InsureBlog

Exposing Your Private Parts

noreply@blogger.com (Bob Vineyard) — Mon, 17 Jun 2013 14:35:00 +0000

The federal government under Obamacare will be exposing your private parts. Most of the consumer protection that was put in place under the Clinton administration now goes away under Obama.

A new rule issued late Friday requires state, federal and local agencies as well as health insurers to swap the protected personal health information of anybody seeking to join the new health care program that will be enforced by the Internal Revenue Service.

Personal health information, or PHI, is highly protected under federal law, but the latest ruling from the Department of Health and Human Services allows agencies to trade the information to verify that Obamacare applicants are getting the minimum amount of health insurance coverage they need from the health "exchanges."

Washington Examiner

And you thought the NSA was bad.

Aetna to exit California's individual insurance market

noreply@blogger.com (Mike Feehan) — Sun, 16 Jun 2013 12:03:00 +0000

Both the Wall Street Journal and Reuters reported Friday that Aetna will exit the California individual-insurance market at the end of 2013.

According to Aetna, this decision "will affect only 49,000 of its 1.5 million policyholders in the state."

Although Aetna declined to say why it is taking this action, it's likely that the reason is California's health exchange rules. According to Reuters the California Exchange rules apply to all health insurance products sold to individuals in the state, "whether or not they are offered through the exchange."

Thus any company that decides after analysis that it's not worth the cost for it to participate in the California Exchange, can only avoid that cost by exiting the market - as Aetna has decided to do.

Preview the Georgia Insurance Exchange

noreply@blogger.com (Bob Vineyard) — Sun, 16 Jun 2013 00:16:00 +0000

To study the likely costs of plans on the Georgia insurance exchange, the AJC selected one proposed plan from the gold, silver and bronze tiers offered by Blue Cross and Blue Shield of Georgia. (Seven companies applied to sell insurance on the Georgia insurance exchange, but these examples are limited to selected plans

on Blue Cross’ filing.) Note that insurers may offer more than one plan within each “metal tier” with co-payments and deductibles that will vary. Here is the cost-sharing information related to the selected plans:

Gold plan: $750 deductible, 0 percent coinsurance
Silver plan: $2,000 deductible, 20 percent coinsurance
Bronze plan: $6,300 deductible, 0 percent coinsurance

The prices, which are premiums per month, assume that the consumer lives in metro Atlanta and is a nonsmoker.

CONSUMER PROFILE: Husband is 32, wife is 30, 1-year-old daughter (2013 rates)

Gold: $1,024 (N/A)
Silver: $771 ($423)
Bronze:$580 ($345 )

Subsidy examples

Income: $20,000 (just above the poverty line). The family would be expected to pay $400 toward for a silver plan.A subsidy projected at about $8,500 would cover the rest.

Income: $60,000 (about 300 percent of poverty line). Family would be expected to pay $5,700 a year toward a silver plan and could get a subsidy of about $3,200 to cover the rest of the cost.

CONSUMER PROFILE: Husband is 47, wife is 42, kids are 25, 20 and 16 (2013 rates)

Gold: $1,790 (N/A)
Silver: $1,348 ($824)
Bronze: $1,014 ($668)

Income: $28,000 (at poverty line). The family would be expected to pay $560 toward a premium and could get a subsidy of about $15,000 a year to cover the rest of the cost.

Income: $84,000 (300 percent of poverty). Family would be expected to pay about $8,000 a year for a silver plan and could get a subsidy of about $7,600 to cover the rest.

Link to full article

Ain't insurance the greatest thing?

noreply@blogger.com (Mike Feehan) — Sat, 15 Jun 2013 21:21:00 +0000

Everyone cashes in. No one has to pay.

And what affordable health insurance plan, its hour come round at last,
Slouches towards Washington to be born?

"We have to pass this bill, so that you can . . . "

noreply@blogger.com (Mike Feehan) — Sat, 15 Jun 2013 13:34:00 +0000

Today’s Wall Street Journal contains this op-ed piece bySenator Orrin Hatch.

In it, he mentions that the Obamacare tax credits “are both advanceable and refundable”. In other words, IRS will pay them first and verify the claims for them later, a practice that could be called “pay and pursue.”

I did not know the tax credits are advanceable. Did you?

So it seems more than three years on after passage of Obamacare, the public is still finding out what is in it.

