insurance

Gamers

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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Oh the games people play, now. Every night and every day, now. Never meaning what they say, now. Never saying what they mean.  </span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiW-UOx_1vGGZUI1dQ3N2c48GjUMsQ5YbvqeYua0_Kq2de3365RjfB2uE1n_WR9yW-JzWTkZeAB72ebHzUuNBQgGnplx1mys8BY-C-3-1g2jDyyeKa835Bz9uKQOk62XK_N29eY3fVznK8/s1600/Obama-Mart.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiW-UOx_1vGGZUI1dQ3N2c48GjUMsQ5YbvqeYua0_Kq2de3365RjfB2uE1n_WR9yW-JzWTkZeAB72ebHzUuNBQgGnplx1mys8BY-C-3-1g2jDyyeKa835Bz9uKQOk62XK_N29eY3fVznK8/s1600/Obama-Mart.jpg" /></a></span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Comes now the biggest taxpayer funded give away in the history of the United States. Obamacare subsidies are nothing more than an invitation to game the system and get more "free" benefits.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"Mike" is a low paid, full time worker in a company that still offers health insurance.</span><br />
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<span style="background-color: white; color: #333333; line-height: 17px;"><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Mike’s $3,241 contribution is tax-deductible. Still, that’s a hefty 11.6 percent of his wage income, which might make it appear that Mike’s coverage meets Obama-care’s definition of “unaffordable.” In that case, he would qualify for subsidized coverage on the exchange. Unfortunately, exchange eligibility is restricted to those whose cost for “self-only” coverage under their employer plan exceeds 9.5 percent of household income, and Mike has family coverage. Since Mike’s share of a “self-only” premium would be only 4.9 percent of his income, he is not legally permitted to buy subsidized coverage through the exchange.</span></i></span></blockquote>
<span style="background-color: white; color: #333333; line-height: 17px;"><b><a href="http://m.weeklystandard.com/articles/dishonor-system_741026.html" target="_blank"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Weekly Standard</span></a></b></span><br />
<span style="background-color: white; color: #333333; line-height: 17px;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span><span style="background-color: white; color: #333333; line-height: 17px;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Do you see his predicament?</span></span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #333333; line-height: 17px;"><i>The way Mike sees it, Uncle Sam is levying a substantial tax on him simply for working for a large employer that responsibly offers health benefits.</i></span><span style="background-color: white; color: #333333; line-height: 17px;"><i><br /></i></span><span style="background-color: white; color: #333333; line-height: 17px;"><i></i></span></span></blockquote>
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<span style="background-color: white; color: #333333; line-height: 17px;"><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The administration’s ineptitude in rolling out Obama-care has given Mike a lucky break. In 2014, his employer may not be reporting to the exchange any details about the coverage offered him at work. The final rule on premium tax-credit eligibility verification requires that any applicant for premium tax credits attest to the exchange whether he or she has employer coverage, its cost, and extent</span></i></span></blockquote>
<span style="background-color: white; color: #333333; line-height: 17px;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span><span style="color: #333333; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 17px;">Now he has a plan.</span></span><br />
<span style="color: #333333; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 17px;"><br /></span></span><span style="color: #333333; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 17px;">Work the system in his favor. If he gets caught, he figures nothing will happen or he can always plead ignorance and promise not to do it again.</span></span><br />
<span style="color: #333333; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 17px;"><br /></span></span><span style="color: #333333; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 17px;">Wonder how many "Dan's" there are who will find a way to game the system?</span></span><br />
<span style="color: #333333; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 17px;"><br /></span></span><span style="color: #333333; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="line-height: 17px;">We may never know unless they go on TV and brag about it like the woman who got the free Obamaphone.</span></span><br />
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Gamers

Oh the games people play, now. Every night and every day, now. Never meaning what they say, now. Never saying what they mean. Comes n...

