Read it? Heck no - Just pass it!

From the "Have to Pass it to Learn What's in it" Files:

"Older adults of the same age and income with similar medical histories would pay sharply different amounts for private health insurance due to what appears to be an unintended consequence of the new health care law."

Well first, I take great issue with the assumption that this was, in fact, "unintended." After all, the whole point of the bill was to increase the disparity of who pays what for health insurance, with the ultimate aim to dilute the coverage of currently insured folks in favor of those who have chosen to abstain from purchasing it.

The "glitch" in question has to do with how some "younger older" adults (between ages 62 and 65) can elect to take early retirement and receive tax-payer assistance with premiums (of course, those of us paying the actual tab get no such break). In fact, those "younger older" citizens who must continue to work are actually penalized for doing so; as Bob Laszewski notes:

"If you get a job for 40 hours a week, you're going to pay more for your health insurance than if you don't get a job."

Of course, HHS Secretary Shecantbeserious is hot on the case:

"The Obama administration says it is working on the problem."

Why doesn't that make me feel any better?

Something Different: Maritime Insurance and Terrorism

Insuring a commercial ship requires a special type of coverage, generally available from carriers that specialize in this area of the biz (Lloyds' syndicates come to mind). Unlike, say, your average home or car policy, there are very few carriers willing (and/or able) to take on this kind of risk. They assess various factors, including potential liability, which can come in many different forms.

Such as this:

"[C]ompanies that have insured the ships that have been assembled to sail to Gaza to break the blockade of the Hamas-run strip [may be] leaving themselves open to prosecution for aiding terrorists"

This is in response to the terrorist-enablers behind the various Gaza-bound flotillas, but represents an apparently novel way to make a point: go for the insurer as the first domino.

There's no guarantee that this ploy will have any effect, but insurers are generally not keen to pile on additional, and perhaps costly, risks for which they haven't accounted.

Obamacare Bites

I have been trying to deal with the constraints of Obamacrap but this is too much. For all the talk about keeping your plan, giving everyone lower health insurance premiums and saving the world from capitalism, this thing with children's health insurance really bites.

Hardly a week goes by when I don't get a call from someone wanting to buy health insurance on their child. The only thing I can offer is either a short term medical through one of two carriers or a basic health insurance plan.

Real major medical on a child only is extinct.

Obamacrap started the ball rolling and HHS put the finishing touches by telling carriers they could not decline children or place an exclusionary rider on a medical condition.

The carriers responded by pulling all "child only" rates and plans and only offering to cover children when applying as a dependent of a healthy adult.

Riders are not a problem for a lot of conditions and can actually make coverage LESS expensive and MORE widely available vs. rate up for the condition.

I have a long time client with family coverage that has been with the same carrier for 5 years. They finally got tired of the rate increases and wanted to look at options.

I found a comparable plan with Humana that would save them almost $200/month so we applied.

One of their children was recently diagnosed with ADD/ADHD but is not yet on any medication. When med's are introduced they can easily run $150/month or more.

Even though she is not on med's now, that could change so the carrier rates for the potential.

That resulted in a $90 increase in the premium. Still a savings vs. the renewal, but Obamacrap rules made their coverage MORE expensive, not less.

They would have been happy with the rider and would rather not pay an extra $1000 per year to comply with Obamacrap rules.

So what happened to the promise of lower premiums for everyone?

Smaller cars, bigger health insurance premiums, Poppa Washington.

Cavalcade of Risk #134 now up

Julie Ferguson presents this week's epic collection of risk-related posts. With security theatre, zombies, cats 'n cars & more, what's not to love?

Dodging the (Tax) HIT

This morning's email brought a link to this HIT piece [ed: /groaner!] on the so-called Health Insurance Tax portion of ObamaCare©:

"A hidden tax known as the Health Insurance Tax, or HIT, which will increase health care costs and threaten our ability to grow and create jobs ... and will have a direct impact on businesses and their employees’ bottom line."

No kidding.

Mr Plemmons, the Executive Director of the Council of Independent Business Owners, continues:

"The tax was originally intended for insurers, but the small businesses, their employees and the self-employed who purchase health insurance on the fully-insured market will be the ones paying the bill."

I repeat: No kidding.

Insofar as he characterizes the net impact of the HIT on the economy, I of course agree with Mr Plemmons' analysis. But I find it distressing that the very folks who purport to represent the interests of "small business" are unable to grasp a core issue at the heart of their advocacy, to wit: insurers (which are, of course, business themselves) and other businesses (large and small) do not pay taxes.

We covered this almost 5 1/2 years ago:

"Companies do not pay taxes, and they do not pay for health insurance."

This obvious point seems lost on Mr Plemmons, which is a shame, because it represents a missed opportunity to address other substantive issues with the HIT. These include "upwards of $90 billion in additional excise taxes," a point we made when we first noted the "Stop The Hit" campaign last month. I'm all for dodging that particular HIT, but please let's keep the rhetoric accurate, and thus credible.

Shecantbeserious Goes on a Medical Mystery Tour! [UPDATED]

Our favorite guest-blogger, Certified Medical Office Manager Kelley Beloff, is back, and has the scoop on the real life implications of the latest ObamaCare© goofiness: Medical Mystery Shoppers:

As part of my daily readings for my job as a medical practice manager, I came across this article from the New York Times, “U.S. Plans Stealth Survey on Access to Doctors.” The article discusses how the United States Government is going to use mystery shopping techniques to assess the wait times for new patients to get into a primary care physician’s office and if patients on Medicaid are treated differently from those with private insurance.

“Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.”

Then the article prints out the script that will be used.

After I fell out of my chair laughing, I decided I needed to point out the error of the government’s ways.

This is how the government has the phone call playing out:

“Mystery shopper: “Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible.”

Doctor’s office: “What type of problem are you experiencing?”

Mystery shopper: “I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath.”

