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]

From the P&C Files: Malpractice makes Malperfect?

My favorite EconBlogger, Jason Shafrin, has an interesting post up on the cost of medical malpractice (aka medmal) coverage for various specialties.

Can you guess which one has the highest rates?

Click on over to Jason's place for the answer.

Buyer's Remorse?


One wonders if folks are beginning to wake up to the cold, hard facts.


"It might seem odd that the law’s supporters should need to convince Americans to purchase a plan, given that those who don’t will be taxed. But the tax will be less expensive than the cost of coverage."

Asked and answered.

We've been saying this for quite a while (although, to be fair, so has everyone else with an IQ above double digits). There are so many ways to game the system - and of course, folks in states with Federally-run Exchanges get no subsidies, making compliance even more expensive - that it's hard to see why any of the PrObamaTax hordes will bother to participate.

Which won't stop them whining, of course, about the unfairness of it all. Oh, bother.

Cavalcade of Risk #177: Call for submissions

Anisha Sekar hosts next week's Cav. Entries are due by Monday (the 18th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Thursday, February 14, 2013

Runs on the ObamaExchange

Tomorrow's the deadline for states which have yet to make their pitch to Secretary Shecantbeserious regarding how they want to handle those Exchanges.

Here's a quick run-down as of this afternoon:

■ Mississippi is sticking with its game of chicken: they've officially turned down Mme Secretary's offer of a Fed-State partnership. Assuming they don't reach some other arrangement, The Magnolia State will default to a Federally-run model.

■ FoIB Patrick P reports that Illinois has been conditionally-approved to set up its State-Fed Partnership type Exchange. Patrick asks, with 16 carriers offering over 260 plans, "think Navigators will be able to handle explaining this?"

Exit question: It's clear that states choosing a Federally-run Exchange forfeit tax-payer subsidies. What's not so clear is what happens if it's a Partnership operation?

■ And FoIB Jeff M, checking in from The Tar Heel State, sends along the news that North Carolina will not be setting up its own Exchange, putting further pressure on Ms Shecatbeserious and her all-star band of technowizards to design and implement yet another Federally-run version.

■ And, finally, via email from UHC, we learn that, nationally, "the deadline for employers to notify employees of the availability of Health Benefit Exchanges has been delayed from March 1, 2013 to late summer or fall of 2013." Oh goody. Because nothing says "success" like pushing back crucial deadlines as the clock ticks down....

And this just in: "The U.S. Department of Health and Human Services (HHS) hopes to take bids from insurers that want to participate in the federal health insurance exchange programs from March 28 to April 30." Yes, one whole month to submit your bids - you hear that Anthem, UHC and the rest?

It'll be interesting to see which carriers take the bait.

Gorillas in the Mist?

If so, then you may have a future as a top-notch radiologist. Sleep tight!

Principles vs Politics in regards to Medicaid Expansion

I read in today's USA Today, only paper at the hotel, that Governors in Wisconsin and Indiana have passed on expanding Medicaid in their State. A rare display of standing on Principle. How are we to end the welfare state and entitlement problem if we continue to expand these programs that reduce and eliminate the need and incentive to work?

The easy math is free money from the Federal Government can't be passed up.

The correct math is there is no such thing as free money. A few thousand dollars in Federal crack to cover someone's Medicaid expenses doesn't begin to cover the cost of someone spending a lifetime working part time or entry level jobs and living off the taxpayor. Compounding the problem is the fact that it doesn't stop when that worker retires: kids raised under that lack of a work ethic are more likely to grow up and also live off the tax payor. Medicaid expansion is just one more step to creating a permanent welfare class. Everyone works 29 hours a week and gets by on Food Stamps, Medicaid, and Section 8 housing.  And then they and the media decry the income gap between these part timers and people working 70 hours a week to support them.

Also of interest is Indiana's request for an exemption; they had a very effective HSA Medicaid model that was being cancelled for not being ideologically consistent with ObamaCare. We'll see what HHS deems more important: a successful and proven program to deliver better benefits at a lower cost, or expansion of the Government Welfare model.

