Ho-Hum

In a recent "news" release, UHC (UnitedHealth Group) announced they will keep most of the Obamacare provisions enacted so far, even if the Supreme Court rules against the law.

The carrier announced it will maintain the "free" (no copay) provisions of Obamacrap for preventive care, continue to cover children under their parents plan up to age 26, and will not limit lifetime maximum benefits.                        


That last one is a bit of a joke since the carrier imposed a $3 million cap on benefits for individual major medical plans in most (if not all) states until they were made illegal by Obamacrap. Almost every one of their competitors moved to an unlimited maximum benefit years earlier.


But with regard to their mind blowing announcement to keep the above provisions you need to note this admission.

None of these provisions will be free for consumers. Insurers have already factored them into the premium, or the cost of the insurance coverage.

If insurers cut these benefits, customers probably will expect a corresponding premium drop, he noted.

As we have stated before, nothing in life (especially if it comes from the government or an insurance carrier) is free. The cost is in there somewhere, you just have to figure how how you are paying for it.


But all is not rosy. The carrier is hedging their bets on at least one provision in Obamacrap.

UnitedHealth did not promise to extend another initial overhaul provision that requires the coverage of children with pre-existing conditions up to age 19. The insurer said it recognizes the provision's value, but one company alone cannot extend the provision if the law is struck down.

Unlike the "free" preventive care, covering anyone with pre-existing conditions (including children under age 19) can be very expensive. That is part of why folks in Massachusetts pay so much for their health insurance. The "guaranteed issue" provisions drive premiums to the point of being the highest in the country.


Regardless of what SCOTUS does, if Obamacrap survives intact you can expect your premiums to be as high, if not higher, than you would pay if you lived in Massachusetts.


And if the law survives but WITHOUT the individual mandate, the premiums will be even higher than that.

What could possibly go wrong

Exchanges, either state or federal, are supposed to be one of the transformative benefits of PPACA. A highly automated, uber-efficient insurance buying experience brought to us by those mavens of technology: government. Recent stories like this has we wondering how the exchange delivered will measure up to the one promised.

From Oregon:

"Choose easy! The woman who used TurboTax to falsely claim a $2.1MILLION tax refund and went on a spending spree until she was caught

...Due to the size of the refund, her electronic claims was examined by several people within the Oregon Revenue Department. Incredibly, they approved the payout and Reyes was sent a visa card ... The revenue department processes about $7billion in tax returns each year on computer systems designed in the 1980s."

Oregon is only one of numerous states that tried and failed to upgrade antiquated computer systems. Most states are running Medicaid systems that are just as bad or worse. No private company could stay in business with the software systems the states use. And when they finally do attempt to upgrade they go tens or hundreds of million over budget and often times fail completely.

From Ohio:

"To accommodate the eligibility changes, health officials are seeking federal support to help replace a more than 30-year-old computer system that frequently erroneously denies Medicaid eligibility and causes a huge administrative burden. "The system is so old that the county case workers have to go in and modify the answer based on information they know, but that the system can't accept"

If the exchanges do stay in place after the SCOTUS ruling we better get use to them, there is a good chance we will be using the exact same system for 20-30 years, in-spite of what technology advances.

Medicare Equal Access Options Act

Medicare Equal Access Options Act, a proposal by Sen. Kerry-Heinz, shows just how out of touch this guy is. John Kerry, a liberal looney from Massachusetts, wants to end Medicare "discrimination" by implementing new mandates that will result in driving up the cost for those who are disabled under age 65 and on Medicare.        
  
If you are under 65 and disabled (by Social Security's definition) you will eventually become eligible for Medicare if you live long enough. Currently, about 7 million people under the age of 65 are covered by Medicare. That number could be even larger if it did not take so long and wasn't so difficult to meet the Social Security definition of total and permanent disability.

How difficult is it to qualify for Social Security disability? Here is information direct from the Social Security website.

Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.
"Disability" under Social Security is based on your inability to work. We consider you disabled under Social Security rules if:

• You cannot do work that you did before;
• We decide that you cannot adjust to other work because of your medical condition(s); and
• Your disability has lasted or is expected to last for at least one year or to result in death.

That is much more stringent than any private disability plan.

In addition to the above, you must have been totally and permanently disabled for 5 consecutive months before you can even apply for Medicare benefits.

Evem if you qualify for SSDI, you have to wait 29 months (5 month elimination + 24 months of SSDI eligibility) before you can qualify for Medicare. There are exceptions, such as those with ESRD or ALS.

People (including children) who have not accumulated enough work credits do not qualify for SSDI which will also disqualify them from Medicare benefits.

So what does Sen. Kerry want to do to make Medicare more accessible and affordable?

Nothing actually.

His proposal outlined here is to change the law with regard to access to Medicare supplement plans and Medicare Advantage plans. Kerry-Heinz believes those who live long enough to qualify for SSDI are discriminated against by Medicare supplement carriers because of their health status. If Kerry-Heinz get's his way those on SSDI and Medicare will see the following changes.

