ObamaCare© Changes (Pretty Much) Everything

Let's start at the top with the new "Grandfathering" provisions (which if course begs the obvious question: what about Grandma?). These make it pretty much impossible to keep the insurance that you currently have, because any changes you might like to make to it (like increasing deductibles or co-pays) will require a new set of forms:

"Starting with benefit changes being submitted Monday August 2nd [MMO is] requiring Groups and Individuals to complete the attached form and for this form to be included with the benefit change submission. MMO is requiring this form to be completed to ensure that Groups and Individuals are aware that they may lose Grandfathered status with their plan change."

And what does "Grandfathered status" mean? Well, it's the provision that renders your plan immune to the penalties and requirements of ObamaCare© except, of course, it doesn't (since you have to complete a new set of forms). This may not be a big deal for an individual, but it will be a major migraine for small groups:

"Member cost sharing for in-network preventive benefits" is removed, meaning that the plan will now have to include first dollar preventive benefits. While that may, in fact, be a good idea, it comes at a price.

As we've mentioned before, there's a whole new (and complex) "internal claims appeal and external review" process.

And just what kinds of "changes" would trigger these requirements? Here are just a few of the seemingly simple but dangerous items:

■ Increasing co-insurance (thinking about an HSA plan? Fuggedaboutit!)

■ Increasing employees' share of the premium (looking to cut some costs by asking folks to chip in an extra 10% means losing your status - wonder how many actual, you know, jobs will be lost due to this provision alone).

■ Changing carriers, fer Pete's sake! Perhaps the simplest, most cost-effective means to reduce premiums, and it's a no-no.

We've said it before, and will state it - unequivocally - again: this is the final nail in the employer-based health care coffin. Now, I happen to think that severing the tie between employment and health insurance is actually a good thing, but this is most assuredly not the way to do it.

Personal Freedom 1 - Sebelius 0

HHS Sebelius lost round one in U.S. District Court in Virginia today in the legal battle of personal rights granted under the Constitution vs. Obamacare. In his ruling, Judge Henry Hudson indicated Obamacrap raises "a host of complex constitutional issues".

Hudson indicated that he was, at best, extremely skeptical of the government’s argument that the health care insurance mandate was a valid exercise of Congress’s power under the Interstate Commerce Clause:

Never before has the Commerce Clause and Necessary and Proper Clause been extended this far. At this juncture, the court is not persuaded that the Secretary has demonstrated a failure to state a cause of action with respect to the Commerce Clause element.

In other words, the government cannot require you to purchase health insurance.

Further support for this argument . . .

With respect to the Federal Government’s argument that the mandate was justified under the Court’s taxing power, Hudson was equally skeptical:

While this case raises a host of complex constitutional issues, all seem to distill to the single question of whether or not Congress has the power to regulate — and tax — a citizen’s decision not to participate in interstate commerce. Neither the U.S. Supreme Court nor any circuit court of appeals has squarely addressed this issue. No reported case from any federal appellate court has extended the Commerce Clause or Tax Clause to include the regulation of a person’s decision not a purchase a product, notwithstanding it’s effect on interstate commerce. Given the presence of some authority arguably supporting the theory underlying each side’s position, this Court cannot conclude at this stage that the Complaint fails to state a cause of action.

Obamacrap seeks to impose a tax for NOT doing something. This is unprecedented.

The battle is not over yet but Sebelius and her gang did not do well in court today.

And speaking of "complex constitutional issues," Rep Kevin Brady (R-TX) had his staff prepare a flowchart of (what we know so far about) ObamaCrap. Hold on to your eyeballs:

Killer Grand Rounds

Life in the Fast Lane presents this week's collection of "killer" medblog posts. Oh, and watch out for the Funnel Web Spiders.

Jump in the Pool, Make $50

Medical Mutual of Ohio is the official carrier for Ohio's new ObamaPool©, and starting today, the pool is open for business:

"Medical Mutual will begin accepting applications for the Ohio High Risk Pool program, with coverage to be effective for the first enrollees on September 1, 2010."

