Interesting HSA Idea

07:00 – by 0
One of the great benefits of 9 years of blogging is that, when something new comes along, there's a good chance that we've already posted on something similar.

The bad news is, it's not always easy to find the relevant (older) post.

Case in point:

In the most recent edition of LifeHealthPro (an industry resource), there's an interesting article about using HSA's (Health Savings Accounts) as retirement vehicle supplements. I know that we've touched on this before, but can't find that post (nor the one explaining how patients could access their HSA's for overdue doctors' bills).

Oh, well.

In the event, the aforementioned article details both the benefits and the potential pitfalls of using one's HSA as a retirement vehicle. This fits in very well with my own worldview: I often characterize HSA's as "medical IRA's." The take-away from the article is that most folks don't seem to know this, and may be losing out on a potentially substantial nest-egg enhancement.

Politics and Religion

10:27 – by 0
What does politics and religion have to do with insurance?

Actually quite a bit.

The insurance industry is heavily regulated, some say over-regulated, by government. These days government is more about politics than it is about doing what is right for the citizens.

And religion?

Like it or not, religion also plays a part in your insurance benefits. Consider the (still ongoing) political and religious battle over the birth control mandate in Obamacare.

Being more of a Libertarian than anything else, it would be nice if there were less intrusion into insurance by politics AND religion.

But the recent shellacking of Rep. Eric Cantor made headlines for a lot of reasons. Many said he was out of touch.

He was.

Others said he was more interested in power than the people.

True as well.

But this bit, buried in an op ed piece really annoys me.
David Wasserman, a House political analyst at the nonpartisan Cook Political Report, said another, more local factor has to be acknowledged: Mr. Cantor, who dreamed of becoming the first Jewish speaker of the House, was culturally out of step with a redrawn district that was more rural, more gun-oriented and more conservative.
“Part of this plays into his religion,” Mr. Wasserman said. “You can’t ignore the elephant in the room.”
 NY Times via Atlanta Journal Constitution

Mr. Cantor lost because he is Jewish?

Seriously?

Cavalcade des risques #210

05:53 – by 0
Monsieur Jeff Root hosts this week's round-up of risky posts from the home of Brie, Merlot and Deneuve. It's a great one, too, with an interesting selection of posts covering everything from Paget's Disease to the World Cup.

Amusez-vous!

More Red Hot Lover/Physician Tricks

11:30 – by 0
Over 4 years ago, we documented this "questionable" provider trick:

"Dr. Daniel R. Lerom is listed in documents as having a long-standing sexual relationship with his Lakeland patient ... Each time the two had sex ... the doctor would bill her Blue Cross Blue Shield Insurance for their "sessions."

Well, it seems that Dr Lerom has been upstaged, by Dr Carlos Danger Arthur Zilberstein:

"Medical authorities have suspended the license of a Seattle anesthesiologist for allegedly sending explicit “selfies” and exchanging sexy text messages during surgeries."

Turns out, the good doctor was apparently quite the multi-tasker, anesthetizing with one hand while sending out almost 250 sext-messages with the other, "including explicit sexual comments.”

So here's the burning question: did he also bill the insurers for his per-text charges?

Inquiring minds and all that...

[Hat Tip: FoIB Holly R]

Professional Help

09:58 – by 0
The Urban Institute released a study yesterday on how people obtained information regarding enrollment and options for health insurance through exchanges. For something we were told would be "more like buying plane tickets or a home appliance" online the results of this study prove exactly what everyone at IB have been saying since this train wreck started off the tracks. 

"Insurance agents and brokers had the highest rating; over 80 percent of adults who used them found them very or somewhat helpful."



83.9% to be exact. Well above the 58% success rate of call centers. This isn't an "I-told-you-so" moment. Rather, it is an opportunity for HHS (listen up Sylvia) to engage with a profession that can actually help them insure more people in the right products to fit their needs and budget.

We'll be waiting for your call.

Tuesday Morning Roundup [UPDATED!]

07:09 – by 0
■ Did you know this? Via email, the folks at Medical Mutual of Ohio alert us that:

"All policies written in 2014, including those with effective dates of June through December using special enrollments, will renew on January 1, 2015."

This applies to any new plans written on or off the Exchange, and folks who believed the lie that they could keep their previous policies, and who were then "mapped" to new, ACA-compliant plans. 

■ Still feeling secure about the ObamaTax Exchange?