11:01 AM

Genworth LTCi in the crosshairs

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<span style="font-family: Arial,Helvetica,sans-serif;">Genworth, one of the last remaining "players" in the Long Term Care insurance (LTCi) market, is about to drop the hammer on some of its long-time policyholders:<br /><br />"<a href="http://www.lifehealthpro.com/2013/07/31/genworth-conducting-deep-review-of-ltci-business?eNL=51f95dfe160ba03d0100014d&utm_source=HealthInsuranceInsider&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=107764095" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">We're conducting an intense, very broad and deep review of all aspects of our [long-term care] insurance business ... believe the company has to increase the price of products sold before 2002 to bring them closer to the break-even point</span></i></a>"<br /><br />Yikes!<br /><br />Actually, this is far from unexpected, and arguably overdue:<a href="http://insureblog.blogspot.com/2013/07/in-news.html" target="_blank"> as we've seen</a> over the years, the current long term pricing models just aren't sustainable. For one thing, too many folks have kept their policies (not a <b>bad</b> thing, <i>per se</i>, just that carriers count on a certain amount of attrition), so both claims and reserves continue to mount.<br /><br />And, of course, as the LTCi business itself matures, it becomes more and more obvious that earlier plans were substantially under-priced. While that may have been a good deal for early adopters, over time it's a problem.<br /><br />Which is not to say that the LTCi market is 'kaput;' indeed, more folks than ever seem to be taking a serious look at these plans. But it's important to keep in mind that, with few exceptions, rates will continue to climb for at least a while.</span></div>
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Genworth LTCi in the crosshairs

Genworth, one of the last remaining "players" in the Long Term Care insurance (LTCi) market, is about to drop the hammer on so...

11:00 AM

Aetna Touch-N-Go, and the Big Picture

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<span style="font-family: Arial,Helvetica,sans-serif;">A couple of days ago, we reported on Aetna's apparent <a href="http://www.insureblog.blogspot.com/2013/07/aetna-back-in-game.html" target="_blank">change of heart</a> regarding the sale of individual medical insurance here in Ohio. Today, they're back in the news:</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">"<a href="http://www.lifehealthpro.com/2013/07/30/aetna-touts-private-exchanges?eNL=51f93d0d150ba0aa4c00022d&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=107687085" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">Aetna Inc. execs remain skeptical about how the [Obamaax] public exchanges will perform ... New and expanded private exchange programs could get off to a faster start</span></i></a>"</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">There are three essential differences between the Public (FFE) and Private Exchange models:</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">First, only plans purchased on the Public Exchange will be eligible for subsidies (maybe: the subsidy rules <a href="http://insureblog.blogspot.com/2013/07/the-obamatax-subsidy-cheat.html" target="_blank">keep changing</a>);</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Second, plans available on the Public Exchange are expected to have much smaller ("skinnier," in the vernacular) provider networks;</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">And third, fewer carriers are expected to participate in the Public Exchanges (limiting competition and choice).</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">It's that third item that's key: absent a robust marketplace, even subsidized plans are likely to remain out of the financial reach of many folks. That's due partly to premiums, and partly to plan design. The least expensive ObamaTax-compliant plans ("Bronze" level) have potential out-of-pocket maximums much higher than many plans available today, further exacerbating the (un)affordability issue.</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">If (when?) major players like Aetna take a pass on the Public version in favor of the Private, it will cause an even greater strain on the former's sustainability. The Private Exchange model, on the other hand, looks poised to be reasonably successful: for the most part, these will offer more choice (and thus competition) and better service.</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Wait, what's that about service, Henry?</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Well, it's like this: agents (you know, the folks who are <b>trained</b> and <b>experienced </b>in the actual business of health insurance) are effectively shut out of the Public Exchanges. But a lot of us have signed up for the Private Exchanges. So when a consumer needs an <i>accurate, knowledgeable and credible</i> answer, to where do you think he will turn?</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">On the other hand, we know that a lot of agents have already thrown in the towel (and/or are<a href="http://insureblog.blogspot.com/2013/07/monday-morning-obamatax-news.html" target="_blank"> planning to do so</a> in the near future), so that may not be a realistic assessment, either.</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Yeah, I'm just full of warm fuzzies today.</span></div>
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Aetna Touch-N-Go, and the Big Picture

A couple of days ago, we reported on Aetna's apparent change of heart regarding the sale of individual medical insurance here in Oh...