And we are continually appalled.

Will this process of Obamacare discovery never end?

Obamacare Misses in Mississippi

noreply@blogger.com (Bob Vineyard) — Fri, 14 Jun 2013 16:40:00 +0000

Obamacare. The promise of lower premiums, you can keep your plan and your doctor, and more competition which is better for consumers.

We are gaining on 2014 and so far no indication of those lower premiums.

Many are also finding they won't be able to keep their current plan OR doctor.

But what about increased competition which was supposed to lead to lower prices?

When the state of Mississippi begins offering subsidized health insurance under President Barack Obama's reform law this year, residents will have only one choice - Magnolia Health Plan - a small insurer little known in most of the country.

The Obama administration hoped to attract robust competition in creating the exchanges, and it is counting on millions of Americans without coverage to sign up for these plans in the program's first year.

But the nation's biggest insurers have decided against joining the exchanges on a large scale, professing uncertainty about the roll-out and how much the uninsured would participate. Most are sticking to states where they already sell insurance directly to individuals, leaving at least half a dozen states with only one or two health plans to choose from.

Thomas Reuters

A competition of one.

But Mississippi isn't alone.

A similar scenario is playing out in Alaska, Vermont, Rhode Island and Maine, where one small insurer - typically a regional insurer - will have an equal shot at the market against one larger player. These states, and others like Mississippi where competition has traditionally been slim, are a land grab opportunity for these small companies.

The Obama plan had envisioned competition keeping prices low and drawing the uninsured into the exchanges.

That's too bad.

Perhaps if the folks who designed this mess actually had any REAL WORLD EXPERIENCE things could have turned out differently.

Clue. Less.

Doctors Behaving Badly

noreply@blogger.com (Kelley Beloff) — Fri, 14 Jun 2013 14:05:00 +0000

As patients, we have all experienced doctors with a bad bed-side manner: gruff in their discussion with you about your issues, leaving you feeling frustrated and angry after the appointment. While we have been in a fee-for-service type of payment model, this kind of behavior has been tolerated from both patients and administrators, but as medicine moves to payments based on quality, then bad behavior will no longer be tolerated. This case from 2011 is used as an example in a recent Kaiser Health News article done in conjunction with the Washington Post:

“At a critical point in a complex abdominal operation, a surgeon was handed a device that didn't work because it had been loaded incorrectly by a surgical technician. Furious that she couldn't use it, the surgeon slammed it down, accidentally breaking the technician's finger. "I felt pushed beyond my limits," recalled the surgeon, who was suspended for two weeks and told to attend an anger management course for doctors.”

Administrators have often had to apologize for bad behavior in physicians - especially surgeons - to both staff and patients:

“For generations, bad behavior by doctors has been explained away as an inevitable product of stress or tacitly accepted by administrators reluctant to take action and risk alienating the medical staff, particularly if the offending doctors generate a lot of revenue.”

Physicians understood that they were in charge; they made the money and if they wanted to behave badly, then they could do so without fear of retribution.

In 2009, the Joint Commission (the body that accredits hospitals) released new guidelines for addressing disruptive and inappropriate behaviors by medical staff. The Commission recommends that hospitals develop a zero tolerance for intimidating and/or disruptive behaviors.

Medicine has changed, making such behavior not only unacceptable but reckless. Medicine is a team effort, mandated by government and a natural occurrence that comes with technology and specialization in the medical field. If a person has a chronic condition, it is not uncommon to have several physicians involved in the care and treatment of the patient. As more physicians become involved, then more staff, more facilities and more administrators are also involved. And, of course, more potential for personality conflicts.

Quality initiatives are also becoming more important, as hospitals and other care venues are now required to submit quality outcomes to the federal government not only for the purpose of monitoring care but also designating payments. When a physician mistreats a staff member, that staff member has a recourse through labor law which dictates that employees must work in an environment free from hostility or harassment, which could interfere with their job duties and thus patient outcomes.

Fortunately the days of administrators mollycoddling physicians and telling staff that had been verbally harassed “that is how (s)he is, ignore it and go back to work” are ending. Once payments are based on quality, these physicians will have to change or risk losing money.