"Managers of Connecticut's relatively smoothly running state-based health insurance exchange are having to answer questions about a security breach. Someone found a backpack containing personal information from hundreds of Access Health CT users at a deli in Hartford."

No word yet on whether this included pastrami or corned beef, but it sure was piled high. 

■ Our friends at FlexBank report that the folks in DC have released the new Health Savings Account (HSA) contribution guidelines for next year:

"The new maximum calendar year contribution for HSAs of $3,350/single and $6,650/family."

Compared to this year, that's an increase of $50 for individuals and $100 for families.

Folks aged 55 and up can also make additional "catch-up" contributions of up to $1,000.

■ Oh, this just in (speaking of ObamaTax Exchanges):

"... the Connect for Health Colorado Board of Directors voted for a $13 million increase in taxes for those insured under the Colorado health exchange to help the exchange make up for a budget deficit"

I'm sure that it's a complete coincidence that the Centennial State's Exchange CEO, Patty Fontneau, just received a $14,000 bonus and a 2.5% pay raise (on a nearly $200,000 annual salary).

Great gig if you can get it, no?

That Bites!

12:20 – by 0
Via email from Humana:

"Due to a system limitation of the Federal Marketplace, when a consumer is enrolled in both a medical and dental plan through the Marketplace, termination of one plan automatically terms the other, even if the plans are through different carriers."

Note that this is not because Ms Shecantberious nor Ms Burntwell have so decreed (for once!), but is a glitch within the 404Care site itself. So what's the recommended solution?

Oh, you'll love this:

"A consumer who wishes to drop one plan ... but keep the other, will need to ensure the Marketplace call center rep understands [this] ... The Marketplace agent can then initiate a Health Insurance Casework System (HICS) inquiry to the carrier of the plan they wish to keep, in order to keep the coverage active."

Easy-peasy lemon squeazy, right?

Um, that's what they thought, too:

"Thousands of Americans who have asked the federal government to fix errors on their Obamacare applications aren’t likely to get solutions anytime soon."

It's an emergency!

08:37 – by 0
Or maybe not. As we noted almost exactly 3 years ago regarding RomneyCare:

"... according to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in emergency room visits."

And since we know that The Bay State's experiment begat the ObamaTax, this should come as no surprise:

"Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they've seen more visits since Jan. 1"

And 90% expect that number to rise in the very near future. Of course, that's to be expected: when you have "free" health insurance, a third party paying for the bulk of your care, and fewer doctors available to provide it, well, what did the rocket surgeons ion DC expect to happen?

Connecting Dots (Again)

07:27 – by 0
So there's this (from FoIB Holly R):

"The uninsured rate for U.S. adults appears to be leveling off ... The uninsured rate so far in the second quarter of 2014 is 13.4%"

Which is pretty much what it was before the ObamaTax and all its broken promises. Great. But it gets better (for a certain value of "better"):

"Almost none of the uninsured will end up paying the ObamaCare mandate penalty, according to an updated analysis by the Congressional Budget Office, which found that 87% will be able to claim an exemption."

So, after 4 years, billions of dollars and a failed website and enrollment system, we've made barely a dent in the number of those going without health insurance, nor incentivized them to remedy that situation.

Surely, though, the new regime has met the president's goal of significantly cutting the deficit, right?

Not so much:

"The CBO has consistently projected that President Obama's overhaul will reduce the deficit ... the agency quietly signaled that it can no longer make that projection; that the law had been changed and delayed so much that there is no longer a credible way to estimate the long-term effects on the deficit."

That's what happens when one uniltaerally decides which parts of the law will be enforced, and against whom.

Quelle surprise.

Cavalcade of Risk #210: Call for submissions

06:03 – by 0
Jeff Root hosts next week's Cav. Entries are due by Monday (the 9th).

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.

Clueless in D.C.

20:22 – by 0
Washington finally did it. They cobbled together a law so complex that no one could
understand it nor estimate just how much it will cost.
Congressional budget scorekeepers said they can no longer measure the fiscal impact of many provisions of ObamaCare because the task is impossible. 
The Hill

But those who are subject to the law are expected to estimate their income a year in advance.


Surprise, surprise, suprise! [UPDATED]

12:04 – by 0
Or maybe not:

"More than 2 million people who got health insurance under [the ObamaTax] have data discrepancies that could jeopardize coverage ... About 1 in 4 people who signed up have discrepancies"

Wow.

