The ObamaTax hits just keep on coming

As we noted earlier, "[m]illions of smokers could be priced out of health insurance because of tobacco penalties in [The ObamaTax]."

Typically, insurers ding smokers (well, tobacco users, really) 30% or more. Under the ObamaTax, this is likely to rise to 50% over non-smoker rates.

That is, they were supposed to.

But just like the (Evil) Employer Mandate, this integral part of the ObamaTax is is coming up short:

"The Obama administration ... has quietly notified insurers that a computer system glitch will limit penalties that the law says the companies may charge smokers."

Actually, given that Ms Shecantbeserious (et al) can't confirm employer group eligibility, and will rely on the "honor system" for subsidies, how many folks would admit to tobacco use anyway? And since plans are guaranteed issue, who cares how accurately an application is completed?

After all, who's to know?

Of COURSE your sensitive, PRIVATE health info is safe....

And speaking of the soon-to-be-online (maybe) Data Hub, isn't it nice to know that all your info is totally secure?

Totally:

"The IRS Mistakenly Exposed Thousands of Social Security Numbers

The incident involves the unwitting exposure of "tens of thousands" of Social Security numbers"

Doesn't that just make you feel so secure?

We Are the Baby Daddy

The upcoming generation of "children" have learned to expect everything and be responsible for nothing. Kind of sounds like our president, doesn't it?  

Helicopter mom's, trophy's for attendance and participation, sports that don't keep score so no one feels left out have contributed to this mess.

Even adults get in on the game. 

You can stay on mommy and daddy's health insurance until your are 26. If you buy a home you can't afford just blame the bank and someone will bail you out.

Or maybe you can afford the home but are now upside down in your mortgage.

No problem.

Now we find out there is a way for two grad students living off grants and stipends have managed to have a baby and get free health insurance for their newborn. Ari Friedman and wife Tara Mendola are living large thanks to hard working taxpayers.

Both of us are graduate students living in Philadelphia, and our universities provide us with health insurance as part of our stipends. But adding a dependent to our coverage is prohibitively expensive—60 percent greater than even unsubsidized CHIP. So we applied for CHIP, grateful that it was one of the few entitlement programs still available to students.

Health Affairs

Sounds like all that education failed to impart a bit of common sense. Why should they let a little thing like "How will we pay for this?" interfere with their sexual activities.

Must be followers of Sandra Fluke.

In late May, more than a month after our son was born, we received a letter indicating that Erik was not eligible for Medicaid, as anticipated. But the rejection letter made no mention of passing the application along to CHIP. After dozens of phone calls, we learned that our documentation had been lost in the Medicaid system for a second time and had not reached Independence Blue Cross. We were told to fax the documentation to Medicaid for a third time and request reconsideration—effectively resetting the clock and beginning the entire process anew. We never learned why the application hadn’t been passed on originally, or why the only way to correct the problem was to start again.

By this point Erik was forty-four days old. Our own insurance provided partial coverage for only his first thirty days. Unwilling to go without some form of insurance, we bought catastrophic coverage for Erik for $90 per month with a $2,500 deductible and a $5,000 out-of-pocket maximum. Our expenses began to pile up: $600 from the hospital for the delivery, $500 in well-baby visits and vaccinations, and $400 for a minor surgical procedure, all of which we paid out of pocket. These were all relatively routine expenses for a healthy, full-term baby; had Erik been premature or sick in any way, the cost would have been much higher. We were lucky. Angry, discouraged, and scared, but lucky.

How much do you want to bet these folks will be guests of the president at one of his Obamacare sales pitch events?

Health Care Good News, and Bad....

■ Japanese scientists have begun growing a liver:

"A group in Yokohama reported it has grown a primitive liver in a petri dish using a person's skin cells"

It's not a complete liver, but it's a big step forward in organ replacement. What will be very interesting is the race between the organic "growers" and the 3D printer folks.

■ Sadly, not all of these efforts work out:

"A toddler who in April became the youngest person ever to receive a bioengineered organ has died ...  implanted a bioengineered windpipe made from plastic fibers to which the girl’s own cells, taken from her bone marrow, were added"

There have been only a handful of these procedures done at all, and little Hannah Warren (who would have turned 3 next month) was the first here in the States.

[Hat Tip: FoIB Holly R]

Eat Your Vegetables and Buy Health Insurance

Moms are great at reminding us of what we need to do.   

• Eat your vegetables
• Say your prayers
• Don't run with scissors
• You could put your eye out
• You will go blind if you keep doing that
• Buy health insurance

OK, that last one is the 2014 version.

Even though Obamacare is the law of the land, and supposedly the American public wanted free health care, the administration is still trying to peddle their plan and convince folks this is a good idea.

