Archive for the ‘Obamacare’ Category

Anthem backs Obamacare reform

Saturday, March 11th, 2017

Boston Herald

Anthem provides Blue Cross / Blue Shield nationally for employers with employees scattered all over the country. Their main customer is the United States government – which gave the Obama administration substantial leverage to blackmail Anthem. The Affordable Care Act required the Medicare / Medicaid operation within HHS to sign up at least two multistate health insurers to offer insurance in states which chose not to set up an exchange. It was down to the evening of the final day before Anthem agreed to sign the contract. Anthem provides insurance in states or areas where there is not an existing Blue Cross affiliate.

The notion of expanded multi-state health insurance operations in what has been regulated by state insurance commissions has to be attractive to Anthem. It comes with complications, which are that the cost controls in health insurance are gained by herding physicians into group practices with prenegotiated prices and discounts.

Organizing that on a national basis is a huge job and might draw an anti trust action if Anthem were too heavy handed – however in the end, health insurance is a “cost plus” business. When they pay a claim, it is not coming out of profits, it is just building the case for higher insurance premiums next year. Blue Cross and Shield were created to maximize profits for hospitals and doctors, after all. It largely solved the issue of patients who refused or were unable to pay by forcing them to prepay ahead of time. This was especially helpful when the patient died and the family refused to pay.

Repealing Obamacare

Saturday, November 12th, 2016

Well, the Republican leadership is going to put their cards on the table in 7 card stud poker with all the cards face up and see what happens.

The Hill

Reconciliation is the convoluted method used to pass Obamacare over the filibuster process (Republicans were the minority party in 2009). Republicans intend to use the same process to pass the repeal over the objections of the 48 Democratic Senators in January.

The Affordable Care Act has many tentacles beyond the few that cause most people grief. The main thing people are unhappy with is the mandate to buy insurance and the penaltax. But that is a relatively minor part of the 2000 page bill.

  • Gender equity was a big part – that men and women of the same age had to be charged the same premium, even though women spend substantially more on health care
  • Medicaid expansion – at its roots, the ACA is a federalizations of the entire health insurance industry. The ACA mandated that states loosen the requirement to be on Medicaid, specifically ending the asset tests and only looking at income
  • Ending lifetime or annual maximums – that is what has killed BCBS of NC, having to pay huge big pharma bills for exotic medicines. BCBSNC has been paying out 10x in benefits what it collects in premiums. That is not a sustainable business model.
  • Subsidies to insurance companies to protect them from bad actuarial assumptions and adverse selection (that only sick people buy coverage after they get sick)
  • Mandates of covered services in a policy, including preventive care having no requirement for deductibles
  • Coverage of children on their parent’s policy up until age 26 (presumably that is mostly there for young adults with preexisting expensive health conditions)
  • Premium subsidies for low income people in between Medicaid eligibility and 400% of the poverty level (about $45,000)
  • “Must issue” requirement – this is closely related to the pre-existing condition test ban, but not totally. Must issue means that an insurance company cannot deny coverage to anyone, but in theory they could refuse to pay the expenses of known problems
  • Limits on overhead expenses (and profit) by insurance companies
  • 300% cap on premiums based on age
  • Medicare provider reform

I will be riding this roller coaster, probably for the next 4 years, should I live that long. Part of the reason I have had no medical expenses for three years (other than one primary care visit) was concern that Republicans would undo “must issue” and pre-existing condition tests would return with a vengeance, and racking up diagnosis codes now could cost me dearly down the road. Many companies that used to write individual coverage have been merged into larger companies or have withdrawn from writing individual policies.

I recognize that notion is somewhat irrational, but my distrust of the medical care system is at the root of that. This point not lost on my niece, the primary care doctor – she didn’t understand why I didn’t want to rush out and find out everything medically wrong with me. Her mother had no health insurance and refused to see a doctor. It runs in our family, because we have doctors in the family 😉 in my case, there are no children to worry about. My sister got her children through college, launched into adulthood, and viewed her job as mother as complete, and if her children wanted an ongoing relationship, it would be on her terms. They refused, and she died. Her kids will never understand.

From a legal standpoint, the US government has a contract with insurance companies to pay the Obamacare subsidies for 2017, and Blue Cross has extended coverage to me for the coming year. If the subsidies are withdrawn, I can pay the full premium, but I am probably the exception.

Each constituency that benefits from Obamacare will fight the repeal. Health Care providers and insurance companies might declare bankruptcy. Small children with horrible medical problems will become props on TV networks. Do you want little Jessica and her cute puppy to die because of evil Mr Trump and greedy insurance companies working for Wall Strert?

Put your seat belt on. No standing. I hope you are tall enough to be on this ride.

It’s Obamacare day!

Tuesday, November 1st, 2016

No pushing!

As promised, all the insurance companies have dropped out, except Blue Cross/Shield of NC, who amended their request to add 24% increase. Without subsidy, the silver plan has around a $1,200 a month premium. While the “risk corridor” payments are going away (I think), the subsidy seems much higher.

