ObamaTax vs RomneyCare

Mike gave us a very cogent analysis of the actual, as-implemented MassCare plan, which was, in fact, much different than the original program set forth by Gov Romney. LifeHealthPro's Allison Bell offers her take on key differences between the two Presidential contenders' visions.

Here are a few examples; I really recommend that you read the whole thing:

"2. Women’s health and abortion"

Contrary to the spin, the ObamaTax does, in fact, include coverage for abortion [ed: please note that this is my take, not Ms Bell's]. And, of course, there's the whole convenience item birth control mandate.

Romney's plan doesn't (seem to) address either issue.

"5. Tort reform"

There's no mention of this in the ObamaTax, which doesn't preclude HHS Secretary Shecantbeserious from requiring it.

Romney proposes caps on "non-economic damages in medical malpractice lawsuits."

"6. Health accounts"

Regular readers know we're big fans of consumer-driven health care, which the ObamaTax effectively guts ("essential benefits," slashing of HSA's and FSA's, etc).

It's probably no surprise that Romney supports expanding these types of plans.

Ms Bell does a great job of thumb-nailing some of the key differences, including treatment of Medicare and Medicaid. Definitely worth clicking through.

Liverpool not just for Beatles

We've discussed the Liverpool Death March Pathway before; in brief, the program's "being used to cut costs instead of as simply a more humane mode of care ... allows medical staff to withhold fluid and drugs in a patient’s final days."

Turns out, even this draconian  measure's not enough for the Much Vaunted National Health Service©:

"Thousands of patients have already been placed on 'death registers' which single them out to be allowed to die in comfort rather than be given life-saving treatment in hospital."

Some 3,000 health care "providers" enthusiastically participate in this (un)official death panel, which targets those victims patients who are expected to die within the year. Of course, one wonders whether there's a sort of synergy inherent in that process...

The program even has a very benign sounding title, "End of Life Care Registers," as if one were engaged or expecting a baby. Perhaps Harrods even has a department just for these folks, where one can pre-order coffins and the like for those "lucky" enough to make the list.

Not that the victims patients themselves would even know of it:

"Although more than 7,000 patients nationwide have already been put on the list, there appears to be no obligation for doctors to inform them."

Which I'm sure they're getting right onto.

What's so scary about this is the banality of the term "Register;" sounds ever so much more pleasant than Death Panel, don't you agree?

Checking up on Check ups

Are those "free" routine physicals over-priced? The WSJ's Shirley Wang reports that they may, in fact, be less helpful than one might believe:

"General medical checkups for healthy adults may not be as beneficial as people tend to think ... raising questions about whether spending on preventive services should be more focused on tests shown to be effective."

This doesn't mean, of course, that they're bad things, or will contribute to an early demise. But it appears that their actual effectiveness may be over-hyped.

One of the primary challenges is that we do love our "freebies," and any threats to curtail them are met with, well, certainly not enthusiasm. But the ObamaTax requires that they be covered in full, so of course there'll be a lot more of them (to the delight of Big Laboratory, one supposes).

Great.

[Hat Tip: FoIB Holly R]

Under the ObamaTax Hood

Behemoth tax and accounting firm Ernst & Young has put out a comprehensive study of exactly how the new ObamaTax fees penalties taxes will impact business (and anyone employed by a business). And it ain't pretty:

"[T]he employer community has reacted with concern to ...  the [ObamaTax's] Medicaid provisions, allowing states to decide whether to comply with the Medicaid expansion provisions without risk of losing existing federal funding ... In states that do not expand Medicaid, employers could face greater exposure to taxes for lower-wage employees who otherwise would have been eligible for Medicaid and may now be entitled to tax credits for Exchange coverage if their employer coverage is not affordable."

Onerous.

But it gets worse: new definitions of "large" versus "small" employers, seasonal versus part time or temporary employees, the employer mandate. All of these create uncertainty and, of course, higher costs of doing business (hiring and training HR personnel or conmsultants, increased tax planning, the list goes on).

But wait, it gets still worse:

"The law states that a plan shall not meet the minimum value determination if “the plan’s share of the total allowed costs of benefits provided under that plan is less than 60% of such costs.” How minimum value is determined will have a tremendous impact on the affordability and administration of employee benefit plans and is intricately intertwined with the other employer provisions."

Follow that?

Don't feel bad, it's going to be a bonanza for the CPA's and JD's.