They put up Web ads on Facebook and Allrecipes.com alongside slogans such as “Moms know best: ‘Get yourself health insurance.’ ” They have enlisted the help of parent-activist groups such as Moms Rising, which has already begun mobilizing its vast network of more than 1 million members and 3 million e-mail subscribers on behalf of the health-care law.

They are collaborating with Elle and Cosmopolitan magazines, organizing mom-oriented wine-and-cheese parties and preparing commercials that will run during shows popular with mothers, such as “Good Morning America.” 

Washington Post

Sounds like a good use of our tax dollars.

Facebook needs the ad revenue.

Lack of Employer Reporting bogus excuse

The inability to get employer reporting up and running is the excuse De Jour for waiving penalities and not substantiating income when it comes to subsidies. It is also BS and a great example of poorly written bill by people with no clue what they are doing. ACA was passed in 2010. Prior to that;

As an employer I report quarterly to my State everyone I employee and how much I pay them for unemployment benefit purposes. When someone files a claim I promptly get notice, or multiple, requesting that I verify this information.

As an employer SS and Medicare taxes are paid monthly or quarterly for all employees.

When it comes to verifying income the States and Federal government are already sitting on the vast majority of this info. There is no need to create any employer reporting or new process to accomplish this. They have had this info for decades and well before the bill was written or passed. If the government can't pass this data between buildings with a 3 year advance notice then trying to collect it a second time from employers is going to really be a disaster.

In regards to other coverage, as a payor we are already required to report our population of insured over 55 to CMS. I rather we report everyone as it is easier than parsing member roles and hoping you don't miss someone. Creating an extract to send everyone is much easier than an extract to send only certain people CMS wants some of whom must be manually identified.

So here now is the federal government perplexed about how they are going to get data on those privately insured, as they continue to tell us to not send everyone privately insured under the current reporting mechanism. To remove the filters that limit what is sent now is a very easy process. To send the file more frequently is an easy process.

To create an entirely new process with new data set and reporting requirements....not so easy.

You can't help but ask, did they write this bill trying to fail or are they really this inept?

ObamaTax: Not Ready for Prime Time

Fresh on the heels of the ObamaTax (Evil) Employer Mandate Reprieve comes this news:

"The Obama administration announced Friday that it would significantly scale back the health law’s requirements that new insurance marketplaces verify consumers’ income and health insurance status."

Hunh?!

The plan is that, for the 16 states (plus DC) that have opted to run their own Exchanges (as opposed to the other 42 who've tasked Ms Shecantbeserious and her minions with that job), the gummint will rely on its citizens' sacred honor as to whether or not they're eligible for their employer's group plan, and thus (subject to income requirements) eligible for subsidies.

Which is, in the words of St Homer of Simpson, a great big "D'oh!"

As co-blogger Bob pointed out, when Ms Shecatbeserious relaxed the employer reporting regs, she made it impossible for the folks in capital City to cross-check this information in the first place. And I'm sure that folks will be just as honest regarding their income eligibility.

Turns out that the ObamaTax is quite the fiscal fiasco.

Gee, who'da thunk it?

And Anthem joins in...

As we noted the other day, some carriers are looking for creative ways to help their clients forestall at least some of the train-wreck:

"If we would like, UHC would change our renewal date to December 1 ... The primary benefit in taking this offer would be to delay the impact of the major rate increases due after January 1 ... A secondary benefit accrues to us due to the nature of our plan: we currently have an HSA-compliant plan"

Many (most?) high deductible health plans (eg Health Savings Accounts) will have to be re-negotiated next year since they won't be ObamaTax-compliant. By putting off the renewal an extra few months, employers buy time to figure out what to do about that.

In the meantime, Anthem has now joined United Healthcare in offering renewal date changes to its existing small group clientele (via email):

"Clients on our non-grandfathered Small Group (2-50) plans ... will be offered a December 2013 off-cycle policy effective date. If they accept the off-cycle policy effective date change offer, they will keep their current plan until November 30, 2014"

They point out several advantages:

• Ease into the new market and delay potentially higher rate increases
• Have more time to work with you to decide what coverage best meets their needs
• Keep their current plan through November 30, 2014
• Lock in a new premium through November 30, 2014

One thing they do note is the very real possibility that this means an extra 2013 rate hike (something our UHC rep assured us would not be the case for their clients). This could just be standard CYA verbiage, but who knows.

One thing Anthem's doing which I haven't seen (yet) from UHC is that they're sending out notices to its eligible groups, and that the "offer letter will illustrate their current rate, their off-cycle policy rate and their estimated 2014 ACA compliant plan rate."

So it's not a complete shot in the dark for small employers.

Cavalcade of Risk #187: Call for submissions

Bob Wilson hosts next week's Cav. Entries are due by Monday (the 8th).

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.

What should they have done?

