Monday, February 18, 2013

Ow! Ow! (This Sceptered Isle Part CCLXXI)

Here is a disturbing story from the London Daily Mail.

It's even more disturbing when you consider that - on average - citizens in the U.K. have but one ovary and one testicle to begin with.  But perhaps the most disturbing of all is this statement:

“The NHS normally pays out around £20,000 if the wrong testicle has been removed.”
Uhhh . . . normally?  Normally??
Oh well, surely no price is too large to pay for the security of a national single-payer medical insurance plan.  

Your (Examination) Table is Ready...

We've been writing about the coming wave of "concierge" medicine for over six years, so this is nothing new to our readers:

"New data from a national survey of nearly 14,000 physicians ... found that 9.6 percent of “practice owners” were planning to convert to concierge practices in the next one to three years."

That's nearly 1 in 10 practitioners, which is pretty significant. The usual suspects are cited: low Medicare and private reimbursement rates, which are only getting worse under the ObamaTax. And the so-called "Doc Fix" continues to hang as an albatross around the future's neck.

What's even more frightening, though, is that the phenomenon seems to be specialty-independent; that is, it's not just primary care, but surgeons and oncologists and, well, the list goes on. Which makes sense: health care is (pretty much) health care, and someone has to pay for it.

Which brings us to the uptick in concierge-style medicine. Some 20 percent of docs already restrict "the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients." So if you can't get into your primary care doc, good luck getting a referral to that cardio guy you need to see.

Concierge-style medicine seeks to get around that problem by having patients contract directly with the provider. Of course, this will work better for some practice areas than others, primary care being the most obvious. How - or even if - this would work with, say, surgeons or radiologists seems unclear at this point. On the other hand, it was essentially the premise (and "promise") of HMO's. On the other hand, we've seen how those have worked out over the past decades.

The biggest problem right now is the threat that HHS Secretary Shecantbeserious will pull another mandate out of pocket and render the whole point moot.

In and Out

Not the burger place, we are talking about HIX. Those federally mandated Obamacare health insurance exchanges that are supposed to provide consumers a path to "affordable" health insurance.

A little more than 10 months from now HIX will go live as they say in the TV business.

At least that's the plan.

Lately it seems like things might go off track as the reality of the much anticipated date for the final rollout of Obamacare becomes a reality.

Maybe . . .
states can decide whether to apply the same regulatory requirements to health plans both inside and outside the exchanges. Federally operated marketplaces don’t have this flexibility, however, because they can regulate only the health insurance plans sold through the exchanges.
If outside plans sold coverage that wasn’t as comprehensive but was cheaper than those in the federal exchanges, sicker people might gravitate toward the federal marketplaces, resulting in adverse selection. “Over time, the coverage sold through exchanges will thus become more expensive as the sicker population incurs more claims — deterring more people from buying coverage through the exchange,”
 This is what happens when amateurs in DC attempt to regulate an industry they do not understand. Of course, that has never stopped them before . . .

Feds make the rules for exchange plans, states make the rules for non-exchange plans.

What could possibly go wrong there?
 “Because HHS will be operating the exchange in 25 states, it will be difficult for the agency to tailor an exchange to meet each state’s unique insurance market needs,”
 And this never occurred to them before?

Maybe "one size fits all" doesn't work so well, huh?
South Dakota Gov. Dennis Daugaard, a Republican, has said he wants to continue to review the situation, but “in our state, a lot of decisions can’t be made until the federal government’s fiscal house is put in order,” Dr. Heinemann said. Daugaard has indicated that he is reluctant to commit to an exchange and spend state dollars on one until he’s seen what happens with the budget sequestration process that is set to make automatic across-the-board cuts to government spending starting March 1.
 Well yeah, but the federal government never runs out of money, right? I mean, PCIP is still around and that is a federally funded and run health insurance program.

ObamaCare...pushing & pulling and going nowhere

There has been a movement to repeal the Health Insurance Tax (HIT) on fully-insured premiums, and now comes a new bi-partisan effort in Congress. An effort last year failed.

The part that confuses me is why you would tax premiums in the first place. Besides the current tax write off, in 2014 most premiums would be subsidized. So the government wrote a bill to subsidize premiums and then will tax those same premiums on the back end. Why not just do nothing; or if that doesn't generate enough subsidy, just reduce the subsidy by the amount of the HIT tax?

Besides creating more work for CPAs and greater opportunity for fraud, the subsidy/tax combination accomplishes nothing. Giving someone a dollar then taxing them a dollar is just wasting time.

PPACA Identity Theft to cost $? Billion per year

I don't think many of us will be surprised to find out the drafters of PPACA either didn't see this coming or weren't smart enough to do something about it.

Start with the fraud we know is happening;

"Using stolen names and Social Security numbers, criminals are filing phony electronic tax forms to claim refunds, exploiting a slow-moving federal bureaucracy to collect the money before victims, or the Internal Revenue Service, discover the fraud. 

Parton was a victim of what officials say has ballooned into a massive, and dangerous, illegal industry that could cost the nation $21 billion over the next five years, according to the U.S. Treasury Department."

I have seen higher estimates from CNN

"Last year, the IRS reported 938,664 fraudulent returns related to identity theft, totaling $6.5 billion, Treasury Inspector General for Tax Administration J. Russell George told a House subcommittee this month."

This fraud is so easy and so rampant because it is done online with no face to face contact or verification.

