Friday, April 26, 2013

News from all over the 58 states...

Ohio: Senate Republicans, in an uncharacteristic display of competence, have put the kibosh on Gov Kasich's plan to expand Medicaid in the Buckeye State. I'm pretty sure that's a sign of the Apocalypse.

California: Surprising exactly no one, fewer employers in the Golden State are now offering group health insurance:

"The percentage of California employers that offer health care coverage to their employees has plummeted ... only 49% of employers with between three and nine employees offered coverage"

The numbers are slightly better for employers with between 10 and 49 employees.

Look for that to change as The ObamaTax lingers on.

Nevada: Long-time IB readers may recall the story of the guy whose COBRA premium was a bit short:

"[C]ancer patient Ron Flanagan lost his insurance coverage because his premium payment was $.02 short ... They are required to follow the law, which they (apparently) did."

Now the good news is that Mr Flanagan's coverage was eventually reinstated, but this was far from a slam-dunk.

The folks who run the Silver State's health insurance exchange are pro-actively addressing this potential pitfall. They were "asked about customers who fail to pay their premiums, or fail to pay as much as they are supposed to pay, by the end of the grace period."

Turns out, it's not a lot different than the example of poor Mr Flanagan:

"QHPs cannot reinstate individuals who are getting advanced premium tax credits (APTCs) and fail to make their share of the payments by the end of the grace period"

Which means that, if you're getting a subsidy, you'd better make darned sure you send in your premium.

'Course if you don't, and you get cancelled, you can just stiff your doc. One supposes we'll see a lot of that.

About that Prevention and Public Health Fund

It seems that the White House is getting itself into a little bit of a pickle.  Early this week the House GOP introduced a bill to take money from the slush fund Prevention and Public Health Fund to re-open the high risk pool. Almost immediately the White House issued a release that President Obama will veto the bill. He will veto it because:

"The Affordable Care Act created the Prevention and Public Health Fund to help prevent disease, detect it early, and manage conditions before they become severe. The Fund supports critical investments such as tobacco use reduction, and programs to reduce health-care-associated infections and the national burden of chronic disease, as well as helping to ensure Americans have access to affordable coverage for preventive benefits. By concentrating on the causes of chronic disease, the Fund helps more Americans stay healthy." 

So if this is what the fund is for then why is HHS taking $54 million from it to pay for Navigators? What about the $454 million that is being taken from the fund to pay for building the Federal Exchanges?

Inquiring minds want to know.

Throwing Water on a Grease Fire

PPACA was passed solely by Democrats. There was not a single vote from a Republican in favor of the law and not a single vote from a Democrat against the law. One would assume that expanding access to insurance for those who are without insurance and are high risk would come from Democrats right? Right?


This week Joe Pitts (R-PA) introduced the Helping Sick Americans Now Act. Essentially this bill would take money from the Prevention and Public Health Fund and re-open the high risk pool that was closed by the Obama Administration last month due to "cost concerns". The bill would also eliminate the 6 month waiting period for someone to enroll in PCIP.

Unfortunately, there are a number of unsettling things about this bill and PCIP. First, it's amazing that Democrats who wrote the law to protect those who need it most are fighting this and doing nothing to revive the broken program. Second, Republicans are willing to fix something broken with a law that they know is going to be a complete "train wreck". Third, while I commend House Republicans for showing some compassion I must ask "what are you thinking?". This bill is going to create an even quicker death spiral of the health insurance industry by expediting the no pre-existing conditions, guaranteed issue, community rating nightmare that we are all going to see in 2014.

The GOP should know that PCIP has served as a sample for PPACA in 2014. It has clearly failed. I just wish they would learn how to put the fire out properly.

Cavalcade of Risk #182: Call for submissions

Jeff Root hosts next week's Cav. Entries are due by Monday (the 29th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

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

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Thursday, April 25, 2013

Bumblebees and Insurance Exchanges

Helicopters and bumblebees have two things in common.

According to aerodynamic experts, they are not supposed to fly, yet somehow they do.

Come October 1, 2013 the Obamacare health insurance exchange is supposed to fly but there are folks who understand these things that say it will never get off the ground. 

