Much ado about not much (Twitter-style)

Several months ago, we posted about a misleadingly-named plan that purported to cover potentially business-hurting Tweets:

"[T]hese plans aren't really what one would call a traditional insurance product; rather than indemnifying via dollars, they "instead offer 24-7 public relations assistance should Trump’s ire befall them."

But with more and more folks (famous or not) baring their souls (among other things) on social media, there's a very real danger that one could end up on the wrong side of a defamation (libel) suit for dissing a company or another person. Our friend Allison Bell (ironically) tweeted a link to a recent story about an actual insurance plan now available to thee and me, not just professional journos:

"A longtime necessity for journalists, such policies are now being sold to the average American, bundled with more traditional policies covering homes and cars."

Which is nice, and true, but hardly "breaking news." I turned to our longtime guru of all things P&C, Bill M, who confirmed that homeowner's plans (and umbrellas) already include coverage for libel and slander, and specifically the "duty to defend;" that is, the insurer is on the hook for one's attorney fees (with some caveats). So, more a new way to look at already common (and important) coverage.

Wednesday Linkage

In no particular order:

■ Back in Aught Nine, we reported on a real life version of a classic sci-fi widget:

"Robert A Heinlein, wrote a haunting short story about a scientist, Pinero, who discovered a means to literally and accurately determine one's date of death."

That post was about an online, virtual lifespan calculator. But now co-blogger Bob V tips us to a company that claims to have a real-life version:

"GWG Life ... started requiring those people to turn over a saliva sample. Its quarry: patterns of DNA methylation. In layman’s terms, it analyzes the samples to see whether certain genes are switched on or off at hundreds of specific spots."

Why?

"In theory, that could help the company predict your life span"

It's not a slam-dunk, but along with the burgeoning market for genetic testing, we may be entering a very interesting (kinda scary) era.

■ Our friend The Political Hat picks up on a theme familiar to IB regulars, assisted suicide as healthcare cost container:

"Increasingly, suicide is being accepted as a legitimate medical treatment."

And he provides video from a Silver State doc to back this up.

Oy.

■ From the Turnabout Is Fair Play Files we have this item, Jay Hancock tells us that former drug reps are now working for insurance companies, touting lower cost alternatives:

"As a drug salesman, Mike Courtney worked hard to make health care expensive ... He’s on a different mission now: When he calls on doctors, he champions generic drugs."

How he got there is pretty darned interesting.

Bonus: FoIB Kim D provided us with this link to a neat slideshow about 15 common mistakes folks make when they're buyng insurance.

The Cobbler's Insurance

Everyone's heard the old saw about how the cobbler's kids go shoeless. Well, here's a cautionary insurance tale along those lines.

Two years ago, we lost our beloved 13 year old puppy to a virulent form of canine leukemia. As with many human cases, the last few days saw some rather hefty health care provider bills (which, all told, included a comma).

This past December, we decided that we were ready to welcome a new puppy into our home, and were adopted by a very cute, lovable, high energy rescue mix. Unlike our previous two, we had this one "chipped." Part of that process involved getting a quote for pet insurance, which we did. It wasn't really a major expense ($30/month? Something like that), but we kept putting it off. After all, she's only a puppy, what could possibly generate a big enough vet bill to justify it?

Yeah, I know.

This weekend, the poor thing let out a major yelp running down the hall, and hobbled back in on 3 legs, the fourth one just ... dangling. We were getting ready to take her to the emergency vet when she "shrugged it off" and resumed 4-legged mode. Okay, just a one-off, no biggie.

Except that this continued every few hours. I was able to get a vet appointment for this morning (we've used this vet through 3 dogs, well over 20 years, and they're wonderful). Take the poor little one in, and turns out she has a congenital knee ligament issue (not uncommon in small breeds like hers). Thankfully, it's not life-threatening, but it does need to be addressed, soon, and surgically.

And yes, there will be a comma involved.

And yes, that $30 a month seems much less of a burden now.

But unlike ACA plans, pet insurance doesn't cover pre-existing conditions. So, (expensive) lesson learned.

Anthem Exiting Ohio Exchanges!

In a producer news release Anthem has announced it will pull out of Ohio for on exchange business in 2018. They will be reducing their off exchange options too. From the release:

"As the Individual marketplace continues to evolve, we look forward to seeing important changes made to the health care law. We hope these changes will stabilize the market and allow us to have a more robust presence in the future." 

This is huge news as Anthem was the only insurer available in 20 counties in Ohio last year. For another 28 counties they were one of two insurers in the market. We will update IB as more details are shared.

