Restoration Project

Last month, we reported on the increasing number of counties across the fruited plain that will have no carriers from which to buy insurance.

Now comes news, via FoIB Ʀєfùsєηíκ, that folks here in the Buckeye State may be getting a slight reprieve:

"Ohio Department of Insurance Director Jillian Froment today joined five major Ohio health care insurers to announce that health insurance options have been restored on the federal exchange in 19 Ohio counties following the withdrawal of other insurers earlier this year."

The carriers include Buckeye Health Plan, CareSource, Medical Mutual of Ohio, Molina Health Care of Ohio and Paramount Health Care, which is great news for folks in those counties, for certain values of "great." As co-blogger Patrick reminds us:

"Molina's nearest physician in Findlay, OH (Hancock County) is 22 miles away. Closest hospital 23 miles away. Great 'option'."

And a reminder, as well, that these plans are available only on the Exchange, which is nice if one is eligible for a subsidy, not so much if not.

So, one step forward....

A friendly reminder

For those folks still on the fence about whether or not ObamaCare has always been about getting to government-run health "care", well:

Rest in Peace, Little One

BREAKING: Charlie Gard, UK baby at the center of dispute over hospital treatment, has died - Daily Mail pic.twitter.com/rgxAkFMyre

— Reuters Top News (@Reuters) July 28, 2017

Dayan HaEmet; may his memory be for a blessing

Note: This was not, as characterized by Reuters, a "dispute over hospital treatment," but a vivid, graphic demonstration of the power of the State when unaccountable bureaucrats are in charge of health care.

Quitting vs Losing

Courtesy of FoIB Scott M:

[click to embiggen]

"Opting out" ≠ "Losing"

Much Vaunted National Health System© puts the hammer down

Well, it was only a matter of time. After all, we noted exactly 3 months ago that:

"NHS bosses are planning a massive expansion of the controversial rationing that forces smokers and obese patients to wait months in pain before they can have surgery"

That's how government-run health "care" works, after all: limited resources controlled by unaccountable bureaucrats. And if the threat of such rationing isn't enough, well:

"NHS units impose surgery ban on obese and smokers ... including an end to the routine funding of hip and knee operations for patients with osteoarthritis"

Sorry (not sorry), grandma!

It gets squirrely from there, though:

"In one area of England obese patients must wait two years for hip and knee replacements while another area plans to deny surgery for smokers, including heart and brain operations."

Might pay to move, no?

But again, this is what happens when you put the DMV (or IRS) in charge of health care.

Worth noting, again, that this is the explicit end-goal of ObamaCare.

Sleep tight.

[Hat Tip: @Ʀєfùsєηíκ‏]

The Clinic and The Insurer

Not sure how this stayed under my radar, but thanks to FoIB Bill M we learn that the estimable Cleveland Clinic is about to jump into the individual medical insurance pool. And they're partnering with New York-based Oscar Health to do it:

"The venture, called Cleveland Clinic | Oscar Health ... will be available on the public exchange, off the exchange or directly through Oscar."

The catch?

They'll only be available in 5 counties in northwest Ohio.

Which, perhaps not so coincidentally, is also the home base of Medical Mutual.

Interesting. Particularly because of this:

"The Cleveland Clinic network now only is available on the exchange through a broad network offering provided by Medical Mutual of Ohio"

Hunh.

To be sure, Oscar's had its own issues:

"[F]or every dollar of premium Oscar collects in New York, the company is losing 15 cents. It lost $92 million in the state last year and another $39 million in the first three months of 2016"

As their CEO noted at the time, this is not "a sustainable position.”

Anyway, the product itself will apparently rely pretty heavily on the telehealth model, which seems like one area that carriers are starting to really embrace as an effective cost-containment strategy.

No word yet on whether or not they'll have any kind of marketing agreement with insurance agents (but smart money is on "no").