I am neither an engineer nor an IT specialist, but I do know a thing or three about computer systems, carriers and the government. Enough to know that most folks in the government won't sit at the same table in the cafeteria if they are from different divisions. Yet somehow we are supposed to believe that the IRS, HHS, DOL, DHS and a few other TLE's are probably not really on the same page when it comes to Obamacare.

Plus we are supposed to believe this massive computer database that cross-checks tax records, citizenship status, terrorist lists and employment status is going to be ready to roll in a little over 160 days.

As if that isn't enough, not only is this "big brother" dossier supposed to exist, but it will actually have the ability to assimilate, evaluate and transmit this data to insurance carriers once you have been blessed with a taxpayer subsidy designed to make your health insurance affordable.
Not that I am skeptical of anything Washington tells me, but let's pretend I am from the Show Me state.
Prove it.

Knowing full well that DC is not the epitome of efficiency, we know they farmed out a lot of this work. For instance . . .
CGI Group will also be part of the build-out of exchanges in Hawaii, Massachusetts, Colorado, and the 30 health exchanges that will be built by the federal government in the states that have opted against building their own platforms.

So who is CGI group?

Canadian information technology firm . . .

We have to send jobs outside of the US? Can't find anyone here who can do this work?

In case you were wondering, the unemployment rate in Canada is a tad better than in the US and as far as we know no one up there is massaging the numbers.

This may not qualify as a "green" job but seems it would be a better investment in the US economy than the $1 trillion in "stimulus" that has been pissed away.

The folks at Yahoo had this observation about expectations for CGI's work.
"Of all the things that are being done in the exchanges that move to simplified eligibility is probably the most sweeping change because it allows states to move to an administration simplification that wasn't ever possible before," Boudreault said.
Until 1969 most folks thought we would never put a man on the moon but we did.

Of course that took nearly 10 years.

This project is less than 3 years old.

But then, the world was made in 7 days, so . . . .

But now we have another firm with dubious ties to the health insurance industry . . . and HHS Sebelius.
 HHS has contracted with a subsidiary of a private health care company to help build and police the very exchanges in which that company will be competing for business. The person who ran the government entity that awarded that contract has since accepted a position with a different subsidiary of that same company. An insurance industry insider (speaking on the condition of anonymity) says that HHS, in an attempt to hide this unseemly contract from public view until after the election, encouraged the company to hide the transaction from the Securities and Exchange Commission.
According to my source (the basis for most of this account), in January, HHS awarded Quality Software Services, Inc. (QSSI) what the Hill describes as “a large contract to build a federal data services hub to help run the complex federal health insurance exchange.” At that time, the director of Obamacare’s newly established Center for Consumer Information and Insurance Oversight (CCIIO) — which the Hilldescribes as “the office tasked with crafting rules for the national exchange” — was Steve Larsen. Larsen had been the insurance commissioner for Maryland when Obama’s HHS secretary, Kathleen Sebelius, was the insurance commissioner for Kansas, and the two are reportedly close.
The Weekly Standard 

Of course Jerry Seinfeld might say "Not that there is anything wrong with that" . . .

But you gotta admit, it sure has a distinct odor of fish.

OK, I have already admitted most of this is WAY over my head, so I ran this by a good friend who really DOES know how to spell I.T.

Her take . . .

A nationally recognized IT infrastructure Project Manager was surprised to even learn about this program.  

This is a fairly small community, and many of them are connected on forums such as LinkedIn. This was not only never on her radar, but no one else with whom she was connected mentioned it, either. 

Now, it seems, we know why. 

The problem is that there are qualified Americans who can do this job, and (by the way) pay income taxes here for doing it. But one supposes that we've got more than enough jobs here right now, no need to be greedy.


Terrorism Insurance?

We've all seen the horrific pictures of the Forum restaurant and the Lenox hotel, as well as the shattered glass from other businesses along the busy thoroughfare that was the site of the attack. Aside from the incredible human toll, though, there's a business one, too:

"Companies could lose insurance payouts for property, lost income and other damage if the bombings are officially declared an act of terrorism by key U.S. officials" [emphasis added]

That last bit is important, and we'll get to it in a moment. First, though, it's important to know that acts of terror are typically excluded from commercial (business) insurance policies, but is also generally available as a rider (for an additional premium). The business owner decides which coverages are important, and which ones are worth an extra premium, knowing that the added cost affects his bottom line now, while a potential exposure may or may not affect it later.