With the latest delay in implementing ACA seeing the employer mandate pushed back a year we should start asking if there might not be a better way to accomplish the goals of ACA. As commenter Jardinero1 pointed out;

http://insureblog.blogspot.com/2013/07/why-obamacare-delay-because-hhs-and-irs

this is not the first failure of ObamaCare nor is it likely to be the last. Some failures, such as LTC insurance, were so obvious and colossal, you have to wonder if they even attempted for them to be viable.

The tough part of the question is even trying to figure out the purpose of ObamaCare in the first place. What did they really intend to accomplish with this bill?

Lower the uninsured rate - Young healthy people make up a disproportionate percentage of the uninsured. They can already buy decent polices for well under $100 per month. I don't think anyone can argue honestly that doubling or tripling the cost of a policy would get them to buy. If they wont pay $70 per month they aren't going to pay $200, even if you do tax them $95 per year.

The number of people that wanted insurance and either couldn't qualify or truly could not afford it was only four to six million. If the goal was to cover those four to six million completely overhauling systems that cover 200 million people makes no sense. What was spent in regulation cost, compliance, advertising, etc etc would have insured those  four to six million. Tweaks to Medicaid and Medicare would have accomplished that without disturbing 200 million other people.

If you want to force people to make the smart financial decision either require they carry insurance or refuse to treat those that don't. Either way keeping insurance as affordable as possible lowers the uninsured rate, using insurance as wealth redistribution only encourages people to exit the system.

Lower the cost of healthcare - An obvious non solution is a huge insurance bill. Insurance is the cost of healthcare plus administrative and risk fees. You might be able to squeeze 5% out of that additional cost but if your goal was to only reduce our healthcare cost 5% again this bill was overkill. Not only does ObamaCare not do anything to lower the cost of healthcare it has numerous provisions that have and will increase the cost of healthcare. Compliance cost being just one of them.

If you want to lower the cost of healthcare that can be done in 6 months and generate revenue for the government. Rent the Medicare network. There is roughly 100 million employees with group insurance most of whom pay a PEPM access fee of $5 to $20. Rent Medicare's network and the federal government is now making $500 million to $2 billion per month. This would also immediately accomplish most of the EDI goals of HIPAA and ACA as well. 

Redistribute wealth - If the intent was to force the haves to pay for the have notes a couple simple taxes could have accomplished that. In fact the bill contains a number of taxes to do just that, but it doesn't explain all the other changes and intrusions.

Taxes already fund Medicaid and thus redistribute wealth. Open Medicaid up to those that have catastrophic healthcare expenses and make them  pooled cost to the nation not a small group of unlucky co-workers or fellow policy holders. The poor quality of Medicaid should be enough to motivate people off of it when better options are available.

It's no wonder so many pieces of this reform are falling apart, they never made sense in the first. It is a bill of multiple actions but no solutions.

This Just In . . . .

Question of the day

In response to my post last night, co-blogger Bob posed this doozy:

"Employers are exempt from reporting and will not be subject to fines.

But . . .

The individual mandate is still in play.

Subsidies require proof that you do not have an employer plan that complies with the guidelines, and if you do have a plan, is it affordable?

But if employers are not reporting this information, how will HHS know if you qualify for a subsidy?"

Indeed.

An offer you can't refuse?

Our group health insurance plan is with UHC; we currently have a March 1 renewal date. Recently, UHC made small group clients an interesting offer:

If we would like, UHC would change our renewal date to December 1.

While that seems rather innocuous, there are a number of implications. First, why would we want to do this? Second, what affect would this change have on our current 2013 rates (since we've already taken the renewal "hit")?

The primary benefit in taking this offer would be to delay the impact of the major rate increases due after January 1 (due to  Community Rating and the like). In effect, we'd be locking in our rates from March 1, 2013 to December 1, 2014. Pretty decent.

A secondary benefit accrues to us due to the nature of our plan: we currently have an HSA-compliant plan with a $3,500 individual deductible. As of next year, these are 'verboten,' and we'll have to either lower that below the $2,000 threshold or find a different configuration altogether [ed: remember when the President promised that "if you like your plan, you can keep your plan?" Good times, good times].

By electing to change our effective date, we also delay making that decision until late next year.

Other carriers have followed suit, of course; via email, Medical Mutual of Ohio offered this:

Q. Can non-grandfathered small group (1-49) or individual customers get an early renewal on December 1, 2013?

A. Yes. We recognize customers have valid business reasons for requesting changes to their coverage period. Just as we have in the past, we will continue to accommodate these requests.

That offer, by the way, doesn't apply to 50+ groups.

Oh, and it's worth noting that it doesn't appear that these renewal date changes will impact calendar year deductibles and co-insurance accumulations.

