insurance

Your Grandfathered Plan

<div class="separator" style="clear: both; text-align: center;"><a href="http://coloringcrew.estaticos.net/coloring-book/painted/201026/657b4a96e75a99c1ac957813833e6f63.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="130" src="http://coloringcrew.estaticos.net/coloring-book/painted/201026/657b4a96e75a99c1ac957813833e6f63.png" width="140" /></a></div><div style="text-align: justify;">If you're one of the lucky (very) few whose plans were "<a href="http://insureblog.blogspot.com/2014/02/the-problem-with-grandpa.html" target="_blank">grandfathered</a>" (ie not subject to most of the more draconian ObamaTax requirements) you've probably already received notice from your carrier about your choices. Some folks, though, have non-grandfathered, non-compliant plans, and they may be eligible to keep their plans (for a while): Some carriers did take the President at his word ("if you like your current plan, you can keep it"), and have filed rates with the appropriate departments of insurance in order to do so. In Ohio, it seems that only three carriers - Medical Mutual of Ohio, United Healthcare (aka Golden Rule) and Humana -  elected to participate. Insureds with these carriers will be able to keep their current, non-ObamaTax plans for a while longer, albeit at higher rates. How they're doing this is interesting: Medical Mutual is offering "transitional rates" that will be good for plans which renew starting in August. They also note that no changes will be permitted on these plans; that is, no increasing deductibles to lower rates, etc. They further note that the renewal also triggers a Special Open Enrollment, so folks who want to move to ObamaTax-compliant plans may do so (on-or off-Exchange). UHC is taking a similar tack, with a twist: "Your clients in [OH and a few other states] can keep their current [UHC plans] without further Affordable Care Act (ACA) changes through September 30, 2017." They do note, however, that "additional ACA requirements must be included in all [non-grandfathered] health plans." This means, of course, higher rates, but at least your basic plan remains largely the same. Finally, Humana "will continue to allow members to keep their Non-Grandfathered Non-ACA policies under the defined rules provided by each state."  Here in the Buckeye State, this means that non-ObamaTax-compliant plans will begin to renew tomorrow (July 1). They also point out that "renewal" also means "<a href="http://insureblog.blogspot.com/2014/06/ehealth-whiffs-it.html" target="_blank">Special Open Enrollment</a>." Not all states have elected to participate in the "renew your old plan" program, so check with your agent to see whether or not you're affected. And remember: this is not the same as the "auto-renewal" issue <a href="http://insureblog.blogspot.com/2014/06/its-government-simple.html" target="_blank">about which Pat wrote yesterday</a> - that affects new, ObamaTax-compliant plans, not these. Clear as mud?</div>

Your Grandfathered Plan

If you're one of the lucky (very) few whose plans were " grandfathered " (ie not subject to most of the more draconian ObamaTa...

10:28 AM

HHS Claims USPO is Inefficient

This just in.  <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9BqEuQr8pyUgjkeXQ4dCqhphLQ-4o1qxDJfBCqw7EOwVa2cb7iqpdxIVLqVWIkHdRS_pv0lfATrx3kWLJxUNyGwUOkCeSXEATbqIiJuXZx2bG3vSLW77U88ZoqE0mUnZoCGJ5aEbXbyE/s1600/pot+calls+kettle+black.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="154" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9BqEuQr8pyUgjkeXQ4dCqhphLQ-4o1qxDJfBCqw7EOwVa2cb7iqpdxIVLqVWIkHdRS_pv0lfATrx3kWLJxUNyGwUOkCeSXEATbqIiJuXZx2bG3vSLW77U88ZoqE0mUnZoCGJ5aEbXbyE/s1600/pot+calls+kettle+black.png" width="200" /></a></div> HHS, designer and ultimate manager of the Obamacare website (healthcare.flub) is calling the USPO unreliable. <blockquote class="tr_bq" style="background-color: white; border: 0px; color: #333333; line-height: 1.5; margin-bottom: 1em; outline: 0px; padding: 0px; vertical-align: baseline;">Managers of the public exchanges run by the U.S. Department of Health and Human Services (HHS) are trying to cut down on use of traditional mail. HHS wants to keep consumers and their assisters, including agents and brokers, from reporting changes that might affect the consumers' eligibility for health benefits programs through the mail.</blockquote><blockquote class="tr_bq" style="background-color: white; border: 0px; color: #333333; line-height: 1.5; margin-bottom: 1em; outline: 0px; padding: 0px; vertical-align: baseline;">Consumers and their helpers would have to report any changes that could affect eligibility through the Web, through calls to telephone call centers, or through in-person interactions with "navigators, certified application counselors and other in-person assistance personnel."</blockquote><div style="background-color: white; border: 0px; color: #333333; line-height: 1.5; margin-bottom: 1em; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="http://www.lifehealthpro.com/2014/06/27/hhs-exchanges-may-trim-use-of-snail-mail" target="_blank">Life Health Pro</a></div><div style="background-color: white; border: 0px; color: #333333; line-height: 1.5; margin-bottom: 1em; outline: 0px; padding: 0px; vertical-align: baseline;">This would be great if the website actually worked.</div><blockquote class="tr_bq" style="background-color: white; border: 0px; color: #333333; line-height: 1.5; margin-bottom: 1em; outline: 0px; padding: 0px; vertical-align: baseline;">The mail is not a practical method for getting change information because automated systems or live humans will need to interact with the consumers to ask follow-up questions, officials say.</blockquote><div style="background-color: white; border: 0px; color: #333333; line-height: 1.5; margin-bottom: 1em; outline: 0px; padding: 0px; vertical-align: baseline;">And in other news, the pot calls the kettle black.</div><div style="background-color: white; border: 0px; color: #333333; font-family: sans-serif; font-size: 13px; line-height: 1.5; margin-bottom: 1em; outline: 0px; padding: 0px; vertical-align: baseline;"> </div>

HHS Claims USPO is Inefficient

This just in. HHS, designer and ultimate manager of the Obamacare website (healthcare.flub) is calling the USPO unreliable. Managers of the...

