Cavalcade of Risk #190: Call for submissions

Jacob Irwin hosts next week's Cav. Entries are due by Monday (the 19th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

NB: We're starting to schedule Fall Cav's, so please consider hosting an edition yourself. It's easy, and it's fun, just drop us a line to claim yours.

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Pick a Plan - Any Plan at All

According to the president and his minions, this fall you will be able to pick a health insurance

plan from any number of offerings on the #Obamacare exchange. The pitch is, it will be just like shopping on Travelocity or Amazon.

Really?

Do either of those sites require full disclosure of prior income and tax information as well as a "best estimate" of future earnings? Am I required to invest 45 minutes of my time (according to CBO) to undergo a financial colonoscopy before I even BEGIN to shop for an airline ticket or book?

Mr. Nowak, a 48-year-old Indianapolis medical-spa owner, likes WellPoint. But he has been seeing an Indiana University-affiliated physician for five years, and "when you get a trust with a doctor, you want to stick with them," he said.

WSJ Online

If Mr. Nowak buys a policy from Anthem Blue Cross (his current insurance carrier), doctors affiliated with Indiana University Health system and their 19 hospitals will not be in network for exchange based policies. The Blue plan will be an HMO which means no coverage for non-emergency services administered outside the network.

Early estimates are that roughly HALF the plans offered on the exchange will be HMO contracts that severely limit the number of available par providers imposes severe financial penalties when consumers voluntarily use non-par providers.

Translation - you pay for everything out of pocket for non-par services.

Insurers are betting that consumers who buy plans on the exchanges will be willing to trade some choice and flexibility in order to get cheaper premiums. Smaller networks of providers generally translate to lower premiums, because insurers can negotiate discounts with health-care providers who will then have less competition for patients within the network.

In other words, price sells.

At least that is the game plan.

If you live in Los Angeles don't count on using UCLA Medical Center or Vanderbilt if you are in the Nashville area.

In some parts of Georgia, your only plan choice will be Blue Cross if you buy on the exchange. That may mean driving 100 miles or more to see a doctor or receive treatment in a par hospital.

Sound like a #trainwreck yet?

Or you can buy OFF exchange and have a greater choice of plans and providers.

So buying on the exchange is like buying an airline ticket online?

Hardly.

Don't like the hand you are dealt? Too bad. Time to ante up or fold.

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Truth hurts

It isn't often that we praise insurance companies for intellectual honesty, but every once in a while one comes through. Case in point: Blue Cross Blue Shield (NC). The Tar Heel State's largest carrier "is warning potential patients about rising premiums and other problems."

While this may seem self-evident to anyone who's been paying attention to the train wreck, there are apparently still people who don't understand that adding millions of previously uninsured with no underwriting and using Community Rating models to set premiums is a recipe for disaster.

BCBS notices something that we've been saying for a while: that younger, healthier folks will likely choose the nominal fine penalty tax over the exorbitant premiums for a product they likely don't believe has much value.

And then there are the dim-witted folks who "call it fear mongering aimed at changing aspects of the law the insurance industry doesn't like, like the $100 billion in new taxes the industry will have to pay over the next 10 years."

Um, guys? The "industry" doesn't pay any taxes. They never have and they never will. No business pays taxes, ever. Sheesh.

[Hat Tip: FoIB Jeff M]

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Health Wonk Review: Dog Daze (of August) edition

David WIlliams hosts this late summer round-up of interesting, provocative and always informative posts of health care wonketry. It's so hot, it's cool.

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So, about those convenience items

Via email, UHC has informed us that Ms Shecantbeserious has (finally) settled on rules for the birth control convenience item mandate, which include four (4) substantive changes:

1.Modification of the Religious Employer Exemption (REE) definition.
2.Extension of the current Temporary Enforcement Safe Harbor (TESH) through Dec. 31, 2013.
3.Replacement of the TESH with an Eligible Organization designation for plan years starting on or after Jan. 1, 2014, including a new self-certification form for Eligible Organizations.
4.Requires that a health insurance issuer providing fully insured coverage or a third-party administrator that receives certification from an Eligible Organization provide direct payment for contraceptives services at no cost to the plan or its members.