11:00 AM

Wednesday Potpourri

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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwt7qHlkv3JTsMSbX3ogKQk0MXfYdqEGqV8A1sPSXzplvopE-r7SN6mdPmspvHn8U5MUvmHb0kgdfgjvZpybpqik1UihUGL1BU7zrniU5tcT8pkZPtjPsZvL9a0p1Kv6thv1BAOd-Z61eH/s320/potpourri+basket.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwt7qHlkv3JTsMSbX3ogKQk0MXfYdqEGqV8A1sPSXzplvopE-r7SN6mdPmspvHn8U5MUvmHb0kgdfgjvZpybpqik1UihUGL1BU7zrniU5tcT8pkZPtjPsZvL9a0p1Kv6thv1BAOd-Z61eH/s200/potpourri+basket.jpg" width="140" /></a></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">■ While you're busy planning that end-of-summer trip to Rome or London (or Istanbul, for that matter), you should know that your health insurance <a href="http://www.daytondailynews.com/news/business/prepare-for-your-health-care-needs-overseas/nY6bk/?utm_source=dlvr.it&utm_medium=twitter" target="_blank">works a bit differently overseas</a>. One way to help protect yourself is with a <a href="https://www.worldtrips.com/quotes/default.asp?referid=24353" target="_blank">Travel Medical plan</a>.<br /><br />■ As if the ObamaTax train-wreck wasn't causing enough damage to the health care and insurance sectors, its broad "appeal" has rippled through the whole economy:<br /><br />"<a href="http://washingtonexaminer.com/obamacare-train-wreck-is-crashing-employment-too/article/2533624" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">This letter was written by the three of the nation's largest labor unions ... Right now, unless you and the Obama Administration enact an equitable fix, the ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40-hour workweek that is the backbone of the American middle class</span></i></a>."<br /><br />Ooops.<br /><br />■ Earlier this month, the (Evil) Employer Mandate was <a href="http://www.insureblog.blogspot.com/2013/07/what-breaking.html" target="_blank">put (temporarily) on hold</a>. Before we start singing and dancing for joy (Hi, Joy!), though, here's some sobering news. According to the Congressional Budget Office:<br /><br />"<a href="http://online.wsj.com/article/SB10001424127887324809004578638282900414410.html" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">The Obama administration's move to delay a mandate on businesses to provide health coverage will mean $12 billion in lost tax revenue and additional costs ... one million fewer people will get employer coverage in 2014 as a result of the postponement</span></i></a>"<br /><br />So we get higher costs and fewer people insured. Yup, sounds like a plan!<br /><span style="font-size: x-small;"><span style="color: red;"><i><b><br />[Hat Tips to <a href="http://themoderatevoice.com/author/holly" target="_blank">Holly R</a> and Gail S]</b></i></span></span></span></div>
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Wednesday Potpourri

■ While you're busy planning that end-of-summer trip to Rome or London (or Istanbul, for that matter), you should know that your hea...