Because NC withdrew from Medicaid expansion, in theory if my income is below about $15k (138% of the poverty level), the subsidy is not available because I am income “poor” but have > $2k in assets, so I am not “asset poor”. Since I am not pregnant and have no minor children, I would not qualify for Medicaid anyhow unless I get declared disabled (probably close to true now). That rule does not seem to be reflected in what the web site is saying about pricing.

$1,200 a month would be roughly what I would have paid for the HIPAA plan I had in Illinois. My YTD medical expenses for 2016 have been $0.00 – eventually that will change.

So I’m “waiting in line” for my turn to actually enroll. If I do nothing, has already said they will automatically reenroll me in a comparable plan to the defunct “gold” United Healthcare plan I have but ignored. Maybe I should get a flu shot or something.

In three weeks, I turn 61, with 1 year until early Social Security and four years left until Medicaid eligibility in the unlikely event the world hasn’t ended by then and the rules don’t change. My sister👻 collected social security for about 9 months before she died.

Repeal and Replace! 😂💸 Trump Trump Trump!

Walmart – Barack Obama’s ally

Monday, August 29th, 2016

That’s the opinion over at Bloomberg…

Obama loves Walmart

The Clinton ties with Walmart go back to the earliest days when Sam Walton ran the company and made a point of buying from American suppliers. That was then and this is now. Walmart has long been on the list of evil targets for the lemmings of the left, for a variety of reasons – one being that they sell guns in the sporting goods department.

Does Donald Trump have an opinion on Walmart?

Obamacare and Equity Funding (1973)

Friday, August 26th, 2016

[Written November 2013]

Back when I was studying accounting, the Equity Funding scandal was fresh – but the lessons learned from it need to be told to the Obamacare brain trust.

The scam involved creating fake life insurance policies that didn’t exist. It involved a thing called reinsurance where the company that signs up the client then sells the policy to another insurance company who then collects the premiums and pays out the benefits.

The finder’s fees were then used to pay the premiums which then fed creating more fake policies. The company grew very fast and was very profitable.

Equity Funding fell apart when the company that had bought the policies noticed that nobody died and they were not paying out claims. It’s pretty hard to fabricate a death certificate for a person that doesn’t exist.

If insurance companies can directly sign up people and get a $6-10k “subsidy” payment, it doesn’t take a genius to see that someone might start creating fake people to get the subsidy – and then have a bunch of people that go the entire year without making a claim.

You know, if the insurance company isn’t “blue”, it could be a “bad apple”

AETNA pulls the plug on Obamacare

Tuesday, August 16th, 2016

Without the protection of the federal “risk corridors”, pretty much nobody is willing to write individual health insurance policies.

With the withdrawal of Aetna, that leaves exactly one provider left in NC – Blue Cross, and they have not said for certain they will offer policies. If they do, the premium will go up 18%.

BCBSNC is being more direct now about the problem they face. 60% of all their expenses are going to pay for exotic pharmaceuticals for 5% of the ADA policy holders – not hospitals, doctors, Preventive cancer screenings or things that can really save lives.

AARP On specialty drugs. Note they focus on copays, not total costs.

Look for Hillary to make this a major campaign issue after September 1st when some states have no company offering individual policies.

Unaffordable Care Act 2017

Saturday, June 4th, 2016

This is the time of year that insurers have to put their cards on the table for next year. Since by now, ACA was going to be wildly successful, the ACA was to phase out the guarantee of Federal money if actuarial projections wildly understated actual costs. Now with two years of data, there is no reason to need “risk corridors” since the data on who will enroll and how much they cost is no longer so speculative. It’s time to set the premiums at levels reflecting actual costs.

United Healthcare has already folded their hand in NC. Cigna has volunteered to fill the void, but only over in the Research Triangle counties which have access to Duke Medical Center. Blue Cross would like another 18% and suggests they may selectively drop out county by county. Connecticut based Aetna expects to keep writing policies. They are acquiring Humana and previously acquired Coventry in 2013.

Lack of competition is never a good thing. If it looks like Donald Trump is going to win, health insurers will become even more reluctant to take risks. I suspect that in the event everyone pulls out or Republicans totally defund Obamacare, things will revert back to state run assigned risk pools under HIPAA which will leave me trapped in North Carolina – but that’s OK.

It’s just the premiums will probably go up to $2,000 a month for the remaining 4 years until Medicare eligibility. With my 2016 Cadillac United Healthcare policy, it’s June and my medical expenses YTD are currently $0.00. That might change, but I’m reluctant to find out all the things wrong with me – racking up new pre-existing conditions to scare insurers away in a post Obamacare apocalypse. I sincerely appreciate the people already on Medicare wanting to dismember the ACA. Perhaps I will be able to return the favor some day.