Another 1,000 Words on #Repeal/Replace

Heh:

[Hat Tip: FoIB Scott]

Dammit’ Jim, I’m a Doctor, not a Coder

In my many years in Healthcare I know that Doctors are looked upon with awe and admiration, sometimes irritation, but never has anyone mistaken a Doctor for a Coder, until now.

The GAO has put out a report that patients are not utilizing their Patient Portals.

“In a report released earlier this year, the GAO found that just 15% of hospital patients accessed their medical records, even though 88% of hospitals offer access. A third accessed medical information from physician practices.

Carolyn Yocom, a director in the GAO’s healthcare team, said in an audio interview in the post that poor interoperability is another roadblock to access, which is especially frustrating when they're trying to prepare for an appointment or, worse, in an emergency.

Providers should make it easy for patients to access everything they need in one place to avoid a frustrating experience, Yocom said.”

I can tell you from front line experience, the majority of patients do not like the portal and there are many reasons. The reasons that I have heard include:

1)      I don’t use the internet

2)      Your portal uses cookies, I don’t do cookies

3)      There are too many portals. I can’t remember all the passwords.

4)      I don’t have a computer, only my phone (Portals do not work on phones).

5)      I want to talk to my doctor.

6)      I want to talk to a nurse about my lab work.

7)      It is too complicated and takes too much time.

8)      The government can track me; I don’t want my information on the internet.

So Carolyn Yocom says that “Providers should make it easier for patients…” WAIT, WHAT?

Does Ms. Yocom know that Doctors did not write the code for the EMR’s that support the Patient Portals? Doctors were only told by the government to buy these expensive EMR’s and provide the service to their patients. If the Doctors did/do not do this, then they can face reductions in their insurance reimbursements in the future. So as good Doctors we bought the EMR’s and we have established portals for our patients to use.

However, as this article points out, nobody bothered checking with patients if they would like to have a portal. It seems patients are not thrilled with this government mandate, as we experience daily with very loud and angry complaints.

On behalf of all Doctors and Medical Offices in America Ms. Yocom, I will not let you lay the blame for this disaster on our doorstep. It was the government that mandated the creation of Portals and it was the Coders who developed the Portals.

So, to Ms. Yocom I respond, “The Government and Coders should make it easy for patients to access everything they need in one place to avoid a frustrating experience; the Doctors have done all they can.”

Tuesday Afternoon Linkfest

■ FoIB Avik Roy makes a point about the Emperor's New Clothes CBO scoring fiasco:

"73% Of Coverage Difference Between Obamacare & GOP Bills Driven By Individual Mandate"

Okay, but what does that mean? It's actually pretty simple: not forcing folks to buy something doesn't mean they won't, anyway. And it certainly doesn't "strip" anyone of coverage, either (another popular meme).

Sheesh.

■ A few years ago, we blogged on the sad case of insurance agent Glenn Neasham, who ran afoul - quite by accident, it seems - of California insurance regulators and was sentenced to jail for selling an elderly woman an (as in one) annuity.

It appears that Mr Neasham was merely a piker:

"Prosecutors in California have accused Shawn Heffernan, a retirement planner and insurance agent, of persuading five older clients to surrender annuities and replace the contracts with new annuities"

To the tune of nearly half a million dollars, of which just shy of $300,000 (allegedly) went into Mr Heffernan's pockets.

Yikes.

■ Finally, our good friend Bob Graboyes dares to tell the ugly truth about all those nifty preventive care initiatives:

"[P]reventive measures generally increase rather than decrease costs."

Ooops.

Which is not to say that we should stop encouraging their use, just that we need to back off on the cost-savings-panacea talk:  "we shouldn’t spend time dreaming up ways to spend the savings that will result" (because we're going to be very disappointed).

Reminds me of something...

The Willard Scott Conundrum

For many years, Willard Scott would announce each morning those lucky folks who'd hit the 100 year marker in life. They likely didn't know, however, the impact that reaching such a milestone would have on any "permanent" life insurance they owned.

