Tag: Insurance

The Republicans May Not Have toRepeal Obamacare

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Obamacare is good only in comparison to the status quo.

The best part of it, of course, is Medicaid expansion, which is basically single payer.

One of the claims made by Republicans is that Obamacare has reduced the quality of healthcare.

This is not true.

Another claim is that it is in the process of collapsing under its own weight.

This is (IMNSHO) untrue as well, but it appears that the ACA is at risk of collapsing its own insubstantiality:

Karen Slessor’s health insurance is hanging by a thread.

Slessor, a Reinbeck widow who has diabetes and arthritis, is one of nearly 72,000 Iowans who are on the brink of losing coverage as Congress tries to overhaul the country’s health care system. The at-risk Iowans buy their own health insurance policies, usually because they don’t work for employers that offer coverage and they don’t qualify for government insurance programs, such as Medicaid and Medicare.

Iowa is the first state where consumers face the likelihood of losing all access to individual health insurance policies, but experts say other states could soon follow.

The two largest health insurers offering individual coverage in Iowa, Aetna and Wellmark Blue Cross & Blue Shield, announced last month that they would stop selling such policies for next year because of heavy financial losses and uncertainty in the market. In most of the state, that left just one relatively small carrier, Medica. The situation became critical on Wednesday, when Medica leaders said they probably also will pull out of Iowa.

If you know your Streetcar, you know that Blanche DuBois depended on the, “Kindness of strangers,” and Obamacare depends upon the, “Kindness of insurance companies.”

Of course, insurance companies have no kindness, and this problem with a lack of providers is not limited to Iowa, Tennessee has s similar (though less dire) situation, and huge swaths of the country have only one provider on the exchanges, meaning that Obama’s neoliberal* vision for healthcare reform would have been in trouble if Hillary hadn’t lost the election.

Barack Obama’s merry band of free market mousketeers may have created a system that is fundamentally unsustainable.

*At Naked Capitalism, in the aptly named post, “Neo-liberalism Expressed as Simple Rules,” gives two basic rules:

1. Because markets.
2. Go die!

This is Not a Surprise

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Concealed within the 123 pages of legislative verbiage and dense boilerplate of the House Republican bill repealing the Affordable Care Act are not a few hard-to-find nuggets. Here’s one crying out for exposure: The bill encourages health insurance companies to pay their top executives more.

It does so by removing the ACA’s limit on corporate tax deductions for executive pay. The cost to the American taxpayer of eliminating this provision: well in excess of $70 million a year. In the reckoning of the Institute for Policy Studies, a think tank that analyzed the limitation in 2014, that would have been enough that year to buy dental insurance under the ACA for 262,000 Americans, or pay the silver plan deductibles for 28,000.

As part of an effort to rein in soaring executive pay, the ACA decreed that health insurance companies could deduct from their taxes only $500,000 of the pay of each top executive. That’s a tighter restriction than the limit imposed on other corporations, which is $1 million per executive. The ACA closed a loophole for insurance companies enjoyed by other corporations, which could deduct the cost of stock options and other “performance-based” pay; for insurance companies, the deduction cap is $500,000 per executive, period.

The idea was to signal that the ACA, which cemented health insurance companies into the center of American healthcare, wasn’t a pure giveaway to the industry.

“Consumers across America should know that when they pay their hard-earned dollars to cover the soaring cost of premiums, they are not just chipping in to pay for the CEOs’ next new yacht,” said then-Sen. Tom Harkin (D-Iowa).

………

The House Republican bill repeals the compensation limit as of the end of this year. The GOP hasn’t exactly trumpeted this provision; it’s six lines on page 67 of the measure, labeled “Remuneration from Certain Insurers” and referring only to the obscure IRS code section imposing the limit. Repeal of the provision apparently means that the insurers will be able to deduct $1 million in cash per executive, plus the cost of “performance-based” stock awards and options, like other corporations.

This is just how Republicans roll.

Take money from poor people so that rich folk can afford that 3rd yacht.

They really should have been drowned at birth, all of them.

Well, This is a Hoot

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It appears that in discussions with the Republican Party leadership, representatives of the healthcare and insurance industries said that they Obamacare repealed and replaced with Obamacare:

The nation’s health insurers, resigned to the idea that Republicans will repeal the Affordable Care Act, on Tuesday publicly outlined for the first time what the industry wants to stay in the state marketplaces, which have provided millions of Americans with insurance under the law.