7:00 AM

Be Careful What You Wish For

A friend of mine described life in this way.   If you pray to God to move mountains, don't be surprised if you open your eyes and see a shovel at your feet. Be careful what you wish for. <blockquote class="tr_bq">"I thought I had done everything right, and it's been awful," said Jean Buchanan, 56. The Fullerton resident found herself stuck with an $8,000 bill for cancer treatment after receiving conflicting information on whether it was covered. </blockquote><blockquote class="tr_bq">"How am I going to come up with that much money?"</blockquote><div><a href="http://www.latimes.com/business/la-fi-obamacare-doctor-networks-20140629-story.html#page=1" target="_blank">LA Times</a> This is not an uncommon for those who purchased Obamacare plans.</div><div> </div><div>Caveat emptor.</div><blockquote class="tr_bq">"These narrow networks are making a huge difference in terms of affordability," said Mark Morgan, president of Anthem Blue Cross, a unit of industry giant WellPoint Inc. "We found in convincing numbers that people value price above all else."</blockquote><div> </div><div>So you expected to get a Cadillac at Kia prices?</div><div> </div><div>Seriously?</div> <blockquote class="tr_bq">Consider Buchanan, who lost her previous coverage when her insurer dropped out of the individual market last year. She was diagnosed with breast cancer in July, so she opted last fall for a Platinum plan, the highest level of benefits on the state exchange, from Blue Shield. </blockquote><blockquote class="tr_bq">Buchanan started treatment at UC Irvine Medical Center in the fall, and her oncologist there took her new Blue Shield insurance in January and February. Then the day before her lumpectomy, UC Irvine called to say her insurance wasn't accepted after all. </blockquote><div> </div><div>Not uncommon.</div><div> </div><div>With all the last minute rule changes by HHS many providers had no idea which network they belonged to.</div><div> </div><div>People want to blame the carriers, but when DC changes their mind based on the way the political winds are blowing that day, businesses can't respond on a dime.</div><div> </div><blockquote class="tr_bq">Nationwide, about half of all exchange plans feature narrow networks, according to consulting firm McKinsey & Co., which has closely tracked the new insurance market. Those narrow network plans cost up to 17% less on average than plans with broad networks. </blockquote><blockquote class="tr_bq">In forming tighter networks, insurers tried to persuade doctors and hospitals to accept less money in exchange for a higher volume of Obamacare patients. </blockquote><blockquote class="tr_bq">Los Angeles pediatrician Danelle Fisher said she couldn't afford the 30% pay cut offered by Blue Shield. She would have received $68 instead of $97 for a routine office visit for a patient with a PPO policy.</blockquote><div> </div><div>And the beat goes on.</div><div> </div><div>Going forward, those with Obamacare plans will find fewer choices, higher premiums, high copay's and more out of pocket.</div><div> </div><div>Welcome to Obamacare.</div><div> </div><div>You wanted it. Now deal with it.</div>

Be Careful What You Wish For

A friend of mine described life in this way. If you pray to God to move mountains, don't be surprised if you open your eyes and see a ...

5:30 AM

It's "Government Simple"

Thursday afternoon CMS released a <a href="http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/508_CMS-9941-P-OFRv-6-26-14.pdf" target="_blank">33 page proposed regulation</a> that will allow individuals who purchased Exchange plans to automatically renew their plan by simply "checking a box on an insurance carrier form and mailing it back". On the surface this regulation appears to make sense. It seems that it would make it easier for the consumer who likes their plan and isn't having a change in their income to receive the same subsidy and benefits. So what's the big deal? We all like simple. Nevermind those pesky details. On second thought, what are some of those details? Here are four reasons why automatic renewal isn't going to work. 1. Due to <a href="http://insureblog.blogspot.com/2014/04/idiots-guide-to-understanding-full.html" target="_blank">strict actuarial value (AV) parameters</a> and changing limits on certain benefits, the plans offered in 2014 may have to be cancelled in 2015. The plans that do renew will certainly not meet the requirements in 2016. Any time there is a plan change you will either have to pick a new plan or be <a href="http://newsmanager.commpartners.com/nahuw/downloads/2014-0626-Bulletin-on-Renewal-and-Termination-Notices-FINAL.pdf" target="_blank">"mapped"</a> to a plan with the same insurer. 2. Insurance companies are submitting plans and rates right now. Each plan will have different premiums than last year. New companies to the market will add their plans. Let's say you purchased the 2nd lowest cost Silver plan with a premium of $200 a month and based on your income you qualified for a $100 a month subsidy. This year the plan you are in has a premium of $250 per month and it is now the 7th lowest cost Silver plan. A new option is now the 2nd lowest cost Silver plan this year. The premium for that plan is $200 per month. If you automatic renew your subsidy will still be $100. But, the premium you will pay is $150. Talk about rate shock. 3. Changes in income or life status result in varying subsidies. HHS is assuming that your taxable income for the next year is the same. What if you have a baby? What if your 23 year old "child" gets coverage through their employer? What if you changed jobs and got a $5,000 pay raise? Sure, it's simple to keep the same subsidy, but that would be a really tough pill to swallow come tax time. 4. Everyone's situation changes. People develop medical conditions. Others have conditions that are now under control. Changes in health status should be taken into consideration when purchasing a health insurance plan that best fits one's needs. Just because you have insurance doesn't mean you have the right plan at the right price. The real benefit of automatic renewal is to help insurers and government. It was designed to reduce their administrative costs. It was also designed to help insurers retain business. They are passing it off as a way to simplify your life and renew your insurance without having to deal with goodluck.gov again. All of this is being done at your (the consumer's) expense. As we head into open enrollment season this year, consider items 1, 2, 3, and 4 when renewing (or applying for) your health insurance. Oh, and <a href="http://insurance.answers.com/methods-to-obtain-insurance/why-you-need-an-insurance-agent" target="_blank">use a health insurance professional</a>. We value your relationship and your business. These are things the insurance company and government certainly don't.