Why Obamacare Delay? Because HHS and IRS Fumbled Rollout

Oh, but that's not exactly what the headline says in this Forbes article:

Why Obamacare Delay? Because Half Of EmployersAren't Ready for Rollout

Half of employers not prepared to administer the employer mandate starting in January? Yeah, probably true.  But - the headline says the delay is because of employer unreadiness.  I think the headline is misleading; it promotes a superficial reason and ignores meaningful underlying reasons for why so many employers are not ready.

What meaningful, underlying reasons?

For starters, the reason many employers are not prepared is because of late-issued HHS and IRS regulations.  Over the past 3 years the agencies often missed their target dates for release of proposed regs, while employers waited.  Add to that the sheer length and typical bureaucratic opacity of the proposed regs when they did emerge, which required lengthy analysis by employers to determine just what the proposed regs asked them to do.

Another factor affecting employer readiness has been legitimate debate over the proposed regs when they were eventually released. As employers began to realize the profound impact on their businesses, they have appealed, demanded hearings, and filed suits to get the proposed regs withdrawn or substantially modified. The obvious example is the ongoing outcry against the requirement to cover contraception (which is nowhere found in ACA) - and there are other examples as well.

Keep in mind this is not the first time HHS was forced to interrupt the planned progress of ACA implementation. Just one example: new enrollment in the individual high-risk pools was stopped because HHS ran out of money (even though only a fraction of the expected population actually enrolled).

On balance therefore it seems to me the principal reasons HHS and IRS are forced to defer the employer mandate comes right back to their own front doors.  Employers were not ready largely because HHS and IRS did not perform their responsibilities in a timely manner.

As to the political convenience of avoiding controversy for the 2014 elections – if ACA implementation were going smoothly and on plan, that would be a political plus, not a minus. So I don’t see politics as fundamentally driving the decision to defer the employer mandate.   Politics plays its part, but I think  the underlying reason is the inability of HHS and IRS to issue timely regs, and otherwise to implement ACA as required by the legislation in the first place.

In my book, this latest decision to defer a key part of Obamacare is just more evidence of an ongoing bureaucratic mismanagement debacle.  And little anyone has seen can give confidence that HHS and IRS will be able to manage Obamacare any better, once it is, finally, implemented. Whenever that happens.

What the...? (Breaking)

So The ObamaTax Man has unilaterally decided to put the metaphoric brakes, at least temporarily, on the (Evil) Employer mandate:

"Businesses won’t be penalized next year if they fail to provide workers health insurance after the Obama administration decided to delay a key requirement under its signature 2010 health-care law."

So a couple of questions off the top of my head:

This was legislation he wanted passed, in fact rammed through, and which he signed, and he's only just now figuring out that it's a stink bomb?

Not the brightest light in the harbor, is he?

More to the point, it is the law, how can he just unilaterally suspend it?

Sheesh.

UPDATE: Mike has more:

"Keep in mind this is not the first time HHS was forced to interrupt the planned progress of ACA implementation. Just one example: new enrollment in the individual high-risk pools was stopped because HHS ran out of money (even though only a fraction of the expected population actually enrolled)"

Click through to read the whole thing.

What Color Was Your Volvo?

The Obamacare health insurance exchange is expected to be operational on 10/1/2013.

The key word here is expected.  

But to get past the first steps you may think you are being grilled by Sgt. Joe Friday.

The potential for problems will begin as soon as would-be buyers log onto their state exchange. They'll enter their name, birth date, address and other identifying information. Then comes the first IT handoff: Is this person who she says she is?

 To check that, credit bureau Experian will check the answers against its voluminous external databases, which include information from utility companies and banks on people's spending and other history, and generate questions. The customer will be asked which of several addresses he previously lived at, for example, whether his car has one of several proffered license plate numbers, and what color his old Volvo was.

It's similar to the system that verifies identity for accessing personal Social Security information. If someone gets a question wrong, he will be referred to Experian's help desk, and if that fails may be asked to submit documentation to prove he is who he claims to be.

CSMonitor

I have trouble remembering passwords for online accounts. And those challenge questions can throw you for a loop.

Give the name of the third pet you owned. (Does a goldfish count as a pet?).

Provide the name of your youngest third cousin on your mother's side.

Yeah, this can be a lot of fun for those wanting a subsidy.

Fortunately you are not REQUIRED to buy on the exchange. There will be a lot more offerings and richer plans OFF exchange.

The answers must be returned in real time, before the would-be buyer loses patience and logs off. If the reported income doesn't match the IRS's records, the applicant may have to submit pay stubs.

These federal computer systems have never been connected before, so it's anyone's guess how well they'll communicate.

Or if they will communicate . . .

The federal hub has to verify even more arcane data, such as whether the insurance offered to a buyer through his job is unaffordable, in which case he may qualify for federal subsidies, and whether the buyer is in prison, in which case she is exempt from the mandate to purchase insurance.