Hey Young Invincible, Can You Afford $6000?

noreply@blogger.com (Patrick) — Thu, 13 Jun 2013 20:00:00 +0000

Last week's Ezra Klein interview with Aaron Smith was a doozy. For those who don't know, Mr. Smith is the co-founder of Young Invincibles. The group works to educate and mobilize (their words, not mine) those between 18-34 years of age. For Ezzie it was the same mantra we always hear: rainbows, pots of gold, unicorns, warm and fuzzies, with a whole lot of "free". The reality is much different. Especially for those who are supposed to spread the ~~wealth~~ health risk and enroll in "affordable" insurance.

Much has been said about the so-called Young Invincibles and whether or not they will purchase insurance. A more glaring concern isn't whether they will purchase or what will be subsidized, but rather whether they can afford the high out-of-pocket maximums. Under PPACA the "catastrophic" plan for those 30 and under is alleged to have a deductible of $6000 (or close to it).

The problem for young invincibles isn't insurance premiums, it is their personal finances. Recently there was a post in the Wall Street Journal that showed:

Young people also are likely to have precarious finances and scant savings socked away for emergencies. When asked if they would be able, in one month, to come up with $2,000 for an unexpected expense such as car repairs, 49% of 18-34-year-old respondents said probably not.

Further, these same invincibles have less discretionary income. Most don't carry insurance because they can't afford the premiums. Paying $100-$150 for the catastrophic plan isn't in the budget. The $20,000-$40,000 they make per year gets completely consumed by rent, car payment, student loans, groceries, cell phone, cable TV, utilities, and cheap beer.

As we approach the deadline of where we are going to force people to buy insurance the biggest question that will remain is: If I have a choice between paying a 1% tax on income OR 3% (minimum) of my income on premiums PLUS a huge out of pocket cost factor should I get sick which one will I choose?

I think you see which way this train is headed.

Just a Minute (Clinic)!

noreply@blogger.com (Henry Stern) — Thu, 13 Jun 2013 19:00:00 +0000

Hard to believe, but we first started covering the "Minute Clinic" phenomenon in the fall of 2005:

"In a little strip mall in San Mateo, California, nestled “between a UPS store and a hair salon” is a new type of doctor’s office ... The office itself is as much coffee shop as medical center: prices for various services and procedures are prominently displayed above a reception desk"

Technically, that story was about QwikHealth, a Minute Clinic fore-runner. But the basic idea was the same: easy access to affordable basic care. We revisited the concept in 2008, when these little beauties started showing up inside Massachusetts "pharmacies and other retailers."

Now, of course, they're ubiquitous, which is both a blessing and a curse: more providers helps meet the increased demand for health care, but it also cuts into more traditional providers' cash-flow. And there's this: "in-store clinics could actually raise overall costs if, by making medical care easier to access, it increased the overall use of services."

Who says more is better?

Actually, it still may be, but then we also need to consider quality of care; that is, is "Dr Nurse" qualified to diagnose and treat what ails ya? It seems safe to presume that for many (most?) common ailments, the answer's probably yes. And for many folks, it may mean the difference between affordable health care and none at all (I'll leave it to the reader to decide if this is a false choice).

[Hat Tip: FoIB Holly R]

California Dreamin': How much is too much?

noreply@blogger.com (Henry Stern) — Thu, 13 Jun 2013 16:57:00 +0000

I find this sad:

That's a snapshot of how a new ObamaTax "Silver" plan is likely to look (at least in the Golden State). It's sad because it's really no different than how insurance worked before the train-wreck. Too often, individuals focus on the co-pays (for doc visits and meds) without looking at "the big picture." I can't tell you how many times I've presented a High Deductible (HSA) plan only to be asked "what's my co-pay?"

Remember, too, that (for many, perhaps most, folks) any subsidies to which one might be entitled are for the premium which, in this case, represents only about a third of what the total potential out-of-pocket might be. There are few (if any) subsidies for co-pays, deductibles or co-insurance. That's strictly "out-of-wallet."

And even this may vastly understate the problem; as FoIB Jeff M reports, "Kaiser Permanente has offered some of the highest rates in the California health exchanges."

Now why would they do that? The article says that KP itself denies any market-rigging motivation, although it notes that:

"Some experts say Kaiser intentionally bid high to avoid drawing too many customers next year who are sick or who have been uninsured for years and may be costlier to treat."

See, that's just good business sense: we already know that the large majority of folks who actually bother to sign up for (first-time) coverage are those with the most motivation to do so: pent-up needs held back by lack of resources (ie a third party to foot the bill). And who can blame them? On the other hand, had I been the KP spokescritter on this, I would have been sorely tempted to answer the charge with a very simple "d'unh!"

