Cleveland Special

Thursday, March 31, 2016
As in "Special Event," and specifically Special Event Insurance, about which we first wrote 9½ years ago:

"World Furniture Mall "promised that if the Bears shut out the Packers in the season opener at Lambeau Field in Green Bay, Labor Day weekend shoppers would get their furniture free."

Fortunately, the folks at WFM had purchased a one-off policy that paid most (all?) of the $300,000 at risk.

What's that got to do with Cleveland, you ask? It's not as if the Browns are in particular danger of winning any championships anytime soon, so why bring it up?

Well, folks following the presidential campaign know that this year's Republican convention takes place in "The Rock and Roll Capital of the World," and that this means a lot of out-of-towners, including revelers, and others. Unlike the Green Bay scenario, such a policy isn't exactly available off-the-shelf. So the city has hired a "risk consultant" (why not just say "broker?") to arrange for "a $10 million insurance policy, required under the terms of Cleveland's hosting of the convention."

I of course have zero idea how much such a policy will cost, but assume that the premium will involve at least a comma or two. Which also (presumably) means a nice commission check - that is, unless the upfront $1½ million brokerage fee already takes care of that.

Oh, what will this particular special event policy cover?

Good question:

"The policy would protect the city and its employees against any claims resulting from hosting and providing security for the convention."

Which is a nicer way of saying "protecting the financial interests of these security folks when they have to handle protesters."

Mayor Daley must be spinning furiously.

[Hat Tip: Mark Naymik]

From the P&C Files: Fully Automatic Insurance Tricks

Back in Aught Seven, we noted the passing of "Evel" Knievel, whose life previous to stuntsmanship included a stint as a very successful life insurance agent. Now comes an interesting story about one John Herbert Dillinger who, when he wasn't robbing banks and/or murdering folks, also took on the role of insurance agent.

Sort of:

"Dillinger and one of his accomplices posed as an insurance agent and asked police to lay out their guns so he could give them a quote."

This was back in 1933; Mr D and his crew used the review as an excuse to "case the joint," and returned that evening to steal his infamous "Tommy gun."

The story doesn't indicate whether or not the claim (if any) was denied.

Talk about an insurance rip-off.

O'Care at 6: Fewer, Sicker, Costlier

Wednesday, March 30, 2016
Yeah, about bending that cost curve. Something sure got bent:

"Consumers who signed up for Blue Cross Blue Shield health plans through the Affordable Care Act’s insurance marketplaces these last two years tended to be sicker and incurred greater medical costs than people with BCBS coverage through their jobs."

Surprise!

This is the manifestation of the insurance term "adverse selection." Briefly, adverse selection occurs when you encourage, and reward, riskier behavior, accomplished in this case by the implementation of guaranteed issue and immediate coverage of pre-existing conditions.

Folks with few or no health problems tend to shy away from buying insurance that they're pretty sure they won't need or use, while folks with chronic and/or expensive conditions tend to over-buy (which, of course, makes sense from their point-of-view). It's exacerbated, of course, when they're rewarded for doing so by premium subsidies.

But wait, there's more!

"Original CBO projections show 24 million fewer people have insurance today ... based on the CBO's own numbers, it seems possible that Obamacare has actually reduced the number of people with private health insurance."

That's right, not only are the newly-insured sicker, there are even fewer less-sickly folks signing up at all. In fact, the government's own  metrics belie the (always phony) claim that "If you like your plan, you can keep your plan." Obviously, that meme's been long and well debunked, but it bears repeating if only to underscore the whole train-wreck.

Cheerio!

Silly HSA Tricks

Over at LifeHealthPro, Michael Thomas reports on new legislation being proposed that seeks to update Health Savings Accounts. He does a great job of introducing the background and history of HSA's, and provides a helpful explication of this new initiative. It's a very well-done piece.

That being said, the legislation itself is stupid. It goes off in myriad directions, focuses on non-essential "benefits," and misses the opportunity to actually accomplish something useful.

