Gaming O'Care in the news

Co-blogger Patrick has written quite a bit about the challenges that carriers face regarding the overly generous 90 day grace period enjoyed by folks who buy their ObamaPlans on the Exchange.

Now, some 4 years since they first opened for business on that platform, carriers are beginning to realize just how dangerous that game of chicken has been.

For them:

"They are using [health insurance] until they need it and then when they don't need it, they get rid of it"

That's Patrick, as quoted in this morning's US News online edition, where he and FoIB Louise Norris share some interesting, disturbing insights.

Recommended.

Hey Senator Rubio, Give Credit Where It's Due

Obamacare supporters need to stop giving Marco Rubio credit for the splinter he wedged into Obamacare's fingertip. The splinter is the language Rubio inserted into the 2014 CRomnibus that made Obamacare risk corridor payments budget neutral.

When Obamacare passed, the risk corridor provision - which is a temporary program - was written with very vague language. The program existed but didn't specify where funding was coming from. Theoretically it was going to come from a combination of the profitable insurers and the federal government sending payments to insurers who suffered losses.

Because there was a chance of government funding, the GOP called out risk corridors as a bailout for insurers. To combat the political gamesmanship, the Obama Administration pushed a narrative that the program would pay for itself and pointed to an April 2014 CBO document stating the budget neutrality position.

Based on the CBO numbers, Senator Rubio's risk corridor language shouldn't have been an issue. But like many CBO reports, the actual results are a far cry from their rosy projections. In 2014, risk corridors paid out roughly 13% of what they were supposed to. CMS just released preliminary data for 2015 and have made it clear that they will have another shortfall this year. All of this is resulting in pundits and politicians calling the GOP the devil or heroes.

Unfortunately they've got it all wrong. Marco Rubio inserting language into a budget amendment didn't make the legislation pass. That would come from all of the brains in DC who vote on the bills. It also comes from a Presidential signature making the bill become a law.

In CRomnibus, its not about what Rubio did. It's about the bipartisan approval (57 Democrats in the house and 25 Democrats in the senate) that voted in favor of the bill. And let's not forget President Obama who signed it into law.

These are the elected officials who put risk corridors in jeopardy. They are the ones who should be given credit.

Sorry Marco.

MVNHS© vs Autism

If you, or a loved one, is on the autism scale, you need to be very afraid of ObamaCare's ultimate goal of Single Payer.

Why is that, you ask?

Here's why:

"The euthanasia of Nancy Fitzmaurice, a severely disabled child who was not dying, has made international waves ... Nancy’s mother had requested that her daughter be killed and was granted approval by the British legal system."

As we've mentioned before, "who pays the piper calls the tune." And while this may the most egregious example of that we've seen, even by the standards of the Much Vaunted National Health System©, it's absolutely how Single Payer works, how it has to work. And of course, little Nancy's only advocate was the one who petitioned for this outcome.

When an unelected, unaccountable Star Chamber is given free rein to make these kinds of life-and-death decisions, and when the cost of life becomes the value of it, well, that's what we're headed for here.

Now, some would argue that this isn't about the MVNHS©, per se; that it's about the British legal system. And they'd be right - up to a point. That point is that regardless of the agency which murdered this little girl, it was the state that ordered it done.

Be careful what you wish for.

[Hat Tip: C. C. Pecknold]

Bad News and Good News, Enrollment edition

As we've noted previously, the Marketplace seems to have a problem keeping out the riff-raff:

"[F]ederal watchdog office did set up 10 phony insurance coverage accounts with no pushback from those overseeing the applications."

That was a year ago, and we're happy to report that there's been a 50% improvement in those numbers:

"Investigators got coverage approval for 15 out of 15 fake people this year"

Okay, I suppose that depends on one's definition of "improvement."

The GAO was apparently unable to make premium payments for three of these "people," which I suppose is reason for celebration, although where those funds would have come from (and where they did originate for the 80% of those who successfully ponied up) remains a mystery.

On the gripping hand, I am pleased to report that none of these "insureds" racked up more than $10,000 in medical expenses.

That we're aware of.