In separate interviews, several doctors said that patients with those symptoms should immediately see a doctor because the symptoms could indicate pneumonia, lung cancer or a blood clot in the lungs.

Other mystery shoppers will try to schedule appointments for routine care, like an annual checkup for an adult or a sports physical for a high school athlete. “

This is how the actual call will go:

Mystery shopper: "Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible."

Doctor’s Office: Dr. Krane is booked out for new patient appointments for three months. Before I can schedule you I need some information. What is the name of your insurance? Are you the subscriber? I need your social security number, birthdate, ID number on your insurance card and your employer for our insurance verification.

Mystery Shopper: "Listen, I just need to see a doctor. I have been in area for four months and I didn’t need a doctor until now, so just schedule me."

Doctor’s Office: Sir, you do not need to take that tone of voice with me. By federal guidelines in the HITECH Act, all physicians’ offices must verify insurance before any person can become a patient. Additionally, by the rules in the Red Flag rule, we must determine that you are you and not using a fraudulent insurance card. Now, if you would like to continue the initial intake…

Mystery Shopper: "I cannot believe you are treating me like this, I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath."

Doctor’s Office: Sir, did you go to the emergency room?

Mystery Shopper: "Why would I go to an emergency room, do you know the wait times there. I just want to see the doc and get some meds, why can’t you understand this simple request."

Doctor’s Office: Sir, it takes at least three days to verify insurance and as I said the doctor is booked out for new patients for three months. At this point I recommend that you go to the emergency room and then please call us back to start the process of becoming a new patient.

Mystery Shopper: "Listen, I can do the new patient appointment later, can’t I just come in to be seen?"

Doctor’s Office: Sir, I am sorry but by federal guidelines, all patients not seen by a physician in three years must be seen as a new patient. Our office is contracted with Medicare and these are the rules mandated by CMS. We will have to see you as a new patient and the doctor does not have any openings for three months. I must insist that you go to the emergency room. Sir your symptoms are very severe.

Mystery Shopper: "Listen, how about if I just pay you cash, that way my insurance company won’t know that I was seen."

Doctor’s Office: Sir, under federal guidelines I cannot have you pay for an appointment if we are contracted with your insurance company for a discounted rate. That is fraud under CMS guidelines.

Mystery Shopper: "Un freakin believable, so what I am supposed to do, just die. I cannot believe you people." CLICK.

The reason for the appointment is not relevant at this stage; the reality is that physicians are booked out for new patients anywhere from two months to six months. If an established patient called me with those symptoms, the physician would tell that patient to go to the ER. Physician’s offices are not the site for this type of problem.

The article continues:

“To make sure they are not detected, secret shoppers will hide their telephone numbers by blocking caller ID information.”

To ensure against identity theft, one of our first lines of defense is a phone number. If a new patient calls with a blocked number then we become suspect of the true intentions of the person calling. In gathering information to make a new patient appointment, a physician’s office will require an address, phone number of home, work and cell, as well as employment status.

And then there is this paragraph:

“Eleven percent of the doctors will be called a third time. The callers will identify themselves as calling “on behalf of the U.S. Department of Health and Human Services.” They will ask whether the doctors accept private insurance, Medicaid or Medicare, and whether they take “self-pay patients.” The study will note any discrepancies between those answers and the ones given to mystery shoppers.”

No reputable physician’s office will give out this information to a stranger. If I received this phone call I would ask for a name and reason for this request, since all physicians taking Medicare or Medicaid have already registered with the U.S. Department of Health and Human Services, thus this is a scam phone call.

“Federal officials said the initial survey would cost $347,370. …Jennifer Benz, a research scientist at the center, said one purpose of the study was to determine whether the use of mystery shoppers would be a feasible way to track access to primary care in the future.”

Ms. Benz, let me save you some time and our government some money. This will not produce the results you are seeking. I can give you your answer for free. There is a shortage of primary care physician’s because the payments from insurance companies, the government included, are too low. In fact, in another posting today, I came across this article which details physicians compensations by category. Family Practice is dead last with a compensation of $178,000. The average compensation of $65.87 from an insurance company to a doctor for a mid-level office visit will not motivate physicians to go into primary care. The compensation has been stagnant for over a decade and it is doubtful that any primary care physician will ever get a raise.

My practice’s specialty is not on the list for the phone calls, nor is Ohio listed as one of the States where calls will be made, but if I do get one of these phone calls it will make my day.

Thanks, Kelley!

UPDATE: Under intense pressure (ie someone finally figured out how bad this looked), HHS Secretary Shecantbeserious (et al) has apparently decided to deep-six the program.

Exit question: how much did this little escapade cost the taxpayer?

Grand Rounds, Colorado-style is up...

Louise Norris hosts this week's collection of interesting medblog posts, complete with vintage pictures that really capture the mood.

If They Won't Play Nice, Beat Them Up

The Massachusetts Attorney General has a solution to the rising cost of health care (and health insurance). If the providers won't behave she will make them do her will.

Forbes magazine reports the OAG (Office of Attorney General):

“at least setting temporary statutory restrictions on how much prices may vary for comparable services” in order to “moderate price distortions, without price setting, . . . as a stop-gap until the corrective effects of tiered and limited network products can improve market function.”

Eliminating the government speak, it means if medical providers and health insurance companies don't toe the line until Obamacrap kicks in the OAG will make you limit your fees.

Yes, that worked so well when Nixon imposed price controls.

"At first prices did go down under the Nixon imposed freeze, but what happened once they were lifted didn't work out so well.

No reason to believe the Massachusetts OAG price controls will work out any better.

First, as was true for the OAG’s 2010 report on cost control, the 2011 report was motivated by continued rapid growth in Massachusetts healthcare costs following the enactment of its healthcare reform law in 2006. That cost growth further highlights the “expand coverage now – deal with costs later” philosophy underlying the Massachusetts law and its nationwide descendant, the Patient Protection and Affordable Care Act. It also highlights that when “later” arrives, proposed solutions will likely include a heavy dose of additional government controls on private contracting."