 The insurers, some which have already started leaving the marketplaces because they are losing money, say they need a clear commitment from the Trump administration and congressional leaders that the government will continue offsetting some costs for low-income people. They also want to keep in place rules that encourage young and healthy people to sign up, which the insurers say are crucial to a stable market for individual buyers.

 ………

 On Tuesday, Marilyn Tavenner, the chief executive of America’s Health Insurance Plans, a leading industry trade group, warned that the state marketplaces were already on unstable financial footing. Failing to continue the funding aimed at low-income Americans, she said, would have far-reaching consequences because the business would become much tougher for insurers.

 ………

 Hospital groups also held a news conference on Tuesday to warn of what they said would be the dire financial consequences of a repeal if the cuts to hospital funding that were part of the Affordable Care Act were not also restored.

 ………

 Ms. Tavenner did not give many details about her group’s positions, but she said its top priority was to stop the immediate threat of eliminating the subsidies for plans sold to low-income people. House Republicans have already sued to block these payments, and the lawsuit is now delayed. If the new administration chose not to defend the lawsuit, the money would disappear, and insurers would probably rush to the exits because fewer potential customers would be available.

 Another of the industry’s concerns is ensuring that enough young and healthy people sign up to stabilize the market. Republicans have discussed eliminating one of the law’s main tools, the so-called individual mandate, a tax levied on those who do not enroll.

 In talking with Congress, Ms. Tavenner said, her members are emphasizing the need for some alternative, especially after criticism by insurers that the penalty is not large enough to persuade enough people to enroll. “There’s not one magic solution,” she said. She pointed to some of the provisions in Medicare that encourage people to sign up before they become sick. And she discussed some options to ease how insurers price their policies to be able to offer plans that are less expensive to younger people.

 She also argued that the insurers had no desire to return to the time before the law was passed, when people with pre-existing conditions were routinely denied coverage in the individual market.

So basically, they want the subsidies, marketplaces, and mandates, but apart from that they are fine with whatever is done.

Of course, subsidies, marketplaces, and mandates are Obamacare:  The rest is commentary.*

*Yes, I am applying a quote from Rabbi Hillel.

Yes

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Over at FT, Gillian Tett asks, “Did Obamacare help Trump?“

The answer, of course, is yes, and it did Even If It Improved Medical Outcomes for one very simple reason:

Or to put it another way, Obamacare is not just a tale about healthcare and costs; it is also a story of people who feel trapped in a capricious system that they don’t understand, much less control. Little wonder, then, that Trump’s message about empowerment and fixing Obamacare turned out to be so popular this year. Now let’s see if he can deliver.

(emphasis mine)

This is typical of incrementalist “squish” progressives.

They create a program with overweening bureaucracy with extensive means testing, and create a system that is opaque and abusive to to its recipients.

For them, it’s a win-win:

  • They think that they can sell this to conservatives, because they ensure that all recipients are “deserving”. (Note: this never happens)
  • They create jobs for the professional class that is the base of the Obama/Clinton wing of the party.
  • They create opportunities for private gain, which is an independent good according to their neoliberal worldview, because it will create market driven innovations.

Of course, this makes any of their programs about as pleasant as a trip to the DMV, and convinces the general population that government screws up anything.

This May be My Best Writing of the Decade

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A participant at the Stellar Parthenon BBS was commiserating about how he had to buy health insurance, and it was all expensive and crappy coverage.

He ruefully observed that  his cheapest option (he’s a Jew) was to join “Medi-Share”, an evangelical Christian health co-op, but that would require him to, “Declare a personal relationship with the Lord Jesus Christ.”

Somehow or other, my muse grabbed my hands, and this flowed from my fingers:

You know, back in the day, Jesus and I went drinking and engaged in pig contests.

The person who beds the ugliest babe wins.

He never lost, and once he came 1st, 2nd, AND 3rd.

Damn! That guy could work miracles with women.

And he could make a Tequila Sunrise like no one’s business.

Eventually though, he flunked out of school.

Test problems, he got nailed on the boards.

I am so glad that (at least until January 21) I live in a nation where blasphemy is legal.