What's interesting is that they're offering a finder's fee for agents to steer folks into the pool. As an agent, I'm pleased that any efforts I make to encourage folks to take advantage of the program will be rewarded in some way (unlike, say, Cigna). On the other hand, there are a lot of hoops through which to jump, which make the $50 "reward" somewhat questionable; for example, I'll have to confirm an individual's eligibility and help them complete and submit the paperwork (including some onerous documentation). I'll also need to collect and submit my new client's check, as well as my own "Broker Verification" form.

Those seeking to purchase coverage through the ObamaPool© have some hoops of their own, which include (among others):

" ■ Be a citizen or national of the United States or lawfully present in the United States;
■ Be uninsured for six months prior to the date the person applies for coverage;
■ Have a qualifying pre-existing condition as evidenced by a denial of coverage by two insurers, or by documentation from a healthcare provider."

My biggest issue is with the second: why six months? Why not 2 months? Or a year? This is arbitrariness for its own sake. In fact, it seems to me that the shorter the better for those who are uninsured. And isn't that one of the stated goals of ObamaCare©: to insure the uninsured?

Or am I missing something obvious?

I'm also having trouble with one of the alternate qualification requirements:

"Written certification by a licensed physician or nurse practitioner, issued within the past six months, certifying that the individual has a history of or suffers from a qualifying medical or health condition."

On the one hand, the site lists almost 100 different qualifying conditions, from Addison's Disease to Wolff-Parkinson-White Syndrome (no word on Zuska's Disease). And you'll need to bring that list with you to the doc. Which of course begs the question: who pays for that doc visit if you're uninsured?

I think we already know the answer to that.

So you have a very serious illness and need insurance. You've been uninsured for at least half a year, and now you can purchase insurance that can take effect in as little as two weeks' time. But what can you buy, and how much will it cost?

There are two plans available, one with a $1500 annual deductible, the other at $2500. Once that deductible's been met, there's an additional $3000 or $4950 in co-insurance, depending on which deductible you choose. The plans themselves appear to be based on the company's "Elite" plan configuration.

Both options include a $30 co-pay benefit for office visits ($50 for specialists), and a $40 urgent care co-pay. Nice. There's also first-dollar preventive benefits for things like mammograms and immunizations. Hospitalized? No problem, the plan takes care of 80% of your covered expenses after the deductible's met; unless it's an ER visit, for which you'll be dinged a reasonable $200 (which they'll forego if you end up admitted to the hospital).

There's even a prescription drug card benefit, including a break if you choose mail-order (home delivery). Heck it even covers "The Pill." All in all, a very nice plan (although I'll remind readers that, around here, we call that "Phantom Insurance").

And since this is part of ObamaCare©'s effort to reduce the number of uninsured, I'm sure it's a bargain.

Fortunately, the site includes handy rate charts, as well. Let's see how the numbers stack up:

Let's take a typical Columbus area resident, say a 27 year old non-smoker (interestingly, the rates are unisex). Should you opt for the $1500 plan, the monthly premium would be $150 (there's a 25% surcharge for smokers). The $2500 plan would save you $14 a month (or $168/year). Frankly, that's not even close to enough of a rate differential to encourage folks to opt for the higher deductible plan.

But let's compare that rate to those for a "healthy" 27 year old, using MMO's own plan design and rates. In that case, Joe would pay just $96 and Jane $133. But that's not the most interesting part: a 37 year old healthy Joe pays just $130 for the $1500 version, versus over $200 for his very sick twin brother. But a healthy 37 year old Jane pays about $190 a month, while her sickly twin pays just $16 more.

Which is actually a much bigger problem than one might think: according to the benefits recap, "Maternity Services" are covered. "Healthy" Jane would pay an additional $456 per month for this (optional) coverage, and have to wait 9 months for it to become effective. Not so for "sick and pregnant" Jane, whose coverage could be in effect in as little as a fortnight. In fact, "pregnancy (current)" is one of the automatic qualifiers for coverage.

