Kiddie Dent

One of the ObamaTax core benefits is pediatric dental care. As we've pointed out, at least some of that care is ripe for abuse, but at least some carriers are looking for ways to minimize the damage.

Superior Dental Care is a regional dental carrier with whom we have a few cases; they've just announced their new "kids' plans" which are designed to "help clients that are domiciled in Ohio fulfill Affordable Care Act (ACA) requirements by covering the dental Essential Health Benefits (EHB's)."

These plans, available for covered "children" through age 18, are available for small groups (under 50 lives) that have opted to carve out the pediatric dental requirement from their group medical plan.

It's nice to see carriers "thinking outside the bun" on these types of benefits. Whether or not these plans will be of value remains to be seen (they're still in development, but expected to be on the street by October 1st), but at least we're seeing some positive reactions to the train wreck.

The Peach State Sabotages Obamacare

According to local Socialist Jay Bookman, the REPUBLICAN's in Georgia are doing their best

to sabotage Obamacare.

How dastardly.

Georgia Insurance Commissioner Ralph Hudgeons recently bragged about "doing everything in our power to be an obstructionist" in the implementation of Obamacrap.

Hudgens went on to give an example of that obstructionist behavior, this one involving so-called “navigators” who are being hired to guide customers through the process of buying health insurance on marketplaces, or exchanges, set up under the federal program.

“We have passed a law that says that a navigator, which is a position in that exchange, has to be licensed by our Department of Insurance,” Hudgens said. “The ObamaCare law says that we cannot require them to be an insurance agent, so we said fine, we’ll just require them to be a licensed navigator. So we’re going to make up the test, and basically you take the insurance agent test, you erase the name, you write ‘navigator test’ on it.”

AJC

Think about this for a moment.

Navigators will have minimal training (40 hours in the class room) and following that will be required to take a proficiency exam.

Navigators are charged with collecting Social Security numbers, personal information,  income and tax information as part of the financial colonoscopy to determine if you qualify for a taxpayer funded subsidy. That process is estimated to take up to 45 minutes and can involved a 26 page application.

Next the navigators are expected to explain your health insurance options, including drug formulary's and PPO networks.

With that kind of responsibility, I would hope they would have more knowledge about the process than someone in the Hi-Fi department at WalMart.

 why would you take pride in making it harder for Georgians with pre-existing conditions to get the insurance coverage that had previously been denied to them, and that might save them from potential bankruptcy or even death? Why would you block the federal government from offering Medicaid coverage to more than 600,000 lower-income Georgia citizens, coverage that would allow them to compensate hospitals and doctors now forced to treat them for free? Why refuse to educate uninsured Georgians on the fact that they will soon be eligible for subsidies to help them pay for health insurance, as other states are doing?

That's a lot of "why's" Bookman.

Let's take this one at a time. I will go slowly and maybe you can follow.

MOST people had access to health insurance before Obamacrap. They could obtain coverage through their job, COBRA and the state assignment system after COBRA expired.

And almost everyone could qualify for individual health insurance unless they waited until their health changed and tried to buy it.

As for your Medicaid expansion argument, in case you have not noticed, we are in a recession. Not a recovery, a recession that has gone on longer than it should have if Washington hadn't bungled everything.

Medicaid expansion in Georgia would have cost the state an estimated $4 billion over the next 10 years. That's $4 billion the state does not have and unlike DC, we can't print money or borrow from the Chinese.

Your last observation is pure lunacy.

The state is not refusing to educate people on Obamacrap. Rather, the insurance commissioner is trying to make sure the navigators have at least minimal proficiency in this 2300 page train wreck.

When you consider the folks who work at H & R Block have 2 months of training and 85% of the returns they prepare are less than 4 pages I think expecting a navigator to have 40 hours of classroom instruction and passing a proficiency exam isn't too much to ask.

Blue Grass Blues

Our friend David Adams reports that Kentucky's Insurance Department has approved Humana's 80% rate hike on individual plans. Of that, 60% is directly related to the ObamaTax Guaranteed Issue requirement.

But remember, rates will decrease by 3000%.

