The Purging Begins

Somehow, I don't think they really have our best interests at heart:

"[HHS Secretary Shecantbeserious] is proposing to reform existing healthcare regulations and purge unnecessary ones ... We are committed to cutting the red tape for health care facilities"

Oh, I can certainly think of one "unnecessary" healthcare law tax, can't you?

In a fit of uncontrolled irony, Ms Shecantbeserious has released a "114-page proposal cover[ing] a range of medical positions and services"

You really can't make this stuff up.

The problem, of course, is that - with these folks - one must always look for the actual, usually hidden, motivation. That is, nothing they do is ever really for our own good. So although this looks good on (lots and lots of) paper, it's fair to ask "what are they really trying to accomplish?"

In this case, it seems pretty reasonable that they're beginning to understand the incredible provider shortage that they've created, and are now scrambling for a way to somehow mitigate the damage.

Rotsa ruck with that.

HIX and Obamacare

One thing we can always agree on, the federal government is in a class by themselves when it comes to redundancy and coming up with creative (and not so creative) acronyms for another bureaucratic process.

Meet HIX.

Health Insurance Exchange will now be referred to as HIX.

One can imagine the looks you will get when you tell your friends you work for HIX.

The exchanges are supposed to use one application process to help consumers find out whether they are eligible for health coverage subsidies or for exemptions from the PPACA "shared responsibility" health insurance ownership mandate.

Life Health Pro

One application.

The 21 page application linked above.

Yes, that should make it simple. Something like form 1040 + Schedule A + Schedule B + Schedule C all rolled in to one.

Don't you just love the term "shared responsibility"? Makes it sound like we are just one big family. Or it takes a village . . .

Now take a look at who is involved in helping you find a plan and determining if you are even eligible.

An exchange program "Data Services Hub" will help exchanges get eligibility information and check applications by pulling data from the Internal Revenue Service, the Social Security Administration, the U.S. Department of Homeland Security, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, the Peace Corps and the federal Office of Personnel Management.

The Peace Corps?

Or as the prez calls it, Peace Corpse.

With that many agencies helping, what could possibly go wrong?

For all exchanges, CMS will administer the new PPACA health insurance purchase tax credit program and the new "cost-sharing reduction" program, officials said.

There's that term again.

Cost sharing gives you a warm, fuzzy feeling, right?

In addition to PII about HIX program applicants, the system will include PII about navigators, agents and brokers; exchange employees and contractors; CMS employees and contractors; insurers that sell coverage through the exchanges; and employers that have workers sign up for health coverage through the new Small Business Health Options Program (SHOP) exchanges.

In addition to names, contact information and health coverage information, the types of data that could be stored in the record system could include information about whether an individual is incarcerated, the individual's religion, the individual's household income, and information about whether an individual is pregnant.

Sounds like hacker's heaven. All that data flowing around between agencies, just waiting to be taken.

Think it will never happen?

Guess again.

Remember the spy drone that was hacked by the Iranian military and forced to land inside their borders? Of course we asked them to give it back.

No word on whether Hell has frozen over or not.

And don't forget you are working with HIX.

Thanks to Henry Stern for the heads up.

Obamacare Logjam

Let's say you have a new give away and need to sign up 30 million folks in 90 days. What do you do?

In the case of Obamacare, you plan to hire "navigators" to assist in the process. These navigators are kind of like online Wal-Mart greeters whose job is to direct you to the right health insurance plan.

While some people will find registering for health insurance as easy as booking a flight online, vast numbers who are confused by the myriad choices will need to sit down with someone who can walk them through the process.

Enter the “navigators,” an enormous new workforce of helpers required under the law. In large measure, the success of the law and its overriding aim of making sure that virtually all Americans have health insurance depends on these people. But the challenge of hiring and paying for a new class of workers is immense and is one of the most pressing issues as the Obama administration and state governments implement the law.Tens of thousands of workers will be needed — California alone plans to certify 21,000 helpers — with the tab likely to run in the hundreds of millions of dollars.

Washington Post

California is broke, as are several other states. Where will they get the money to pay for these navigators?

Groups such as unions, chambers of commerce, health clinics, immigrant-service organizations, and community- or consumer-focused nonprofits can use the grants to train and employ staff members or volunteers to provide in-person guidance — especially to hard-to-reach populations — and to provide space for them to work.