Future of Risk Pools

Most folks assumed state run risk pools and the federal PCIP would go the way of the dinosaur when Obamacare rules prevail on 1/1/2014.

But perhaps not  . . .

More than 300,000 people are now covered through special plans for people with pre-existing conditions — about 100,000 in pools created by the health law and more than 200,000 in older, state-run pools.
The federal plan was designed from the start to be temporary and to shut down as soon as the exchanges open.
But many states had planned on moving their high-risk pool populations into the exchanges slowly to mitigate the shock to the individual market. But now, the state high-risk pools may offload as many people as they can onto the exchanges as soon as they open in 2014 or risk losing a piece of that $20 billion pie.


Well isn't this exactly why Obamacare was conceived? To prevent big bad health insurance companies from DISCRIMINATING against those with pre-existing conditions?

Did the folks who wrote this law (but never bothered to read it) not anticipate an influx of people with serious medical conditions? Did they fail to realize young people would pay the tax penalty rather than purchase coverage?

Some actuaries say it won’t make much of a difference as millions of people start getting covered; other studies see this population boosting premiums significantly in the individual market. One Indiana study projected premiums would rise by up to 45 percent.
HHS says the reinsurance program will keep premiums on the individual market 10 percent to 15 percent lower than they would be without it. But even some supporters of the law believe the impact will be significant
And HHS has never been wrong about anything, right?

Health Wonk Review: Cupid edition

Peggy Salvatore presents this week's very sweet collection of wonky blogposts. It's really well done - there's no question that she read each entry, and adds helpful context to each one.


Wednesday, February 13, 2013

Mississippi Burning (The ObamaTax)

In a post yesterday, we reported on the travails of The Magnolia State's ObamaTax Exchange efforts. HHS Secretary Shecantbeserious had denied their request to install a state-run program, citing lack of inter-agency coordination, and had countered with an offer to set up a joint Fed-State operation.

As Mike pointed out, this seemed odd: "And yet, the federales tell Missippi that there's every possibility of coordinating with the same state agencies, under the same governor,  in a fed-state partnership Exchange."

I posed this dilemna to Elizabeth Festa of the National Underwriter (she wrote the original story which prompted my post). After a few emails back and forth, she came back with the Feds' final "answer" to this apparent contradiction: "Don't worry your pretty little heads about it."

Okay, that's a paraphrase; their actual reply was "a  partnership marketplace can still be set up without help from the governor's office because HHS has such a heavy role."

I'm pretty sure that my version would have gone over better.

The problem, of course, is that this is a non-answer. As I pointed out to Ms Festa (who seems like a very well-meaning and industrious person), "the HHS folks are being deliberately obtuse. Cohen (HHS) says "With ... no formal commitment to coordinate with other State agencies, we do not see a feasible pathway"

[As I explained to Ms Festa, I omitted the issue of the Governor's apparent recalcitrance because it's largely a distraction from the key issue]

I continued:

"But if MS agrees to a (Fed-State) Partnership, there's still not going to be any coordination. And if the HHS answer to that is "a  partnership marketplace can still be set up without help from the governor's office because HHS has such a heavy role," then Chaney's right when he says that "[t]he feds call the shots and we do all the work." And in that case, the lack of agency coordination becomes even more intensified."

One supposes that this could still end amicably, but at this point, it seems less likely. Ms Shecantbeserious has a pretty critical timing problem here: if they can't reach an agreement, then it automatically defaults to a Federally-run Exchange.

So what's the problem with that, Henry?

Well, there's (at least) two:

First, that countdown clock keeps on tickin', and HHS will have one more Exchange to set up (and how swimmingly is that effort going, Madame Secretary?). And second, it means that Magnolia State residents will forfeit any potential premium subsidies.


The Future of Medicare

In last night's State of the Union (SOTU) address, President Obama gave his vision of the future of Medicare and how to save it. Seniors turning 65 as well as those who are currently Medicare beneficiaries should pay close attention.

