Questions: We Got Questions About PCIP, the federally-subsidized Pre-Existing Conditions Insurance Program

More than two years after healthcare reform legislation created PCIP and its $5 billion appropriation, enrollment has been far below expectations, and HHS has not released emerging cost information. So the first Q has to be this: "Why isn't HHS telling the public anything about PCIP?”

PCIP is undoubtedly a godsend for the people who have enrolled. It’s just that very few have actually enrolled. And financial results aren’t available (at least no one can find the financial results - for example DecisionHealth can't find them)

The lack of information from HHS just raises more Q’s: Why did PCIP require a $5 billion appropriation (in addition to individuals’ own premiums)? Does the $5 billion meet a real need? Does the $5 billion create a political mirage i.e., to persuade the public that a need of this magnitude actually exists? Was there some other reason?

According to a GAO report in July 2011, “initial projections of total enrollment varied from 200,000 to 375,000.”

According to NCSL (The National Conference of State Legislatures), the PCIP enrollment was fewer than 50,000 individuals as of the end of 2011 – after almost two years, far below the projected enrollment.

What has HHS done as the result of the low early enrollment results?

(1) it reduced premiums in the 23 federally run PCIP states
(2) it increased enrollment outreach
(3) it began to require regular reporting of expense and enrollment data, and annual completion of independently audited financial reports.

The first two responses suggest HHS still thinks PCIP will help hundreds of thousands of people, even though there just don’t seem to be that many people interested.

More Qs: Are the HHS responses overreactions? Are they even necessary? (In fact as InsureBlog reported here and here, HHS has already ended one of the outreach efforts, a broker incentive arrangement).

These first two HHS responses also remind us of a previous HHS attempt to portray the Early Retirement Reimbursement Program as helping a huge number of small, private employers when, in fact, it mainly helped a small number of unions and heavily unionized major employers (recall that unions, perhaps coincidentally, are important Democrat campaign contributors):

Is the third HHS response simply an admission of poor management from the start? Or, if not, did HHS fail to include these elementary controls in the first place because PCIP funding was ONLY FIVE BILLION??? Surely HHS would not treat $5 billion of our dollars as whisky spillage . . . ?

And so we're back to the first Q – if regular reporting of expense and enrollment data from the states to HHS is now taking place – where is it?

Note however from the NCSL report: in the 23 states that ran their own high risk pool before PCIP the average cost for 2010 was just under $11,000 per covered person. It’s not clear whether a “high risk” person will have similar costs to a “pre-existing conditions” person. Maybe, maybe not. But what if PCIP will in fact cost $11,000 per year per person? That means the cost of 50,000 PCIP individuals would be $1.1 billion for 2012 and 2013, or less than 25% of the $5 billion appropriated – and that’s before counting the premiums that enrolled individuals pay.

At this time it appears that neither the PCIP enrollment nor its estimated cost come anywhere near the appropriated amount. So we must also ask: Is PCIP just another overfunded federal solution in search of a problem?

A Dickens of a Day

The Wall Street Journal today reported some optimistic health care news:

“Johnson & Johnson Tuesday . . . pointed to early signs of improvement in the health-care market.”

And in the same issue, the Journal reported some pessimistic health care news:

“Johnson & Johnson Tuesday . . . said it has seen a recent uptick in surgical procedures . . . this might be a sign that consumers are seeking more medical attention after years of sluggish health-care spending.”

In health care – as with so much else that is going on these days - perhaps 2012 will be both the best of times, and the worst of times.

". . . it is the age of wisdom, it is the age of foolishness, it is the epoch of belief, it is the epoch of incredulity, it is the season of Light, it is the season of Darkness, it is the spring of hope, it is the winter of despair, we have everything before us, we have nothing before us . . . "

Agents vs. The Exchange Part II

The future role of insurance agents in an Obamacare world is questionable at best. Even if agents are invited to participate, there are many questions that need to be addressed.