Garden State Breaking: Another one bites the dust

Oops:

"The [New Jersey] state Department of Banking and Insurance moved Monday to take over Health Republic — known as a consumer-operated and –oriented, or COOP, plan — because of its “hazardous financial condition.”

As with Ohio's own InHealth, and most of the other Co-Ops, the numbers just didn't add up. and the carrier has been forced to fold.

Just in time for Open Enrollment v4.0.

And the timing couldn't be better (for certain values of "better"): when this happens, policyholders are generally eligible for a Special Open Enrollment. Which means they'll be looking for new plans over the coming weeks, and then new new ones a few weeks later. Oh, and looking at three - yes three - deductibles to be met in a year's time.

Yippee!

If You Like Your Plan: Part #4,287

One of the most pernicious claims made by President Obama (and his surrogates) has been the promise that "if you like your current insurance, you can keep it." No rational person ever actually bought that, but it made a great sound-bite (or 3,000). As we all know, with each passing year we're been offered fewer and fewer choices, and very few people have been able to actually keep their plans.

Folks in the Tar Heel State have even fewer choices coming up in November:

"Most in N.C. will have one Obamacare option in 2017"

And to no one's real surprise, that carrier is ... Blue Cross/Blue Shield. Yes, that Blue Cross:

"The N.C. Department of Insurance announced Monday it will broaden its investigation into Blue Cross and Blue Shield of North Carolina, citing “disagreements” with the insurer."

Looks like that particular endeavor is about to hit the trash bin of history.

[Hat Tip: FoIB Jeff M]

Off Topic: Gamer edition

FoIB (and gaming entrepreneur) Fat Dragon Games has just fired up their latest KickStarter, and it's a doozy:

"The DRAGONLOCK™ terrain system for 3D printers allows you to create modular interlocking buildings of your own design."

Pairing the incredible opportunities of newly-affordable 3d printers (I've been assured that really good ones can be had for less than $400) with over 20 years of terrain design experience means tremendous value, and some really good fun.

Click here to get in on the ground floor.

Read all about it at this week's Health Wonk Review

This week's Health Wonk Review is hosted by David Williams at Health Business Blog.  

Do check it out, no library card required!!  You'll be glad you did.   

Don't Get Too Excited Pinal County

News broke of Blue Cross Blue Shield of Arizona remaining in the marketplace in Pinal County, Arizona late on Wednesday. Obamacare supporters will rejoice with a thunderous round of applause to the insurance company and positive vibes about how tax credits will keep costs low. But the folks in Pinal County have little to get excited about.

In 2016 residents of Pinal County had two insurers to choose from. The previously mentioned BCBS and United Health Care. UHC offered ten insurance options including Gold, Silver, and Bronze plans. All ten were PPO plans that included a more robust provider directory. With UHC exiting the market those are gone.

BCBS offered five plans. Two Silver plans and three Bronze plans. The lowest deductible with their plans is $2750 for single coverage. The two Silver plans were the highest and 3rd highest cost silver options available which should make them less appealing to shoppers. But the limited number of plans isn't the worst of Pinal County's concerns.

Cost is the number one driver for purchasers of insurance, which makes the accompanying statement from BCBS even more concerning. In their announcement to remain in the marketplace, their Senior VP of  sales, strategy and marketing, Jeff Stelnik, said premiums will increase by 51%. 

Obamacare is working for you Pinal County residents. You have an option. You have choices in that option. Be grateful for what you have. Because unless we eliminate this train wreck of a law the next time government talks about "health care reform" it will be for single payer.

Precision Cannon Fire

As we noted a week ago, some Grand Canyon State citizens are going to have a problem this November:

"People in Pinal County are at risk of a health insurance problem that hasn't happened anywhere else in the country: no companies offering marketplace health insurance"

Turns out, Aetna was the sole remaining carrier on that state's Exchange, and they've bailed. That means that, if you live in Pinal County (home of the Boyce Thompson Arboretum) and you want to buy health insurance, you'll have to buy if off the Exchange.

Which also means you get to pay full-freight: no subsidies for off-Exchange plans.

And that most likely means you'll be faced with plans that are unaffordable. No problem: the ObamaTax makes provision for such circumstances, and offers an exemption for folks who can't afford premiums.