That is a rather diverse group that is expected to become versed in the business of health insurance terms, plans and procedures. So if you need landscaping work, a green card and health insurance you can get it all at one place . . .

Compounding the difficulty, de Percin said, is that many of the uninsured struggle with English or don’t have easy access to the Internet. Others aren’t familiar with concepts like co-payments and deductibles, let alone the subsidies that will be provided for lower-income people or the new eligibility rules for Medicaid.

And the folks that wrote this law never considered any of this . . .

In a kind of Catch-22, the money must come from an exchange’s operating funds, which will rely on fees from insurers. But those won’t be available until at least Jan. 1, well after navigators must be in position.

States can pitch in during the meantime. But that’s an unlikely option in Colorado, which has stringent rules governing its budget.

Buy now, pay later. Hire someone that knew how to ask if you want fries with that order and make them navigators.

What could possibly go wrong?

Cavalcade of Risk #176: Short and Sweet edition

Dennis Wall hosts this week's collection of risk-related posts. From telecommuting to drug prices, you're sure to find something helpful.

Lame Stream Media MIA

Two big Obamacare stories have cropped up in the last week or so, but the low information voter will probably never know anything about these developments. If they are Fox news fans, or follow conservative blogs like Heritage (or InsureBlog) they will be informed.

But if they live under a rock, or get their news from the lame stream media of ABC, CBS, CNN, NBC or USA Today they are SOL.

A few days ago as reported here on InsureBlog, the IRS informed us that the average family health insurance premium under Obamacare will run $20,000 per year.

Where did we get our information?

From CNS News.

We also could have found out from Drudge, Townhall, Rush Limbaugh, Sean Hannity, Daily Caller, Hotair and numerous other sources.

But not from ABC, CBS, CNN, NBC or USA Today.

Keep in mind this information did not originate from some dirty old man in a dark alley, or a shadowy figure named "Deep Throat".

The proclamation that health insurance rates will rise to $20,000 came from the I.R.S.

Yes, the folks in D.C. that come calling every April, 15th and will be responsible for oversight of the Obamacare premium subsidy program are telling us health insurance premiums are expected to go through the roof.

This of course is in direct opposition to the campaign promise of lower insurance premiums.

Now we learn that an estimated 7 million people will LOSE health insurance under Obamacare.

More Americans lose employment-based insurance. CBO has updated its projection for the number of Americans who will lose employer-sponsored insurance (ESI) as a result of Obamacare. In August 2012—about six months ago—it estimated that 4 million people would lose ESI. It now estimates that 7 million Americans will lose ESI due to Obamacare. Also, employers are now anticipated to pay $13 billion more in penalties compared to the August 2012 baseline, totaling $130 billion over 10 years.

Heritage

Where did the folks at Heritage get their information?

From the CBO (Congressional Budget Office).

You can also learn this information from WND, Twitchy (Michelle Malkin) and the Washington Examiner.

But if you rely on ABC, CBS, CNN, NBC or USA Today you are once again part of the low information crowd.

There is a reason they are called the lame stream media.

Now you know why.

Calhoun Memorial Hospital Closes

Calhoun Memorial Hospital is closing. The loss of this Georgia hospital is a combination of the failing economy and financial strain caused by uninsured patients and increased number of Medicaid patients.

A handful of other rural hospitals in the state also may be teetering on the brink, with rising levels of uninsured patients and with Medicaid continuing to pay low rates for services.
HomeTown Health, an organization of rural hospitals in Georgia, says a half-dozen facilities could follow Calhoun Memorial’s move and shut down in the coming months.

Georgia Health News

Providers that accept Medicaid patients receive roughly 20% less than Medicare pays for the same services and Medicare pays about 15% less than private insurance carriers. With more patients relying on Medicaid doctors and hospitals feel the squeeze and have to take action.

Hospitals that accept any kind of federal funds cannot refuse Medicaid patients but doctors and other medical providers are not obligated to treat Medicaid patients.

