Health Insurance Info for Colorado

news & commentary on health insurance and benefits

The Alternative to Obamacare is Easy

Tags: , , , ,

I’ve said for some time that “health care reform” wasn’t the goal of Obamacare, and it certainly shouldn’t have cost however many trillions of dollars thats been forecast to pay for it (the actual figure isn’t important, save for one fact: it’s a lot more than we were promised, before we knew “what was in it”).

The mass media seems to be of the opinion that Republicans have no alternative to Obamacare, but the truth is that any number of alternative policies have been discussed within Republican circles. Most critics of outright repeal like to point out that the individual and employer mandates were Republican ideas; this canard has been bandied about for so long that it now been accepted as fact. The reality is that the mandates were viewed as essential only by a handful of think-tank policy wonks, and never really achieved critical mass with conservatives who study health care policy closely.

One of those individuals is John C. Goodman, from the Independence Institute. Mr. Goodman is considered to be the “father” of the health savings account, and he has a brand new article on what Republicans can do, now, to repeal the worst parts of Obamacare. In a previous article, “How The GOP should now deal with Obamacare”, he discussed the pitfalls that Republicans will likely encounter as they try to “repeal and replace” Obamacare with a new system that will inevitably be some version of what is currently in place.

In “A Republican Alternative To Obamacare”, he expands on his earlier work, by advising Republicans to concentrate on the promises made to voters in the 2014 elections: “keep your job; keep your health insurance; and keep your doctor”. And his solutions to health insurance, and health care, issues are the best I’ve read, encompassing great ideas and solutions to the kind of Washington-driven, centrally-planned health insurance environment we find ourselves in, with narrow networks, a return to highly steered “managed care”, rigid health care design, and lack of choice and flexibility.

I highly recommend the policy solutions he puts forward, and dearly hope that someone in the Republican leadership is listening and taking copious notes. The bottom line is this: without a clear cut and simple approach to replacing the disaster now known as Obamacare, Republicans will stand little chance of gaining any ground against entrenched interests, which include progressive Democrats, insurance company executives, and others who are beginning to reap the benefits of a quasi-monopoly driven by the central planners at HHS. Taking the alternative directly to the American people is the best way to get the message out, and that requires more than a statement in front of a podium at the Capitol, which is essentially all we’ve been given from the current Speaker of the House. It requires a full-court press by the leadership, because there isn’t a more pressing issue than repeal and replace Obamacare. I believe the political will can be found, and not just from Republicans.

Health Insurance Reform for Dummies

Tags: , , ,

Anyone who thinks that Obamacare was about heath care, let alone health insurance, reform, is either, at best, naive, or, at worst, completely ignorant of the law – and how it was passed, and the consequences of its various statutes, regulations, rulings, and case law.

Obamacare was about social engineering – much the same way that Common Core is about federal control of school curriculum, to advance certain, shall we say, dogmas that most of us would find puzzling, if not outright outrageous.

But I digress. I’ve often told those that will listen that I could have written a health insurance reform proposal that would have numbered a few hundred pages and would have been much, much more successful than the Affordable Care Act, assuming that its goal was the elimination of the chronically un-insured in these United States, probably around twenty million or so (it wasn’t, re-read paragraph two). And, it certainly would not have cost upwards of $2T plus that we see now (and that figure will continue to rise, even as deductibles rise, and out-of-pocket expenses rise, and so on). And I would agree that reform was needed, just not what we got.

James C. Capretta is one of a handful of experts who I respect wholeheartedly with regards health care reform policy. In this article he lays out the compelling reason why we need, not just to repeal, but replace Obamacare: because reform is just as needed now, as it was in 2009.

Here is the most interesting conclusion that Mr. Capretta advances: “The hard work of developing a credible alternative plan has already been mostly completed. What is needed now is a spirit of practical compromise among key Republican policymakers. It will not be possible to beat an incumbent program — the ACA — with abstractions, good intentions, and idealistic concepts. What’s needed is a workable, politically viable plan, one that voters can see for themselves would work better than the ACA.” 

As the article points out, the hard work for a viable replacement for the ACA has already been done. It will take Republicans to advocate for it in a forceful way. And, if SCOTUS disallows the payment of premium credits in the federal exchanges, as detailed in King v. Burwell, then Republicans won’t need to wait for control of the White House to replace Obamacare.