Just. Wow.

Here's the thing: all these people think they have insurance (well, such as it is). Presumably most of them aren't going to the doc every day, so it may be a while until they find out that things are amiss.

What happens if that's in the ER after a heart attack?

Or the OR for that unscheduled caesarian?

Or at CVS for the insulin that just ran out?

Think those might cause some issues?

UPDATE: A reader points out (correctly), that the linked article is unhelpful as to the nature of the "discrepancies." While the point of this post was primarily to underscore the implications of them, it's a fair cop.

So, after a little digging, we found additional details:

"For consumers, a discrepancy means that the information they supplied, subject to perjury laws, does not match what the government has on record ... Most of the data conflicts involve important details on income, citizenship and immigration status — which affect eligibility and subsidies."

So it seems that this isn't about misstating age or location, but income and citizenship status. This is potentially explosive, because of the perjury issues, but also whether the coverage was ever actually in force.

Thanks, Matt, for the nudge!

Just Like They Have in England ...................

06:37 – by 0
For those who pay attention to the real news, and have connected the dots between the VA
mismanagement scandal and Obamacare, it seems you are right.
The first name to emerge as the favored choice to head the Department of Veterans Affars previously predicted that Obamacare will eradicate employer-based insurance and push the U.S. towards a single-payer system “like they have in England”. The Wall Street Journal reported that Dr. Delos “Toby” Cosgrove, who heads the Cleveland Clinic, is being heavily sought by the Obama administration to replace Gen. Eric Shinseki, who was forced out last week amid the VA wait list scandal.
If you think that's bad, here is the other shoe.
In the interview, Cosgrove was asked if he thought employers would stop providing health insurance despite being penalized under Obamacare.Cosgrove indicated they would. "The first ones will be the small companies,” he told the Wall Street Journal. “Every CEO I’ve talked to knows how much he’d save between insuring his people and paying the federal penalty.”“The first time some big player does that, it’s going to fall like dominoes,” he continued. “What that does is drive everybody to the exchanges.”
If this gives you warm fuzzy feelings, you might want to see a doctor.
While you can still get in ...........................

Tuesday Potpourri

09:54 – by 0
■ Britain's Much Vaunted National Health System© continues to defy attempts at parody:

"[MVNHS©] patients could be forced to pay for their bed and board in hospital unless there is a cash injection into health services after the next election"

Who knew "free" health care could cost so much?

[Pictured above: new MVNHS©-approved suturing kit]

Keep in mind that this is the system upon which our own ObamaTax is largely based.

■ And speaking of the ObamaTax, the IRS [ed: ever notice that "the IRS" can easily be shortened to "TheIRS?"] has helpfully released the new employer reporting requirements:

"First, Section 6055 requires health insurers and employers sponsoring self-funded group health plans to annually report to the IRS and to responsible individuals (the enrolled employees), whether the coverage constitutes minimum essential coverage under the ACA."

Seems reasonable enough, until you consider the admin costs of compliance. And there's this: people leave jobs and move away; is it now the (ex-)employer's onus to track them down?

Take a wild guess.

And lest we forget:

"Second, Section 6056 requires large employers ... to report to the IRS and to full-time employees for two purposes: To assist the IRS with enforcing the employer pay-or-play penalty; and To assist full-time employees with determining their eligibility for a [subsidy]."

"[E]nforcing the employer pay-or-play penalty" Looks like they're serious - good thing they can't force you to eat broccoli.

Yet. 

■ This is nice:

"The Obama administration is distributing fourth round of health plan rate review grant money to state insurance departments"

And now in English:

"Secretary Shecantbeserious is skimming off tax dollars and then sending out what's left to states which have knuckled under."

And how much of this largesse is she ready to dole out?

$40,000,000 of your money.

You're welcome!

Oh, you want to know the purpose of this grand gesture?

Here ya go:

"States can use the money to get the legal authority to review rate changes, to expand the scope of existing rate review operations, to make rate information available to the public through the Web, and to analyze medical claims reimbursement data"

Funny, but I thought the states already had the authority to review rate hikes, er, changes. And why, pray tell, does an Insurance Department need to "analyze medical claims reimbursement data?"

Inquiring minds want to know.