It's "Government Simple"

Thursday afternoon CMS released a 33 page proposed regulation that will allow individuals who purchased Exchange plans to automatically ren...

6:32 AM

Oh Frabjous (Fri)Day!

<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk9ZM2XuK1ffA-awaglbzAbkse7Y0U4vAhOKY98Up9ETwrt-1XgeuLrsN1luXRDJdsZlJxr0V-McLwM3nYAStkucpZnbsy_sPuZ5jM3SG1DbCOEsH0Lqb3wwyUI1XYdOHmYjZt5YrgKt0X/s1600/Picture+7.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="116" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk9ZM2XuK1ffA-awaglbzAbkse7Y0U4vAhOKY98Up9ETwrt-1XgeuLrsN1luXRDJdsZlJxr0V-McLwM3nYAStkucpZnbsy_sPuZ5jM3SG1DbCOEsH0Lqb3wwyUI1XYdOHmYjZt5YrgKt0X/s1600/Picture+7.png" width="140" /></a></div><div style="text-align: justify;">Last summer, agents received notice from the Folks in DC that "<a href="http://insureblog.blogspot.com/2013/08/oh-frabjous-day.html" target="_blank">Agent/broker training for the Federally-facilitated Marketplace (FFM) is now available</a>," and were encouraged to sign up for said training in order to sell policies on the Exchange. Last fall,<a href="http://insureblog.blogspot.com/2013/09/obamatax-health-exchange-marketplace.html" target="_blank"> I finally got around</a> to doing so (there was no particular rush, since the initial Open Enrollment didn't begin until October 1st). This year, open enrollment begins in November (<a href="http://insureblog.blogspot.com/2014/06/obamacares-christmas-in-april-surprise.html" target="_blank">unless Bob's right</a>, and they move it to to Tax Season). So, this arrived in email today: "You successfully completed both Parts I & II of the agent/broker registration process for the 2014 Plan Year in the Federally-facilitated Marketplace (FFM). Today we are announcing that the FFM registration process for the 2015 Plan Year will start on July 7, 2014!" No idea why they felt that "!" was necessary, unless they think we're really excited at the prospect of more "training" by the rocket surgeons who can't launch or run a website. My favorite part, though, is this: "Agents and brokers may access Part I starting on July 7, 2014 ... (Please note that scheduled maintenance of the MLN is currently underway)" Why am I not surprised: Pre-broken for your (in)convenience. What a shocker.</div>

Oh Frabjous (Fri)Day!

Last summer, agents received notice from the Folks in DC that " Agent/broker training for the Federally-facilitated Marketplace (FFM) i...

1:00 PM

Obamacare's Christmas in April Surprise

The rocket surgeons in DC finally figured out people really don't want to buy health insurance at Christmas, so they are considering moving open enrollment to another time. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtQwCgm8Wf89LQoHhwhrRua5U4NLnAdsbkFIkPDOO8Z5y_0e5pXjZVcNtV9EfVGbCPRfap9QBDYPQC5dtAymeH3u1lxRMBwiA1PJ_6_PRS2KELowFYnhpe9jiyPKzDKovbFdQrVEBf17c/s1600/hillary+out+of+touch.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtQwCgm8Wf89LQoHhwhrRua5U4NLnAdsbkFIkPDOO8Z5y_0e5pXjZVcNtV9EfVGbCPRfap9QBDYPQC5dtAymeH3u1lxRMBwiA1PJ_6_PRS2KELowFYnhpe9jiyPKzDKovbFdQrVEBf17c/s1600/hillary+out+of+touch.jpg" width="182" /></a></div> Say April, when you get your tax refund. What better use of money (that you willfully loaned the government interest free) than using it to buy a brand new health insurance policy? <blockquote class="tr_bq">The methodology is interesting in and of itself — the authors looked at Google query data to see when people searched for certain terms, including health insurance. Previous studies have used Google query data, too. </blockquote><blockquote class="tr_bq"> It found that during the winter holiday season — which is typically open enrollment season for health insurance — people searched for terms such as "payday loan" and "cash advance" that indicated they needed financial help. People did not search for health care information in the middle of winter, when they had other financial stressors.</blockquote><a href="http://www.usatoday.com/story/news/nation/2014/06/25/study-tax-refunds-could-boost-health-coverage/11389321/" target="_blank">USA Today</a> Maybe the folks looking for payday loans are the same ones lined up at tax prep offices in early February. These are also the ones that pay loan shark fee's for the tax refund RAL (refund anticipation loan). <blockquote class="tr_bq">According to a 2014 report by the Urban Institute, 75 percent Americans receive a tax refund, and the average amount is $3,000.</blockquote>Don't you just know those folks are going to turn around and fork over $3 grand to an insurance company? Further proof the folks in DC are out of touch. And you thought the former first lady who claimed to be dead broke after living in public housing for 8 years who was out of touch.

Obamacare's Christmas in April Surprise

The rocket surgeons in DC finally figured out people really don't want to buy health insurance at Christmas, so they are considering mov...