The Coming Disaster

Tags: , , , , ,

OK, there – I said it. It will be an unmitigated disaster. The relationship between The State and The Citizen has now been forever altered. I’m of course speaking of Obamacare, a.k.a. The Affordable Care Act. But, from now on, we’ll just call it Obamacare for short. Has such a great ring – after all, hasn’t The Prez himself now embraced it?

It will not be our place, going forward, to rail against the excesses of the great unwashed masses who really did vote for “stuff”, including “free” health care, such that it is. Rather, it will be our  pleasure to point out all of the unintended (really – unintended? but I jest) consequences of the greatest piece of social engineering that has ever hit a nation, short of the Russian Revolution. Stay tuned, as this is going to get really entertaining – or, perhaps not, depending on your viewpoint (you small business owners, who have just been reclassified as a “large business” – you know what I’m talking about).

Obviously, I’m no fan of this legislation (thankfully, having an opinion isn’t a hangin’ offense – yet). Obamacare is, of course, the opening gambit in the final throes of a complete government takeover of the health care sector – whether five years or twenty years from now. In spite of the near-complete abdication by the media of their responsibility to report what is factual and accurate about Obamacare, some truths have filtered out. So, one of our responsibilities will be to elaborate on these “truths”, in spite of the near-total blackout you’ll get from most in the media, so that you, my dear readers, can begin to understand the enormity of what one-party rule and flagrant “gifting” to minority coalitions can create. Havoc, in other words.

(My sympathies in advance of those who will look back fondly on these pre-Obamacare days of full-time employment – meaning, forty hours a week, that is. Working two part-time jobs is really going to be stimulating!)

Beyond that, there will be numerous changes (hell, I might as well say it – changes in the thousands!) to health insurance, health insurance regulation, health insurance markets, health insurance policies, health insurance coverage, health insurance taxes – you get the idea – over the coming five years, as we rush headlong into the full implementation of Obamacare, which doesn’t fully  land on everyones doorstep until 2018. We will be here, barring some unforeseen event, giving you all of the gruesome details, so that you can watch the unfolding train-wreck with us. Get the popcorn. Lock the door.

By the way, as of this writing, SCOTUS has decided that the Liberty University lawsuit, essentially about religious liberty and the new contraceptive mandates, should be heard, and apparently will be tracked to eventually wind up with the Justices. This may or may not be a side-show: it may give the Court a second bite of the apple when it comes to the constitutionality  of Obamacare. Yawn. I don’t think this is going to change much – I mean, what are we now 0 for 3? – not counting an election. I feel somewhat better about the Courts’ recent decision (9-0) regarding religious liberty, but beyond that, I don’t see this impacting the roll-out of Obamacare except in certain narrow ways – and this Administration will just do what it wants anyway. And besides – who ever said that Obama wants religious groups, such as the Catholic Church, delivering health care anyway? Better to turn it over to non-profit and completely controllable Accountable Care Organizations. They’re easier to unionize, anyway.

Next week I’ll talk about the new federal health plan option for states that have decided to back-hand the feds and refuse to start their own exchanges. Yes, we finally now have a “public option”. Stay tuned…

 

 

 

The Argument Against Obamcare

Tags: , , ,

The Supreme Court of the United States, beginning this week, will hear arguments in the case against Obamacare, brought by 26 states against the federal government. Their legal ruling, due sometime this summer, will determine, in the words of David B. Rivkin and Lee A. Casey, writing in an op-ed in the pages of The Wall Street Journal, “the Constitution’s structural guarantees of individual liberty, which limit government power and ensure political accountability by dividing that power between federal and state authorities”.

In their article, published today, attorney’s Rivkin and Casey may be giving us a sneak peek at how Paul Clement, the attorney arguing against Obamacare, will craft his arguments to the Court. Mr. Clement is the former United States solicitor general charged with arguing that Obamacare “represents an unprecedented overreach into the personal lives of Americans”, according to Jess Bravin, writing in the WSJ (“Courtly Battle in Health Case”). Mr. Clement is lead counsel in the case, brought by 26 states to overturn the Affordable Care Act, notoriously known as Obamacare.