The purported purpose is to expand eligibility for purchasing and definitions of acceptable distributions (expenses). As to the first, the law "allows Medicare recipients participating in Medicare Advantage MSAs to contribute their own money to Medicare Medical Savings Accounts" which they're currently prohibited from doing. Why is this stupid? Well, go find me an example of a carrier that currently even offers one of these plans.

I'll wait.

In a related section, the legislation "amends the existing law to reauthorize health opportunity accounts in Medicaid as a demonstration program." What, you didn't know that there was such a program in the first place? Don't feel too bad, the original pilot program was such a rousing success that "South Carolina was the only state applying for and approved to participate" in it, and at its peak had enrolled "only two adults and three children."

Winning!

There are a few decent ideas here: allowing one to buy over-the-counter meds with HSA funds, ducking some of the more onerous Cadillac tax issues. But they are far outweighed by the silliness of allowing "fitness programs" and dietary supplements as legit. I do recall, years ago, being asked if a hot tub qualified (the insured in question has back issues). Maybe this is the answer.

What does it miss? Access.

What do you mean, Henry?

Just this: why must HSA's be tied to a specific type of insurance plan? IRA's don't require you to have a certain job, or tie you to a specific investment plan. Why should HSA's (which are really just medical IRA's)? And why not expand the amount one can contribute? After all, if the idea is to really bend that health care cost curve down, doesn't it make sense to give folks even more opportunity to put their own skin in the game?

Sigh.

On "Losing" a Client

Tuesday, March 29, 2016
So I lost a client yesterday, and that's a good thing.

I wrote Sue's health insurance a year or so ago; her husband's on Medicare, so it was just her. She chose an Anthem Gold-level plan, and has been reasonably satisfied with it. A month or so ago she and her husband moved to Texas and asked me for help with notifying Anthem of their address change.

I pointed out that, although Anthem's BlueCard program would offer some relief, pretty much every claim she has going forward is going to be treated as out-of-network (at least initially). Plus, there may be better and/or less expensive options available in her new town. Finally, I'm a big believer in local agents, and so I offered to help her find one.

As usual, I turned to my "posse" (a loose-knit collection of fellow agents around the country whom I've been fortunate enough to "meet" over the years). Alas, I could find no one in her area. When I called to tell her this, she mentioned that her new auto/home insurance agent had recommended someone that he knew. I told her to jump on that right away: from the insured's standpoint, that's one of the very best types of referral.

Why's that, you ask?

It's a matter of simple self-interest: if the agent recommends someone whom he's not vetted and the client has a bad experience, that client's going to blame the initial agent. No one wants to take that chance, so these kinds of referrals are generally rock solid.

I offered to speak with the new guy to answer any questions about her existing coverage (it's what I do), and we did, in fact, touch base. He seemed like a nice, professional, knowledgeable guy, who'd actually found a comparable local plan with a lower rate for her.

So, a happy ending all around.

Monday LinkFest

Monday, March 28, 2016
■ First up, seven (just seven??) ways The ObamaTax has let us down. A sampling:
"1. Low enrollment. Many people would not have jumped on the Obamacare bandwagon if they had known the relatively small number of Americans who would actually be enrolled on the exchanges by 2016.

4. Lost plans. Speaking in the Rose Garden, on July 21, 2009, President Obama said, “If you like your current plan, you will be able to keep it."

Yeah, how's that working out?

■ Speaking of low enrollment, the Congressional Budget Office (CBO) has once again slashed its estimate for 2016 ObamaPlan enrollment:
"About 12 million people are now expected to have ObamaCare coverage by the end of 2016 ... Just three months ago, the office had predicted that 13 million people would have coverage."

Any bets on when it's revised downward again?

■ And now, 1,000 words neatly summarizing the two items above:


A Piping Hot Cup of ObamaCare



[Hat Tip: Ʀєfùsєηíκ]

When will they learn?