But then, truth often hurts.

Even DC Hates Obamacare

noreply@blogger.com (Bob Vineyard) — Thu, 13 Jun 2013 12:33:00 +0000

Wonder what would happen if the folks who had to pass the law before they would know what was in it actually read the law?

Something like this . .

Dozens of lawmakers and aides are so afraid that their health insurance premiums will skyrocket next year thanks to Obamacare that they are thinking about retiring early or just quitting.

The fear: Government-subsidized premiums will disappear at the end of the year under a provision in the health care law that nudges aides and lawmakers onto the government health care exchanges, which could make their benefits exorbitantly expensive.

Politico

Whoa!

Why is Obamacare suddenly "exorbitantly expensive"? What happened to reducing your premiums by $2500 or 3000%, whichever is greater?

The problem is far more acute in the House, where lawmakers and aides are generally younger and less wealthy. Sources said several aides have already given lawmakers notice that they’ll be leaving over concerns about Obamacare.

And younger, less wealthy individuals can qualify for taxpayer subsidies to make their premiums . . . affordable.

Rep. John Larson, a Connecticut Democrat in leadership when the law passed, said he thinks the problem will be resolved.

“If not, I think we should begin an immediate amicus brief to say, ‘Listen this is simply not fair to these employees,’” Larson told POLITICO. “They are federal employees.”

So federal employees should be treated differently from the rest of us?

Some would say that is a racist comment.

I choose to think the attitude in DC is elitist.

Currently, aides and lawmakers receive their health care under the generous Federal Employee Health Benefits Program. The government subsidizes upward of 75 percent of the premiums for the health insurance plans. In 2014, most Capitol Hill aides and lawmakers are expected to be put onto the exchanges, and there has been no guidance whether the government will subsidize those premiums. This is expected to cause a steep spike in health insurance costs.

Sounds like the caffeine kicked in.

Welcome to America!

Some Very Strange Bedfellows

noreply@blogger.com (Mike Feehan) — Wed, 12 Jun 2013 19:22:00 +0000

The New York Post reports today (June 12, 2013) that the Freelancers’ Union is seeking relief from Obamacare, and the State of New York may be about to help them.

It seems the Freelancers’ Union – which in 2012 was granted $341 million in Federal loans to set up an insurance CO-OP under Obamacare - has run into a big problem. It’s figured out that Obamacare will seriously damage its insurance business.

Will this damage come from “unexpected” problems encountered by an expert insurance organization blindsided by completely unpredictable insurance requirements? You can believe that if you like, but I think you would be wrong.

According to the Post, the Freelancers’ Union says that Obamacare’s “onerous regulations and taxes will burden its innovative health insurance model for the self-employed with enormous added costs.” In other words, Freelancers’ problems are the same Obamacare problems that businesses and other insurance companies have been warning about for the past four years. They were neither unpredictable nor unexpected.

So what does Freelancers’ want? It wants authority from the State of New York to convert its health insurance model to a self-funded model. If it provides self-funded coverage rather than insurance it becomes an issuer of “ERISA Plans” that won’t be subject to Obamacare.

Freelancers’ Union states that Obamacare will cost its members “$38 million a year” which translates into “a per-person premium load of $178 a month”. That’s the additional amount that would be needed just to pay for the Obamacare load.

Is that devastating? Well if it is, wouldn't Obamacare be equally devastating to the other insured small group plans in New York – and all across America?

Yet Freelancers’ Union asks the State of New York to step in and spare their successful small-group insurance plan from the devastating effects of the President’s ‘affordable’ health law - but not to spare any OTHER insurance plan from that law.

And say, isn’t it ironic that the Freelancers Union has taken up the conservative cry that Obamacare will hurt more than it can help? Obamacare is creating some very strange bedfellows.