Hipsters and Health (insurance)

07:01 – by 0
Our good friend Bob Graboyes, senior research fellow at George Mason University's Mercatus Center, has a really biting, witty and incisive post at Reason.com, about how young folks are the ones getting ripped off by the ObamaTax:

"One day, you'll be 60 years old with a big house" doesn't imply, "so pay big bucks now to subsidize unlucky me and my grand digs ... No one says a healthy 26-year-old should subsidize the life insurance for the 60-year-old because 26 is lucky and 60 is unlucky"

Read the whole thing (it's a quick read).

Ballsy Insurance Carrier Trick

11:06 – by 0
I believe this may be a first:

"The Farmers Insurance Company is suing 98 Illinois towns, Cook County, and the Metropolitan Water Reclamation District of Greater Chicago, asserting they were insufficiently prepared to deal with the effects of global warming that allegedly caused  heavy rains and flooding in those areas last spring, damaging property, which led to expensive claims against the company"

Really?

At first glance, this seems pretty silly, but it appears that the entities involved may have hobbled themselves:

"Cook County, the City of Chicago, and other municipalities had “adopted the scientific principle that climate change has caused increases in rainfall amount” and to help address the problem had adopted the Chicago Climate Action Plan."

Seems like they have only themselves to blame.

One thing I'd like to know is why Farmers waited so long to take action. Here's what I mean:

Carriers do periodic inspections of properties they insure, and notify clients of any deficiencies. For example, it may be a roof badly in need of repair: the carrier may require the insured to have it fixed or the policy will be cancelled. So if Farmers knew about the Change Plan (which they obviously did), then were they actively following up to see if it was being implemented and, if not, why not?

Bizarre.

Maybe I can be of Assistance [UPDATED]

11:53 – by 0
I have been closely following the VA situation - I cannot call it a scandal, for reasons I will explain - and wish to offer some much needed assistance. This is of interest to me for two reasons:

First, my husband served 8 years in the Air Force and as such is eligible for the VA Healthcare. However, even when he was in (1985-1992) we knew then that the VA did not deliver either on-time care or good quality care and we always planned on using the civilian system.

Second, of course, I am interested since I am in Medical Practice Management. As a previously certified medical manager with my MBA and over 15 years of management experience, I think I can help them solve the problem very quickly and easily.

“In a testy exchange Wednesday evening, Rep. Tim Huelskamp (R-Kan.), a member of the House Veterans Affairs Committee, blasted a government bureaucrat for his failure to do something about the 1,700 veterans who were waiting for primary care appointments at the Phoenix veteran’s hospital, but who were never placed on an electronic waiting list.”

So let’s break this down. How can the VA see and treat 1,700 veterans? In the civilian world, primary care appointments are approximately 15 minutes. So, 1,700 veterans seen at 15 minute intervals are 425 hours. When my husband was in the military he routinely worked 12 hour days. So, since this is an emergency, let’s set the workday for 10 hours, with staggered lunches so patients can continue to be seen. So, at 425 hours broken down in 10 hour days, that would be 42.5 days. So in a little over one month, every patient can be seen and this is based on one provider seeing all 1,700 patients. In the civilian world a primary care doctor normally sees 30 patients a day, so that doctor would see 1,700 patients in 56 days. At 20 business days a month, 12 months a year, a primary doctor sees a minimum of 7,200 patients a year; any primary doctor will tell you that they probably see double that number in a year.

This would solve two issues; 1) it would remove the need for wait lists, simply schedule the patient for their next appointment at the time of service (how many times has your primary care doctor put you on a wait list instead of scheduling your next appointment?) and 2) the veterans would have the care they deserve.

I did not call this a scandal because this is business as usual in the world of military medicine, or socialized healthcare in America. When my husband was in the Air Force we used the military healthcare system, which while it was not difficult, it was also not a pleasant experience. The issues revolved around lack of timely appointments, physicians unable to quickly treat a condition without first a lab test, x-ray, etc. (I once waited 5 hours in a wait room for the test results of a UTI so I could get medication. After 5 hours, the doctor gave me a prescription while he waited for the results), not willing to remedy a medical situation, (After driving 3 hours to the nearest base with an ENT, the doctor refused to remove my daughter’s ear tubes, which had been in over a year. Once we were civilian, she needed surgery to close a hole in her ear caused by the tube being in for over 2 years), and general attitude by the medical community that we, their patients, were a bother. Sound familiar?