Friday, March 25, 2016
Of course, that question pre-supposes that ObamaTax proponents want to learn, of which there is scant evidence.

What makes me so skeptical?

Here:

"More people will get insured through the Medicaid expansion ... because they now see slower wage and salary growth in the future, meaning that more people will be eligible for the low-income health program."

See the problem here?

People do not "get insured" through Medicaid. They receive medical care entirely paid for by someone else. There are no deductibles, or co-insurance or premiums, and, to drive the point home, one cannot "buy" a Medicaid "policy."

It is simply income redistribution, period (NTTAWWT).

And there's a corollary effect:

"[M]ore will get insured through Medicaid, fewer are expected to get coverage through the exchanges."

As the insured population plummets, insurance companies are enrolling fewer and fewer paying customers, and of course those that do pony up are getting less and less bang for their buck as out-of-pocket costs continue to rise.

Happy days, indeed.

[Hat Tip: Ʀєfùsєηíκ]

Interesting point

Waste, Fraud and Abuse CMS Style

Thursday, March 24, 2016
Politicians love to talk about how they will eliminate waste, fraud and abuse if you will only elect them to office. If you are one of those who believe the folks in DC have their own WFA Task Force you
would be mistaken.

When it comes to Medicare, John Minnino, Esq. has come up with a way to beat the CMS cops at their own game.

By using statistical analysis, Mr. Minnino has identified 5 "red flags" that indicate a strong possibility of Medicare fraud.
In 2014 prosecutions initiated by the government led to a mere 31 settlements yielding $88 million in fines. 
In 2014 there were 469 of these (whistle blower) health care fraud settlements—many involving huge pharmaceutical corporations and hospital networks—resulting in $2.2 billion in fines.- Wired
Makes you wonder what the CMS cops are really doing to eliminate fraud.

Maybe a better use of taxpayer dollars is to fire the folks at CMS responsible for policing fraud and let private citizens acting as bounty hunters do the job.

Whistle blowers typically receive 15 - 30% of the settlement as their cut.


#MedicareFraud  #WasteFraudAbuse

Health Wonk Review: ObamaTax Anniversary Edition

Charles Gaba makes his (impressive) hosting debut with this week's informative roundup of health care policy and policy. His very sly (and much appreciated) sense of humor is on display, as well; this one's just a joy to read.

Thanks, Charles, and kudos on a great 'Review!

Joe Garagiola 1926 - 2016

Wednesday, March 23, 2016
Baseball is a funny game.

But not today.

Happy ObamaTax-iversary!

In case you'd forgotten (heh!), today marks the 6th anniversary of the date on which ObamaCare began to be implemented.

'Nuff said.

UPDATE: via our friend Rich W, here are five charts showing ObamaCare's "success."

PARE-ing Back?

Our friend Louise Norris has written about the issue of balance billing, and advocates its (eventual) eradication. While she's a very thoughtful agent and writer, I take issue with her premise and her solution(s). Regular IB readers know all about PARE claims (these are typically the kinds of providers who join no networks and so bill pretty much whatever they want) and why they usually result in a balance due after insurance pays its part. What Louise and others advocate is forcing those providers to accept whatever an insurance carrier deems appropriate, and eat any difference.

Which sounds rather noble, until one looks at how that's handled currently, and what expansion would entail. Thanks to co-blogger Bob, we have access to a report from the Robert Wood Johnson Foundation (hardly a right-leaning outfit) which gives us an overview of how a handful of states currently handle the issue.

To our knowledge, balance billing isn't really an issue for life-threatening emergency claims; all 58 states offer at least some protection in that scenario. Where it gets dicey are non-emergency situations, and whether one's plan is a PPO or HMO model.

According to the folks at RWJF, there really isn't a lot of "there there" when it comes to how the states they surveyed handled these situations. All banned the practice for emergency situations (as do all the other states). Some applied this to both HMO's and PPO's; Florida really only locked down HMO's.