Except there's a pretty significant, but under-the-radar, catch: this exemption won't be available to the folks in Pinal County.

Why not?

Well, as FoIB Michael Cannon explains, "[t]he unaffordability exemption applies only if “the annual premium for the lowest cost bronze plan available in the individual market through the Exchange” is unaffordable." But there are **no** plans on the Exchange.

See the problem?

Read the whole thing, you'll be glad (and/or furious) that you did.

Medical Necessity: Here we go again

If you want to understand why your rates keep going up, you can lay a big chunk of the blame on items like this (in email from Medical Mutual this morning):

"To be compliant with the non-discrimination rule outlined in the Affordable Care Act (section 1557), we will remove broad exclusions for gender transition treatment"

Let's dial back a bit, and talk about why this is so stupid. In the earliest days of this blog, we participated in a discussion with other bloggers about medical necessity and In Vitro Fertilization (IVF). We averred that:

"[A]ccording to the standard industry definition, “medical necessity refers to treatment which is required to treat or care for symptoms of an illness or injury or to diagnose an illness or condition that is harmful to life or health.” Thus, we see that IVF fails to meet the threshold of “medical necessity,” ergo it should not be covered by insurance."

That is, no one has ever died because they couldn't/didn't get pregnant. Likewise, there is no evidence that anyone has ever died because they didn't get their personal bits chopped and/or replaced (excluding obviously medical issues like cervical or breast cancer and the like). There is, however, ample evidence that these folks are at much higher risk for attempting suicide (which would then require medical treatment in the most expensive part of the hospital).

So when insurers are forced to pay for non-medically necessary procedures, that cost is going to be passed along in the form of higher insurance premiums. Now, am I blaming Medical Mutual for this change? Of course not, they're simply following directives sent down from Our Betters in DC©.

What choice do they (or any other carrier) have?

It's not rocket surgery, after all.

More 3000% rate decreases

This never gets old:



So two more individual medical renewals hit my desk this morning. Both are with the same carrier, both are HSA-compliant with $3000 per person deductibles then 100%, both are grandmothered (meaning they're only partially ObamaCare-compliant, but still "kosher") [ed: for now]:

Sally and her family of four currently pay about $930 a month; their rates are going up 15%, to $1,065 per month. This means that the family will spend just shy of $13,000 before the plan pays bupkes.

Still, that's a bargain: a comparable fully compliant plan will set them back about $1200 a month, and that's with a $6500 per person deductible. So they'd have the privilege of more than doubling their medical expense out-of-pocket while paying only 20% more in premiums.

Such a deal!

Terry's increase is 17%, from $295 a month to about $350. That's also still a bargain: a comparable new plan goes for $480 a month and also comes with a $6500 deductible. This means that Terry would be out almost $11,000 before the plan paid a dime. Well, except for pap smears, mammograms and birth control convenience items. Oh, did I mention that Terry's a 53 year old guy?

And they're the lucky ones.

Insurance working properly, Wellmark-style

They say that "the exception proves the rule," and I think that FoIB Allison Bell has found the exemplar:

"Wellmark Blue Cross Blue Shield of Iowa says it spent $18 million on medical bills for just one patient in 2015."

And that's just from July forward. The patient suffers from a ""severe genetic disorder," and is racking up about $1 million a month in claims. In fact, this one insured accounts for some 10% of the almost 43% rate hike Wellmark's seeking for 2017. As this is a fully compliant ObamaPlan, there's no end in sight, since there's no cap (aka "lifetime maximum").

So why do I call this "insurance working properly?"

Well, because insurance should be about spreading the risk (and the pain). And this certainly qualifies: no average person could afford this kind of health care spending on his own. And since it's a genetic disorder, I don't feel any moral qualms as I would for someone with a lifestyle-related condition. This is simply the hand that this person was dealt.

And yes, it's a lot of money, and money means resources, being spent on one person. My faith requires me to "choose life," and that's the over-arching sentiment here. It's not for birth control convenience items or routine expenses, it's for a catastrophic claim, what health insurance should be about.

May this poor soul find a path to healing.