Bay State Irony

From the home of RomneyCare (which begat the ObamaTax), we see the effects of the train wreck:

"New ACA Medicare Payroll Tax Hits Massachusetts, $1.7 Billion Over 10 Years"

According to a new report from the folks at the Pioneer Institute, some Bay Staters will see their annual Medicare payroll tax burden jump over 60%. They've even figured out how the new taxes will affect famous (and not-so-famous) Massachusetts sports figures. For example, Tom Brady will pay an additional half-a-million dollars in new taxes, while David Ortiz can anticipate an increase of almost $130,000.

Talk about a foul ball.

Oh, the folks at the PIU also point out that, starting this year, "the federal government will require all employers to withhold an additional 0.9 percent in Medicare payroll tax (increasing the tax rate from the current 1.45 percent to a permanent 2.35 percent). Unlike "basic" Medicare taxes, this additional tax is paid solely by the employee."

But I'm sure we'll get our money's worth, right?

Right?!

Exchange Subsidy: Feature or Bug?

FoIB Brian D offers this poser:

Many "mature" workers have resisted early retirement because it's been so difficult to find health insurance due to age and/or pre-existing health issues. 

Given that the ObamaTax premiums are required to be lower for older workers (and higher for young'uns), and since ObamaTax-compliant plans are guaranteed issue, how many folks in their early 60's will now feel comfortable bailing out of the workforce, taking their experience and institutional memory with them?

A Half-Finding about Physician Incomes

Bloomberg News carried this fascinating article on September 2:

  

“Female physicians in the U.S. continue to earn less than their male counterparts, with the pay gap widening during the past two decades to more than $50,000 annually in 2010, researchers said.”

The article suggests that because of limitations in the source data the researchers “couldn’t adjust for a physician’s specialty or practice type.”   Thus the study would seem fatally flawed.

 But then the researchers go on to conjecture:

". . .  or do female physicians have less opportunity to enter higher paying specialties despite having similar preferences as male physicians?”

I think that's a reasonable conjecture, yet I wonder.  For one thing, what incentives are there for hospitals and group practices to hire male physicians at substantially higher compensation than equally-qualified female physicians?  For another, doesn't managed care in fact provide pretty much the opposite incentive?

I also wonder because worry has been expressed for years about a growing shortage of physicians in the U.S.    This shortage will become much worse if predictions turn out to be true that the ACA substantially increases the number of patients (by increasing the number of insured people) while the number of physicians increases only nominally.   This implies a lot more physicians will be needed than are likely to be in practice over the next few years, so demand for physicians would soar.  Don’t these circumstances actually increase women physicians’ bargaining power?

So I wonder - what's the mechanism, exactly, under which equally-qualified female physicians are being denied opportunities that exist, and that the female physicians seek?  

As it stands, the article reports only a half-finding: it's certainly true that there's an overall gap in median incomes.  But the research does not explain why this might be so.  Clearly more research is needed.

Keep in mind that statistically, it’s treacherous to rely on an overall result, be it median or average.  My favorite example is that, on average, Americans have one testicle and one ovary.  While that's certainly true, don’t expect to meet any such American right soon.   

Rosh Hahannah 5774

Tonight marks the beginning of the 10 Days of Awe, as we welcome the New Year. Although this is a very serious time,  it's also an opportunity to celebrate and have a little fun.

One enduring tradition is dipping apples in honey; the apple represents the world, the honey represents sweetness. Typically, apple slices and a bowl of honey are passed around; everyone takes a slice, takes a dunk, recites a prayer and takes a bite.

And then there's this:

Cavalcade of Risk #191: Death by Shower edition

Julie Ferguson hosts this week's clean - but potentially deadly - roundup of risk-related bloggetry.

Bring a fresh towel.

NB: We've still got some Fall hosting slots available - just email us to claim yours!

Obamacare - Sitting on the Sidelines

HHS is spending $700 million of YOUR money to teach you something your parents did not. In

an effort to save Obamacare the government is hoping to convince young invincible's it is time to grow up, act like an adult and assume responsibility for your actions.

people like Kay Lamberti, age 29, a former nursing assistant now working a temp job in Providence, R.I., aren't cheering for the health exchanges just yet. Ms. Lamberti has gone for five years without health insurance and doesn't plan on getting it until she gets a higher paying job.

"It's not in the budget," says Lamberti. "I'm pretty healthy at the moment and I know things could happen, having had worked in the healthcare field, but I can't afford it based on that chance."

Christian Science Monitor

Rational decision (in her mind). Why buy something you don't need? Health insurance isn't sexy like the iPhone 5.