Interestingly, some states only apply the ban to providers that have previously agreed to accept assignment of benefits from the insurance carrier (which makes sense, really). If interested, details are available in that report.

But here's the rub: so what? Two things are in play here, neither of which are good: for one, as co-blogger Patrick notes "several states prohibit balance billing and we work with clients on claims where this occurs and used to have a 100% success rate of having these charges written off. Along comes ACA and now insurers say too bad."

Does anyone seriously think that's going to improve by extending it to non-emergency expenses?

And second, how do we force non-participating providers to accept less than what they've billed? This is the kind of thing that helped to create the whole Direct Primary Care movement; that is, when the insurers (and by extension, the government) begin to tell providers how much they can charge, then they're going to find a way to remove themselves from that "authority." Ever ask yourself why vets can charge pretty much what they want?

Be careful what you wish for: You might just get it.

Unusual Definition: Success

Tuesday, March 22, 2016
ObamaTax proponents like to tout its success in reducing the number of uninsured (using dubious metrics). The first problem with this, of course, is that health insurance ≠ health care . But that's only part of it:

The Bureauweenies in DC© claim that almost 13 million victims citizens enrolled in Exchange-based plans during the most recent Open Enrollment. That's up from an alleged 12 million last time 'round.

What they're not telling you is that this is basically meaningless.

Why's that, you ask?

Well:

"[O]nly 8.8 million people remained enrolled in Obamacare on December 31, 2015. That is a drop of almost one quarter from the end of 2015 open enrollment."

One step "forward," two steps back.

Funny way to define "success," no?

Apple Ooopsies

Monday, March 21, 2016
Runh ro:

So it turns out that one of the things Apple debuted today is a new medical-related app that grew out of its "ResearchKit framework," to be called CareKit.

There seems to be just one little problem:
 

Ka-ching!

Outstanding Customer Service Tricks

Every once in a while, we run into an extraordinary customer service experience, and appreciate the opportunity to publicize it. So often in life, we're quick to tell folks about poor service or rude service providers, so it seems appropriate to let others know when an experience exceeds all expectations:

Recently, a dear friend managed to screw up his computer "pretty good;" he'd been experiencing slow response times, maybe a virus or three. He made the (common and understandable) mistake of relying on one of those "let us dial in to your computer and fix it" services.

Yeah, he knows (now).

The result: not only was his computer freezing up, but he'd apparently lost (access to) his email, which was pretty critical. He called me for advice on what to do next; I recalled how glowingly my friend and colleague Roger D had spoken of DNA Computers (a local outfit) and suggested my friend seek their help.

Because he no longer drives, I picked him (and his wayward PC) up and drove him over, where he was met by several young, enthusiastically geeky young men. What was so impressive was how patient and understanding they were as he walked them through his travails, and reassured him that they were confident that they could repair most, if not all of the issues. They warned him upfront that the lost email might be unresolvable, but that they'd make every effort on its behalf.

They then quoted him a max, flat price, and told him that that would be the worst case scenario; if it turned out that they didn't need to do everything they'd laid out, they'd charge less, and if they needed additional time they wouldn't charge any more.

Over the next few days they kept in regular contact, and today I went over to help my friend hook his newly refurbished computer back up (he and his wife had already picked it up). He went on and on about how well he was treated, how happy he was with the service and attitude, what a terrific experience it was.

My friend can be fairly picky, and isn't afraid to speak his mind if wronged, so this is high praise indeed.

Kudos, DNA!

Hey, it's only (your) money

Friday, March 18, 2016
The folks at Guarantee Trust Life send along this helpful chart showing that even with (because of?) those shiny new ObamaPlans, folks are getting further and further behind the health care cost eight-ball:

As we've long noted (most recently here), it's not just the (outrageous) premiums, but the ever-increasing deductibles and co-insurance that are hurting our wallets.

And, of course, our health.

Silly Section 125 Tricks

Thursday, March 17, 2016
Sigh.

