Category: Insurance

Bait and Switch on Healthcare ……… Again

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This time, it is the out of pocket limits for group plans that has been delayed:

In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.

The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.

The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.

The discovery is likely to fuel continuing Republican efforts this fall to discredit the president’s health care law.

Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.

Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.

The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs.

Gee, they had only 4 years to get this working, and they “can’t get their computers to work”.

Am I the only one who is beginning to suspect that maybe the real intent of Obamacare is to eliminate employer sponsored health plans?

This is exactly the sort of thing that Obama’s economic brain trust ***cough*** Cass Sunstein ***cough*** would like.

There are a lot of academic economists out there who hate employer sponsored health insurance.

It’s Like a Slow Motion Car Wreck

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So, the little people will be required to buy health insurance under the PPACA (Obamacare), but the requirement for big employers has been pushed back a year:

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.

The government will postpone enforcement of the so-called employer mandate until 2015, the administration said today. Under the provision, companies with 50 or more workers face a fine of as much as $3,000 per employee if they don’t offer affordable insurance.

The move addresses complaints from employer groups to President Barack Obama’s administration about the burden of the law’s reporting requirements. The decision pushes the issue past the 2014 midterm congressional elections, as Republicans have sought to make the health law a symbol of government overreach.

“In our ongoing discussions with businesses we have heard that you need the time to get this right,” Valerie Jarrett, a senior adviser to Obama, said in a White House blog post announcing the decision. “We are listening.”

The move may lead some employers to delay providing coverage to workers. The law’s individual mandate remains in effect, a provision that requires most Americans to carry health insurance.

You knew that this was coming.

When big business talks, they, “Are listening.”

When it’s civil libertarians, , the poor and elderly, advocates for financial reform, the Democratic wing of the Democratic Party, etc., it’s, “talk to the hand”.

H/t to my Dad, who sent me a link to a (subscription only) WSJ article.

Quote of the Day

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From the always informative Charlie Savage:

You think any of these guys looked at what happened in 2008 and thought, “Boy, those guys really were crooks and bought the country a helluva catastrophe. We should learn from them and not do that ourselves.” Nope, I guarantee you the first thoughts among the people who thought up this scam for the insurance companies was, “Holy crap, look at the dough those guys made!” And I guarantee you those same people all got raises. The upper levels of American capitalism is so rotten with amorality, so utterly devoid of any conventional sense of ethics, let alone social responsibility, that it hardly seems worth pointing it out any more. Congratulations to America’s graduate schools of business. You have bred three generations of vampires to feed on the rest of us. It’s as though every medical school in the country adopted the basic approach to thoracic surgery of Sweeney Todd and married it to the economic philosophy of Bialystock And Bloom.

He is talking about the insurance industry, which has recently been discovered to have been using complex accounting tricks to boost their apparent assets and revenue.

If the Banksters had been sent to a “federal pound me in the ass prison,” these insurance executives would have thought twice before engaging in accounting fraud.

Medicare Trust Fund Lifetime Extended

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Score another one for Obamacare, the exhaustion date for the exhaustion of the Medicare trust fund has been pushed back:

Falling health-care costs are brightening the financial outlook for Medicare, extending the life of the trust fund that supports the program until 2026 — two years later than previously forecast.

The new projections, released Friday by the program’s trustees, credit President Obama’s Affordable Care Act in part for the improvement in the finances of the federal health insurance program for the elderly. The act’s limits on Medicare Advantage, a more expensive form of Medicare run by private insurers, are proving more effective than previously forecast, the report said.

The trustees also cited lower-than-expected spending in “most . . . service categories — especially skilled nursing facilities,” a development that is not well understood. Costs have been slowing throughout the health-care industry, partly because of the recent recession, economists say, but also because of what appear to be more fundamental changes aimed at reducing waste and improving health outcomes.

This is particularly interesting when juxtaposed against the New York Times article on the pricing of colonoscopies:

A major factor behind the high costs is that the United States, unique among industrialized nations, does not generally regulate or intervene in medical pricing, aside from setting payment rates for Medicare and Medicaid, the government programs for older people and the poor. Many other countries deliver health care on a private fee-for-service basis, as does much of the American health care system, but they set rates as if health care were a public utility or negotiate fees with providers and insurers nationwide, for example.

………

But she noted that gastroenterologists in Austria do have their financial concerns. They are complaining to the government and insurers that they cannot afford to do the 30-minute procedure, with prep time, maintenance of equipment and anesthesia, for the current approved rate — between $200 and $300, all included. “I think the cheapest colonoscopy in the U.S. is about $950,” Dr. Ferlitsch said. “We’d love to get half of that.”

