Breaking: Silver State HIX Plot Thix

LifeHealthPro's Allison Bell tips us to this interesting news, thus far flying under the radar:

"The #Nevada exchange, @NVHealthLink, has canceled a meeting that was scheduled to take place tomorrow"

Last time we checked in, Nevada's Exchange was having trouble paying commissions on policies written through it by agents.

Was that a portent of things to come?

Retreat!

Obamacare (full Monty version) is not even 2 years old and already the riptide

effect is being felt as carriers such as Assurant are leaving the market.

There has been speculation as to which carrier will be the next to leave the dance and party talk has focused on Cigna, Aetna, Coventry (now owned by Aetna) and to a lesser extent, Humana.

Apparently this is more than just backroom talk.

Leerink’s Ana Gupte wouldn’t be surprised if Aetna (AET) merged with either Humana (HUM) or Cigna (CI):

Consolidation remains likely, with CEO Mark Bertolini asserting that government business is the focus for inorganic growth, while compatible cultures for post-merger synergies were viewed as the driver in all transactions, with cheap debt making either Aetna-Humana and Aetna-Cigna meaningfully accretive possibilities and imminent. - Barrons

The next few months could be interesting. How many carriers will actually go to the 2016 prom?

This is looking like a bad remake of Carrie.

Stay tuned.

Your Genes vs Your Job

Every once in a while, the question of genetic testing in the workplace - and especially as relates to employer-based health insurance - rears its (ugly?) head.

We've covered this several times over the years; in fact, our very first year we reported that "40 percent of people already undergoing genetic testing are worried that participation might affect their future insurance coverage.”

At the time, this seemed kind of a stretch, inasmuch as health insurance companies were forbidden to use these results in their underwriting process (and since group insurance has been guaranteed issue for almost 20 years, it was moot to begin with).

On the other hand, you really can't be too careful, and so we got the Genetic Information Nondiscrimination Act of 2008 (GINA), "which prohibits genetic information discrimination in employment" (the law went into effect the following year). In fact, the law goes even further, in that it also forbids the use of this information as regards benefits (including insurance).

And yet:

"Big companies are considering blending genetic testing with coaching on nutrition and exercise to help workers lose weight and improve their health before serious conditions like diabetes or heart disease develop."

At first glance, this specific use seems to skirt the letter of the law, so it's probably "kosher."  As long as the results aren't used to, for example, determine premium contribution or subsidy levels (ie how much of the premium the employer pays*), this seems to be a legitimate use of the data.

Now, the efficacy of using the information in the manner being proposed may indeed be questionable:

"[E]mployee benefits experts have doubts that such a novel approach will gain momentum. It first has to conquer steep challenges like ... employer skepticism about its effectiveness."

That is, whether or not there's actual value there, and whether it's worth the cost of implementation (these tests aren't necessarily cheap, and one presumes that the employer will be footing the bill).

A potentially more serious concern arises as to who will have access to this information, and how secure it will be. But that's another post.

[*For illustrative purposes only; regular IB readers know that employers actually pay 0% of the premium]

ObamaCare Aloha

Here's co-blogger Bob almost exactly a year ago:

"Hawaii Medical Services Association posted losses of $30.1 million in the first quarter and said it recorded $46.1 million in fees related to Obamacare."

Fortunately, the success of O'Care has helped immensely...

Wait. What?

"The Hawaii Health Connector has prepared a contingency plan to shut down operations by Sept. 30 after lawmakers failed to pass legislation to keep the state's troubled Obamacare insurance exchange afloat."

Looks like ObamaCare #Fail from sea to shining sea.

Under the plan, Aloha State residents will be cut off from enrolling in new plans at the end of this week, and be completely shuttered by the end of next February (costing another 73 hard-working Americans their jobs). It appears that Island citizens will be transitioned to the 404Care.gov site for Open Enrollment Season v3.0 beginning this fall.

Chalk up another one to the Unaffordable "Care" Act.

MassCare unraveling

We've been covering the Massachusetts health insurance Connector since it was merely a gleam in Johnathan Gruber's eyes. So it comes as less than a surprise to us that it continues to implode under the new ObamaTax regime. Thanks to the intrepid Josh Archambault (senior fellow at the Foundation for Government Accountability), we learn that the noose is tightening. Turns out, Bay State Brahmins:

■ Failed to execute a contract with CGI, the vendor hired to build the site, that would track the progress of the project and ensure on-time delivery of a product that included all required features

■ Failed to implement a governance structure that would ensure ongoing quality of the project

[And worst of all:]

■ Attempted to conceal these shortcomings by misrepresenting the progress of the health insurance exchange to a number of stakeholders including the Centers for Medicare and Medicaid Services [among others]

Major no-no there. In fact, their behavior was so egregious that the Feds "have subpoenaed records related to the commonwealth’s ‘connector’ dating to 2010.”

In other words, this is now a criminal matter, with actual fines and (hopefully) jail time potentially on the table.

One wonders which of the other 57 states will be next...

Bob G on O'Care

Our good friend Bob Graboyes (senior research fellow for the Mercatus Center at George Mason University) has some key insights into the failed ObamaTax roll-out. Among them:

"Other than “more people with insurance,” the law’s goals were never clearly stated, so there are few objective metrics on which to judge it. More are insured, but there’s no increase in supply of health care to meet any new demand."

As our own Bob Vineyard pointed out some years ago, this is an utterly predictable result of inelasticity:

"The economics of goods and services can be reduced to simple demand and supply. Health care is no different. It follows economic theory just like every other consumer good.At either extreme you have inelastic price curves and elastic curves. Most consumer items track a bell curve but some things are totally elastic or totally inelastic."