11:00 AM

Rakin' in the ObamaTax Bucks

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<span style="font-family: Arial,Helvetica,sans-serif;">As Patrick noted last week, the ObamaTax Medical Loss Ratio (MLR) provision seems to have been a wonderful gift to the health insurance industry:<br /><br />"<a href="http://insureblog.blogspot.com/2013/07/how-much-did-that-rebate-cost-you.html" target="_blank"><i>So, thanks to MLR, insurance companies took in an additional $50 Billion in 2012 and paid out $800 Million less in rebates</i></a>"<br /><br />Lest our readers think that this is an exaggeration, we learn today that at least one carrier, WellPoint, is making some serious coin off of the ObamaTax:<br /><br />"<a href="http://www.lifehealthpro.com/2013/07/30/wellpoint-expects-20-billion-ppaca-windfall?eNL=51f82d98150ba06d5200003d&utm_source=LifeHealthProDaily&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=97611471" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">[N]ewly minted CEO Joseph Swedish said the company expects a windfall of sorts from the [ObamaTax] — as much as $20 billion by 2016</span></i></a>."<br /><br />While that's only partially due to the MLR (other factors include increased market share and more folks buying coverage through the Exchanges), it's certainly looks to be "<i>berry, berry good</i>" for the folks at Blue Cross.<br /><br />By the way, take a look at your renewal and let us know how well <i><b>you're</b></i> faring.</span></div>
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Rakin' in the ObamaTax Bucks

As Patrick noted last week, the ObamaTax Medical Loss Ratio (MLR) provision seems to have been a wonderful gift to the health insurance ...

11:00 AM

Insurance as a loss leader

Insurance as a loss leader

It's often asked how long carriers will put up with low margins and tight regulations. It's not a very attractive market to be in r...

10:59 AM

Detroit Loves Obamacare

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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">The folks in the motor city may have Obamacare to thank for providing a way out of their </span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD5VY7zjqPEb0Qs8DfXtKufMsdMy-ZPtwYT5eUzeCsk7Xm_-NypN-938Vo1cJkOK11Wd9qdIq_ECIyd6b5D1D6nHcoRpbvsHl6OkqiYzx2xR7Hc6T_miWA45qfz89MXsc00AfNYtnGUEI/s1600/obamacare+saves+detroit.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="236" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD5VY7zjqPEb0Qs8DfXtKufMsdMy-ZPtwYT5eUzeCsk7Xm_-NypN-938Vo1cJkOK11Wd9qdIq_ECIyd6b5D1D6nHcoRpbvsHl6OkqiYzx2xR7Hc6T_miWA45qfz89MXsc00AfNYtnGUEI/s320/obamacare+saves+detroit.jpg" width="320" /></a></span></div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">financial mess.</span><br />
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<span style="background-color: white; line-height: 22px;"><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">As Detroit enters the federal bankruptcy process, the city is proposing a controversial plan for paring some of the $5.7 billion it owes in retiree health costs: pushing many of those too young to qualify for Medicare out of city-run coverage and into the new insurance markets that will soon be operating under the Obama health care law.</span></i></span></blockquote>
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<span style="background-color: white; line-height: 22px;"><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Officials say the plan would be part of a broader effort to save Detroit tens of millions of dollars in health costs each year, a major element in a restructuring package that must be approved by a bankruptcy judge. It is being watched closely by municipal leaders around the nation, many of whom complain of mounting, unsustainable prices for the health care promised to retired city workers.</span></i></span></blockquote>
<span style="background-color: white; line-height: 22px;"><b><a href="http://www.nytimes.com/2013/07/29/us/detroit-looks-to-health-law-to-ease-costs.html?_r=1&adxnnl=1&partner=rss&emc=rss&adxnnlx=1375114035-qqBvTrhzyXSeeX1NEzTq+A" target="_blank"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">NY Times</span></a></b></span><br />
<span style="background-color: white; line-height: 22px;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span></span><span style="background-color: white; line-height: 22px;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">And they are not alone . . .</span></span><br />
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<span style="background-color: white; line-height: 22px;"><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Similar proposals that could shift public sector retirees into the new insurance markets, called exchanges, are already being planned or contemplated in places like <b>Chicago; Sheboygan County, Wis.; and Stockton, Calif.</b> While large employers that eliminate health benefits for full-time workers can be penalized under the health care law, retirees are a different matter.</span></i></span></blockquote>
<span style="background-color: white; line-height: 22px;"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Thank you Obamacare for bailing out cities that have no clue how to manage money.</span></span></div>

Detroit Loves Obamacare

The folks in the motor city may have Obamacare to thank for providing a way out of their financial mess. As Detroit enters the federa...

