Friday Afternoon Dreams

Friday, June 24, 2016
I'll take "Wishful Thinking" for $400, Alex:

Amusing Vendor Tricks

So, a couple of weeks ago I posted on a (new?) insurance funding product called HMA (Health Matching Account). I was mildly critical of it, primarily because the folks pushing it were working very hard to conflate it with tax-advantaged Health Savings Accounts.

They've also been pushing it pretty hard on LinkedIn, which is fine, of course,  but now they've added FSA (Flexible Spending Accounts) to the list of vehicles their product can replace. Of course, HSAs and FSAs are officially IRS-approved, tax-advantaged vehicles, while HMAs are not. Which is not to say that the product itself is necessarily evil (or even fattening), just that the marketing thereof is, well, questionable.

When I called them on this at LinkedIn, I was greeted with a barrage of derogatory comments and threats from their Marketing Director to "expose" me as "a paid troll. His articles can't be trusted because he ignores all that is true to chase a buck.. I will troll his all his post [sic] and expose this quack!"

Seems like I got under someone's skin.

Which gives one pause to wonder why, no?

Settling for Life

We've written before about viaticals, which are generally used by folks with end-of-life financial needs. But there's another, related strategy called life settlements:

"The insured had a $300,000 term policy that was also at that end of the level premium paying period and conversion period. When he called his agent to drop the policy because he no longer needed the coverage, the agent said, “Before you do, let’s see if there could be value in the secondary market.”

That is, the client had no particular health issues, but no longer needed the plan. Since life insurance is property, it can generally be sold. In this case, the client saved the annual premium and picked up an easy $5,000.

Which sounds great, and far be it from me to pooh-pooh anyone coming into a windfall. But I also have some major reservations about mentioning this "secondary market." It's not that I have any particular ethical qualms; after all, it's my client's policy, so why should I care? It just feels ... weird to bring this up.

So I reached out to some colleagues for their thoughts; FoIB Brian D immediately pegged it for me:

"I also fear how it would be received. Would it poison the well right before finalizing a sale."

Exactly. Now, perhaps this makes sense after the application has been approved, as a way to help the client pick up some extra cash now that their new plan is in place. And to be fair, this may well be what the folks who wrote that article do, as well, but it's just not explicitly noted.

And full disclosure: here in Ohio, agents are allowed to help make, and receive compensation for, these arrangements.

Something to consider going forward.

Thursday Insurance Conundrum

Thursday, June 23, 2016
Good question:

Waivin' in the wind

We've written before about group plans suspending spousal coverage, or applying a penalty to employees whose spouses have access to coverage through their own employers. It's a way to reduce overall health insurance spending, to be sure, but it comes with its own set of problems.

Over at Benefit News, Zack Pace takes a look at how this practice affects real people, and how it continues to grow:

Zack takes a page from our own experience, and writes about a young lady who's reached out to him for advice. It's compelling, disturbing, but quite insightful.


Potential Good Small Employer News

Wednesday, June 22, 2016
Yesterday, I met with a couple who own their own small business, and had recently hired their first employee. They wanted to offer health insurance, but really don't qualify for a group plan. Regardless, they wanted to do something to help out the young man and his family.

So we started looking at individual plans, and they asked if they could pay some of the premium. Time was, they could do this, but those days are long gone, thanks to The ObamaTax.

Of course, we can still do it the old-fashioned way, via salary bonus; that has its own set of issues, as well.

Now, there's some hopeful news out of DC:

"Members of the U.S. House of Representatives are getting ready to vote on H.R. 5447, a bill that could let small employers reimburse employees for individual health insurance premiums."

FoIB Allison Bell reports that the bill passed, by voice-vote, this morning.

Be interesting to see how much farther it gets.

Interesting LTCi Idea

So, have a client interested in Long Term Care insurance (LTCi), with some provisos. First, they are very concerned about potential rate increases. Second, they want to deal with only top-rated carriers, and third, they really don't care about Partnership compliance. So we ran our usual pre-screen process (which vets financial suitability and medical history) and went to town.

Here's what we came up with, and I thought it might be of interest to our readers:

We start with a monthly benefit of $6,000 (client's request), a three year benefit period and a 3% inflation guard. Both plans include the "shared care" benefit.

Company A offers a "traditional," pay-as-you-go product, and the initial annual premium for this is $5,400, which yields a total pool of $430,000 for their long term care needs.

Company B is what we call "one-and-done;" that is, they make an initial, one-time deposit ($150,000 in this case), which yields a total pool of $610,000 (about 30% higher than Company A).

Flash forward 10 years, and Company A's received $54,000, and the pool has grown to $590,000. But, if my clients quit or die, they get back exactly $0. And that assumes that there've been no rate increases.

Company B has received nothing past the initial $150,000, and its pool has grown to over $700,000. But here's the thing: if they quit, they get back almost all the money they'd deposited, and if they die, they (well, their beneficiaries) get back twice as much as they'd put in (and tax-free, to boot).

Plus, they have the peace of mind that comes from knowing that they will never see a rate increase.

Pretty cool.

[Thanks to FoIB Randy G!]