Given that there are any number of ways, on any number of separate issues, that the Supremes could rule, I will refrain from making any predictions. It is interesting to note, though, that health insurers, who have been reluctantly complicit in the birth of Obamacare, the major negotiating point in their favor being the individual mandate, presented the court with a brief that was remarkably neutral, suggesting that, if the individual mandate is overturned, then the entire bill must be overturned. This is nothing more than window dressing: the insurers know that their survival, at least at the time, required a healthy dose of government-imposed regulation on their business model, turning them into crony-capitalist utilities in exchange for the chance to continue profiting from a system that many Democrat legislators have decried as “evil” and have vowed to destroy. What this means is that insurers signed on to Obamacare as soon as the government promised them that everyone must be on coverage, essentially mandating a compulsory market (with compulsory profit, too). As it turns out, given the kind of remarks we’ve heard from former Administration officials and the Secretary of HHS, their flight to regulatory safety was ill-advised and will result in their ultimate demise. Perhaps they should have stood their ground and made a fight for it, rather than make a pact with the devil.

 

 

 

The Prez stiffs Catholics

Tags: , , , , ,

In spite of The White Houses’ best attempts at muddying the waters and shifting the contraceptive controversy to one of “women’s health” from “religious freedom” (and, frankly, some success with this, albeit in cahoots with their progressive brethren in the press, not to mention Democrats in Congress, who excel at press conferences masquerading as committee hearings) in order to get the public on board with his free birth control mandate, Mr. Obama is signaling that, like most anything else he decides he wants, he’ll say whatever he knows the press will echo loudly while doing exactly the opposite – namely, mollifying the religious community with worthless platitudes while giving them absolutely no real reason to think that anything has changed.

Not so fast, say Catholics.

Frankly, to this observer it almost appears as if… is it possible?.. the Prez really wants the Catholic Church and any other religious organization that provides health care of any kind, and objects to unconstitutional mandates that impact their religious freedom, to get out of the business of health care, completely and forever. And, close the door on your way out. To those who scoff at such a notion: the reason given for cutting the guts out of Tricare, the military health care system for active duty and retired military, is to move more people into the (Medicaid-style) Obamacare. So, I think it’s entirely plausible that the Prez isn’t interested in what the Catholic Church or any other religious organization that provides health care thinks: he just wants them out of the way.

As an aside, let me say to the Church: hey, I know exactly how you feel: I’m a health insurance agent.

Let’s recap: The Obama Administration announces the most restrictive definition of religious exemption possible, thereby guaranteeing him a collision course with anyone with a religious objection to mandatory contraceptive coverage. After a day or so of Catholic weeping, wailing, and gnashing of teeth, the President decides that, rather than the Church, insurance companies can pay for it. Problem solved, The One has spoken.

Problem is, Mr. Obama apparently either doesn’t know, doesn’t care, or doesn’t think the press will report on the most important fact of all: the Catholic Church is, for the most part, self-insured. There is no “insurance company” to pay for it, as they provide and pay for their own care for their employees, a fact pointed out by Cardinal Timothy Dolan, president of the U.S. Conference of Catholic Bishops, in a letter to his fellow bishops.

The rest of the letter is illuminating, most of all because the good Cardinal accurately points out that, as we have now seen demonstrated over the last week in excruciating detail, Democrats are busy painting the entire issue as one of “women’s health care” and abortion-inducing drugs rather than one of religious freedom, as evidenced by the vote on the Blunt Amendment. And obviously, there is little evidence in the “mainstream” media that the religion issue is even an issue, or even important. Why, the temerity of those Catholics, to attempt to discuss religious freedom when we all know that women need free contraception, if only to keep the nations’ birth rate down and help hold those health care expenses in check.

The fact that this Administration is doubling down on their position, by publishing the decision in the Federal Register, etc., points out that, on matters of ideology (as in, progressive action), there is no room for any accommodation that deviates from long-held and cherished policy goals of the left, no matter who they have to skewer. And Catholic Bishops, who stood by and actively supported Obamacare, have now learned that very important lesson. They have been used, and others should heed this warning. Republicans in the Senate, take note.

 

Canada: Back To The Future?

Tags: ,

A recent study shows that Canadians are facing the longest waiting times for medically necessary care in almost two decades.

With all the talk about how bad Obamacare will be, with its standardized benefit structures, centralized command and control, and over-arching subsidy program that will drive as many as 80 million Americans into Medicaid (yes, you read that right, it’s in the bill!) one should remember why so many Canadians have come south of the border to access care: they can’t get any, which is something we are going to be facing in the not-too-distant future, as anyone who’s ever studied socialized, government run or controlled, capitated health care delivery systems knows all too well. Remember: in the Orwellian future of American health care, you are no longer the customer – you are a unit.

ITEM: In a report from late last year, the Fraser Institute, Canada’s leading public policy think-tank, said this:

  • “Canadians are being forced to wait almost four-and-a-half months, on average, to receive surgical care, prolonging the pain and suffering patients and their families are forced to endure.”