What requirements must be met for an agent to be "approved" to participate once the exchanges are established? How will the agent be compensated? Will agents be compensated? Will agents be paid a finders fee or a continuing service fee as well?

Or, will agents be thrown under the bus?

The Lund Report on happenings in Oregon seems to indicate a not-so-promising future for Oregonian agents.

The Oregon Health Insurance Exchange wants to train and use insurance agents to help uninsured individuals and small businesses purchase insurance starting in 2014

.

So far, so good.

Using the agents makes business sense for the exchange, which can use agents to help people find out about the exchange once it begins providing coverage in 2014, and buy insurance through it.

All true.

The Oregon exchange needs 100,000 to 125,000 enrolled in the plan by the end of 2015 in order to be profitable. Since when are government agencies worried about profits?

The agents working for the exchange, Wirtz said, will be paid by the exchange itself, which will take the commissions from insurance companies and pay them directly to agents. She also said that agents would be given a special training about the exchange and the plans the exchange will offer. The exchange would also develop criteria that would determine whether an agent would work for the exchange.

Special training. Criteria.

Which begs the question, what kind of training, and what is the hiring criteria for navigators that will work for the exchange on salary and have benefits?

And then some legislator had this brilliant thought.

“I have a problem with people being charged when they don’t use an agent,” he said. ““They ought to know what they’re paying for. It should not be hidden, or buried in the costs.”

In other words, if someone elects to buy direct they should get a lower premium.

I figure the folks who want to do it themselves already pay too much any way. Under the current set up, I get quite a few new clients who bought direct from a carrier only to find out the plan doesn't work quite the way they were told by the carrier rep.

I see no reason why that would change with a navigator.

the executive director of We Can Do Better, asked how agents will be “removed,” or fired, if they do not perform adequately. She also wondered how the exchange could find particular information about an agent, such as if they speak a second language and could do outreach to minority communities.

My question is, will these exchanges work the way PCIP has? Will agents be invited to participate and then cut off at the knees once the program hit's their quota of insured individuals?

My guess is, the agents will be thrown under the bus, just like PCIP did.

Only the Healthy need Apply

“Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It’s also key to keeping Medicare solvent.”

That's from a Washington Post article, “Medicare moves to tie doctors’ pay to quality and cost of care.” The mantra since the passing and signing into law of the Affordable Healthcare Act has been that doctors need to be paid on their quality of care. The prevailing theory is that better quality will result in lower healthcare costs. This theory only works, though, if you don’t get one of those expensive diseases or costly injuries. Now, however, Medicare has made the doctor responsible for the cost of care. A doctor is no more responsible for the cost of care than an oil driller is for the cost of gasoline.

A doctor provides a service. The doctor prices the value of that service on the same factors that drives all pricing in a free market society. Cost of overhead and competition. Cost of overhead is what it costs the doctor to deliver the service and competition is what the doctor down the street is charging for the same procedure. Now this is where the free market stops and reality of medicine today takes over. If a provider has a contract with a third party payer, Medicare or private, then the provider is paid based on the set fee schedule of the third party payer, meaning that the doctor can charge whatever he wants for the procedure, he will only be paid what the third party payer has deemed he will be paid. Thus, it is the third party payers, including Medicare, that are controlling the cost of healthcare, not the physician and certainly not the patients.

The article continues with this gem in response to quality care:

“…properly assessing how a doctor affects costs must include not just the specific services she directly provides, but also care other providers may give, either because the patient was referred to them or because the original doctor didn’t take the right preventive steps to avoid more expensive treatments later on. And without properly adjusting for patients’ health problems, paying bonuses to physicians who use fewer Medicare resources might encourage doctors to stint on care or shun patients with expensive-to-treat ailments.”