• Medicare supplement carriers would be required to GUARANTEE ISSUE Medigap policies to those on SSDI and Medicare
• Allow those on a Medicare Advantage plan to switch back to original Medicare and a Medigap plan during open enrollment
• Allow dual-eligibles (those who qualify for Medicare and Medicaid) to buy a Medigap plan if they lose their Medicaid eligibility
• Allow those with ESRD to purchase a Medicare Advantage plan

Equal acess under the Kerry-Heinz proposal?

Yes.

More affordable?

Absolutely not.

This bubble head thinks all this comes without a cost. Not surprising given his lack of experience in the real world, other than his time as Swift boat Johnny in Viet Nam.

If Kerry-Heinz get's his way, here is what will happen.

Medicare supplement plans for disabled, under age 65 which are already priced in the $1000/month range for Medigap plan F by most carriers will become even more expensive. (There are a few Georgia Medicare supplement plans in the $200 - $300 range for under age 65 Medicare enrollee's).

Some carriers that offer Medicare Advantage plans will most likely withdraw from the market, while others will raise premiums dramatically or substantially cut benefits, especially on the $0 premium Medicare Advantage plans.

If you like your Medicare supplement plans and Advantage plans the way they are now, tell Sen. Kerry-Heinz to take a hike, or perhaps go wind surfing, and keep his mitts off Medicare.

Backs + Wash: Some Assembly Required

For anyone still harboring delusions about the sacred underpinnings of ObmaneyCare©, we bring unwelcome news:

"Central to Mr. Obama’s drive to overhaul the nation’s health care system was an unlikely collaboration with the pharmaceutical industry that forced unappealing trade-offs."

In one fell swoop, importation of less expensive meds was swept off the table, and less expensive alternatives remain verboten. And, of course, it's one more nail in the coffin of "transparency" in the process.

[Hat Tip: FoIB Holly R]

Holocaust Life Claims Update

Last Fall, we reported on the efforts to get Allianz and other insurers to honor the death claims of Holocaust victims' families. Spearheading this effort was Florida Congresswoman Ileana Ros-Lehtinen, who at the time was trying to convince the media to deny commercial time to the carrier.

While I have some issues with her apparent ignorance of how free speech is supposed to work (cf: Citizens United), I certainly applaud her enthusiasm.

Her latest effort to allow victims' families to sue the various insurers is currently stalled in committee:

"That brought dozens of Holocaust survivors, many of whom live in Florida, to Washington on Thursday to urge the House Judiciary Committee to consider legislation that would allow lawsuits to be filed in U.S. courts ... The proposed bipartisan bill ... would give thousands of survivors the right to sue Germany’s Allianz SE, Italy’s Assicurazioni Generali and other major European firms in U.S. courts to recover the value of life insurance policies bought before World War II."

Unfortunately, this looks like an uphill battle, since the current claims process was pretty much set in stone over the course of the three most recent administrations. And it also doesn't help that there's little enthusiasm on the part of Congress for revisiting the issue.

Still, it's a noble cause, and one which doesn't seem to be going quietly into that good night.

Cavalcade of Risk #159: Call for submissions

Next week's Cavalcade of Risk will be at My Wealth Builder's place. Entries are due by Monday (the 11th).

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).

Thanks!

Thursday Afternoon Link-Fest

■ From FoIB Jeff M, we learn that Medicaid may be in even more dire straits than we'd imagined:

"West Virginia is peering over the cliff of a Medicaid funding shortfall ... Medicaid goes into FY 2013 with a slight budget surplus, but FY 2014 poses a $236 million shortfall, “which is daunting.”

Now what could possibly be happening in 2014 that would cause this financial earthquake?

Oh, yeah.

■ Next up, the Institute for HealthCare Consumeris​m (IHC) reports that consumer-centric health plans (aka High Deductible Health Plans, or HSA's) could save tens of billions of health care dollars each year. They note a RAND study claiming that "[g]rowth Of Consumer-Directed Health Plans To One-Half Of All Employer-Sponsored Insurance Could Save $57 Billion Annually."

Regular readers know that we're big fans of these kinds of plans, but I have to say that I'm still a bit skeptical of that number. And, since these plans are outlawed under ObamneyCare©, we may never know the truth.

■ We've written before about "hidden providers" (most recently, here); recently, a local man and his son ran into that particular buzz-saw (metaphoricaly, anyway):

"Steve Mahoney took his youngest son ... to the emergency room at Children’s Medical Center of Dayton after the boy sliced off his fingertip in a door ... no one told Mahoney that the plastic surgeon ... doesn’t accept health insurance."

On the one hand, it's really not the hospital's responsibility (or even ability) to confirm whether or not a particular provider is in-network, or even accepts any insurance. On the other hand, when you're dealing with your young child's missing digit, how likely are you to be considering that at all?

As you'll see in the article, the problem stems in part from EMTALA.

What's EMTALA?

Glad you asked.

■ And, finally, FoIB Holly R sent us this article on health care alternatives for folks without insurance:

"I’ve gone to a bunch of doctors, and have learned some things along the way about getting health care without health insurance"

Well-written, not preachy, some helpful tips.