The 25-bed “critical access’’ Calhoun Memorial is the first rural Georgia hospital to close since Telfair Regional Hospital in McRae, in south-central Georgia, closed in 2008, Lewis said Monday.
Earl Whiteley, CEO of Calhoun Memorial, cited the increase in charity care that the Calhoun County hospital incurred as a major reason for the hospital’s demise.
He told GHN on Monday that indigent charity care rose from $834,000 in 2008 to $1.8 million last year.
“You just can’t continue to give away free care,’’ Whiteley said.

Tell that to the low information voters that gave Obama another 4 years.

Whitley said part of the financial crisis is due to the loss of indigent care funds under Obamacare. Those patients were supposed to be covered under Medicaid expansion but Georgia, like most other states, do not have the money to pay their share of the cost of Medicaid.

Prior to Friday’s action, the Calhoun hospital authority had sold an assisted living facility and its nursing home. The hospital had stopped admitting patients, so there were none left to transfer to other hospitals. A medical clinic will remain open in Arlington, Whiteley said.
The economic impact on Arlington and Calhoun County will be profound, with up to 100 employees losing jobs.

With the closing of this Georgia hospital, local residents will have to drive about 45 minutes to the nearest hospital.

Everyone Counts (except you) . . . A timely reminder about government exercise of power

Via Drudge, we learn this from the London Daily Mail Feb 1:

The British National Health Service (NHS) is launching a program called Everyone Counts.  This program requires family physicians to hand over to NHS their patients’ confidential and personally-identifiable records including drinking habits, waist size, weight, cholesterol, BMI, family health history and pulse rate, and other details.  Physicians are ordered to comply.  Patients cannot opt out.

NHS plans to “analyze” the data.

I’ll just bet they do, too.

NHS officials say the data will be stored in a giant information bank where, they insist, it will be “anonymous and deleted after analysis.”

This raises several questions about the program er, excuse me, programme. 

Will anonymous third-parties be supplied with this patient data for analysis? 

Is the patient data easier to hack when it resides in a “giant information bank” or when it's supplied to an unknown number of anonymous third-parties, or when it remains where it is now, in tens of thousands of physician office files?

How long “after analysis” will NHS delete the data?  A day?  A decade?

Here's a better question  – will a day ever come that is "after" NHS “analysis” ends?

Here's the best question of all – what reasons do the British public have, to believe anything NHS officials say about this new program, er programme?

This seems to me a timely reminder that, when the people agree to give powers to the government, the government will actually, you know, use those powers.  This also seems a timely reminder that sometimes governments will use their powers for purposes the people don’t want - and which the government may strenuously deny it's doing.  Thus, the article quotes an unidentified NHS spokesman: "The NHS constitution makes clear what information can be used for by the NHS and this proposal complies exactly with that."

History teaches that to expect governments to behave otherwise is foolishly naïve. 

Excise tax on Medical equipment costing jobs

The 2.3% excise tax on medical equipment kicked in and has already been blamed for hundreds of layoffs.

Looking back at some larger claims we have paid over the years, this tax could be fairly significant. Seeing $100,000 in equipment charges is not at all uncommon for back surgeries and other procedures. This would appear to be another great reason to go out of country to have these procedures done. $2,300 would cover airfare and accommodations.

"The medical device excise tax applies to manufacturers and importers and generally does not apply to individual consumers."

Those attacking our healthcare system will cheer the $300,000 back Surgery bill  only costing $40,000 in India, Costa Rica, or where ever else. I think the American workers who used to make the equipment and perform these procedures - who are now out of work - might not agree so much.

How long before this loss of revenue has the TSA screening for people wearing untaxed equipment crossing back over the border? Are you bringing any fruits, vegitablles or untaxed medical devices with you today?

Someone who passed economics might have an interesting time rationalizing the impact of $300,000 in domestic spending replaced by $40,000 in foreign spending and its impact on our economy. I have a feeling we don't really "save" $260,000.

Stupid Consumer Tricks

From the same LA Times act of Psuedo Journalism comes this gem of projection;

"The Long Beach woman said she sought treatment in 2009 for a pain in her abdomen. First her doctor ordered a CT scan of her abdomen and pelvis at Liberty Pacific Medical Imaging, an independent facility near Long Beach Memorial.

She got approval from Blue Shield, and she paid the negotiated rate of $660."