We have summarized opinions on SOTU and how these concepts will impact the future of Medicare.
"We’ll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn’t be based on the number of tests ordered or days spent in the hospital — they should be based on the quality of care that our seniors receive," the president said.
 However, fiscal diets for giant entitlement programs such as Medicare and Social Security should not be so severe that they put the burden of deficit reduction mainly on seniors and the middle class "while asking nothing more from the wealthiest and most powerful,"
Obama said. Earlier this week, his administration announced that it opposed the idea of raising the eligibility age of Medicare from 65 to 67 years, a measure supported by Congressional Republicans.
This sounds great, but as we have pointed out before, when it comes to health care paying for outcomes is counter-productive. Doctors and hospitals faced with penalties or lower reimbursement based on patient results may refuse to take on chronic conditions that will never get better or the sickest patients whose likelihood of recovery is marginal.

In other words, the sickest patients may have trouble finding a doctor to treat them.

Obama continues his class warfare assault by asking the wealthiest to pay more for Medicare. There are also some in Washington that want to change Medicare supplement plans by imposing a penalty on those who have "rich" plans such as Medigap plan FMedicare supplement rates for plan F are already higher than other plans. Asking seniors with Medicare supplement plan F to pay a penalty tax is overkill.

Most who have wealth in their senior years also enjoyed high earnings during their working years and paid more in Medicare taxes than middle and low income workers.
Medicare is already means tested.
Just check out this official website outlining the premiums for Medicare recipients. Premiums for Medicare Part B (which covers services like lab tests, surgeries and doctors’ visits) range from $99.90 to $319.60 per month and prescription drug coverage costs wealthier beneficiaries $66.40 more per month than it does for those who receive the standard benefit.
The "wealthy" pay more all around. Class warfare will not improve the Medicare balance sheet.
And yes, let's not overlook the impact of Obamacare on the future of Medicare.
Hospices—health care facilities for the terminally ill—along with other Medicare providers are facing Medicare pay cuts. Of the $716 billion in payment reductions, hospice care was hit by a $17 billion payment cut from 2013 to 2022.
San Diego Hospice recently laid off 260 workers, closed a 24-bed hospital, and has recentlyfiled for Chapter 11 bankruptcy. San Diego Hospice’s financial condition is attributed mainly to reduced Medicare reimbursement, fewer patients, and a federal audit that hurt the center’s reputation.
Another provider, Delaware Hospice, had to lay off 52 workers, citing lower federal reimbursement as the cause. “The decision,” said CEO Susan Lloyd, “is a direct result of a consequential decline in census and the need to position the organization to meet additional changes and challenges that the hospice industry anticipates with health care reform.”
Obamacare cuts are already having an impact on seniors, especially those who need hospice services. If you are concerned about the future of Medicare, get involved and let your representatives in Congress know how you feel.

Tuesday, February 12, 2013

Another Hidden ObamaTax

Hadn't thought of this before (my bad), but there's another little gem implicit in The ObamaTax:

Currently many (most?) working folks get their health insurance through employer-sponsored plans. And many of these folks pay their portion of the premium pre-tax, via Section 125 (or "cafeteria") plans.

Since many (most?) group plans will be going away over the next few years, employees dumped onto the Exchanges will lose that feature, and will have no alternative but to pay all their premiums with after-tax dollars. Adding insult to injury, a lot of these folks will be making too much money to qualify for any subsidies. And, of course, those in states with Federally-run Exchanges will get none.

But remember,The ObamaTax will lower your health insurance costs by 3000%.

[Hat Tip: Ace of Spades]

Tuesday Health Notes

■ First up, some great Food Pyramid news:

"Researchers ... in Spain have found that beer can help the body rehydrate better after a workout than water or Gatorade."

Apparently, the carbonation is a key factor, and the carbs help out, too.

■ Next, some good news for stroke survivors:

"A single injection, then a five-minute wait ... Now they're walking more steadily, reading more easily, concentrating better, speaking more clearly and regaining use of once-rigid limbs"

The secret? A 25mg shot of etanercept (an anti-inflammatory med). And the results?

"Of the total studied, more than 80 percent saw improvements in their ability to walk; more than 80 percent had less spasticity; and more than 85 percent exhibited improved motor function."

So if you (or someone you love) had a stroke, this may be just what the doctor orders.