So in other words, make promises to get elected and deal with the truth later. Kind of makes you wonder just what the REAL price tag will be for Obamacrap.

"The report vaguely blames that unexplained variation on “dysfunctional” markets. The analysis parallels studies of geographic variation in Medicare spending and associated views that Medicare spending can be cut significantly in high cost regions without any reduction in the quality of care. In contrast to the conclusions of the OAG analysis and much of the Medicare research, substantial uncertainty exists about the extent to which variation in spending across regions or providers that researchers have been unable to explain is in fact attributable to unmeasured differences in patient health and quality of care."

Don't confuse me with facts, my mind is made up.

When government interferes with the private market costs never go down, only up.

"The report contains no discussion of the potential (inevitable) adverse effects of price controls. It’s not even clear that limits on “how much prices may vary for comparable services” would help lower costs, as opposed to exerting upward pressure on reimbursement to providers currently receiving relatively low reimbursement. Overall, the price control recommendation seems to come out of Fenway’s short left field."

The left field is where the Green Monster resides.

But don't read anything in to that . . .

Thanks to Henry Stern for the heads up!

Google It! (Or not)

From the Time Flies Dept: Over three years ago, we reported on Google's EMR (Electronic Medical Records) initiative "Google Health," which was touted as "a long-anticipated U.S. health information service that combines the leading Web company's classic search services with a user's personal health records online."

Partnering with Walgreen's and CVS, not to mention the highly esteemed Cleveland Clinic, the effort was meant to bring the efficiency of data warehousing to the health care field.

So, how's that working out?

About as well as might be expected:

"Google is giving up on its vision of helping people live healthier lives with online personal health records. ... Google Health never really caught on."

To some extent, that's a hazard quite common to path breakers, and the search engine giant (and its partners) faced a significant field of competitors, not to mention a natural reluctance on the part of us patients to entrust our private health information to the vagaries of tech.

The true reason, though, may be much simpler. According to a former Google Health manager, most folks weren't too enthusiastic about typing in a bunch of personal information:

"In the end ... it was an experiment that did not have a compelling consumer proposition.”

No kidding.

[Hat Tip: Bob V]

Swedish Meatball MedCare & Scottish Non-Care

Over the years, we've chronicled the (mis)doings of the MVNHS© and CanuckCare. Some critics have asked why we don't focus as well on more...ahem..."successful" national health care systems, such as Sweden's. Aside from the fact that America is more culturally akin to Great Britain and Our Neighbors to the North©, there's the rather striking fact that Sweden's health care scheme is not exactly a paragon of virtue.

And now, the Swedes have proven once again that their system is, in fact, broken:

"After sustaining an open chest wound of 10cm long while trimming her horse’s mane, Sweden’s emergency response services refused to send an ambulance, suggesting the 11-year-old girl take aspirin instead." [ed: 10cm~4"]

The girl's mother called the Swedish equivalent of 911; the dispatcher refused to send an emergency response team and instead suggested that mom simply dress the gaping, bleeding wound and give her daughter an aspirin.

Great bikini team, not-so-great health care.

And speaking of the MVNHS©, we would be remiss if we missed noting the sage wisdom of Dr Brian Keighley, who chairs the British Medical Association Scotland. Which is nice for him, but maybe not so nice for his (and/or his colleagues') patients:

"The leader of Scotland's doctors has questioned whether society can afford to pay thousands of pounds to keep terminally-ill people alive for weeks or months ... the GP said the country had to debate the merits of these kinds of aggressive treatments and the effects they had on the NHS budget."

Indeed.

But don't you dare say "Death Panels."

Or else.

Risk Management and Floods

The good people of Minot, ND may be forgiven for allowing their flood insurance policies to lapse:

"When the federal government lifted a requirement a decade ago that low-lying valley homes have flood insurance, most residents stopped buying it."

Now, one may argue that, just because the gummint doesn't require you to purchase flood insurance (as opposed to health insurance, of course), doesn't automatically mean that it's not a good idea to do so. But that same government, courtesy of the U.S. Army Corps of Engineers, has spent the past 6 decades ensuring that the Mighty Missouri would and could be controlled through a series of dams and levees.

Unfortunately, snail darters (or whatever) have now taken precedence over human lives, industry and livelihoods:

"The Corps began to utilize the dam system to mimic the previous flow cycles of the original river ... On February 3, 2011, a series of e-mails from Ft. Pierre SD Director of Public Works Brad Lawrence sounded the alarm loud and clear."

The net result: lives endangered, valuable crops destroyed, houses washed away.

And, of course, many (most?) of these losses are uninsured because the people believed that the Engineers worked for them, not the snail darter.

Which is not to let those folks completely off the hook: if you own something valuable, then it often makes sense to mitigate the risk of its lost by purchasing insurance to cover it.

Stupid Client Tricks: P & C Edition

So, your car sits idle (but hopefully not idling) 22 hours a day. Your car payment and insurance meters, though, run 24/7. Wouldn't it be great if there were some way to turn that down-time into cold cash?

Turns out, there just might be, but there's a catch. Actually, there are a lot of catches.

Here's the scoop:

Yesterday's McPaper featured a front-page item on "personal car-sharing:"

"Seeing a business opportunity in millions of cars that sit idle at office parking lots or on weekends, several start-up companies have introduced "peer-to-peer" car-sharing services ... Renters pay typically $5 to $15 an hour for a car in their neighbor's garage or office parking lot."

It goes like this: Jim's newish Saturn sits in the parking lot all day, and Bob needs to run some errands out in the 'burbs. Bob signs up with (for example) Getaround, to which Jim is also subscribed (as a vehicle provider). Getaround charges Bob $10 an hour for the use of Jim's car, which it then splits with Jim. Win-win-win.

Or is it?

