You Can Check Out But You Can Never Leave

As we posted before, sometimes getting OUT of Obamacare is as difficult as getting in. 

Well, it get's worse.

A fellow agent in the midwest has two clients that are turning 65 and would like to get OUT of Obamacare and INTO Medicare.

But they can't.

Both bought through the exchange.

In his own words . . .

First case tried to log in (to healthcare.guv) and do life event and change the needed information on the application. It removes any/all subsidy for the spouse who is not Medicare. Agent in my office could have made this easier by putting the account in husband's name, not the wife.

The second, my 10am this morning, was a DIY case, no log in, will have to call the exchange this morning. Same, account should have been put in his name and not hers since she was only a few months off Medicare.

Yes my friends, it seems it is easier to enter the U.S. illegally than to get rid of your Obamacare plan.

Pesach 5774 / Passover 2014

Tonight marks the first evening of Passover, and the first of the two traditional meals called "seders" ("seder" means "order"). It's a ritual and a meal, and commemorates the end of the Israelites' 400 year stint as slaves to the Egyptians.

I use the term "Israelites" because there is a significant school of thought which holds that we didn't really become "Jews" until the Covenant at Sinai.

The ritual itself, at least as practiced today, dates back about 1000 years or so, so it's actually a rather recent addition to our history. Still, it's by far my favorite "Chag" (holiday). This year, as most, we will host seders both nights, with a great (and different) mix of folks at both.

Chag Pesach Sameyach!

(PS Click here for a detailed and interesting deconstruction of so-called "Christian Seders")

Caution, Socialism at Work

Universal health care is a wonderful consideration, but the political dogma doesn't match up with results.  

We were told the U.S. was the only civilized nation that did not have free health care. 

So?

Is free better?

Half of nurses are working through breaks or beyond their shift, revealing a health service under severe strain

Three out of five of those questioned felt that staff numbers led to lower standards of care, while almost half said they were looking after eight or more patients.

Guardian

And this is good in what way?

"Despite all the government rhetoric, despite the Francis, Keogh and Cavendish reports, the spectre of another Mid Staffs still looms large over theNHS. Progress on safe staffing levels has been glacial and that means poorer care and patients still at risk.

"It's clear that despite nurses working through breaks and beyond their hours, they simply do not have enough time to give patients the care and attention they need. That is distressing for patients and for the staff trying to care for them.

Government rhetoric.

Has a familiar ring . . .

"The government needs to face up to the damage it is inflicting on patients and staff, by not introducing legally enforceable nurse-to-patient ratios, and take urgent action."

So a problem created by the government needs a government fix?

Egad. It's worse than I thought. Does Britain have low information voters too?

Stupid is as stupid does.

Goodbye Shecantbeserious, Hello Burntwell

While I realize that it's not a "done deal," the latest from DC tells us that the ObamaTax is in the very best of hands:

"[Burntwell] testified “in laborious detail about what she had found in Mr. Foster’s garbage on the night he died.”

Dumpster-diving Diva Burntwell seems to be eminently qualified to continue the ObamaTax.

Split Personality

The creators of Obamacare envisioned a massive overhaul of the U.S. health care system that

would insure millions. Noble idea, long on grand intentions, short on effectiveness.

Liz Linton feels stuck in health insurance limbo. She has policies protecting herself and her husband, but no coverage for her two children. "They pretty much told me I'm out of luck," said Linton. "If something happens, you're responsible for the bill." On December 16th, the Goreville mother met with an enrollment counselor. She discovered her children qualified for the All Kids state program.  "I signed up," said Linton. "She told me it would probably be a month or two before we hear anything." However, two months have now stretched into more than four. Her youngest child also came down with a case of bronchitis.

WSLITV

The Medicaid angle isn't working so well. Too many people want free health insurance.

But Mrs. Linton should share some of the blame. Open enrollment started October 1, but she waited until December 16 to start the process.

She rolled the dice and lost.

Cavalcade of Risk #206: Call for submissions

Dennis Wall hosts next week's Cav. Entries are due by Monday (the 14th).