■ Finally, the feel-good story of the week (or more), an early (and amazing) Valentine's Day gift. Forget flowers, candy and PJ's, here's a gift that truly keeps on giving:

"Three days before Valentine’s Day, a Florida woman gave her husband the most special gift of all ... Melissa DeGeso-Jones had her kidney transplanted at Florida Hospital in Orlando to her husband, James Jones, who has been suffering from renal failure."

His next major challenge? How does he top that?

Warning signs...

Earlier this week, we noted that the problems which the Much Vaunted National Health System© is experiencing at Stafford and other facilities is nothing new or even particularly obscure. What we didn't know at the time, though, is that they were warned about these problems by none other than  Sir Donald of Berwick (well-known to regular readers of InsureBlog):

"Its 84-page report ... warned ministers that the [MVNHS©] did not pay enough attention to quality of care because it was too focused on targets. It concluded that hospitals were “hitting the target and missing the point”.


Pretty sad when one of the architects of The ObamaTax finds your system critically flawed.

Missing Mississippi

Y'know, for an agency facing a quickly-approaching deadline, the folks at HHS seem to have an attitude problem:

"[Secretary Shecantbeserious] rejected approval of the Mississippi insurance commissioner’s state-based exchange application ... To be successfully approved and to even work as a marketplace, a state-based exchange would need working relationships with other state agencies ... there was no possibility of coordinating strategy with other agencies under his authority"

Which is all well and good, but fails to address the Magnolia State's main problem with the premise, to wit:

"[T]he health insurance exchanges mandated by [The ObamaTax] are not free-market exchanges. Instead, they are a portal to a massive and unaffordable new federal entitlement program. They trigger new taxes on businesses and will ultimately drive more people onto Medicaid rolls"

Please, Gov Bryant, tell us what you really think.

Underscoring the divide is the inherent conflict between what Madame Secretary wants and that pesky 10th Amendment. It seems reasonable to predict that this issue will also head to SCOTUS in the near future. How that plays out will be interesting to watch.

ADDENDUM: In the comments, Mike points out the fallacy of Ms Kathy's contention that that there's "no possibility of coordinating strategy with other agencies under his authority." In his link, a local paper reports that (as Mike puts it) "the federales tell Mississippi that there's every possibility of coordinating with the same state agencies, under the same governor,  in a fed-state partnership Exchange."

So which is it, Madame Secretary?

Monday, February 11, 2013

Draft Dodging

As Bob noted last week, some of the 58 states have begun to take a serious look at how their Exchanges (if any) will be run. A key issue is the role of agents/advisors, and how they're to be qualified and compensated.

Now comes word that HHS Secretary Shecantbeserious is planning to "start registering agents and brokers around July 1."

Okay, when you're through laughing, we can continue.

Have you noticed the little countdown timer in our sidebar? That's the countdown to the day the Exchanges are to go "live." The date? October 1st. Now, keeping this in mind, wrap your head around this:

"The federal exchange managers want to promote the agents by publishing lists of individual exchange producers starting in August and lists of the producers registered to sell Small Business Health Options Program (SHOP) exchange coverage starting in September." [emphasis added]

Now, given the institutional efficiency for which the HHS is so widely admired, what are the odds of this actually working out?

Yeah, that's what I think, too.

Anther question we might be asking ourselves is whether or not any sane insurance agent wants to participate. After all, under a state-regulated system, worst case scenario is generally a fine and/or loss of license. But these are (presumably) going to be subject to Federal laws, so the down-side must surely be more serious, no?

Which is not to say that it won't happen (I'm still on the fence, for example), but it does give one pause. And since that clock is clicking down at a pretty good clip, this may end up being a rather high-stakes game of chicken with Ms Kathy.

The Social Problem of Medicaid Expansion

Avik Roy has done a good job explaining some of the financial misconceptions our Governor has used in proposing Medicaid Expansion in Ohio.

Not discussed are the common sense social problems with expanding it. Simply: why bother working? When I was younger and wanted money, I got a job. When that wasn't enough, or I wanted a new car or paid myself to go to school, I got a second job. There have been a couple times in my life I held had three jobs. 70 to 80 hour work weeks were not uncommon; even now, with one job, 70 hours is not uncommon.