This is a blog about insurance, after all, and there are a host of issues with this seemingly simple and convenient new business model. Unlike a regular rental car service, Getaround doesn't own the vehicles. And since these are private passenger automobiles, they're covered by private passenger automobile insurance. Thanks to my friend Bill M, I was able to score the relevant portions of a typical auto policy (YMMV):

"Exclusions:

... to any automobile while used as a public or livery conveyance." [emphasis added]

Now, this doesn't apply to "ride-share" or other car-pooling arrangements. But the Getaround model isn't a car-pool: you're renting out your car, and that changes the risk in a myriad of ways.

When you bought your policy, you agreed to the coverages and exclusions in the policy, and also to your own (minimal) obligations, one of which is to inform the carrier of a "material change" in the risk. Those of us with teenagers are well-aware of how this works: you can't just neglect to tell your insurer that your 16 year old son is now driving the family station wagon minivan and expect them to pay up with no fuss when it gets totaled. Likewise, renting out your car to someone you've never met (and will probably never even see!) is a dramatic change in the nature of your insurance policy's risk.

Which then raises all kinds of issues:

First, let's say that you've already bought insurance, and then you sign up with Getaround. If you call your agent and tell him, the likelihood is that the policy's going to be canceled, because you now need a commercial lines plan.

Let's say you don't call him: what are the odds you're going to be a happy camper when Bob totals your car into the side of a schoolbus full of elementary students?

Then there's this: you've now dramatically restricted your ability to shop around for new coverage. Again, if you don't tell the new carrier, then you've lied on the application (a bad idea, and a felony). If you do disclose it, you're going to be looking at some major premiums for a commercial policy.

California recently passed (and Oregon is poised to pass) a law forbidding carriers from dropping drivers who engage in car-sharing. That seems great on paper, but again, Bill M points out that this will have one of two outcomes: either carriers will flee the state, or they'll raise everyone's premiums to make up for the increased risk.

At least one of the carshare companies provides liability coverage to the renters. That's nice, but anyone that thinks that the parents of the kids in the aforementioned schoolbus aren't going to be coming after the car's owner is definitely inhaling.

In perhaps the stupidest comment I've read in a long time, Getaround's CEO avers that "[o]wners' insurance carriers are not liable for anything that happens during the sharing period. Consequently, it should be no impact to owners."

Rotsa ruck with that, Mr Zaid.

Cavalcade of Risk #134: Call for submissions

Julie Ferguson hosts next week's CavRisk. Entries are due by Monday (the 27th).

NB: We're now using this submission tool: The BC WorkAround

Once there, you'll be asked to provide:

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

At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.

And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

The ObamaPool©: Rest Period!

It's important to remember that, when we "passed the bill to read what's in it," we were told that some 4 million people would be jumping into the state-run ObamaPools©.

Would that it were so.

Talk about underselling:

"Barely a dozen Mainers have signed up for an insurance plan that covers pre-existing conditions, which has been available in the state for nearly a year."

Remember, this is highly subsidized coverage, which includes pre-existing conditions including maternity, at reasonable rates and no underwriting or exclusions for pre-existing conditions.

The underwhelming result?

"[O]nly 14 people have subscribed to the plan"

That's out of a total population of over 1.3 million people. If we take the (debunked) figure of (say) 15% uninsured, then we're talking about a potential client base of almost 200,000 people, of which a grand total of a baker's dozen + 1 have availed themselves.

Or, as the gummint might say, "success!"

DTC explained

Direct to Consumer (DTC) advertising has been a pharma staple for quite some time. We've all seen them; heck, most of us could probably parrot back key points ("for more than 4 hours," "nausea, dizziness, constipation," "if you're pregnant or may become pregnant," the list goes on).

Some folks have finally had enough, and produced this video template for pretty much every DTC campaign you can think of:

Health Wonk Review, "Big Men" edition is up...

Tinker Ready hosts this week's roundup of thoughtful posts on health care policy and wonkery.

Thursday Morning Linkfest

■ FoIB Holly R sends us this tidbit, the truthfulness of which I can confirm from personal experience:

"Staying out of [the] hospital is cheaper and safer ... One in three hospital patients experiences an adverse event."

This makes sense, of course: after all, there's lots of sick people there.

■ My better half recently started a new job helping an insurer with IT issues. It's something we tend to take for granted: home office tech includes not just rating tools, but secure systems to handle sensitive personal data, in-force policy info, and more.

Stephanie Majercik recently emailed us some results from a recent Oracle Insurance survey about insurers' top concerns. The results were interesting:

Insurers struggle with business agility and see their legacy IT systems as a hurdle to optimizing customer service and faster time to market for new products and channels

Insurers feel hindered by current technologies in their efforts to deliver efficient customer service

There's more, but the bottom line is that, at least for major players, the breath of new tech is breathing heavily down their necks.

■ Finally (for now), Lab Tests Online is a web-based, non-commercial tool here you can plug in the names of various tests and learn what the doc's are really looking for. They recently celebrated a couple of important milestones, "reaching its 10th anniversary and hosting its 100 millionth visitor."

Kudos, LTO!

What are they smoking?

So, Jennifer Arnold of Avalere Health ("a leading advisory company focused on healthcare business strategy and public policy") tips us to their recent study which claims that, contrary to all actual evidence, ObamaCare© won't disrupt the commercial insurance market. Or, as Avalere so quaintly terms it, "Employer Sponsored Insurance (ESI)."

According to the brain trust at AH (LLC!), "the ESI market will be fairly stable after 2014 when key ACA coverage provisions go into effect, primarily due to stability in offer rates among large employers."

As Mike so succinctly puts it, "Stable as in "assume room temperature" ??

I think that's about right.

Flying in the face of logic, common sense and the stated intentions of the actual subjects of their predictions, AH (LLC!) avers that "large employers are more likely to take a “wait and see” approach on coverage."

Really?

Of course, they then go on to completely negate their entire argument with this little gem:

"[ObamaCare©] will have differential impacts on ESI depending on factors such as firm size, composition, and sector."

No kidding?