And this:

  • “Despite significant increases in government health spending, Canadians are still waiting too long to access medically necessary treatment.”

Amazingly, Canadians put with waiting times between referral by a general practitioner or PCP and consultation with a specialist of between 7 1/2 weeks to almost 10 weeks, depending on where they live. Obviously, Canucks are way more patient than anyone in my family.

It gets worse:

-I pity the poor fool who needs orthopedic surgery: average wait is more than 39 weeks (more than 9 months).

-And, this is a stunner: if you need neurosurgery, like, on your brain (!) be prepared to pray a lot: you’ll wait 38.3 weeks.

No wonder Canada has introduced “market reforms” that finally allow some people to buy private health insurance. Too bad we’ve taken the wrong path and will have to learn the hard way what Canada and Britain have already learned.

 

My Opinion: Exit Stage Left, Health Insurance

Tags: ,

In a brazen and somewhat twisted (in that, it’s so cheerful!) online op-ed piece in the New York Times online, authors Ezekiel Emanuel and Jeffrey Liebman, ex-Obama Administration advisors on health care policy, posits the wondrous new world of “Accountable Care Organizations” (ACOs) amidst the utopia of Obamacare (assuming the Supreme Court doesn’t render it mute; but then, when did the Left ever let something as silly as nine black-robed Justices exercising their constitutional duty stand in the way of equality and social justice?).

Disclaimer: it should be noted that neither of these “experts” has any experience in the private sector.

The problem, dear readers, is this: they aren’t telling you the whole story (what, you’re surprised??). And what story they do tell is full of inaccuracies and oft-quoted myths/distortions. Much like the current brouhaha concerning enforced contraception mandates for all religious organizations, the story is, err, telling more for what it doesn’t spell out accurately as opposed to what it tries to say badly.

So, here’s my take on their not-so-distinguished attempt at becoming fiction writers:

  • “Already, most insurance companies barely function as insurers. Most non-elderly Americans — or 60 percent of Americans with employer-provided health insurance — work for companies that are self-insured. In these cases it is the employer, not the insurance company, that assumes most of the risk of paying for the medical care of employees and their families. All that insurance companies do is process billing claims.”

BEEEEP: Wrong. There are MANY inaccuracies in this statement, but the basic premise is so faulty it’s difficult to even say that this is anything but pure spin, or pure hatred for health insurance companies, who they love to portray as the villains, instead of themselves. While it’s true that many companies, both public and private, “self-insure”, very few (none to my knowledge, actually) do so completely, at least for medical coverage. There are any number of reasons for this; particularly, reserving for future claims of this potential magnitude would be a drag on earnings, and the kind of companies these two are talking about are almost certainly public, not to mention what an unexpected $2M cancer claim could do to the bottom line. No, the reality is that under a self-insured scheme of insurance, an employer contracts with an insurer to take all risk after a certain level of claims, which lowers the cost of premiums. This is called aggregate and specific stop loss coverage, and it’s a marvelous way for companies to lower costs relating to providing health insurance coverage to its employees. Beyond the mega-corps (who use stop-loss coverage almost exclusively) this insurance technique, almost always done under the eye of ERISA regulation at the federal level, is the norm. And of course, the employer sets the level of risk retained, thereby exercising a means to regulate and control their premium costs, based on their unique needs and circumstances. Does it work? YES. As for the last part, “all that insurance companies do is process claims”, is simply false, and denigrates the administrative-services-only component of modern insurance management, as only two eggheads with no practical real-world experience could do. In fact, ASO is just part of what insurers, whether dealing with self funding coverage or fully insured plans, do best: run efficient, honest, and reliable network and claims processes. And let’s not forget that it’s the insurers and their pursuit of negotiated fee networks that have saved patients billions of dollars, unlike government mandates which often inflate the cost of care and therefore insurance costs. These networks are so efficient that the federal government went so far as to contract with them to gain access to their networks – as compared to the dinosaur known as “original Medicare”, which has major problems with doctor availability. Or, have these two policy wonks never heard of Medicare Advantage?

  • “For individuals and small businesses, health insurance companies usually do provide insurance; they take a premium and assume financial responsibility for paying the bills. But the amount of risk sharing that is accomplished is limited because the insurers charge premiums that vary, depending on the health of an individual or a group of employees, and use their data and market power to identify healthy people to cover and unhealthy people to exclude from coverage.”