Dr. Cesare Hassan, an Italian gastroenterologist who is the chairman of the Guidelines Committee of the European Society of Gastrointestinal Endoscopy, noted that studies in Europe had estimated that the procedure cost about $400 to $800 to perform, including biopsies and sedation. “The U.S. is paying way too much for too little — it leads to opportunistic colonoscopies,” done for profit rather than health, he said.

The real problem here is that prices are are not transparent, and they are excessive to boot, being many times for routine procedures compared to the rest of the industrialized world.

The idea of market driven healthcare does not work, because there is no transparency in pricing, and even if there were, much of the time there is no opportunity to engage the market as a rational actor (auto accident, gun show wound, etc.).

It’s why, even with its apparent benefits, Obamacare, does not address the core of the problem, which is that healthcare in the US is tremendously overpriced.

Obamacare Seems to be Working in Oregon

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In Oregon, they have up exchanges that allow people to easily compare standard insurance policies, and as a result, premiums are falling:

This is what competition looks like: One health insurer wants to charge $169 a month next year to cover a 40-year-old Portland-area non-smoker. Another wants $422 a month for the same standard plan.

The new health insurance marketplace envisioned by federal health reforms doesn’t formally kick in until fall. But it already is taking shape – and consumers for the first time can compare, premium by premium, identical plans by different insurers.

Soon they’ll be able to compare benefit-by-benefit as well.

On Thursday, a comparison of proposed 2014 health premiums became public online, causing two insurers to request do-overs to lower their rates even before the state determines whether they’re justified.

The unusual development was sparked by a comparison that used to be impossible because plan benefits varied so widely. But under the federal reforms that take effect Jan. 1, health insurance is mandated and every insurer must offer certain standard plans.

Good, but somehow, I do not think that it’s going to last.

Expect to see an orgy of mergers and acquisitions, and inventive ways to collude to follow.

H/t John Aravosis.

Confusopolies are Obamacare’s Achilles Heel

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At the heart of healthcare reform, it is the insurance exchanges, and your average consumer lacks the sophistication necessary to see how the insurance companies will f%$# them until it is too late:

One of the big reasons I’m so pessimistic about the new health insurance exchanges created under the Affordable Care Act is the principle behind them. The idea is that everyone will be well- informed dedicated shoppers who will know how to select the best plan to fit their needs, which will reduce cost for everyone. Aflac’s 2013 WorkForces Report shows how deeply misguided this assumption is in reality.

Two numbers from the report really stick out. The survey found 54 percent of workers would prefer not to be more in control over their health insurance expenses and options because they will not have the time or knowledge to effectively manage it. This is completely understandable. Selecting the best insurance plan requires not only significant knowledge about every component of insurance, but also the ability to accurately predict the likelihood of future medical needs.

One thing that you can be sure of is that the insurance companies will do their level best to confuse customers so that they will make a decision that will increase their profits.

As John Maynard Keynes noted, “Capitalism is the theory that the worst people, acting from their worst motives, will somehow produce the most good.”

The health insurance industry is one of the best examples of this, and the health insurance reform plan requires us to rely on their good will.

Pleasant dreams.

Obamacare Hiccup ……… Is this the Shape of Things to Come

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The healthcare market for small business medical insurance mandated under the PPACA will be delayed:

Unable to meet tight deadlines in the new health care law, the Obama administration is delaying parts of a program intended to provide affordable health insurance to small businesses and their employees — a major selling point for the health care legislation.

The law calls for a new insurance marketplace specifically for small businesses, starting next year. But in most states, employers will not be able to get what Congress intended: the option to provide workers with a choice of health plans. They will instead be limited to a single plan.

The choice option, already available to many big businesses, was supposed to become available to small employers in January. But administration officials said they would delay it until 2015 in the 33 states where the federal government will be running insurance markets known as exchanges. And they will delay the requirement for other states as well.

The promise of affordable health insurance for small businesses was portrayed as a major advantage of the new health care law, mentioned often by White House officials and Democratic leaders in Congress as they fought opponents of the legislation.

Supporters of the law said they were disappointed by the turn of events.

………

D. Michael Roach, who owns a women’s clothing store in Portland, Ore., said the delay was “a real mistake.”

“It will limit the attractiveness of exchanges to small business,” he said. “We would like to see different insurance carriers available to each of our 12 employees, who range in age from 21 to 62. You would have more competition, more downward pressure on rates, and employees would be more likely to get exactly what they wanted.”