Wait just a minute there, Henry: what's with the "scare quotes?"

Glad you asked.

Recently, co-blogger Bob V tipped me to this article by insurance industry heavyweight Joseph Belth:

"For decades, life insurance carriers ... sold permanent universal life insurance policies, marketed as "insurance for life," utilizing outdated mortality tables that did not take into account the fact that Americans were, and are, increasingly living to and past the age of 100."

In his book "My Life in Court," the late, great litigator Louis Nizer wrote of a case where a young man was killed when the train he rode on his daily commute crashed and he was killed. The court originally based his lost and future wages on an older mortality table which generated a relatively modest settlement; Mr Nizer was able to show that this was a grave injustice due to more recent tables, and won a more substantial settlement for the young widow.

Now, what does a 1950's-era train wreck have to do with a centenarian's life insurance policy?

Well, it turns out that the life insurance industry seems to have been playing fast and loose with that word "permanent." The case at hand concerns a Universal Life policy, but this issue would appear to affect Whole and Variable Life plans, as well.

The problem is that when plans "mature" (end) at age 100, they aren't permanent:

"The life insurance industry has left its customers (who faithfully paid their premiums with the expectation that they would have coverage for the remainder of their lives) uninsured."

And it gets better:

"These terminations have exposed customers to adverse tax consequences that are in direct contradiction to the guarantees made when these policies were purchased."

One of the great benefits of cash value life insurance (another industry term of art, perhaps much more useful in this discussion) is that the equity in the policy grows with no taxes due if the policy is paid out as death benefit (those that do  cash in their policies early may have a tax liability if the amount they receive is greater than the premiums paid in). But what if you've paid your premiums in the expectation that the plan would pay out whenever it was that you shuffled off this mortal coil, only to learn that, upon reaching that wonderful milestone you'd be uninsured and, adding insult to injury, owe a potentially astronomical tax bill?

Now, some (many?) carriers have addressed this by issuing policies that go to age 120 (or 121). But that's only good for folks who've bought plans from these carriers in recent years. The vast majority of folks, I daresay, don't fall into this category.

And frankly, I'm a bit nonplussed that this issue has been so long under the radar. Why's that you ask?

Well:

"The United States currently has the greatest number of known centenarians of any nation with 53,364 according to the 2010 Census"

Of course, not all of them own life insurance, but even a small percentage means thousands, perhaps tens of thousands do.

What then?

Mr Belth proposes a class action lawsuit. My own understanding of these is that they generally benefit the lawyers that file them much more than the plaintiffs themselves. Still, if that's the clue-by-four my industry needs to address this, well...

#ItCanWait

Courtesy FoIB Bill M:



'Nuff said?

Interesting RC Twist

No, not that RC; RC as in Risk Corridor. Regular readers may recall that these were payments promised to insurers to help mitigate the extraordinary claims wrought by ObamaPlans, and which were woefully underfunded.

Back in 2015, HealthyCT (that state's now-defunct Co-Op) received "more than $128 million and covered only 6,094 people – more than $21,000 per enrollee." And that still wasn't enough: they went under last summer.

But in a surprising (well, to me) development, Juris Capital (a "litigation funding firm ") is offering to infuse over $10 million "to the estate of HealthyCT." First, I've never heard the term "estate of" used in the context of an insurance company, but it really does work, no?

And second, why they're throwing money down that particular hole is pretty interesting, as well: the failed insurer is still due over $30 million in RC funds; if those actually come through, well, nice payday for Juris Capital (of course, that's a big "if").

And they're at the mercy of two different government entities: Constitution State insurance regulators who are suing the Feds. Not an appealing notion, but best of luck to Juris Cap.

Mid-Summer Health Wonk Review

Steve Anderson hosts this month's eclectic collection of health care wonkery. From teamwork to Siri to ransomware, it's all interesting.