10:59 AM

Lucy (Peanuts fame) found working in Maryland

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Lucy would be called an inflation-denier for her never-ending demand that it cost $0.05. Even today hocking life insurance she is set on five cents being the price. I have to wonder if officials in Maryland aren't giving their price setting just as little thought:<br />
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"<a href="http://www.lifehealthpro.com/2013/07/29/maryland-cuts-some-carriers-rate-requests" target="_blank"><i>The Maryland Insurance Administration is telling some carriers that want to sell coverage through its individual exchange program to make deep cuts in their premiums</i></a>. "<br />
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"<i>In the bare-bones, “bronze level” of coverage, for example, the  monthly premium rates originally requested for a 25-year-old nonsmoker  living in Baltimore ranged from<u><b> $136 to $350</b></u>.</i><br />
<i><br /></i><i>The rates approved in that category of coverage range from <u><b>$124 to $237</b></u>.</i><br />
<i><br /></i><i>The rate reductions demanded range from 1.1 percent for a QHP to be  sold by a unit of Kaiser Permanente to 32 percent for a QHP to be sold  be a unit of  </i><a href="http://www.unitedhealthgroup.com/" target="_blank"><i>UnitedHealth Group Inc</i>.</a>" <i><span style="font-family: Arial,Helvetica,sans-serif;">[emphasis added]</span></i><br />
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It is important to remember that if the actuaries for United are wrong they don't get to keep the money, it would go back to the policy holders; thus they don't have any incentive to be that far off.<br />
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I have to wonder where $237 came from. That doesn't sound far off for a healthy person policy today with maternity. Guaranteed issue with community rating and $350 even sounds aggressive.  </div>

Lucy (Peanuts fame) found working in Maryland

Lucy would be called an inflation-denier for her never-ending demand that it cost $0.05. Even today hocking life insurance she is set on fi...

10:59 AM

Stupid Carrier Tricks: Timing is Everything edition

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<span style="font-family: Arial,Helvetica,sans-serif;">A few weeks ago, I mentioned that Anthem had <a href="http://abagailreidphotography.blogspot.com/" target="_blank">sent out a batch</a> of December 1 individual medical plan renewals for these "grandmothered" plans. Yesterday, I received a similar batch of January 1 renewals for some Medical Mutual clients.<br /><br />Keep in mind that I received these on November 17th:</span></div>
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<a href="http://abagailreidphotography.blogspot.com/" target="_blank"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXdjgykwLNTEuOMOAkAu98l7gMO2Yu4dejr7Ef6wMeQGkOtf8P4_vTEd83LGKJmYya3sJEBoBAZdzYS53R_mjL0J34QLCeVc2HxqL-ZjihXNOK5g8uSQQJqeEJs2kKJaVlRKzLuHt9pbE/s1600/mmo+2015+letter.jpg" width="562" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span><span style="font-family: Arial,Helvetica,sans-serif;">And when were they actually <i><b>mailed</b></i>?</span><br />
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<a href="http://abagailreidphotography.blogspot.com/" target="_blank"><img border="0" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUYuyEu7EYtYU2rOZVQlEfXcTTrJ70UPueG3AofURQPOeCIs1VoW4zT78q5QKRe5SkbhgxlQkxqm4MEFws8gfgUBPshak_nbM6VeT96Z17ouZq3cAAPf-N0Ci-15yy3HoaOhlSLIiJvSI/s1600/mmo+2015+env.jpg" width="640" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;">[<i>ed: date highlighting added</i>]</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span><span style="font-family: Arial,Helvetica,sans-serif;">Great timing there, MMO.</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span><span style="font-family: Arial,Helvetica,sans-serif;">Sheesh.</span></div>

Stupid Carrier Tricks: Timing is Everything edition

A few weeks ago, I mentioned that Anthem had sent out a batch of December 1 individual medical plan renewals for these "grandmothere...