UPDATE: Anthem is also pulling all off exchange plans except for one Catastrophic plan offering in Pike County. They are doing this so it doesn't constitute a full exit. Under HIPAA rules full exits require insurers to leave markets for five years.

SOMETHING TO PONDER: The echo chamber is focusing on CSR's as the main reason for the pullout. If this were true then why would Anthem pull their off-exchange products? These plans don't offer CSR's to low income nor do they offer subsidies.

Carrots and Sticks: Empire State-style

As more and more carriers exit more and more states, New York Governor Andrew Cuomo thinks he's hit on a useful solution: leave the health insurance market, kiss other opportunities goodbye, as well:

"Insurers that leave the individual market would be cut off from participating in other government health programs, including Medicaid, the Children’s Health Insurance Program and the Essential Plan"

Two thoughts here:

First, good for him. While I generally dislike the heavy the hand of government forcing a company into a specific behavior, it seems to me that it's not only within that entity's purview to make the choice to leave a painful one. After all, he';s not forcing carriers to stay, just incenting them to consider such a move in terms of the bigger picture.

After all, I've always been a fan of the 58-state laboratory model.

Second, what the heck is an "Essential Plan?"

Well, it turns out that it's one of the "Basic Health Plans" the previous administration greenlit targeted at low- and moderate-income folks. It's not quite "bare bones," since it still includes a number of "freebies." On the other hand, it costs $20 a month per person (in some cases, not even that), and includes "free" preventive care.

Your tax dollars at work.

[Hat Tip: FoIB Allison B]

Self Defense Insurance

We've blogged before about the challenges one faces if forced to use a weapon in self-defense, even folks with concealed carry permits. After all, you intentionally hurt or killed someone. The permit may help you out in court, but you're still on the hook for attorney's fees.

The problem is that your typical homeowner's policy (where one would ordinarily look for some help) excludes intentional acts like shooting someone, and there's no "except when they're attacking you or your loved ones" clause.

Recently, though, Erie Insurance has introduced its Select bundle, which "includes criminal defense cost reimbursement ... when the insured is found not guilty of the charges." Of course there are some hoops, but this is the first time we've seen a major carrier extending this kind of cover.

Kudos, Erie!

[Hat Tip: FoIB Bill M]

Another Outstanding Customer Service experience

So, we decided it's time for our now-9 month old puppy to finally have free rein (well, mostly) in the back yard. Some 17 years ago, we'd purchased an "invisible fence" type system for her predecessor (this one as a transmitter rather than an in-ground wire). When she passed, we tossed the radio collar (long story).

Fast forward two years, and I go online to buy a emplacement collar. What I didn't know (and failed to check) is that not all such collars (even ones from the same manufacturer) are equal. I soon learned this the hard way.

This weekend was "the" weekend, and I opened up the package, inserted the battery, and powered up. I could tell that the unit was powered on (the little LED blinked just fine), but I couldn't get it to actually work. In desperation, I even read the directions - but alas, no joy.

I called PetSafe's (the manufacturer) 800# helpline, and spoke with a very nice young lady who confirmed that I had purchased the type that goes with the hard-wired system, and suggested I contact the seller to see what could be done.

And so I did, and even though I'd bought the unit in April, and had opened it, they immediately refunded the entire purchase price, and set me up with the correct one (which should arrive tomorrow). I could not be happier.

And just who is this remarkable vendor? Well that would be Chewy.com (from which we've also been buying the little one's food). I just can't say enough good things about them.

Recommended.

Yeah, about that Golden State Single Payer Plan

Hahaha.

Bwahahaha!

"In addition to a 15% payroll tax, Sacramento is looking at a 2.3% business tax on gross sales receipts."

Look at that last bit carefully: the new tax is on revenue, not profit.

I'm sure this will pose no problem for California-based businesses.

Totally unrelated: is that Greg Abbott I hear?

But wait, it gets even better (for certain values of "better"):

"The state will also impose a new 2.3% sales tax on top of a statewide average sales tax of 8.44%"

By the way, this is a regressive type of tax, meaning that it will disproportionally affect (ie hurt) the poor.

[Hat Tip: Insty]

Timing really *is* everything

A couple of years ago, I noticed that one of our client's 20 year term policy was about up. As I usually do, I reached out to him to suggest that it might be a good idea to pre-empt the anticipated rate hike (SOP on plans of this type) by looking at either a new plan with a fresh lock-in period, or perhaps considering a permanent plan of some type, either through the conversion option or a new plan altogether.

Or some combination of these.