11:34 AM

For the Chillun'

<div class="separator" style="clear: both; text-align: center;"><a href="http://thewritepractice.com/wp-content/uploads/2012/07/may-i-have-some-more.-or-is-might-600x342.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="79" src="http://thewritepractice.com/wp-content/uploads/2012/07/may-i-have-some-more.-or-is-might-600x342.jpeg" width="140" /></a></div><div style="text-align: justify;">Another day, another ObamaTax "glitch." This time, we're talking about 2 million kids who may not only lose their current coverage, but be left with no affordable alternative:</div><div style="text-align: justify;"> </div><div style="text-align: justify;">"<a href="http://dailycaller.com/2014/06/24/report-obamacare-glitch-could-endanger-coverage-for-millions-of-kids/" target="_blank">One of Obamacare’s ongoing structural problems is preventing close to 2 million low-income children from getting affordable health coverage ... prevents children who would be eligible to participate in the Children’s Health Insurance Plan ... from getting access to their own subsidized coverage if the program is to end when it’s up for reauthorization this year</a>."</div><div style="text-align: justify;"> </div><div style="text-align: justify;">We've blogged on <a href="http://insureblog.blogspot.com/2007/10/you-want-answers.html" target="_blank">the (infamous) SCHIP program</a> before, but this is a new twist. It's up for re-authorization later this year, and there's a possibility that it will be shut down (much like the <a href="http://insureblog.blogspot.com/2014/03/cliff-kathy-and-pcip.html" target="_blank">promising PCIP program</a>). Should that happen, the kids currently covered under SCHIP would have few (if any) alternatives.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">But Henry, they can just buy an ObamaPlan on the Exchange!</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Um, maybe, maybe not. A couple of issues arise:</div><div style="text-align: justify;"> </div><div style="text-align: justify;">First, it's not entirely clear that losing such coverage would automatically trigger a Special Open Enrollment. The relevant definition says "<a href="https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=2" target="_blank">losing eligibility for Medicaid or CHIP</a>." Technically, though, the children aren't necessarily "losing eligibility," the plan is going away. </div><div style="text-align: justify;"> </div><div style="text-align: justify;">Look at it this way:</div><div style="text-align: justify;"> </div><div style="text-align: justify;">COBRA lets you keep your previous employers' health insurance for a while. But if that previous employer goes out of business, and the health plan goes away, then there's nothing to continue, and you're outta luck.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">I think this falls in the same category: you didn't lose eligibility, the program went away. Now, given the reckless/feckless way this administration has implemented the ObamaTax, it's entirely likely that these kids will be issued waivers and granted Special Open Enrollment Periods.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Which would be nice, but that then brings us to the second issue:</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Who's going to pay for that new ObamaPlan? As co-blogger Bob V explains it, "the health-care law <a href="http://insureblog.blogspot.com/2013/01/gray-lady-joke-of-day.html" target="_blank">doesn’t offer subsidies</a> to workers whose employer offers what the federal government deems affordable coverage — but doesn’t consider whether employer coverage for workers’ families is affordable as well. The structure potentially bans spouses and children from receiving Obamacare’s much-touted help with premium payments while their available insurance is extremely costly."</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Double-whammy.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">But hey, we had to pass it to learn....</div><div style="text-align: justify;"> </div><div style="text-align: justify;">[Many Thanks to Bob V for his help in noodling this one through!]</div>

For the Chillun'

Another day, another ObamaTax "glitch." This time, we're talking about 2 million kids who may not only lose their current cove...

5:30 AM

Goose, Gander: Saucey!

<div class="separator" style="clear: both; text-align: center;"><a href="http://i.walmartimages.com/i/p/00/02/44/63/06/0002446306109_500X500.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="140" src="http://i.walmartimages.com/i/p/00/02/44/63/06/0002446306109_500X500.jpg" width="140" /></a></div><div style="text-align: justify;">Ha ha. Ha ha ha ha! "<a href="http://www.forbes.com/sites/theapothecary/2013/07/26/irs-employees-union-is-very-concerned-about-being-required-to-enroll-in-obamacares-health-insurance-exchanges/" target="_blank">IRS Employees Union Is 'Very Concerned' About Being Required To Enroll In Obamacare's Health Insurance Exchanges</a>" But PresBo and his minions keep claiming how wonderful their new system is, what with the lower costs and so many folks getting insured. One would think that the good, honest and transparent folks at the IRS would be thrilled to participate. Right? Um: "[T]he union that includes employees of the Internal Revenue Service is asking its members to write letters to their Congressmen, stating that they are “very concerned” about legislative efforts requiring IRS and Treasury employees to enroll in the Obamacare exchanges." What could they possibly be "concerned" about? Ah: "Today, federal employees are offered subsidies, or vouchers, which they can use to shop for insurance on the popular federal employees’ exchange ... it’s not clear whether the law allows similar subsidies to flow to federal employees on the Obamacare exchanges." Too bad, so sad. Here in the real world, we're no longer able to do this, either. So why would the <strike>elitists</strike> folks who work for the IRS (or any government entity) be exempt? Surely they don't think that they're better than us peons, right? Nah, must be something else.</div>

Goose, Gander: Saucey!

Ha ha. Ha ha ha ha! " IRS Employees Union Is 'Very Concerned' About Being Required To Enroll In Obamacare's Health Insuranc...

10:37 AM

Medicare, Docs and the ObamaTax

<div style="text-align: justify;">Our friend <a href="http://insureblog.blogspot.com/2012/10/musings-interview-with-dr-rob.html" target="_blank">Dr Rob Lamberts </a>has joined the growing list of providers who no longer service Medicare "beneficiaries:" <script src="http://WFXG.images.worldnow.com/interface/js/WNVideo.js?rnd=443064;hostDomain=www.wfxg.com;playerWidth=347;playerHeight=196;isShowIcon=true;clipId=10301767;flvUri=;partnerclipid=;adTag=News;advertisingZone=;enableAds=true;landingPage=;islandingPageoverride=false;playerType=STANDARD_EMBEDDEDscript;controlsType=overlay" type="text/javascript"></script><a href="http://www.wfxg.com/" title="WFXG FOX54 Augusta - Your News One Hour Earlier">WFXG FOX54 Augusta - Your News One Hour Earlier</a> This is significant: as we've long noted, Medicare reimbursement rates have been <a href="http://insureblog.blogspot.com/2013/02/your-examination-table-is-ready.html" target="_blank">driving docs from the program</a> for a while. But what has that got to do with the ObamaTax? Well, it's hardly a stretch to see how the same issues (lower reimbursements and more strictly controlled networks) will soon drive more doc's to turning away from accepting any insurance (especially when all plans become ACA-compliant). I'm not convinced, by the by, that this is necessarily a bad thing: a lot of the expenses one incurs at, for example, a Primary Care provider would be considered 'routine,' and it's long been our position that routine expenses ought not be covered by health insurance. Interesting trend.</div>

Medicare, Docs and the ObamaTax

Our friend Dr Rob Lamberts has joined the growing list of providers who no longer service Medicare "beneficiaries:" WFXG FOX54 Aug...