Oh, one last bit:

"Even among employers who for decades have voluntarily offered health benefits to their employees, a driving force in [ObamaTax] compliance efforts is the avoidance of unanticipated tax liabilities and controlling administrative costs. As such, employers must take a holistic view ... to assess and valuate their risk for increased tax liabilities under the law."

Shorter version: bye bye group health plans.

Told ya so.

Oh! Those who wish to "read the whole thing" can download it here.

[Hat Tip: FoIB Jeff M]

Outliving Your Insurance

While it may seem counter intuitive, it is possible to outlive your life insurance policy. A lot of folks buy term plans with premiums that are level for 10, 20, even 30 years. But when that lock-in period expires, rates go through the roof. Often, we're much older and not necessarily in great health, making it more difficult - and expensive - to buy a new plan.

No problem, Henry, by that time my mortgage will be paid off, kids will be out on their own, and my 401k will be bursting with cash. I'll no longer need any life insurance.

Maybe, maybe not.

But as FoIB Jeff M tips us, you may be in for an unpleasant surprise:

"It is a fact that when the price guarantee ends on a level term insurance policy, the premiums skyrocket ... the only people who continue the policy beyond the price guarantee period are those who can't qualify for a new level [plan]."

Which isn't to say that term plans are bad: just that you need to know the pitfalls. And many (most?) plans are "convertable," meaning that you can trade them in for a permanent plan with premiums that never go up, even if your health has declined.

Nice to know.

Cavalcade of Risk #168: Come and get it!

Jacob Irwin presents this week's round-up of interesting risk-related posts, including his Top 3 picks.

The AMA, Medicare and PR

The "PR" in this case being Paul Ryan. We've been pretty rough on the AMA (whose membership, IB readers may recall, "represents only 17% of the doctors in the U.S."). But fair's fair, and one of that organization's committees has come out with a plan that looks just like...well, let's FoIB Avik Roy set the stage:

"[T]his past weekend, the AMA’s key policy committee, the Council on Medical Service, voted to endorse a Medicare reform plan that shares key traits with the ones put forth by Mitt Romney and Paul Ryan."

As Avik points out, the AMA-endorsed plan is heavy on choice and the defined-contribution model, just like Ryan's. And there's more, but you'll need to see Avik's post for that.

Tuesday Afternoon LinkFest

In no particular order:

■ As we've noted, the "Essential Benefits" facet of the ObamaTax continues to be up in the air. Those states that have gone "all in" on the train wreck have been sending out a flurry of info:

"More states have been posting essential health benefits (EHB) announcements on the Web ... [HHS Secretary Shecantbeserious' minions] are letting states express their EHB preferences."

Yeah, that'll end well.

■ Guardian Life has been looking at the extent to which employees actually value their employer-sponsored benefits. They've even come up with a unique "measure of perceived value" metric.

The study is available here.

■ From the Big Picture Department:

"Dr. John Butterly recently urged insurance regulators in New Hampshire to recognize the importance of reducing the entire cost of care for an entire patient and an entire population of patients."

Rather than addressing pieces of health care, he urges lawmakers and insurers to take the long view, including the difficult to ascertain costs of total care.

■ And finally, the Peach State thinks it can step on the Feds:

"Can Georgia control how quickly self-funded employer health plans pay doctors in the state?"

The US Department of Labor is the agency tasked with overseeing ERISA plans, which would seem like an insurmountable obstacle. The state law requires carriers to "pay claims in a timely manner" (whatever that means), but ERISA (self-funded) plans have typically been understood to be immune.

America's Health Insurance Plans (AHIP) has joined the fray, filing a suit in federal court seeking to block Georgia's insurance commish from enforcing the statute.

Sounds like fun.

Reason and IB

FoIB Holly R tips us to a terrific item at the Reason online site. It's a major fisking of a New York Times diatribe that tries (unsuccessfully) to argue that the ObamaTax is long overdue, and in fact could have saved lives. Well, one life in particular:

"Kristof tells the story of a college pal ... who has Stage 4 prostate cancer and would have been better off ... had [the ObamaTax] been around a decade or so sooner."

As Reason's Ed Gillespie notes, however, Kristof's story is "equal parts wilfully stupid decisions on the part of [his friend] and ... health care costs being driven up by precisely the sort of regulations and bureaucracy that [the ObamaTax] will put on a heavy dose of steroids."

Along the way, he touches on themes quite familiar to InsureBlog readers: personal responsibility (or lack thereof), the fact that the ObamaTax is already leading to a shortage of providers, and the loss of personal freedom (ie choice).

It's a great take-down - read the whole thing.