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

Dennis would specifically like to see posts about residential mortgages, force-placed insurance, the participants in the mortgage process, the participants in securitization of mortgages.
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.

Patrick's in The Federalist (Again)!

For the second time in as many months, co-blogger Patrick has penned a post for The Federalist. This time, he discusses O'Care's impact on Employer-based (ie group) health insurance plans:

"Now that there is a tax for not having it many have simply added on to their employer’s plan. As shown in the Kaiser Employer Sponsored Benefits Survey from 2013, small employers foot a significant portion of the premium."

Definitely read the whole thing.

Is your healthcare different today than it was yesterday?

The Center for Medicare services has released how much it paid doctors in the year 2012. The big news is that one doctor in Florida made a lot of money:

“Medicare paid a tinygroup of doctors $3 million or more apiece in 2012. One got nearly $21 million.”

Let’s take a look at these doctors based on CMS own data: “a small sliver of the more than 825,000 individual physicians in Medicare's claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.”

So if only 344 physicians earn the top dollar out of 825,000 physicians how much did the other 824,656 physicians make?

“The median payment — the point at which half the amounts are higher and half are lower — was $30,265.”

While we don’t know what the other physicians made, we do know that the median amount paid to all physicians was $30,265. Medicare makes up about 30% of the payer mix for an average physician’s office. So what we can concur from this information, from the most transparent administration in the history of America, is that 30% of a physician’s revenue was approximately $30,000. Does this information in any way change how you choose a doctor?

“Employers, insurers, consumer groups and media organizations pressed for release. Together with other sources of information, they argued that the data could help guide patients to doctors who provide quality, cost-effective care”

An argument for releasing this information is so consumers can be better educated on choosing their doctors based on how much Medicare pays the doctor for the service provided. One piece of insight already data mined from all this information is that Medicare pays for cataracts and cancer treatment.

“In the $3 million-plus club, 151 ophthalmologists — eye specialists — accounted for nearly $658 million in Medicare payments, leading other disciplines. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments.”

So using the rationale that this data will allow consumers better decision-making on choosing physicians, are we shocked that Medicare -  insurance for the elderly - pays out a significant amount of money for cataracts and cancer treatment, both illnesses of the elderly?

Having been both a provider and an administrator in the medical field for close to 15 years, what this information tells me is that doctors are for the most part underpaid by Medicare. If the median amount is $30,000 that any one physician makes in treating Medicare patients and the Medicare population is rising, then it is obvious that the reimbursement rates are lowering. This is exactly what is been happening since the year 2003 with a Medicare fee schedule that, while it does not cut, it does not give raises. As a medical administrator, all this information has done is prove to me that Medicare is not adequately paying for the work performed by physicians.

When failure is achievement

To remind us how little they really know about health insurance the Obama Admin decided to brag about a failure thinking they did well;

"White House officials were quick to point out the many successes during Ms. Sebelius’s tenure: the end to pre-existing conditions as a bar to insurance"

In the dark ages prior to ACA an individual could buy an insurance policy any time they like. No matter the month if you wanted insurance you could buy it. If you waited till you were sick you might pay more. A very small group of people were denied or had to enroll in high risk pools. But 85 to 90% of the population could buy any time they liked.

Now that ACA is in place and open enrollment closed unless you have a qualifying event you can't buy insurance no matter what, and that applies to 100% of the population.

That is progress under the Obama Administration.

Breaking: Oy!

HHS Secretary Shecantbeserious is resigning:

"Sebelius leaves the administration after the tumultuous launch of the Affordable Care Act exchanges last fall. Despite calls for her ouster from Republicans at the time, she stayed on until the enrollment period ended at the end of March."

That;s the good news.

Now the bad:

"White House budget office director Sylvia Matthews Burwell [will] replace the outgoing secretary"

Hmmm.

Burwell.

What to do, what to do....

Ms Kathy has Sgt Schultz Syndrome

Just a reminder that, two weeks after the (ostensible) end of Open Enrollment, Ms Shecantbesrious still can't (or won't) say how many of the "billions and billions" who signed up were simply victims of the ObamaTax "You Can Keep Your Plan" Hoax.