And then it gets interesting:

The website offers a helpful FAQ section, under which we find the following: "What happens to my first payment if I am placed on the waiting list?" Ironically, this section is the first, last and only one to even mention the term "Waiting List." So I called up the helpful folks at MMO, where I confirmed what I'd already inferred: remember that the budget for the whole Ohio version of ObamaPool© is $150 million? You guessed it: when that initial funding is gone, then whoever's left behind has to wait for the next round (if and/or when). How many childbirths are going to chip away at that $150 mil before it's gone?

Your guess is as good as mine.

[Hat Tip: FoIB Beth D]

Health Care Reform - Hype and Change

Much has been said about Obamacare, both pro and (mostly) con, but few have managed to so eloquently and succinctly sum up the impact of Obamacrap. Michael Tanner of the Cato Institute does his best to separate substance from hype in this article which is posted at the Orange County Register.

Obamacare was conceived around three goals: 1) providing health insurance coverage for all Americans, 2) reducing insurance costs for individuals, businesses and government, and 3) increasing the quality of health care and the value received for each dollar of health care spending.

Just over 100 days after the law was signed, the evidence shows it is failing on each and every one of those goals.

Tanner nails it right there, and then goes on to offer supporting commentary.

Remember "if you like your plan you can keep it"? Not so.

How about extending health insurance to everyone? Close, but no cigar.

nearly half of the newly insured coming through the troubled Medicaid program. Thus, how much the law expands access to private insurance is still an open question. And still, at least 21 million Americans will still be uninsured by 2019.

Forcing 16 million or so on to Medicaid rolls hardly took a trillion dollar, 2300 page document. That could have been done almost with the stroke of a pen on a 10 page document.

Funding the expansion is another issue, but Obamacrap really doesn't solve that problem either.

The law also makes some modest insurance reforms that will prohibit some of the industry's more unpopular practices. However, those changes will come at the price of increased insurance costs, especially for younger and healthier individuals, and reduced consumer choice.

Oh yes. Those mean old health insurance companies will no longer be able to turn people down because of a pre-existing medical condition.

And the crowd all roared.

Now the bad news.

The cost of health insurance will rise dramatically for everyone, at least doubling the premiums by 2014 over present levels. How is this helping, especially in a recession where people are losing their homes due to lack of jobs and income?

Obamacrap takes a workable, but not perfect, system and makes it a product only the wealthy can afford. 

Meanwhile, the legislation is a disaster when it comes to controlling costs. The administration's own chief health care actuary reports that the law will actually increase U.S. health care spending. Accurately measured, the Patient Protection and Affordable Care Act will cost more than $2.7 trillion over its first 10 years of full operation. This does not even include more than $4.3 trillion in costs shifted to businesses, individuals and state governments.

Even Snooki could figure out something is wrong. These figures make the folks in DC look like Dumb and Dumber.

This promise was not part of the Obamacrap legislation but it was a selling point repeated over and over again to the public. "If you like your plan you can keep it."

Tanner pulls back the curtain on this pledge.

It is also becoming increasingly clear that millions of Americans will not be able to keep their current coverage. Seniors with Medicare Advantage and workers with health savings accounts are the most likely to be forced out of their current plans. A leaked administration memorandum warns that more than two-thirds of companies could be forced to change their current coverage. For small businesses, the total could reach 80 percent.

So what is the bottom line?

If you are not insured now good chance you will go on Medicaid and take your chances of finding a doctor willing to accept you as a new patient. If you are insured and like your plan you probably won't be able to keep it. Even if you don't like your plan you probably won't be able to afford it much longer.

How is this hype and change working for you?

Limiting Choice in Health Insurance

During the campaign and over a year of debate and backroom deals to get Obamacare passed, much was made about expanding the number of choices consumers will have for health insurance. Like most promises from Washington, the facts don't live up to the hype.