Mid-Week Linkage Roundup

■ From the "Everything Old is New Again" Department: My late mother had Post-Polio Syndrome, a result of childhood exposure, but (thankfully) she never had the full-blown version of the dread disease. A common treatment for those that did was the so-called "iron-lung." Fortunately, we've long since eradicated polio, but FoIB Allison Bell warns that we may have to dig those old machines out of mothballs:

"Zika May Be Polio All Over Again ... the CDC concluded, “after careful review of existing evidence,” that “Zika virus is a cause of microcephaly and other severe fetal brain defects” in newborn infants."

Heads' up.

■ Co-Blogger Mike thinks that Belgium might be catching up to Sweden in the Bizzaro World medical tourism race:

"Euthanasia tourists are flocking to Brussels to get a lethal dose. Doctors at hospitals and clinics at Belgium’s capital are seeing an increase in number of euthanasia tourists who are travelling from across the world"

Supply and demand.

■ FoIB Jeff M first alerted us to troubles brewing for North Carolina's Blue Cross franchise back in May. Today he shares this update in the continuing saga:

"The N.C. Department of Insurance announced Monday it will broaden its investigation into Blue Cross and Blue Shield of North Carolina, citing “disagreements” with the insurer."

At issue are continuing IT and claims processing issues.

Gotta love the tech.

■ And finally, via FoIB Holly R, this sad (and highly unusual) case from Great Britain (and for once, it's not about the MVNHS©):

"[A] 61-year-old British bagpipe player who developed a dry cough and breathlessness that worsened over a period of seven years ... He died several weeks after entering the hospital"

Turns out, several different - and deadly - fungi had taken up residence in his bagpipe, which he had neglected to clean. Truly sad, but perhaps a helpful warning to fellow pipers.

Death by Amazing Grace?

Tick-Tock: Welcome to the Walmart Marketplace

As we noted earlier this month, agents have the opportunity to sell ObamaPlans at Walmart stores around the country. But the window for signing up to do so is closing.

From email:

"Tomorrow (August 31) is the last opportunity for agents and brokers to sign up to enroll consumers in Marketplace plans in Walmart stores.

In order to participate in this Walmart event, you must hold a valid state license and be trained and registered to participate in the Marketplace for 2017."

Interested? Then click here to get started. And any readers that do choose to participate are encouraged to let us know what you think of the experience.

MVNHS© circling the drain?

Earlier this month, we noted the financial difficulties facing the Much Vaunted National Health Service©, and observed that if you're a government-run health care system and you're going broke, that's a problem. But it's not the only problem - lack of self-awareness is also strong:

"Yet oddly, rationing is not entirely dead. It is alive and well and making a comeback in our “precious” National Health Service." [emphasis added]

Just now noticing that, Jeremy? Had you been a regular IB reader, you'd have seen examples for years. Better late than never, one supposes. And he does, in fact, make an extraordinarily brilliant point:

"In a tax-funded health care system, the normal, self-limiting rules of supply and demand don’t apply."

Which is exactly right, and we're already seeing signs of it here, with only a partially government run health care scheme:

"A majority of new enrollees are considered high risk, meaning insurers will have to spend more money on people in poor health and requiring expensive  care."

Mr Warner goes on to point out three "new elements" that have entered the picture: mass communication, an aging society, and ever-growing, ever-changing tech. Notice the elephant in the room that he doesn't mention?

[Hat Tip: FoIB Peter K]

History Can Be Fun

Shortly after ACA was enacted into law in 2010, Senate Finance Chairman Max Baucus, whose Committee wrote most of it, "tried to calm an angry Montana voter by saying this: “Mark my words, several years from now, you’re going to look back and say, “Well that wasn't so bad after all”. 

Senator, we did mark your words.
 
It’s now been several years. 

It's pretty clear the average person today would NOT say: “Well, that wasn’t so bad after all”.  

In fact, a great many Americans are still looking for a good reason to calm down about Obamacare.

I think perspectives like these help explain why history can be fun.

Now in fairness to Senator Baucus, he had begun to change his opinion of Obamacare, in fact had become a critic, within a couple years of its passage.  Not necessarily because he disagreed with Obamacare's goals; more likely because the Administration's fumbling, bumbling, and rumbling threatened to prevent the law from accomplishing its goals.