AG 38 and You

Back in the day, we did a two-part series on Universal Life (UL) insurance policies, pointing out some of the pitfalls inherent in those plans. Since then, there've been some terrific advances, industry-wide, addressing these shortcomings. Called Guaranteed Death Benefit UL, they promised to keep the policy in-force regardless of whether or not there was sufficient (or any) cash value.

In a sense, these are term-to-age-100 (or even 120!) policies, since they're heavy on death benefit guarantees and pretty light on cash values. But for long term planning, they're difficult to beat.

So of course the National Association of Insurance Commissioners felt the need to step in and meddle:

"The [NAIC] adopted revisions to a controversially applied actuarial guideline that governs reserves for universal life products with secondary guarantees after almost a year of intense debate among regulators on all levels and the industry."

So what, you ask?

Here's what:

"For example, for certain policies, companies must “perform a good faith high-level analytical review of the product design with respect to the premium payment patterns to be expected with respect to that design.”

In short, look for premiums on newly written plans to be substantially higher than existing ones. And don't even think about messing around with your in-force policy (if you have one).

MS (Cure) in a Bottle?

Potentially great news for folks suffering from MS:

"A trial has shown [that Gilenya]  not only cuts the risk of an MS attack, it can also slow brain shrinkage, which otherwise can occur in patients at three times the normal rate."

Gilenya, aka fingolimod, is already in use to help both treat (and sometmes prevent) symptoms, and to slow down the damage that MS can cause. This new study "showed the drug cut the risk of an attack by up to 60 per cent and brain shrinkage by 35 to 39 per cent."

That's a significant reduction in both areas, and provides fresh hope in the fight against this ravaging disease.

Growing Old with the MVNHS©

Or maybe not. A new report from those on the front line of British medical "care" paints an  unflattering picture, with "damning evidence of variations in surgical care based on patients' ages, with the chances of being operated on peaking in middle age and plummeting for those in their 60s, 70s and 80s."

It's not just life or death issues, either:

"[T]hose needing new hips and knees are missing out on treatment routinely offered to younger patients even though they could benefit."

This isn't really news to IB readers, of course; we've long documented the shoddy care provided, or rather rationed, by the Much Vaunted National Health Service©. What continues to be most frightening, though, is that this is the future of health care under the ObamaTax.

Bullying Insurer Trick?

Maybe, maybe not. That question mark's there because it's not entirely clear that Fortune 500 company Western & Southern Life is really in the wrong here:

"Western & Southern .... has been trying for several years to buy or force the Anna Louise out of the Lytle Park Historic District, the beautiful and serene neighborhood they share, and turn it into a boutique hotel."

The current owner is Cincinnati Union Bethel, a non-profit that runs the facility, which "provides safe and affordable housing for women so they can live independently and within their means."

On the other hand, the folks at Western & Southern aren't necessarily bad guys just because they disagree with the Bethel folks:

"Our proposal for Anna Louise Inn, its owner Cincinnati Union Bethel and Lytle Park is a win-win for every stakeholder involved. It will cost taxpayers less; provide a new, improved facility for the residents of the Anna Louise; create economic opportunity for the city; and preserve the building and its historical significance."

In fact, there may be no "good" or "bad" guy here: sometimes organizations (and the people who support them) can have fundamental disagreements. From this vantage point, at least, I think both sides present compelling arguments; which one ultimately prevails is a matter for the courts.

MVNHS©: Just ignore it and she'll go away

The Much Vaunted National Health System© keeps finding new ways to kill off its victims "beneficiaries:"

"Mother-of-four Jeannine Harvey died after doctors missed her advanced cervical cancer 30 times ... By the time Harvey's cervical cancer was treated, the tumor had become infected and shattered her pelvic bone. She died shortly afterwards."

It's difficult to imagine a more painful way to go (although I'm sure the MVNHS© will keep looking). And it's not like the signs weren't there all along. But under government run health "care" schemes (like, for example, the ObamaTax plan), the incentive is on saving costs, not lives.

But I'm sure that there are some in the Obamastration that think this is pretty funny.

Minimum, Shminimum

Ohio has joined the list of states thumbing their noses at HHS Secretary Shecantbeserious:

"Gov. John Kasich’s administration won’t meet this week’s deadline for establishing the minimum benefits Ohioans will be entitled to in 2014 under the [ObamaTax]."

As we've noted, it's not so much a refusal to cooperate as it is pointing out Madame Secretary's dereliction of her own duties:

"Lt. Gov. [and Insurance Commissioner] Mary Taylor ... cited a lack of information and guidance for Ohio’s failure to submit its list of “essential health benefits.”