This is not a new development, but instead an ingrained culture in the Military Medical Community. Now this is, of course, not true for every individual in the Military Medical Community, but being in the system and working in the civilian medical world this is the rule rather than the exception. If the government is serious about correcting this situation, then may I suggest that they pattern themselves after the civilian model, which has worked very well for decades or they can keep doing what they have been doing and getting the same results.

ADDENDUM [HGS]: Well, this guy certainly seems promising:

In case you were wondering...

07:46 – by 0
Yeah, it was that bad:

"This document shows that, on its first full day of operation, October 1, 2013, Obamacare’s Healthcare.gov received only one enrollment! That’s one – out of 334 million Americans. On the second day, 48% of registrations failed to process."

Now, we've covered that part before, but here's something else to consider:

"As of October 31, 2013, there were 1,319,425 accounts created nationwide – but only 30,512 actual enrollments."

That's a 98% fail rate - and that's after they had over 3½ years to design, test and implement the Exchange.

And yet, Ms Shecantbeserious and her boss continue to tout the Exchange as a "success," and House Minority Leader Nancy Pelosi calls it "Beautiful:"

On Vaccines and Health Insurance

07:00 – by 0
Over the years, we haven't been afraid to express our doubts about the efficacy and/or safety of certain vaccination regimes, notably Gardisil and the various flu varieties. we've not, however, weighed in (in any substantive way) on the controversy over the potential correlation of MMR vaccination and autism. The one link I could find that even touched on this was from early 2009:

"Turns out that the doc who connected the dots between the MMR vaccine and childhood autism may have significantly fudged his numbers"

But there is a large segment of our society that does buy into this connection, and they're having an effect:

"Between 2009 and 2010, there were 3,502 cases of mumps among New York City’s Jewish community ...  in 2010, 9,210 children in California contracted whooping cough ... it’s just a matter of time before insurers seek subrogation for claims stemming from outbreaks directly tied to an unvaccinated person."

Here's the problem: your unvaccinated child comes to school and causes an outbreak of, say, whooping cough. Presumably, this won't include the kids who've been vaccinated, but those who haven't are going to have some insurance claims.

Who pays for this?

First, it helps to understand the concept of subrogation. It's really pretty simple:

"The right for an insurer to pursue a third party that caused an insurance loss to the insured. This is done as a means of recovering the amount of the claim paid to the insured for the loss."

Here's an example: you get bit by a dog and go the the ER, which bills your health insurance company for the shots, x-rays and stitches. Your health insurance carrier then goes after the dog's owner (or their homeowner's insurance carrier) for reimbursement.

How does this relate to non-vaccinated kids?

Well, take that example of the child who caused a whooping cough outbreak. Would the various health insurance carriers paying out for expensive tests and treatments like to find a source for reimbursement? You bet they would, and guess who's coming under those cross-hairs?

Now, how likely is it that there'll be a spate of these cases? Probably not very, at least not yet. But if this movement continues to grow, then it seems probable that carriers - always on the lookout to maximize returns - are going to be looking for additional opportunities.

We'll definitely be keeping our eyes on this one.

A dollar here, a dollar there... [UPDATED]

10:30 – by 0
Remember when the ObamaTax was going to solve the "crisis" of the uninsured?

Yeah, about that:

"About half of uninsured Americans surveyed didn’t try to sign up for health coverage under Obamacare because they said they couldn’t afford it"

And by the way, kudos to Ms Shecantbeserious for making sure these folks knew about the subsidies.

Wait, what?

"[M]ost [were] unaware that financial assistance was available."

It's almost as if the whole excercise was screwed up from Day 1.

UPDATE: So just how many folks have signed up since Open Enrollment ended?

Hard Impossible to say:

"The U.S. Department of Health and Human Services has not released any QHP enrollment figures for the exchanges it runs since the end of the open enrollment period, and some observers say it may not release new QHP enrollment figures until the 2015 open enrollment period begins."

Here's a thought: if it was a rousing success, do you think they'd be keeping these numbers under wrap?