That is, more people may have insurance (although this remains unproven), but the supply of actual health care remains steady (or is, in fact, falling). So how valuable is your ObamaPlan if you can't find a provider who accepts it?

Then there's the little problem of administering your plan if you're fortunate enough to be able to afford and are successful in actually buying one:

"[T]he back end is still dysfunctional. It’s very difficult for a consumer to conduct a transaction as you would with, say, Amazon.com, that results in verifiable coverage. Pen, paper, and processing time are still required"

And how does one track changes made this way?

There's lots more, all of it good, all of it important.

Read the whole thing.

Health Wonk Review - Grumpy Cat edition

Steve Anderson hosts this week's compendium of health care policy and polity, channeling negative vibes into positive outcomes.

Kudos!

Hey Brother, Can You Spare a Dime?

During the Great Depression when 1 out of 4 were out of work a song made

popular by Bing Crosby was everywhere on the airwaves.

The song tells the story about a beggar that lost his job and strikes back at "the system" that contributed to his job loss.

They used to tell me I was building a dream
With peace and glory ahead
Why should I be standing in line
Just waiting for bread?

Once I built a railroad, I made it run
Made it race against time
Once I built a railroad, now it's done
Brother, can you spare a dime?

The tune was based on a Russian-Jewish lullaby sung by composer Jay Gorney's mother when he was a child.

Today we have our own challenge, except this one is about health insurance.

Obamacare has turned the health care, and health insurance system on its head. Premiums today are anything but affordable, except to the extremely poor or extremely wealthy.

Everyone else is screwed.

Yesterday I had a call from a woman who would be losing employer group health insurance at the end of the month. They had coverage through her husband's job but that is going away and he will become self employed.

The family of 5, all in good health, are looking for something affordable to replace their group health plan.

Accustomed to paying $200 per month for a good plan that included dental and vision, they needed to get an idea of what was available.

Projected income is over $100,000 so they will not qualify for a subsidy.

Sounds odd doesn't it?

The new system says if you earn less than $100,000 you are poor and need a government handout to afford your affordable health insurance plan.

To replace their existing health insurance plan they will need to come up with $1,115 per month, and that's just for the Gold health insurance plan.

Add another $100 for dental and vision.

That's disgusting.

Comparable coverage before Obamacare would be less than $500 per month.

Hey brother, can you spare a dime?

ObamaCare ka-boom

As if we needed them, two more reasons why the ObamaTax is imploding. One we've already covered:

"Almost half of the insurance exchanges set up by states are struggling financially"

Again, this should surprise exactly no one.

But the Daily Caller article then posits an interesting possibility:

"[O]fficials are considering raising fees on insurers, asking the state for more money and working with other states to improve their exchange. Connecticut plans to sell advice and strategy to struggling states."

Given its history, seems like the only bit of Connecticut's advice of any value would be on how not to set up or run an Exchange.

But what's remarkable to me is how many folks still don't 'get' that insurers don't pay these fees, and that states don't have money: customers pay the fees, and tax-payers provide the funds.

So the only thing they're going to accomplish is higher premiums (so fewer folks buying or keeping plans) and raising taxes (same same). Where do they think all this money's coming from?

Oh yeah, us proles.

[Hat Tip: FoIB Holly R]

Three sides of a coin

When one considers insurance, the majority of claims are paid to 3rd parties. For example, life insurance proceeds are paid to one's beneficiary, auto claims to the body shop, medical claims to a doctor or hospital, and so on.

But three types of plans, all of which are fairly similar, actually pay benefits to the insured. These are  (in no particular order) critical illness (CI), long term care (LTCi), and disability insurance (DI).

We've blogged on LTCi many times (most recently here). Thanks to FoIB Sandy M, we learn that Fidelity (of investment fame) has produced "a pretty cool chart of US and various sorts of health care" including a very useful interactive map of how much long term care costs around the US.

We haven't blogged much on Critical Illness coverage, which is a shame, because these plans also pay the insured cash benefits for things like heart attacks and cancer. These plans can be particularly useful if one has a high deductible (HSA) plan or one of the newfangled ObamaPlans with sky high out-of-pocket exposures. By providing a quick injection of cash, these plans can mitigate a lot of financial pain.

Finally, the fine folks at the Council for Disability Awareness remind us that May is Disability Insurance Awareness Month. To that end, they're sharing the results of their 2014 consumer survey. Among the key findings:

• 57% of working adults report having no private disability insurance
• One third would consider buying disability insurance if they knew more about it
• 41% would consider buying it if it were less expensive, but perceptions about costs vary considerably

That last is important: many (most?) folks think disability coverage is unaffordable, but seldom check to confirm that by asking for a quote. So if you're one of the 57%, why not check with your employer about a short or long term disability  group plan or - better yet - ask your professional, independent agent for a quote.

You may be surprised by just how affordable coverage can be.

So, How's That Obamacare Working For You?

POTUS made a lot of promises about Obamacare. Lower premiums. More

people covered. If you like your plan..............

And, Obamacare was supposed to REDUCE ER visits.

Well...........

Three-quarters of emergency physicians say they've seen ER patient visits surge since Obamacare took effect — just the opposite of what many Americans expected would happen. - USA Today

No real surprise there,

So why did it happen?

In addition to the nation's long-standing shortage of primary care doctors — projected by the federal government to exceed 20,000 doctors by 2020 — some physicians won't accept Medicaid because of its low reimbursement rates. That leaves many patients who can't find a primary care doctor to turn to the ER — 56% of doctors in the ACEP poll reported increases in Medicaid patients.

Isn't that special?