With regard to the religious exemption issue, instead of having to meet 4 criteria to be eligible, an organization must meet only one:

"A “religious employer” now must only be organized and operated as a non-profit organization and referred to under Code section 6033(a)(3)(A)(i) or (iii), which refers to churches, other houses of worship, their integrated auxiliaries and conventions or association of churches, as well"

And if that's not clear enough for you, The Fair Kathleen has also introduced the "Eligible Organization Designation," which seems simple enough:

"An Eligible Organization is a non-profit religious organization with religious objections to covering contraceptive services. Those organizations that self-certify as an Eligible Organization may exclude coverage for some or all contraceptive services."

There's even a handy self-certification form that needs to be submitted by the end of the year.

You just knew there'd be a "but" in here somewhere, didn't you?

Well, here 'tis:

"Under the final rules, a health insurance issuer providing fully insured coverage that receives an Eligible Organization certification form must provide direct  payment for contraceptives services at no cost to the plan or  its members."

Why is it so difficult for the folks in Capital City to understand that nothing is "free?" All that happens here is the usual sleight of hand as insurers pad everyone else's premiums to pay this tax (and that's what this is, whether Ms Shecantbeserious calls it that or not). Or do they truly believe that pills and condoms grow on trees?

Wouldn't surprise me if they did, at that.

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HumpDay LinkFest

■ Will they or won't they? Back in May, Patrick quoted Ron Pollack, Founding Board Chairman of Enroll America (EA), who told him that "Enroll America  has not filed to serve as navigators and has no intention of doing so."

Fast forward a bit, and we learn that EA is still a bit less than forthcoming about its role in the train wreck:

"Jessica Barba Brown, national communications director at Enroll America, says the exchange promotion team now has a staff of 130 and about 3,000 registered volunteers ... The campaign organizers said the Get Covered America campaign is a "metric-focused" organization but declined to discuss numerical goals for their outreach efforts."

So what, exactly, are those "tens of millions of dollars" doing? Inquiring minds want to know.

■ The Gem State, which had initially opted to design and run its own Exchange, has run into a spot of trouble:

"Idaho will be relying on the federal health insurance exchange for at least a year while it develops its own"

Turns out that they took a little too long in getting their Exchange planned out, let alone implemented.

■ Most folks love their chocolate, and now there's another reason to rejoice in the confection:

"In a study published [recently] in the journal Neurology, researchers reported that chocolate may help improve brain health and thinking skills in the elderly"

Some words of caution, though: the benefits appeared to accrue only to those who were already at higher risk of dementia, and it's not clear how long the affects actually last. But hey, it's a tasty way to potentially decrease one's risk of dementia.

■ FoIB Jeff M tips us to this news from the Tar Heel State:

"Triad Adult and Pediatric Medicine, Inc. will close its adult practice on S. Eugene St. in Greensboro on Aug. 30"

Now this might seem like a "local news story," but it's actually more significant: it affects some 20,000 patients, who will now have to find new health care providers. The bulk of these folks (70% or more) are currently uninsured. his means that, once they've bought their shiny new, government-mandated policies, they'll need to spend some quality time trying to find someone with whom to use them.

Good luck with that.

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This is Another Fine Mess . . .

The comedy team of Stan Laurel and Oliver Hardy reigned supreme for years during the early

years of "talkies". Something that started out as a seemingly good idea often ended up going wrong which led to Hardy's admonishment of Laurel using the line "This is another fine mess you have gotten us into".

One could say the same of #Obamacare.

Now comes word that another costly provision of the health law—its caps on out-of-pocket insurance costs—will be delayed for one more year.

Obamacare contains a blizzard of mandates and regulations that will make health insurance more costly. One of the most significant is its caps on out-of-pocket insurance costs, such as co-pays and deductibles. Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for the any participant or beneficiary.”

Forbes

In an effort to minimize the financial burden of Obamacare the administration has eliminated or delayed many provisions of the law that promised to lower the cost of health care.

The truth is, almost nothing in the law lowers the cost of health care but does manage to significantly increase the cost of health insurance.

Most of the provisions in Obamacare have only a nominal impact on insurance premiums and many that do have already been implemented. Annual caps and eliminating lifetime benefit maximums have already been applied to existing plans with a barely noticeable effect on premiums.

Frankly I have no idea why this latest announcement is news, nor do I understand how delaying this section of the law will have an impact on premiums.

The coming wave of cost increases, especially in the individual health insurance market, is due to a combination of "guaranteed issue" and community rating.

Obamacare is in reality, another fine mess.

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