Hotdoggin' it with Oscar

Tuesday, June 21, 2016
Almost three years ago, Bob wrote about the travails of a New York-based health insurance start-up called Oscar. The fledgling carrier's "hook" was to be an emphasis on telemedicine and consumerism.

Bob was understandably skeptical, noting that "if it delivers anywhere close to the promise, Oscar should run for public office."

So, how's the campaign going?

"Oscar has attracted 135,000 customers ... But for every dollar of premium Oscar collects in New York, the company is losing 15 cents. It lost $92 million in the state last year and another $39 million in the first three months of 2016"


On the bright side, Oscar's CEO 'gets' it:

That’s not a sustainable position

No kidding there, Mario.

So what seems to be the problem, not just with Oscar but others, such as InHealth? It's simple economics, really:

"[I]nsurers put prices on their plans that have turned out to be too low to make a profit."

No kidding. And, of course, there's increasing pressure on state departments of insurance to rein in double digit rate increases. Anyone who owned a car and needed to buy gas in the early 70's knows exactly how this'll turn out.

Monday Morning Linkage

Monday, June 20, 2016
We first noted the Institute for Clinical and Economic Review (ICER) back in May, noting how it so closely resembled the famed Independent Payment Advisory Board (aka Death Panel). Well, seems that the cat is now officially out of the bag as regards the insurance industry's subterfuge as implemented by this organization:

"In the wake of ridiculous Obamacare mandates, the insurance industry is under tremendous cost pressure to deny its customers access to expensive lifesaving drugs. But those insurance companies don’t want to take the public relations hit for denial of these drugs that cost billions in research and development to get to market"

Hence: ICER

It's almost become too easy taking shots at the 3000% rate decrease, but the hits just keep on coming:

"Health insurers are seeking steeper premium hikes in 2017 than in previous years ... The report offers the most comprehensive and alarming data so far about the premium costs that ObamaCare customers will see when they renew their coverage this fall."

Just in time for Open Enrollment.

Oh, and an election.


From the Lay Down With Dogs Department:

"A nonprofit health insurer in Maryland is suing the federal government to avoid more than $22 million in fees ... said it has been unfairly asked to pay millions of dollars — about one-quarter of its 2014 premiums revenue – under the law’s “risk adjustment” program"

That fine print'll kill ya, brah.

[Hat Tip: FoIB Holly R]

Friday Afternoon Hat Trick

Friday, June 17, 2016
The Political Hat
No, not three posts, but one very interesting - and provocative - post from a blog friend:

"Rationing Healthcare, Misunderstanding Healthcare, Privatizing Healthcare?"

The Political Hat hosts an eclectic blog about - you guessed it! - politics, but this post is focused on a couple related health care ideas or themes, which are really about free market health care solutions versus socialized schemes.

Really interesting, and TPH has a, well, unique way with words.

Good Friday afternoon fare.

Absolutely Amazing Customer Service Experience

Thursday, June 16, 2016
Over the years, we've been pleased to blog on some really exceptional customer service experiences (here and here, for example). And now we have another one to report.

For more than a few years, I've been cajoling my Better Half to hire a service to install mulch for us. This year, she finally relented and, as is her wont, began detailed research on the best and most cost effective vendor. After considering a handful of quotes, she chose Joe's Landscaping in Beavercreek, OH (motto: "Not Your Average Joe")(really!), and they came out this morning to do their thing.

The first thing that caught my attention was their professional attire, and then how respectful and helpful they were as I asked questions about the process and walked them around the abode pointing out where mulch needed to go.

The second thing I noticed was how cool the equipment was: instead of dumping a load of mulch on the driveway and then hauling it around in wheelbarrows shoveling hither and yon, they actually hooked up a huge hose and blew the mulch where it needed to go (bonus Y-chromosome points: it operated via remote control!):

They carefully blew the mulch into the designated areas, and when they were finished, I complimented them on the job. The lead guy, Paul, thanked me and observed that it was messy, too (there was mulch overspray on the walks and grass). I said "no problem, we have brooms and blowers," and he said "no need, we clean everything up, too." And so they spent another half hour carefully blowing all the overspray back into the beds.

And then there was the finale: we have a very small flower bed around the mailbox out by the curb. I'd asked them to mulch that, as well. And they did, but: instead of blowing a bunch of mulch on the delicate lilies, they grabbed a shovel and carefully scooped and spread out - by hand! - the appropriate amount.

I can't say enough good things about Joe's, and especially Paul and Derrick. They were friendly, professional and took obvious pride in their workmanship.

Highly recommended!

Pot Luck Health Wonk Review

This week, Chris Fleming hosts the venerable HWR, and it's a doozy. Lots of thought-provoking posts, along with really helful context.


Another 3000% Rate Decrease Report

Wednesday, June 15, 2016
Remember this?

I recently received renewals for some Grandmothered major medcial plans with August effective dates. Let's see how they fared this year. Both are HSA plans where the carrier pays 100% of covered expenses after the deductible:

Max is only a few short years from Medicare eligibility. His deductible (out-of-pocket) is a paltry $3,000 per year. He's been paying about $690 a month since last August; this year his rate will increase a modest 45%, to just shy of an even $1,000.