Obamacare Medi-Cal Fail

08:32 – by 0
The California gold rush to gain free health insurance is on the rocks. Alameda Alliance,
founded in 1996, appears headed for bankruptcy.
As more Californians fall under Medi-Cal, the state's health care program for the poor, the Alameda Alliance for Health was one of a handful of local providers poised to cover them after the new national health law took effect this year.
But the financial problems of the Alameda Alliance are a "calamity" and a "debacle" for its mostly low-income enrollees, the state Department of Managed Care said in court papers this month after naming a conservator to oversee the nonprofit public health care provider.
More than 200,000 area residents that rely on the Alliance will be kicked to the curb.
"The crisis is not simply a matter of bookkeeping woes," said a court memo by Carol Ventura, deputy director of the state Department of Managed Care, which regulates health plans. Ventura wrote that the Alameda-based insurer could also be committing "serious violations" of state law by not promptly paying back some 280,000 backlogged claims.
That's a good way to pi$$ off providers as well.
"The Alliance has no controls over its spending," he wrote. He wrote that Alliance increased staffing faster than membership growth, and spent more on furniture, equipment and software than comparable providers.
Hmmmmmmmmmm. Where have we heard this kind of thing before?
He blamed a combination of factors, including problems with the new mandated computer system, a huge number of new members in January and underpayment by the state for care of seniors with disabilities.
Government run health care, a thing of beauty.
Not!

Employer Move Blocked

20:34 – by 0
Employers thinking of dropping health insurance and sending employees to the exchange
might want to reconsider.
Such arrangements do not satisfy the health care law, the administration said, and employers may be subject to a tax penalty of $100 a day — or $36,500 a year — for each employee who goes into the individual marketplace.
New York Times

Ouch!

First the gummint says you MUST buy health insurance, now they block you from buying it on the exchange.

Aren't there laws against this?
Many employers — some that now offer coverage and some that do not — had concluded that it would be cheaper to provide each employee with a lump sum of money to buy insurance on an exchange, instead of providing coverage directly.
Nice idea, but don't forget to factor in the $36k penalty.
“For decades,” Mr. Biebl said, “employers have been assisting employees by reimbursing them for health insurance premiums and out-of-pocket costs. The new federal ruling eliminates many of those arrangements by imposing an unusually punitive penalty.”
No kidding.

Wonder what other surprises are in store?


Interesting Carrier News

07:30 – by 0
Not all of our company-related posts are for Stupid Carrier Tricks© [ed: believe it or not]. Sometimes, there's just interesting announcements. For example:

■ In Special Open Enrollment news, United Healthcare has come out with its take on what counts as a Qualifying Event. What's interesting to me is that, for once, a carrier also explicitly details those things which don't trigger a Special Enrollment, most notably: "Voluntarily ending coverage."

Why is that so notable?

Because I've been getting a number of folks complaining about their existing plan's premiums, and wanting to switch (as if an ObamaTax-compliant plan is a real bargain). I've had to explain to them that, even if I could find less expensive coverage, it does them no good until next Fall.

■ As one who has seen Hospice Care up-close-and-personal, let me assure you that there are no finer people in the health care delivery system. What's a shame is that not everyone even knows about Hospice, or how to access their services. In fact, Dr. Randall Krakauer (a vice president at Aetna) recently testified before a Senate committee on Aging " urg[ing] senators to improve end-of-life benefits for patients in Medicare Advantage plans by changing the rules that govern use of hospice benefits. Medicare managers should let enrollees who seem to have as many as 12 months to live use hospice benefits."

Typically, Hospice services are available only to those who face imminent death, not a year away. Expanding that could relieve some of the burden from traditional health care facilities.

■ Our friend (and Long Term Care insurance guru) Randy G tips us that Genworth has made available an interactive map comparing cost of (long term) care across all 58 states.

Of course, I checked my own beloved Buckeye State, and saw that the average cost for a (semi-private) room in a nursing home is north of $75,000 a year.

Are you prepared?

Cavalcade of Risk #209: Call for submissions

05:48 – by 0
Claire Wilkinson hosts next week's Cav. Entries are due by Monday (the 26th).

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.

Just When You Thought it Couldn't Possibly Get Any Worse ...............

13:14 – by 0
You run across this report on the Obamacare SNAFU:

The full extent of the failure, however, is reflected in the details provided by the Judicial Watch FOIA document revelations. They include:

  • On October 1, there were 43,208 accounts created and 1 enrollment. 
  • As of October 31, 2013, there were 1,319,425 accounts created nationwide -- but only 30,512 actual enrollments in Obamacare. 

Keep in mind that enrollment means someone selected a plan and put it in their shopping cart. It doesn't mean they actually applied for coverage ..................... or paid their premium.

A New Twist on an Old(er) Idea?