Taking it on Faith

So, got this in email today from Sally and Dave:

"Due to the cost per month now with [carrier], we are looking at one of the medical cost sharing programs.  If we finalize this, when do I need to notify [carrier]?  Our renewal date is August 1.  Thank you."

I replied:

"Don’t blame you. I actually know someone who’s in one of these and is pretty happy with it. He lives in another state, but presume is similar. Would you like me to connect you?

Also, whenever you do pull that trigger, just have to notify [carrier] to cancel. I can help with that when the time comes. It’s not a big deal."

Sally responded:

"Thanks for the info.  Just wanted to make sure I didn't miss anything.  I will call them.  I am close to finalizing with Medishare, so I don't think I need more info, but I appreciate the offer!  Thank you so much!"

I thanked her and Dave for their years as clients, and my hope that they'll keep me in mind for future insurance purchases.

So, what's the lesson here? Well, this family has, as a direct result of ObamaCare, lost their coverage It was a plan that fit their needs at (for a while) an acceptable cost. But now, they can no longer afford it, and a new ObamaPlan would cost even more, with even higher out-of-pocket exposure.

Of course, they'd still get "free" birth control convenience items and maternity coverage, something no late-50's couple should be without.

Sad, really.

Thursday LinkFest

■ First up, FoIB Dana Beezley-Smith has a really powerful post on her blog about the actual, real-world impact that ObamaCare has had on the individual insurance market. While various pundits and pols criticize (often justifiably) on the Republican's latest attempts, they seem to have missed the ACA's "trajectory of higher premiums and costs” and “fewer, if any, coverage choices.”

Read the whole thing.

■ Co-Blogger Bob V has the latest from the annals of the Much Vaunted National Health System©, where a "nurse has revealed she was charged £80 for parking, on top of parking fees already docked from her wages," all because she overstayed her shift to provide actual, you know, care to a cardiac patient.

But hey, gotta pay for that "free care" somehow.

■ And today's new word comes from FoIB Holly R: "Buurtzorg," Dutch for "neighborhood care." And it's not just a fun tongue-twister, it "allows nurses to act as a ‘health coach’ for their patients, advising them on how to stay healthy, caring for their needs and using their initiative."

And the results are impressive, allowing the Dutch "healthcare system to reduce costs by around 40%, while the time it takes to administer care has been slashed by a staggering 50%."

Maybe worth a look here?

Deconstructing Government-run Health Care

[Hat Tip: Co-blogger Mike F]

Stunning: 1,000 Words on ACA '18

Courtesy of co-blogger Bob V, "2018 Projected Health Insurance Exchange Coverage Maps." Here's the latest:

[click to embiggen]

As Bob notes, would suck to be in Nevada.

Tweeting up a storm

For those unfamiliar with the term, a Tweetstorm is a series of short messages posted in a string (a function of the Twittter's 140 character per message limit). These are often annoying, but two recent 'storms' are really great reads. Both are from Friends of InsureBlog, and both have important insights into the health insurance/health care debate.

The first is from Dave W, posting at Ace of Spades blog (mild language warning). A sample:

The other is from Cato's Michael Cannon. And a sample of his 'storm:'

Good stuff, all.

Health "Care" Fraud Bust: By The Numbers

Courtesy ForAmerica:

[click to embiggen]

It's Time To Fully Implement Obamacare

Enough of the BS already. Obamacare can't and won't be repealed without 60 votes in the Senate. Any Republican alternative claiming to replace Obamacare that takes away money from states won't pass either. Instead of trying to do the same thing over and over while expecting a different result why not simply implement what President Obama signed back on March 23, 2010?

Members of Congress - on both sides of the aisle - have two objectives, protect themselves and find a way to get reelected. Full implementation will put both of these objectives at risk.

Want to know the perfect place to start? Eliminate Congress' illegal status as a "small business" and force all 12,000+ members, staffers, and their dependents to purchase insurance legally as the law was written. Anything less would be uncivilized.