John C. Arensmeyer, the chief executive of Small Business Majority, an advocacy group, said that the delay of “employee choice” was “a major letdown for small business owners and their employees.”

Gee, the delay shafts small businesses, and favors the big players in the FIRE (Finance, Insurance, and Real Estate) sector.

Gee, that’s a surprise ……… Not.

The Obama administration doesn’t work hard for anything that does not have a payoff for the banksters and their ilk.

Obamacare Fail

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Employers are required to cover children, but not spouses, and they are looking at canceling coverage on spouses to save money:

By denying coverage to spouses, employers not only save the annual premiums, but also the new fees that went into effect as part of the Affordable Care Act. This year, companies have to pay $1 or $2 “per life” covered on their plans, a sum that jumps to $65 in 2014. And health law guidelines proposed recently mandate coverage of employees’ dependent children (up to age 26), but husbands and wives are optional. “The question about whether it’s obligatory to cover the family of the employee is being thought through more than ever before,” says Helen Darling, president of the National Business Group on Health.

While surcharges for spousal coverage are more common, last year, 6% of large employers excluded spouses, up from 5% in 2010, as did 4% of huge companies with at least 20,000 employees, twice as many as in 2010, according to human resources firm Mercer. These “spousal carve-outs,” or “working spouse provisions,” generally prohibit only people who could get coverage through their own job from enrolling in their spouse’s plan.

Such exclusions barely existed three years ago, but experts expect an increasing number of employers to adopt them: “That’s the next step,” Darling says. HMS, a company that audits plans for employers, estimates that nearly a third of companies might have such policies now. Holdouts say they feel under pressure to follow suit. “We’re the last domino,” says Duke Bennett, mayor of Terre Haute, Ind., which is instituting a spousal carve-out for the city’s health plan, effective July 2013, after nearly all major employers in the area dropped spouses.

But when employers drop spouses, they often lose more than just the one individual, when couples choose instead to seek coverage together under the other partner’s employer. Terre Haute, which pays $6 million annually to insure nearly 1,200 people including employees and their family members, received more than 20 new plan members when a local university, bank and county government stopped insuring spouses, according to Bennett. “We have a great plan, so they want to be on ours. All we’re trying to do is level the playing field here,” he says.

It’s a race to the bottom. Whee!

This was foreseeable.  

Adverse selection/the race to the bottom are the most salient feature of our current healthcare clusterf%$#.  To assume that insurance providers would not avail themselves of every opportunity to benefit from this is policy malpractice.

What the F%$#?

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So, I’m driving to work, and they are discussing auto insurance rates, and they note that Massachusetts is one of the 3 cheapest states for auto insurance in the USA.

Over lunch, I confirm this.

I went to school in Massachusetts, and I had friends who used friends and relatives addresses in New Hampshire to register their car to save on insurance costs.

We have entered Bizarro world.

The idea that Massachusetts drivers have among the lowest rates in the nation is mind boggling.

Here’s a Meme to Run On

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This is a rebate check from an insurance company because of Obamacare:


Click for full size.

The short version (more at link) is that insurance companies have to spend 80% of premiums on healthcare, as opposed to paying obscene bonuses to its executives.

Any excess has to be returned to the ratepayers.

I’m no political consultant, but I think that video of people holding up checks that they got back from insurance companies might play well on Youtube.

I’m just sayin’.

Why It’s Not Eleventy Dimensional Chess, It’s an Epic Fail

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At Digby’s place, David Adkins notes that the Obama’s “compromise” on birth control coverage with the US Conference of Catholic Bishops has had the effect making opposition to birth control mainstream:

And guess what? As Digby points out, it’s working. What just a few weeks ago was considered so mainstream as to an afterthought (providing contraception) is now seen as some sort of controversial touchstone, even as “religious freedom” has become a buzzword in the press.

Democrats can high-five one another about Republican overreach and laugh hysterically at the increased number of votes Barack Obama will receive in 2012 over Mitt Santorum. But ultimately the joke’s on us. It’s been on us ever since the Obama Administration decided to concede an inch to the misogynist conspiracy of extremist fanatics that are the Bishops, rather than mock them immediately for being out of touch with their own flock, to say nothing of the mainstream American public.

The political ground on contraception has suddenly shifted to the right faster than I have seen on any social issue in my lifetime. It’s incredible.

The appropriate response to the outrage from the medieval set is, “Sorry, I live in the 21st century, if they don’t want to, then maybe they aren’t qualified to provide medical care or education.”