Imagine that.

Obamacare Regulates Doctor Profit Margins

Here's one I bet you didn't know. 

A key provision in Obamacare requires doctors to spend at least 80% of their gross revenue on patient care, leaving them 20% for overhead.

It seems that the onerous MLR rules for carriers also apply to physician practices.

Some doctors say they need to charge the extra fees because of the rising costs of running a practice. Some even cite the Affordable Care Act, also known as Obamacare, as adding to their costs.

Anthony Wright, of the consumer watchdog group Health Access California, says that reason doesn’t fly.

“The Affordable Care Act has another provision that puts a limit on how much your premium can be spent on patient care, rather than administration and profit. So, again, having an outside fee that is for administration is in violation in the spirit of the law, which is to try to limit the amount of money that’s spent on administration profit, and really target those dollars towards patient care,” Wright said.

CBS Local

It's on the internet, therefore it must be true.

Health Wonk Review: Not So Foolish (Early) April edition

Billy Wynne hosts this edition of the Health Wonk Review, and you'd be foolish to miss it. And definitely check out Julie Fergosun's take on Workers Comp and GoogleGlass.

Free Contraceptives aren't that important after all

Interesting fact among a few;

"The top 10 therapy classes by claims volume for exchange enrollees and those in a commercial health plan were largely similar, with a few notable exceptions. The proportion of pain medication was 35% higher in exchange plans; the proportion of anti-seizure medications was 27% higher in exchange plans; the proportion of antidepressants was 14% higher in exchange plans; the proportion of contraceptives was 31% lower in exchange plans." [emphasis added]

As major an issue as Saundra Fluke and free birth control was, those actually buying the plans don't seem to need it. By the time you're signed up for ObamaCare you have already been screwed so they don't need it?

Quelle surprise!

To the surprise of only those who haven't been paying attention, the latest ObamaTax "enrollment" numbers are in, and they're not pretty:

"People who signed up early for insurance through the new marketplaces were more likely to be prescribed drugs to treat pain, depression and H.I.V. ... early enrollees face more serious health problems and are older than those covered by their employers"

They also tend to use more expensive meds, further driving up costs for healthier folks who may have been suckered in signed up.

But don't worry, they'll make up for it in volume.

And speaking of which (volume, that is), rotsa ruck to all those "newly insured" folks who think they've successfully signed up for "health care:"

"As a proud new beneficiary of the Affordable Health Care Act, I’d like to report that I am doctorless. Ninety-six. Ninety-six is the number of soul crushing rejections that greeted me as I attempted to find one"

Hope and change, indeed..

The ObamaTax Domino Effect

While we've all seen the horrendous rate increases caused by the ObamaTax (including on our 1040's), there are other victims. According to a recent RAND Corporation study:

"The expansion of health insurance accomplished under the Affordable Care Act may alter costs for several major types of liability insurance ... Automobile, workers’ compensation, and general business liability insurance costs may fall under the Affordable Care Act, while costs for medical malpractice coverage could be higher"

It makes sense, of course, once one stops to consider it. Workers' Comp is, after all, essentially a government-run health insurance scheme. Auto insurance liability and med pay coverage is basically health insurance, as are comparable homeowners' coverages.

On the one hand, the study posits that the rate increases will likely be "modest" - in the 5% range. But we really don't know, since the full effects are still to come.

Recently, my P&C colleague across the hall was complaining about homeowners' insurance rate increases, and I jokingly suggested that he do what I do, blame the ObamaTax.

Little did I know...

Winning!

Well, for a certain value of "win:"

"The number of Americans who were enrolled in Medicaid at any time during fiscal 2013 exceeded the entire population of the United Kingdom"

Thanks to The ObamaTax, many (most?) of these are folks who've "benefited" from Medicaid expansion, and access to the program through the Exchanges.

Of course, each of these folks represent a net drain on the system, since they pay no premiums while gobbling up services.

A Pyrrhic Victory, no?