Sharon and Dave have a similar plan, albeit with a $5,000 deductible. They've been paying about $590 a month since last summer. Come August, though, their rate goes to $690 (a paltry 17% increase).

And remember, since these are Grandmothered plans they can't be changed, and most companies don't accept mid-year renewals as Special Open Enrollment triggers.

On the bright side, their current carrier will allow them to "upgrade" to ObamaPlans.

Let's see how that might work out, shall we:

Max may choose a $4,000 deductible (33% higher than his current plan) for the low, low price of just $852 a month (about 50% higher than his renewal). Plus, he gets to re-start his deductible for the year (and then again in January).

Sharon and Dave are also eligible for this tremendous deal: they can opt for a $6,000 deductible (20% higher than their current plan) for the bargain basement price of just $1,200 a month (about twice their renewal rate). And they, too, qualify for a brand new annual deductible to satisfy.

Come on down!

Conflicting Fees

Tuesday, June 14, 2016
As previously noted, many carriers have decided to stop paying commissions on new health insurance business written between Open Enrollment Periods. This has prompted agents to look at other income models, including fee-based.

Back in April, I wrote about my own search for an answer, and a webinar I attended explaining the ins and outs of such an arrangement. One key point that was made more than once was that one couldn't "offer to refund any part of [the fee] based on the completion of a sale or any commissions." That is, there can be no off-setting for plans that do generate a commission.

Which made sense in the context of rebating, and that was fine.

But last week, I received new guidance from another source. In their newsletter, Ohio Insurance Agents, also mentioned the issue, and offered its own take on commissions and fees:

"To help with this troubling trend, OIA wants agents to be aware that Ohio law does permit agents to charge fees for services in several instances. For personal lines policies, such as sickness or accident insurance, agents may charge a fee if the policy is sold on a no-commission basis" [emphasis added]

You can see the dilemma: one reliable source says an agent can (must) collect both a fee and a commission, while another equally trustworthy source says one may only charge a fee if there is no commission.

There's really no middle ground here.

I've reached out to the folks at Cornerstone to see what they have to say about this, and will keep readers posted as the situation develops.

Outstanding Compassionate Carrier Trick

Monday, June 13, 2016
Just now via email:

"UnitedHealthcare and Optum, the health benefits and services companies of UnitedHealth Group, are taking immediate action to support people affected by the recent mass shooting at a nightclub in Orlando. The company is opening Optum's Help Line, providing affected residents access to specially trained mental health specialists.

Optum's toll-free help line number, 866-342-6892, will be open 24 hours a day, seven days a week, for as long as necessary. The service is free of charge and open to anyone

Also available online here.

Kudos, UHC.

Top O'The Week Linkfest

LifeHealthPro's AllisonBell has some disheartening news about critical illness plans:

"Officials are ... thinking about the possibility of banning the sale of critical illness policies and other policies that cover two or more specific diseases"

The Bureauweenies in DC© see these plans as some kind fo threat to ObamaPlans, as if they were an alternative when in fact they are useful supplements.

FoIB Holly R reminds us that even pot-smokers need life insurance, but what effect will marijuana use have when they apply for a policy? As always, this will depend on the carrier, but some companies are more, um, liberal than others when it comes to Mary Jane:

"29 percent classify marijuana users as nonsmokers, potentially allowing them to qualify for the best nonsmoker rates:"


Last we looked, so-called "Junior Doctors" working for the Not So Vaunted National Health Service© had called for a major work slowdown. So how'd that work out?


"The NHS is paying junior doctors to learn how to land lucrative new jobs outside medicine"

Fewer doctors, better health care.

Got it.

Another Friday InHealth Update

Friday, June 10, 2016
Not much has changed since last week, as the DOI is still noodling through how to proceed. One issue which had flown under the radar has to do with the ObamaTax:

As we've previously noted, placing the $500,000 claim cap on IH policies renders them ACA non-compliant, which means that folks will lose their subsidy if they stay. But it also means that they'd be subject to the ObamaTax if they stay on longer than 90 days. And they have but 60 days to make a switch.

Talk about rocks and hard places.

Still, I have at least one client that's already met her out-of-pocket for the year, and would have to start over again mid-year if she switches. She's going to have to decide how that will play out for her financially.


Tightening the Screws

Thursday, June 9, 2016
As The ObamaTax continues to auger in, the Rocket Surgeons in DC© have the perfect solution: Less choice!

"The government's move would limit short-term health coverage for an individual to less than three months each year and bar renewal."

There is so much wrong with this that it's difficult to know where to begin (not that that's going to stop me, of course).

First, Short Term plans (STM's) are never "renewable." The term has a specific meaning, and it doesn't apply to STM's. They are often re-writable (that is, one can buy another plan after the current one expires), but this is very different.

And no, I'm not splitting hairs:

Short Term plans don't cover pre-existing conditions (one of the reasons they're inexpensive, plus non-O'Care compliant). If they were "renewable," then anything I was treated for under one plan would be covered when I re-upped. But this is not the case, nor has it ever been. Rather, when the initial coverage period is up, one buys a new plan, and anything that was covered under the previous one is now pre-ex, and excluded.