Remember that 50th employee?

noreply@blogger.com (Henry Stern) — Wed, 12 Jun 2013 16:30:00 +0000

Almost exactly a year ago, we noted the pending demise of 50-employee companies. It now appears that even those fortunate enough to keep their current jobs (let alone obtain new employment) may be subject to reduced hours (and thus pay):

"Under [the ObamaTax], employers' cost to employ workers will climb up to $96.15 per person in the 30th hour they work each week"

That's because of a little-known "feature" of the ObamaTax called "Full Time Equivalent" (FTE). The purpose of FTE's is to discourage employers from hiring too many part-time workers by essentially combining multiple part-timers' hours and calling that one employee. So, for example, an employer with 48 actual full-time employees hires 4 part-timers. The IRS sees not 4 individuals working part time, but 2 working full-time, and that magic 50 employee threshold is reached (thus triggering mandates and ~~fines~~ additional taxes).

But wait, it gets worse (seriously!):

"Employers who offer health coverage that is deemed either too pricey or too skimpy will owe $3,000 for each full-time, 30-hour-per-week, worker who taps ObamaCare subsidies. Because the $3,000 fine is nondeductible, it's equal to $5,000 in deductible wages for a profit-making firm facing a 40% combined federal and state tax rate."

Remember, these are (by definition) small businesses, allegedly the backbone of our economy. Well, they *were* the backbone of our economy.

But wait, it gets murkier:

Co-blogger Bob tipped me to this little gem:

"Under the existing Senate immigration bill, immigrants who have been in the United States illegally can obtain a provisional legal status ... But this population would have to wait at least 13 years to be able to obtain full citizenship, and it isn’t until then that they could qualify for [the ObamaTax benefits]."

The net effect of this little lovely is that employers will have major economic incentives "to hire newly legalized immigrants over American citizens" because the former won't count against them in ObamaTax mandate calculations.

Hooray.

Cavalcade of Risk #185: Lean and (not so) Mean edition

noreply@blogger.com (Henry Stern) — Wed, 12 Jun 2013 15:22:00 +0000

Rebecca Shafer hosts this week's roundup of risk-related blogetry, simple and straightforward, with lots of interesting posts.

Morning After Pill - No Copay?

noreply@blogger.com (Bob Vineyard) — Wed, 12 Jun 2013 00:41:00 +0000

It's official. Now any woman (or girl) of any age can buy the morning after pill (Plan B) without a prescription.

If the woman (or girl) has health insurance presumably they can get the abortion pill without a copay.

Monday, the Department of Justice notified him that it was reversing course and seeking prompt Food and Drug Administration approval of all-age sales — an announcement that pleased girls’ and women’s rights advocates who said it was long overdue and disappointed social conservatives who claim it threatens the rights of parents and their children.

Washington Post

Any age.

Including your 13 year old daughter.

Without your knowledge or consent.

Let that sink in and digest.

HSA's vs The ObamaTax: Part XXCVI

noreply@blogger.com (Henry Stern) — Tue, 11 Jun 2013 14:35:00 +0000

As we've previously noted, the survivability of Health Savings Accounts (HSA's) and High Deductible Health Plans (HDHPs) under the ObamaTax has been questionable. The challenge is that the train-wreck limits one's total out-of-pocket costs and, as important, Exchange-qualified plan designs themselves.

Still, there's no denying the appeal of a plan that offers (potentially) lower premiums coupled with the ability to sock away tax-advantaged dollars to help offset those out-of-pocket costs. While I still have my doubts as to whether these plans will survive unscathed, the folks at Life Health Pro firmly believe that this will be the case:

"Whether your clients fear direct premium increases or higher annual deductibles, their out-of-pocket costs can be slashed using a tax-preferred vehicle that has been on the market for years: the health savings account (HSA) ... For 2013 and 2014, an HDHP is a plan with an annual deductible of not less than $1,250 for self-only coverage or $2,500 for family coverage."

And of course, there may be additional coinsurance that increases one's potential out-of-pocket liability. There are two major obstacles here:

First, Exchange-qualified plans are standardized. That is, there are pre-approved plan designs (often referred to as "metal plans" due to their names - "gold," "silver," etc). I have yet to see one called "aluminum."

Second, plans must meet stringent actuarial value standards, some of which have yet to be finalized. So while I'm hopeful that these plans will, in fact, continue to be available after full ObamaTax implementation, I'm not holding my breath.

IRS - Birth Control - Government Monitoring

noreply@blogger.com (Nate O) — Mon, 10 Jun 2013 22:10:00 +0000

To don my tin foil hat for a moment....

The IRS has been in the news for tough grilling of conservative groups seeking tax exempt status, asking for donors, what was discussed, material, etc etc and some claim using that info to target audits.

