Noted right-winger disses O'Care

It's a shame when politicians attack President Obama's signature achievement in such a vicious way:

"It doesn't make any sense. The insurance model doesn't work here"

Really, such partisan assaults have no place in civil discourse, and I call upon  this naysayer to offer a suitable apology.

Wait, what?

"Bill Clinton calls ObamaCare 'crazy system' while campaigning in Michigan"

Oh.

L'Shannah Tova 5777

This evening marks the beginning of the Days of Awe, starting with "Jewish New Year's" (Rosh HaShannah) and culminating in the Day of Atonement (Yom Kippur). This year, I thought I'd let Dr Amy Farrah Fowler Mayim Bialik and her friends do the honors of explaining some of the symbols and rituals.

May you and yours enjoy a happy, healthy New Year.

Hey, it's only (Your) money

So it appears that Our Betters in DC© are funneling money to their O'Care enablers:

"The Obama administration is illegally sending payments to health insurers instead of to the federal Treasury as Obamacare requires, according to a new report from the Government Accountability Office."

Now, where is it getting this money? Well, that's a good question:

"The industry [poor suckers that actually bought ObamaPlans]-funded reinsurance program was supposed to provide $10 billion to insurers and $2 billion to the federal Treasury."

When that fell (way) short, they shoveled the whole amount, all $12 billion to their AHIP cronies, shorting those of us who actually pay our bills, including finding the government, by $2 billion.

And that was just for plan year 2014 losses. There's also last year's and this year's losses, which are even more substantial, to be reckoned with. Predictably, some congressional Republicans are threatening to hold their breath til they turn blue making threatening noises.

But that's not the only money source in this shanda:

"Justice Department officials have privately told several health plans suing over the unpaid money that they are eager to negotiate a broad settlement ... payments most likely would draw from an obscure Treasury Department fund intended to cover federal legal claims"

There used to be a term for this kind of thing...let me think...oh, yeah.

Business as usual, then.

Frustrating Circumstances

I originally thought this would be another in our series of either Stupid Government or Frustrating Carrier Tricks. But it's really about how "life happens."

So we know that HHS has been cracking down on off-season ("Special Open") enrollments, leading carriers to be particularly stringent on what documentation they'll accept, and adhering tightly to the 60-day open window.

But sometimes, even having all the documentation one thinks is necessary just isn't enough, and it's not the fault of the proposed insured, the carrier, or the government.

Here's the story:

Bill was covered under his wife's health insurance policy until their divorce this summer. The divorce was actually finalized on July 13th, but Bill's ex told him that her boss had promised to keep him on the plan through the end of the month (that would be July 31st, for those following along at home). Divorce is one of the Special Open Enrollment triggers, as is involuntary loss of group coverage. Typically, the clock starts ticking the day the divorce is finalized, or when the coverage ended.

Because we believed that Bill was covered until July 31, we presumed that the clock started then, and we had 60 days to obtain new coverage. Bill didn't contact me until early this month, so we knew that clock was ticking, but believed we'd be clear for an October 1 effective date.

We submitted the application and supporting documents (well, those we knew about), one of which was the Proof of Coverage from the group plan. It said that coverage ended July 1, but since we'd been assured by Bill's ex that this wasn't the case, we pushed forward.

As the 60 day window continued to close, I asked Bill for more documentation to prove that we'd gotten in under the wire.

This is what I got in  email this morning:

"It was not supposed to end until Augus! I found out yesterday that it was cancelled July 1, and my ex's was cancelled August 1. She has left that position and is suing the guy she was working for. I have not been able to reach this former employer. Calls not being returned. I really don't know what to do at this point."

So basically, the carrier was correct that we'd missed the deadline, and will be refunding Bill's initial payment shortly. On the bright side, I was able to come up with a pretty nifty solution to Bill's coverage and ACA problem (but that's another post).

The moral of this little [ed: "little‽"] story is that sometimes one can dot all the right i's and cross all the right t's, and still come up short.

About those "High Deductible Health Plans"

Back in 1992, I was introduced to the world of Medical Savings Accounts. These then-cutting edge plans were unique in that they touted $1,000+ deductibles in a world where $500 was considered exorbitant. But they offered substantial savings, part (or all) of which could be socked away to help defray future needs.

As time went on, MSA's evolved into tax-advantaged HSA's, but the basic premise was undisturbed: in consideration for the insured taking on more risk, the carrier agreed to a lower premium.

Win-win.

Especially because a young, healthy person could sock away quite the nest egg.

Eventually, though, the ObamaTax came along, with out-of-pockets that dwarfed traditional HSA's, coupled with premiums that matched what used to be considered the most expensive "high end" plans. So: lose-lose.

FoIB Allison Bell has a terrific new article on the effect that ACA-compliant plans with ever higher deductibles - and premiums that don't reflect them - are having on the average person. She cites a new Guardian Life report "based on a recent online survey of about 1,700 U.S. workers."

And the findings are eye-opening (or cringe-worthy; your call). For instance:

"[O]only 44 percent of the workers surveyed this year told Guardian they had enough cash in a checking account or savings account to pay a $3,000 medical bill.

About 34 percent said they would use credit cards to pay bills that big."

Great.

And here's another:

"About one-third of the workers in high-deductible plans said they had skipped what they thought was a necessary doctor visit, avoided a blood test, delayed a procedure, failed to fill a prescription or avoided X-rays because of cost."

We've seen this before: your insurance is too expensive to use. Of course, because plans are guaranteed issue and can't exclude pre-existing conditions, by definition they're going to cost more - much more - so any savings that were once available to those with higher deductibles is now gone.

#O'CareWinning!

If you like your plan... (Part 6,392)

And the hits just keep on coming: first Nebraska, then Indiana, and now The Volunteer State:

"Blue Cross Blue Shield of Tennessee is dropping most of its Obamacare customers"

And no wonder: the carrier anticipates eating half a billion dollars in losses from these plans. That's a lot of scratch, even for the Blues.

Look for more of these as we inch closer to Open Enrollment v4.0.

#O'CareWinning!

It's only money [UPDATED]

[Scroll down for update]

The ostensibly toothless Individual Mandate seems to have hit more people in '14 than previously reported.

A lot more:

"[A]bout 560,000 more taxpayers paid about $200 million more in penalties than was previously reported"

That upped the total for the year to $1.7 billion, and graphically demonstrated (as if this weren't obvious from the git-go) just how "sustainable" the ObamaTax isn't.

To help mitigate the pain, several senators have introduced the Obamacare Tax Relief and Consumer Choice Act under which, if passed and signed into law [ed: Heh], "individuals would not have to pay the penalty if health insurance premiums in their state rose by 10 percent or more or if they could not afford deductibles."

Exit question: Why won't the Powers That Be tell us how many folks actually paid the penalty (in cold hard cash) as opposed to having it withheld from their refunds?

[Hat Tip: FoIB Holly R]

UPDATE: And it just got more challenging for folks in Indiana:

"About 27,000 Hoosiers will lose their Obamacare plans next year, after Indiana University Health Plans announced it is withdrawing from the Indiana marketplace."

But remember:



[Hat Tip: Adriana Cohen]