7:54 AM

Cavalcade of Risk #211: Bolt from the Blue edition

Cavalcade of Risk #211: Bolt from the Blue edition

Lightning quick Julie Ferguson hosts this week's electrifying round-up of risky posts. Don't be shocked - she does a brilliant jo...

6:15 AM

Success! (Again)

<div class="separator" style="clear: both; text-align: center;"><a href="https://relationalmentalhealth.files.wordpress.com/2011/09/leaky-bucket.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="105" src="https://relationalmentalhealth.files.wordpress.com/2011/09/leaky-bucket.jpg" width="140" /></a></div>For a certain value of "success:" "<a href="http://dailysignal.com/2014/06/24/obamacare-exchanges-disappointing/" target="_blank">Obamacare Exchanges Are ‘Disappointing’ With Fewer Than 4 Million Newly Insured</a>." Well, 4 million, how bad can that be? Oh: "The Government Hoped for 26 Million." Less than a quarter of their stated goal (which you just know was low-balled in the first place, taking advantage of <a href="http://startrekspace.blogspot.com/2011/01/scottys-laws-of-physics.html" target="_blank">Scotty's Law #14</a>).

Success! (Again)

For a certain value of "success:" " Obamacare Exchanges Are ‘Disappointing’ With Fewer Than 4 Million Newly Insured ." W...

10:59 AM

Medical Tourism and the MVNHS©

<div class="separator" style="clear: both; text-align: center;"><a href="http://www.sfu.ca/medicaltourism/images_layout/stock_photos/iStock_000005332991Small.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="92" src="http://www.sfu.ca/medicaltourism/images_layout/stock_photos/iStock_000005332991Small.jpg" width="140" /></a></div><div style="text-align: justify;">Interesting dilemna: "<a href="http://www.express.co.uk/news/health/483161/Migrants-will-pay-for-the-NHS" target="_blank">UP to £500million a year spent by the [MVNHS©] on treating migrants is to be clawed back in a new crackdown on welfare tourism</a>." Seems that our Cousins across the Pond are facing some of the same challenges we are. That is, a shortage of qualified health care providers (an obvious result of nationalized health care) has prompted a lot of Britons to seek appropriate care elsewhere. They in turn count on that government-run scheme to help pay for their care, this further driving up the system's costs: "At present, the Government pays more than £800million [$1.3 Billion] a year to cover the cost of Britons receiving healthcare abroad" That's a lot of health care dollars, er, pounds sterling going out the door. And there's a twist: While the Brits are paying out that huge chunk of change to other countries, they receive "only £29million a year back from EU and associated countries for treating overseas visitors." That's about 3.5% of what the Much Vaunted National Health System© is sending to those countries. But how to turn that around? Well, money talks: "The Government yesterday unveiled an initial scheme designed to reward health trusts that reclaim payments for caring for EU patients." Under this new bonus system, the providers themselves share in the bounty - that's a powerful incentive: "If a hospital reclaims £100 spent on an an overseas patient it will receive a total of £125" Wait a second, though. Where's that extra £25 coming from? Oh: "... with the extra coming from the Government." Of course.</div>

Medical Tourism and the MVNHS©

Interesting dilemna: " UP to £500million a year spent by the [MVNHS©] on treating migrants is to be clawed back in a new crackdown on w...

7:09 AM

Google Life?

What if you could buy life insurance with one click?   <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2ng8X3GOMrLGlDHLDWVFOpwAUnk7yo5jTfRh-U3qSOTv0zlFJG1kyyJP2D0uTHP3pJNQT7dNAL9pntPJqsm3GIKn24nxaEwl4HZWiqkmETdndCZZhKSKZMJs3HkeYbq0M4Puc-vbqy0k/s1600/insurance+quote+button.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2ng8X3GOMrLGlDHLDWVFOpwAUnk7yo5jTfRh-U3qSOTv0zlFJG1kyyJP2D0uTHP3pJNQT7dNAL9pntPJqsm3GIKn24nxaEwl4HZWiqkmETdndCZZhKSKZMJs3HkeYbq0M4Puc-vbqy0k/s1600/insurance+quote+button.png" width="200" /></a></div> What if you could buy life insurance with one click while you were driving? What if you could buy life insurance with one click while Google was driving your car? <blockquote class="tr_bq">Getting a quote from a single carrier has become so "old school" with the introduction of <a href="http://www.lifehealthpro.com/2014/04/15/what-if-google-or-amazon-sold-insurance" style="-webkit-tap-highlight-color: rgb(121, 161, 162); background: rgb(255, 255, 255); color: #5b5753; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;">Google DirectLife</a>, an initiative that works with multiple life carriers and can provide you with several quotes, features and better coverage instantly. Functioning in about 750 locations in high-traffic malls, DirectLife interacts with its clients using the Internet, phone calls and in-person meetings as a medium. It designs the coverage and the product based on the feedback of the client.</blockquote><a href="http://www.lifehealthpro.com/2014/06/23/will-google-and-amazon-offer-one-click-life-insura?eNL=&t=life-sales-strategies&page=2" target="_blank">Life Health Pro</a> And <a href="http://www.lifehealthpro.com/2014/06/23/will-google-and-amazon-offer-one-click-life-insura?eNL=&t=life-sales-strategies&page=3" target="_blank">Amazon</a> is considering something similar. <blockquote class="tr_bq">Giant online retailer <a href="http://www.lifehealthpro.com/2014/06/11/naifa-president-urges-increased-product-innovation" style="-webkit-tap-highlight-color: rgb(121, 161, 162); background: rgb(255, 255, 255); color: #5b5753; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;">Amazon diversifies into life insurance</a> with the launch of Amazon Life (ALife) — a life insurance company that deals with term insurance. The move is being viewed as a game changer in the industry as it is based on a customer’s point of view of obtaining a life insurance policy.</blockquote>Enable one-click shopping.