Assuring Clarification

We're not generally in the habit of carrying water for insurance companies, but last week's news about Assurant Health has engendered some confusion. Briefly, Assurant Health is (was?) a subsidiary of a larger company that also owns Assurant Employee Benefits (which sells group non-medical coverage, such as dental and disability).

Unlike its sister company, Assurant Employee Benefits continues to enjoy robust growth and financial stability. According to the carrier:

"Assurant Employee Benefits (AEB) is not exiting the benefits market ... By approaching the sale of Assurant Employee Benefits in this public manner, it allows for us a faster process.  The public announcement allows us to be transparent and control the process.  We expect to know within a few short months who our new parent company will be."

I've been fortunate to work with some great folks there over the years, and know them to be a solid company. Someday I'll have to tell you about my first death claim with them....

Who'da thunk it?

As Bob reported a week or so ago, the Golden State's health exchange is fast approaching room temp. But they're not alone:

"Nearly half of the 17 insurance marketplaces set up by the states and the District under [the ObamaTax] are struggling financially ... wrestling with surging costs, especially for balky technology and expensive customer call centers"

That's right: the much-touted call centers don't work, but we'll keep throwing money at them anyway.

Makes sense (if you're in DC).

On the other hand, even Ms Burntwell (et al) may have begun to see the value that professional agents bring to the party:

"The agency that runs the public exchange system in the HealthCare.gov states has given navigators, certified application counselors (CACs) and other nonprofit assisters a webinar on how to work with insurance agents and brokers."

Unlike these "counselors," agents must be vetted for prior criminal activity, licensed by their state, have strict continuing education requirements, and carry malpractice (Errors & Omissions) insurance.

Nice that DC finally got a clue.

On keeping your plan if you like it

By now, posts on "grandfathered" and "grandmothered" plans must seem like old news. And yet, the hits keep on comin'. In email from Medical Mutual of Ohio:

"“T" Plans Now Available on MyBrokerLink/Converting Grandfathered "S" Plans to New Grandfathered "T" Plans"

Clear as mud, no?

This is what happens when the government takes over the health insurance industry (and make no mistake, if you exercise control over a market segment, you own that segment). And so we get authentic frontier gibberish like the above.

Oh, what does it mean?

Basically, the Feds have graciously (and illegally) allowed insurers to make modest changes to grandfathered/grandmothered plans, which MMO will be implementing as they renew. This particular email targets small group plans. The change is ostensibly an effort to help hold down premiums; let's just say that I'm not holding my breath.

Another One Bites The Dust

Obamacare continues to claim victims as it marches forward. Lost insurance coverage and job loss.

Employees of Assurant are about to be the latest victim.

With Milwaukee-based Assurant Health continuing to bleed red ink, its parent company announced in a Tuesday news release it will either sell the health insurer or exit the health insurance business. - Bizjournals

The company was established in 1892 and was profitable every year until 2013.

Assurant Health posted a $63.7 million operating loss in 2014. Assurant Inc. said Tuesday Assurant Health will report a net operating loss for the first quarter in the range of $80 million to $90 million.

Assurant has more than 1,000 employees and over 1 million policyholders.

If Assurant Inc. does not sell Assurant Health, the parent company will begin the process this year of exiting the health insurance market and will not participate in the next ACA open enrollment period beginning in November.

Goodbye.

#Obamacare  #Assurant

Covering Baltimore

As was the case in Ferguson last year, the riots in Baltimore over the past few days have caused widespread property damage, mostly to folks who had nothing to do with the proximate cause of them:

Homes, businesses and cars have been burned, looted and otherwise damaged, leaving owners wondering what, if any, insurance payments they can expect.

The Insurance Information Institute (III) has helpfully published a media advisory confirming that, generally speaking, such damage is considered a covered event, and claims will likely be honored:

"Auto, homeowners, and business insurance policies generally include coverage for property losses caused by riots and civil commotions, such as those occurring this week in Baltimore ... Standard business property insurance policies provide coverage for the structure of the building as well as the contents inside"

And for folks with Business Interruption coverage, "insurance reimburses losses when a covered peril forces a business to temporarily close its doors ... [and pays] employees and vendors, not to mention the rent and electric bills."

Whew!

As always, be sure to check with your own carrier to confirm whether or not these exposures are, in fact, covered.

Employer Sponsored Insurance: Behind the Little Tree is Obamacare's Forest

Obamacare was passed with a promise to reduce premiums, elevate the level of care we receive, and put an end to rising health care costs. It was also promised that everyone would have access to good insurance and that if we liked our plans we could keep them. These promises have gone empty, yet in the eye of public perception, the favorability/unfavorability of the law (according to the Kaiser Family Foundation Poll) is tracking close to even. However, the most important question that is asked, but not discussed, is what will lead to changes in views in the next few years.

For now, the favorable perception can be attributed to the fact that Obamacare is front loaded with warm and fuzzy feel good benefits. From "free" benefits like birth control and preventive visits, to the slacker rule - keeping your "kid" on insurance to age 26 - every provision of the law that has been implemented has a positive result.

On-the-other-hand, things that have a negative impact have been repealed, cancelled, delayed, or extended. We have had a repeal of the 1099's and CLASS Act, an offer to extend "transitional" policies (the lie that if you like your plan you can keep it), and numerous delays in employer reporting including a year long delay in the employer mandate. We also haven't felt the impact of "indexing" which will increase what people have to pay for premiums while reducing benefits.

In keeping with the "kick the can down the road" theme, two new pieces of legislation are gaining momentum. One is to repeal the Health Insurance Tax and the other - introduced today - is to eliminate the Cadillac Tax.

These taxes, reduced benefits, higher costs, and administrative burdens will increase over the next few years. Moreover, they will reach the employer sponsored markets impacting a much larger share of our population (roughly 55% of our population are covered by their employer). 

