Just say no?

Here's a thought: what if they gave an Exchange and nobody came?

That's the premise behind a group calling itself the Citizens' Council for Health Freedom, which has rolled out a campaign to dissuade folks from buying plans on the public Exchanges. CCHF offers four rationales:

1.No private insurance – Obamacare is “Medicaid for the middle class” – or as CBO director Douglas Holtz-Eakin calls exchange coverage: “a second Medicaid program.”

2.No privacy – Data enters federal database accessible by IRS.

3.Limited choice – Coverage is “narrow network” policies.

4.High-cost premiums – Income redistribution to pay for exchange operations and subsidizing high-cost individuals.

While we certainly applaud their efforts, someone really needs to debunk some of their premises.

That would be me:

1. While the ObamaTax certainly encourages (and subsidizes) the expansion of Medicaid, the Exchanges themselves are a separate initiative. Conflating the two seems, well, confusing.

2. Anyone who's been paying attention to the news the past few months and still believes they have any privacy left is fooling themselves. The Data Hub doesn't care whether or not you've enrolled via an Exchange: all of that info is shared across agencies [ed: well, supposed to be shared might be more accurate].

3. Agreed: there is little doubt left that Exchange-based plans will employ "skinny" networks in an effort to rein in costs. A futile effort, of course, but an effort nonetheless.

4. This one's a maybe, and based on how one perceives the role of the government in what should be private transactions. On its face, I'd have to agree that the subsidies are simply robbing Peter to pay for Paul's insurance. Others might take a more charitable view.

CCHF also claims that "people still will be able to buy coverage outside the public exchange system, and that PPACA does not impose penalties on individuals simply because they buy coverage outside the public exchanges."

This is simply not true: only folks buying coverage on the public Exchange will be eligible for subsidies; I'd call that a pretty steep penalty for taking a pass.

In any case, it'll be interesting to watch this play out.

ADDENDUM: Bob has a slightly different take on privacy, the Exchanges and the Data Hub.

A disturbing ObamaTax thought...

"House Republicans received a boost from Democrats on Wednesday during votes to delay ObamaCare’s individual and employer mandates ... Twenty-two Democrats joined Republicans in a vote to delay the individual mandate"

This in response to the Obamastration's unilateral suspension of the (Evil) Employer Mandate a few weeks ago. The premise seems to be "if employers are off the hook, why shouldn't individuals be off it, as well?"

Which may well be "fair," but it raises a disturbing point: having looked high and low, I can find no evidence that either side is also proposing a moratorium on the Guaranteed Issue provisions of the ObamaTax.

Now you may be wondering, why is this a big deal, Henry?

Here's why: as of January 1, insurers will no longer be able to decline coverage to unhealthy people. In fact, they must write anyone and everyone who applies, regardless of health status. But if no one is required to "buy in," it seems likely that only the least healthy among us will do so. After all, absent the (evil) individual mandate, healthy folks have no real incentive (other than personal responsibility) to sign up. But "sick" people have ample motivation, and will likely do so in droves, further driving up rates for those already insured, and presumably causing some (many? most?) to drop their increasingly unaffordable coverage.

ObamaTax supporters, of course, consider this a feature, not a bug.

Monday Morning ObamaTax News

■ Late last month, the 10th Circuit Court of Appeals gave Hobby Lobby a temporary reprieve from the birth control convenience item mandate. Last Friday, "U.S. District Judge Joe Heaton ... stayed the case until Oct. 1 to give the federal government time to consider filing an appeal with the U.S. Supreme Court." So for now, at least, the owners of Hobby Lobby can enjoy their 1st Amendment rights (until SCOTUS rules it a tax, one supposes).

■ FoIB Holly R alerts us that Anthem Blue Cross will not be participating in the California small business health insurance Exchange:

"The company said it still intends to sell policies outside of the small-business exchange ... so its decision to stay out of the exchange could hamper the state's ability to make the marketplace attractive to businesses."

What does this mean? It means that Golden State businesses will have even fewer SHOP choices than they'd thought. Less competition means higher prices (compared to off-Exchange plans).

Econ 101.

■ And speaking of fewer choices:

"Nearly half of America’s brokers (45 percent) say they’re considering exiting the health insurance business altogether, with the majority (51 percent) saying they are only slightly or not at all confident about the future of their firm and their industry"

So if you like your agent, you can keep your agent.