Google Life?

What if you could buy life insurance with one click? What if you could buy life insurance with one click while you were driving? What if y...

1:27 PM

Obamacare, How Nothing Has Really Changed [UPDATED]

Did the "Affordable Care Act" really make things more affordable? Who gave it that stupid <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6kjTjB1X41obyVML29VRF1y4uo3LKne-n915N0Tw9AI0zmmcJNtmdreQ-ufljNQVq1lhh9Xfh2wuTlQvFQ2ykbAOouRW_U8X3VuimgH9Mb941I2Iu2cnFCjHcaohhJ_i40fu-9MffViE/s1600/obamacare+stool+sample.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="197" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6kjTjB1X41obyVML29VRF1y4uo3LKne-n915N0Tw9AI0zmmcJNtmdreQ-ufljNQVq1lhh9Xfh2wuTlQvFQ2ykbAOouRW_U8X3VuimgH9Mb941I2Iu2cnFCjHcaohhJ_i40fu-9MffViE/s1600/obamacare+stool+sample.jpg" width="200" /></a></div>name anyway? <blockquote class="tr_bq">“The critics’ view of the law as an unmitigated disaster is far from true, but it’s not what advocates might have hoped for either because many people still have concerns about affordability,” </blockquote><a href="http://www.dallasnews.com/news/local-news/20140619-poll-many-still-struggle-to-pay-health-premiums.ece" target="_blank">Dallas News</a> So, it really isn't affordable for many. What a shock. <blockquote class="tr_bq"> Fifty-seven percent of the 8 million people who bought a plan through the new insurance exchanges were previously uninsured.</blockquote>That only leaves about 35M or so uninsured ................... not counting those that LOST existing coverage due to Obamacare. When will HHS release those numbers? <blockquote class="tr_bq">63 percent of those covered by health law plans said they are confident they will be able to pay for routine medical care. Enrollees were divided about paying for a major illness or accident, with 52 percent expressing confidence and 46 percent saying they were not too confident or not at all confident.</blockquote>Insurance is not needed for ROUTINE care. Auto policies and homeowners don't cover routine maintenance. Can you imagine someone saying they can't afford an oil change until they get car insurance? UPDATE [HGS]: Well, one thing's certainly changed, and not for the better: "<a href="http://finance.yahoo.com/news/heres-much-people-actually-paying-150104510.html" target="_blank">The Congressional Budget Office estimated in April the federal government would spend about $12 billion in subsidies and related spending — numbers that are projected to rise to $29 billion and $62 billion over the next two years as more people sign up</a>." That's the cost of the subsidies that make the ObamaPlans "affordable" for those lucky enough to qualify (and to actually sign up through the 404Care.gov site). This term, "affordable:" I dunna think it means what you think it means.

Obamacare, How Nothing Has Really Changed [UPDATED]

Did the "Affordable Care Act" really make things more affordable? Who gave it that stupid name anyway? “The critics’ view of the l...

8:50 AM

Obamacare Problems Solved

Obamacare Problems Solved

We now know that went wrong with Obamacare. The dysfunctional (non-functional) website. Endless delays. Selective waivers. Inability to trac...

3:54 AM

ACA vs STM

<div class="separator" style="clear: both; text-align: center;"><a href="http://www.splitendzsalon.com/files/2012/02/AnimatedStopwatch.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="140" src="http://www.splitendzsalon.com/files/2012/02/AnimatedStopwatch.gif" width="104" /></a></div><div style="text-align: justify;">LifeaHealthPro's Allison Bell has <a href="http://www.lifehealthpro.com/2014/06/18/web-broker-charts-supplemental-health-prices?eNL=53a35d55160ba0f56c8b45b3&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=107687085" target="_blank">an interesting piece today</a> comparing the average costs of a Short Term Medical plan to a full-blown ObamaTax-compliant model, with an emphasis on how this plays with the younger crowd. She correctly points out that these can be a viable alternative for folks who missed the last Open Enrollment, or even as just a cost-saving measure. One thing that she didn't touch on - and, in fairness, I haven't seen this dealt with anywhere - is a specific "gotcha" that's lurking for folks who are just looking to bridge the gap between last March and this coming November. To wit: Recently, I had a call from a gentleman who had lost his group insurance, but had waited <a href="http://insureblog.blogspot.com/2014/06/ehealth-whiffs-it.html" target="_blank">more than 60 days</a> to do anything about it. By then, he'd lost his opportunity for a Special Open Enrollment, so we started to write a short term medical plan that would run to the November Open Enrollment, when he could then hop onto a "regular" plan. So, got the quote, made the appointment, and figured we were all set. And then the little light-bulb went off: He could indeed sign up for a new plan in November, but that plan <a href="http://insureblog.blogspot.com/2014/06/tuesday-morning-roundup.html" target="_blank">wasn't going to go into effect until next January</a>. We needed two more months of coverage, for a total of eight (May to January). Most STM plans will only allow a maximum of 6 months, and then can be re-written for the other 2. But if you've had any claims during that initial 6 months, these then become pre-existing conditions on the new 2-month plan and won't be covered. Fortunately, one of my carriers has a plan that can be written for up to 11 months, so we dodged that bullet. But I wonder how many folks in this situation (and the agents servicing them) are aware of this little issue. At this point, it's probably moot for this year: plans written with July effective dates will be fine at six months. But remember: there's always next year....</div>

ACA vs STM

LifeaHealthPro's Allison Bell has an interesting piece today comparing the average costs of a Short Term Medical plan to a full-blown O...