Oh My. BEEEP. Where have these guys been all these years, stuck in the Executive Office Building reading back issues of  The New Republic? To be fair, they get part of it right: health insurance companies do take a premium and assume financial responsibility for paying the bills. Good enough. But the spin enters promptly when they disregard acres of state regulation of individual and small group insurance that actually prevents much of what they allege happens. In Colorado, and in much if not all of the nation, small group insurers aren’t allowed to charge more for health conditions present at time of underwriting except in very narrow circumstances and in very limited amounts, and employers aren’t expected or even allowed to carry their own claims, as all claims must be pooled. In point of fact, insurers in Colorado aren’t even allowed to rate up OR down at time of underwriting, except for basic underwriting criteria such as, say, SIC Code and address. They must also make available guaranteed-issue plans for business groups of one, again, without regard to the health of any individual in the group. In the individual market, very few medical conditions actually result in outright declination of coverage, and many insurers have very liberal underwriting standards that allow for sensible rate-ups or exclusions for medical conditions present that might prove to be too risky for the insurer to accept and still be able to meet reserve requirements mandated by regulatory agencies. As usual, these two spin-meisters miss the point: no health insurer in the individual market can knowingly accept obviously uninsurable conditions and attempt to stay in business and do what their corporate charter almost certainly mandates: provide a pool of money to pay for catastrophic or other kinds of medical illnesses and injury, without regard to rationing or other capitation schemes that are at the heart of Obamacare. As an individual health insurance agent for many years, I fail to see ANY evidence of the charge they make: using their data and market power to cherry-pick the market, especially given the regulatory environment in Colorado. As pointed out in this piece, they use their ability to provide quality coverage to increase their client base, the governing rule of insurance being the law of large numbers. And assessing premiums relative to risk is the heart and soul of insurance underwriting – something that these two propeller heads obviously don’t think is very important, especially since they’ve never had to worry about covering costs except by raising taxes. Strike Two.

  • “Many health insurance companies also impose barriers — like requiring prior authorization for tests and treatments and denying payment for covered services, which forces patients to appeal — to discourage patients from using the medical services for which they are insured and to attempt to avoid paying for those services.”

Health insurers aren’t fools, and know (and respect, even fear) the power of the regulatory apparatus that claims “consumer protection” as its primary goal, so this statement is suspect on its face. So-called “barriers”, such as prior authorization, aren’t designed as gate-keepers to that care, but are designed to ensure that premium dollars are used for medically necessary procedures or treatments, and that the treatment is appropriate – which saves money for care that is needed and appropriate. Denying payment for covered charges in, for instance, fully-insured, state regulated plans triggers an avalanche of remedies, including economic sanctions in the form of market conduct fines or other penalties that all insurers wish to avoid at all costs; in ERISA governed plans, remedies can be brutal in federal court or via federal regulatory remedies. To be sure, self-insured plans that are governed or managed by a complacent Third Party Administrator with an employer allowed to run rough-shod over the governing documents, are a problem in some instances (and has nothing to do with the general health insurance industry, a fact not commonly or even casually reported). Fraudulent, self-insured Multiple Employer Welfare Arrangements (MEWAs) can also be a problem; this has been the case for as long as they’ve been in existence, though. But this hardly represents the current state of the industry in terms of insured health insurance coverage, which is remarkably free of corruption, impropriety, taint, market excess, or accounting or claims issues. This is fear mongering, much akin to the famous and ill-advised rant of a certain former Speaker of the House, who famously railed against “evil insurance companies” with little or no evidence to support her emotional outburst. Foul Ball.

  • “Because most physicians and hospitals today are paid on a fee-for-service basis, medical care is organized around treating a specific episode of illness rather than the whole patient. This system encourages overtreatment and leads to mistakes and miscommunication when patients are sent between their primary care doctors, specialists and hospitals.”