CCW, Guns and Insurance

Just because you've done the training, passed the test and obtained your Concealed Carry permit doesn't mean that you're covered if you ever need to use it. In fact, you should probably assume that if you injure or kill someone, even if you're eventually exonerated by law enforcement, your worries may be far from over.

What prompts this insight is an article by insurance expert and instructor Ted A. Kinney, writing in this month's PIA (Professional Independent Agents Association) newsletter. It's rather eye-opening stuff, because it addresses something that's been under the radar for a while.

Lots of attention was given, in the aftermath of the Newtown tragedy, to liability issues when a gun is used in a crime. And almost exactly a year ago, we discussed the proposal put forth by retired business owner Tom Harvey to compensate victims of illegal gun violence.

But what about the legal use of a weapon in self-defense? The rate of concealed carry permits has risen dramatically the past few years, and most folks have either home or renter's insurance. What part might these policies play if one were to injure or kill someone else in self-defense?

[ed: we'll deal here only with homeowners' policies - as always, we urgently suggest that you consult with your own agent about your specific policy]

The typical homeowner's policy follows a fairly predictable pattern: "we give you coverage, we take it away, then we give some of it back to you." The relevant policy section in this instance is "Coverage E - Personal Liability." This coverage protects one's assets if one is sued for injuring someone else. The policy extends coverage for this type of claim, but then excludes those claims that arise due to intentional acts. In this case, it's pretty clear that you intended to shoot your attacker, so it seems as if you're on your own.

Right?

Not so fast there, pardner:

Mr Kinney points out that newer policies will generally have an "exception to an exclusion;" that is, a policy clause that gives us back some coverage. In this case, it is for intentional acts that result from the use of "reasonable force." Unfortunately, as Mr Kinney also points out, the policy doesn't actually define "reasonable force."

So is there coverage, or not?

In Ohio, the law says that "a person is presumed to have acted in self-defense ... when using defensive force that is intended pot likely to cause death or great bodily harm ...  if the person against whom the defensive force is used in in the process of unlawfully ... entering ... the residence or vehicle occupied by the person using defensive force"

[ed: contra Mr Kinney's characterization, this is an expression of "the Castle Doctrine," not "Stand Your Ground"]

Let's take a real-life example: George Zimmerman was (famously) found 'Not Guilty' of murder. But what if Trayvon Martin's parents sued him in civil court? Would his homeowner's policy have picked up that tab? Unfortunately, the answer is "it depends:" just because a jury said it was justified doesn't necessarily mean that your insurer will pick up the tab from a civil verdict, or even cover your defense costs (which can be quite expensive). That's determined by the policy wording, and it's possible, bordering on likely, that your policy does not, in fact, afford this coverage.

So what to do.

Mr Kinney offers some suggestions for "stand alone" policies that will (purportedly) offer legal and liability coverage. It's a good idea to check with your own carrier to see if such coverage is available, and to stay as up to date as possible on the changing law (I heartily recommend Andrew Branca's  "The Law of Self Defense" which covers both federal and state laws and issues).

The bottom line? Don't assume that, just because you've dotted all the i's and crossed all the t's in order to get your concealed carry permit, that your insurance policy is going to cover you. You have a lot to lose.

[Many Thanks to FoIB Bill M for vetting this post]

Another Cup o' Joe, Please

We've been touting the health benefits of coffee for a while (most recently here). And the good news just keeps on rollin' in:

"...  a new study has linked drinking more than two cups of coffee a day to a 66 percent decrease in the likelihood of dying from cirrhosis, particularly in non-viral hepatitis."

Sweet (or, unsweetened).

Most surprising? That regular coffee drinkers significantly cut their risk of dying from cirrhosis and non-viral hepatitis.

A caveat: the article does not specify whether this was all coffee or just hi-test (no decaf), so it's not clear whether it's something in the coffee itself, or the caffeine.

Wills and Won'ts

A little over four years ago, we pointed out how important it is to periodically review one's life insurance beneficiary designations. Today, the Wall Street Journal has a similar warning for folks with 401(k) or similar retirement plans:

"If you haven’t updated that paperwork to reflect how your life has changed, you might not be able to leave your wealth to your heirs as you wish. Instead, you could bequeath them a bureaucratic nightmare."