8:09 AM

GruberGate: The Musical

GruberGate: The Musical

GruberGate: The Musical

8:08 AM

Health Wonk Review: Post-Turkey Day edition [UPDATED]

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<a href="http://primephysique.com/Portals/46981/images/thanksgiving-now-what-diet.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: justify;"><img border="0" height="254" src="http://primephysique.com/Portals/46981/images/thanksgiving-now-what-diet.jpg" width="400" /></a></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">As we count down the days from Thanksgiving to Christmas, there's always this incredibly exciting sense of anticipation in the air. This is no less true of us health care wonks, as you can see from this eclectic assortment of bloggetry:</span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"> <span style="color: red;"><u><b>Mea Culpa Update</b></u></span>: In the rush to get this put together, I inadvertently left out two great contributions, from HWR regulars, no less (I've put them in the top two spots).<br /><br />Please make sure to click on through, you'll be glad you did:</span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> <a href="http://healthcare-economist.com/2014/11/30/the-end-of-urgent-care/" target="_blank"><b>Jason Shafri</b></a>n (my favorite econ-blogger) wonders about the curious phenomenon of provider networks converting freestanding urgent care centers to emergency departments. It's not as obvious as one might think.</span><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> The NCPA’s Health Policy Blog's <a href="http://healthblog.ncpa.org/crisis-in-pharma-r-2-5-times-more-than-in-2003/" target="_blank"><b>John R. Graham</b></a> takes a look at the skyrocketing cost of developing new drugs and what’s changed to cause the increase (according to Mr G, it costs $2.6 billion to develop a new med, more than twice what it cost in '03).<br /> </span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span> First up, <a href="http://webcache.googleusercontent.com/search?q=cache:Efdd0Yhz4rgJ:www.piperreport.com/blog/2014/11/28/how-undocumented-immigrants-could-receive-obamacare-subsidies-hypothetical-uses-of-aca-waivers/+&cd=5&hl=en&ct=clnk&gl=us" target="_blank"><b>Kip Piper</b></a> wonders if <strike>undocumented</strike> illegal immigrants are in line for ObamaCare subsidies, not to mention abortion coverage and the Halbig/King cases [<i>ed: um, you just mentioned them...</i>].</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> Next, the folks at <a href="http://wingofzock.org/2014/11/20/scholarship-in-medical-school-skating-to-where-the-puck-will-be/" target="_blank"><b>Wing of Zock</b></a> (which, I'll repeat for the umpteenth time, would make a <i><b>great</b></i> name for a rock band)  present a post by two co-founders of a scholarly collaborative that promotes and shares best practices on medical student scholarship across institutions. In it, they describe the benefits of, and barriers to, undergraduate medical student research. As a great poet once observed, the children are our future.</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> Uber-wonk <a href="http://hcrenewal.blogspot.com/2014/11/public-relations-and-obfuscation-of.html" target="_blank"><b>Roy Poses</b></a> takes a look at PR, medical errors and the Great Texas Ebola <strike>fustercluck</strike> mismanagement/debacle. His (eminently reasonable) conclusion is that the interests of hospital management appear to conflict with those of public health. Not exactly confidence inducing.</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> And speaking of Uber-wonks (and all in a <i>very</i> good way!), <a href="http://healthbusinessblog.com/2014/11/14/medicaid-for-all/" target="_blank"><b>David Williams</b></a> takes on the very real problem of providers getting clobbered financially if they take on too many Medicaid patients. On the other hand, David observes, there are policy solutions at hand if we are willing to discuss them. In particular, the disparities between Medicaid, Medicare and commercial payments should be reduced, and we should move away from fee-for-service toward risk-based models [<i>ed: risk? Isn't that the purview of insurance?