The Christian Science Monitor reports that New Mexico may seek to limit choices by only showcasing certain plans on their Exchange.

New Mexico Gov. Bill Richardson recommended that the state establish an exchange that "assumes an active role in driving market reforms and protecting consumers."

The panel's report goes on to explain: "This could include restricting plans from the Exchange that would exceed specified premium growth levels or by requiring cost containment initiatives of plans participating in the Exchange.

That may sound well and good to a politician but it has no bearing on real life. Obamacare has absolutely NO impact on the cost of health care and health insurance companies only slightly more.

Health insurance companies are primarily bill payers, but they can have some impact on the cost of health care that is reimbursed under their policies. Network providers agree to accept negotiated pricing in exchange for increased foot traffic (patients) and prompt payment. This can hold down pricing which in turn leads to lower health care costs.

Another way to hold down the cost of health care is by monitoring treatment protocol and looking for ways to promote the most effective medical practices. This is usually done through plan design but may also be achieved on the reimbursement end by restructuring health care provider networks or drug formulary's.

Health insurance is a competitive market. There is no need for government interference in a free market product. If company A spends too much on overhead or claims the result will be higher premiums that are non-competitive. When state or federal government bodies thump their chest and talk about how they are going to protect the consumer by beating up the health insurance companies they really look stupid. Mandating loss ratio's, limiting premium increases, requiring certain levels of benefits achieve nothing in holding down the cost of health care and have a negligible effect on premiums.

Bill Richardson probably was looking for a political sound bite but he made a fool of himself if he thought limiting choice for consumers was a good thing.

Stop and Smell the....Scooter?

On the one hand, advances in med-tech have an adverse impact on the cost of health insurance; after all, the "new stuff" often (usually?) costs more, at least for first-adopters. Of course, a couple generations in, the costs generally go down (bought a SmartPhone lately?). Sometimes, though, it's not about the money, but the result:

"The severely disabled, including those "locked in" to their bodies as a result of accidents or disease, may soon have a new way to communicate and move around ... By sniffing in and out through their noses, more than a dozen quadriplegics were able to control computers that allowed them to write and to guide a wheelchair."

It's easy to see the humor in that, but the empowerment of those who find themselves so physically challenged is undeniable. Developed by a team of Israeli scientists, the device has so far been tested on about a dozen or so "severely disabled patients," with mixed (albeit promising) success. More testing and refinement is planned, so keep your eye out for some creative ads from the local Scooter Store.

Child Health Insurance Update

The market, or lack thereof, for children's health insurance is changing daily. I got a memo earlier today from Cigna stating that any policy written for a 10/1/2010 effective date or later that contains even one family member that is guarantee issue will pay $0 to the writing agent.

Barring further refinement, children's health insurance after 9/23 is essentially guaranteed issue. That means any child under age 18 is guaranteed to get health insurance coverage at some price.

The price is still a moving target but we expect children's rates to double from current levels and possibly even higher.

Compensation to agents is a small piece of the total pie which makes this a foolish move on the part of Cigna.

Of course it is things like this that give us our "Stupid Carrier Tricks" series.

Since agents will not be paid to place business with Cigna when an otherwise uninsurable child is part of the mix you can bet Cigna will not be included in the list of possibilities. Call this mercenary if you wish, but agents don't work for free.

Because of this move, Cigna will see fewer agent initiated applications of any kind and their average premium per application will fall.

Cigna has essentially removed themselves from the children's health insurance market except on policies written direct. House accounts are not free. There is an acquisition cost associated with self generated business and that cost is usually higher than agent driven business.

In this move, Cigna is willing to accept less business at a lower premium and when they do write business it will be at a higher acquisition cost than going through agents.

It remains to be seen if any other carriers will follow this path.