Obamacare Just Gets Better and Better

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As part of health care reform, consumers are supposed to be getting clear and simple summary of benefits and of an insurance policy.

This means things like deductibles, maximum out of pocket, and co-payments are supposed to be presented to the consumer in a simple and readable format.

The rather unsurprising development in all this is that Obama administration caved to insurers on the most important number of all, and there is no requirement for insurers and employers to tell people what they have to pay in premiums:

The Department of Health and Human Services recently announced that health insurers and employers must provide more information to consumers shopping for health insurance. The ensuing coverage, shall we say, was a classic case of journalistic bungling. Reporters took what HHS officials fed them and crafted their pieces for public consumption. But the stories were confusing—in some cases flat-out wrong—and did not exactly offer the clearest of explanations about what’s supposed to be a clearer process for buying health coverage. I’d wager the public didn’t understand much of what the media dished out, and probably won’t until they actually start shopping for coverage again in the fall and find the government hasn’t made it easier after all.

…………

The report that HHS released to the media discloses some important numbers: the amount of the deductible; what services don’t count toward satisfying it; what’s not included in the out-of-pocket limits, like premiums and charges from doctors who balance the bill; the copays; and, probably most important, the amount of coinsurance—the percentage of a bill patients must pay, which is increasing with each passing year.

But insurers and employers do not have to tell consumers how much a policy costs—in other words, no premium information has to be given. Yep, that’s right—the key piece of information needed to make a good decision is missing. When insurers design a policy, they consider the interplay of coinsurance, copays, deductibles, coverage, and, of course, the premium, which lets them know what price point will make a consumer say “yes.” Price is the bottom line for consumers, but it’s poison for sellers, who fear a shopper might choose a policy with a lower price, other things being equal. So much for that price competition that was to solve all the ills of U.S. health care.

This was followed up by the media almost entirely simply reprinting the HHS press releases, which means that this crucial omission was largely ignored:

What was needed from the media was analysis and sharp questioning about what these new disclosures would really mean for consumers in terms of ease of use and availability during the shopping process. We know consumers hate shopping for insurance, and take shortcuts to finish the task as fast as they can. But instead of helping them through this dreaded chore, the media gave the Department of Health and Human Services a free pass.

This is not a product of a biased media, this is a product of lazy media, which is the real problem with the media, particularly given the financial pressures present in today’s media environment, because a lazy media is a cheaper media.

Obama and Contraception

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When your opposition looks this pampered and out of touch, you have a winning issue

So, in the ginned up controversy over the requirement that religious non-profits cover contraception for their employees, Obama has split the baby:

Mr. Obama announced that rather than requiring religiously affiliated charities and universities to pay for contraceptives for their employees, the cost would be shifted to health insurance companies. The initial rule caused a political uproar among some Catholics and others who portrayed it as an attack on religious freedom.

Meeting with his top advisers in the Oval Office last week amid rising anger from Catholic Democrats, liberal columnists and left-leaning religious leaders — a fed-up Mr. Obama issued an order meant for Kathleen Sebelius, the secretary of health and human services. Ms. Sebelius and agency lawyers had initially told the president they needed a year to work out a compromise that had seemed obvious to some in the administration from the start: make the new rule more like that offered by the State of Hawaii, where employees of religiously affiliated institutions obtained contraceptives through a side benefit offered by insurance companies.

But in difficult internal negotiations, a group of advisers had bested Vice President Joseph R. Biden Jr. and others and sold the president on a stricter rule. Now the political furor surrounding it was threatening to consume signs of economic improvement giving a boost to the White House and put the Obama re-election campaign on the defensive.

So the mandate for coverage is now on insurance companies, rather than the employers.

If this is the end of this matter, then this is a good thing.

My concern, based on past history, is that this is only the first step in a larger retreat.

Then again, there are a number of people I respect who see it as eleventy dimensional chess, with people like Amanda Marcotte suggesting that Obama punked both the Conference of Bishops and the woman hating wing of the Republican Party, by forcing them to publicly oppose contraception, which is used by something like 99% of all sexually active women in the US at one time or another.

Certainly the optics, for now at least, are good, and the effect on coverage of this change is zero, so it’s a win win.

But the most powerful knock against Obama is his unwillingness to fight, and in the 2-3 days before this decision, news outlets were starting to note that there are 28 states that have had an identical mandate, and have had such a mandate for years, with nary a peep from the pedophile protection bureau US Conference of Catholic Bishops, so it was clear that the worm was turning in the media as well, so keeping this up until they blinked would, to my mind, have been the optimal approach.