After all, absent these guidelines - which the ObamaTax itself requires to be made available in a timely fashion - there's no way for any state to legitimately comply.

Oh bother.

And by the way, 19 of the 58 states have thus far avoided that deadline:

"10 of the states that have not recommended EHB benchmark plans have taken steps such as analyzing existing state benefit mandates and assessing benchmark plan options. Nine states ...  have taken no formal steps toward recommending benchmark plans."

Small wonder, since Madam Secretary still can't be bothered to publish the guidelines. I'm sure Kathy finds it all very amusing.

Cavalcade of Risk #168: Call for submissions

Jacob Irwin hosts next week's Cavalcade of Risk - Entries are due by Monday (the 15th).

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.

Thanks!

Long Term Care and Life Insurance

Recently the Wall Street Journal had a "Family Value" item on policies combining life and long term care insurance. Often referred to as "hybrids," the premise is that one can avoid future rate increases, and guarantee that someone gets some money out of the insurance company.

The article bothered me, and I couldn't quite put my finger on why that was the case, so I turned to our on-call Long Term Care insurance (LTCi) guru Herman Bruns:

The writer is somewhat confused in her terminology: when the term "hybrid" was coined for LTCi plans, it was more for permanent life plans that would triple, quadruple, etc the death benefit if you ever needed LTC, and give you all your money back if you changed your mind. She does not appear to refer to these at all.

Eventually, some carriers got smart and took the accelerated death benefit feature that has long been around, and tweaked it into a LTC rider that allowed you to accelerate the death benefit if a long term care need developed. This seems to be more what she is referring to. The insurance company is just potentially paying out a death claim early at a predetermined payment schedule.

The latter choice (with the rider), which I do *not* call a hybrid, still gives you a reasonably cost-effective permanent life insurance policy....as opposed to an overpriced life policy in the case of a true hybrid. The hybrids want the big up front, single premium payment, whereas the life plans with the riders can be paid just like any other life plan: as you go.

The general problem with life insurance policies as a LTC solution is that you have to buy two polices to protect a couple; that is, there is no such thing as a "shared" life plan. I have seen no second to die plans that come with LTC riders so far. You have to qualify for the life insurance medically, so sometimes you can get LTC and not life, and vice versa.

Bottom line is that there is a place for all these products.

Thanks, Herman!

Health Wonk Review: Surprise, it's October!

FoIB David Williams presents this week's collection of wonky posts, heavily influenced by the recent Presidential debate. If that's not your thing, though, don't fret - there's lots of other interesting info, as well.

Unfortunate Agent Tricks

And yeah, that "tricks" is a double entendre. From upscale Kennebunk, Maine:

"[A] local fitness instructor who's been charged with running a prostitution business out of her Zumba dance studio and secretly videotaping her encounters ... her business partner, 57-year-old Mark Strong Sr., pleaded not guilty to 59 counts of promotion of prostitution and violation of privacy."



And what does this have to do with insurance? Well, "[t]he Strong Agency is an automobile, home and commercial insurance business located in Thomaston" whose owner (the aforementioned Mr Strong) has "pleaded not guilty to 59 counts of promotion of prostitution and violation of privacy."

One wonders if his E&O (Errors and Omissions) policy covers that.

Medicare :: ObamaTax

One of the major problems with government-run healthcare schemes (such as, say, Medicare or the ObamaTax) is that the bureauweenies running them have so little accountability or motivation to ensure that things run fairly and effectively.

Last week, for example, almost 100 people were arrested and charged in one of the biggest Medicare fraud cases to date. Attorney General Steadman and HHS Secretary Shecantbeserious were quick to pounce on this major bust as a turning point. But it's the culture of the system itself which encourages - nay, facilitates - these kinds of crimes.

And it's not just erstwhile providers on the line:

"More than a quarter-million Medicare beneficiaries are potential victims of identity theft and hampered in getting health care benefits because the government won't issue new IDs"

Medicare officials' excuse will surprise exactly no one who's been paying attention: "it's too expensive and too many agencies are involved to reissue" the cards and numbers. So all those "potential victims" are outta luck. Sure, they can call Medicare's equivalent of 9-1-1, but instead of a dispatcher sending a squad car, Ms Kathy will send a "so sorry" letter (at best). This is the perfect illustration of why government-run health care provides neither health nor care.

And it's this system writ large which is responsible for implementing much of the ObamaTax. Which means that it's not just those poor 284,000 medicare beneficiaries at risk, but you, too.