UPDATE - Piling on: By the way, it's not just lil ol' us that makes the case against AH's specious claims. No less than the President of the Federal Reserve Bank of Atlanta, one Dennis Lockhart, notes that:

"We've frequently heard strong comments to the effect of "my company won't hire a single additional worker until we know what health insurance costs are going to be."

Amen.

Stealing Health Care

Need health care? Can't afford it? Rob a bank.

James Verone lost his job of 17 years due to the recession. He has supported himself with part time and temporary jobs but that wasn't enough.

On a side note, he is to be commended for this attitude. Rather than wait on the government to bail him out he went out and looked for work. Honest work . . . before he turned to crime.

In jail, Verone said he skips dinner to avoid too much contact with the other inmates. He's already seen some nurses and is scheduled to see a doctor on Friday. He said he's hoping to receive back and foot surgery, and get the protrusion on his chest treated. Then he plans to spend a few years in jail, before getting out in time to collect Social Security and move to the beach.

The rest of the story is here.

Obamacare - Millions on Medicaid

The folks in Washington that crafted Obamacare never bothered to read the bill before making it law. Nor did the ask OMB to score all the associated costs of the law.

So now, almost a year and a half later, they are just now discovering a "glitch" in the Affordable Care Act, the one we call Obamacrap.

According to the Washington Post, Obamacrap will cause employers to lay off employees, drop group health insurance and result in millions going on Medicaid.

President Barack Obama's health care law would let several million middle-class people get nearly free insurance meant for the poor, a twist government number crunchers say they discovered only after the complex bill was signed.

The change would affect early retirees: A married couple could have an annual income of about $64,000 and still get Medicaid, said officials who make long-range cost estimates for the Health and Human Services department.

Up to 3 million more people could qualify for Medicaid in 2014 as a result of the anomaly. That's because, in a major change from today, most of their Social Security benefits would no longer be counted as income for determining eligibility. It might be compared to allowing middle-class people to qualify for food stamps.

While $64,000 isn't wealthy for most it is a comfortable wage . . . especially if you can get free health insurance.

But the folks in DC refuse to admit the error of their ways.

“Indeed, administration officials and senior Democratic lawmakers say it’s not a loophole but the result of a well-meaning effort to simplify rules for deciding who will get help with insurance costs under the new health care law. Instead of a hodgepodge of rules, there will be one national policy.”

Not a loophole, we PLANNED it this way . . .

Right.

So why are we just now learning of this?

Perhaps someone finally got around to READING the bill.

It's all in the Genes

Cancer treatment continues to be an expensive and difficult proposition. One of the main challenges is the diagnosis itself, and of course treatment protocols run a large gamut. One particularly promising avenue has been the use of genetic testing in determining a particular cancer's origin. This kind of testing is often (generally?) excluded from coverage under most health insurance plans (and perhaps rightly so, but that's another post).

But this may be changing. I recently received an email from Ed Stevens of Pathwork Diagnostics, a "privately held molecular diagnostics company focused on oncology." They've been working with SelectHealth (a nonprofit health insurer) to find better ways to help folks identify primary tumors.

In the event, SelectHealth has apparently become the first carrier to cover Pathworks' new "Tissue of Origin Test." This is significant because better diagnostics can mean better outcomes, which is beneficial both to the insured and the insurer.

In related news, the test has now also been approved for coverage under Medicare, a first for this type of test. Potentially life-saving good news for seniors.

Obamawaivers

I gotta ask, just who is Ezra Klein and why should anyone care? More importantly, how does this guy manage to keep his job when he is so far off base that he should be tossed out of the game just on principle.

On the Obamacrap waivers he offers this view.

the law to do something in the four years between passage and implementation. So they created a host of early benefits: modest, high-polling ideas like letting kids stay on the parents’ health plans until they turned 26 and eliminating lifetime caps on coverage and ending discrimination against kids with preexisting conditions.

But the health-care market works the way it does for a reason. Insurers set those caps because if they don’t, people who know they’ll have huge lifetime expenses buy insurance and people who know they won’t have huge lifetime expenses don’t.

Oh really?

Those who KNOW they will have big medical bills buy health insurance and those who KNOW they won't don't buy insurance?

If someone is seriously ill and is already spending a lot of someone's money on health care, and they know they are not imminently terminal, then yes. Those people have a good idea they are going to need a lot of big bad insurance company dollars to pay for their continued care.

Only one problem.

They won't be able to buy such a plan. They are uninsurable under today's rules.

As for the rest of us, how would anyone KNOW with certainty they will never need a health insurance plan with an unlimited lifetime maximum?

They discriminate against kids with preexisting conditions because if they don’t, parents who know their kids are sick will sign them up in greater numbers than parents who are pretty sure their kids are healthy. You can change that by changing the whole insurance market, and the Affordable Care Act does that, telling insurers they can no longer discriminate and individuals that they can no longer wait till they’re sick to buy insurance. But it doesn’t do that until 2014.

Does this guy engage his brain before pounding his keyboard?

Any idea what will happen to rates in 2014 when you can indeed wait until you get sick before buying health insurance? Why is this a better concept than the current plan?

And won't this new Obamacrap plan discriminate against HEALTHY people by virtue of allowing sick people to skate until they get sick? Why is it OK to discriminate against healthy people but not OK to discriminate (or as we call it, underwrite) against sick people?

In the absence of bill’s real reforms — which are, incidentally, projected to lower premiums

The only one projecting lower premiums are the idiots that sold this crap to the American public.

House Republicans promptly asked the Government Accountability Office to investigate. The results of that investigation were released yesterday. The bottom line? There’s been no evident favoritism. The administration has greenlighted 95 percent of the requests for waivers,

95% approval is phenomenal.

Most of the plans cover union workers and businesses in Nancy Pelosi's district, but that is all probably just a coincidence.

Even though Obamawaivers are supposedly coming to an end one has to ask, if Obamacrap was so good why are waivers even necessary?