Which takes us to the most important question asked when discussing public views on Obamacare:

"Would you say the health care law has directly helped you and your family, directly hurt you and your family, or has it not had a direct impact?"

It's not who has been helped (19%) or hurt (22%) by the law. It's the significant majority of respondents - 56%!!! - who have felt no direct impact.

It's not a coincidence that the respondent percentage is almost identical to those with employer insurance. It shows that until Obamacare is fully implemented and a majority feels an impact, public opinion will see little change.

But until then, we will still be focused on the trees and completely be overlooking the forest.

Monday Afternoon Link Potpourri

Some interesting items for your consideration:

■ "Nearly a fifth of the National Football League settlement approved this week compensating former players with head injuries could go to their health insurers instead"

Briefly, the NFL settled a players-filed lawsuit asking for compensation for life-altering head injures. The problem is, most of the costs associated with treating those injuries were borne by the players' health insurers. Under the concept of subrogation (a common feature in health, auto and other indemnity-based insurance products), the players waived their rights to any amounts rewarded that could go towards reimbursing those carriers. It's not really "news" except that most people haven't read their policies, and are unfamiliar with the principle.

■ Next up, this helpful info courtesy of FoIB Jeff M:

"COBRA considerations when Medicare-eligible. Clients may not realize the need to combine them."

A lot of folks who've recently retired (voluntarily or otherwise) opt for COBRA continuation of their previous coverage, since that's often the path of least resistance. But that may, in fact, be disastrous:

"With rare exceptions, COBRA coverage is secondary to Medicare Parts A and B ... The result is that when Medicare-eligible individuals do not have Medicare Parts A or B, they are left to pay 80% of their costs out of their own pocket."

And that's not all:

"Medicare has a window of opportunity to enroll in Medicare Parts A and B that lasts eight months after leaving employment."

Miss that special enrollment opportunity and you're facing a lifetime of fines once you do manage to sign up, which could also be a while.

Good info here.

■ Finally, some news on the viatical front:

"In 2013, the top 15 life settlement providers paid more than $362 million for unwanted life insurance policies."

That "investment" was worth a potential $2.2 billion in death benefits. It's also a major (29%) increase over the previous year. But what's driving this thriving [ed: really?] market?

According to the article, it's a rebounding economy, with institutional investors looking for better returns. I'm not convinced: it seems to me that more and more middle class folks, still hurting in a reduced labor market, are looking for ways to raise capital quickly, and what better way than to sell off unwanted (or unaffordable) policies, raising quick cash and easing the budget?

Running on Empty

California is running out of water and money.

Gov. Moonbeam blames global warming and wasteful usage on things like lawns and toilets for the water problem. But what about the money issue?

Covered California, the Obamacare exchange for residents (legal or otherwise) of Kalifornia, was built with seed money from Obama's fat wallet. Problem is, those funds are running dry.

Indeed, there’s no more money coming from Washington after the state exhausts the $1.1 billion it received from the federal government to get the Obamacare exchange up and running. And state law prohibits Sacramento from spending any money to keep the exchange afloat.

That presents an existential crisis for Covered California, which is facing a nearly $80 (billion) budget deficit for its 2015-16 fiscal year. Although the exchange is setting aside $200 million to cover its near-term deficit, Covered California Executive Director Peter Lee acknowledged in December that there are questions about the “long-term sustainability of the organization.” - OC Register

Unlike the federal govt, the Republik of Kalifornia cannot print their own money and must balance the budget.

What a novel idea.

But wait. There's more.

Covered California’s enrollment growth for 2015 was a mere 1 percent, according to a study this month by Avalere Health. That was worst than all but two other state exchanges. Meanwhile, California’s Obamacare exchange managed to retain only 65 percent of previous enrollees, the nation’s fourth-lowest re-enrollment rate.

Not only are they running through money like it was water, but they aren't doing a very good job of managing resources.

OK, maybe that water analogy was a cheap shot.

#Obamacare #CoveredCalifornia

Working for Free

Agents that dared venture into the Obamacare morass at healthcare.gov are discovering, in many cases, they

were donating their time and expertise for the cause.

If you want to get paid on business submitted through goodluck.gov the form that is transmitted to the health insurance carrier must have you identified by your NPN (National Producer Number). That number is the key to getting paid.

Without it, you get nada.

CMS recently identified that healthcare.gov is not always passing the agent's name and National Producer Number (NPN) to health insurance carriers. As a result, Highmark cannot assign agent and agency numbers to these policies, and commission cannot be paid.
If producers believe this information is missing, they should contact their General Agency (GA). The GA should then check the daily activity reports and commission statements to see if this information was sent to Highmark, prior to taking any additional action. Please note - the producer hotline cannot verify if the agent's name or NPN is on an application. - URLINS

Is this a glitch or something deliberate?

Could be either. No way to know.

There have been rumors that hc.gov enrollers are being instructed to strip NPN's from the file if they have any direct contact with the applicant during the application stage.

But it could be something as simple as a hard drive crash ............... or the server being stripped of this information.

From the Life Files

So about 30 years ago, my since-retired colleague wrote a policy on a 30 year old client (whom we'll call Gene). Gene's wife was named as the beneficiary, and all was well.

A few years - and two children - later, Gene and his wife divorced, and Gene changed the beneficiary of his policy to his brother.

Problem is, he never told his brother (or his kids) that he was doing so. Recently, Gene passed away, and his ex-wife called me to inquire about the policy. I called the home office and confirmed that a) he did, in fact, have a policy (and it was in force) and b) his brother was the beneficiary (again, news to all of us).