12:27 – by 0
We've been blogging about Medical Tourism for going on 8 years. Generally, we've referred to two "flavors:"

1 - Foreign nationals taking advantage of what they perceive to be superior health care here in the US, and

2 - Americans traveling abroad for less expensive treatment, ostensibly as good as what's available here.

But there seems to be a new and growing trend: inter-state medical tourism.

Hunh?

Here's the idea:

"The phenomenon of this new trend in medical travel -- inter-state to Centers of Excellence (COEs) throughout the country and inbound to the U.S. – is largely the result of the impact of U.S. health reforms, employer receptivity to introducing a medical travel benefit, consumer willingness to travel to other parts of the United States to access quality care with improved outcomes, and increased demand for more cost-effective care"

Nate's discussed this idea before, that higher cost doesn't necessarily translate to better outcome. And there's a growing sense among employers that this is an area that can be addressed. Currently, it appears that only self-funded plans will be able to easily add this benefit, but one wonders if there'll be a move among the fully-insured crowd to do so.

One obstacle, of course, is the ObamaTax and its requirement for plan conformity. Perhaps this could be marketed as an "ancillary" benefit, available to groups (maybe even individuals) who are willing to pay for it.

Health Wonk Review: Life's a Beach edition

05:30 – by 0
Good morning, and welcome to this edition of the Health Wonk Review.

In casting about for a theme suitable to the occasion, my mind wandered a bit (as it's prone to do this time of year), and I flashed on a serene stretch of sand and crystal clear water (and no, I did not have my hands wrapped around an ice cold Corona).

And so, I figured I'd share some moments of calm as we plunge into the best of the blogosphere's posts on health care polity and policy:

■ First up, a blast from the past: Jared Rhoads has transitioned from the more traditional blog platform to the v-log model (Mazel tov, Jared!). He last hosted the HWR back in January of 2012. In this vid-post, he presents the Urban Institute's Howard Gleckman discussing the challenges of financing Long Term Care.

■ Next, Chris Langston (Program Director of the John A. Hartford Foundation) offers his take on how the Center for Medicare and Medicaid Innovation (CMMI) might improve its effectiveness.

■ Bradley Flansbaum thinks that maybe the P4P (Pay for Performance) train has lost its caboose. He points out that the P4P phenomenon isn't an exclusively American idea: the Brits have been at it for a long time, "with mixed results."


■ HWR co-founder (and all around mensch) Joe Paduda ventures into Workers Comp territory (watch out, Julie!), ACA plan rate increases, Medicaid non-expansion and a few other interesting tidbits in this eclectic (and interesting) post.

■ Health care guru Roy Poses is concerned about how much money is being thrown at the boob-tube over the past few years in attempts to influence the public's perception of ObamaCare. He's also leery of the anechoic effect (which he introduced and explained way back in '06: "Why is it that folks can behave like such miscreants and everyone turns a blind eye?").

■ David Williams offers us the transcript of a podcast he recently did with the director of a new, not-for-profit effort designed to provide unbiased information to help patients choose physicians. It's called "The Doctor Project," and David's interview provides some background and a progress report.


■ I refer to Jason Shafrin as my favorite health care economist for a reason: he knows his stuff. This time out, he explores how the ACA's Medicaid enrollment expansion has affected even those states which didn't opt in to it.

■ For some reason, I always smile when I see posts from Wing of Zock. Ann Bonham, PhD (chief scientific officer at the Association of American Medical Colleges) offers her insights on the need to address sex differences in pre-clinical research that relies on cell and animal models (Whew!). I say: Viva la difference!

■ Julie Ferguson is one of my very favorite blog-buddies: she coordinates the HWR, helps me out when I run into glitches with the Cavalcade of Risk, and always has interesting, thought-provoking posts. This one's sure to take your breath away, perhaps literally, as she presents a last letter from a dying miner caught in a 1902 collapse, and takes to task public authorities both here and in Turkey for failing to safeguard the lives of contemporary miners. 

 ■ Louise Norris is another great blog-friend, and this week she offers her perspective on reference-based pricing. She explains how it's really just another way of looking at the difference between in- and out-of-network costs, and that the patient just needs to be more aware of them.

■ Harold Pollack interviews Sabrina Corlette, a Research Professor and Project Director at Georgetown University’s Health Policy Institute. They discuss how the new health insurance marketplaces are actually working: how many have paid their premiums, differences between the kinds of available insurance plans, the likely impact of the “Cadillac tax” on high-expenditure insurance plans, and more.