JeffLinks: Good News and Bad

From FoIB Jeff M, two interesting links. The first is good news for folks trying to figure out if they've saved enough to pay for any long term care needs that might arise, and if they might need to be looking at Long Term Care insurance. This interactive tool, from LTCi giant Genworth, includes average costs for nursing care both at home and in a facility, and can even help you determine how much these costs will escalate over time.

Now for some bad, or at least disquieting, news: if you've lost a loved one in the past few years, you know that life insurers no longer just send a check. The default option (in some cases, the only option) is a checking account from which one can withdraw funds.

Actually, that should be "checking account" since it's not a real one:

"Lohman, a public health nurse ... had always believed that her son’s life insurance funds were in a bank insured by the FDIC. That money -- like $28 billion in 1 million death-benefit accounts managed by insurers -- wasn’t actually sitting in a bank.

It was being held in Prudential’s general corporate account, earning investment income for the insurer."

And unlike a bank account, this money isn't protected by the FDIC, nor is it even held in a separate, specific account. It's just considered part of the carrier's overall assets.

I always advise my clients (well, technically, their beneficiaries) to immediately cash out that "account" and transfer the money directly to their own real bank account. What they do with the money from there is really none of my business, although I do caution folks not to go on a spending spree right away.

Thanks, Jeff!

Health Insurance for Children - Open Enrollment

The Associated Press is reporting that Washington has agreed to let health insurance companies utilize an open enrollment period for children applying for health insurance under Obamacare.

Insurers were concerned the new health care law would allow parents to sign their kids up in emergency rooms while the child is in the middle of a health crisis.

The administration now says insurers can limit the sign-up to an "open enrollment" period, for example, December 1 to December 31 for plans that start January 1.

No word on how this may impact children's health insurance rates (which were expected to rise two-fold at a minimum) or if any carriers will modify their position in rejecting "child only" health insurance applications.

Details to follow . . .

Ch-ch-changes: HSA/FSA vs ObamaCare©

As if further proof were needed that ObamaCare© has little (if anything) to do with actual care, we learn from our favorite Flexible Benefits guru Pete Deist that, come January:

Health Savings and Flexible Spending Account (HSA and FSA) "funds can no longer be used to purchase OTC drugs and medicines ... unless you have a Note of Medical Necessity (NMN) or a prescription from your doctor."

In classic gummint fashion, though, one may (apparently) continue to use these tax-advantaged dollars to purchase non-medical items (such as contact lens supplies, batteries for hearing aids, etc). This just underscores how out-of-touch our CongressCritters really are. This is especially egregious when it comes to HSA money, since these types of plans are the only ones which actually impact the cost of health care.

The other "alternative benefit," HRA ([Health Reimbursement Arrangement], is similarly curtailed. And it's also worth noting that, come 2013, the cap (maximum contribution limit) on FSA's is reduced to $2500, a 50% reduction in this valuable benefit [Correction from FoIB Alissa C: "health FSAs currently have a federal cap of earned income (essentially no cap). It's currently up to the employer to set the maximum. $5,000 is the maximum for dependent care if single or married/filing jointly." HGS].

The real problem here is that this actually increases the cost of health care, in direct contradiction to the stated purpose of ObamaCare©. It makes less expensive treatments less affordable, and actually requires additional office visits (which aren't free) in order to buy Over-The-Counter med's. Sure glad we "passed it to see what's in it."

Aren't you?

[Hat Tip: FoIB Suzy R]

Cavalcade of Risk #110: Rocky Mountain High edition

Jay and Louise Norris host this week's picturesque edition of the Cavalcade of Risk. Stop by for the beautiful scenery, stick around for the thought-provoking posts.

Buying Health Insurance From the Government

Washington is excited about their consumer health insurance portal and are perhaps having visions of providing "direct to consumer" choices for health insurance. Healthcare.gov is an expanding and changing site with quite a bit of information, some of it actually useful.

The latest addition is an "Explore Your Options" button that allows consumers to share personal information with the government in exchange for ideas on how to find health insurance coverage. You start by selecting your state then proceed through different pages based on your response.