The writer puts it together that if a doctor will be rewarded for healthy patients and penalized for unhealthy patients, then the doctor will not see unhealthy patients. These patients will be dismissed from the practice so that the doctor’s numbers will be healthy. According to the article, this will happen sooner than people had expected, “although the program is still being devised, it will become reality for many doctors starting in January, because CMS plans to base the 2015 bonuses or penalties on what happens to a doctor’s patients during 2013."

Physicians are being squeezed financially with rising overhead and stagnant reimbursements from third party payers. Now physicians are facing the unpleasant prospect of denying care to a patient because that care will cause the physician to lose money, a prospect that no business can take on and survive. It is for this very reason that a policy has been in place for decades that a doctor cannot take into account the cost of a procedure, treatment or medication as that will unduly influence the doctor’s decision. Malpractice is based on the concept that the doctor will inform the patient of the best course of treatment, regardless of cost, because what is important is the life of the patient, not the cost. Now, that underlying concept has been deemed inappropriate and instead it is the cost of the care that will matter.

Cavalcade of Risk #155: What's Happenin' edition

Jaan Siderov presents this week's collection of risky posts, and adds his own helpful and unique spin to each one.

By the way: We're looking for summer Cav hosts. Just click here to grab yours!

Barney Says No

According to a Forbes article, retiring Rep. Barney Frank tried to tell Obama to focus on the economy, not health care.

President Obama made a “mistake” in pushing for his signature health law. “I think we paid a terrible price for health care,” he told Jason Zengerle of New Yorkmagazine. “I would not have pushed it as hard.

This is the same guy who, while in office, not only wanted Obamacare but felt the law did not go far enough. It stopped short of single payer.

So which is it?

Did Obama err or did you lie?

Ill-timed Carrier Tricks

Given the high stakes ObamneyCare© SCOTUS case, the on-going MLR assault, and the pending PCIP implosion, what better time could there be for a major health insurance company to announce....wait for it....

A new logo.

Yes, that's right, when those who actually sell its products are about to lose their livelihood, the rocket surgeons running Aetna think now's the right time to re-brand:

Oh, you may be forgiven for thinking that the one at the top of the post was it.

Grand Rounds kaput?

No, but it is "on hiatus."

If, like us, you're missing your weekly 'Rounds fix, you may want to check out the bi-weekly Health Wonk Review. Like Grand Rounds, HWR is hosted on a rotating basis - a different blog each edition. Unlike 'Rounds, however, the focus isn't on the clinical so much as the philosophical. It's a different experience, to be sure, but no less satisfying.

Brad Wright hosts the most recent issue, with a fun Masters (as in golf) twist.

Life and Death and Insurance

Ran across an interesting and provocative article the other day, the premise of which is that philanthropic-minded folks may be missing a charitable opportunity sitting right under their noses.

We've discussed Stranger Owned Life Insurance many times here at InsureBlog, generally as it relates to insurable interest and, often, fraud. But as with most things, there's a good side, as well; in this case, it's turning unneeded life insurance policies over to a charity:

"Don wished he could do more to help his son realize his dream of building that [children's ER]. Don is about to let a $4 million term life policy lapse because he and his partner have sold their medical practice and they do not need it anymore. Don is unaware the policy is convertible into a permanent policy ... he is unaware that he has the option of gifting that converted policy into the hospital foundation and contributing tax deductible cash to the charity each year to pay the annual policy premiums and create a $4 million endowment"

One imagines that some home office critter or other will again raise the (bogus) "insurable interest" issue, but maybe not: donating life insurance policies to charity is a time-honored tradition.

Interesting article - Recommended.

Death, Taxes and Risk

FoIB and Tax Meisterblogger Joe Kristan reminds us to be extra careful as we speed over to the Post Office to mail in our 1040's:

VEBA: Where you want to be

Well, maybe.

I recently attended a class on health insurance alternatives for early retirees. These are folks who are too young to qualify for Medicare, but old enough that the 18 months of COBRA just isn't enough. Some employers offer their retirees health insurance, most don't, and that was the purpose of the class.