So yesterday, I got a call from a gentleman pushing a "very special Section 125 program" that basically wrapped a limited benefit ("mini-med") plan inside a group's Section 125. I'm not really sure why one would want to do that, but I didn't talk with him long enough to find out.

Why's that, you ask?

Because the first thing he said was "it's a 125 plan with a twist."

Which of course set my spidey senses tingling. And it went downhill from there:

I responded that I was concerned about the legality of such a thing, and he assured me that "oh, they've got lawyers who vetted it, and it's got a trust."

ProTip: Never - and I do mean never - use the terms "twist" and "trust" and "Section 125" together in the same month as the Internal Revenue Code, let alone conversation.

Needless to say, I bid the gentleman good luck and adieu.

Sigh.

Mid-week Potpourri

Wednesday, March 16, 2016
■ First up, Rich W warns that the new ObamaTax numbers are a lot more dangerous than we've been led to believe:

"[O]nly about 28 percent of enrollees, or 3.5 million, are between the ages of 18 and 34 -- the younger, healthier people needed to offset the costs of older, sicker ones."

That's bad news because it underscores just how unsustainable the whole system has become. Look for this number to get even worse as premiums and out-of-pockets continue to rise.

■ Talk about an understatement: FoIB Holly R sent us this link that starts out by noting that "[d]ifficult patients — those who are angry, abusive, or rude — may not get the best medical care." No kidding.

Click on through to see how patients that threaten to shoot their doctors fare.

■ This is actually two items in one. On the one hand:

"Maple syrup isn't just delicious, it could also cure Alzheimer's disease"

While you're pouring that tasty Grade A Amber on your flapjacks, don't forget to sprinkle some blueberries on 'em, too:

"Start munching on blueberries. Researchers at the University of Cincinnati say chowing down on the "superfruit" may help treat patients with cognitive impairments."

Yummy and helpful.

Self-service writ large

Tuesday, March 15, 2016
A while back, we noted with some disgust that "[t]he number of foreigners traveling to Switzerland to commit assisted suicide doubled over a four-year period." Seems that that enlightened country had made it even easier for folks to pull their own plugs.

Fortunately (for some values of "fortunate") the Golden State is making it unnecessary for those so inclined to have to book expensive airfare [ed: one way?]:

"Governor Jerry Brown signed a landmark bill into law ... [granting]terminally-ill individuals the right to die, or request life-ending medication from their physician."

He actually signed it this past fall; it takes effect early this summer.

There's a supposed "fail-safe" built into the law, requiring two doctors to agree that the "patient has six months or less to live and is mentally competent." There are some other caveats, as well.

Some folks are a bit leery that depressed patients might "doctor shop" to find providers more willing to participate. For what it's worth, California joins four other states that have legalized doctor-assisted suicide.

Yay?

[Hat Tip: Ace of Spades]

MVNHS© claims another one

It's almost as if nationalized health care schemes are designed to kill off their intended beneficiaries:

22-year-old dies of rare cancer after doctors mistook disease for pregnancy

To be fair, her initial pregnancy diagnosis was due to elevated hormone levels. But as time went by, and her pain continued unabated, one would think that her "care" providers would have at least tried to nail down a cause. By the time they finally got around to that, it was too late:

"[I]n February, doctors at Addenbrooke Hospital in Cambridge found Wright actually had adenocarcinoma— an aggressive form of cancer that affects multiple organs and was diagnosed as terminal. On Feb. 23, Wright passed away"

Well played, Much Vaunted National Health System©.

More (bad) trainwreck news

Monday, March 14, 2016
As we mentioned at the end of January, Open Enrollment v3.0 was pretty much doomed from the start:

"About 6 million people have signed up for health coverage that will take effect on Jan. 1 in the states that use the [404Care].gov enrollment."

That was way off the (implausibly) predicted 21 million anticipated to sign up. But it's also only part of the story:

"New exchange enrollment data released by the Obama administration reveal in multiple ways that ObamaCare is failing to live up to its goal of providing affordable care."

