insurance for a valued employee, who could then name his beneficiary (usually his spouse). To keep the arrangement simple, the employer simply "bonused" the premium to the employee. Since the bonus was taxable, employers often included the estimated amount of the taxes in the bonus.

Fast forward a year, and "Christopher Condeluci ... says employers can offer a non-conditional cash bonus that employees use to purchase health care coverage."

[ed: Mr C is apparently a benefits attorney]

Sound familiar?

His idea is that employers could simply identify how much they want to pay towards their employee's health insurance (perhaps based on the soon-to-be-deleted group plan?) and then simply bonus the employees that amount. Because the ObamaTax outlaws using tax-advantaged Health Reimbursement Arrangements (HRAs) to accomplish this, the employee must receive the cash with no strings attached. So he can use those funds for his insurance, or a new car, or a cruise.

Where it gets interesting, though, is the means by which Mr C proposes to ensure that the proceeds do, in fact, go for insurance: "use a payroll vendor to allocate the money to be paid to a carrier for monthly premiums." That is, arrange it so that, even though the money technically goes to the employee, it's actually routed to the payroll vendor and then on to the individual's health insurer of choice.

I had some questions about the legality (not to mention efficacy) of this arrangement, and reached out to Louise Norris, proprietress of the Colorado Health Insurance Insider blog and a valued colleague. I wondered whether she also had reservations about this, since it's certainly pushing the envelope.

Here's her take:

"Personally, if I were an employer, I'd stay away from stuff like that, because I wouldn't want to have even a hint of anything that might be seen as skirting the law."

Succinct, and exactly on point. I also wonder how much the payroll vendor will charge to set up multiple accounts with various carriers to process these transactions. And I further question how insurers will react to payments for individual plans from payroll companies.

I just don't see value here.

Two strikes?

As the Halbig/King/Burwell circus plays on in the background, it might be instructive to see how the ObamaTax is working out so far in real life:

Case 1: FoIB Jeff M tips us to this article from Brant Clifton [ed: what a great name!], who relates the story of friends of his that endured the bureaucratic nightmare of learning that they're not as American as they thought they were:

"This couple had — apparently — not sufficiently proved to Blue Cross Blue Shield that they are legal US citizens.  (Now, for the record, these two are the whitest white  people with the whitest white people names ... They both have social security numbers and birth certificates showing that they were born in US states.)"

And they're still not covered.

Case 2: And a bit of schadenfreude. California citizen Melissa Klein was a good little Democrat, faithfully supporting the President and his signature legislation. But that was then, and this is now:

"Dear @CoveredCA - you've turned a staunch supporter of #Obamacare into an opponent. Id rather die broke than have to go thru your exchange."

Something about fury and a woman scorned?

Well:

"[I] support obamacare, but not incompetence. i cant file my taxes because of a form that was never generated and may never be"

Um, cognitive dissonance much?

But wait, it gets better:

"[T]here is an app for purchasing weed & yet our health care system can't generate a form for the IRS"

So she's saying that the ObamaTax has gone to pot?

Read the whole thing - consider it an antidote for the Clifton story above.

You're doing it wrong...

So, some years back, one of our clients - we'll call him Bruce - bought a life insurance policy on his son, Bruce Jr. He named himself as the sole beneficiary, and declined to name a contingent.

(A contingent beneficiary is one who would receive the proceeds if the primary pre-deceased the insured)

About 4 years ago, Bruce Sr died, and his estate settled by his widow, Susie, who then passed away. Very sad, but that's how life goes.

Now Bruce Jr has passed away.

Quick: who gets the insurance money?

I must admit to a bit of surprise here: according to the carrier, the son's estate would get the proceeds. This makes no sense to me: he was merely the insured, with no ownership or beneficiary rights.

Here's another way of looking at this: suppose I bought an insurance policy on my mechanic (assume I could show insurable interest), naming myself as the sole beneficiary. He makes no premium payments, has no rights rights in the policy. I pass away. Why would his widow (or children) have any claim on the proceeds?

Weird.

The primary lesson here is that periodically reviewing your insurance policies - particularly the beneficiaries thereof - is a good idea.

Another day, Another CoOp Snafu

Last week, Bob posted his take on the rather tumultuous CoOp situation. As fate would have it, I was working on a post about the same thing, but with a slightly different "angle." Now, I frequently claim that "I was told there'd be no math" here, but for once I'm going to be the culprit.

Thanks to a heads' up from FoIB Josh Archambault, we have this little gem:

"The Minuteman Health Inc. Co-op in Massachusetts got more than $156 million and covered only 1,822 people – over $86,000 per enrollee."

But wait, that's not all!

"HealthyCT Inc. Co-op in Connecticut got more than $128 million and covered only 6,094 people – more than $21,000 per enrollee."

If that doesn't give you the warm fuzzies, I have no idea what will.

Cancel that, sure I do: there are another handful of CoOp "success" stories at that link (for a given value of "success"), with a combined cost of $800 million in 2014, insuring a total of just over 22,000 people. For those keeping score at home, that's an average cost of $35,000 per enrollee.

To really drive home the point of just how wasteful this whole exercise has become, that's about $3,000 per month per enrollee.

Seems spendy.

So, I meandered over to the 404Care.gov site to find out how much a Platinum plan would cost a 64 year old Prairie Stater (the MA connector link appeared to be broken when I tried it). You'll likely not be surprised that the most expensive plan I could find was just over $1,500 a month, roughly half the cost of the average CoOp.

Your tax dollars (not) at work.

[Thanks to Co-Blogger Pat P for his help]

Five Little Words: An Epiphany

"Exchange established by the State under 1311"

I've always believed the adage that "words mean things;" that is, words have meaning and one should be careful in how they're used. Sometimes, silence is golden: not speaking can communicate better than words.

In the original series opening of Star Trek, William Shatner speaks of the ship's "5 year mission." That always struck me as self-limiting: what if it had been picked up for a 6th season? Would Captain Kirk have become Captain Steubing?

Likewise, in The Next Generation, Patrick Stewart calls it an "on-going mission," an unnecessary redundancy. How much more sense it would have made to just say - in both shows - "its mission,"  no qualifier needed.

And so it is with the subsidies. The whole of Section 1311 refers to "each State" and "a State" over and over; if Congress had truly wanted subsidies available for everyone whose income justified it, why not just say so? It would have been simple enough: "... enrolled in through an Exchange established  under the Patient Protection and Affordable Care Act."

Easy peasy.

That they chose to specify Exchanges established by a "State"  means something. Words matter.