Or not.

Fees, Glorious Fees (continued)

As Nate reported earlier this week, the ObamaTax Patient-Centered Outcomes Research Institute (PCORI) fees taxes are due this month.

Despite the conventional wisdom (and official line) that carriers pay the fee for fully insured plans, we know that's not the case. They simply pass them along to their customers (policyholders). Self-insured plans already understand this, because the employer (plan sponsor) has to pay the fee directly.

For plan years ending last October through this September, the fee is $1 per covered life; for plan years ending this coming October through September of '14, they take a modest 100% increase (to $2). After that, the sky's the limit (technically, they'll increase as a function of medical inflation, but we'll stand by our characterization).

Yippee!

[Hat Tip: Cornerstone]

Easy Peasy, Lemon Sqeezey

Behold, the ObamaTax, simplified: 

[Hat Tip: Heritage]

Meantime, FoIB David Adams reports that Blue Grass State health insurance premiums are set to rise a modest amount.

And by "modest" he means upwards of 80%.

Hunh.

CoBlogger Kudos!

To our own Bob Vineyard, runner up in this year's National Underwriter Industry Elite Awards (for Industry Awareness):

Congratulations, Bob!!

Cavalcade of Risk #188: Call for submissions

Nina Kallen hosts next week's Cav. 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.

MVNHS©: If You See Something, Shut Up

Well, this is hardly a surprise:

"Any organisation that is treated as being beyond reproach is bound in time to become flabby ... When I pointed out that the NHS fared badly by most international comparisons three years ago, my since-deceased mother was harassed by Left-wing journalists"

No, the "journalists" didn't kill his mum, but they'd certainly like to kill any dissension, as would the folks at the top of the MVNHS© food chain:

"[O]f course, this isn’t about different policy options. It’s about preventing any serious discussion from beginning."

Sound familiar?

ObamaTax Exchange Setup Running at Peak Efficiency

Well, peak government efficiency:

"Two U.S. government officials warned on Wednesday that the launch of new state healthcare exchanges could potentially be delayed"

No kidding?

Why is that, do you suppose?

Oh:

"[A]n auditor with the Treasury Inspector General for Tax Administration, an Internal Revenue Service agency that monitors performance, said testing the systems needed to implement the exchanges "will be difficult to complete" by the October 1 start date."

I bet.

Not a big deal though, right Mr Taxman?

Well....

"The lack of adequate testing could result in significant delays and errors in accepting and processing"

The good news is that all is proceeding according to plan:

"Obamacare, the president said, is "doing what it's designed to do"

Indeed.

ObamaTax stormin'

It ain't sci-fi:

Health Wonk Review: The Bard's edition

Louise Norris presents this week's intellectually stimulating ode to Billy Shakespeare, aka the Health Wonk Review. What makes Louise's HWR's so great is the time and care she puts into making sure each post includes context that shows she's read each and every one.

Kudos, Louise!

Burying the Lede

In newspaper parlance, "burying the lede" means to "begin a news story with nonessential details," or to obfuscate the actual "news." In this case, the New York Times lauds the ObamaTax, quoting sources in New York that claim it will reduce premiums in the individual market by 50%.

[ed: Gosh, whatever happened to the president's promise that they'd plunge 3000 percent?]

To hear Gov Cuomo tell it, "New York’s health benefits exchange will offer the type of real competition that helps drive down health insurance costs for consumers and businesses"

There's just one little problem:

It's a meaningless claim.

How's that, you ask?

Simple, but it takes 12 paragraphs to get to the real reason rates may be lower:

"While the rates will fall over all, apples-to-apples comparisons are impossible from this year to next because all of the plans are essentially new insurance products."

The new "metal" plans have much higher out-of-pocket exposures than plans currently allowed to be marketed in the Empire State; it's really not difficult to understand why Kia's cost less than BMW's.

But that doesn't fit the meme.

Scamster Tricks

So I return from lunch to find a voicemail from a distraught young lady. Seems she had bought health insurance this morning (or so she believed) but didn't have sufficient funds in her checking account to cover the premium, and wanted to make sure that, once that was fixed, her coverage would begin tomorrow, as agreed.

What makes this interesting is that I had no idea what she was talking about. I am a relatively successful agent, but I don't have so many clients that I can't remember one from a few hours earlier (more's the pity, one supposes).