Tom Daschle Would Suck off a Corpse for a Cheeseburger

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Tom Daschle, who never left Washington, DC after losing his bid for reelection in 2004, and has become a lobbying hired gun, and as Matt Taibbi noted in the above hed, has no shame.

Case in point, lobbying Hillary Clinton while refusing to register as a lobbyist:

Former Democratic Senate Majority Leader Tom Daschle pushed Hillary Clinton’s top aides to consider supporting a massive health insurance merger for one of his clients — even though at the time he was not registered to be a company lobbyist.

Daschle registered to be a lobbyist for Aetna in February of 2016, which subjected him to disclosure and ethics regulations. However, an email released Thursday by Wikileaks shows Daschle pressing the company’s agenda with political power players in October 2015.

“I wanted to reach out in reference to Hillary’s statements today regarding the insurance mergers,” Daschle wrote to Clinton campaign chairman John Podesta on the day Clinton publicly raised questions about the merger. “I certainly understand her concerns over the pending deals. I’ve been working with Aetna on ACA [Affordable Care Act] involvement for the past several years. That has led to other health related matters including the merger. Their team has what they view to be compelling arguments around the benefits of the Humana merger and why it will be beneficial for consumers.”

Then Daschle said: “Would you and your team be willing to have a conversation with them?”

Clinton’s campaign ultimately declared its support for a Justice Department lawsuit aimed at blocking the merger.

In 2015, a joint study by the nonpartisan Center for Responsive Politics and the Sunlight Foundation spotlighted how many former members of Congress appear to be circumventing ethics rules by working in government relations on behalf of corporate clients, but not registering as lobbyists.

Daschle’s wife — a former federal aviation regulator-turned-airline lobbyist — opened her own lobbying firm in 2008.

This isn’t just an ethics issue.  It’s what I call back loaded bribery, and it is a cancer on the American body politic.

The Darkside of Obamacare

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This is Grim

The problem with the PPACA is that it relies to a large degrees on the better angels of the insurance companies.

You probably notice the problem here. The Venn diagram of “Insurance Companies” and “Better Angels” is a null set:

The health care costs that Americans pay out-of-pocket are rising–both in total amount, which is perhaps not a surprise, but also as a share of incomes, which is perhaps more disturbing. Ann Foster discusses the pattern in “Household healthcare spending in 2014,”  written as a “Beyond the Numbers” short essay for the US Bureau of Labor Statistics (August 2016, vol. 5, no. 13). She has lots of details of spending in particular areas, but here’s an overall figure showing out-of-pocket spending by households as a total amount (left axis) and as share of total expenditures (right-hand axis).

 Part of the reason for this rise is that more Americans have health care insurance with high deductibles: that is, the amount you pay out of pocket before the insurance kicks in. Here’s some information from the most recent Kaiser Family Foundation 2016 Employer Health Benefits Survey.  The report notes:

“[T]he share of covered workers in plans with a general annual deductible has increased significantly over time: from 55% in 2006, to 74% in 2011, to 83% in 2016, as have the average deductible amounts for covered workers in plans with deductibles: from $584 in 2006, to $991 in 2011, to $1,478 in 2016.”

One of the central conceits of Obamacare is that if “Consumers”* have “Skin in the game” it will constrain healthcare costs.

This ignores the looting by insurance companies, pharma, as hospitals, as well as the fact that the price of medicine in all forms is ruinously expensive in relation to every other industrialized nation on the face of the earth.

Obama, and the rest of his nudge theory† obsessed free market mousketeers, are completely captured by the Chicago School world view.

I would note that the Chicago boys have been wrong about everything since Mrs. O’Leary’s cow knocked over that damn lantern.

*Consumers, never citizens, because we have no significance beyond consumption.
†Nudge theory posits that by making small market based influences, you can accomplish anything without significant government intervention.‡
‡It’s also almost complete bullsh%$.

Doing the Right Only Requires Months of Public Shaming

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For months, it has been known that Katherine Wade, former in-house lobbyist for CIGNA and now Insurance Commissioner for Connecticut, has had major conflicts of interests in the states review of the merger between Cigna and Anthem. (Her husband is a lawyer for Cigna as well)

She has finally agreed to recuse herself from reviewing the merger:

Connecticut Gov. Dannel Malloy’s top insurance regulator, Katharine Wade, agreed to recuse herself from her state’s review of a massive healthcare merger between Anthem and Cigna, amid mounting criticism of her ties to Cigna. Wade had been leading a multistate review of the deal, which critics say could raise insurance premiums for 53 million Americans across the country. The recusal announcement came from Wade’s attorney during a meeting of the Office of State Ethics, which has been investigating the situation.