The Washington Post reported Senator Baucus' changing opinion during 2013.   Early that year,  the Senator told HHS Secretary Kathleen Sebelius, “I just see huge train wreck coming down. You and I have discussed this many times and I don't see any results yet.” Later that year, the Post reported Senator Baucus commented (about the health-care exchanges and the government enrollment Web site) "Let's just see how much of this can be put together, how much Humpty Dumpty can be fixed, in the next month."

Well, hmmm.  Mmmaybe it WAS so bad, after all?  Even my Magic 8-Ball replied "It is decidedly so".  

I suspect Senator Baucus' deteriorating confidence in the success of Obamacare may have been a factor in his decision to retire from the Senate at the end of his term in 2014.  I also wonder if Senator Baucus' public criticism of Obamacare, especially his use of the descriptions "train wreck" and "Humpty-Dumpty," was a factor in prompting Mr. Obama to name him an Ambassador in 2014 and get him out of the country.  China, to be exact.

I think questions like these also help explain why history can be fun.

EpiPen: The EpiLogue

The other day, I linked to David Williams' insightful post countering the conventional EpiPen narrative. Turns out there's even more fallout:

"Mylan, said that the generic EpiPen would be available in several weeks and be identical to the existing product, which is used to treat severe allergic reactions. But it would have a wholesale list price of $300 for a pack of two, compared with just above $600 for the existing product."

As a friend noted today on Twitter, it's unclear on how they're going to compete with themselves and still come out ahead.

Not my monkeys, not my circus.

[Hat Tip: Co-Blogger Bob V]

Healthcare is Different. Real Different.

Modern Healthcare has released its list of the top 100 most influential people in healthcare.  It's an annual list.

It's worth your time to scan the whole list.  As you do, don't overlook the fact that not one of the top 25 is a physician.

Not one.

Plenty of politicians, lawyers, MBA's, and accountants. Couple of nurses. A phys Ed. Major. Not one physician.

President Obama is #1. (Modern  Healthcare doesn't really say whether it distinguished between positive or negative "influence" assembling their list.). You'll also notice Loretta Lynch, Paul Ryan, John Roberts, even Bernie Sanders.  But not one physician.

Can anyone imagine the automotive industry's 25 most influential people not including even one senior mechanical engineer?  Or the 25 most influential construction executives not including even one experienced building contractor?  Or the 25 most influential American military figures not including even one general or flag rank officer?

But it's all good, because, you know, "Healthcare is different".

Bad News for Obamacare in Ohio

Ohio’s individual health insurance market is failing. In less than 12 months we have seen HealthSpan, InHealth, United Health Care, and Aetna exit the Obamacare Marketplace. Another insurer local to Northwest Ohio, Paramount, is reducing its footprint for their HMO products. Now comes official word that Medical Mutual will be eliminating all PPO products and will no longer participate in 65% of the state.

For people living in 19 counties choice is no longer an option. Anthem will be the sole insurer they can purchase a plan from. In 28 counties there will only be two insurance carriers to choose from – Anthem and one other. These 47 counties make up more than half the state of Ohio. This is a far cry from 2016 when Ohio boasted of having at least four insurers in every county.

MMO’s PPO plan elimination is even more important for those it will still serve. Their largest number of insured members were enrolled in a PPO product. The PPO network was very robust and allowed members to utilize several hospital systems and specialists. That choice is gone. Going in to 2017 the remaining insurers all utilize narrow networks. For consumers in some counties this means that they cannot have services from the local community hospital that serves them. For others it means that they will have to find new cardiologists or oncologists. This will be especially problematic for outlying communities.

The bad news doesn’t stop there. In addition to less choice, rate increases are estimated to rise nearly 13%. As the only statewide insurer, Anthem is seeking a 9.9% average increase for their plans. Overall this is less than the average but it is relevant to point out that they already had some of the highest rates in the state. Other insurers such as Medicaid managed care providers Caresource and Premier are seeking increases of 13.5% and 39% respectively. Now they will be taking on the additional risk coming from insurers who are losing their shorts in the Obamacare marketplace.

Higher rates, less insurers, and fewer providers. Exactly the opposite of what Obamacare promised.