Choice about coverages is nice, isn't it? It's times like this that I envy my P&C colleagues.

In the event, claims arising from the attacks may or may not be covered, depending on whether or not the owners purchased that terrorism rider. If they didn't, the claims may still be paid if DHS (or equivalent) declines to officially categorize the incident as terror-related. We may never know, but businesses still shuttered a year from now might be a clue.

By the way, I also wondered about life insurance claims in this instance. Back in the day, there were often exclusions for acts of war and the like, and it occurred to me that terror might be a problem for life insurance policy holders, as well. I checked with our primary carrier, and was told

"Some Accidental Death riders include a war exclusion, which would not pay the ADB In the event of “war, declared or undeclared, or any act of war”. Some very old life policies may have a similar exclusion, but typically this is not included as part of a [modern polcies]. So, generally, the answer is that these types of claims would be paid."
Good to know.

[Hat Tip: FoIB Holly R]

Health Wonk Review: Money Tree edition

As maples and oaks begin to blossom, we turn our attention to another kind of tree, the much vaunted 'Pachira aquatica.' Well, knot really - ours is metaphoric in nature [ed: ISWYDT]. As I leafed through the submissions, it was easy to see where this was headed. Going out on a limb didn't appeal to me, so I decided to let the posts just naturally fall. Into place.

I do realize that some of these posts will be more poplar than others, but please give each one a fair shake. Thank you!

■ First up, Louise Norris takes a look at health insurance costs versus subsidies under the ACA. She notes that, for some folks, paying the penalty (versus premiums) makes good sense. On the other hand, she also points out that some (such as well-off seniors) may find the premiums a better deal.

■ Hospital blogger Brad Flansbaum is a fan (as are we) of transparency in health care. In his post, Brad explores how much financial info really is available to folks interested in knowing, for example, just how many dollars go where. Starting with a simple document (IRS Form 990) he drills right down to the truth.

■ The Sequester has been much in the news lately, from air traffic controllers to White House tours. HWR's co-founder Joe Paduda takes a look at its impact on health care; specifically, how it impacts Medicare (reimbursement cuts), genetic screenings ($365 million up in smoke) and a tidy list of others.

■ I've said this before, but it bears repeating: if you're not reading (my favorite health care economist) Jason Shafrin regularly, you're missing out on important info. This week, for example, Jason digs deep into Medicare Part D, and finds some interesting trends. For example, who knew that the low cost prescription plans were so popular? Well, you will, and you'll know why once you click on over.

■ Health Business Blogger David Williams reports on The Bay State's next big effort: to try to rein in health care costs. As MassCare served as a primary influence for the ACA, I think we're all interested in any lessons we can learn from their efforts.

■ Over at Health Care Renewal, Roy Poses has some sharp words for providers that take advantage of lower-skilled workers to pad exec's paychecks, and especially when the folks involved run an ostensibly charitable institution.

■ I really like this post from Peggy Salvatore: she manages to bring a very human perspective to a typically dry and impersonal subject. She takes a look at health insurance "back in the day" and contrasts it to what it's become (and becoming). She even manages to make MLR understandable; and if you don't know what MLR is, then all the more reason to check out her post).

■ Health Access blogger Anthony Wright takes a look at the President's proposed budget, noting that it includes full funding for the ACA and most of Medicaid. On the other hand, Medicare doesn't fare so well, and Anthony explores the President's priorities. Big dollars indeed.

John Goodman has a fascinating piece on a significant care coordination effort that brings together providers, patients and payers in a more cost- and treatment-effective way. He then explains how this concept can apply to a much bigger population (like, the US).

■ Guest blogging at Health Affairs, Paul Ellwood (considered the "father of managed health care") proposes a unique "indexing" system for health care that essentially converts Medicare from a fee-for-service to a capitated model in order to rein in runaway health care costs.

■ Of course, it wouldn't be a Heath Wonk Review without some blatant politics, but this one might surprise folks that know me as a "whinger:" The Stupid Party lives up to its name trying to throw more dollars down the PCIP drain, and is taken mightily to task for its efforts.

Joe Paduda hosts the next edition at Managed Care Matters on May 10th. I'm certainly rooting for him.