Second, how in the world would the gummint enforce the "3 month rule?" It's not like there's some secret Washington database of STM clients. The most they could do is prohibit carriers from issuing plans that last more than 3 months. Okay, rocket surgeons, but what's to stop me from then going to another carrier for another 3 month stint, and on and on? Nothing, that's what: as noted above, there's zero reason not to, since there's no inherent value in sticking with the same carrier (no continuity of coverage).

Perhaps the Powers That Be should instead look at the reason this has become a problem: ObamaPlans have become unaffordable, and we have as many - perhaps more - uninsured as we did before this train wreck.

But that's just me.

Questionable Vendor Trick

Wednesday, June 8, 2016
So I received an interesting response to my recent post on Health Savings Accounts (HSAs). I had lamented that "there aren't any Medicare HSA options. One would think they'd be ideal for healthy seniors," and noted that it was an "opportunity lost."

The response came from someone on LinkedIn who'd seen the post:

"Opportunity found! The Health Matching Account - HMA has no age limits, no underwriting, and is the same contribution regardless of age Assuming no claims to to reduce the account balance, accounts double after 3 years"

Intriguing, no?

So what is a Health Matching Account (HMA), exactly? Well, it purports to be "the ultimate medical savings account available ... the HMA awards our cardholders up to $3 in medical benefits or more for every $1 contributed into their HMA account balance as the program progresses."

They further claim that the plan is "a medical savings account governed by the requisites of IRS Publication 969 and 502, as they relate to medical care for reimbursement of medical expenses under IRS Code Section 213(d)."

All well and good, but here's the rub:

I'd specifically commented on the lack of a Health Savings Account option for seniors; HSAs are characterized by a number of requirements and benefits:

■ An HSA-compliant high deductible health plan
■ Tax deductible deposits
■ Tax advantaged growth and withdrawals

I have no particular objection to the HMA idea, but I was a bit put off by the way it's marketed.

For one thing, the IRC cite seems to lend HSA authenticity to the HMA concept, but it really doesn't. All that does is confirm that certain medical expenses may be reimbursed tax-free from a qualifying account. But the HMA folks state upfront that "reimbursements or payments made to an individual [from the HMA] are tax-free given the fact that they were paid with after-tax dollars."

Neat sleight of hand there.

I had some other concerns, as well, so I reached out once again to the Gurus of All Things HSA at FlexBank for their take:

"It sounds to me like I could open a master bank account, have employers funnel contributions to my bank account vs one they own (like we do now). I give employees a debit card for eligible expenses, manual submission for in-eligible (i.e. plastic surgery as they mention). I then get all of the interest credited on the master account and then "actuarially" credit some sort of interest back to each person individually based on their own account balance.

Not sure why someone wouldn't open their own savings account

Which pretty much echoes the conversation we had when I first mentioned this concept to them.

I couldn't find anything about the costs of this plan, other than a cryptic reference to "small maintenance fees." That's not really a big deal: if folks are interested, they'll call up for a quote. What did bother me was their comparison of HSAs to HMAs: there are some very disingenuous claims there. For example:

"HSA: Allows member balance to carry over to next year" [emphasis added]

Um, no: Health Savings Accounts by definition belong to the owner (insured), there's no "may" about it.

And this:

"HSA: Provides little to no interest crediting on member account balances."

This is also problematic: it's up to the individual to decide where (or if) to either save or invest (or both) their funds, and they're also free to move them to another  vendor (bank, investment firm, etc). There is no such freedom with the HMA.

All in all, while I appreciate that the HMA folks offer another alternative to more traditional plan design, I remain skeptical because of the rather dubious manner in which they're being touted.


Another Day, Another InHealth Update

Tuesday, June 7, 2016
Via co-blogger Patrick, some interesting news on the InHealth front, clarifying some things we already knew:

"Today, the Ohio Department of Insurance announced the approval of a 60 day Special Enrollment Period (SEP) for InHealth enrollees due to its recent financial problems which resulted in Lt. Governor/ODI Director MaryTaylor being appointed liquidator of InHealth."

Since the DOI took over the troubled carrier on May 26, the SEP will run from that date to July 26. There were two other items in the announcement that I found interesting:

First, as we suspected, it look like it will be up to individual carriers as to whether or not folks will have to satisfy a new deductible if they switch:

"[Y]our deductibles and out of pocket maximum may reset and your benefits and provider network may change"

"May" reset. My money's on "will."

The other item is one I hadn't really considered, but answers questions raised in the comments to the last post we did on this:

"If you choose not to obtain other coverage, your current deductibles may stay in place but your overall coverage will be subject to a $500,000 maximum. As a result, this option may cause you to be subject to the individual mandate penalty. You should contact the IRS or a tax professional to discuss further."

Since the ObamaTax lifted the cap on a person's claims, and the state's Guaranty Fund puts one back on, it renders the IH plan non-compliant, and therefore subject to the penalty tax fee.

And there's this:

"In addition, any subsidy that you may have been receiving will not apply to continued coverage."

Which is probably self-evident, but probably best to point it out.

SEP Clarification

The folks at CMS (Centers for Medicare & Medicaid Services) emailed to let us know that they have an updated list of the 6 Special Enrollment Period triggers. These are all pretty routine, but I thought this was interesting.