The IRS is about to start enforcing the birth control mandate.

If you're an agent, any second thoughts on discussing ways to circumvent this regulation or minimize it if your client asks? Sounds crazy, but then so did the idea they would target groups teaching the constitution or speaking up for honest elections. Would you risk being excluded from selling exchange policies? With the new licensing organizations at a national level is it really a jump to think the government might not want to work with agents not working the products they want?

Obamacare - For Agents Only

noreply@blogger.com (Bob Vineyard) — Mon, 10 Jun 2013 19:22:00 +0000

The public is probably not aware of this potential hitch in Obamacare nor do they care. This only concerns agents and health insurance carriers.

More specifically, agents that are going to write health insurance business through the exchange (AKA marketplace).

People who buy through the exchange will be credited with a premium subsidy designed to reduce their out of pocket cost for health insurance.

At least that is the promise.

But the subsidies are not instant. Only the calculation, which is an estimate of your subsidy, is (almost) instant once you spend about 45 minutes completing the (up to) 26 page application.

So let's say you take time out to complete the subsidy application then (and only then) go shopping for a health insurance plan. This is not like your EBT card where money is transferred to merchants at point of sale. Once you select a policy the issuing health insurance carrier will have to notify HHS (or whoever is running this baby) and then wait on the government to issue a check on your behalf.

Let's say for argument sake that your gross premium is $500 but you will only be expected to pay $150 and the government (taxpayers) will fund the $350 balance.

Brokers normally are paid a percentage of premiums collected.

So if a broker, agency or approved entity assisted you in the process will they be paid on the $150 you actually paid?

Carriers pay "as earned" on collected premium.

When (if) the carrier finally does receive your subsidy from the government it will presumably come in the form of one check and an accompanying list (and amounts?) of who is included in the wealth redistribution scheme. How quickly will the government turn around these subsidy checks to the carriers?

No one knows.

Consider that with Cash 4 Clunkers some car dealers waited MONTHS before they got their checks and that was a small program that only generated a one time check (per individual).

This is much more massive with (possibly) repeat checks every month going to carriers.

So let's say this all runs smoothly.

And let's say a policyholder decides to exercise their right to a 90 day grace period and does not pay their premium for 3 months. But the government keeps sending subsidy checks to the carrier on the assumption that you are in fact paying your part.

Does the carrier pay the agent on the subsidy but not the premium? At what point is the carrier obligated to tell the government the insured is no longer insured and here is a refund for amounts paid?

I see this as a real nightmare for carriers, agents and providers that may wind up treating people that are not really covered since they stopped paying premiums for a few months.

Is it any wonder why some carriers really don't want to participate in the exchange?

Monday Morning ObamaTax Alert

noreply@blogger.com (Henry Stern) — Mon, 10 Jun 2013 13:14:00 +0000

■ FoIB Holly R alerts us to this breaking news that the ObamaTax will leave some 30 million Americans without health insurance. The whole article is well worth the read.

■ And leave it to Tar Heel State FoIB Jeff M to bring this Buckeye State news to our attention:

"Ohio’s insurance regulators are warning that some health policy premiums may skyrocket next year because of the [ObamaTax] ... The department’s initial analysis of the proposed rates show consumers will have fewer choices and pay much higher premiums for their health insurance starting in 2014.”

But that can't be right: we were assured that premiums would, in fact, fall by over 3000%.

■ Update from Friday's item on renewal dates. We had noted that:

"[A]t least one carrier ... is offering a special, one-time deal to existing client groups to "avoid the effects of adjusted community rating until 12/01/2014"

Since then, we've gotten a bit more detail. What they're offering is the "opportunity" to have two 2013 renewal dates: their original one, and a new 12/1/13 one. The idea is that even though a group would then have two premium increases (despite ObamaTax protestations to the contrary, they're not going down this year) the change would enable them to put off the potentially catastrophic 2014 rate increases.

Interesting gamble.

Bait and Switch

noreply@blogger.com (Bob Vineyard) — Sat, 08 Jun 2013 15:25:00 +0000

Why do presumably otherwise intelligent people cry foul when getting an online health insurance quote and then discover the quoted rate is not the final rate once an application is submitted?

Do they claim bait and switch when they get a solicitation from a credit card company advertising 2.9% rates? Or mortgage loans at 2.9%? Or car loans?

