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”.

Ouch!

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?

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.

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.