8:25 AM

Cavalcade of Risk #211: Call for submissions

Cavalcade of Risk #211: Call for submissions

Julie Ferguson hosts next week's Cav. Entries are due by Monday (the 23rd). To submit your risk-related post, just click here to e...

6:02 AM

ElderCare, the Differently Abled, and Progress

<div class="separator" style="clear: both; text-align: center;"><a href="http://img1.wikia.nocookie.net/__cb20080506144205/wikiality/images/a/a1/IceFloe4Elderly.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="109" src="http://img1.wikia.nocookie.net/__cb20080506144205/wikiality/images/a/a1/IceFloe4Elderly.jpg" width="140" /></a></div><div style="text-align: justify;">While it's <a href="http://www.straightdope.com/columns/read/2160/did-eskimos-put-their-elderly-on-ice-floes-to-die" target="_blank">likely apocryphal</a> that Alaskans actually set their elderly adrift on ice floes, it's no myth that our current society could stand some circumspection regarding its treatment of Seasoned Citizens. To that end, a group of experts has gotten together and published an insightful, somewhat disturbing, but ultimately uplifting post about how the disabled and elderly are treated, and what the future may bode: "<a href="http://justwalkers.com/how-the-disabled-and-elderly-are-treated-differently-experts-weigh-in#.U5CEkPldWkE" target="_blank">I have several friends that have disabilities which require mobility device. Just seeing them come into a room, you can see the look on peoples’ faces when they come by. It’s like a feeling of sympathy – my friends don’t ask for it, you know? They don’t want sympathy ... Advancements in technology just give people a better opportunity to show off their talents, and to show what they can do. It’s all about giving people the freedom to live the life that they want for themselves</a>." Recommended.</div>

ElderCare, the Differently Abled, and Progress

While it's likely apocryphal that Alaskans actually set their elderly adrift on ice floes, it's no myth that our current society co...

12:20 PM

Hepatitis C (for Conundrum)

<div style="text-align: justify;">Here's a poser: "<a href="http://www.mail.com/scitech/health/2922460-1000-a-pill-sovaldi-jolts-us-health-care-system.html#.7518-stage-hero1-4" target="_blank">Sovaldi, a new pill for hepatitis C, cures the liver-wasting disease in 9 of 10 patients, but treatment can cost more than $90,000</a>" On the other hand: "[I]f Sovaldi didn't exist, insurers would still be paying in the mid-to-high five figures to treat the most common kind of hepatitis C ... older alternatives involve more side effects, and are less likely to provide cures" And on the gripping hand: "For each middle-aged person [insurers] pay to cure with Sovaldi, any financial benefits from preventing liver failure are likely to accrue to Medicare, not to them." This really isn't about the ObamaTax: it would be a highly charged question under the old system, as well. For perspective, according to the CDC, "<a href="http://www.cdc.gov/hepatitis/c/cfaq.htm" target="_blank">[a]n estimated 3.2 million persons in the United States have chronic Hepatitis C ... In 2009, there were an estimated 16,000 acute Hepatitis C virus infections reported in the United States</a>." So, dear readers, what say you? <script charset="utf-8" id="adpEmbed225727" src="http://www.addpoll.com/poll-225727.js" type="text/javascript"></script><noscript><a href="http://www.addpoll.com/hgstern/poll/225727">Should health insurers and/or Medicaid pay for Sovaldi for all Hep-C patients?</a></noscript> And feel free to expand on your answer in the comments.</div>

Hepatitis C (for Conundrum)

Here's a poser: " Sovaldi, a new pill for hepatitis C, cures the liver-wasting disease in 9 of 10 patients, but treatment can cost ...

7:30 AM

Health Wonk Review: World Cup edition

Health Wonk Review: World Cup edition

Julie Ferguson scores a goal with a terrific collection of wonky posts , from watch dogging and egg poaching to 404Care.gov and the VA. Pret...

5:49 AM

eHealth Whiffs It

<div style="text-align: justify;">So, the folks at<a href="http://insureblog.blogspot.com/2014/04/may-i-have-envelope-please.html" target="_blank"> eHealth</a> (who generally do a pretty bang-up job communicating the ins-and-outs of the ObamaTax), recently released (and publicized) this video:</div><div style="text-align: justify;"> </div><div style="text-align: justify;"><iframe allowfullscreen="" frameborder="0" height="221" src="//www.youtube.com/embed/gxypx4XR7tE" width="392"></iframe></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Great production values, but I'm shocked that their compliance department let this stinkburger through.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">"Stinkburger," Henry?</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Yes, and here's why:</div><div style="text-align: justify;"> </div><div style="text-align: justify;">The video explicitly names three events that would qualify one for a <a href="http://insurance.answers.com/health-insurance/aca-basics-open-enrollment" target="_blank">Special Enrollment Period</a>: Job Loss, Job Change, and COBRA termination. Problem is, only running out the 18 months of COBRA is recognized as an automatic qualifying event. The other two? Nope.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">But don't just take our word for it, <a href="https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=2" target="_blank">here's the HHS list</a>.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Do you see job loss or change as a qualifying event? No: they are only relevant if one loses coverage as a result.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Big difference, and important when considering one's options. Two examples: Scenario 1 (Job Loss): Joe's employer doesn't offer group (medical) insurance. When Joe quits or is laid off, this does not trigger a Special Open Enrollment (SOE). Scenario 2 (Job Change): Joe's employer doesn't offer group insurance. Joe quits to go work for another firm which also doesn't offer coverage. Again, no SOE is triggered. Now, one could also understand the video to mean job changes within the same employer. Same outcome. </div><div style="text-align: justify;"> </div><div style="text-align: justify;">And there's this:</div><div style="text-align: justify;"> </div><div style="text-align: justify;">The young lady says that "it's a good idea to have some proof of your loss or change in your health coverage."</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Um, no, it's a requirement, there's nothing optional about it. Is that a big deal? Maybe, maybe not, but if you've just spent hours and hours on the 404Care site or on hold, and you don't have that? Good luck.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Finally, there's the time-frame issue. The video is absolutely correct that the clock stops 60 days after the qualifying event (and this is important: HIPAA requirements include an extra 3 days). But it then states that if you do make that 60 day window, "your application for new health coverage cannot be declined."</div><div style="text-align: justify;"> </div><div style="text-align: justify;">That will come as quite a shock to all the folks still <a href="http://insureblog.blogspot.com/2014/03/harrys-407000-bind-liar-or-victim.html" target="_blank">waiting on confirmation</a> of coverage.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">All in all, I'd rate this a C- (at best). Which is a shame, because it had the potential to be quite helpful to folks now that we're in the long drought between Open Enrollment periods.</div><div style="text-align: justify;"> </div><div style="text-align: justify;">[Hat Tip: FoIB <a href="http://themoderatevoice.com/author/holly" target="_blank">Holly R</a>]</div><div style="text-align: justify;"> </div><div style="text-align: justify;"> </div>