Fortunately, the brother lives relatively close by, and was in town attending to the funeral arrangements and such. I was able to connect with him, and we met yesterday to complete the claims paperwork (we're still awaiting the official death certificate, without which the claim can't be paid).

That's when I learned that not only did Gene never tell his brother about the policy, but that he died without a will (aka intestate for all you legal-beagles). The brother had no idea what Gene wanted to do with the proceeds of the policy (well, the balance after final expenses), nor of his house or other belongings. He's decided that he'll just divvy up the balance with his nieces once all the (modest) estate costs are settled.

This is just so sad: Gene died alone, and never made his wishes known to those that were (ostensibly) closest to him. I suppose there's a lesson here, somewhere, but danged if I know what it is. Any suggestions?

Health Wonk Review - Windy Spring edition

HWR co-founder Joe Paduda hosts this week's outstanding round-up of wonky blog posts, with an emphasis on the ACA. Come for Louise Norris on coverage gaps, stay for Dr Jaan Siderow's "pretty cool" moment.

News from Ms Burntwell

Actually, there are quite a few ObamaTax-related items cluttering the in-box. In no particular order:

■ A dataset which purports to provide "the total number of Qualified Health Plan selections by ZIP Code for the 37 states that use the [404Care.gov] platform." It includes basic plan info about which plans folks in a given area selected during Open Enrollment. It's not clear how many (if any) of these folks actually bought a plan at all.

■ A handy little (one page!) .pdf letting us proles know how much HHS collected from reinsurers in 2014 to offset costs of the Transitional Reinsurance program. Spoiler alert: thus far, less than 75% of target.

■ The death of the insurance agent's role has been more than a little exaggerated. Case in point:

"The drafters of the [ObamaTax] seemed to think that brokers were mostly a waste of money ... For a look at how the new, humbled SHOP exchange system has done since then, read on."

Please do.

The reality is that (competent, professional) agents do far more than just suggest plans designs. They are an integral conduit between the client (individual or employer) and the carrier. Of course, that sales role can't really be underplayed, as witness the fate of the SHOP (Small group insurance exchange):

"HHS has been notoriously reluctant to release any numbers hinting at how many employers or workers might be using SHOP plans"

Any bets on whether that would hold true were it a rousing success?

Thought not.

Now, I happen to be one of those (competent, professional) agents who is authorized to sell SHOP plans. I can tell you that I have yet to experience any employer asking me for a SHOP quote (neither current clients nor prospects). I have suggested to a few current clients that we at least look into it, but when they learn what's involved, well, any interest seems to fade away quickly.

It may be the cumbersome (but intrusive!) data entry process, it may be the confusing requirements, or some combination of these and other factors. But it's certainly not surprising.

And speaking of cost of care....

Yesterday, we noted trends in cost of healthcare over the next decade. But what about the cost of Long Term Care? Well, the folks at Genworth have just released their latest "Cost of Care Survey," including an interactive map and state specific data.

According to the Executive Summary:

■ The National Median Hourly Rate for home ehalth aides is $20
■ Adult Day Care now runs about $69 a day
■ Assisted Living Facilities now north of $3600 a month
■ And full on nursing care is $220 a day (semi-private room)

Now's an excellent time to review your current coverage, or to contact a reputable, independent agent with experience in this market.

In the meantime, you can stop by Genworth for even more in depth analysis and information, including the aforementioned maps and charts,.

[Hat Tip: FoIB Randy G]

What a difference a decade makes...

With the spate of folks expected to retire in the near future, and their (understandable) concern about how they're going to pay for their health care, the folks at LifeHealthPro have put together 5 helpful charts that seek to predict how much that care's going to cost.

Here's the first one, from the perspective of a 65 year old couple:

[click pic to embiggen]

There are a handful more here.

Most Excellent Perm vs Term Review

Over at LifeHealthPro, an insurance agent (and financial planner), eviscerates populist "advisor" Dave Ramsey on the latter's arguments against permanent insurance versus term.

Highly recommended.

Two caveats:

First, I sell a decent amount of term insurance, as it does, in fact have its uses; permanent plans are no panaceas in and of themselves.

Second, I think Michael misses the real problem with the 'buy term and invest the difference" scenario: almost all the folks who buy into this end up spending the difference, not saving it.

An important message from...Brussels?

So this arrived in email:

"Anthem is committed to providing our brokers with best-in-class service, and we are always looking for ways to make it easier for you to do business with us – and to help you better serve your clients. Currently, we’re working with a research firm called North American Testing Organization (NATO) to conduct an online broker satisfaction survey to help us better understand your needs."

I must admit to a bit of a spit-take upon reading that I might be contacted by (that other) NATO, but must settle for these wannabe's.

Be interesting to see what they ask ... I was told there'd be no geography.

How NOT to do Narrow Networks

We've long noted that one of the negative - and completely foreseeable - consequences of the ObamaTax is the rise of so-called "narrow" networks:

"Nationwide, about half of all exchange plans feature narrow networks ... Those narrow network plans cost up to 17% less on average than plans with broad networks."

It also means that you're less likely to be able to keep your doc, or even find one willing to take on new patients.

And it certainly doesn't help when a doctor decides to implement his own version:

"A Long Island cardiologist had the office of another doctor torched, then hired someone who turned out to be an undercover police officer in a failed attempt to have the doctor hurt or killed"

Geeze, doc, have a heart!

Yeah, about keeping your Doc

As we've long documented, increasing the demand for care (more folks with insurance) will of necessity run into the brick wall of supply of said care. That is, when everyone has access to "free" healthcare, who's going to provide it, especially with narrow networks reimbursing providers less and less?