■ Finally, our own Kelley Beloff (a Certified Medical Office Manager) posts about the reality of physicians' wages. Spoiler: they're not as great as you've been led to believe.

Thanks for stopping by, and please make sure to join us again in 2 weeks over at Joe P's place.

You Are a Man, Not a Woman

10:30 – by 0
Woe be unto you if you have an Obamacare plan and the government does not know your
gender.

A report that aired on Asheville, NC ABC affiliate WLOS on Tuesday detailed the plight of college student Shelby Higdon, who under ObamaCare was refused medicine because of a gender mix-up within the ObamaCare provider's system, which according to Higdon could not be fixed due to bureaucratic red tape. 
"When it was time to get my medicine, they told me that they couldn't give it to me because on my insurance I was registered as a man," Higdon said. 
Breitbart

Guess you need to borrow Tina Fey's bossy pants

Predictive Analytics (A Risky P & C Post)

07:00 – by 0
So, a few weeks ago, I attended one of our carriers' annual sales meeting. This is a fun-filled afternoon of speakers discussing topics ranging from commercial automobile polices to surplus markets, loss ratios and liability umbrellas.

Oh yeah, and 5 minutes on life insurance.

Oddly enough, I always enjoy this meeting, primarily to put faces and handshakes with voicemails and intercompany emails. And this year, my curiosity was piqued by the introduction of a new (to me, anyway) term: Predictive Analytics (PA).

This is a risk-assessment tool that enables Property and Casualty companies to further refine the underwriting process. After the meeting, I spent a few minutes with the gentleman who had discussed the topic, and he agreed to put me in touch with one of his PA experts.

A few days later, I had the opportunity to spend about a half hour on the phone with Sam (not his real name - carriers are generally skittish about speaking on the record, which I can understand). In the event, Sam was forthright and interesting. Here's the low-down:

Predictive Analytics (aka "modeling") is used primarily on underwriting commercial (and sometimes other) risks. It really began in the 90's with personal auto policies; it's an extension of a concept called "risk segmentation" that's used in addition to more traditional categories.

Basically, PA delves more deeply into the financial and demographic data of a given risk (property or business). This goes beyond, by the way, just credit scores (which are the subject of some controversy in the industry). In commercial lines insurance, this could include information from the Bureau of Labor Statistics and even the Census Bureau.

Sam stressed that PA is useful in the aggregate, but (obviously) can't predict how an individual risk would behave; it's an indication of what's "likely" to happen, not what's "going" to happen. Which seems a lot like traditional underwriting (just because you have diabetes doesn't mean you're going to lose a limb). The difference is something called "univariate" versus "multivariate" analysis.

Yikes.

Univariate analysis is generally used in traditional underwriting: things like construction (steel vs wood), protection class (is it near a fire hydrant) and occupancy.  These are looked at individually and summed up.

Mulitvariate analysis uses these, but then adds in financial, demographic and other information and - most importantly - how all of these factors interact with and affect each other.

And then there's the "secret sauce:" each carrier has its own formula for determining what weight to give each of these factors and how they interrelate: what's the propensity for a loss to which this information leads you? This will differ from carrier to carrier. That's why, for example, Company A might say "no thanks, we're not writing that" and Company B might say "hey, we'll give you a great rate!"

Sam also stressed that these models have to be constantly updated, as data and relationships change over time with the change in a carrier’s book of business. The models are (as noted above) customized for each carrier, but there's a bit of a catch to that:

There's a limited pool of Subject Matter Experts available in this field, so each carrier's models will be similar but still variable based on each carrier’s history and philosophy.

Thanks, Sam!

Health Insurance with Medicaid is the Perfect Gift

11:08 – by 0
This is not a headline from The Onion. It was an email I received yesterday from the "team" at Healthcare.gov. Even better than the headline was the message that followed.

Mother's Day might be behind us but it's not too late to give your mother a special gift. Let the moms in your life know that health insurance is available through Medicaid and the Children's Health Insurance Program (CHIP)

Wait, I'm confused? Wasn't the last enrollment blitz focused on mothers telling their children to sign up? Obviously that didn't work since Obamacare fell way short of enrolling the necessary number of Young Invincibles.

I guess the "Nag Toolkit" used in Rhode Island didn't work either. Although I highly doubt any mom would want to use sites like Tinder, OK Cupid, Vine, SnapChat, or Twitter to inundate their kids.


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