"This time, her surgeon referred her to the hospital's imaging center. Snyder said she assumed her bill would be about the same because it was the identical test. Instead, Blue Shield's rate with Long Beach Memorial was $3,497 and the insurer told Snyder she owed $2,336,"

Wow. I would be pissed, too, if I was asked to pay $2,336 for a test I could get down the street for $660. She should go after the hospital or the doctor who referred her to the hospital....right...?

"In a complaint filed last month in Orange County Superior Court, Snyder accused Blue Shield of unfair business practices, breach of good faith and misrepresentation over her medical bills. The suit seeks class-action status on behalf of other Blue Shield customers."

HIPAA would make it hard to find out, but I have to wonder if her chronic case of stupid was pre-existing or not. Sue your health insurance because you assumed a hospital would charge the same as a free-standing imaging center.

What is the Part B late enrollment penalty?

This is not intended to be a trick question.  But in the Fair Kathleen Sebelius' HHS, it appears to have a trick answer.

On page 25 (page 26 in the on-line version) the 2013 Medicare handbook "Medicare and You" states that "Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it."

That sounds pretty clear - what's the praahblem? 

Well.  Since you ask.

It seems there is a Social Security document called the “Program Operations Manual System.”  This document is essentially the operating instructions and rules for Social Security.

As it happens, a little-known, double-secret codicil in this manual requires that anyone who declines Medicare benefits thereby forfeits their Social Security benefits.

In early 2012, a legal challenge arose - Hall v Sebelius - over this double-secret Social Security rule.  The plaintiff argued that neither the Social Security Act nor the Medicare Act allows administrative agencies to precondition benefits under one program on acceptance of benefits from another.

The district court disagreed and the U.S. Court of Appeals for the D.C. Circuit affirmed the lower court decision. Both decisions were sharply divided.  In January 2013, the Supreme Court declined to hear the case. By its decision, the Supreme Court let stand the lower courts' controversial ruling.

So the "trick answer" is yes, you face a 10% per year premium penalty for failing to enroll in Part B when eligible.  But that is the least of your worries -  your penalty is actually much greater.  You have forfeited your Social Security benefits.

This much greater penalty for non-enrollment is NOT included on page 25 (or 26) of the Medicare and You handbook.  It's still double-secret, you see.  

Are we all clear now?

Left unanswered at this time - "how long does the SS Admin wait after you are eligible for Medicare but don't enroll, to take away your SS benefits?"  One quarter?  One month?  One hour?

LA Times' Pseudo Journalism

I have believed for a long time that one of the major reasons our healthcare system has sunk so far is the public knows so little. They are fed endless misinformation and downright lies by politicians and our so-called journalists,  while the public blames greedy insurance companies with 40% profit margins. The LA Times has dumped the latest pile of journalistic malpractice on us; So many problems with this piece of agenda propaganda, possibly the worst:

"For those patients who have insurance, getting the lower price would typically mean withholding that information from the hospital or clinic. Experts warn that doing so, however, means any payments don't apply to customers' annual insurance limits for out-of-pocket spending."

According to these "Experts" (and why are they never named?), if you pay a medical bill, you can not submit it to your insurance company.  Apparently insurance companies don't have claim forms or mail boxes where members can submit claims.

As usual, hacks like Chad Terhune - who rush in to push a lie - miss the real story: the far bigger problem is people paying cash to get a discount, then submitting to insurance and getting deductible credit for more than they pay. If someone accepted the cash discount then billed their insurance, the insurance company would have no way to know the member paid a discounted rate and would process the deductible credit at the higher allowable. Not exactly the story Chad was trying to sell, is it?

We see this already in Rx: Member co-pay cards circumventing plan designs and allowing members to pay substantially less then their benefit plan calls for.

The error was pointed out to Chad, but don't expect the LA Times to actually correct an article. They don't like facts getting in the way of their agenda.

Ding Dong - Obamacare Calling

Next time your doorbell rings it may not be the Avon lady or Jehovah's Witnesses. It very well could be Obamacare peddlers.

Organizing for Action, the successor to President Barack Obama’s presidential campaign, and Enroll America, a group led by two former Obama staffers that features several insurance company bigwigs on its board, are planning to unleash the same grass-roots mobilization and sophisticated micro-targeting tactics seen in the 2012 campaign.

Instead of getting people to vote, they’re trying to get people to buy insurance.