It was interesting enough (certainly better than our last outing!), and I took several pages of notes. Unfortunately, the most intriguing piece was also the one least discussed; there was a very good reason for this (the carrier doesn't offer them here), but my interest was piqued, and so I decided to do a little digging.

VEBA's the acronym for the unwieldy "Voluntary Employee Beneficiary Association." Briefly, a VEBA offers a way for employers to offload their retiree health plans while maintaining minimal control of them (aka purse strings). Employers (well, former employers, really) set up and fund a trust, the purpose of which is to pay for specific insurance products (typically retiree health insurance plans). The donations (payments) are generally tax deductible, and the requirements seem pretty tame.

The VEBA tax exemption comes via the Internal Revenue Code (501(c)(9) to be precise); once the money's deposited in the trust, though, the employer gives up control of it to the Trust's administrator.

VEBA plans can be set up as either Defined Benefit or Defined Contribution plans, and often include a Health Reimbursement Arrangement (HRA). Those that include the HRA are called "Hybrid VEBA" plans.

Now you know.

[Hat Tip: Anthem]

Medicare in Crisis

To say Medicare is fine or there is no crisis is to be in denial. With 45 million people on Medicare and a trust fund filled with IOU's while the federal government is hemorrhaging money at some point you have to admit there might be a problem.

The first step for alcoholics is to admit they have a problem.

Maybe it is time for Congress, and the nation as a whole, to do likewise.

The N. Y. Times offers this information.

About 65 percent of the cost of the Obama health care law is supposed to be met by Medicare expense reductions and tax increases totaling roughly $1 trillion over 10 years. The deficiency with this plan is that it amounts to double-counting, using urgently needed Medicare economies to finance the new law.

Medicare expense reductions. Code for paying medical providers less and shifting more of the cost of care to Medicare beneficiaries.

Thanks to escalating health care costs and repeated sweetening of benefits without commensurate increases in revenues, Medicare was underfinanced by a staggering $37 trillion as of Sept. 30.

That’s the amount — about two and a half times the annual output of the United States economy — that would have to be deposited into the Medicare trust funds to adhere to the principle that members of each generation would contribute enough to Medicare while they were working to pay for their care after age 65.

If corporations were mismanaged in the same fashion there would be a Congressional investigation. Congress is doing a poor job of policing themselves.

The current effort to trim Medicare costs, through initiatives like limiting payment increases to health care providers, amounts to picking the low-hanging fruit. What comes next will surely be more painful and contentious.

Given that context, the government’s accounting practice — counting $748 billion of cost savings and $259 billion of revenue increases toward both Medicare and the cost of the Obama plan — is particularly troubling. Moreover, this problem is largely hidden from public view.

Under Washington’s delusional rules, budget crunchers in both the White House and Congress credit this $1 trillion twice: once in calculating that the care law will generate more revenues than costs, and again in concluding that the Obama plan will chip away at the Medicare problem.

Only in DC can you not only spend the same dollar twice, but you can continue to spend money you don't have and never have to worry about the downside risk of your stupid decisions.

It’s fine to ask the wealthiest to pay disproportionately for important social programs. But the top taxpayers, who are already on the hook for around $260 billion of the law’s costs, can’t be expected to shoulder the entire $1 trillion burden that would flow from intellectually honest accounting.

At a time of trillion-dollar deficits, new initiatives must be paid for in reality, not just the world of Washington arithmetic. The effort to curb Medicare costs must continue and accelerate — but all sides need to be more honest by counting these savings just once, not twice.

Reality check time.

When is a battle not a battle

The title of the article says it all: “The Battle over Billing Codes.”

On Marketplace Tuesday (April 10, 2012), Gregory Warner did a report about one physician who has decided to use the billing codes, known as CPT’s to the maximum effect for maximum revenue. The physician states that by maximizing codes he has increased his revenue “by 70 percent -- hundreds of thousands of dollars per year” by doing the same thing he did.