Grand Rounds is HOT!

Shrink Rap hosts this week's sizzlin' round-up of great medblog posts. I really like the way it's laid out, with summaries PLUS excerpts. Looks like the Shrink Rap folks are en fuego!

Punishing the Good Guys: An Update

About a month ago, we reported on the travails of Bill and Mary, two hard-working folks who played by the rules and, as a result of circumstances beyond their control, were punished for doing so. Specifically, Mary is not eligible to take a dip in the Ohio ObamaPool© because she was recently insured. She was left with few options, none of them particularly appealing.

Recently, Bill learned about an "exciting new insurance" product that promised to cover Mary's health woes. But he had to act quickly (within 24 hours!) because "open enrollment" for this plan ended the next day ("the 17th!").

First, no legitimate insurance carrier ends "open enrollment" on anything other than the end of a given month. Second, any kind of "deal" is going to be a deal the day after tomorrow, too, else it's not really "a deal" at all. My colleague knew this when Bill came to him for advice, and was promptly referred back to me to confirm that this wasn't what it appeared to be. I'll give Bill credit: he did call me, and listened as I explained all the tell-tale signs of a rip-off.

And, of course, our words fell on deaf ears.

And why shouldn't they have? What, after all, did we offer as an alternative? What safety nets existed to help Mary? As my colleague mused, "of course he was grasping at straws, we can't give him a drink."

Indeed.

Bladder up!

I've always subscribed to the conventional wisdom that emptying a full bladder as soon as (practically) possible was always the "way to go."

But new research seems to pour cold water on this idea:

"New research shows that seemingly trivial things, such as the fullness or otherwise of your bladder, have a huge influence on the way you make decisions."

Who knew?!

The question, though, is whether or not to avail oneself of "the facilities."

Turns out, the answer's no:

"Long-term decisions made on a full bladder, the research showed, will be more rational than those made while running on empty"

Good to know.

MVNHS©: Into the Breach

For those still skeptical that government-run health care means rationed health care, here's a little somethin' to nudge you along the road to reality:

"Official figures for April showed 51 trusts - a third - missed the target for 90% of patients to be seen within 18 weeks ... The target for hospitals to see 90% of patients within 18 weeks was to reflect the fact that there needed to be leeway ... Nationally, 90.5% of inpatients ... were seen within this time in April."

It was difficult finding a corresponding stat for American patients - pretty much every study focused on ER wait times - but I did find this little nugget, which at least offers some perspective:

"A 2009 study found that on average the wait in the United States to see a medical specialist is 20.5 days."

The point here is that those who think that shifting to a system run by the Feds is going to magically and drastically improve care are definitely inhaling. Key metrics which we take for granted are noticeably worse under the MVNHS©:

"In the worst performing area - Hastings and Rother - more than a quarter of patients were waiting longer than 18 weeks."

But the "money quote" is right here:

"The problem has been put down to the squeeze in budgets that the NHS has seen in the past year."

So let's sum up: less care, longer waits, more expensive.

Now what does that remind me of?

ObamaWaiver© Mania Waning? [UPDATED & BUMPED]

Maybe so:

"The Obama administration says it will end a controversial health care waiver program in September.

Officials announced Friday that all applications for new waivers and renewals of existing ones have to be in by Sept. 22."

Considering that the program wasn't even in the bill we had to "pass to see what's in it," this is quite an accomplishment.

As it became more and more obvious that these were handed out as door-prizes to favored groups (ahem), it's become an ongoing bone of contention among those of us who, perhaps naively, expect a modicum of transparency and (dare I say it?) fairness in the way laws are implemented.

Of course, this administration has a history of reneging on its promises, so who knows whether or not they'll actually peter out this fall.

Bob Adds [6/18/11]: Check out the number of folks who had their application denied but then received approval on appeal.

Bark, Screech, Yowl!

Try as I might, it's difficult to imagine a more useless, bigger waste of money than auto accident coverage for one's pet:

"(A)n auto insurer's pet-injury coverage typically kicks in if a pet is traveling in your car, is injured in an accident and needs veterinary care."

Seriously?

This is not to be confused with regular ol' pet health insurance, which can help pay more typical veterinary bills. What it reminds me of more than anything is what we used to call "accident plans," which paid a specific sum if one had (for example) a broken arm or the like.

Apparently, this coverage has been available since 2007 for customers of Progressive Insurance, and now Chubb and Arbella Mutual Insurance have introduced their own versions.

The coverage runs about $20 a year for a $500 benefit. Granted, we're not talking big bucks here, but this seems like a colossal waste of a double-sawbuck.

Unless, of course:

Ode to Rube Goldberg

If you ever played the board game Mousetrap as a child you have an idea of a typical Rube Goldberg contraption. The health insurance exchanges as required by Obamacrap are an example of taking a simple idea and making it overly complicated . . . Goldberg style.

The folks at Kaiser Health News pretty much nailed it.

In order to qualify for federal financing, the state exchanges must be able to ensure that premium-support recipients are living U.S. citizens -- a requirement to protect against fraud -- and are not felons. They must have household incomes between 133 percent and 400 percent of the federal poverty line (about $90,000 for a family of four). They also cannot be recipients of other health benefits from another source, such as an employer.

Logistically, these requirements present a massive challenge. For the first time, secure data feeds from the Departments of Homeland Security (establishing legal immigrant or US citizen status), Justice (for felon history), Treasury (for tax return information to impute income) and the Social Security Administration (establishing that the recipient is not deceased) would have to be combined. These data feeds would then have to be securely coordinated by the Department of Health and Human Services. There is no history of these agencies ever bringing their data together at this scale. It would qualify as the largest IT integration project in U.S. history.

Next, all 50 states would have to integrate this data into 50 different versions of a Travelocity.com for health insurance -- all while seamlessly shifting millions of recipients back and forth between private insurance and public programs like Medicaid and CHIP; allocating subsides; and collecting insurance premiums.

