by Handoyo susanto | at 12.26
If Republicans are going to degrade and destroy Obamacare they better bring their "A" game to the table. The ideas put forth in The New Republic are obviously from the J.V. team.
Consider this:
According to some, repealing the individual mandate (to buy health insurance) is number one on their agenda.
Certainly the most unpopular of the Obamacare provisions, but also the glue that makes it work.
Without a mandate you can expect carriers to take their ball and bat and go home.
The business mandate is also on the chopping block.
The employer mandate is a requirement that all companies with more than 50, full-time employees provide affordable insurance or pay a fine. It also defines “full-time” as at least 30 hours a week. The law’s critics say that has encouraged businesses to reduce the hours of some employees, in order to prevent them from hitting the 30-hour threshold and thus triggering the penalty.
The employer mandate has been, and will continue to be, a jobs killer. Eliminating the mandate is good, but exempting business from all Obamacare provisions is even better.
Employees have already seen undesirable benefit changes and unwanted premium increases as a result of Obamacare. There is nothing affordable about the "Affordable Care Act" and this extends to group plans as well as individual coverage.
The so-called insurance company "bail out" is viewed by some as unfair. This government reinsurance program is one of the main reasons why carriers agreed to come to the Obamacare Ball.
Protection against losses put them in the game. Taking it away will collapse the system.
Don't get me wrong, I never was an advocate of the risk corridor coverage. The reinsurance is scheduled to go away in a few years any way. Accelerating the removal is also accelerating the financial collapse of the Obamacare house of cards.
Add more metal plans.
Insurance available through the new insurance marketplaces must fit into one of four “metal” levels—platinum, gold, silver, and bronze. Platinum are the most generous plans: They would cover about 90 percent of the typical person’s medical bills. Bronze cover 60 percent. Critics of the Affordable Care Act say that the law forces some people to get more insurance than they want. They’d like to introduce a new metal level—copper plans, which would cover about 50 percent of the typical person’s medical bills.
The people that want to add copper plans must clearly have a cranial - rectal inversion. Throwing a (slightly) lower premium plan into the mix won't help anything.
Many of the so-called Essential Health Benefits are viewed by many as forcing them to buy coverage they don't want. This is especially true when you tell a 60 year old woman her new Obamacare plan includes free birth control and a maternity benefit.
But the EHB's have minimal impact on the new cost of health insurance.
Guaranteed issue requirements, telling carriers they must issue a policy to anyone, regardless of pre-existing medical conditions, drives up the cost more than anything else.
This is followed closely by community rating and age banding.
If Congress wants to make Obamacare more workable, they'll need to return to a market-based insurance product, probably with simplified underwriting, and coupled with a national risk pool.
Get rid of all mandates, including the MLR, and allow carriers to operate in a free market.
Anything else will just make things worse than they are now.
#repealobamacare
by Handoyo susanto | at 11.35
by Handoyo susanto | at 12.30
If memory serves, we first addressed the insurance challenges of ride sharing some 3½ years ago:
"When you bought your policy, you agreed to the coverages and exclusions in the policy, and also to your own (minimal) obligations, one of which is to inform the carrier of a "material change" in the risk."At the time, we noted that hiring out your vehicle, or offering rides therein, made you a commercial insurance risk, and that personal auto policies explicitly exclude this from coverage. Fast forward a bit to this past Spring, and we restated the problem in the age of Uber and Lyft:"The Nebraska Departments of Insurance and Motor Vehicles are urging caution before people sign up for Internet services that connect drivers, riders and vehicle owners for car-sharing and ride-sharing."Again, the problem is whether or not one's policy allows for commercial use, and whether or not one had alerted one's carrier to the change (and obtained appropriate cover).The challenge takes on a new urgency today:"A spokeswoman for rideshare service Lyft says one of its drivers was involved in a multi-car crash in Northern California that left a man dead"It appears that the Lyft driver was at fault (swerving to avoid a broken down vehicle), so the question arises: did he have appropriate insurance? We don't know, but one suspects that we'll soon find out. In the meantime, I've reached out to our favorite P&C guru for his thoughts.Stay tuned....
UPDATE: Thanks to Kevin Sullivan, we have a bit more on this developing story:
"While a driver is providing a ride or on the way to pick up a passenger, Lyft offers $1 million in liability insurance, and $1 million in uninsured/underinsured motorist coverage. That coverage, which once was “excess” — kicking in only after a driver’s personal auto policy had been exhausted — became primary coverage in July."
Here's why this is important: it's possible (perhaps likely) that the underlying coverage - that is, the driver's insurance - will not cover this event. That being the case, it couldn't be "exhausted" and therefore Lyft's plan might not come into play at all.
Since Lyft's policy is now considered primary it shouldn't matter whether or not the driver's insurance steps up.
Time will tell.
by Handoyo susanto | at 10.30
A couple of weeks ago, Anthem sent me a list of my clients whose plans renew this December. These are so-called "grandmothered" plans, but because Anthem chose not to participate in the expanded transition program, no changes can be made to them: my clients' only choice is to keep them or ditch them.