Now lets look forward to PPACA subsidy and verification. 474 pages of rules can be found here.

The exchanges are suppose to mainly be websites where someone can go online and purchase insurance. Again no face to face contact or method to verify identity.

Employers will be notified if one of their employees received a subsidy after the fact.  They can appeal, which would mean hours dealing with the IRS or some similar agency trying to convince them you don't owe a penalty. Anyone that has had tax issues can attest as to how efficient and cost effective this is. In most cases it would probably be cheaper to just pay the $2,000 penalty.

Individual applicants will certify what they are eligible for, with minor verification. Read any of the annual Medicaid reports to see how rampant with fraud and errors that already is. It is key to remember that no one has a vested interest in keeping people off Medicaid, it is never their money. They get paid to process paper. not protect the financial interest of the plan. The same problems exist here, it is much easier to just approve a subsidy and let someone else appeal than to question it. I deal with this all the time with unemployment; every employee I fire was let go - according to them - for lack of hours. I spend a few hours dealing with paperwork showing it was for cause, and the majority of the time they don't collect. The rest of the time Ohio Jobs and Family tells me I didn't properly fire someone and awards them unemployment anyway. Never for lack of hours but no one is EVER held accountable for lying on their unemployment insurance claim form.

Illegals, on a daily basis and with ease, already steal SSNs to work, how much harder is it going to be to apply for insurance with a Subsidy?

How do you recover stolen HealthCare?

It is problem enough when the government, through lax enforcement, watches $6 billion a year in refunds walk out the door. As an employer, I will someday pay a share off that. Of immediate concern is a system that allows systemic fraud for which I am immediately liable; $2,000 to $3,000 a year for a couple employees plus hours and hours of my time trying to fix it is something I can't afford.

All of this raises one final question: is this a bug in the system or intended?

Sunday, February 17, 2013

PCIP - Brother, Can You Spare a Dime?

The Obamacare Pre-existing Condition Insurance Plan (PCIP) is flat broke. Busted. Don't bother applying for PCIP because you won't get in.
Tens of thousands of Americans who cannot get health insurance because of pre-existing medical problems will be blocked from a program designed to help them because funding is running low.
Obama administration officials said Friday that the state-based “high-risk pools” set up under the 2010 health-care law will be closed to new applicants as soon as Saturday and no later than March 2, depending on the state.
But they stressed that coverage for about 100,000 people who are now enrolled in the high-risk pools will not be affected.

What happens now?

If your state does not have a high risk pool or carrier of last resort, you will have to wait until October to sign up for coverage to be effective January 1, 2014.
Initial fears that as many as 375,000 sick people would swamp the pools and bankrupt them by 2012 did not pan out. This is largely because, even though the pools must charge premiums comparable to those for healthy people, the plans sold through them are often expensive.
Congress miscalculated.

Not enough money to fund PCIP.

Not enough people signed up.

All things considered, the premiums are quite affordable. Makes you wonder how well Obamacare 2014 will work when current premiums for everyone, including healthy people, are 2x current rates.
Asked why the administration has not requested additional money from Congress to keep the program open — admittedly a tough sell in the current political and budgetary environment — Cohen said, “My responsibility is to work with the appropriation we have.”
So what happens if Congress fails to make funds available for the subsidies and Medicaid expansion?

Did it ever occur to these folks that running PCIP costs money?

Yes, but we were promised that Obamacare would "not add one dime to the deficit".
About 129 millionpeople nationwide have a medical condition or prior illness that would make it hard for them to buy their own insurance plan.
That's about a third of the population.

I find that figure hard to swallow.

So what happens next year when hardly anyone can afford Obamacare health insurance?
Among those stunned by Friday’s news was a 61-year-old Virginia woman who is battling stage-four breast cancer. The woman, who asked to be identified by her middle name, Joyce, because she wants to keep her illness private, is self-employed and had bought her own insurance for years.
Late in 2010, however, the insurer that Joyce was using pulled out of Virginia. She was healthy at the time. But when she applied to other companies, she was told that because she had been diagnosed with — and successfully treated for — an earlier breast cancer, she was ineligible for coverage.
Carriers pulling out of the health insurance market before 2014 is another concern the birdbrains in DC failed to consider. We have no idea how many people are like Joyce, that had coverage until the carrier bailed.

PCIP ran out of money. DC is running trillion dollar deficits every year.

Brother, can you spare a dime?

Friday, February 15, 2013

No means...."No"

Since North Carolina has officially put the kibosh on both a state-run ObamaExchange and Medicaid expansion, some folks are wondering "why?"

Something that gets short-shrift in the media is that, in addition to forfeiting tax-payer subsidies, states with Federally-run Exchanges also get to avoid the employer mandates.

But it gets better:

"Justice John Roberts deemed the taxes levied for noncompliance to be too low to constitute a real mandate. They are simply taxes – and in many cases they apply only when employees are eligible for federal tax credits"

But Henry, we already know this; so what?

Here's what:

"If tax credits are disallowed under federal exchanges, such taxes are no longer applicable. Oklahoma and other states are currently suing the federal government to enforce these terms of the Affordable Care Act."

North Carolina Gov McCrory seems to be playing a game of poker here: if Oklahoma's lawsuit is successful, his state can piggyback onto that. If not, well, there's little downside for his state's employers, and economy. And, of course, he can always revisit the idea of setting up a state-run Exchange.


[Hat Tip: FoIB Jeff M]