Only the folks from Washington could conceive something so complex as to be impossible to implement.

Immigrants, Babies and the MVNHS©

"Walk into Ealing Hospital and you could be forgiven for thinking you were in a foreign land ... new figures revealed that 80 per cent of the children born at the West London hospital over the previous year were to foreign nationals."

And it's not just labor and delivery costs, either:

"(A) team of translators, funded by the taxpayer, has to be on hand around the clock."

And now to the crux of the matter:

"(R)enewed concern that the NHS is being overwhelmed by an influx of foreign mothers keen to take advantage of free healthcare."

Sound familiar?

The fault here lies, atypically, not with the MVNHS©, but with the British government's immigration policies coupled with a system geared to provide free (albeit sporadically qualified) care to everyone, legal or not.

And tell me, dear readers, how this could be expected to play out differently under ObamaCare© and our current immigration policies?

What to make of this...

Consulting firm Accenture recently published the results of their survey of physicians, which reveals a disturbing (but unsurprising) trend:

"(T)he rate of independent physicians being employed by health systems will grow by an annual five percent over three years. By 2013, less than one-third of physicians are expected to remain truly independent."

I characterized this as "unsurprising" because we've been predicting this for quite some time. For example:

"As we reported ... 40% of doctors said they would "retire, seek a nonclinical job in health care, or seek a job or business unrelated to health care ... Dr Bradley Wertheim ... finds that new physician training standards will exacerbate the problem ... We have too many patients and too few doctors."

The interesting twist in the Accenture study is that so many docs seem to be casting their lots with hospital-based practices, aka ACO's. When hospital bean-counters, not physicians themselves, are calling the health care shots (so to speak), what do you think will happen to quality of care?

Breaking: Aetna Quits the Bluegrass State

From this morning's email:

"Effective July 1, 2011, Aetna will stop selling new Individual Insurance and Small Group policies in Kentucky. After reviewing their portfolio of Individual and Small Group plans in Kentucky, Aetna determined they can no longer meet the needs of their customers while remaining competitive in the Individual and Small Group market."

If you're a current insured, you can still add spouses and dependents, but not change plans. That last is critical, because that's often the only way to maintain affordability.

But remember, "if you like the insurance you have, you can keep the insurance you have."

Ah, expiration dates!

Huntsman Countdown

God created the world in 6 days. Apparently Jon Huntsman feels his contribution is worthy as well as he is counting down the days until he allegedly will announce his candidacy for president.

But is Huntsman a non-Romney candidate worthy of this race? Perhaps not but let's leave that part of it to the political handicappers.

HuffPo has their own view on Huntsman and his SCHIP political baggage.

As governor, Huntsman expanded Utah's Children's Health Insurance Program (CHIP, formerly known as SCHIP), a taxpayer-funded, government-run entity. In fact, he turned it into an entitlement program.

Yeah, no kidding.

According to the UCHIP website a family of four earning $44,100 can qualify for free children's health insurance. That's 200% of the Federal Poverty Level.

It is also more generous than Obamacrap that pegs free insurance (Medicaid) at 133% of the FPL which for a family of four is $29,726.

Granted, Obamacrap will give everyone in the family free Medicaid while HuntsCHIP only gives free insurance to the kids but still, where is the personal responsibility?

And where does this money come from to provide free "anything you want" benefits?

As to whether Huntsman's expansion of SCHIP is good or bad politically, Judi Hilman, director of the Utah Health Policy Project has this to say.

"It's a feather in his cap. We've seen a 30 percent decrease in our uninsured rate for kids -- real progress for all kids.

Yup.

A 30% decrease in number of uninsured kids and a 100% shirking of responsibility as a parent.

The Medicaid - Obamacare Challenge

Folks on Medicaid have trouble finding a doctor to accept them as a patient. Obamacrap is going to expand Medicaid rolls by 15 million or more in 2014 and that is just the ones who are uninsured now. Doesn't count those who have coverage through their employer and voluntarily drop out when they can get "free" health insurance.

In 2014 those earning 133% of the Federal Poverty Level or less get free health insurance.

That's the good news.

The bad news is, your free health plan is Medicaid.

The worse news is, you may not find a doctor willing to take you as a patient.

MSNBC reports on the challenge of finding a doctor when you have Medicaid.

Children on public insurance are being denied treatment by doctors at much higher rates than those with private coverage, according to an undercover study that had researchers pose as parents of sick kids seeking an appointment with a specialist.

The study results suggest many of the 40 million publicly insured U.S. children are not getting recommended timely treatment for dangerous conditions including asthma, diabetes and depression, she said.

Here are the numbers behind the survey.

The researchers phoned 273 specialty clinics twice, a month apart, seeking an appointment with doctors including dermatologists, allergists, psychiatrists and bone specialists. In one call, the children were said to have private insurance; in the other, they were insured through Illinois' Medicaid program.

Overall, specialists refused to grant appointments for 66 percent of the Medicaid children, versus only 11 percent of privately insured youngsters.

Among 89 clinics that accepted both insurance types, Medicaid children had to wait an average of 42 days for an appointment, versus 20 days for private coverage.

The underlying reason for this should be obvious, even without a study.

In Illinois, Medicaid pays doctors about $100 for office visits like those sought in the study, versus an average of $160 from private insurers, the researchers said.

Other factors against Medicaid patients include "delays in payment and hassles of payment procedures," the researchers said.

The government wants the same level of care but is only willing to pay 60% of the going rate.

The problem is further complicated by the fact that almost every state is in the red when it comes to Medicaid and SCHIP.

Washington borrows 40% of every dollar they spend and yet they want to expand Medicaid rolls by at least a third. What is wrong with this picture? It doesn't take a rocket surgeon to figure out this won't work.

AMA Backs Off Obamacrap Mandate

The AMA is backing off their earlier support of Obamacrap. The contentious individual mandate is no longer endorsed by the doctor group. According to the Chicago Tribune:

The AMA should "regard the purchase of health insurance to be a matter of individual responsibility to be encouraged by the use of tax incentives and other noncompulsory measures," those opposed to the mandate said in their resolution.