How about those nothing down, no payment until 2015 on cheap furniture?

People like Rick Unger must either be ignorant or the have an agenda.

As the premium prices published by any Internet health insurance exchange cannot possibly deliver the entire pricing picture, due to the fact that no insurance company listing a policy on a web-based exchange can give a ‘pre-Obamacare’ quote until all the details of an applicant’s health situation is fully known to the issuer, I viewed—and continue to view—the comparison as wholly unreasonable. To underscore the point, and to highlight the substance of my objection to Avik’s argument, I relayed some of the comments and criticisms offered up by past customers shopping at eHealthInsurance.com who experienced higher rate quotes once they went through the application process.

Forbes

Heads up Ricky. The same phenomena would occur if you applied direct to the carrier or went through an agent . . . unless you were in perfect health.

Rates quoted for health insurance, car insurance, life insurance, car loans, mortgage loans, etc are for PREFERRED customers.

If you aren't preferred, you won't get the quoted rate.

Why is this so difficult to understand?

I would say your analysis is equally wholly unreasonable.

But I do applaud you for finally coming out of the Obamacare ether and figuring out that "Washington, we have a problem".

eHealthInsurance.com—along with smaller websites providing similar services—is, in virtually all respects, an existing healthcare exchange and has operated as such for long before the Affordable Care Act introduced the concept of the health insurance exchange into the vernacular of national health care policy.

Well duh!

Did you think the Travelocity and Priceline examples used by the DC crowd was unique and there are no other industries that have shopper sites?

Ever heard of Amazon? Bankrate? Ebay?

Last year, approximately 20 million people visited eHealthInsurance.com with roughly 10 million of these visitors falling into the all-important 18 to 34 year old demographic. These younger buyers are critical to the ability of insurance companies to drive premium charges lower as these ‘young immortals’ tend to be the healthiest participants in the insurance pool. Thus, the more young people included in the pool to balance the older and sicker participants, the lower premium prices should go.

However, it is the young immortals who are also the most likely to skip the requirements of the ACA mandate and chose to pay a penalty rather than buy insurance, thereby posing a threat to some of the key objectives of Obamacare.

So, when a company like eHealth is already established in the business of operating a health insurance exchange—not to mention having an established track record when it comes to attracting the critical buyers in the younger demographic—one is left to wonder why the ACA would not have created a situation where private, web-based exchanges could function as an additional option for uninsured Americans seeking to connect with insurance companies offering qualified health plans in accordance with the law.

Duh!

Wonder how many more folks like you are out there that have completely missed the internet revolution.

Obamacare - There Will be Blood

noreply@blogger.com (Bob Vineyard) — Fri, 07 Jun 2013 17:42:00 +0000

Less than 4 months away and the excitement over Obamacare and the exchanges is almost reminiscent of the old days when the car companies rolled out their new models for next year. Ads appeared on TV and in print where shiny new cars were strategically hidden behind a leggy model who invited you to see the USA in your Chevrolet.

Most of the ads were geared towards males. Apparently women didn't buy cars then, or if they did they sent their husband or a relative to negotiate for them.

That was then.

This is now.

Obamacare is just around the corner and plenty of you have "the fever" and can't wait to see the new models that promise to be faster, sleeker and have more get up and go than the old model.

But not everyone is excited.

The folks responsible for building the exchange, now called a more consumer friendly "marketplace", are hoping the wheels don't come off.

As the WSJ reports "Something will be up and running on October 1, but it will be full of issues, bugs and technological challenges.

Wonder how DC and the HHS will spin it?

"Only 45 minutes to complete the subsidy application and you will be rewarded with a subsidy worth thousands of dollars."

Your mileage may vary.

According to HHS, "Our experience in running Medicare for nearly 50 million people has given us valuable skills and lessons to prepare us for preparing to run the Health Insurance Marketplace."

No doubt the folks at Edsel had similar feelings.

"This is less likely to be like a travel booking experience and more like applying for a mortgage online."

Don't you just love that new policy smell?

Thanks to Henry Stern for the tip!

Friday ObamaTax Miscellany

noreply@blogger.com (Henry Stern) — Fri, 07 Jun 2013 16:47:00 +0000

■ First, a word on "strategery:" Got snail-mail from United Health One (UHC's individual medical outlet), alerting folks that plans "with an effective date up through December 31, 2013 ... can feel secure knowing that their plan/benefits will stay the same until the end of 2014."