Most at risk? The very folks on whose behalf the whole effort was expended in the first place:

"Millions of working-class Americans face a choice between paying a penalty they surely can’t afford and buying a policy ... that may still wreck their finances if they land in the hospital."

And that's assuming that they can even afford to buy a plan in the first place. With ever-increasing premiums, deductibles and maximum out-of-pocket costs spiking, no wonder so many people are opting to just skip signing up in the first place. As we've noted time and time again, that $700 or so penalty fine tax is peanuts compared to the actual exposure dictated by massive ObamaPlan holes.

And the subsidies are doing little to mitigate the problem:

"While the cheapest bronze-plan premium (before subsidies) rose about $250 in Mississippi for a $25,000-earner, the subsidy fell $300, yielding the $550 increase."

Talk about a double whammy.

Sausage making at the MVNHS©

Friday, March 11, 2016
There's an old saying:

"Laws are like sausages: Better not to see them being made."

This seems to apply to how (at least one) nationalized "health" schemes work, as well. We've blogged on the shortcomings of the Much Vaunted National Health System© for many, many years; one thing we've consistently pointed out is that perhaps the most insidious form of health care rationing (and under any national health care scheme care is rationed) is the use of wait times to "cull the herd" of the most needy.

But don't just take our word for it; thanks to co-blogger Bob, we have access to "A Guide to Health Cover for the Self-Employed." Don't let the title fool you: the critical issues addressed apply equally to those who work for someone else.  And what's the Number 1 issue?

"Waiting times to see a doctor are lengthening – 70% of GPs surveyed for the Royal College of General Practitioners said patients will have to wait longer to see them over the next two years"

[ed: And don't be getting too smug about that; the ObamaTax has it baked into the cake]

Now, there's a double-whammy for self-employed folks: the obvious (and shared one) of 'care delayed is care denied,' but there's the additional onus that "[w]hile an employee with a sympathetic employer can easily take the time off work for appointments, it’s not so easy if you are self-employed."

Lotta truth there.

I was also bemused by this little observation:

"[T]he service we remain so justly proud of is cracking under the strain of an increasing population and a curb on expenditure"

Denial: not just a river.

Hey, it's only (YOUR) money!

A month or so ago, we noted that it costs taxpayers "$50,000 for every person who gets health insurance under the Obamacare law." Looks like that might be a bit optimistic:

"Watchdog finds $447 million IRS PPACA tax credit math error"

Ooops.

Apparently, the rocket surgeons at the Infernal Revenue Service misunderstood their own calculations due to a "programming error," which resulted in substantial overpayments on behalf of ObamaPlan victims buyers.

Here's the very best part:

"The accounting errors identified are primarily attributable to the lack of comprehensive testing"

Seems to be something of a habit with these folks, no?

Health Wonk Review is up

Thursday, March 10, 2016
David Williams hosts this week's collection.

Note: This edition is rather heavy-handed on the politics. Be forewarned.

Ducking the MVNHS©

Wednesday, March 9, 2016
As we noted a few weeks ago, many (most?) countries with national healthcare schemes also have robust private insurance markets.

For the naysayers (via email):

 
<Click to embiggen>

And just how does it work?

So glad you asked:

"If you are taken ill, can you rely on the NHS to ensure you recover quickly?

Private medical insurance (or health insurance) is designed to cover the costs of private medical treatment, so that if you happen to have the misfortune to suffer from a disease, illness or injury you can rest assured that you will be well cared for to help you on the way to a full and speedy recovery.

While we are fortunate in the UK to have the NHS, the reality is that you can often wait months for diagnosis and treatment. Private healthcare not only enables you to receive treatment quickly it also offers you far more choice as a patient. You can choose everything from what treatment you receive to where you are treated
."

"While we are fortunate..." Heh.

The site acknowledges something we've maintained for many, many years: that under the Much Vaunted National Health System© care may be free, it is strictly rationed. The most common rationing method is, of course, long wait times, where the beancounters in charge can be sure that at least a few of their fellow countryfolk will succumb to attrition.