Well, some enterprising Golden State folks have come up with an intriguing (if ill-fated) idea:

"Physician Retraining and Reentry (PRR) an online program designed to give experienced, medically licensed physicians and specialists, retired or otherwise, the opportunity to practice adult outpatient primary care in understaffed clinics across the country."

So the first question would be: um, why now, when reimbursements are at an all-time low and headed south? Follow-up: why do you suppose all these folks retired in the first place? (Hint: see Question #1)

But all is not lost, dear readers, because they've come up with a fool-proof way to fill in the gaps:

"The program has also given new hope to disabled surgeons who are no longer able to practice surgery"

To be fair, the folks at PRR aren't (necessarily) advocating that disabled surgeons start operating again, merely "treat patients in a primary care setting." What, exactly, that would entail is left to the imagination of the reader.

(Sorry 'bout that)

While I certainly applaud the group's willingness to think outside the box, I'm just not seeing a path to success here.

[Hat Tip: Gabriela Torres-Soler]

Who is Reading Your Medical File? The more things change (Part 2)

Last week, we broke the story of how some medical records, particularly those stored on off-shore servers, are likely not protected by HIPAA's privacy reg's. I reached out to Dr Rob Lamberts (whom we've previously interviewed) for his thoughts on this as a provider:

Very troubling issues here.  The question of “who has the record” is the most important one.  There needs to be a certainty of who has access to the records unless the patient is made aware of that insecurity and gives consent.  An example of insecurity is the use of Google Spreadsheets for monitoring blood pressure, etc which people sometimes share with their doctors.  They should be aware that there is an insecurity of these records, and their consent to use them can be seen as acceptable in a narrow usage.  Similarly, the tendency of patients in my practice to communicate via email must be covered by some sort of agreement in which the patient agrees that their use of email is “at their own risk” and that our practice will make every effort to only communicate securely.

The  storage of records in an off-site setting where the actual location and potential access to them is unknown to both physician and patient is troubling.  If the vendor is selling the doctor something that claims to “meet HIPAA security requirements” (which many 3rd party vendors do), then the onus is on the vendor.

I told Rob that I wasn't sure I agreed with that last part: It seems to me that, if I'm coming to you as a patient, I'm presuming that you have my records under lock-and-key, or at least in-house. Why is it my obligation to ask if that's the case? Rob replied:

The contract between a provider and an IT vendor is one where they take on the task of IT security (among others) in exchange for payment.  Legally, the physician has gone into that agreement in good faith, and so the vendor would be liable should there be a breach.  That is the same thing the patient does with the physician, overall.  They assume the doctor is acting in a way that is responsible with the medical records.  While I agree that there is a certain right of knowing where the records are stored, in some way we must trust that those making the sausage are being overseen by others who will make sure only reasonable things are being put into that sausage.  There is a reasonable degree of trust we must all have (which is no excuse for naiveté or gullibility).

Okay, that makes good sense from the provider's POV. I'm still not convinced that a doc using a vendor with off-shore servers isn't obligated to notify his patients of such. Now, one might argue "well, Henry, how's the doc to know?" To which I'd reply "simple: ask."

Why not?

And a Special IB Thank You to Dr Rob for his insights and willingness to share them!

The 4% Solution

Heh:

"Only 4% of people who signed up for ObamaCare got the correct subsidy"

Oops.

Expected, of course; actually, I'm surprised the "success" rate was that high. After all, calculating one's subsidy necessarily meant that one was guesstimating the next year's income. Since I've never seen a Ouija board with a $ sign on it, this always seemed...unlikely.

And it didn't help that the IRS sent out faulty forms to over three quarters of a million suckers filers, "nearly all of [whom] are being told they'll have to wait, maybe until Oct. 15, to straighten it out."

Oh goodie!

The good news (for certain values of "good") is that folks will get to repeat this process again in a mere 12 months. One wonders if a) the IRS will finally have the correct forms available and b) significant numbers of suckers citizens will choose to play again.

Time will tell.

[Hat Tip: RedState]

War on Women

The battle cry for the last few years revolves around a so-called "war on women". One political party seeks to manipulate sentiment for their side by proclaiming there is a war on women promulgated by the other party.

Incendiary comments are rife in politics and neither side has cornered the market. But in the case of the war

on women, apparently one side has a short term memory problem.

In a response to the March letter sent by Senate Health, Education, Labor and Pensions (HELP) Committee ranking member Sen. Patty Murray (D-Wash.) with 36 signatures, HHS Secretary Sylvia Mathews Burwell said the agency does not have “the legal authority to establish pregnancy as an exceptional circumstance” to create a special enrollment period.

Burwell said pregnant women could enroll in Medicaid and the Children’s Health Insurance Program (CHIP).

“Women with low and moderate incomes can enroll in these programs at any time if they qualify,” she wrote. “And, like all other qualified individuals, pregnant women can enroll in the Marketplace during the annual open enrollment period.” - The Hill

Apparently rewriting Obamacare by decree is only convenient if this is an election year.

• granting "free" birth control
• exemption waivers granted without regard to the law
• delaying employer and individual penalties for non-compliance
• extending and expanding the annual Obamacare enrollment period
• creating a new way to define a health insurance purchase
• allowing exchange enrollers to create an SEP in places where the law says otherwise
• granting extensions and waiving tax penalties
• blah, blah, blah ...............

#Obamacare #SEP  #pregnancy

HillaryCare -> ObamaTax

So, who made this promise:

"If you like Blue Cross, you can keep your Blue Cross"

If you guessed President Obama, well: close, but no cigar.

That one comes from a 1994 meeting laying out strategy for the future SoS's health care "initiative:"

[click picture to embiggen]

 Time after time....