We went back and forth for a few days, and he ultimately decided to "let it ride."

It's amazing how quickly 20 years flies by: the term lock-in period ended in April, and he missed sending in the new premium; the policy is in immediate danger of lapsing.

Ordinarily this likely wouldn't be the end of the world, but in this case there's a rather significant twist:

When I got in the office yesterday morning, there was a voicemail from Roy asking for my help. I first called Home Office for some info I knew I'd need, then Roy, and suggested that he pay a quarterly premium to buy us time to figure out where to go from here. He asked me about a new term policy, and so I started asking my usual pre-screen questions. Started, and then immediately stopped:

Roy told me that he'd had a bout with prostate cancer last year. After surgery, he's now fine, but he's also now off the market for an underwritten plan (yes, I checked with our primary and another carrier to confirm). We're still exploring options (again, he still has the conversion privilege available), but they're expensive, and there aren't a lot. I did confirm that he still needed the coverage, so we'll have to figure out what's the best alternative.

Of course, the best alternative would have been to have secured new coverage before the cancer. And of course no one knows when or if it'll strike. But as a good friend is fond of saying, we don't buy insurance with our wallets, we buy it with our health.

#NotNews: Euthenasia edition

The Washington Times is reporting that carriers are now (allegedly) denying life-saving treatment to folks who live in states that have approved assisted suicide:

"A Nevada physician says insurance companies in states where assisted suicide is legal have refused to cover expensive, life-saving treatments for his patients but have offered to help them end their lives instead."

Well first, this is hardly news; regular IB readers have known about this since last fall:

"One young mother says her insurance company denied her coverage for chemotherapy treatment after originally agreeing to provide the fiscal support for it, but indicated it would be willing to pay for assisted suicide instead."

This was in Oregon, one of the states cited in the WT article.

Second, I question why the folks in Nevada want to transfer their patients to other states, especially knowing that they've approved assisted suicide. Seems like almost every other state would offer a better path, no?

And I don't get this: the Patients Rights Action Fund(?) has released a video purporting to prove that carriers just care about the bottom line, not saving lives.

Here's a news flash, PRAF: of course they do. Insurance is a business, and its stakeholders expect a return on their investment. As long as what they do (or don't do) is legal and aboveboard, then that's the extent of their obligation. Do carriers do stupid things? Of course they do (we have a long-running series on Stupid Carrier Tricks).

But this doesn't seem to be one.

[Hat Tip: FoIB Holly R]

The $1 Million Question

Recently, we reported that The Hawkeye State will be facing a severe shortage of health insurers quite soon:

"Medica, the last insurer selling individual health policies in most of Iowa, likely to exit"

But before that development, Wellmark Blue Cross had already announced their departure from the state's market next go-round. One of the reasons cited was an extreme case involving a claim that (according to Wellmark) is costing the carrier some $1,000,000 a month. As expected, there was some (much?) skepticism about this, but now the carrier's Exec VP has disclosed - at a Des Moines Rotary Club meeting - that the insured is a teen-aged boy with hemophilia.

She didn't mention his name or hometown.

But here's my question: should she have even disclosed this much? I wonder because it seems to me that this comes pretty close to the line regarding disclosure of PHI (personal health information). On the other hand, folks are constantly railing on carriers to "put up or shut up" about the effects of claims on premiums.

On the gripping hand, I just have this feeling that a line was crossed here.

What say y'all?

Health Wonk Review has Sprung!

As in: Andrew Sprung hosts this week's outstanding collection of posts on health care bloggetry. As expected, lots on the ACA/AHCA, but also interesting posts on the opioid crisis and quality-of-life issues.

CanuckCare in Crisis

Last we looked, our Neighbors to the North© had some serious problems with their national health "care" scheme:

"Euthanasia became legal in Canada in June and by December Quebec bioethicists had already published an article in the Journal of Medical Ethics calling for organ donation after euthanasia."

How lovely. But certainly things have progressed and they're no longer in such a bind, right?

Um:

[Hat Tip: IP4PI‏]

Interesting STM Solution

Regular readers know that, effective April 1st, the maximum amount of time for which a given short term medical plan may stay in effect is 3 months. This poses a number of challenges to folks who, for whatever reason, are between Open Enrollment periods and find themselves uninsured.

When the gummint, in its infinite wisdom, unceremoniously (and frankly, of dubious legality) announced that no plans could extend past three months, these folks had a problem. Previously, they could have bought a 9 month plan, paid it monthly until they no longer needed it, and been relatively okay: although these plans don't cover pre-existing conditions, if something new cropped up during the term of the plan it'd be covered.