Don't want to answer a question?

Too bad. Just like Seinfeld's Soup Nazi, "no information for you!".

The site will not let you progress until you answer every question.

At first the questions seem non-threatening but gradually become more personal.

You start by telling the government where you live by selecting one of the 57 states in a drop down box. Next you must pick one of the following that best describes your situation. Are you:

Family, healthy individual or sick individual (you must decide which), pregnant woman (can males get pregnant?), someone with a disability, senior, young adult, small employer or self employed.

Assuming you pick something that best describes your situation you can progress to the next page. If you are under age 26 and a pregnant female you must pick one since the government does not allow you to be both.

Before you go on you might want to read their privacy policy. Of course they would not collect any information that is not pertinent to helping you find the best health plan for your needs.

Or would they?

We automatically collect and temporarily store the following information about your visit:

the name of the domain you use to access the Internet (for example, aol.com, if you are using an American Online account, or stanford.edu, if you are connecting from Stanford University's domain);

the date and time of your visit;

the pages you visited; and

the address of the web site you came from when you came to visit.

I will let you decide if you really want to share this much information with big brother.

Back to the health insurance info . . .

I opted to pick a category that best described me and chose healthy individual. I admit I was lured in by the "Just two quick steps" at the top of the page. After all, if this is all they need, no big deal, right?

On the next page they tell you "Just a few more questions . . ."

Why does this seem like a visit to the dental office where he says you might feel a slight prick?

On this page you need to make some decisions again, including how much more you want to share with the government. Are you losing coverage through your employer or do you need health insurance?

Apparently if you are not losing your employer plan or if you do not have any pressing medical needs they feel there is no reason for you to even be at this site. Healthy people need go no further.

If for some crazy reason you decide you want to explore your options, even if you are healthy, you must decide which age bracket fits your situation. If you are a family and one individual is over 25 and the other is under age 26 you are again faced with a dilemma. Pick one if you want to progress.

The next category lets you make more than one selection so you can be a pregnant military veteran (presumably a woman) as well as an American Indian or Alaskan Native and still qualify for something.

The last question before leaving this page wants to know if you have trouble affording health insurance. I don't imagine they will have many "no" answers but since I like to be as helpful as I can since the government is taking such an interest in my personal life I decide to answer this as "no".

Based on the answers I have provided so far I am offered four choices. The options include finding a job with health insurance (good luck on that one), buying health insurance in the open market, exploring the PCIP plan, and finding local free health care clinics.

Already they have lured me in but I don't want to leave without finding out what is behind door number 2, so I tell the government I want to explore insurance in the private market.

Now they want to know just a bit more information before letting me proceed.

They want my zip code.

Why do I feel like there is a government drone or spy satellite watching my every move?

The next page gives me the option of going to the Georgia Department of Insurance website or picking a link to any one of 14 health insurance company websites. They currently offer 45 plans to pick spread over the 14 carriers. Some have only 1 plan while others have 13.

When you click on a carrier link you are offered a very brief description of plans that are readily available in the market either direct from health insurance companies or through an insurance broker. The difference here is, if you want rates you have to come back in October. There are no rates available at this time on the government site.

So you have given the government all this personal information only to find there are no answers.

I don't know about you but this just makes me feel used.

For what it is worth, I have offered visitors a health insurance quote engine on my site for years. Anyone looking for affordable health insurance in Georgia is free to visit my site, run quotes and apply for health insurance. They can do this on their own or solicit my advice.

Either way, I do not collect information and send it to the government.

There are some things that are constant based on my experience. Over half of those who run a health insurance quote don't want anyone to know who they are or how to contact them. On average, about a fourth are willing to seek advice about which plan to pick and how to apply.

Roughly 5% of those who run a health insurance quote will also start an application for coverage without asking for assistance. Well over 90% of those never complete the application and about half that do are turned down mostly because they did not know how to respond to the questions on the application.