Moving to a new location to live has always been a legitimate trigger, and apparently enough folks used that as a way to game the system that the Rocket Surgeons in DC©
have finally figured it out:

"Note: Starting July 2016, you must prove you had qualifying health coverage for one or more days in the 60 days before your move, unless you’re moving from a foreign country or United States territory. Also, moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for a Special Enrollment Period."

Who says bureauweenies have no sense of humor?

From the Mailbag: Interesting HSA scenario

Monday, June 6, 2016
Health Savings Accounts (HSAs) are generally pretty transparent; after all, there aren't a lot of moving parts: a compliant health insurance policy, a properly administered savings account (typically help at a bank and using a debit card for access). Pretty simple, no?

Sometimes, though, things aren't as easy as they may at first appear. From the mailbag:

"Thank you for reaching out to me. My husband will be 65 in a few months. I have a HSA account. He and our daughter are on my account.  My question: is he able to enroll in Medicare and also use the HSA account?  He does not contribute to the  account."

Pretty straightforward, although I did have a few questions to ensure that we were on the same page. Once those were cleared up, it was a simple matter to reach out to our own Gurus of all things HSA, the fine folks at FlexBank, who assured us that:

"The wife can use the HSA funds  for her husband's qualified medical dental vision and hearing expenses. She cannot use it for his Medicare premiums unless she is also age 65."

Interesting, no?

What's sad is that there aren't any Medicare HSA options. One would think they'd be ideal for healthy seniors.

Oh, well, opportunity lost.

[Hat Tip: FoIB Jeff M]

MedMutual Update

Last week, Medical Mutual of Ohio announced that it would pay no commissions on plans written for folks coming to them from InHealth. They've since clarified this position:

"We would like to clarify that renewal commission will be paid on business that renews with Medical Mutual for a January 1, 2017, effective date, that was originally transitioned as the result of a delinquency proceeding."

Which is nice, of course, until one realizes that this does nothing to address the underlying substantive issue, which is that the carrier is still charging for those commissions but then not disbursing them, effectively defrauding their new-found clients through the end of this year.

Underwhelming, no?

To be fair: Other carriers, such as Anthem, are refusing to pay any commissions on plans written between Open Enrollments, period.

InHealth Mutual - A Week Later [UPDATED]

Friday, June 3, 2016
So it's been a week, and I sent this out to my InHealth clients; it occurred to me that IB readers might find it interesting, as well (given that it's unlikely that this will be the last Co-Op to go kaput):

Good afternoon!

So, we have a little more info, and further clarification should be forthcoming.

First, you can keep your IH plan through the end of the year, which may be helpful if you've already met a substantial part (or all) of your deductible. The premium and benefits won't change, but the overall maximum benefit will be $500,000 (as opposed to current unlimited). I think it's a personal decision as to whether or not that's a reasonable roll of the dice.

Second, and related, it's not yet clear whether moving to another carrier will necessitate a new deductible. As I've told those of you who've asked, I'd guess "yes," but we don't know that for sure (yet).

Third, if there's any 'good' news here, it's that we don't have to make a decision about any changes for a few weeks yet, and I would advise holding off on that until we hear more from the Department of Insurance, and as we learn more about how other carriers are treating this. As an example, Medical Mutual has said that it won't pay any commissions on policies written on former IH clients. Make of that what you will.

So, that's where we are today, and I will keep everyone posted as we go forward. Please know this: no matter what happens with carriers, commissions, etc I am proud to be your agent and I will not leave you hanging.

Have a GREAT weekend!

UPDATE: In the comments, folks have wondered how claims can be capped at $500,000 since O'Care lifted the cap altogether. I was at first nonplussed, as well, and then I recalled this from the original announcement:

"Should the reserve and receipts of Coordinated Health Mutual not be sufficient to operate InHealth during this process, the law provides that the Ohio Life & Health Insurance Guaranty Association support up to $500,000 of a policy holder’s claims."

In layman's terms, this means that since the carrier has now been placed under the stewardship of the Department of Insurance, and thus subject to the terms of the state's Life and Health Guarantee Fund, individual claims are limited to $500,000.

Late-week LinkFest

Thursday, June 2, 2016
First up, via FoIB Jeff M, this little factoid:

"North Carolina Leads The Nation In Health Insurance Mandates"

Most folks likely know by now about the ten Essential Health Benefits that make up the core of ObamaPlans, but the Tar Heel State's Powers That Be have decided that these don't go nearly far enough, and have imposed "56 health coverage mandates."

All "free" of course.

We've noted before the rather incestuous relationships enjoyed by folks in the upper echelons of the health insurance industry and those that "regulate' them. FoIB Holly R tips us to one about which we were unaware:

"Cigna lobbyist-turned-regulator playing the key role deciding if Cigna & Anthem can merge"

Now, we'll pass no judgement here regarding the merits of such a merger; we'll just note the old adage about foxes and hen houses.

The folks at United Healthcare have kindly sent us the latest schedule of first-dollar ("free") Preventive Care benefits released by the Rocket Surgeons in DC©. It includes adult blood pressure and sugar screening, and of course a litany of women's health bennies, including for iron deficiency and breast cancer.