The carrier is pretty insistent that plans with 2013 effective dates will see their benefits remain the same until the end of next year. Note, though, that they don't make the same promise about rates.

I have a problem with this: as we noted in April, there's simply no way to know what Ms Shecantbeserious will do with in-force plans.

■ Along similar lines, FoIB Beth D alerts us that at least one carrier (UHC, perhaps not coincidentally) is offering a special, one-time deal to existing client groups to "avoid the effects of adjusted community rating until 12/01/2014"

She helpfully sends along an "Attestation Form" that the group would complete and submit in the next week or so requesting that their effective (renewal) date be changed to December 1rst.

I expect to see similar efforts from other carriers shortly.

■ Finally, The Wall Street Journal finally figures out what we've been saying all along:

"But Chris Angelo, a second-generation owner ... doesn't expect a groundswell of enrollments next year from lower-wage workers ... They'd rather have the cash than pay the employee portion of the premium."

Hunh.

This has ripple effects, of course:

"[E]mployers may struggle to figure out how many of their low-wage workers will opt in for employer coverage in 2014. By the same token, it suggests that many low-wage workers could remain uninsured next year, despite the law's subsidies and penalties."

Where's my free insurance?

Cavalcade of Risk #185: Call for submissions

noreply@blogger.com (Henry Stern) — Fri, 07 Jun 2013 13:46:00 +0000

Rebecca Shafer hosts next week's Cav. Entries are due by Monday (the 10th).

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.

LICERA (Large Insurance Company Expense Relief Act) out of Committee

noreply@blogger.com (Henry Stern) — Thu, 06 Jun 2013 20:37:00 +0000

Well, technically it's the "National Association of Registered Agents and Brokers Reform Act (of 2013)," but as we noted a few short months ago, its stated purpose and it's actual 'raison d'etre' are quite different.

According to the folks in Capital City, the legislation "before you today represents over a decade worth of effort and ... will finally achieve the goals ... that ensures that regulators can continue to protect consumers"

Lofty words.

Now let's run them through the Capital City Sunshine Removal Filter:

"The NARAB would not only duplicate many (most?) of the functions of the existing NIPR, but it would afford these large carriers a welcome break in their cost of doing business ... it's industry-funded, which means a non-trivial portion will be borne by smaller, regional carriers to subsidize their larger competitors"

Doesn't have quite the same ring, though, does it?

On the other hand, it does have the value of being, you know, accurate.

Tri-State ObamaTax Roundup

noreply@blogger.com (Henry Stern) — Thu, 06 Jun 2013 19:35:00 +0000

So, news from 3 of the 58 states today.

■ First up, Vermont deals a blow to an ObamaTax co-op:

"A Vermont regulator said today organizers of a proposed Obamacare health insurance co-op who claimed last week they were "blindsided" were told "from the beginning" of problems with their application to operate in the state."

Oops. As we've noted before, co-ops "are nonprofit, customer-owned health plans, designed to compete against the major for-profit insurers." And, as we've also noted, they don't seem likely to fare very well. Screwing up the initial paperwork is probably not a good sign for Green Mountain State co-op wannabes.

■ Next, news from Oklahoma (okay!):

"Oklahoma attorney general Scott Pruitt has found an ingenious way to call a halt to the Obamacare project: Hold the federal government to the letter of that misbegotten law."

Turns out, the Sooner State is sticking by its guns in its federal lawsuit challenging the train-wreck's (sorry, Max!) constitutionality. As one of the 33 states that took a pass on creating its own Exchange, its citizens stand to get hit with tax penalties that seem pretty blatantly illegal.

'Course, they're only illegal if SCOTUS Chief Roberts says they're illegal.

■ Finally, the Natural State (really!) is trying out a bold new Medicaid experiment:

"Arkansas appears poised to move ahead with a plan that will bring private coverage to a population very close to the poverty level while defanging [the ObamaTax's] controversial Medicaid expansion ... that would allow — if the federal government grants a waiver — those for whom the Medicaid expansion was intended to buy private health insurance through the Arkansas health insurance exchange or marketplace."

If you "get" vouchers, then you'll "get" this: instead of an expensive and ineffectual bureaucracy, you give folks the means to purchase their own coverage, which also reinforces the basic (but recently all but extinct) concept of personal responsibility.

Win-win.