But hey, it's free.

Clawbacks and fees, Oh my!

As we've mentioned before, more than a few folks who were initially eligible for ObamaPlan premium subsidies subsequently become ineligible, with predictable consequences:

"Consider the case of Erica Cherington that bought an Obamacrack plan for 2014 and only paid $89 monthly because her low income entitled her to a $284 per month taxpayer funded subsidy.Then she got a new job that paid more. As a result she had to pay back $600 of her subsidy"

But that was then, and this is now:

"Only 52 percent had to repay a portion of government subsidy during last year’s tax season, compared to 60 percent this year ...  three out of five customers who received advanced tax credits to help them buy private plans on Obamacare’s web-based exchanges must pay a portion back to the IRS"

That's because they mis-estimated [ed: is that even a word, Henry?] their 2015 income ... Of course they did: whose Ouija board has a $ sign? Sheesh!

And what, you may be wondering, was the average ding for this little "problem?" Well, how about $579? Of course, as we've pointed out numerous times, this represents one - maybe two at the outside - month's premium. Why not roll the dice; after all, the next Open Enrollment is only a few months away...

[Hat Tip: Rich Weinstein]

From the "No Kidding" Files

Tuesday, March 8, 2016
Courtesy of FoIB Holly R, we learn that making health care more convenient doesn't necessarily make it any less expensive. "Bending the cost curve down" has become the Holy Grail, but as we've seen over and over this just doesn't happen in a vacuum (or at all).

Or put in more relevant terms:

"Rand researcher Dr. Ateev Mehrotra said a minute clinic is to healthcare what an iPhone is to email.
 
“Because it’s so convenient for me to check my email on my iPhone, I check it a lot. Way more than I may need to,” he said."

Of course, checking your email really doesn't cost anything above the monthly Verizon (or whichever) charge; very different from the per visit charge (reasonable as it may be) at the Wally World Minit Clinic. And thus over-utilization rears its ugly head:

"[T]hanks to the rise of all these clinics, folks with a cold, the flu or a sore throat are getting care instead of staying home."

"So what?" you may ask, it's their choice, and their dollars. Ah, not so fast, grasshoppa: there's always a cost: over-utilization means higher insurance rates, for one thing. And even if one accesses that clinic without insurance. there's a societal cost as that provider is no longer available to care for a more sickly patient.

As I mentioned to Holly, this reminds me of a favorite saying:

You can have it good.
You can have it fast.
You can have it cheap.

Pick any 2.

Interesting SEP news

Monday, March 7, 2016
Open Enrollment v3.0 is fading quickly from the rearview, which means that you'll need to come up with a valid reason to trigger a Special Open Enrollment for the opportunity to buy an (overpriced, underperforming) ObamaPlan.

And by the way, the rules are the same whether you buy it on or off the 404Care.gov site.

As we noted earlier this year (3rd item), the bureauweanies in DC are tightening up the rules for those triggers, primarily because folks have figured out how to effectively game the system by using them. Carriers have been losing their shirts on these plans (awww!), and they really needed the Feds to step in and save themselves from...themselves.

So, said Capital City rocket surgeons have released new guidance on what does - and doesn't - constitute a Special Open Enrollment window. Frankly, I think it's about time, but one wonders why it took them so long to figure this out.

[Hat Tip: MMO]

MVNHS© Plays Grim Reaper

At first glance, this concept appears to have some merit:

"Mothers of children with fatal defects will have the option to give birth. Once the infant has been declared stillborn, doctors will remove its organs. They will then be used to save the lives of other children who are currently being placed on 7,000-strong waiting list"

After all, if the baby isn't itself viable, and could save the lives of others who may be, that's potentially a good thing, no?

The problem is, the Much Vaunted National Health System© hasn't shown itself to be particularly concerned with ethics, which leads folks to (justifiably) call into question the rationale behind this effort, not to mention the motivations of those tasked with implementing it.