If someone's income qualifies him for Medicaid, or his children for the Children's Health Insurance Program (CHIP), software has to divert him from the ACA exchange and into those systems. Many of the computers handling Medicaid and CHIP enrollment are, as IT people diplomatically put it, "legacy systems," meaning old, even decades old.

What's the problem? Doesn't the NSA have all this?

I think Sen. Max Baucus' assessment was generous. Train wreck doesn't begin to describe what lies aheas.

In the news....

■ Is one ever too young to buy life or disability insurance? There are certainly some compelling reasons to do so: depending on the policy type, one can lock in much lower rates for a long period of time. And of course, it guarantees that you have at least some protection in place should your health go south. The WSJ has more.

■ Back in the day, President Obama promised that rates would decrease by 3000%. As we now know, that was, um....optimistic to say the least. Blue Grass blogger David Adams reports that "the Kentucky Department of Insurance has leaked data showing health insurance premiums under ObamaCare will increase by an average of eighty percent at the start of 2014"

■ And speaking of the WSJ, they also report something we've noted for a while now:

"The long-term-insurance industry now is shrinking, premiums are soaring and there is no fix in sight."

There are, of course, a number of contributing factors at work here, most notably retention and claims.

Hunh?

Here's the thing: Long Term Care insurance (LTCi) is most similar to disability insurance in terms of complexity and benefits. So it stands to reason that many (most?) carriers who've been in the market for a while based at least some of their rate structure on assumptions carried over from the DI side. One of those is "retention;" that is, how many policies stay in force over the long haul. It appears that many more folks have kept their LTCi plans than the carriers had anticipated.

Which sets up the next problem: claims. If more folks are holding onto their policies, then more folks than expected are experiencing claims. And the cost of care isn't abating, either, which tends to create a vicious cycle.

■ And finally, a while back we brought you the news that 3d printers were helping to fashion new organs. Apparently, that was only the beginning:

"Damaged bones could be fixed with a new technique that involves 3D printing ... if a child had a jawbone defect, you could take an image of the defect, feed it into a computer and print a replacement to precisely fill the defect using the patient's own cells"

Very cool.

[Thanks to FoIB Holly R and Gail S for their news tips]

What if your carrier exits the market and there is no exchange to fall into?

United Health just announced they are exiting the CA individual market.

http://www.latimes.com/business/la-fi-unitedhealth-insure-calif-20130702,0,4370321.story

"The nation's largest health insurer, UnitedHealth Group Inc., is leaving California's individual health insurance market, the second major company to exit in advance of major changes under the Affordable Care Act.

UnitedHealth said it had notified state regulators that it would leave the state's individual market at year-end and force about 8,000 customers to find new coverage. Last month, Aetna Inc., the nation's third-largest health insurer, made a similar move affecting about 50,000 existing policyholders."

That is 58,000 individuals/families that will not have insurance January 1st, 2014. Most will have no choice but to sign up in the Exchange. I have heard a number of people speculate that the government will push back  the start of the Exchanges as they will not have them ready in time. If they do, what happens to all these people whose carrier has exited the market?

This is the problem with comprehensive solutions like ACA: you miss on one part and you crash (or at least damage) the entire system. A more logical bill would have created the Exchanges without all the impact on the existing market until they were up and running smoothly. That way, if they missed, the impact would have been minimal.

This announcement also doesn't bode well for competition and choice. It appears the regulation is so onerous that even with 8000 or 50000 members it is not worth competing in the market. If established players don't want to join in, I can't imagine many upstarts wanting to give it a try.

Obamacare Gold Mine

Obamacare subsidies are a gold mine for those who know how to game the system and you can bet there are plenty of folks who are experts.   

Many "special ed" children live in foster homes. The foster parents receive monthly stipends for each child in addition to SSI. Often the parents qualify for other forms of government assistance including Medicaid, SCHIP and EIC.

Each program has guidelines and forms that must be completed. Many times the parents only sign the forms. Someone else, someone they paid to help in filling in the blanks, entered the answers. These "assistants" will charge $400 or more and guarantee you will get the maximum allowed for your situation.

Often these assistants work in the school or a welfare agency. In addition to their salary they have a sideline business completing forms. Some will make $30,000 - $40,000 or more in their sideline business.

All cash.

They complete the forms but never sign or file them. Once the form is done you pay for the completed work then it is your responsibility to file the form.

If there is ever an issue it is your responsibility to deal with the blow back.

Obamacare subsidies are just another government gold mine.

If you doubt this, consider how the federal government paid out an estimated $500 million in fraudulent Katrina claims to roughly 134,000 people who were ineligible.

Many did not own homes or live anywhere near the affected area.

This is not an isolated event.

A recent investigation by the Inspector General revealed the IRS paid over $46 million in tax refunds to 24,000 illegal aliens living at the same address.