The article also states that we are paying for medicine the way we have been doing it for years, by procedures. As a business professional, with over 15 years in retail and medicine, I have a question for Mr. Warner. How else are we to pay for services rendered than for the service rendered?

At the end of the segment there is a tease related to ObamaCare:

“So can we get rid of the codes? Well, some doctors and hospitals are already signing up for a new program under the health care reform law that would pay doctors by a lump sum instead of per procedure. “

The new program is the ACO initiative, which is a revised capitation HMO program. A capitation program is where the provider is paid a lump sum at the beginning of a set time frame, usually the beginning of the year, to take care of a patient. What is left at the end of the year, i.e Fee Paid less Medical Expenses = Physician Revenue, is the doc's to keep. But wait: if the care for the patient exceeds the fee paid, can the doctor go back and request more money to take care of the patient? The answer is no, because that would be fee for service. The doctor then has to take money from other patients to pay for the really sick patient or take money from his own coffers. Once the docs realized they were on the losing end in capitation, it went the way of the dinosaurs and the only docs who do capitation today are the ones straight out of med school.

Mr Warner continues:

“But other doctors don't want to give up their independence. Larry Rabon and his family have gotten used to playing the chess game. And if every doctor played as well as they do, then our deficit would really be in trouble. “

Mr. Warner refers to payment for procedure as a chess game, meaning there are winners and losers. The implication is that doctors are “winners” because they want to be paid for their services rendered, as any other service professional. Payment for services rendered is how all services are paid. We pay our hairdresser for a haircut, we pay our tarot card reader for a tarot card session, we pay for a ticket to see a movie or play, etc.

Then as a winner, he states that if all doctors understand the CPT rules and bill as Dr. Rabon does, then it will expand our deficit. I hate to tell Mr. Warner, but with people living longer, 86 is now average, and with the Baby Boomers entering Medicare in droves, that is enough to destroy the Medicare system. Dr. Rabon is not only billing Medicare, which has the strictest billing rules, but also the private insurers in order to maintain his revenue stream.

After years of berating doctors to take coding more seriously, which results in them getting paid for what they do, it is refreshing to find out that one doctor has decided his time has worth.

Drink up, Think up?

Turns out, a drink or two really does lubricate the brain-pan:

"Scientists found that men who either drank two pints of beer or two glasses of wine before solving brain teasers not only got more questions right, they also were quicker in delivering correct answers ... alcohol may enhance creativity problem solving by reducing the mind’s working memory capacity"

It appears that Cliff was right.

Agents vs. The Exchange

Assuming Obamneycrap survives, in 2014 consumers will be expected (told) to buy health insurance through an exchange. Agents have already taken a 50% or higher pay cut on health insurance and many have either left the industry or moved on to other, more profitable lines of coverage. Those that are hanging on in hopes of better times may be disappointed.

LifeHealthPro, an industry publication, has this interesting article on the future of exchanges and how the agent may, or may not, have a place come 2014.

Under the final rule, states will also be allowed to:

• allow agents and brokers to assist qualified employers and employees (as well as individuals) in enrolling in exchange plans (known as “qualified health plans (“QHPs”), and in submitting applications for premium tax credits and cost-sharing subsidies to help individuals pay for their insurance

• allow agents and brokers to participate in the “Navigator” program that is specifically designed to educate the public about exchanges and assist with enrollment

• display information about agents and brokers on the websites that exchanges will be required to set up to serve as an access portal for the public

Supposedly there are several agent associations and even some insurance commissioners petitioning HHS to allow agents to continue to act as advisers for those seeking health insurance.

Then there is the issue of compensation . . .

In light of the recent termination of agent compensation for referrals to PCIP I am (for obvious reasons) skeptical of any income from health insurance activity in 2014 and later.

Even if agents are allowed to participate, there are still some excruciating requirements for those who want to press forward.