They cite the case of a recently deceased executive who had the bulk of his wealth tied up in his 401(k), but failed to coordinate the beneficiaries with his will. The result was that his wife (widow) of two months stands to gain a great deal, while his kids are left holding the (empty) bag. As the article points out, one's will does not control one's retirement funds' ways.

The lesson? Go review your plans, and update them as appropriate.

Your loved ones will someday appreciate that.

Is That All?

The most transparent administration in history, except in matters involving their own mischief, is about to pull back the curtain on how much doctors earn.

The Obama administration announced on Wednesday that it will for the first time reveal how much Medicare pays individual doctors for medical services and procedures, including MRIs and CT scans.

Raw Story

Really doc? Medicare pays you $18 for an office visit? Maybe I should tip the receptionist on the way out.

The data to be released, which officials described as nearing 10 million lines of information, will show the number and type of health services each professional delivered through Medicare Part B in 2012 and how much the program paid for them.

I wonder if this will be printed in book form and mailed out to anyone who asks?

All told, HHS officials said the data covers 6,000 different types of services and procedures that cost Medicare a total of $77 billion. 

And what purpose will this serve?

I wonder how many people actually read their EOB?

Coming Out of the Ether

Hard to believe, but apparently some people never read InsureBlog. Probably some of the same folks that thought you could wait until you are sick to buy insurance. 

"I have people that can buy insurance, but the companies shut them down. They won't take the applications," insurance broker Steve Bobiak of Frackville, Pa., said. "We're a free country. You should be able to buy anything anytime you want."

Yahoo News

Steve, have you been under a rock for the last 6 months? Have you been spending too much time with Pelosi?

As for freedom, that was given up in 2008 when there were people who voted for free stuff over hard work and initiative.

Bobiak, whose NICA Benefits company helps people buy insurance in New Jersey, Ohio and Pennsylvania, said he learned only a couple of weeks ago that insurers were cutting off new policies.

You must have been absent the day that was taught in the certification classes. Heck, even carriers knew this day was coming. Wonder why they never told you?

Maybe they just assumed you knew it.

"It's lousy communication out there," he said. "If we don't know, my God, how do they expect other people to know? It's terrible."

A survey by the Kaiser Family Foundation in mid-March found that 6 out of 10 people without insurance weren't aware of the marketplace deadline on March 31. 

Six out of 10.

That would be the low information crowd.

Wonder if anyone told Steve the widely reported claim that you could wait until you get sick to buy health insurance is false as well?

I guess Steve doesn't read InsureBlog either.

7 Million Minus 6 Million Equals

They spent how much to provide health insurance to a "net" 1 million people?


We may never know. But on the surface it seems obvious our tax dollars would have been better spent by simply giving money away to people who simply declared their health insurance was too expensive.

But really, Nancy Pelosi's statement was a historic admission (We had to pass the bill to see what was in it) that she was fighting hard for something she herself didn't understand, but she had every confidence regulators and bureaucratic interpreters would tell her in time what she'd done. This is how we make laws now.

Her comments alarmed congressional Republicans but inspired Democrats, who for the next three years would carry on like blithering idiots making believe they'd read the bill and understood its implications

WSJ

Frightening isn't it?

It seems like burger flippers at McDonalds have a better understanding of what is expected of them than members of Congress.

The White House, on the other hand, seems to have understood what the bill would do, and lied in a way so specific it showed they knew exactly what to spin and how. "If you like your health-care plan, you can keep your health-care plan, period." "If you like your doctor, you can keep your doctor, period." That of course was the president, misrepresenting the facts of his signature legislative effort. That was historic, too. If you liked your doctor, your plan, your network, your coverage, your deductible you could not keep it. Your existing policy had to pass muster with the administration, which would fight to the death to ensure that 60-year-old women have pediatric dental coverage.

Speaking of burger flippers, that was quite a whopper, wasn't it?

The man has no shame.

My goodness, how helpful you are!