I don't know what the government is expecting, but if they think they are going to provide a service that will result in thousands or millions obtaining health insurance they will probably be disappointed.

You may be able to build a ballpark and they will come, but not so for a health insurance website.

MVNHS©: Death Panels alive and well

One may argue over the efficacy and/or morality of end-of-life care, but it has long been a personal choice. The emphasis, however, appears to be on the "has been" piece; it appears that the MVNHS©:

"Plans to cut hundreds of thousands of pounds from budgets for the terminally ill, with dying cancer patients to be told to manage their own symptoms if their condition worsens at evenings or weekends."

Sorry mumsy!

And that's just the beginning. One of the primary models for ObamaCare© (now spearheaded by a major MVNHS© proponent, by the way), facing major budget setbacks, seems to have no choice but to implement some pretty draconian health care rationing:

"■ The closure of nursing homes for the elderly.

■ A reduction in acute hospital beds, including those for the mentally ill

■ Tighter rationing of NHS funding for IVF treatment, and for surgery for obesity."

Actually, three out of four isn't bad: there's no medical reason to cover IVF in the first place. But at a time when the Brits are focusing so (ahem) heavily on childhood obesity, one would think that this would be a no-no.

Which leaves one to ponder: did the Brits have to "pass it to see it," too?

Grand Rounds is up

InsideSurgery hosts this week's eclectic collection of great medblog posts.

Child Health Insurance Rates Rising

From the "What did you think would happen?" division of the land of Obamington comes this report from The Hill.

The rule barring insurance plans from turning away sick children or denying coverage for specific illnesses for children who are already covered was one of the most popular parts of the new law.

But the new rules are leading some health plans across the country to stop issuing new child-only coverage, the state officials said. That could force parents to buy costly family coverage where in the past they could have saved money by buying separate policies for themselves and their children.

Let's look at this logically, something that completely escapes the clowns in Washington.

Beginning in September, health insurance companies will not be able to refuse coverage to any child (under age 18) REGARDLESS of their medical condition(s) and must cover any all necessary treatment for those conditions. If your child is healthy or sick, you are not required to purchase coverage. There are no penalties for failing to provide health insurance for your children. You may buy health insurance on your child once their health changes and the insurance carrier is required to cover them.

In whose world is this considered insurance?

This is not insurance. This is asking someone else, in this case an insurance company, to pay for your expenses AFTER you know you are sick and can't afford to pay for your health care.

If you could buy auto insurance AFTER your car was stolen, or after the wreck, I doubt anyone would consider that a good business model. But try to apply this kind of logic to health insurance and suddenly a lot of people think that buying health insurance AFTER you get sick should be allowed if not required.

The state commissioners, who are helping write the regulations governing the overhaul of the nation's health insurance system, said they expect to see more insurers ceasing to offer new child-only coverage. They said middle-class families with healthy children, who don't have access to state public programs, will be the hardest hit.

Anyone with half a brain would have seen this coming.

Obviously the folks who designed Obamacrap are either like Dorothy's Scarecrow or they got Abby Normal's brain.

This would certainly qualify for our Stupid Government Tricks award.

When Denial isn't just a river...

So you've had that emergency earectomy, and you're relieved that the bulk of the cost will be borne by your health insurer. How disheartening, then, when the EOB (Explanation of Benefits) arrives, and you learn that the claim has been denied.

What now?

Most states require carriers to not only justify a claims denial, but guarantee the insured the right to an external appeals process (Alabama, Mississippi, Nebraska, North and South Dakota do not guarantee the latter). And so-called ERISA (self-insured) plans don't have this requirement, either.

But that's about to change:

Beginning September 23rd, new ObamaCare© rules come into effect that require "the right to appeal denials directly to their insurers, and if necessary, to external review boards." Frankly, the only really new thing here is that this blanket requirement will apply to the four aforementioned states, and self-funded plans.