If a website of an agent or broker is used to complete the QHP selection, the website must meet certain minimum requirements.

The private website must: meet all disclosure standards and QHP display requirements regarding standardized comparison information and accessibility (e.g., plain language and accessible, timely disclosures), provide consumers the ability to view all QHPs offered through the exchange; not provide financial incentives, such as rebates or giveaways; and display all QHP data provided by the exchange, these lawyers say.

The private website must also maintain audit trails and records in an electronic format for a minimum of 10 years; and provide consumers with the ability to withdraw from the process and use the exchange website instead at any time.

These lawyers note that all agents and brokers enrolling qualified individuals in QHPs or assisting individuals applying for advance payments of the premium tax credit and cost-sharing reductions must enter into and abide by an agreement with the exchange.

At a minimum, the lawyers say, the agreement must require agents and brokers to register with the exchange in advance of enrolling any individuals in QHPs; receive training regarding the range of QHP options and insurance affordability programs; and comply with the Exchange’s privacy and security standards.

Agents and brokers enrolling or assisting individuals through the exchange must comply with all state laws related to agents and brokers, including laws related to confidentiality and conflicts of interest, these lawyers said.

Uh, thanks, but no thanks.

Giving Agents the Boot

Received today via email . . .

Dear PCIP Broker,

You are receiving this notice because you are currently or have previously been registered to participate in the Pre-Existing Condition Insurance Plan (PCIP) Broker Referral Payment Program. The Centers for Medicare & Medicaid Services (CMS) authorized payments to insurance producers with a health care line of authority who successfully refer people to PCIP.

We are writing to thank you for the extraordinary efforts you have made in helping to increase awareness of and enrollment in the PCIP program. The PCIP Program has provided access to health coverage and peace of mind to thousands of Americans who otherwise would not have access to health benefits. You have been an important partner in this effort.

We are pleased that PCIP has provided valuable coverage to Americans with pre-existing conditions. We have determined that our outreach efforts have succeeded in significantly raising awareness of PCIP and enrollment in this program. As such, CMS will end the PCIP Broker Referral Payment Program in federally administered PCIP states as of May 1, 2012. The ability to submit new client referrals will be discontinued on May 1, 2012; however, all referrals that are received prior to May 1 will continue to be processed. So, we encourage you to submit any qualified referrals that are pending before May 1 to ensure that they are received.

If you have any questions about this notice, you may call a PCIP Broker Communication Specialist toll-free at 1-877-872-7890 between 9 a.m.-5 p.m., Central time, Monday-Friday. You can also send questions via email to PCIPBrokerQuestions@geha.com. We appreciate your dedication to helping individuals obtain quality, affordable health care coverage.

PCIP Broker Referral Payment Program

Friday Exchange Update

FoIB (and Director of Health Policy for the Cato Institute) Michael Cannon has 2 words of advice for the 58 state departments of insurance: Civil. Disobedience:

"The most important front right now is to ensure that states do not create the health-insurance exchanges [ObamneyCare©] needs ... Refusing to create exchanges is the most powerful thing states can do ... Think of it as an insurance policy in case the Supreme Court whiffs."

Even I can applaud the mandate for this kind of policy.

On the other hand, Empire State Governor Mario Cuoma has not heeded Michael's sage advice:

"New York Gov. Andrew Cuomo is being heralded as brave for moving forward to set up a statewide health exchange by executive decree ... The Executive Order allows for regional advisory committees of all stakeholder representatives to make recommendations on the establishment and operation of the Exchange."

And so what, you ask?

So this:

"Sen. Greg Ball ... does not see cost savings but more spending the state can ill afford ... “any rush towards enacting [ObamneyCare©] is more political than reality. The promise of federal funding is not without strings and the program itself will ultimately ... cost New York taxpayers billions of additional dollars that we do not have."

Now that's an expensive insurance policy.