</i>]</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> <a href="http://healthsystemed.com/the-man-and-the-mission-why-data-integrity-is-important-to-the-first-cms-chief-data-officer/" target="_blank"><b>Peggy Salvatore</b></a> has a tale of mystery, intrigue and data (but mostly data), as she examines changes at the top echelon of CMS. Seems they have a new First Chief Data Officer, Niall Brennan, who understands how effective data usage can be in achieving value and accuracy.</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> Our good friend and colleague <a href="http://www.healthinsurancecolorado.net/cost-sharing-reduction-plan/" target="_blank"><b>Jay Norris</b></a> takes on the oft-misunderstood CSR (Cost Sharing Reduction) component of certain Exchange-based ACA plans. For example, if a family with kids and a CSR-eligible income is shopping for coverage, they’re not going to see CSR plans in the browsing tool nor will they see CSR plans in any quotes.  That makes it tough to compare plans prior to enrolling, since the CSR plans offer such a good value and definitely need to be considered by anyone eligible for them. This makes shopping at "The Marketplace" even more <strike>exciting</strike> challenging.</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> <a href="http://healthaffairs.org/blog/2014/12/02/the-payment-reform-landscape-tying-it-all-together-2/" target="_blank"><b>Chris Fleming</b></a>, proprietor of the Health Affairs Blog, sends along a Contributing Voices post by the executive director of the Catalyst for Payment Reform, Suzanne Delbanco. In it, she summarizes lessons learned, comparing and contrasting different payment models (eg Pay for performance, “payment for non-visit functions”).</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> Count on the folks from </span><span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.healthinsurance.org/blog/2014/12/02/bruised-by-the-benchmark/" target="_blank"><b>healthinsurance.org Blog</b></a> to come through with a timely (it is, after all, Open Enrollment season) and cautionary post on ACA "benchmark" plans and renewals. The story of a low-income family in Philly who, if they renewed a plan they were told would cost  “pennies per month,” could pay almost <b>$200</b> a month helps illustrate the dilemma [<i>ed: um, that <b>is</b> "pennies per month:" 20,000 of them</i>].</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> HWR co-founder - and all-around good egg - <a href="http://www.workerscompinsider.com/2014/12/workers-compens-10.html" target="_blank"><b>Julie Ferguson</b></a> looks at the seismic impact that the executive order related to immigration is likely to have on workers’ compensation. Here’s a hint of the scope: “…<i>one-fifth of work injuries are likely sustained by foreign-born workers, 10% by undocumented workers, whether or not they are reported</i>.” Yikes!</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: red;">■</span></span> And last, but (hopefully) not least, <a href="http://www.insureblog.blogspot.com/2014/11/missing-mark-mvnhs-style.html" target="_blank"><b>our own small contribution</b></a>: Even (especially?) in Jolly Olde, the Much Vaunted National Health System© proves inadequate for the task, this time missing key targets for critical cancer care.</span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">Thanks to our great contributors, and to you for dropping by! Please join us next time at <a href="http://www.workerscompinsider.com/" target="_blank"><b>Julie's place</b></a>.</span></div>
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Health Wonk Review: Post-Turkey Day edition [UPDATED]