Now, though, they'd have to buy a new plan for month 4, and if something happened during months 1 through 3, they were outta luck.

Which is a quandary, indeed.

Yesterday, though, I got an email from the "General Agent Center" touting a plan offering up to 9 months of short term coverage. Intrigued, I called to see how they could do this. Turns out, they have a very interesting set-up: one buys (up to) four 3-month policies (payable monthly). The first one, of course, covers no pre-existing conditions. At the end of each 3-month term, the deductible and co-insurance "reset," but any health issues arising after issue are covered during successive periods.

So, for example, if one had a heart attack in week three of the first "duration," it wouldn't be considered pre-existing (and thus excluded) in durations 2 or 3 or 4. There would be new deductibles to meet, but I'm guessing these are a miniscule fraction of the ICU costs.

Outside-the-bun solution, no?

More ACA Anecdata

Another in a continuing series on the impact of ObamaCare on the lives of ordinary citizens:

Sally and Dave are longtime clients, with a Grandmothered plan boasting a $5,000 per person deductible, then 100% after that for covered expenses. The family max out-of-pocket is $10,000, and the plan is built on the PPO model (which means they have coverage both in and out of network). They're in their late 50's, and in good health.

Their current plan renews in a few months, and will be going up some 15%, from $680 to about $790. As usual, I went out to the 404Care.gov site to do some comparison shopping. The least expensive plan I could find ran a little over $900,with a $6500 deductible, and a max out of pocket of just over $14,000.

So they could spend an additional $1,200 for a plan with 40% higher exposure.

On the other hand, it does cover birth control.

Oh, and they shouldn't feel too awful about that 15% rate hike. As FoIB Holly R notes:

"Premiums for individual health plans doubled between 2013 and 2017"

Such a deal!

More #ACAWinning, BX-style

Another day, another Blue Cross blues story.

Or rather, a couple BX blues stories:

■ Not to run up the score, but about that "if you like your plan, you can keep it" promise?

Well, FoIB Holly R has some sad news:

"Blue Cross and Blue Shield of Kansas City ... just announced that -- everyone, put on your shocked faces --  it's withdrawing from Obamacare."

Of course, if you lose north of $100 million over the previous 3 years, this shouldn't be a surprise.

■ And FoIB Jeff M alerts us that:

"Blue Cross and Blue Shield of North Carolina announced that it has filed for a 22.9 percent rate increase"

Seeing as how they're the only statewide carrier, seems like that may, in fact, be a bargain.

A major factor in the amount of the increase is the cutting off of CSR (cost-sharing reduction); that is, the Feds are shutting off the flow of that sweet, sweet slush fund carrier-subsidy fund. Which, contrary to conventional wisdom (ie The MFM), as always been the plan.

Oh, well.

Oh No CBO

The world is coming to an end! According to CBO (cough, cough) by 2026, 23 million people will lose insurance as Obamacare is "dismantled". This is the headline reverberating through the MSM echo chamber.

The reality is something very different than what is being portrayed. Here are four reasons why the CBO score is flawed.

Baseline Data

Under CBO rules the only way to determine the impact of a new law is to compare it to the data presented under current law. The baseline that was used in calculating the impact of AHCA was from 2016. At that time CBO projected that this year there would be 15 million people enrolled in exchanges. Actual plan election - not paid enrollment - for 2017 was 12.2 million. History shows that 10% never pay a premium giving a conservative true paid enrollment at 11 million.

What this means for the AHCA score is that CBO is assuming 4 million more people starting out with insurance than the actual number.

Medicaid Expansion Assumption

Another significant figure is the number of people who will lose Medicaid. There are 31 states plus DC who have expanded Medicaid. Without a doubt killing the expansion over the course of a few years will decrease the number of people eligible in these states. But, with no changes to Medicaid funding prior to 2020 why would any state that has expanded coverage elect to kill the program early? I highly doubt any of them will.

Using the logic that no state will turn away the Federal matching funds for their expansion, the question becomes why does the AHCA have 6 million people dropped from the Medicaid rolls before 2020? The answer is, AHCA's CBO score includes the potential enrollment from the 19 states that "could" expand their Medicaid rules.

Defining Insurance

Under Obamacare the definition of good insurance is set by the government. CBO, in it's infinite wisdom, thinks that they know what good insurance is too. So much so that they have set their own parameters in the scoring. In their estimation "a few million people" would buy policies that don't meet their definition of having "sufficient financial protection". Never mind that it might be what the consumer wants.

