Thursday, April 24, 2014


You'd think that this would have been fixed...

Embarrassment of (Link) Riches

■ Say it ain't so! Seems that the Silver State's Health Exchange has a few problems, not the least of which is that it's intent on hiding its problems:

"Confidential documents which appear to be from a Nevada Health Link employee may reveal huge problems within the state health exchange."

See - I told you so!

And what, exactly, are these problems? Well, to start with, there's the case of Lawrence Basich. Regular readers may recall Mr B as the gentleman who's been trying - unsuccessfully - to sign up for an ObamaPlan since last Fall. Turns out, he (and upwards of 10,000 others in similar circumstances), may have been the victim of the Exchange itself, which was apparently miscalculating subsidies and premiums.

The scary part is that administrators apparently knew of these problems and, rather than fix them, chose to hide them.

But according to their state's senior Senator, they're all lying.

■ We've written pretty extensively on the Death Panel IPAB controversy, but as FoIB Holly R tips us, that may not be the worst of it:

"The Center for Medicare and Medicaid Innovation has flown below the political radar. That's due to its seemingly innocuous mission: promoting new and more efficient "payment systems" and "models of care."

As Bob pointed out almost two years ago, the CMMI may sound anodyne - it is anything but:

"Obamacare’s Center for Medicare and Medicaid Innovation will conduct payment and delivery reform demonstrations with a goal of changing Medicare from fee-for-service to “capitated” or salaried payments. Unlike a pluralistic system of competitive plans, Medicare patients will have little or no control over whether or not they will be subject to these changes."

Shorter version: bye-bye, Grandma.

■ Up is down and left is right:

"Actuary Jac Joubert, along with a pair of Oliver Wyman analysts, say a big new federal risk-management program could pay carriers too much for covering consumers with health problems and too little for covering low-risk people."

That's the take-away from a study of how the ObamaTax is faring thus far. Ms Shecantbeserious (well, for now) and her minions are using a "risk adjustment model" originally designed for  Medicare Advantage plans, which are vastly different than ObamaTax-compliant major medical policies.

The result: decreased profit margins and a faltering - or even failing - carrier.

Perhaps Ms Kathy sees this as a feature, not a bug?

Meanwhile, on This Side of the Pond . . .

Henry likes to write about the MVNHS (Most Vaunted National Health Service). Mike brings us tales about health care  in the Sceptered Isle.  

As it turns out, they don't have to travel that far to find stories about government run health care.
At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.
The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.

Treatment at V.A. facilities has been a dirty secret for some time. Just a few years ago the Walter Reed scandal made the news.

Now this.

The secret waiting list sounds like Schindler's List, except much more ominous.
The VA requires its hospitals to provide care to patients in a timely manner, typically within 14 to 30 days, Foote said.
According to Foote, the elaborate scheme in Phoenix involved shredding evidence to hide the long list of veterans waiting for appointments and care. Officials at the VA, Foote says, instructed their staff to not actually make doctor's appointments for veterans within the computer system.
Instead, Foote says, when a veteran comes in seeking an appointment, "they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there's no record that you were ever here," he said.

Data manipulation by the government? 

That's a first . . .
Foote says the Phoenix wait times reported back to Washington were entirely fictitious. "So then when they did that, they would report to Washington, 'Oh yeah. We're makin' our appointments within -- within 10 days, within the 14-day frame,' when in reality it had been six, nine, in some cases 21 months," he said.
What is the impact on the health of our veterans?
Teddy says his Brooklyn-raised father was so proud of his military service that he would go nowhere but the VA for treatment. On September 28, 2013, with blood in his urine and a history of cancer, Teddy and his wife, Sally, rushed his father to the Phoenix VA emergency room, where he was examined and sent home to wait.
"They wrote on his chart that it was urgent," said Sally, her father-in-law's main caretaker. The family has obtained the chart from the VA that clearly states the "urgency" as "one week" for Breen to see a primary care doctor or at least a urologist, for the concerns about the blood in the urine.
"And they sent him home," says Teddy, incredulously.

Seems we have our own version of the Liverpool Care Pathway right here in the U.S.

So what happened with 71 year old Navy veteran Thomas Breen? 

When no one called from the V.A. about his follow up appointment family members made several inquiries.

"Well, you know, we have other patients that are critical as well," Sally says she was told. "It's a seven-month waiting list. And you're gonna have to have patience."
Sally says she kept calling, day after day, from late September to October. She kept up the calls through November. But then she no longer had reason to call.
Thomas Breen died on November 30. The death certificate shows that he died from Stage 4 bladder cancer. Months after the initial visit, Sally says she finally did get a call.
"They called me December 6. He's dead already."

The V.A. saga that started on Sept. 28, marked as "urgent", ended for Mr. Breen on November 30.