After some probing, it turned out that the young lady had spoken with - and given all her private health, checking account and other personal information to - an agent who shares my last name but is no relation. The more I asked, and the more she shared, the more alarm bells were going off in my head. For one thing, I explained to her, the company from which she purportedly bought her policy does not sell health insurance.

For another, no professional agent is going to take an application over the phone (too easy to claim fraud, and where, exactly, does one "sign" over the phone line?). Add to that the fact that the call-back number she'd been given appeared to be non-functional and, well, we have a problem.

Based on recent ObamaScam stories, I asked her if perhaps the gentleman had mentioned the "new health care law." She told me that the agent had called her husband, who'd directed him to call her.

So much of this screams "scam" that I gave her two pieces of advice: first, that she should call her bank to determine whether her account had, in fact, already been dinged, and that if it hadn't, she should freeze the account. I also gave her the consumer hotline number for the Florida Department of Insurance (she's a Sunshine State resident), and suggested that she share her entire story with them as soon as possible.

Fingers crossed hopefully for a happy ending to this one.

5 Years in the Making: An OmniCare Update

We first started covering the OmniCare prescritpion drug whistleblower/kickback debacle just over 5 years ago; our most recent update was early last year, when we noted that the government's position on the whole mess was, erm, equivocal.

And now, thanks to tenacious FoIB Holly R, we (seem to) have resolution:

"A federal judge in Chicago has approved a settlement between Omnicare Inc., the U.S. government and two states, bringing an end to a whistleblower lawsuit filed under the False Claims Act"

Whew.

Cost of PCORI tax

This week we are gathering data for clients to file their PCORI Tax payment, and explaining it to them. Between our time, the groups' time, the Broker, and CPA it takes hours and cost at least a couple hundred dollars per group.

The tax on the first three groups I have done this AM;

$11
$8
$15

And they wonder why wages stagnate, small businesses don't hire or offer insurance, and the economy doesn't grow....

Friends with Benefits

It appears that those who are benefitting most from the financial side of the Patient Protection Act have been engaged with the Administration in some capacity over the years. Here's a short list of who has been "rewarded".

Sara Horowitz - Her organization, The Freelancers Union, was chosen to receive a $340 million loan to start a new insurance CO-OP in New York. She led one of George Soros' organizations who also was linked to President Obama back when he was in the Illinois legislature.

Anne Filipiac - She served in the White House as Deputy Director of Public Engagement and had a prominent leadership role in the 2008 Obama for America campaign. She also worked at HHS. Now she is President for Enroll America. We all know how much the administration and HHS admire her organization, right Kathleen?

Planned Parenthood will be serving as navigators. They will be receiving grants to help educate and enroll consumers into the very services they provide. Seems like a pretty sweet deal.

Trevor Neilson - Former member of the Clinton Administration who is now president of Global Philanthropy Group has been targeted by the White House to get celebrity endorsements from the likes of his client list that includes: Eva Longoria, John Legend, and Madonna to name a few. Mr. Neilson served as one of President Obama's surrogates during the 2012 campaign.

The advertising firm Porter Novelli was founded by William D. Novelli, who was the CEO of  AARP from 2001-2009. Catherine “Kiki” McLean is a senior partner and managing director of Porter Novelli.  She is a Democratic Party operative who worked for the campaigns of Al Gore, John Kerry, and Hillary Clinton, as well as the 2008 presidential campaign of Barack Obama.  McLean was hired by Porter Novelli in June of 2009. Since 2010, Porter Novelli has been awarded $49 million in HHS contracts.

Must be nice knowing your time and donations can come back tenfold.

Your receiptionist will be verifying subsidy eligibility...?

Received this notice from an association we belong to, not much more to be said

“solution” CMS has for random checking the subsidy eligibility for Exchanges starting 1/1/14. The CMS July 5^th announcement that the fancy data-hub verification system will not be used the first year, so they’ll just accept whatever income the person verbally says.  This seems like a huge invitation for lying & fraud.  So, what is CMS’ “solution”?  They’ll make random calls to employer firms, and ask whoever answers the phone, “Is John Doe employed here, and does he or his family make $X thousands of dollars?”  Not only will the random person who happens to pick up the phone not know such very personal details, but also this will be a crisis for company morale & privacy.  (This is yet another reason why your clients & prospects need to have the P-or-P data & system in place for such calls.)"