[on edit]
I think that the real policy and political implications are best synthesized by the following from Lindsay Beyerstein:

But if the bishops won’t accept this deal, Obama should stop trying to accomodate them. Respect for religious freedom does not include paying solemn lip service to the contraception cooties.

So, the Pedophile Protection Bureau Wants Contraception Coverage Banned

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So, the Conference of Catholic Bishops, or more accurately the guy they hired to represent their position, has admitted that they want to ban coverage for all forms of contraception for everyone:

“There has been a lot of talk in the last couple days about compromise, but it sounds to us like a way to turn down the heat, to placate people without doing anything in particular,” [Conference general council Anthony] Picarello said. “We’re not going to do anything until this is fixed.”

That means removing the provision from the health care law altogether, he said, not simply changing it for Catholic employers and their insurers. He cited the problem that would create for “good Catholic business people who can’t in good conscience cooperate with this.”
“If I quit this job and opened a Taco Bell, I’d be covered by the mandate,” Picarello said.

They want to pull all coverage for contraception for everyone, and so we should take it seriously when they they say want to ban all contraception.

At least the Taliban does not find f%$#ing little boys to be a moral imperative.

If Only They Could both Lose………

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It’s a battle between an insurance company and a pharmaceutical company over a drug that probably doesn’t work but has a lot of fans:

Blue Shield of California will no longer pay for the use of the drug Avastin to treat breast cancer, a sign that support for the widely debated and expensive treatment may be eroding among health plans.

Blue Shield, with 3.2 million members, is apparently the first large insurance company to end payments since a federal advisory committee unanimously recommended in June that the Food and Drug Administration rescind Avastin’s approval as a treatment for breast cancer, saying the drug did not really help patients.

The F.D.A. commissioner, Dr. Margaret A. Hamburg, has not made a final decision, so Avastin retains its approval for now.

Because it is an emotional and politically contentious issue, with some women saying the drug is keeping them alive, many insurers have said they will wait until a final decision from the F.D.A. before re-evaluating their coverage policies. And Medicare has indicated it will continue paying for the drug even if the F.D.A. revokes the approval.

Until people realize that there is not a problem with the cost of prescription drugs because the real problem is the price of drugs, and so private solutions to innovation, with the associated exclusivity provisions, are the problem, not the solution.

This is What You Get When You Cut a Deal With the Devil

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Could it be ………… Satan?

As Obama did when he kowtowed to the insurance industry and killed the public option.

You get accelerating inflation for medical insurance:

The cost of health insurance for many Americans this year climbed more sharply than in previous years, outstripping any growth in workers’ wages and adding more uncertainty about the pace of rising medical costs.

A new study by the Kaiser Family Foundation, a nonprofit research group that tracks employer-sponsored health insurance on a yearly basis, shows that the average annual premium for family coverage through an employer reached $15,073 in 2011, an increase of 9 percent over the previous year.

“The open question is whether that’s a one-time spike or the start of a period of higher increases,” said Drew Altman, the chief executive of the Kaiser foundation.

The steep increase in rates is particularly unwelcome at a time when the economy is still sputtering and unemployment continues to hover at about 9 percent. Many businesses cite the high cost of coverage as a factor in their decision not to hire, and health insurance has become increasingly unaffordable for more Americans. Over all, the cost of family coverage has about doubled since 2001, when premiums averaged $7,061, compared with a 34 percent gain in wages over the same period.

I wonder what could be driving this?  Maybe the desire to beat implementation dates for price controls?

How much the new federal health care law pushed by President Obama is affecting insurance rates remains a point of debate, with some analysts suggesting that insurers have raised prices in anticipation of new rules that would, in 2012, require them to justify any increase of more than 10 percent.

The difference between health insurance companies and Satan is that there are some things that Satan just won’t do.

I Love Our Healthcare System

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My wife has spent much of today finding who we need to call in order to get a certificate of what is called “creditable coverage,” which we need to get or pre existing conditions covered.

I am seriously considering moving to Vermont when their single-payer plan becomes operational.

Posted via mobile.

Vermont Senate Passes Single Payer Healthcare

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The Vermont state Senate has now passed the single payer healthcare bill, and, assuming no problems in conference committee, will shortly head to the governor’s desk, where he has promised to sign it.

Of course, the whole thing is dependent on getting a waiver from HHS, and I’m dubious of that bit, because Obama has shown himself to be the FIRE (Finance, Insurance, and Real Estate) sector’s bitch, and you can be sure that the insurance companies will be trying to do whatever they can to drive a stake through the bill’s heart.