And, of course, there's a nice little carrot attached: "$30 million in grants to states to establish or strengthen consumer assistance offices." That's about $600 thousand per state (or, in Obamington, about $526,000 for each of the 57 states). Your tax dollars hard at work.

One thing I found quite interesting, though, is the fact that this legislation seems to explicitly exempt the most egregious claims denier of all: Medicare.

Wonder why.

[Hat Tip: FoIB Holly R and NAMI]

Big Fat Deal [UPDATED]

Coming soon to a classroom (or physician's office) near you?

"They look like happy, healthy children - and that is exactly what they are ... Yesterday their parents told how they were sent letters which began with the stark warning: 'Your child is overweight for their age and sex."

Turns out, the MVNHS© is using something called the Body Mass Index, ostensibly a measure of one's overall health based on height, weight and percent of body fat. Which sounds reasonable, until one considers:

"Those of you who are in great shape yet feel betrayed — and baffled — by your BMI, take heart. A study released earlier this month by the American College of Sports Medicine finds that you can be in great shape, yet deemed overweight by your BMI."

Confused? Wondering why we even bring it up?

Well, it's about to get murkier:

"New federal regulations issued this week stipulate that the electronic health records ... record not only the traditional measures of height and weight, but also the Body Mass Index: a measure of obesity."

"This week?!" Wasn't ObamaCare@ passed months ago?

Yes, yes it was. These new reg's are part of the new Stimulus Bill that extended unemployment benefits. And yes, I'm as confused as you as to what one has to do with the other.

To paraphrase Bob, Poppa Washington: Less common sense, more nanny state.

UPDATE [7/26/10]: It appears that Germany's weighing in on this issue, as well:

"Marco Wanderwitz, a conservative member of parliament ... said it is unfair and unsustainable for the taxpayer to carry the entire cost of treating obesity-related illnesses ... The German teachers association recently called for school kids to be weighed each day ... fat kids could then be reported to social services."

There appears to be ever-growing concern over this weighty issue; assuming our readers can stomach it, we'll continue to provide the skinny as best we can.

[Hat Tip: Bob V]

COBRA Subsidy to End

Nothing lasts forever, even in the LaLa world of Washington. The land where money seemingly grows on tree's has at least for now seen a halt in reckless spending. 

U.S. workers who lost their jobs as of June 1 won’t be eligible for a 65 percent federal subsidy to help pay for health insurance under an unemployment bill Congress will send to President Barack Obama for signing.

Eligibility for the financial help expired May 31, meaning workers who lost their jobs after that date don’t qualify. Those already receiving the benefit may continue to pay reduced premiums for up to 15 months, according to the Department of Labor.

Had Washington spent their resources on encouraging the private sector to create jobs instead of pissing money away on welfare programs there might not be a need for continued assistance.

Workers who lose their job and are no longer eligible for the health-insurance subsidy should check if they or their children may be eligible for other public aid such as Medicaid and the Children’s Health Insurance Program, said Kaiser’s Schwartz.

Most folks would rather have a job than rely on public assistance. Given the anti-capitalist mood of the White House it doesn't appear the economy and the jobs that come with it will turn around any time soon.

More CLASS

As mentioned previously, ObamaCare@ includes a half-hearted attempt to encourage folks to insure their own long term care expenses. Called the CLASS Act (for Community Living Assistance Services and Supports), it posits a voluntary (for now) program enabling folks to purchase, through payroll deduction at their worksite, a long term care "assistance program." On the one hand, it's nice that the gummint is making an effort to get folks to consider buying long term care insurance. On the other, I'm not convinced that this is the way to do it.

Still, it is the law, and we may as well make the best we can of it. To that end, carriers like John Hancock are putting out informative presentations that help cut through the clutter. Hosted at Brainshark, this 15 minute slideshow provides a solid, basic explanation of what the CLASS Act does and doesn't do, and what other alternatives may be available.

And if you haven't already read it, I highly recommend guest-blogger Herman Bruns' thoughtful, insightful post on why and when you should be considering Long Term Care insurance.