"The fear in the Obama administration is you're going to get the sick people signing up and the nonsick not signing up and that would be a disaster. The insurance pools won't work," 

A failure in the making?

You mean like PCIP?

Officials expect that if 7 million uninsured enroll in the marketplaces this year, 2 million to 2.5 million of those need to be young adults in order to make the insurance rates work.

Roughly 30% of Obamacare enrollee's need to be young, healthy people.

Even if they hit those numbers, I doubt that will be enough to make it work.

Health insurance carriers know that 20% of insureds generate about 80% of large claims. If Obamacare is to work they probably need something like 5 million healthy people to sign up if they truly do get 7 million enrolled overall.

Yeah, this is going to be interesting.

The Promise of Obamacare

About that Union label...

Back in the Spring, we noted that "some unions leaders have grown frustrated and angry about what they say are unexpected consequences of the [ObamaTax]."

Unexpected. Heh.

Fast forward a few months, and we learn that this anger and frustration has brought forth this result:

"[T]he 40,000 members of the International Longshore and Warehouse Union (ILWU) announced that they have formally ended their association with the AFL-CIO, one of the nation's largest private sector unions. The Longshoremen cited Obamacare" as one of the two primary rationales (the other being immigration "reform" which, perhaps not coincidentally, will heavily impact the train-wreck, as well).

Never say die, though, exclaims HHS Secretary Shecantbeserious, and out come the big guns:

"[A]ccording to a report from InsideHealthPolicy, the Obama administration is considering offering insurance subsidies—intended for the uninsured—to labor union members who already have employer-sponsored coverage."

As the indispensable Avik Roy points out, folks covered under their employer's group plan aren't eligible for subsidies (although I would add that, technically, no one in states with Federally-run Exchanges are, either, but that hasn't stopped Ms Kathleen from handing them out willy-nilly).

The upshot is that funds that were earmarked for those previously unemployed will now be diverted to the more favored constituency (union members). Seems fair, no?

And it what is certainly "coincidental," grocery behemoth Krogers is following the UPS route [ed: very funny] and cutting off health bennies to its employees' spouses. But remember, "if you like your plan, you can keep your plan."

Or not.

HHS wants you to meet Lupita

 
 [In case you missed it, HHS also wants you to meet Howard]

Lupita and her nine year old daughter are uninsured. She works at a dental office as a dental assistant. She scrapes by every month trying to earn a few extra dollars by staying late just to make sure she and her daughter "have enough" at the end of the month. According to her story over at hhs.gov, she is really looking forward to the value Obamacare will bring to she and her daughter.

According to the Bureau of Labor Statistics, the average income for a dental assistant is $33,470. Assuming she is making this amount, the cost for her to purchase insurance through the marketplace Exchange would equate to 5.41% of her income or $2,294 per year. While that will clearly be less than the full premium, for Lupita to make up the $191 of monthly income she will have to pick up an additional 140+ hours of work per year just to come close to breakeven.

There is an alternative: continue to go bare and only have to pay a tax; I mean "shared responsibility payment" of roughly $240.

Interesting Life Underwriting news

Little did I realize when I recently posted about a client that I was on the bleeding edge of a potential revolution in life insurance underwriting. But that seems to be the case, as "new research by Timetric [shows that] three key technological developments have had a substantial impact on life insurance underwriting: automation, social media and big data."

[ed: gotta love "Big Data." Brent Spiner must be jealous]

Two items caught my eye:

First, that social media seems to be playing a larger role in detecting insurance fraud (we tend to see this more in the disability and workers comp fields, of course). But it strikes me as a little creepy that underwriters access FaceBook, Twitter and the like as part of their process. On the one hand, this makes sense: you checked "non-smoker," but there you are, tagged at a party, with a joint or a Marlboro. On the other hand, it seems to me that this comes awfully close to cyber-stalking. One supposes that the message is to be careful regarding your on-line presence.

The second is the idea of "Big Data." As we've seen from the recent NSA scandal(s), the idea that you have any real data privacy is quaint. Unlike Facebook posts, though, there's little you can do to control what's in your "file." And of course, to the extent that the privacy notice you signed allows, most of that info is legally accessible by the folks who are, after all, potentially on the hook for major dollars.

Brave new world, indeed.