One can argue that Mr. Breen's stage 4 bladder cancer was too advanced, treatment would not have saved him.

Yes, you could say that. But you miss the point.

No one deserves this kind of neglect.

Especially our veterans.

Health Wonk Review: ACA "Improvement" edition is up

Louise Norris always does a great job hosting, but this week's edition is arguably her finest work. It's full of great posts and helpful context, just a really terrific job. Definitely worth clicking over to read the latest and greatest on ObamaCare.

Wednesday, April 23, 2014

Alphabet Soup News

From our friends at FlexBank:

■ "The IRS announced [last October] the ability to permit employees to carryover up to $500 of an unused health FSA balance. IRS Notice 2013-71 now offers an employer the option to amend their Section 125 plan to allow up to $500 of unused funds remaining at the end of a plan year to be carried forward into the following plan year."

This is significant because these plans have traditionally been "use it or lost it," and now participants may have the opportunity to roll-over unused dollars.

 "The IRS released a memorandum on March 28, 2014 that confirms that employees participating in a general purpose health FSA, and who have carryover from a prior year, cannot contribute to an HSA for the entire following year."

General Purpose Flex Spending Accounts are those which cover any so-called 213(d) expenses (a laundry list of eligible expenses) as opposed to a Limited Purpose FSA which covers only those specifically stated in the plan document. This is significant because it may severely limit one's participation in a Health Savings Account.

 "Section 125 Plans (also known as a Cafeteria Plan or Premium Only Plan (POP), must follow the general principle that employees' pre-tax elections are irrevocable for the plan year, except under certain conditions"

Generally speaking, you only get to change your "cafeteria plan" choices once a year - at Open Enrollment. But there are exceptions to these rules, although they're quite limited. These would include a "Change in Status" (eg marriage, adoption, etc), as well as a few others. The fine folks at FlexBank offer you this link for an overview of the permitted election changes.

Tuesday, April 22, 2014

Look out below! [UPDATED]

Such a success:

"[A]n intriguing analysis of Covered California’s state-run exchange found that up to half the 1.2 million new enrollees might actually drop their coverage."

To be fair, some of these folks will find new jobs with employer-sponsored insurance plans. On the other hand, a lot will find themselves now eligible for (taxpayer funded) Medicaid coverage. And some will take a look at their high premium, high expense, low benefit plan and decide to chuck it.

Sounds like a plan.

UPDATED: Perchance there's an even simpler explanation:

"California Obamacare customers are expressing outrage after finding out that nearly 1,000 California doctors were listed on the Covered California website as accepting Obamacare plans when in fact they do not"

As we've mentioned numerous times, "narrow networks" are one of the more insidious ways in which the ObamaTax tries to rein in costs. This is, in fact, a fairly obvious method of rationing health care: "sure, here's an insurance plan that guarantees your insurability, but good look using it to actually access, you know, care."

Dying of Thirst (Literally)

One of the major problems of the ObamaTax is that it does not, in fact, save health care dollars. This problem plagues similar regimes as well, most notably the Much Vaunted National Health System©.

Never fear, though, the MVNHS© has a solution:

"At least 1,000 hospital patients are dying needlessly each month from dehydration and poor care by doctors and nurses."

A perfectly sensible way to deal with runaway health care costs, don't you agree?

Monday, April 21, 2014

Bounty Hunter

What happens when you can't get enough people to follow the "law of the land" and purchase
health insurance they don't want and can't afford unless the government robs the rich to pay the poor?

If you can't threaten, coax, cajole or force them to buy, you pay a bounty hunter.
At least 79 tax service providers, including offices of major companies like Liberty Tax Service and Jackson Hewitt Tax Service, are listed as certified Obamacare enrollment entities in the state of California, according to state exchange records.
California’s Obamacare exchange, Covered California, pays enrollment entities for signing people up for Obamacare.
“Certified Enrollment Entities are paid a flat-fee of $58 per successful application and $25 per successful annual renewal,” according to California Health Benefit Advisers. ”The Enrollment Entities compensate the individual Enrollment Counselors.”
Apparently taxpayer funded commercials wasn't enough to get the job done.

May I Have the Envelope Please?

And the winner is . . .  

(pregnant pause)

One company, though, stands out from the crowd as probably the single biggest real winner from Obamacare so far -- private health insurance exchange operator eHealth

The national insurance brokerage firm did something the federal government could not.

Establish and run a WORKING consumer portal to facilitate the search for and purchase of Obamacrap health insurance policies.

And . . . they did it without taxpayer dollars, taxpayer funded road shows, nightly news updates on the status of Ocare and even more taxpayer funded celebrity commercials.

EHealth's stock also steadily climbed during October as the federal website suffered through an embarrassing launch. 
Why was eHealth so much more successful on this front? One reason could be that the company's website is easier to use than the federal site.
In a survey of shoppers on the company's website who selected Obamacare plans this year, more than half indicated that they were previously uninsured
The federal government hasn't released any official figures on how many previously uninsured individuals have signed up. 