What it still doesn't include is any such benefits for men. Why the misandry. HHS?

Frustrating Carrier/DOI Trick

As regular readers know, Ohio's O'Care Co-Op, InHealth Mutual, bit the dust last week. This morning, Medical Mutual of Ohio let us know that they won't be paying commissions on any business that comes to them from InHealth.

I just spent a good chunk of the morning going 'round and 'round with the wonderful folks at the Department of Insurance, who kept shunting me from one department to another, insisting that this somehow isn't fraud, and then dumping me at a voice mailbox.

Look, this is so simple that even a government drone should be able to understand it: Medical Mutual's rates include a commission, they've announced their intention to keep that commission, they've not adjusted their rates to reflect this, therefore they are defrauding any InHealth Mutual client who switches to them.

But apparently our Betters in Columbus just don't care.

Your tax dollars at work.

Health Wonk Review: Springin' out edition

David Harlow hosts this week's roundup of interesting and provocative health policy related posts. From Ibsen to telemedicine to the NFL and beyond, you're sure to find something that piques your interest (fancy that!).

Rocket Robin Hood

Wednesday, June 1, 2016
As in "rocket surgeon" Robin Hood:

"The risk adjustment program was designed to dissuade insurers from targeting only healthy people ... The problem is that measuring metrics often encourage companies to optimize their score"

Let's unpack this, shall we?

First, as we've noted before, "carriers have an incentive to make their own insureds look as sick as possible" if they want in on that sweet, sweet risk adjustment money. And let's face it, there's precious little they can do about making this happen; after all, there's no underwriting so they're actually shooting in the dark about what kind of demographic they're appealing to.

And second, it's not as if this is a deep, dark secret: heck, we've been blogging on it for years, as have many, many others.

Frankly, I fail to see the problem: carriers are simply following (willfully stupid) rules as intended, with entirely predictable results. When you incentivize a behavior, you tend to get more of it, no?

[Hat Tip: FoIB Joseph Snable]

Something You Don't See Everyday

Tuesday, May 31, 2016
And now for something completely different.

According to the NY Times, the details of Obamacare
were revealed to the IRS in a "by special invitation only" meeting. Here are the bullet points.

  • IRS doubted the Obama administration had legal authority to spend the projected $3.9 billion on health insurance premium subsidies
  • Attendees were given an OMB memo outlining the salient points of the proposed spending
  • Attendees could read and discuss the memo, but could not take notes or copies
  • Then Attorney General Eric Holder signed off on the legality of government subsidies
  • The Obama administration failed to get Congress to sign off on spending $3.9 billion but they went ahead and spent over $7 billion anyway
  • Obamacare premium subsidies are not authorized by  IRS code

For those that want the details, here is the link "In a Secret Meeting ...."

You can file this away in your Obama administration transparency filing cabinet.

#ObamacareFail #TheMostTransparentAdministrationInHistory

Breaking UHC News

From UHC via email:

"Next year UnitedHealthcare will offer individual plans through the Exchange in a limited number of states. This change in market footprint reflects our longstanding goal to offer products that are both affordable for consumers and financially sustainable for our company."

Which is surprising enough (given the on-Exchange losses), but then there's also this:

"After a detailed review ... we have determined that we will not offer individual Off-Exchange plans in 2017 except in the state of Utah. These changes reflect our longstanding goal to offer consumers products that are both affordable and financially sustainable."

Frankly, this surprises me: I would have thought that it would be the other way around.

Regardless, here's the money quote:

"If you have clients with 2016 Off-Exchange comprehensive medical plans, they will remain covered until Dec. 31, 2016."

How's that go again?

Oh, yeah.

[Hat Tip: Cornerstone]

Stupid Vendor Tricks

I've always believed that the best way to do business is to look for ways to do business; that is, throw up as few roadblocks as possible (with zero being optimum). Glitches do happen, of course, but a good attitude and a smile go a long way towards smoothing things out.

And then there are the incompetents at ExamOne.

I just wrote a combination case for one of my clients: life insurance with Company A, and disability coverage with Company B (long story, not really relevant here). I double-checked with each to confirm that we could do one exam (so poor Betty only gets stuck once); no worries, they were both fine with that as long as I noted it on the applications.

I've used ExamOne pretty much exclusively for many years, solely from inertia. Never had any real problems (until now). On the other hand, I've never really challenged them before.

So, this morning, I called to place the order. I explained to the gentleman what I needed done, and he asked to put me on hold to see if that the carriers would agree to "share" the information (since we were looking to get by with one needle-stick). Since I'd already pre-cleared this, I knew the answer, but I did understand that he couldn't just take my word for it. So he asked me for the carrier names and then put me on hold while he checked it out.

After a few minutes, he came back to confirm that he had the right name for the DI carrier (hint: it's not exactly obscure). After confirming it with him, he again put me on hold to see if he could ascertain whether or not they would be able to accomplish this very simple task.

After a while, he came back and told me that "I can't find a definitive answer, so I'll just go with no."


Making up our own rules as we go along, are we?

This is absolutely unacceptable.