Our present-day welfare state, on the other hand, discourages work. Work just a little, be sure to show less than $15,000 in income on paper, and you can qualify for all sorts of benefits:

·Free Health Insurance under Medicaid Expansion
·Free food and spending cash with your EBT card
·Housing assistance
·Utility Assistance
·Education Assistance

Why get a second job or work more hours and lose all the free benefits? I see McDonald's and other fast food companies that are looking for workers. How can we have this level of unemployment and demand for assistance but unfilled entry level jobs?  That is a sure sign government assistance has supplanted the need to work.

We might have a Republican Governor in Ohio but we need a Conservative to replace him.

TPAs to pay for Birth Control

Apparently I am going to be spending a fortune on birth control, sadly I don't expect I will have time to use any of it.
"The preamble to the proposed rule suggests several ways in which this could be done, but the basic idea is that the TPA would take responsibility for providing coverage, and in turn contract with an insurer in the individual market to provide the coverage.  The insurer would in turn pass the cost of the coverage (which now will be a real cost since the insurer has no responsibility for covering maternity or any other health care costs) on to a federally facilitated exchange (FFE), which would offset the cost through a reduction in user fees — in other words, the insurer would receive a reduction in the user fee it otherwise owes to the FFE to cover both its costs and any administrative costs incurred by the TPA."
That's just the summary. Where to begin....

I have never seen a contraception-only policy before; are they even legal to sell?

I need to find a carrier, send them eligibility on a regular basis, and not get paid for any of it?

I am going to be really pissed if some carrier has a data breach and exposes PHI or Red Flag Data and I have to deal with the cost for services I didn't get paid for; I haven't seen any mention of immunity.

Will MLR apply to these policies? I foresee a lot of work to provide a small dollar benefit. In fact, I could see the administrative cost being higher then the cost of the drugs.

And who gets the rebates?
"Insurers providing contraceptive coverage would be responsible for notifying plan participants and beneficiaries of the availability of the coverage using language found in the proposed regulation.  The notice would be provided separately from any other plan information, generally on an annual basis."
There starts the excessive administrative fee.  Apparently single males would also need to be offered this policy and notice?

Fraud potential in this is huge: I don't see where anyone is asking the TPA to verify who these policies are being purchased for.

Sunday, February 10, 2013

Old Dominion vs The ObamaTax

Well, well, well. So it's not just universities and businesses cutting employees' hours to avoid some of the more pernicious elements of The ObamaTax. Now, states are getting in on the act, too:

"Virginia ... is about to limit part-time employees to 29 hours per week in order to avoid triggering Obamacare’s requirement that employers provide health insurance to those working 30 hours per week or more."

That's because the state can ill-afford the estimated $100 million+ cost of implementing the train-wreck. Look for at least a few more of the other 57 states to follow suit.

Feature or Bug?

The other day, we reported on the latest scandal plaguing (heh) the Much Vaunted National Health System©.  And despite the fact that, as Mike pointed out, we covered this very same facility (among others) over three years  ago (!), little has changed, and nothing has improved.

Now comes British Health Secretary Jeremy Hunt (the MVNHS© version of HHS Secretary Shecantbeserious), openly calling for a police investigation into the affair, opining publicly that it's "absolutely disgraceful” that no doctors, nurses or managers have been held to account for the substandard care which led to the deaths of up to 1,200 patients."

Which begs the question:

If, after (at least) three years of ongoing and documented “abuse on such a wide scale,” isn't it fair to ask whether this might actually be by design, and not happenstance? After all, none of this is "news;" indeed, it's been common knowledge for some time. And yet, it's only after a British newspaper reported the abuse in detail that a high government official thinks it's time to ditch the famous stiff upper lip, and get cracking. 

But wait, it gets worse:

"[Secretary Hunt] admits he is not sure which hospitals are doing a good job ... I think it’s absolutely outrageous that potentially more than a thousand people lost their lives because of poor care and not a single person has been brought to book."

A suggestion, Mr Hunt? Try a mirror.