Reminds me of when my high school would call home to verify absences, all legit of course, and how well that system worked. 2 years from now I bet we hear stories about 10,000 employers linked to a single phone number.

The IRS sent more than $46 million in tax refunds to 23,994 “unauthorized” alien workers who all listed the same address in Atlanta, Ga., in 2011, according to an audit report by the Treasury Inspector General for Tax Administration (TIGTA).

Gee, Ya Think??

As we've repeatedly pointed out, the whole ObamaTax Exchange roll-out is a magnet for fraud. And the evidence for that continues to pile up:

"As California prepares to launch its health care exchange, consumer groups are worried the uninsured could fall victim to fraud, identity theft or other crimes at the hands of some of the very people who are supposed to help them enroll."

No kidding.

Here's the problem (well, one of them, anyway): the Golden State is on course to"register" some 21,000 Navigators, most of whom will have no prior insurance background. But that's not the best part: the Feds require no background checks on would-be Navigators, and the rocket surgeons in charge of Cover California (the state's health insurance Exchange) confirm that they don't "have a plan for investigating any complaints that might arise once the counselors start work. That means consumers who might fall prey to bogus health care products, identity theft and other abuses will have a hard time seeking justice if unscrupulous counselors get hold of their Social Security number, bank accounts, health records or other private information."

Gee, what could possibly go wrong?

The Exchange has adopted new rules which would require fingerprinting and background checks, but how likely is it that these will actually be implemented?

Yeah, that's what I thought, too.

Too little, too late?

The good news is that the MVNHS© has apparently come to its senses, and is planning to shut down the Liverpool Pathway:

"...the Government will announce today the end of the deeply controversial Liverpool Care Pathway ... relatives and patients claimed that the LCP was being used to accelerate death, or even to kill patients who were not dying at all by starving and dehydrating them until they did, in fact, die."

The question then becomes whether or not this step is, in fact, enough:

"The NHS’s medical director will spell out the failings of 14 trusts in England, which between them have been responsible for up to 13,000 “excess deaths” since 2005."

That's roughly 2,000 per year, certainly a great savings on health care for the Much Vaunted National Health System©, but not necessarily the outcome many families (let alone patients) would have preferred.

What's striking about this is that it appears that what we saw with the Stafford fiasco was not an isolated event, but a function of MVNHS© culture. We in the States should be taking careful note of these events, since they're likely to play out very much the same way here under the ObamaTax.

As is this:

"Thousands of people are being put at risk of losing their sight unnecessarily due to variations in rates of cataract operations across England ... More than half the country’s Clinical Commissioning Groups, organisations set up by the health service to organise and buy treatment, restrict access to operations."

These are essentially mini Death Panels, and they seem to operate on the "lottery system;" that is, depending on where you are, you may or may not receive care in time, or even at all. And if you think this is happening just with eye care, I've got a bridge to sell you.

Did Obama waive employer mandate to save the rest of ObamaCare?

CATO had an interesting write up on the Liberty University v. Lew case, Liberty lost the battle but it could have been a victory in the War.

http://www.cato.org/blog/fourth-circuit-deals-hidden-blow-obamacare

"The plaintiffs in both Pruitt and Halbig claim, correctly, that Obamacare forbids the administration to issue the law’s “premium assistance tax credits” in the 34 states that have refused to establish a health insurance “exchange.” The Pruitt and Halbig plaintiffs further claim that the administration’s plans to issue those tax credits in those 34 states anyway, contrary to the statute, injures them in a number of ways. One of those injuries is that the illegal tax credits would subject the employer-plaintiffs to penalties under Obamacare’s employer mandate, from which they should be exempt. (The event that triggers penalties against an employer is when one of its workers receives a tax credit. If there are no tax credits, there can be no penalties. Therefore, under the statute, when those 34 states opted not to establish exchanges, they effectively exempted their employers from those penalties.)"

If the Obama Admin fears the entire law could be struck down the knee jerk reaction would be to remove the penalty. With no employer penalty the plaintiffs would have no damages.  

"Third, shortly after announcing it would effectively repeal the employer penalties until 2015, the administration wrote the Liberty, Pruitt, and Halbig courts to argue that the delay should (at the very least) delay the courts’ consideration of those cases. In Liberty, the Fourth Circuit rejected all of those claims."

What the removal of the penalties would do to the cost would be horrific from a budget standpoint, but Obama has never really been shy of trillion dollar budgets anyways.