My Presidential Obamacare Veto Speech to the nation

Friday, December 4th, 2015

(After the House adopts the Senate version)

[roll TelePrompTer]

Good Evening fellow Americans and Republicans,

The Republican controlled House and Senate have placed on my desk a Repeal of the Affordable Care Act, which I believe has been the most important thing done during my administration. [why it is important, blah blah blah]

I believe in Democracy and I do hear the voices of those that want to strip away health coverage from the weakest and most defenseless in our society. I don’t believe those voices represent the majority of Americans.

I will never agree to a repeal of the affordable care act, but neither will I oppose the majority of Americans that Republicans believe they represent.

The process for putting bills into law gives me 4 options. I can sign the repeal, which I will not do. I could veto the bill and the repeal won’t happen – but I won’t do that either.

If I do nothing, after 10 days, the repeal becomes law without my signature, leaving Republicans completely responsible for the consequences. If we break our word with Health Insurance providers, they assure me all individual policies for 2016 will be cancelled immediately as the US government will have breached our contract with them to cover their underwriting losses.

The fourth option is called a pocket veto. If I do not sign the repeal and Congress adjourns in less than 10 days, The bill does not become law. Republicans will essentially veto their own repeal bill.

So my fellow Americans [and supporters in the Media]. It is time to tell Congress your opinion, either for or against. The only situation in which I will sign a veto is if the Republican leadership asks publicly that I veto their repeal bill. The responsibility is entirely theirs.

Good Night America, and may God protect the children and the helpless…

Obamacare Update

Monday, November 30th, 2015

My enrollment confirmation and temporary ID card has arrived from United Healthcare. That leaves the loose end that Blue Cross will automatically renew my policy for 2016 if I don’t tell them to not renew me.

So this morning at 10 AM, I called BCBS Customer support and the computer/phone maze urged me to have a call back – if I stayed on the line, I could expect at least a 25 minute! wait due to heavy call demand. I stayed on the line. My call was answered in less than a minute.

After explaining the situation, I was informed because I pay by bank draft, she could not do anything until the payment for December has cleared. I stated that was unreasonable and that I would be calling the State Insurance Commission if she could not come up with a better answer. She called my bluff.

I called the State Insurance Commission in Raleigh, and my phone call was immediately answered. The guy who answered did some uh-huh’ing, but otherwise basically showed no interest in getting involved. None of that was unexpected.

So I’ll wait until Friday and call back and enter round 2 of the fight to disconnect from Blue Cross.

Delta Dental sent their paperwork to arrange drafting my bank account. The “pay online” link from returns an “unknown error”. Their process seems to be to fill out a form by putting numbers in boxes and putting it inside an envelope (none was provided) and send it via postal mail in order to be keypunched by a data entry clerk. What year is this?

Obamacare Year three

Wednesday, November 11th, 2015

This time did what it should have done the first year. It delivered what it said it would. I could seem plans and premiums before identifying myself. In North Carolina, there are three active insurers – Blue Cross/Shield of NC (Not Anthem), Aetna (formerly Coventry) and United Healthcare.

By reviewing the providers I can see
– Blue Cross is offering an overpriced total crap plan with only desperate providers
—– aligned with Carolina Health Care hospitals
– Aetna is aligned with Carolina Health Care, generally the lower quality hospital
– United Healthcare is aligned with Novant, the other health care oligarch
—— my family doctor works for them
—— my niece also works for them
—— the hospital is downtown, not quite as convenient
—— seeing a specialist requires a referral

By estimating my 2016 “income” at $35,000 the generous federal government money fairy offers $580 a month “subsidy”.

The “gold plan” from United Healthcare will be about $450 a month with the subsidy – a little over $1000 a month if I paid the whole premium. Annual deductible is $1000 instead of $5000 for the $815 a month Blue Cross bronze plan.

The magic to the subsidy is if I claim it now, but then don’t qualify, I don’t have to pay it all back. Nancy Pelosi loves me. If I actually “earn” $0 in 2016, I am not eligible for any subsidy for 2015 (because NC did not expand Medicaid), but I don’t have to pay a penny of the ~$7000 back when I file taxes for 2016 in April 2017, if I live that long. If I “make” less than $22,900, I have to pay back $300 of the $7000 (ouch!).

I clicked “I accept”.

The Republican debate convinced me there is no chance Obamacare is going away. Not one of the candidates appreciates the institutional inertia they face. Fighting to end abortion, impose a no fly zone over Syria, keep the King of Jordon in power for a thousand years, rebuild the 6th Fleet or promising to implement a flat tax will not create a groundswell that puts 60 Republicans in the Senate. Anything substantial Republicans will try to do even with a President and filibuster proof Senate will be immediately thrown out by the Federal Courts. They don’t need a reason. They have power.

2016 will likely become the year I “fix” things I’ve put off like getting a hearing aid. Even though I think it is a sham, I even signed up for dental insurance through Delta Dental.

What’s your story?