If the coalition is successful, 30 million uninsured Americans will get health coverage and the now-unpopular law that Obama’s team pushed through Congress and defended at the Supreme Court could go down in history alongside lauded national institutions such as Medicare and Social Security.

Politico

What is questionable is, among other things, the legality of such an approach.

Most areas ban door to door solicitation unless you have a permit. We also have federal and state do not call lists.

Some states, Ohio being one of them, ban door to door solicitation for Medicare supplement plans (and possibly other forms of insurance as well).

Agents that are approved to offer Medicare Advantage plans are EXPRESSLY PROHIBITED from direct solicitation, either door to door or telephone. The Advantage plans are regulated by CMS and HHS.

And of course you must understand that ANY insurance product can only be applied for through a licensed agent.

 if large numbers of younger and healthier Americans don’t sign up for coverage this fall alongside the older and sicker ones, the whole thing won’t work.

The challenge is real: The White House has not been able to penetrate the confusion and skepticism about the law in the nearly three years since its passage. Numerous polls have shown that people still don’t know what’s in the law, or how it could benefit them. 

Young people, those under 30, typically do not buy insurance now and there is no reason to believe that will change under Obamacare.

The exception would be if coverage was free.

Even if 100% of the under 30 crowd signs on, the premiums generated by them is not enough to offset the claims of the older, sicker crowd.

Furthermore, carriers really don't want the highly subsidized crowd as policyholders. Anyone that has ever been to an "all you can eat" buffet knows you don't exactly attract the tri-athlete crowd and free or almost free health insurance will be the same.

On top of all the other challenges is, and always has been, where will DC get the money for the 18 million or so to be covered under Medicaid expansion plus a like number (or more) that should qualify for significant premium subsidies?

The PCIP concept was a good example of a good idea gone bad. The program has lost money in every situation in spite of the fact it failed to meet enrollment objectives. Since DC isn't accountable for anything, we may never know how many taxpayer dollars were pissed away on PCIP.

Obamacare is just another scheme that will leave the folks behind the concept twisting in the wind.

Did Shecantbeserious Blink?

Perhaps, but any celebration over victory of her usurpation of the 1st Amendment is premature:

"[HHS Secretary Shecantbeserious and/or her minions] on Friday announced a broader opt-out for religious-affiliated groups that want to skirt the so-called contraceptive convenience item mandate ... Businesses like Hobby Lobby ... would probably not be affected by the change ... For those with insured plans, the insurer would be required to provide enrollees with "no-cost contraceptive coverage" through a separate policy."

As usual with these rocket surgeons, there's more exemptions than anything else. So who would likely benefit?

A much smaller list:

"[R]eligious nonprofits that object to the mandated coverage of contraceptives, one that will allow large faith-based hospitals and universities to issue plans that do not directly provide birth control coverage."

But even that's a cop-out, because they'll still be required to provide a "stand-alone, private insurance policy that would provide contraceptive coverage at no cost."

At "no cost" to whom?

Yeah, I know.

By the way, sharp-eyed readers will note that I elided over "self-insured plans, a third-party administrator would work with an insurer to set up no-cost coverage through other policies." Your patience will be rewarded.

Cavalcade of Risk #176: Call for submissions

Dennis Wall hosts next week's Cav. Entries are due by Monday (the 4th).

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

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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.

The New ObamaRate$

Remember this:

"Your health insurance premiums will decrease by 3000%"

Yeah, no:

"[T]he Internal Revenue Service (IRS) assumed that under Obamacare the cheapest health insurance plan available in 2016 for a family will cost $20,000 for the year ... In the examples, the IRS assumes that families of five who are uninsured would need to pay an average of $20,000 per year to purchase a Bronze plan in 2016."

Which is, of course, much higher than any (non-enforceable) penalty tax that might be due.

Adding insult to injury, those expected rate increases will be coming in ahead of schedule. In email this morning from Aetna:

"On January 17th, we sent an email message announcing our decision to discontinue the initial 12-month rate guarantee for new business policies with a January 15, 2013 or later effective date ... To prepare for 2014 when new health care reform changes regarding products and rates will take effect"

As Aetna notes, they are not the only carrier to make this change, and I can't imagine any other carrier sticking with annual rate guarantees from here on out.

Glad we passed it to find out what's in it?