Obviously these two have never been to a physician who advises a reduction in salt, exercise, and blood pressure medication after a physical that shows.. wait for it.. high blood pressure. This statement simply ignores the fact that the vast majority of physicians always perform care using ethical guidelines that promote returning the patient to health, regardless of treatment required or billed, or where the physician practices medicine. This statement is akin to a physician treating a long-standing headache, or history of headaches, with a dose of aspirin and doing nothing more – and nothing could be further from the truth (physicians, already faced with trial attorneys’ who salivate at the chance to cash in on a lawsuit alleging substandard or negligent care, go too far the other way, practicing “litigation medicine” in the absence of realistic tort reform). Fee-for-service is just what it claims to be: you buy a service and you pay for it, which is in fact the way most services are provided in our free enterprise system. In fact, most physicians nowadays aren’t governed by pure retail fees in any event, but in fact already accept, due to negotiated contracts with health insurance companies and their networks, fees based on a pre-determined schedule that substantially lowers the insureds’ cost of coverage and out-of-pocket costs. In response to this, the authors’ claim, in the classic Alinsky Method, that the system somehow, even in the face of insurers who relentlessly pursue fraud (currently a small fraction of expenses compared to estimated Medicare losses) and unwarranted health care expenses and charges, promotes “overtreatment” and mistakes or miscommunication without advancing any rationale or basis for this claim – we are simply to accept their assertion of “fact” as accurate (and disregard or ignore the fact that the federal government doesn’t even attempt to calculate the fraud and mismanagement in original Medicare – a fact seemingly lost to these two snake oil purveyors). One thing is certain, though – they have identified their enemy, and it’s private, fee-for-service physicians and the health insurers that pay out millions in claims and live on 2-3% profit before taxes that they wish to destroy. Foul Ball Two.

  • “A.C.O.’s are not simply a return to the health maintenance organizations of the 1990s. Although in both models patients are members of a provider network with a specific group of doctors and hospitals, and both are paid primarily per member rather than per procedure or test, there are big differences between them. H.M.O.’s were often large national corporations far removed from their members.”

In actuality, the public rejected the HMO model on a nation-wide basis for issues relating to access to care, per member per month limitations on care, restrictive gatekeeper provisions, and a host of other issues; mention “managed care” to anyone who had such a plan in the 90s and the reaction is usually negative, probably due to the inability to access care easily, especially specialists. Even many local health maintenance organizations of the type  that ACOs are supposedly drawing their identification with have issues relating to high doctor to patient ratios, long waiting lists for specialist care and other issues; pod plans, so-called because they represented a group of doctors and other care providers that practiced in a specific facility and thereby represented a mini-network of care for insureds, had limited success and appeal and were never wholeheartedly accepted by the public; they most closely mirror the structure of ACO’s but with troubling and ominous “big differences”, such as the fact that ACOs will increasingly come under the sway of the Centers for Medicare and Medicaid Services (CMS), which will use that power to enact more and more top-down, bureaucratic control over Americans’ health care choices, including the recommendations of the Independent Payment Advisory Board (IPAB). This is, folks, proof of the sinister take-down of the private health delivery system in our country, replaced by a government funded and controlled single-payor style, collectivist health delivery system modeled as a co-op, non-profit socialized version of the British National Health System, with physicians who are employees rather than private docs and nurses that can be more easily unionized. And if that doesn’t scare you…

This will:

  • “Today, consumers have to choose among insurance plans with a bewildering array of copayments, deductibles and annual out of pocket maximums — choices that few of us are any good at making.”

All of which I thought was… choice. Now, they’ll do our choices, for us. Strike Three.

Gosh, a thinking human being might have to apply some basic cognitive skills and assess what might be best for themselves based upon a set of criteria as complex as a copay, or a deductible, or out of pocket costs. Wow. Thank you, THANK YOU! Federal Government – what would we do without you? Will you help me choose a new car now? It’ll be green, I’m told. Or, perhaps, help me so that my VCR (yes, I still have one) stops blinking. I am soooooo thankful that we have actual Government Bureaucrats that will come to our aid when we need it…most. I’m just stunned… these difficult questions will now finally be answered for me. Tell me, will all of these be, say, less confusing than your current Medicare rules and process which, I have to say, isn’t..umm… user-friendly. Every year I have seniors who call me up and ask me … beg me actually… to try and explain, in some manner related to common-sense, what all of that Medicare mumbo-jumbo means, what with the 300 page booklets full of government-speak that no one understands (alas, I’m no longer allowed to speak to seniors except in very very limited circumstances, so.. no help for you!!).

The reality, and what is NOT written in their upbeat, everything-is-just-going-to-be-fine-with-Obamacare article, is that ACOs represent an intrusion into the private medical care of all Americans that will not be pretty: in the words of The Heritage Foundation, “they are more like a vessel for Centers for Medicare and Medicaid Services (CMS) statisticians and health policy gurus to work their craft than a mechanism that actually delivers better care.” And that is not the prescription for health care that many Americans will find appealing, especially from advocates who distort and mislead the public about the very disturbing nature of their prized tool for re-making the American health care delivery system, especially when coupled with Medicare cuts and the nature of IPAB. Because, the patient isn’t the customer. And that is the most troubling conclusion of all.