The IRS sent 11,284 refunds worth a combined $2,164,976 to unauthorized alien workers at a second Atlanta address; 3,608 worth $2,691,448 to a third; and 2,386 worth $1,232,943 to a fourth.

How incompetent do you need to be to blow this much money in a short amount of time?

Any time there is a new government give away there are folks ready, willing and able to take advantage of the ineptitude of the federal government pig trough.

Obamacare and the subsidies are no different.

Big Hat, No Cattle

The folks in Texas have a saying.                      

Big hat, no cattle.

A phrase used to describe someone  or some thing that makes a lot of noise (brags) but has nothing of substance.

The U.S. Chamber of Commerce published a report on The Path Forward for Health Care Reform. Some of the tidbits.

The Mission:

To achieve greater value in health care, as measured by more affordable coverage options and greater access to higher-quality, prevention-oriented care, leading to better population health and sustainable U.S. health care costs. By prioritizing efforts to improve the employer-sponsored health system which covers millions of Americans, we will use these solutions to drive system-wide changes.

As Emily Litella would say, "Isn't that special?".

Sounds great but offers nothing you can, uh, hang your hat on.

The recommended changes released by the Chamber’s Health Care Solutions Council include:

-Facilitating and rewarding better coordination among all providers – nurses, hospitals, specialists, and primary care doctors;-Advancing efforts to define quality simply and clearly so that providers understand the metrics by which they will be measured;-Removing barriers to easily understandable and comparable information on the cost and quality of health care services;-Encouraging consumers to use this information to make health care decisions based on careful consideration of the expense and the likely outcome;-Protecting the ability to buy (or offer) affordable health care coverage that promotes higher-value care in the near term; and-Applying the lessons of these private sector reforms to improve Medicare and Medicaid by providing better care to the rapidly growing beneficiary populations served by these programs entitlement programs; and supporting innovations in the employer-sponsored system.

You need a secret decoder ring to figure that one out. 

Is There an App For That?

Obamacare needs people under 30, especially the healthy ones, to buy health insurance in droves if this master plan stands a chance of working. Without the under 30 crowd the rate structure will start to collapse.  

So why did Congress come up with a plan that increased rates on the under 30 crowd significantly more than those that are 50 and up?

Still waiting on a good answer to that one, along with a lot of other questions.

Less than 64% of employees under 30 working for large companies sign up for health insurance when it is offered by their employer, compared with at least 76% of all employees over 30, according to a new report by benefits administrator ADP. And Americans ages 18 to 34 are the least likely of any age group to be insured:

MarketWatch

I see no reason why Obamacare rates and benefits is going to change any of this, and the nominal penalties (greater of 1% of income or $95) certainly won't strike fear in the hearts of these young "adults".

As much as 70% of a company’s workforce doesn’t use any health coverage at all in a year, Ryan says, but insurance plans still need their contributions to pay for those who use more.

Not surprising.

Stats similar to this have been around for a long time. Which of course leads to the argument, "Why should I pay for something I never use?".

Anyone who has been around a while can answer that, but trying to tell the young, invincible crowd they need to buy health insurance is an uphill battle.

Not my "yob", man.

Et tu, Marian?

Last week, Bob asked a very crucial question: why, if it's such a great idea (and a requirement), "is the government still trying to sell the public on the greatness of Obamacare?"

It's a great question, especially in light of this:

"Up to 17,000 U.S. libraries will be part of the effort to spread the word about the [ObamaTax] ... The library association ... appears to be all in"

What, exactly, qualifies librarians as experts on health insurance? And why are my (municipal) tax dollars going to promoting a national law train wreck? Most important, of course, is why is this even necessary?

We're from the Government, and we're...

Well, you know. We're about three months out now from the Exchange roll-outs (maybe), and of course Top Men are making sure that things are proceeding apace.

Or not:

"Guess who has no idea who is going to be running the exchanges in those states?  Or how much a basic policy is going to cost?  Or who is going to be paying the difference between the amount a “low-income” person will have to pay and the cost of the policy? "

Definitely read the whole thing (but first, make sure to take your BP meds).

Hunger Games and the MVNHS©

Sometimes, the headline really is the story:

Nearly 1,200 people have starved to death in NHS hospitals because 'nurses are too busy to feed patients'

On the one hand, this apparently took place over four years, so that (presumably) "only" about 300 Brits per year were killed off this way. Still, death by starvation is no treat:

"Pain in the stomach often quickly develops, then can turn into digestive and waste-related syndromes such as severe and painful constipation followed by uncontrollable diarrhea. Early symptoms of starvation include faintness, weakness, and dizziness. Thirst may also rapidly increase."

Oh, and apparently starvation isn't the only problem facing patients victims of the Much Vaunted National Health Service©:

"[F]or every patient who dies from malnutrition, four more have dehydration mentioned on their death certificate."

No big deal, really: just think of it as a very dry Liverpool.