While CBO doesn't actually define what constitutes insurance in the score, they insinuate that some states will cut or reduce the number of essential health benefits and cause out-of-pocket limits to rise. Suffice it to say it's amazing that they can't give us this definition yet count a few million people as uninsured because of this definition.

Who Doesn't Want It

Finally, the CBO score doesn't tell us who doesn't want to buy insurance. Without a mandate any number of people might simply say no thanks. These people aren't losing insurance, they simply don't want it.

Does it Matter?

Take the 4 million baseline error plus 6 million Medicaid error plus a few million with "bad insurance" and add in an unknown amount who don't want insurance and the CBO scoring model just doesn't add up. The echo chamber will say it does and many will fall in line with the narrative. But, reality is this CBO score doesn't matter.

At the end of all the political gamesmanship and shouting matches AHCA will not pass. Not because of a fictitious number people losing insurance. Not because of pre-existing conditions. Not because of funding cuts. Definitely not because Obamacare is working.

It will fail because just like Obamacare it focuses on the effect and not the cause.

Outside the bun insurance

So, got a call the other day from one of our (numerous) long-term P&C clients asking for some help with a life policy. I'd met with her a few years ago to review it, and now she had some additional questions.

As requested, she brought with her the policy and as much documentation as she could.

In a nutshell:

This is a Variable Universal Life policy (basically a UL with mutual fund-like cash accumulation options). It's for a sizable amount on the life of her ex (I believe as part of the divorce settlement). There had been a pretty significant cash accumulation, but the policy is already looking to go upside-down in a half dozen or so years. Still, there's currently about $60,000 in cash surrender value.

After I explained all this, we discussed her needs and concerns; she's trying to determine whether or not to keep it until it fails or cash it in now. She asked me what I would do, and I of course demurred. But she persisted, and I told her that, based on our discussion, I thought she would do well to consider something called a Single Premium Immediate Annuity.

Briefly: these are plans, sold by insurance companies, that pay out a constant stream of income payable for the rest of her life. There are some tax issues, but in her case they'd be pretty insignificant, and she asked me to get her some numbers.

After receiving and reviewing  quotes from several carriers, I called her to discuss them. She was elated, and asked when we could get together to make this happen.

What's so fun about cases like this is the opportunity to look at different types of plans to find effective solutions based on what our clients need and want. It's a lot of fun, actually, and I'm pleased as punch that we can help her out.

Premier Health fires back

Last we looked, local healthcare behemoth Premier health and health insurance biggie UHC had parted ways:

"As of yesterday (April 30), folks with either individual or group medical plans from UHC are no longer able to receive services at Premier Health facilities at negotiated rates"

This was significant because a lot of folks in this area count on Premier Health doc's and hospitals for health-related services. The stated roadblock was (no surprise) cost-related. Earlier, UHC had claimed that "Premier is one of the most expensive health systems in Southwestern Ohio." On the one hand, that doesn't really say a lot: after all, you (generally) get what you pay for. On the other hand, of course, carriers are always on the lookout for cost-savings opportunities (NTTAWWT).

Anyway, we promised to keep our readers "in the loop," and the other day we received a letter from Premier stating their case. It's addressed to business owners, but the general points are applicable to pretty much all local UHC insureds. Here are some hightlights (full document available for download here):

"We are writing out of concern for recent events that have left Premier Health out-of-network with UnitedHealthcare ... Premier Health has done everything it can on behalf of our patients."

Okay, but if it's "all about the Benjamins," then what's your argument?

Ah:

"Premier Health works to fulfill its nonprofit mission ... We serve more than 60 percent of the region's adult patients who are covered by Medicaid."

Hunh.

Now, I have no inherent objection to charitable care, but I'm already paying for Medicaid through my taxes. I see no reason to further subsidize it by paying more for my own health insurance. After all, Gov Kasich (among others) welcomed Medicaid expansion with open arms, further exacerbating the problem. Premier's argument seems to be heartstring-pulling, not sound financial acumen and planning.

Gonna have to do better, Ms Boosalis.

Breaking: BX Bails

Remember that running gag about how "if you like your plan, you can keep it?"

Well, if you're in either the Sunflower or Show-Me States, the joke's on you:

"Blue Cross pulls out of Obamacare markets in Kansas, Missouri ... the insurer says it has lost more than $100 million on Obamacare."

Imagine that.

Now, almost 70,000 BX insureds, both on and off the Exchange, will be kicked off their plans next year.

But hey, I'm sure there'll be lots of other choices...

[Hat Tip: FoIB Holly R]