[Hat Tip: Ace of Spades]

Under a Rock

It has been 5 years since Obamacare was signed into law and (almost) fully operational for nearly a year and a half, but it seems some people still don't understand it.

Forget that it was supposed to be as easy as going online and buying an airplane ticket. The final product just never lived up to the promise.

But speaking of buying an airline ticket, consider the plight of retired airline flight attendant Mike Highsmith.

"I wasn't very happy," said Mike Highsmith, 61, a retired US Airways flight attendant who learned after having his taxes done that he has to pay back every cent of the $6,624 in federal subsidies that helped pay the lion's share of his HealthCare.gov-purchased plan.

"This shocked me ... I didn't know this was coming."

Highsmith was one many Obamacare financial-aid recipients in 2014 who didn't know their plans were being subsidized. - CNBC

Yes, you read that right.

He didn't know his health insurance was being subsidized by the rest of us who pay taxes and the full premium.

"I was paying $89 per month and they [the federal government] were paying $736," said Highsmith, who only learned about the subsidy and its value when he received a 1095-A form from the IRS this year. He said he wasn't told about the subsidy when he applied for insurance over the HealthCare.gov telephone assistance line.

He really thought he could get a plan at age 61 for $89 per month? Was he disappointed when he didn't get a free Obamaphone with his insurance?

Isn't it comforting to know there are buyers and sellers of Obamacare that really don't understand what this is all about.

I know I can sleep better at night knowing this.

Dumb Prospect Tricks

So, as I've mentioned before, I'm often the recipient of referrals from other agents. Yesterday, I fielded a call from one such that still has me shaking my head.

The setup:

John is referred to me by a (his?) local State Farm agent for information on signing up for health insurance. Since Open Enrollment season is (finally) over, the first order of business is to determine whether or not he and his family are eligible to even buy a plan.

Turns out, none of the family (2 parents, 4 kids) has been insured for a while: the folks for over 20 years (!) and the kids for several (they had apparently been covered by Medicaid/SCHIP some years back). So, no obvious path there.

Turns out, though, that The Mrs has a job offer in another state, and they'll be moving there. She's been asked to determine the cost of a health insurance plan, to be included as part of the comp (she'd be a 1099 employee). So, John wanted to know how much a plan would cost.

Pause.

The good news, I explain, is that since they're moving to another state, they'll be eligible for a Special Open Enrollment. The bad news is that I'm not licensed in that state, don't know the market or the plans, nor do I know if he'd be subsidy eligible, so there's no way to know rates, let alone best options. I explain all this, and offer to hook him up with a local agent, but John's insistent, really wants to lock down a number. So I told him that it would likely range between $2,000 and $50,000 per year.

He didn't like that.

So I explain - again - why I can't just give him a number, and he abruptly hangs up on me. What to do?

Of course, "the sticker" provides a quick answer, so I hopped over to the NAABC site to find a few agents in the Austin, Texas area, and emailed those to him (along with the site for determining subsidy eligibility).

I do understand that he needs this information, but it really isn't as simple as he'd like to believe. And since he's essentially asking for me to provide my services for free, I'm not really clear on why he thought his attitude was going to be all that helpful.

Dumb.

One step forward, two steps...

So, even as the 2105 Open Enrollment season was (illegally) extended and expanded, turns out all was not a bed of roses, especially for Tar Heel State residents:

"North Carolina had a higher attrition rate out of Obamacare exchange plans than many other states."

North Carolina uses the Federal Exchange (like 36 others), and saw only about three quarters of its ObamaTax enrollees re-up this year. There doesn't seem to be any clear-cut explanation for the large discrepancy between different states' attrition rates.

That last observation may, in fact, be key: what, exactly, drives folks in different areas to either sign up or forgo coverage from year to year? Be interesting to see the rate differentials between the various states; cost would obviously be a major factor.

[Hat Tip: FoIB Jeff M]

Obamacare RIF

For sometime now conservatives have said Obamacare was a jobs killer. Of course the White House and

the HHS puppets claimed there was no credible evidence of jobs being lost for any reason, much less Obamacare.

Now comes this ...........

Enroll America conducted an organized campaign to spread the word about new health coverage provided under President Obama's healthcare law. But with year two of enrollment coming to an end, the group is shuttering 100 jobs, the group confirmed to the Washington Examiner. - Washington Examiner

Oops!

But they are not alone.

There are quite a few agents out of work too because of Obamacare.

#Obamacare  #EnrollAmerica  #jobskiller

Who is Reading Your Medical File? The more things change...

So, 9 years ago, Bob wrote an eerily prescient post on the future of health records:

"In a time zone 17 hours ahead, a radiologist in Australia, working for a company called NightHawk Radiology Services, had been sitting before the same images ... In an effort to hold down costs, hospitals and other medical practices are outsourcing certain functions half way around the globe."

Turns out, one of those functions is patient record-keeping.

About a month ago, we wrote a long term care insurance policy for a very nice couple. Sam and Sally are relatively young, and in good physical shape, but pretty much every case requires an APS (medical records). Generally, the carrier sends a request (and a check) to the doc, who then instructs his clerical folks to get the records together and faxed/emailed over to the carrier. This can take a couple of weeks, but it's not usually a major roadblock.

Until now.

Seems that Sally's doc uses an off-site electronic records keeping outfit, which relieves the doc of certain administrative costs and burdens. But according to the way the contract is written, the vendor may specify that it will only fulfill these kinds of requests once a month. Here's the first problem: let's say that Sally's doc's vendor’s contract specifies that requests are fulfilled on the 15th of each month. So Doc Smith sends the request on the 13th, no problem.