This in particular raises moral hackles:

"Amid a chronic shortage of donated organs, mums will be 'supported' to have the baby at nine months so that the child's vital organs can be taken for transplant"

Law of supply and demand seems particularly tempting here; so who makes the call as to whether this or that baby is the viable one, and which is to be sacrificed? After all, these are the folks responsible for the (notorious) Liverpool Pathway.

Thus far, this is only in the "proposal" stage.

Thus far.

[Hat Tip: Co-blogger Mike F]

Another 1,000 Words on PPACA

Friday, March 4, 2016
Remember when The ObamaTax was going to "bend the cost curve down?"

Good times, good times.

[Hat Tip: A M Best]

1,000 Words (Give or Take)

Thursday, March 3, 2016

Note well how the various age cohorts are clustered: very heavily skewed towards the more claims-prone older ages, very few in the crucial (ie low claims) 25-and-under crowd.

Think that's a problem?

Yup.

[Hat Tip: A M Best]

Wednesday LinkFest, FoIB edition

Wednesday, March 2, 2016
As we've noted, the issue of agent compensation (commissions) for writing new Obamaplans has become quite the issue. More than a few carriers have decided to stop paying agents, and thus staunch the flow of claims dollars pouring out the door. Kentucky has put carriers on notice that in the Blue Grass State such practices are a no-no.

Thanks to FoIB David Williams, we learn that California is considering outlawing this practice, and for the very reason we've long put forth:

"California’s health exchange may require its health plans to pay sales commissions to insurance agents to keep insurers from shunning the sickest and costliest patients."

Of course, by next year it may be a moot point.

■ Next, SoIB Gail S tips us to the latest in the struggle to find lost life insurance policies:

"Smaller insurers balk at searching databases to check if policyholders have died; ‘It wasn’t priced in’"

Which is true, of course, but belies two other more pressing issues: the fact that it's the insured's responsibility to make sure his or her beneficiaries know about any policies and, two, even if they *could* afford to track down who's currently at room temp, there's no effective means to do so. As we reported almost 4 years ago:

"[T]he SSA has itself acknowledged, the DMF [Death Master File] is itself rife with potential errors and misinformation"

Oh, I'm sure they'll get right on that.

■ Finally, longtime FoIB Jeff M alerts us that North Carolina Blue Cross/Shield's woes aren't going away any time soon:

"Blue Cross and Blue Shield of North Carolina finished 2015 with just $500,000 in net profit, due largely to losses associated with Affordable Care Act plans."

But that's only part of the picture:

"Reserves" are the insurance company's "cushion" against future claims [Correction: as Mike points out in the comments, it would be more accurate to say that reserves are amounts held back from current premiums to pay for certain past claims, not future claims]. It's important that they be sufficient to handle not only anticipated claims (which follow  generally predictable trends) but unexpected ones as well (say a major listeria outbreak). Jeff points out this little nugget on that article:

"The insurer reported having 3.2 months of reserves, a measure of how long it could operate if it did not collect any more in revenue, down from 3.6 months at the beginning of 2015"

Seems a little light, no?

Told ya so

Tuesday, March 1, 2016
While it may not be a surprise to those who've been paying attention, the overall response to the "benefits" of The ObamaTax have been, in a word, meh:

Poll: Only 15 percent say they have benefited from ObamaCare

Which is interesting, no? After all, the stated premise in the first place was that roughly 15% of us were (at any given time) uninsured. On the other hand, over a quarter of us feel harmed by the train wreck.

But here's what's interesting to me: over half of the respondents claim that they've been personally unaffected by it. So by the "glass half full" metric, it seems that a (bare) majority don't see any great benefit, but neither have they (personally) felt a terrible loss from it.

Yet.

But then, the (so-called) Cadillac Tax has been pushed back (again); since most folks get their health insurance through employer-sponsored plans, it'll be interesting to see if (how?) these numbers begin to move.

[Hat Tip: FoIB Sam B]