So it turns out that one doesn't need an agent, a Navigator, a computer or a phone to "enroll;l" in the ObamaTax. Just drawing a breath while on American soil should do the trick:

"Health and Human Services was mailing out letters notifying certain Americans that they had already started a healthcare coverage application on their behalf"

The twist: Ms Shecantbeserious had already started completing the process for them.

Fries with that?

Mission Accomplished! [UPDATED]

For a certain value of "accomplished:"



[Thanks to Bob V for the video link]

UPDATE: If Centennial State sign-ups are indicative (and there's no reason to believe that they're atypical), then The Kraut is really on to something. According to the Colorado Springs Gazette, about a quarter of a million Coloradans have enrolled through the state's Exchange.

That's the good news.

Here's the bad:

Most of these folks signed up for taxpayer funded Medicaid, not private health insurance. And of the less than 120,000 who did sign up for insurance, there's no information yet on how many are subsidized, let alone how many have actually paid for their new "coverage."

Way to go!

[Hat Tip: Ace of Spades]

Truth Serum

"Congratulations on getting 7.1 million people enrolled in Obamacare before the March 31st deadline!

Not to muddy the festivities by harping on technicalities, but I thought I’d pass along just a few corrections, in case you plan on giving anymore speeches or anything:

Alright, by ‘March 31st’ you mean ‘sometime in April,’ and by ‘deadline’ you mean‘suggestion which is subject to change.’

And, obviously, by ‘enrolled’ you mean ‘people who have filled some information out on a website.’"

Courtesy of The Matt Walsh Blog

Let The Games Begin

Barely a day following the end of Obamacare season comes word of a class action suit over mishandling of the enrollment procedure.  

Just days after the deadline to enroll for insurance coverage through Nevada Health Link, the first class-action lawsuit has been filed on behalf of residents who say they signed up and paid their premiums – but were never given coverage.

Law firm Callister & Associates filed the lawsuit on behalf of Larry Basich, who signed up for state health insurance and paid premiums as far back as November, but then was not covered following a Jan. 3 triple bypass procedure that saw his $400,000 in medical expenses passed between the wrong insurance companies,

CBS Local

Wonder what Dirty Harry will have to say about this one? Another lie?

Attorney Matthew Callister told the Review-Journal that about 40 people had called saying they had also paid their insurance premiums but have no coverage. As of last week, the Nevada Health Link had a “pends” list totaling more than 10,500 people still without coverage.

Lea Swartley, who also has received no coverage despite paying premiums, is the co-plaintiff in the lawsuit.

“There are hundreds, if not thousands, of Nevadans who have been paying premiums for 2, 3, 4 months, not receiving any coverage whatsoever,” 

Wonder if Obamacare navigators have E&O coverage?

Yeah, that's a stupid question. Just checking to see if you are paying attention.

Tea and (Dark) Chocolates

We've been reporting for a while that chocolate (particularly dark chocolate) has some major health benefits. But have you ever wondered why that is?

Turns out, the sweet treat actually works with the microbes in our stomachs to promote specific health benefits. Specifically, "beneficial bacteria that reside toward the end of our digestive tract ferment both the antioxidants and the fiber in cocoa."

Neat!

Also neat?

Earl Grey tea may actually be better at reducing your cholesterol than oft-prescribed (and much more expensive) statins:

"Researchers from Italy’s University of Calabria explained that the tea contains extracts of a Mediterranean citrus fruit called bergamot, which is made of enzymes known as Hydroxy Methyl Glutaryl Flavonones (HGMF)."

Yes, that's a mouthful, but it seems that this HGMF helped to increase "good" cholesterol and reduce the "bad."

Now about those scones....

Cavalcade of Risk #205: Mistake avoidance edition

Nancy Germond hosts this week's terrific roundup of risky posts, from employee safety to school shooting drills, you're sure to find something of interest.

Obamacare Closed for the Season

Thanks for your patronage. Y'all come back now.

IB SAYS OBAMACARE IS WORKING!

Premiums are lower by $2500 a family, 100% of people have insurance, Medicaid has been expanded in all 57 states, and most important we believe single payer is the answer to all of our problems. 

Happy April Fools Day!!!