But if he sends it on the 16th, we've now just lost one month. And this is significant, because the underwriter can't finish...underwriting…without the records, and so that app just went to the bottom of the pile.

Not a pleasant thought.

Here’s the next problem (they keep getting "better"): Sally had no idea that her doc was using such a service. When she called to find out why the doc hadn't sent her records, she was told that the doc had, in fact, requested them over two weeks ago. Unfortunately, no one told the carrier, which has been waiting patiently, and the vendor hasn't returned phone calls asking about status.

And to add further insult to injury, Sally also had no idea that her records were being stored not just off-site, but on a vendor's cloud server.

Why is this a problem?

Well, let's skip down a bit in Bob's 2006 post:

"Most are aware of the privacy laws that come as part of HIPAA but few stop to think about how much of that law is lost once your medical information leaves the shores of the United States."

That is, HIPAA stops at the border. So here’s a question: exactly where is the vendor's cloud server physically located? Denver? Or New Delhi? Makes a difference: if the former, HIPAA applies, if the latter...

So here's a question: does the doctor have the obligation to notify his patients that he is, in fact, using such a service? Does he have a further obligation to determine whether or not his patient’s PHI (Private Health Information) is, in fact, protected by HIPAA?

In Part 2, we discuss these issues with Dr Rob Lamberts.

[Hat Tip: FoIB Randy G]

Life Insurance Snapshot

Hard to believe, but it's been almost 7 years since we blogged about Progressive Insurance's (then) new "Snapshot" program, a "high-tech monitoring device [which] makes it possible to reduce insurance premiums for drivers who avoid jackrabbit starts and slam-on-the-brakes stops...The catch? Bad drivers who take a chance on the program may wind up paying a surcharge instead."

Insureds merely "snap" (get it?) the widget into their cars, and their speed, distance, etc are then uploaded to the carrier, and rates adjusted accordingly.

Now, what would you say to applying that tech (or something very much like it) to humans?

Well, thanks to FoIB Holly R, we learn that John Hancock is proposing to do just that:

"Once you sign up, John Hancock sends you a Fitbit monitor as one way to track your fitness. You earn Vitality Points for your activities. As you accumulate points ... the more you save each year on your life insurance premiums." [emphasis in original]

And those savings could be substantial: up to 15% off your premium. The downside, of course, is that if one starts to slip, premiums creep back up (maxing out at the original rate).

Of course, privacy advocates aren't necessarily thrilled by this, and I have to admit that it's got a whiff of Big Brother going on. But - and this is key - it's completely voluntary, so I'm not really too put out by it.

Another objection is that "the plan will raise insurance costs for lower-income people juggling two jobs who don't have as much time to get to the gym." Which is, of course, a valid point, but it's exactly backward: their costs don't necessarily go up because someone else's goes down; it's not a static value.

It'll be interesting to see how many folks take advantage of the program, and how it ultimately pans out.

Let Us Pause And Reflect

on all the things we have now that we didn't before Obamacare.

Such as taxes ...............

Obamacare contains 18 separate tax increases. A few of the biggest include a tax on “Cadillac” health insurance plans, which doesn’t take effect until 2018, long after President Obama and many in Congress who voted for the tax in 2010 have departed Washington. Also, there is a tax on health insurance premiums and a higher rate on the Hospital Insurance payroll tax for single filers with incomes above $200,000 ($250,000 for married filers) that also applies to investment income. - Daily Signal

Just Because .....

A real Cinderella story.

This has nothing to do with insurance. Get over it.

Take 3 minutes to read this.

It will do your heart good.

This is a long shot, but I'm looking for a woman that was at Tannehill Premier tonight seeing Cinderella at 7pm. I dropped my teenage daughter, step daughter, and son off at the movie. My son later told me, much to my humiliation and embarrassment, that my girls were rude and obnoxious during the movie.

The woman I'm looking for addressed them and asked them to be quiet and they were disrespectful.

After the movie she approached my girls and told them that her husband had been laid off and this was the last movie she would be able to take her daughter to for a while and my girls ruined that for her.

If you are this woman, please message me. I can assure you that these girls are being strongly dealt with and appropriately punished. This rude, disrespectful, and awful behavior is unacceptable and they owe you an apology. My husband and I are having them write your apology letter tonight and we would like to pay for your next movie and snacks out of their allowance. Please message me if this is you. I apologize profusely for their disrespect. - Facebook via Happy Place

You won't believe what happens next.

Click to read the rest of the story.

Second Verse, Same as the First

Anyone who had a radio in the 60's will remember the British invasion of pop

singers, some more celebrated than others. Herman's Hermits would never rank with The Beatles or Rolling Stones but they did have a few memorable hits if for no other reason than the fact you couldn't get the tune out of your head.

Henry the 8th was one of those songs. Catchy tune combined with a bit of a history lesson about a former king of England.

Must not have been much to say about Henry. At the conclusion of the first verse lead singer Peter Noone said "Second verse. Same as the first".

And so it repeated.

Obamacare seems to be stuck in a Herman's Hermits time warp.

First there was that website (that still doesn't work).

For their next hit we have the IRS snafu.

Some 800,000 tax filers got the wrong information a few weeks ago.

Corrected forms in the mail.

Kind of.

Just like that infamous website, the IRS still can't get their act together.

ObamaCare customers who received the wrong tax form from the federal government this spring will not face penalties if they miss the April 15 deadline, officials announced Friday.

Anyone who have not yet been sent corrected tax forms and are “unable to file an accurate tax return” now have until Oct. 15 to file — as long as they request an extension. - The Hill

As of a week ago, some 80,000 people still did not have the corrected forms.

Yeah, we just can't get that tune out of our head.

Second verse, same as the first.