The Neasham Chronicles: A Contrarian's Take

For those just tuning in, a quick summary: (now former) California insurance agent Glenn Neasham sold an annuity to an elderly woman. Her family, claiming that she was in fact suffering from Alzheimer's at the time, took umbrage. Mr Neasham, stripped of his license, now sits in jail for felony theft.

The longer version is here and here.

From the first, I've been on the fence regarding this case. For one thing, I fail to see how the "victim" was actually harmed. For another, I fail to see how forwarding a check to an insurance company constitutes "theft." And as much as has been written about this case in the industry media, we still don't have all the facts.

This morning, I came across a terrific analysis of the case written by Sheryl Moore, herself a licensed agent and the grand-daughter of two Alzheimer's patients. She points out several details which, if not disregarded by that media, has seen precious little airtime:

"It is a known fact that the state of California is one of the worst insurance departments to deal with ... they also have a senior-protection law (SB620) that imposes severe penalties for insurance agents selling “unsuitable” annuities to seniors."

Was the indexed annuity product "unsuitable?" We don't know, but it's not a question to be taken lightly.

She notes also that "[t]he bank that held the certificate of deposit [the funding vehicle] ... had discussed with Mr. Neasham their concerns about the prospective annuitant’s decisions, independence and ability to understand the annuity purchase."

This is actually a two-edged sword: the fact that Mr Neasham agreed to accompany Ms Schuber to the bank at all would seem to be a net positive regarding his character and belief that she was, in fact, competent to make the purchase decision.

On the other hand, once he had heard these concerns, perhaps a call to the carrier's compliance department would have been prudent.

I think Ms Moore is a little premature in letting Allianz off the hook. As she (correctly) notes, Mr Neasham represented the carrier, and had a fiduciary duty to it. But it seems to me that this is not a one-way street: the carrier processed the application; as we've been noted, indexed products receive additional scrutiny compared to their fixed-design counterparts.

On the whole, though, I find Ms Moore's analysis to be a refreshing change from the hand-wringing that's characterized this case. Again, my natural sympathies lie with Mr Neasham, and I do believe - based on the facts as we know them - that jail-time was a clear abuse of prosecutorial power. But there is certainly more here than initially met the eye.

Cavalcade of Risk #155: Call for submissions

Jaan Siderov hosts next week's CavRisk. Entries are due by Monday (the 16th).

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 ("Remarks")

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

Thanks!

Update - Mandated Contraception Coverage

On March 21, 2012, the Federal Register contained an Advance Notice of Proposed Rulemaking [ANPR] released jointly by the Departments of the Treasury, Labor, and HHS. This ANPR concerns the recent dust-up over coverage of contraceptives under the Affordable Care Act.

For anyone who is interested, the complete ANPR can be found here [.pdf file].

In the Overview of Intended Regulations (Section II, page 16503) we read:

"The starting point for this policy development includes two goals"

"First, the Departments aim to maintain the provision of contraceptive coverage without cost sharing to individuals who receive coverage through non-exempt, non-profit religious organizations with religious objections to contraceptive coverage"

"Second, the Departments aim to protect such religious organizations from having to contract, arrange, or pay for contraceptive coverage."

Later in the same section, we read:

"For such religious organizations that sponsor self-insured plans, the Departments intend to propose that a third-party administrator of the group health plan or some other independent entity assume this responsibility."

Notice that the first aim quoted above makes it crystal clear that the administrations’ consistent use of the term “accommodation” is both significant and deliberate. No compromise is intended, and accordingly this ANPR does not seek ideas for any compromise.

Second, the remark regarding self-funded plans reminds me of every manager’s last desperate hope when completely out of ideas: “ . . . and then a miracle happens.” It will be fascinating to see which, and how many, third-party administrators or other independent entities will actually agree to assume this responsibility. It will be equally fascinating to find out how it will be paid for. Who knows, maybe there will be a miracle - I'm guessing that’s what the administration hopes, anyway.