Individual responsibility . . . something that makes the folks in Washington cringe.

Without an individual mandate, the AMA, insurers and employer groups have said, people will wait to buy health insurance until they are sick, and that would lead to a spike in premiums for everybody.

"If large numbers of people wait to purchase health insurance until they are sick, these patient protections will drive up premiums for the insurance pool and force more people to drop coverage," said supporters of the individual mandate, including the American Academy of Family Physicians and at least eight state delegations. "Such cost shifting could lead to the collapse of private insurance markets, leaving government programs as the only recourse for many Americans."

Aha!

Obamacrap must have the individual mandate in order for it to work. Even with the mandate and "100%" participation, rates for almost everyone will at least double beyond current rates. Without the mandate premiums will be even higher.

Think of it like this.

If people can wait until their house is in danger of flooding before buying flood insurance, or they could wait until diagnosed with a terminal illness before buying life insurance, how much more expensive would these items be?

This is not like waiting until you are hungry before buying food.

UHC/Medco Update: Resolution

On Monday afternoon, I spoke with Lynne H, UHC's Director of Media Relations. As noted last week, I had already discussed the issue with the Communications VP at United Health Group, and the UHC Account Coordinator at Medco. There have been two basic concerns here:

First, the original mis-pricing which cost my co-worker over $100, and

Second, ascertaining the extent of the problem (how many other insureds have been affected?).

Yesterday (the 15th), my co-worker spoke again with the Medco Account Coordinator, who assured her that there is no dispute on their part that this occurred (thanks to the screenshots we kept), but that he had never seen this particular problem before (more on that in a moment).

He went on to confirm that, now that they're aware of the problem, they're looking to correct it going forward, and that they would issue a credit to her charge card for this transaction (which we have confirmed has taken place). He also confirmed something we already knew: that the system does, in fact, know the status of her account (deductible credit, claims paid, plan design, etc), and that it takes these factors into account.

The underlying problem seems to be that the med that showed up with the $33 pricing was, in fact, not available through the Medco mail-order program, and that an alternative (more expensive, natch!) was substituted. According to "the Medco guy," this was an honest mistake, not an attempt to defraud my co-worker.

I'll accept that - we have numerous enough examples of Stupid Carrier Tricks to support such a contention.

Finally, he and his staff will be reviewing their customer service processes; the fact that this took almost 2 weeks, numerous emails and phone calls, and two blog posts to be resolved does not reflect well on their current practices. It didn't help that my co-worker was told to wait 3 days and then call them; this is also not acceptable, and they're working on that, as well.

Here's the thing: I do appreciate the quick response once the powers-that-be at UHC and Medco read the original post. It's humbling for me to know that IB is able to help folks amplify their voices, and that what we say has some authority. On the other hand, just because the Medco guy has never seen this before doesn't mean that it hasn't happened (or doesn't continue to happen). How many folks have run into this and just thrown up their hands in resignation that they've been "screwed by the insurance company again?"

Hopefully, this is a small number of insureds, and the problem will now be a thing of the past.

Thanks to UHC's Tyler M and Lynne H, and Medco's Steven W for their help in resolving this.

Hearts and Noses

Surprisingly, DC isn't the only place you'll find clowns (amateur or otherwise):



[Hat Tip: David Williams]

(Un)Healthy Exchanges

Mike Cannon, Director of Health Policy Studies at the Cato Institute (and FoIB), has a thought-provoking proposal:

"A key battleground is whether states will implement the law by creating government bureaucracies that Obamacare euphemistically calls health insurance "exchanges" ... Creating any sort of exchange is unnecessary, wasteful and counterproductive."

But it's in the law we had to "pass to learn what's in it."

Mike proposes a simple, elegant alternative:

"States are under no obligation to create these bureaucracies, however, and many have wisely refused."

Worst-case scenario? HHS "makes them" do so.

Keep in mind, though, that the Exchanges are still several years away, and "(i)f the Supreme Court overturns Obamacare, any money [states spent] creating an exchange would be wasted."

I would add several additional factors:

First, there's a distinct possibility that, come 2014 (when the Exchanges are scheduled to come online) we'll be calling her former HHS Secretary Shecantbeserious.

Second, we've seen how well the ObamaPools© have worked; any takers on whether or not the Exchanges will fare any better?

Cavalcade of Risk #133 now up

IronMan hosts this week's eclectic collection of risk-related posts. As usual, it's thoughtfully laid out and easy to click through.

Ohio DOI Info Bleg

Under new rules, Ohio agents must now renew their licenses every two years (this is separate from CE requirements, and a change from the previous "perpetual license" model).

The renewal process is itself unnecessarily (and counter-productively) difficult, tedious and ill-defined. I'd like the Department to investigate and correct this, but with the new administration, I no longer have the connections necessary to "get this done."

I know that folks from the DOI read IB; would one of you please be kind enough to contact me to discuss this issue?

I also know that some of our readers may have appropriate contacts in the Department; would you please let me know if you can help?

Thanks!!

Miracle Weed

A while back, Bob pondered whether or not medical marijuana would be a covered expense under ObamaCare©. Well, we're still waiting on that one, but at least one unlikely player has stepped forward to offer assistance to, um, "providers:"

"Scotts Miracle-Gro Co. [see note] has long sold weed killer. Now, it's hoping to help people grow killer weed ... Scotts Chief Executive Jim Hagedorn said he is exploring targeting medical marijuana as well as other niches to help boost sales at his lawn and garden company."

[ed: Formerly Stern's Miracle Gro. Just sayin'.]

Turns out, 16 of the 58 states "have legalized medical marijuana ... The market will reach $1.7 billion in sales this year."

That's a lot of extra pizzas and Doritos.

One wonders if Scott's is bucking for an ObamaWaiver©.