The merger between Anthem and Cigna appeared to be moving forward for months, but was thrown into turmoil after a months-long International Business Times investigative series into Wade and Malloy’s ties to Cigna. That series prompted a state ethics probe — and soon after the Department of Justice sued to block the merger.

………

As IBT’s series documented, Cigna and Anthem pumped campaign cash into the Democratic Governors Association — which is run by Malloy — at the very time they were pursuing their merger. While the cash flowed into the group, Malloy appointed Wade to head his state’s insurance department. She had served as an in-house lobbyist for Cigna, is married to a Cigna attorney and is the daughter-in-law of another attorney listed as representing the company. Malloy’s administration also promised to help Cigna if it pursued the merger.

Even by the standards of Connecticut politics, (The state is pretty much a wholly owned subsidiary of the insurance industry) this was pretty brazen.

Corrupt as Hell, but Completely Legal

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I have made mention of Connecticut Governor Mike Malloy’s unseemly closeness to Cigna and Anthem while his administration was reviewing a merger between the two insurance behemoths, appointing an insurance company lobbyist to review their merger.

Well, this story just got even more brazenly corrupt:

Facing criticism over his decision to appoint a former Cigna lobbyist to a position regulating Cigna’s controversial merger, Connecticut Governor Dan Malloy has sought to distance himself from the merger review. The regulator in question, Katharine Wade, has said she followed all applicable conflict-of-interest rules. But newly unearthed documents detail Malloy’s meetings with company officials and with Wade — and also raise new questions about Wade’s financial connections to Cigna.

The emails were released to International Business Times in response to a series of open records requests amid a state ethics probe that has helped throw the colossal Cigna-Anthem deal into turmoil. Connecticut has been leading the multistate regulatory review of the deal, which physicians and consumer groups say could raise healthcare premiums for up to 53 million Americans across the country. Soon after the launch of the ethics probe about whether Wade must recuse herself from the regulatory review, the Department of Justice filed a lawsuit aimed at blocking the transaction. Connecticut’s ethics office is expected to rule on the Wade controversy in the coming weeks.

Malloy has maintained that his state’s merger approval is “an independent decision” by his insurance department and that he has not been involved in the merger review. The documents, though, shed new light on his contacts with the companies and his regulator while that review was proceeding.

One set of documents shows that the governor met with Anthem CEO Joseph Swedish on August 28, 2015. That was two days after Anthem and Cigna executives met with Wade’s agency specifically about Connecticut’s merger review, and the same day Anthem donated $25,000 to the Democratic Governors Association, which backed Malloy’s closely contested election campaigns. At the time, Malloy was already gearing up to lead the DGA in 2016.

Emails previously obtained by IBT show that Malloy spoke with Swedish and Cigna CEO David Cordani the night before the merger was announced. They also show that Malloy’s top economic development official told Cordani the governor’s administration would help Cigna if the company pursued the merger. Calendar items just obtained by IBT show Malloy later met with Cordani in the governor’s office in June of 2016 — three days after Connecticut Common Cause called for the ethics probe of Wade over her ties to Cigna.

………

Another set of documents shows that Malloy met with Wade a few weeks after Anthem announced its bid to merge with Cigna and just days before the transaction was cemented. Malloy met with Wade two more times as the merger progressed. Immediately after one such meeting, Insurance Department visitor logs show Wade met with Amy Lazzaro — Cigna’s lobbyist in Hartford who had previously served as the Connecticut Insurance Department’s chief of staff.

………

Connecticut has suspended its review of the merger, pending the outcome of the federal lawsuit against Cigna and Anthem. But because that case could be settled and the merger could still go forward, ethics regulators decided to continue their review of Wade: She is a former Cigna vice president whose husband works at the company and whose father-in-law has been listed as a company attorney. Emails obtained by IBT suggest that their inquiry into whether Wade must recuse herself from the merger review is focusing specifically on her own agency’s strict conflict-of-interest rules.

The depressing thing is that with recent court rulings on corruption prosecutions, this is all completely legal.