eHealth Whiffs It

So, the folks at eHealth (who generally do a pretty bang-up job communicating the ins-and-outs of the ObamaTax), recently released (and pu...

11:30 AM

Perception isn't Reality

By definition, “success” is a favorable or desired outcome. To determine if something is a success, one identifies a set of goals to achieve in order to reach this outcome. When it comes to Obamacare, then, what is the definition of success? It all depends on what set of goals we use. This week Obamacare cheerleaders such as Enroll America and Sarah Kliff have been touting the “success” of the first open enrollment season. Enroll America is hosting a National Conference under the headline <a href="http://www.stateofenrollment.org/documents/conference-program.pdf" target="_blank">State of Enrollment - Getting America Covered</a>. The featured speaker, The Artist Formerly Known as Ms. Shecantbeserious, blamed the lack of help enrolling people on "states where state governments didn’t cooperate." She wrapped up her speech by saying that she would rather have a rocky rollout and 8 million signed up than a fully functional website and 4 million enrolled. Kliff, the Vox.com Senior Editor and self-proclaimed health care wonk, (hint: <a href="http://insureblog.blogspot.com/2014/02/helping-sarah-kliff-solve-her-medical.html" target="_blank">she can't even understand her own EOB's</a>) has a long post titled: <a href="http://www.vox.com/2014/6/12/5785864/8-million-how-obamacare-met-its-enrollment-goal" target="_blank">Selling Obamacare - How the White House convinced 8 million Americans they could afford health insurance</a>. She starts by using a 60 year old Pilates instructor whose insurance premiums before Obamacare would have been upwards of $900 per month. Instead of buying then she went uninsured. Now she has a plan with premiums at $359 after a subsidy. For this healthy woman who "only gets one or two colds a year" this is much higher than she had hoped and it has come with trade-offs. She's skipping a trip to Brazil to visit her niece and also putting off building a website to advertise her business. So what's the big point? We have 8 million people covered. Obamacare is a huge success! Right. Right? Right? Maybe we should take a history lesson back to 2009 when we were told about how great President Obama's health care plan was going to be. This is what Obama said in his <a href="http://www.whitehouse.gov/the-press-office/weekly-address-president-obama-outlines-goals-health-care-reform" target="_blank">weekly address</a> as to what the goals of his health care law would be: <blockquote class="tr_bq">This week, I conveyed to Congress my belief that any health care reform must be built around fundamental reforms that lower costs, improve quality and coverage, and also protect consumer choice.  That means if you like the plan you have, you can keep it.  If you like the doctor you have, you can keep your doctor, too.  The only change you’ll see are falling costs as our reforms take hold.</blockquote> In addition to these three fundamental changes, the CBO also projected in 2010 that we would have 14 million more people insured either through Medicaid or private markets. Measuring the success of Obamacare is extremely important. It represents a massive change to 1/6 of our economy. The stakes are high, and so is the risk of failure. These are things that <a href="http://heartland.org/policy-documents/vote-results-house-passes-obamacare" target="_blank">all but 34 Democrats</a> in Congress either didn't care about or were just too busy to read the bill before passing it. They took the White House and the authors of PPACA at their word. That word called for success in the form of lower premiums, more choices, better benefits, and more people with insurance. None of the above have met expectations. Costs continue to rise. Small businesses are leery of whether or not they can afford to provide insurance benefits going forward. “If you like your plan you can't keep it - period.” Narrow networks restrict physician and facility choice. Outrageous limits on out of pocket maximums of $6350 for single and $12,700 for families aren't providing security through better benefits. Strict limitations on plan design (<a href="http://insureblog.blogspot.com/2014/04/idiots-guide-to-understanding-full.html" target="_blank">ActuarialValue</a>) are reducing benefit flexibility. The only thing we have been told is the number of people who picked a plan and may have enrolled. The number they share is 8 million, yet when you look at the total - Medicaid, SCHIP, and Exchanges - the figure used is 12.8 million*. What we are not told is that little asterisk: * Of the enrolled HHS has no idea how many were previously uninsured, were previously enrolled in Medicaid, lost lower premiums, lost better benefits, or were forced out of their current plans. Instead we hear the few stories of “success.” It is these tiny threads that groups like Enroll America will cling to in order to prove their worth. They now are trying to push a new narrative to feel worthy of their cause. At this point it’s no longer about success. Perception isn't reality: that ship sailed long ago.

Perception isn't Reality

By definition, “success” is a favorable or desired outcome. To determine if something is a success, one identifies a set of goals to achiev...