SHOP Sweat

How desperate are the rocket surgeons in DC to make something - anything, really - of the Small Business Health Options Program (SHOP)? This desparate (via email from CMS):

"Do you know that from November 15 through December 15, small businesses can enroll in SHOP Marketplace coverage without meeting a Minimum Participation Rate (MPR) requirement? Think about your new and existing clients who may not otherwise be able to meet the minimum participation requirement."

Now why is this a big deal?

Well, let's just say that the response to the program has been underwhelming:

"After nearly two years in operation and millions of dollars spent in development ... about 85,000 people, from 11,000 small businesses, have coverage through the [SHOP]."

So now we know why the gummint would (illegally, natch) lift its own requirements. But then one is faced with the dilemma of Chesterton's Fence:

Carriers require certain participation levels because of "adverse selection;" that is, if only those with health problems sign up, then the carrier is going to be losing money very quickly since there's no corresponding offest from healthy employees.

But then, understanding basic insurance principles was never a strong suit of O'care proponents in the first place.

"In the end, there can be only one"

In email from our friends at Cornerstone:

"In 2017, the Centers for Medicare and Medicaid Services (CMS) will automatically re-enroll individuals of discontinued “on exchange” plans into similar plans offered by other carriers still selling in the marketplace."

To be sure, with so many carriers ditching the marketplace for the 2017 plan year (and, perhaps, beyond), such a streamlined process makes a certain amount of sense. And as we're also seeing, Blue Cross seems to be the one carrier still left standing in state after state.

Still, doesn't it seem a bit...presumptuous for a government entity to so brazenly (and without much fanfare, really) automagically assume that citizens prefer that the choice be taken from them?

Or, as FoIB Allison B so wryly observes, "Anthem gets everybody."

Indeed.

Obamacare Gaming Edition

Obamacare is almost 3 years old and an even bigger mess than ever. The billion dollar website still crashes and is not fully functional. Navigators and "enrollment assistants" are nothing more than phone jockey's trained (in a manner of speaking) on how to key in questions and read answers off a computer monitor.

Most have no clue about the difference in a PPO, POS or HMO plan. Of course with most of the PPO/POS plans going away that will make their job easier.

Drug formularies are another story.

But this is to be expected when health insurance agents with years of experience are forced out of the market only to be replaced by former minimum wage workers who have gone through 2 weeks of training and are now earning a "livable wage" of $17 per hour.

Savvy consumers who are not subsidized and are now facing monthly insurance premiums higher than mortgage payments and STILL required to shoulder tens of thousands in out of pocket expenses before the carrier pays a single dime are saying ENOUGH!

Consider the case of Will Denecke.

Will Denecke, a self-employed urban planning consultant in Portland, Ore., said he planned to skip buying health insurance for 2017 because the premium had shot up to $930 a month. Instead, the 63-year-old man said if he developed a medical issue sometime during the year, he would go to the Affordable Care Act marketplace and buy a plan outside the open-enrollment window, which he's aware he's not supposed to do. 

He said the ACA rules sharply limiting such midyear enrollment are easy to get around. Last time he simply claimed a change of income. “I've done it before, and my broker helped me - Modern Healthcare 

Obamacare is three years old and DC still hasn't closed all the loopholes. Agents, the few that have not left the business, are sticking it to the government and carriers every day.

Too bad Obama and company pissed off some of the most talented people this industry has ever known.

#ObamacareFail

If you like your doctor...

Remember this:



Ah, good times, good times.

Reason I ask is this:

"The number of physicians who say they’re accepting health insurance plans offered on Obamacare’s federal and state marketplaces has plummeted nearly 20 percentage points"

Now, we've blogged on this for a long, long time, but as we head into Open Enrollment v4.0, it's not enough to make sure your plan is affordable, but that it's actually useable. That is, all those "freebies" (colonoscopies, mammograms, routine physicals)? Well, they're not going to be free if your doc doesn't take your plan. And good luck finding a new provider:

"[O]nly about 57 percent of doctors said they'll be taking new patients insured by the plans next year"

That's less than two-thirds, and may be even worse in some areas.

#ObamaCareWinning

[Hat Tip: HotAir]

Game 7 Health Wonk Review is up

Brad Wright hosts this week's World Series (and election) themed collection of the best health care wonkery on the 'net.

And, like the Cubs this year, a winner indeed.

Heads' I win...

There's a popular meme circling the 'net that says the rate increases really won't affect most people because their subsidies will cover the spread:

"Yet most Obamacare participants won’t feel the full price hike or anything near it. Nationally, 85% of those enrolled receive a tax credit"

This is why I get so frustrated with the media, which seeks to isolate the Marketplace (Exchange) from the big picture: all ACA-compliant plans are ObamaPlans, not just those on the Exchange. That is, if it's ACA-compliant, then it's ObamaCare. By trying to split "ACA compliant" from "bought on the Exchange" these oh-so-clever "journalists" seek to put daylight between the two that doesn't actually exist.

The reality is that yes, most folks who buy on the Exchange are going to be getting subsidies (aka "a several hundred dollar health insurance gift card from taxpayers"), which is the only reason one should even consider buying there. But this completely misses the point that most folks don't buy on the Exchange or receive subsidies, and thus feel the full brunt of these fully operational Death Stars rate hikes.

And these same reporters also ignore the fact that even those "shielded" from rate hikes are still going to feel the MOOP pinch.

What's "the MOOP pinch," you ask?

That's the newly increased Maximum Out of Pocket limit. Care to see how this works in the real world?

Well, FoIB Jeff M has graciously forwarded his own plan rates and specs for this year and next:

So not only does he have the privilege of paying almost $3,000 a year more in premium, but his out-of-pocket increased by $300.

One supposes he doesn't feel "shielded."

[Hat Tip: HotAir]

O'Care Implosion (Anecdotal)

So got a call yesterday from a very nice lady who was looking for information on health insurance, and specifically an HSA plan. Seems she and her husband have been uninsured for several years, paid the tax penalty fine, but were thinking maybe it's time. She'd apparently been calling around, and no one was returning her calls.

I explained to her that if this had been a few short years ago, I would have been surprised, but that times have changed. Nevertheless, I was willing to see if we could help her out.

First, I completed a referral form to send to Cornerstone. She was concerned that, due to their ages, she and her husband would find premiums, even for an HSA-compliant plan, unaffordable. I think she was expecting me to pooh-pooh that, but of course I did not (could not). All I could say was that the fine folks at Cornerstone would do the best they could for her.

She had mentioned that they were self-employed, and that her husband was the minister of a small congregation. So I asked if they'd looked into a health care sharing ministry; she said they'd had a very bad experience with one such, and so I dropped that and asked if she was aware of the Direct Primary Care model.

She was intrigued.

So I offered to see if  we could help connect her with a DPC provider in her area, which was fine with her. I reached out to Dr Rob, of course, but also others I know in that field. Within a few hours I had a handful of leads for her, which I of course passed along.

I've asked her to keep me apprised of what she ends up doing; she's under no obligation to do so, of course, but I'm really curious to see how this turns out. Developments here as they occur.