And speaking of the MVNHS© and pools, the good news for "aspiring glamour model" Josie Cunningham is that she'll be a knockout in a bikini. That's because the rocket plastic surgeons at the Much Vaunted National Health Service© gave the go-ahead for her "upgrade" to 36DD (and no, that's not her seat number).

The bad news is that these same folks took a pass on "upgrading" 2-year old aspiring walker Oliver Dockerty. Apparently the boobs in charge at the MVNHS© found Ms Cunningham's case more, ahem, compelling. After all, why would any two-year-old want to walk?

Obamacare Stress Relief

The Obamacare exchange opens October 1, 2013 but will it be ready to roll?

Probably not . . .

That process is complex enough by itself. How much coverage do you want? What deductible? Are family members on the plan? Do you need an asthma program? Do you want to keep your current doctor? What about dental?

Kaiser Health News

That's getting ahead of yourself.

Before selecting a plan, if you go through the exchange you need to know if you qualify for a subsidy. That is a 45 minute process.

Like other filtering software, Connecture’s program is a multi-step search engine, screening out inappropriate options (based on your input) to deliver a manageable menu. After getting past the basics (Stripped-down “bronze” plan or high-benefit “platinum”? High deductible or low?), the program asks if it’s important to keep your current doctor.

“Based on our research, the choice of doctor was probably the No. 1 and No. 2 [features] of what people are looking for in a plan,”

Good luck on that.

It may be almost impossible to find "your" doc on the exchange plans.

Need to see if your drugs are on the formulary?

Fat chance

To try to reduce sticker shock, Connecture shows your net premium price — after the tax credits are applied — early in the shopping process. But perhaps the most important feature is the one estimating the total cost of coverage, including deductibles and co-pays, based on your reported health status. Without that information somebody with a chronic condition requiring lots of care could choose a plan based only on a low premium, not realizing the total expense could be substantially reduced by paying a larger premium up front.

How is this working for you so far?

Might need to chill out a bit.

Friday Morning Updates

Updates on a couple of yesterday's items:

■ Unlike Aetna and UHC, Anthem will not be sending out rebate checks to Buckeye State insureds. Via email:

"On June 1, 2013, Anthem filed the required MLR report with Health and Human Services for the 2012 calendar year and met the required loss ratio for all lines of business for 2012. This means no notices will be sent and no rebates will be issued."

Good for them!

■ Hobby Lobby, much like Beckwith Electric, gets a reprieve on implementing the birth control convenience item mandate (Hat Tip: Hot Air):

"The 10th Circuit Court of Appeals moved to reverse a lower court's decision to deny Hobby Lobby Stores Inc.'s quest for an injunction against part of the Affordable Care Act that requires it to cover the cost of emergency contraceptives for some of its employees."

It's not a done deal, though: the case now goes back to the lower court for another round.

Still, some good news heading into the weekend.

Stuck in Folsom Prison

RIP Johnny Cash. Yes, he did spend time in prison but fortunately for him he had a trade to fall back on once he got out.

Perhaps the same is true for today's felons.

Republican senators slammed the Patient Protection and Affordable Care Act’s navigator program Thursday arguing that the rule is so lenient that a convicted felon could qualify as a navigator and get access to consumers’ confidential health information.

“The standards proposed by your Department could result in a convicted felon receiving federal dollars and gaining access to confidential taxpayer information," the letter stated. "The same standards allow any individual who has registered with the exchange and completed two days of training to facilitate enrollment, as if the decision to purchase health insurance is similar to the decision of registering to vote." 

Life Health Pro

and time keep dragging on . . .

Obamacare Whether You Like it or Not

They're baaaack: ObamaWaiver Mania

In fairness, this first item isn't so much an ObamaWaiver as a court-ordered time-out:

"A Largo high-tech engineering firm doesn't have to offer emergency contraception under its medical plan while its case challenging part of the federal health care law is pending in court"

The company's owner is a "devout Southern Baptist" whose religious beliefs [ed: remember when those were protected under the First Amendment? Good times, good times], prohibit abortifacients. Timing is everything, which seems to be working in Mr Beckwith's favor: since his "insurance plan was up for renewal this month, Beckwith could have been required to start covering the contraceptives while the case was under review. U.S. District Judge Elizabeth Kovachevich granted Beckwith a reprieve, saying the company may be due religious protections under federal law."

Whew!

There's no denying, though, that this one is a full-bore ObamaWaiver:

"The Obama administration on Wednesday broadened an exemption for American Indians from the new health care law's [Evil Mandate] ...  tribal advocates are pleased that the administration added an exemption for Native Americans who are eligible for services through an Indian health care provider."

Um, guys? Be careful what you wish for. You might just get it.