To learn more, go here. And, here. For background on ACOs, click here. For research and commentary, see this. For a simple example deconstructing how they will likely work, go here. John Goodman’s Health Policy Blog has excellent articles/links on ACOs – search! And last but not least, a comment from the FTC Commissioner that says ACO’s will make everything worse, in Forbes.

In closing, my opinion: the condescending attitudes and arrogance expressed by these two “public servants”, and their hatred of  private sector mechanisms, is telling, and clearly demonstrate their “government is the solution” mentality,  which should give all Americans pause to stop and think about whom to vote for this November. Liberty comes in many forms; being beholden to a government that views health care as an item on the bottom line is synonymous with a loss of that liberty – especially if you are no longer working and “contributing” to society. Food for thought.

Health Reform = higher health insurance premiums

Tags: , , ,

We tried to tell ’em, but no one on that side of the aisle listens: health reform inevitably drives health insurance rates even higher due to mandates and required coverage benefits on every policy (in Colorado, this was made worse by action at the state, not federal, level, when the Democrat ‘super-majority’ passed mandatory maternity coverage for every individual health policy sold or renewed in the state). This year, the average premium nation-wide rose 9 percent, higher than the last two years combined.

Want the whole story? go here.

And, before you think this report is biased, read this: the Centers for Medicare and Medicaid Services (CMS) estimates the growth in health insurance costs will increase 10 extra percentage points in 2014 because of health reform – a 14 percent increase, versus 3.5 percent without the law.

DOI reverses on mandatory maternity in individual health plans

Tags: , , , ,

In a bulletin issued March 15th, 2011, the Colorado Division of Insurance has “changed its interpretation” of their previous bulletin, issued in December of 2010, regarding maternity coverage for individual health policies issued in Colorado.

The controversy stems from a difference between the “applicability clause” in the enabling legislation, HB 10-1021, and the statute, as enacted. The applicability clause states that maternity coverage was to be provided for both issued and renewing policies, while the statute, as enacted, calls for maternity coverage to be provided only for “issued policies”. The Divisions’ initial guidance under the previous Bulletin did not require the coverage on renewal policies.

In it’s new bulletin, the Division, after “further statutory review”, finds that, in its opinion, the provisions of HB-10-1021 does indeed require coverage for maternity expenses for issued and renewing individual sickness and accident insurance policies and health care coverage contracts, reversing in toto it’s previous position, without showing any specific reason or legal basis for the change in its position.

Now, it’s no secret that this Bill was controversial, rammed through a Democrat-controlled legislature without any input from either the industry or the minority, and signed by the Governor post-haste. While touted as a “reproductive services” bill that ensured fairness, in actuality there is no fairness in requiring males of any age, children, and females of non-child bearing years to pay for this expansion of maternity coverage. Certainly, purchasing individual health insurance with maternity coverage was available in Colorado – so, what was the point of the legislation?

Colorado’s Democrat legislators have been attempting to recast the individual health insurance market as the mirror image of the small group market for years, and this legislation is one result of that thinking. The downside to this, and the biggest problem, is the cost to such a policy. Anyone who looks at group coverage, as compared to individual coverage, is aghast at the price, a point most Democrats seemingly ignore, and which has contributed to the decline in Colorado’s small group insurance pool, especially since the repeal of risk-based premium provisions in the small group market.

A quick analysis of the rates now being charged for individual health policies shows that the legislation has, indeed, made individual health insurance policies more expensive, and will have a negative effect on new policy issuance in Colorado. One wonders if that was the intent of the legislation – after all, with higher premiums, a certain segment of the population is locked out of the market, just simply based on price. If one can only buy Cadillacs, rather than something cheaper, does one simply not buy? This has the effect of increasing the pool of un-insureds in Colorado,  rather than expanding the pool of covered individuals, regardless of what the PR coming from Democrats would suggest.

Let’s not forget that Colorado residents lost a strong carrier when Aetna withdrew from the Colorado market due to this legislation. Will we have others withdraw, as well? One only needs to look at the disastrous outcome of the Kentucky health insurance market (and others, notably New Jersey) to see what will transpire as more and more carriers flee the state because of their inability to expand the risk pool because of high premiums, mandated benefits, and hostile regulatory and legislative actions.

Of course, Democrats have us covered there, too: their real solution is to get rid of all carriers and saddle the residents with a single-payor system. I shudder to think what that will cost in higher taxes and job loss.