Private industry vs. DC incompetence.

“Pay No Attention to the Man behind the Curtain”

The government, this time the State of California, has decided that maybe it should ensure that the plans it has been selling to unsuspecting the general public will be accepted by the patient’s choice of physicians.

“A little too little a little too late,” but I digress.

So they came up with a brilliant plan to find out if doctors are taking the insurance by setting up “secret shoppers” to check the provider networks. Seems like I have heard this song and dance before:

U.S. Plans Stealth Survey on Access to Doctors.” The article discusses how the United States Government is going to use mystery shopping techniques to assess the wait times for new patients to get into a primary care physician’s office"
But that was then (June of 2011, almost 3 years ago), and this is now:
The secret shoppers would call or visit the providers in a plan provider directory and see whether the providers would take new patients with coverage from that plan, or whether the providers would let patients use that plan to pay for care.”
This is the latest rocket surgery dreamt up by the Covered California folks, who appear to have learned nothing from previous experience.

The short answer is that, IF the doctor is contracted with the insurance plan, then YES the doctor will see the patient and accept payment. IF the doctor is not contracted with the insurance plan and IF the patient agrees to pay the doctor, then YES the doctor will see the patient.

But, it appears that the problem is not the doctors seeing patients, but a “narrow provider network.”

So in answer to the first IF, it seems that there are not enough doctors in the network. So move to the second IF: if not in-network, then will the patient pay and accept it being applied to the out-of-network deductible? Let’s look at the article for an answer:

Priscilla Myrick, a Berkeley, Calif., activist and plan enrollee, wrote to the board to say she was surprised to find  her providers are no longer in her  network, even though she replaced a pre-PPACA plan with a plan from the same carrier. She said her plan issuer increases the deductible to $20,000 for out-of-network, from $10,000 for in-network care, and increases the annual out-of-pocket maximum going to $12,700, from $6,350.”
It seems that Ms. Myrick's out-of-network deductible is a little high - like stratosphere high - which can be a detriment to seeing her provider.

“If you like your doctor, if you like your insurance company….”

So it seems that the insurance plans have incredibly high deductibles, a narrow physician network, and the reason that patients cannot find doctors is ... drum roll please ... the doctor’s fault. And when you cut off all legs of a frog and yell jump, the frog goes deaf.

Obamacare Ka-Ching . . . . Not!

When is a door not a door? When it is ajar.

Old joke. Never understood it as a child since no one I knew ever said ajar. A jar was something you put moonshine in.

So when is a sale not a sale?

When you don't pay the seller. (Don't confuse this with five finger discounts).

"Georgia insurers received more than 220,000 applications for health coverage in the Affordable Care Act’s exchange as of the official federal deadline of March 31, state officials said Wednesday.

Insurance Commissioner Ralph Hudgens, though, said premiums have been received for only 107,581 of those policies."

Georgia Health News

Less than half of those that applied during Obamcare open enrollment have actually paid for their purchase.

Yes, it is still early, and those that applied late still have a few weeks to pay their initial premium. What we don't know from this figure is how many of the 220k applied during October through December for a January effective date.

The deadline for paying the initial premium is long past.

The state estimated some 650,000 Georgian's were eligible for subsidies so the number of applications represents about a third of the eligible.

What we still don't know is:

• How many were previously uninsured?

• How many dropped existing coverage and replaced it with a subsidized plan due to lower premiums?

• How many bought because their existing coverage was dropped due to Obamacare?

• How many bought plans outside the exchange?

But are we making progress?

"Cindy Zeldin of Georgians for a Healthy Future ... [says] the enrollment number in Georgia “is a good start. We are encouraged.”

“The number of uninsured is going down"

How does she know the number of uninsured is dropping?

So many unanswered questions.

One wonders if the low information crowd will ever acknowledge that, in the big picture, Obamacare is a disaster.

Thanks to Henry Stern for this tip!

Sunday, April 20, 2014

Easter, More than Bunny's and Eggs

Easter is a sacred time for Christians throughout the world. However, like many religious traditions,
the meaning and symbolism of this Holy day has become commercialized.

Easter shares some of the tradition with Passover, but Easter is not Christian Passover any more than Passover is Jewish Easter. The central characters in both events involve Jews but beyond that the meaning and purpose move in separate directions.

Easter is representative of the Sunday following the crucifixion of Jesus, son of Mary and Joseph. Jesus was a prophet as well as the Christ, the One who was foretold in the scriptures.

According to our teaching, Jesus was crucified on a Friday and rose from the dead two days later on Sunday. We believe not only in his deity but also the resurrection of the body. Without the resurrection He was just another man.