MLR: More Loony Results

And the hits just keep on comin'. Last week, LifeHealthPro's Allison Bell reported that "insurers did a better job of meeting the new federal minimum medical loss ratio (MLR) targets in 2012 than in 2011, and they will end up paying fewer rebates to a smaller number of people."

Maybe so, maybe not:

■ FoIB Jeff M tips us that "North Carolina health insurance consumers will receive close to $10 million in [MLR] rebates"

But how will the other 57 states fare?

■ Via email, we learn that "[b]eginning in June and by August 1st, Aetna is scheduled to mail rebate notices and checks to policyholders and subscribers whose plans are due a rebate ... In this second year of MLR reporting, Aetna's rebates represent 0.2 percent of the premiums we collected"

That's down quite a bit from last year (the first for which MLR "rebates" were due), which the carrier interprets as indicating that they've met their pricing goal.

■ United Healthcare is also rolling out their 2013 MLR rebate initiative. Via email we learn that:

"In the second Medical Loss Ratio (MLR) Reporting Year, UnitedHealthcare’s results show that 83 Aggregation Sets in total (group and individual combined) qualified to receive premium rebates totaling $149,861,252 for 2012."

That's also down from last year; in fact this year's rebates are less than half of last year's.

 ■ Interestingly, both carriers indicate that the checks will be going to the group (employer) for distribution. Chalk that up as one more accounting and tax headache for businesses.

Guess who pays for that?

Punchline: RomneyCare vs The ObamaTax

From Josh Archambault at Forbes:

"A very interesting ACA development is taking place in Massachusetts today as the state that “inspired” Obamacare tries to reconcile its current law with the new federal law ... The amendment that was filed would force President Obama’s good friend Governor Deval Patrick (D), and his Administration, to seek a waiver from certain elements of Obamacare." [emphasis added]

Too. Funny.

Cavalcade of Rick #186 now on line....

Van Mayhall hosts this week's grand collection of risk-related posts, covering everything from the new Insurer Provider Fee to the FHA's stance on mortgage insurance cancellations.

And a friendly reminder to newbies and regulars alike that, while it's not mandatory to give a link back, it’s the way that carnivals work best. If your submitted post has been included in the Cav, please remember to post about it on your blog because it helps us all.

OH! Still looking for a host for the July 10th Cav - how 'bout it?

Because it's Better Than Drinking Alone

The folks who are responsible for policing Obamacare are already celebrating on our dime.

Poor oversight by the Internal Revenue Service allowed workers to use agency credit cards to buy wine for an expensive luncheon, dorky swag for managers' meetings and, for one employee, romance novels and diet pills, an agency watchdog said Tuesday.

Two IRS credit cards were used to buy online pornography, though the employees said the cards were stolen. One of the workers reported five agency credit cards lost or stolen

Breitbart

Billy Joel was right.

The Obamacare Reality Show

Just when you thought it was safe, it seems the folks who gave us Obamacare have moved beyond jokes on late night TV and is now moving towards reality entertainment.

The Obamacare question regarding subsidy eligibility seems innocuous enough.

The ACA requires Medicaid, CHIP and tax-subsidized exchange coverage to use Modified Adjusted Gross Income (MAGI) to determine eligibility for most individuals.

Statereforum

Until you scroll down a bit and view the comments.

MAGI Training Materials for States - Check this Out!Louisiana - ever a font of creativity - has created this really ingenious and funny email training materials called MAGI Monday directed to eligibility workers. Using a "real life" case study of the Kardashians, the missives walk workers through how changes in household, income, and custody might impact how the eligibility determination is implemented and whether and who is eligible for Medicaid. The state is using this tool to help get their line staff acclimated to new concepts and rules before the in-depth trainings get underway. Susan Wright in Louisiana has kindly shared these so other states can use them or be inspired to create their own serials. We will be posting these weekly so you can keep current with all the twists and turns in the MAGI saga. Enjoy!

Just another MAGI Monday . . .

Flopping and Obamacare

HHS is reaching out to the major sports leagues in hopes of partnering to promote the Patient Protection and Affordable Care Act. So far they have engaged with the NFL and the NBA.

For the NBA this partnership could have mixed outcomes. While it hits a significant part of their fan base, it is also a controversial law that could alienate the part of it's fan base who happen to be the drivers of the financial spend for tickets, concessions, and merchandise. For now.

More importantly it will impact their players. According to data listed on ESPN.com there are 534 players who received compensation during the 2012-2013 season. Of these, 492 earned more than $250,000. This is the magic number for paying the additional Medicare tax of 0.9% when filing as joint married. (I know some players are single but just bear with me)

Total salaries for all players over the threshold come to $2,021,287,266 which means that NBA players will be paying $17,086,835 in new Medicare taxes this year just on their salaries.

When PPACA flops will Joey Crawford be there to make the call? If so, what can the NBA fine HHS and President Obama for their efforts? If so, my guess is it won't come close to $17 million.