I thanked him for his time and hung up, seething.

Recently, I'd received an email from our new ExamOne rep (who even knew we had an ExamOne rep?), so I reached out to her to tell her about this experience, and that they had just lost a customer (there were also other issues with the original call that aren't relevant here). She promised to "look into it," and I promised to find another vendor.

Which I almost immediately did: I called both the life and disability carriers for suggestions, and they both recommended APPS - Para Medical Services. Well, I called, spoke with a rep right away, and had everything locked down in under 5 minutes. They understood exactly what I needed and knew which insurance carrier was which, no problem.

So, out with the old and incompetent vendor, in with the helpful new one.

Happy ending.

On this Memorial Day

Monday, May 30, 2016

Thank you.

[Hat Tip: RedState]

InHealth Collapse: Immediate Aftermath

Friday, May 27, 2016
So I reached out (via email) to my InHealth clients today:

"Yesterday afternoon, the Ohio Department of Insurance placed InHealth into receivership. This was not completely unexpected: almost all the Co-Ops nationally have failed; we were hoping that IH would be an exception.

The good news is that the DOI will handle taking care of outstanding bills, etc, and this is a trigger for a Special Open Enrollment period so that you can obtain coverage elsewhere.

I'll be in touch early next week to let you know how we can help with this transition. Meantime, have a GREAT (and safe!) Memorial Day Weekend."

I sent this to all my IH clients, and almost immediately received this reply from one:

"Does this mean that I will be required to meet my deductible again this year with the new company?  I've already met my deductible with IH for this year and have more expected medical expenses scheduled in the next few months (MRI for GI and more testing for the neurosurgeon).  Hopefully they take these sorts of things into consideration. 

Hope you have an enjoyable weekend as well!

Keep me posted..."

Good question.

Here's my reply:

"That will depend on the carriers, but my guess would be that yes, everything would reset to zero. I’ll know more as they roll out what options will be available: it’s possible (no idea how likely) that the DOI could make some provision for this. But just don’t know yet."

To which he responded:

"Ugghhhh.....not the answer I was hoping for; however, the one I had expected.  Guess they feel like the working middle class is made of unlimited amounts of money. Rant over.  Lol!"

I can certainly empathize. I'm sure that the coming weeks will bring some clarification, both as to how the transition will be handled by the DOI, and my own choices viz fees.

A dear friend has reminded me that things change, and I do need to be more open to other practice choices (less medical, more life, etc). I know that he's right, and I've been wrestling with this for a while (as regular readers have likely gathered). I do love what I do (mostly), so one supposes that it's natural to sound off on having to adjust course.

But time and tide....

BREAKING: InHealth Mutual Now Under DOI Control [UPDATED]

Thursday, May 26, 2016
[From email just now]

"COLUMBUS - Lt. Gov. Mary Taylor was appointed receiver for Coordinated Health Mutual, Inc. today following the Ohio Department of Insurance (ODI) request to liquidate the company which provides health insurance to nearly 22,000 Ohioans under its InHealth Mutual brand.  The action allows ODI to assure that claims of policy holders, providers and vendors are provided for in an orderly manner while it winds down company operations."

More as this develops.

Really disappointed, had hoped that they'd make it. Take-away? Co-Op model = wishcasting.

UPDATE: Full DOI statement here.

ACA-related Spelling Problems [UPDATED!]

Folks keep misspelling "3,000% rate decrease." For instance:

"Most health insurers in Pennsylvania are pressing for double-digit rates increases for Obamacare plan coverage starting in January"

This is unpossible.

Or this egregious example:

"Health insurance industry lobbyist tells me that Blue Cross Blue Shield of Texas will announce a 59% rate increase today for next year."

Sure wish they'd get this under control.

UPDATE: Check out this post at Bob Laszewski's place for the full story of the Empire State's health insurance market travails. Money quote:

"Let me also suggest that people don't pay rate increases--they pay premiums."


Of Belly Dances and Obamacare

Wednesday, May 25, 2016
Quick update on how our tax dollars are being spent to promote and enroll people in Obamacare.

A recent audit of the Nevada state Obamacare exchange looked at how money was spent on education, training, etc. Among other things they found this .......
Six of the nine navigator organizations offered explanations for the time they weren't at events, saying they were working on social media posts, emails, training or helping with walk-in customers, but auditors said it was still unclear whether those paid hours were spent on exchange-related activities.
Gilbert also took issue with auditors singling out one navigator organization's attendance at the belly dance and lingerie events, saying the exchange needs to target women who are self-employed or operate small businesses and prioritize women's health issues. He said the exchange's success came in part because it appeared at less-traditional events. - Herald Online

Less traditional indeed.

Where to I sign up?

#ObamacareFail  #LingerieShow

O'Care Hall of Shame (Part 367)

So, the McKinsey Center for U.S. Health System Reform has released the findings from its most recent survey of the last Open Enrollment (its 8th such). Those of us who've been following along at home are not surpriosed, but one suspects that folks who haven't been paying attention (and those with their eyes willfully closed) may well be.