Lastly, to add insult to injury, the Division, in its decision requiring maternity coverage in all policies renewing after January 1st, 2011, has authorized carriers to retroactively charge additional premium for the coverage, assuming the carrier has filed and has approved such premium. Even if the carrier has not filed for rates relative to renewal maternity coverage, the Division will allow such retroactive charges, once rates are approved, to the policyholder.

I’ll research and comment on the average rate increases this latest exercise in “fairness” will cost the average Colorado health insurance consumer in another post, assuming that such information is even available.

OK, now what?

Tags: , ,

The Republicans, to their credit, are determined to fulfill a campaign promise to repeal Obamacare and have scheduled debate and most likely hearings on the legislation, which should keep the issue front-and-center as a national campaign issue as we enter the 2012 Presidential campaign – something that has already started, for those who don’t yet know it.

“Let’s be clear” – to borrow a phrase – the POTUS will veto anything that smacks of repeal, or anything that waters down his intent to bring the private health insurance industry under the wing of the federal regulatory apparatus via wage and price controls that were legislated and are now being promulgated as regulations by HHS, CMS, and the IRS. The “battle lines” are drawn (sorry for the un-civil reference; it is a good one, though).

Democrats are doing their usual bang-up job, aided and abetted by like-minded media types, of characterizing Repubs as cruel and inhuman for wanting to, say, do away with the reforms that Obamacare brought to pre-existing conditions limitations, even though, in practical terms, the issue really isn’t an issue, only affecting 2-4 million people yearly, out of a total insured population of around 260 million under age 65. And the solution they’ve proposed through Obamacare, which essentially forces individual health plans to become small group health plans in all markets, will be substantially more expensive for all, driving even more people into the ranks of the uninsured – until the subsidies kick in, mind you, which really just redistribute tax dollars from those with more income to those with less income (and explains why the feds are setting up for a massive increase in Medicaid enrollees – I’ve seen estimates of more than 80 MILLION enrolled by 2014!). Never mind that solutions already exist, and have existed for years, but have never been enthusiastically developed to provide an efficient, truly workable safety net for those unfortunate 2-4 million people who do have pre-existing conditions and would like to remain covered. No, what was needed, claim the proponents of Obamacare, was a massive expansion of the federal entitlement bureaucracy and a new redistributive scheme. We even have the words of Donald Berwick, recess appointed as administrator of the CMS, as proof.

So, what now?

Opponents of Obamacare need to counter the overblown and, frankly, inaccurate claims by progressives that repeal of any part of the Affordable Care Act will lead to “people dying” or other incendiary comments thrown around by those who are in a lather about dismantling their latest entitlement expansion. Bottom line is that it needs dismantling.

First, Republicans need to outline, in no uncertain terms, what they are proposing and what they will support – and then let everyone know it. Otherwise, from this observers’ position, the Democrats’ win the public relations battle hands-down. It’s the old “they are going to take away your Social Security” argument, one that Dems have honed to a fine edge – and that some people accept as conventional wisdom, even if it contains not one shred of truth.

Second, while repealing Obamacare right now is essentially a symbolic act (although, given the nervousness of some Senate Democrats, I’m not so sure a repeal couldn’t land on POTUS’ desk for him to veto; that would be a gift) politics is all about symbolic acts, and the Republicans need to stick to their principles, and the promises made during the 2010 election cycle, and do everything possible to repeal it entirely, now and in the months ahead. This is a defining moment for Republicans, and they better not waver. Symbolic or not, it will prove to the voters who handed them the keys that they can be trusted.

Since outright repeal is probably not going to happen, given the veto pen over at the White House, constructive replacement is called for, and here is a good list to start.

The biggest danger, though, is one that is receiving little media coverage, which, to my suspicious eye, is by design. The Medical Loss Ratio (MLR) provisions are essentially wage and price controls which will drive out companies currently in the health insurance market, further weakening an already under-performing industry and essentially mandating their financial performance. For proof, look no further than Forbes, which gave the industry a 2.2% profit margin – lower than your grocer. What’s more alarming is that MLRs make no practical sense, as detailed here.

If Republicans want to gain traction quickly, this is one of the first places I’d target (oops -my bad) to change. Mandatory Medical Loss Ratios only make sense if you hate insurance companies and see no practical benefit to allowing them to survive – a view not endorsed by the millions of Americans (a majority, actually) who view them favorably.

© 2009 Health Insurance Info for Colorado. All Rights Reserved.

This blog is powered by Wordpress and Magatheme by Bryan Helmig.