So I put together a brief (but informative) email explaining this, and sent it to the folks to whom it applied:
"Good morning!
As you know, there have been (and continue to be) a lot of changes with health insurance. Your current Anthem plan is "grandmothered;" that is, you may keep it as-is, or we can shop it around.
Your current rate is: $xxx
Your December renewal rate: $xxx
Based on recent experience, don't expect great results from shopping for a new plan (sorry!): your current plan doesn't meet all of the new ACA mandated requirements, but a new plan would (and I'm seeing some pretty horrendous rates on those). If you're interested in checking that out, here's a link to our (private) Exchange - it does NOT go to the .gov site:
[link]
There, you can see if you're eligible for a subsidy and get quotes for different plans. Of course, I'm always happy to run those for you if you'd prefer (or even just walk you through).
Thank you so much for the opportunity to be of service!"
As you might imagine, I've had quite a few replies: folks are generally pleased to have been kept in the loop, and most have asked me to see what else is available. Curiously, only one or two seem to be eligible for a subsidy, but we can't get those rates yet.
In the meantime, we started ...
Wait, what do you mean "we can't get those rates yet?" It's less than two weeks until Open Enrollment starts, and the carriers haven't figured out what they're going to charge? How can that be?
Have you not been paying attention? We reported a month ago that carriers were enjoined by Our Betters in DC© from disclosing Exchange-related testing results, which of course would include details such as rates. Makes sense, really: after all, we have to hide the site in order to learn what's in it.
Right?
As I was saying, I began running quotes for my December renewals, and (as expected) they weren't pretty. By way of example:
Client 1 - HSA plan, current rate $241, renewal rate $276, comparable ACA-compliant plan $540
Client 2 - HSA plan, current rate $355, renewal rate $432, comparable ACA-compliant plan $1,020
[ed: Almost all my clients are in HSA-compliant plans. Funny, that]
The point is, there don't seem to be any attractive options for these folks; their best bet is to stay put, at least for the nonce. I'll add that I see no reason to be optimistic about the January 1 rates - when they're finally released.
by Handoyo susanto | at 07.59
by Handoyo susanto | at 11.21
Randy Essex, editor of the Glenwood Springs (Colorado) Post Independent, has an interesting, if disingenuous, article on a recent health care claim. Briefly, he underwent what he called "routine blood tests" that had previously cost him $45, and for which he was recently dinged $958.
He then proceeds to complain about transparency, pricing and claims, without ever actually demonstrating any knowledge of what actually happened.
So let's deconstruct this for him, shall we?
By his own admission, his previous tests cost him $45 because he had a (presumably generic) co-pay plan. Of course, the tests cost much more than $45, and he pre-paid the balance with inflated premiums (versus a catastrophic, HSA-compliant plan).
Flash forward a few months, and he has a new (catastrophic, presumably HSA-compatible) health insurance plan. As an aside, he laments that he was a victim here: "The only thing that had changed was my insurance, which, like so many other workers’ plans in America, had been switched by my employer to a high-deductible policy."
Here's a new flash, Randy: your employer can't require you to sign up for his group plan. You could always say "no, thanks." Look for that option to go away, though, as employers dump their employees onto the Exchanges.
But I digress.
Next, Randy admits to a very stupid choice: "the doctor wanted to put me on Lipitor, and I acceded. I hated it and stopped." This is called "self-medicating" and is generally a very stupid idea. At the very least, you should discuss this in advance with your physician (for whose services you've paid, by the way).
He goes on to detail his most recent encounter, and it's here that things begin to go sideways quickly:
First, he laments that he needs "to be able to see the prices without spending hours on the phone." Most carriers have made this information available for years (heck, we first wrote about it almost exactly 9 years ago!). Then he "assumed this was a preventive, covered procedure meant to help lower my risk of heart disease" (emphasis added: we all know what happens when we assume). Rather than assume, why wouldn't you ask the purpose, and then check to make sure? Based solely on the article, it sure seems to me that this was diagnostic, not preventive, and thus subject to the deductible.
Generally speaking, even diagnostic items would be eligible for in-network pricing, but that appears not to have been the case here:
"The bill also showed an insurance adjustment that lowered my cost by $1. One. Dollar." After speaking with the plan administrators, he was assured that this was a mistake and that it would be corrected, but that seems not to have happened. Rather than pursue a solution with the insurer, though, he indicts "the clearly ridiculous cost, the complete lack of transparency in medical prices and the lack of any real consumer choice."
Really, Randy? I don't think so: you have no idea what drives those "ridiculous costs," such as malpractice and other liability insurance, lab fees, the actual costs to run the various tests, and of course the experts to analyze the results. The lack of transparency is on you: why didn't you check the carrier's site, or ask the tech? Most likely he (or she) wouldn't know, but could direct you to someone who did. And finally, you had your choice of any number of facilities where this work could be done (Google and/or your carrier's site come to mind).
No, it's much easier to blame others for your own lack of foresight. On the flip side, congrats on your lower lipid level.
[Hat Tip: FoIB Holly R]
by Handoyo susanto | at 06.21