For starters:

"Over half of QHP-eligible uninsured individuals have been uninsured for over three years." [ed: QHP = O'Care compliant]

This dovetails perfectly with how long we've been going through this charade. The very obvious conclusion is that the scheme is not working, period. The whole point was to get people insured, and that's clearly not happening.

"While awareness of penalties and subsidies continues to rise, fewer consumers understand their personal eligibility or are shopping."

Um, d'unh! People do understand quite well that even if they could afford the outrageous premiums, how do they afford the additional out-of-pocket costs?

As an aside, I find it interesting that it's quite difficult to determine how many people actually paid the ObamaTax: there are plenty of articles of how many were subject to it, and how many had the amount dinged from their tax refunds. But what about folks who were due no refund? How many of them actually ponied up?

'Tis a mystery.

Here's something quite interesting:

Almost 40% of those eligible for an ObamaPlan have opted not to sign up. Not exactly a ringing endorsement of this train-wreck, is it?

Subsidies vs Rate Hikes

Tuesday, May 24, 2016
ObamaTax architect Herr Jonathon Gruber famously quipped that "the stupidity of the American voter ... was really, really critical for the thing to pass.” Confusing go-along-to-get-along as "stupidity" may have been his arrogance speaking, but he wasn't wrong:

"86 percent of the people who use the marketplaces get health insurance subsidies” to buy coverage, a point repeated by policy shops and advocates who want to downplay the effects of possible rate increases"

That's the popular press' spin on the impact of continued premium increases - some higher than 45% - and fewer carriers with narrower networks. If only there were a term for this.

Oh, yeah.

Regardless, the point is that trying to gloss over significant rate and out-of-pocket increases by touting potential subsidies is not just wishful thinking, it's delusional:

"Subsidies diminish in value the more money a family has ... Higher premiums matter a lot to those receiving smaller subsidies and could potentially force some of them to drop their coverage."

It also touches on something we've observed before:

"One's premium and subsidy (if applicable) are based in part of where one lives (zip code, county), but the penalty is simply a flat percentage of income regardless of one's location."

And, finally, roughly the same number of people buy unsubsidized plans as subsidized ones, but few in the press seem the implications of this. That is, an awful lot of folks don't enjoy the benefit of fellow tax-payers footing significant portions of their health insurance tab, amplifying the effect of these rate and out-of-pocket increases.

But we had to pass it to....

[Hat Tip: Charles Ornstein]

"Winning," O'Care Style

Gosh, what a complete surprise:

"Obamacare Poll: Most Enrollees Hate Their Plans"

According to the (not exactly right-leaning) Kaiser Family Foundation, "just over half (54 percent) now rate the value of their coverage as ‘only fair’ or ‘poor.’”

And of course they throw in the lie that rates - and out of pockets - have increased.

What has increased is that dissatisfaction trendline:

"[In]n 2014, the percentage of enrollees who rated their coverage “only fair” or “poor” was 39 percent."

This new result indicates a 40% increase [ed: Gee, what else has increased over 40% the past few years, health insurance-wise?]. Adding insult to injury, a recent Gallup poll shows that a majority of Americans favor repeal of the train-wreck.


Death (Panel) Comes a'Calling

Monday, May 23, 2016
We first wrote about the IPAB (Independent Payment Advisory Board) almost exactly 6 years ago:

"A stealth, 15 member panel appointed by the king, I mean president, to make sure Medicare doesn't spend too much money on health care."

At the time, the idea that the IPAB was in reality a Death Panel was mocked and derided as hopelessly over the top. But was it?

Turns out, not so much:

"ICER [Institute for Clinical and Economic Review] portrays itself as being independent when it is nothing of the sort, as it was founded and is being run by people with strong ties to the insurance industry ... ICER is set to review new therapies for small cell lung cancer."

So what, you ask?


"It recently reviewed a drug for another type of cancer, Multiple Myeloma, and, not surprisingly, it found the drug too expensive."

When insurance companies (and Medicare) pay the piper, they call the tune, and if the price is deemed too high, then the music stops. Britain's Not So Vaunted National Health System© bases care on quality-adjusted life years (QALY), and "seldom endorses treatments costing more than [$43,000] per additional year gained." No matter how one spins this, it is rationing.

Now, there's a case to be made that this is for the public good: after all, we all most of us pay premiums and taxes, and therefore have a horse in the race. But what's insidious about this method is that, unlike the one used by the NSVNHS©, ICER is not transparent. And so one is left wondering when one's spigot will ultimately be turned off.

Second look at a cancer policy?

[Hat Tip: FoIB Holly R]

A Cancer Story

Full disclosure: I have yet to sell a cancer policy myself, but I've been told by more than a few colleagues that I'm remiss in this.

And here's a perfect illustration of why:

"When Shirley Tully was just starting her career ... in 1993, she had a number of reasons to buy cancer coverage. When she bought the policy, she wasn’t even eligible for some of the benefits, such as mammogram wellness benefits, because of her young age."

One day, that all changed:

"In September 2008, however, her life changed forever. When she visited the doctor for the follow-up appointment, she got the news: “Shirley, the test did not come back as well as we had hoped.”

Please click through for the rest of this incredibly moving, and ultimately uplifting story.

And maybe ask your agent about a cancer plan.