There were no Easter bunnies. No one died chicken eggs and hid them. Chocolate bunnies and Cadbury eggs, while delicious are not mentioned in the Bible.

Easter is a time of rebirth and renewal. It is a time to reflect on our past and strive to make changes going forward.


Saturday, April 19, 2014

My Bleeding ( Heart

By now, IB readers are presumably fully aware of the dangerous Heartbleed virus (well, major internet security flaw). Some may recall that a week or so ago, the folks in DC assured us that users of the site weren't at risk there.

But that was then, and this is now:

" users told to change passwords following Heartbleed flaw ... People who have accounts on the enrolment website for President Barack Obama's signature healthcare law are being told to change their passwords following an administration-wide review of the government's vulnerability to the confounding Heartbleed internet security flaw."

Actually, this is potentially very bad advice: unless and until a site has been demonstrated to be HB-negative, changing one's password may simply open one up to even more shenanigans:

"If you find that a site is still vulnerable, don’t enter any passwords or data that it doesn’t already have."

To determine whether a particular site will leave you vulnerable, **here's a simple test* you can use.

In the meantime, use extreme caution when visiting the site (if you must visit it at all).

[Hat Tip: John Hayward]

Friday, April 18, 2014

We’re lost, but we’re making good time

Today's Wall Street Journal reports President Obama saying that eight million people had picked health-insurance plans through the Affordable Care Act.  “The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working..."

Well yeah, it's a start, but it's still at most only 20% of America’s uninsured, leaving aside what this obsessively word-smithing president might mean by "picked".

The insurance underwriter in me knows what Obama said is sales talk.  His are not the words of a knowledgeable experienced salesman, or an experienced executive, or even a realistic person. They are the words of someone trying to persuade me with weak logic, scant evidence, and a story contrary to what I can see with my own eyes.  They are the words of a man trapped inside some Mary Poppins fairy tale in which “Well begun is halfway done.”  In short, it's sales talk.

And the problem with the president's sales talk is that he is selling a fantasy world, not the real world.  The real world sets a higher bar for "it's working":  people who have enrolled must be able to obtain services they need when they need them; their personal costs counting premiums, deductibles, co-pays, and wait times must be truly affordable; after first enrolling, people must be willing to re-enroll for the next year.  Not only that, but in the real world, almost all the remaining 30+ million uninsured Americans must soon also enroll.  In the real world, physicians and hospitals must be able to accommodate millions of additional patients without harming quality or accessibility. In the real world the insurance companies must be able to set premiums with confidence based on hard facts about the covered populations.  In the real world, the feds must actually, you know, get around to building the back-end systems needed to transmit enrollment info and premiums to the insurance companies.  And of course, in the real world, our president promised back in 2009, “I will not sign [The ACA] if it adds one dime to the deficit, now or in the future, period.”  And yes, he really did say “period”.

All of that and more is how the real world will decide if “it’s working.”  Clearly, despite what the president wants me to believe, this administration still has promises to keep, and miles to go before it sleeps.  Those promises cannot yet be counted as kept.  That's why I think it's misleading to say The Affordable Care Act "is working."

For right now at least, it's much closer to the truth to say, as Yogi Berra once said, “We’re lost, but we’re making good time.”

Friday Spindle-Clearing Time

Each of these may well deserve their own post, but alas, 'tis not to be:

■ The Obamastration's touting the latest (fake) number of sign-ups at 29 gazillion (or 8 million - I've heard it both ways). Thing is, that seems to include thousands of actual prison inmates.

Kudos, Kathy!

■ From the MVNHS© Files comes this unfortunate statistic:

"Majority of foreign doctors in the UK, including from India, would fail Britain's health service exams if they were held to the same standard as their British colleagues."

But hey, it's free!

■ More ObamaTax lies:

"A New York woman suffering from a neurological disease that has required four brain surgeries has been dropped by all of her doctors and denied medications due to her Obamacare plan."

According to Harry Reid, though, this woman is lying:

Lose Your Husband, Insurance [UPDATED]

Apparently, the ObamaTax is all about the "glitches:"

"More than two dozen widows who were married to retired Madison county employees, lost their health insurance coverage earlier this year."

That's Madison County, Alabama (no, not that Madison County), which had been self-insured. It's not really clear to me why that would preclude them from offering coverage of some kind, but according to county commission chairman Dale Strong, "new regulations in Obamacare would amount to an extra $25 million dollars per year."


UPDATE: Okay, turns out that (of course), there's more to the story. Yes, the county was self insured, and yes, the ObamaTax would have made it too expensive to continue covering these poor widows. So the county "instead joined a statewide network that dozens of county governments already are in. That plan, though, does not offer coverage to husbands and wives when their government employee spouses die."

That makes a lot more sense than just dropping deceased employees' spouses. And, of course, it reinforces the truth that, dead or alive,  you can't keep your plan..