As we count down the days from Thanksgiving to Christmas, there's always this incredibly exciting sense of anticipation in the air. ...

8:07 AM

Gov tries to circumvent ACA in way HHS clearly tells employers not to

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How sweet this would be if not for the inevitable consequences:</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD5VY7zjqPEb0Qs8DfXtKufMsdMy-ZPtwYT5eUzeCsk7Xm_-NypN-938Vo1cJkOK11Wd9qdIq_ECIyd6b5D1D6nHcoRpbvsHl6OkqiYzx2xR7Hc6T_miWA45qfz89MXsc00AfNYtnGUEI/s1600/obamacare+saves+detroit.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD5VY7zjqPEb0Qs8DfXtKufMsdMy-ZPtwYT5eUzeCsk7Xm_-NypN-938Vo1cJkOK11Wd9qdIq_ECIyd6b5D1D6nHcoRpbvsHl6OkqiYzx2xR7Hc6T_miWA45qfz89MXsc00AfNYtnGUEI/s1600/obamacare+saves+detroit.jpg" style="text-align: left;" /></a><i>"<a href="http://www.nytimes.com/2013/07/30/us/politics/wrinkle-in-health-law-vexes-lawmakers-aides.html?pagewanted=all&_r=0" target="_blank">Under a wrinkle that dates back to enactment of the law, members of Congress and thousands of their aides are required to get their coverage through new state-based markets known as insurance exchanges. But the law does not provide any obvious way for the federal government to continue paying its share of the premiums for the comprehensive coverage</a>" </i></div>
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Like any true Democrat, Rep Waxman doesn't think they should be bothered by any actual law. </div>
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<i>Representative Henry A. Waxman, a California Democrat who helped write  the 2010 law, said, “The federal government, as our employer, should  provide the same contributions it makes to our current health plans.” </i></div>
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HHS has made it very clear to the rest of us though that we dare not even consider such an arrangement.</div>
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<i>"<a href="http://slphrbenefitsupdate.com/2013/01/27/employers-aca-health-reforms-prohibit-using-hras-to-pay-individual-medical-policy-premiums-impact-other-hra-arrangements/" target="_blank">FAQS About Affordable Care Implementation (Part XI)” (FAQ) available here issued by the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Agencies) on January 24, 2013 sends a clear message to employers that<b> trying to escape ACA or other federal group health plan mandates by replacing their traditional insured or group health plans or policies with health reimbursement arrangements (HRAs) or other arrangements under which the employer agrees to provide a fixed defined contribution to be used to buy or reimburses employees for buying individual health insurance generally won’t pass legal muster</b>.  The FAQ also indicates that employers sponsoring HRAs that only reimburse medical expenses, not individual health insurance premiums also need to review their arrangements to verify that those programs also comply with ACA and other applicable rules</a>." <span style="font-family: Arial,Helvetica,sans-serif;">[emphasis added]</span></i></div>
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It  has been prohibited to use Section 125 unreimbursed medical funds to reimburse insurance premiums. Outside those two mechanisms I'm not aware of any way to reimburse individuals for premiums and not run afoul of any other law. The one exception being giving them a raise and taking the tax it. Would love to see Congress pass out $10,000 raises to everyone and how that would go over.</div>
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Gov tries to circumvent ACA in way HHS clearly tells employers not to

How sweet this would be if not for the inevitable consequences: " Under a wrinkle that dates back to enactment of the law, membe...

8:07 AM

The Rate Game

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<a href="http://abagailreidphotography.blogspot.com/" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;" target="_blank"><img border="0" height="275" src="http://img2.mmo.mmo4arab.com/news/2010/08/03/game_rate/game_rate08.jpg" width="400" /></a><span style="font-family: Arial,Helvetica,sans-serif;">Patrick's post yesterday about <a href="http://insureblog.blogspot.com/2013/07/death-of-small-group-insurance-one-chart.html" target="_blank">small group renewal rates</a> seems to have touched a nerve, and I think it's worthwhile spending some time on the whole "<a href="http://insureblog.blogspot.com/2013/07/and-anthem-joins-in.html" target="_blank">early renewal</a>" issue. The premise of early renewal is that some groups may benefit from moving their renewal dates back from (say) early 2014 to late 2013. To that end, carriers have begun offering this service to existing groups.<br /><br />Yesterday, Anthem sent me a list of my eligible groups, along with what they anticipate will happen to those groups' rates once community rating (and all the rest) kicks in.<br /><br />As with Patrick's experience, some of my groups would actually see significant rate reductions come next year, while others would see substantial rate hikes. What became immediately obvious is that the "sicker" (and/or older) the group, the better they will fare come January 1. And, of course, the converse is also true.<br /><br />As a practical matter, then, those sicker/older groups will most likely stay put, since they have nothing to gain from renewing early. But the healthier ones will most likely pull that trigger in an effort to stave off those hefty renewal rates for as long as possible.<br /><br />And I'm just a very small fish in a very large pond. Imagine this scenario playing out across the country, with many (most?) of the sicker groups staying put, and the healthy ones renewing early. The practical - and obvious - result will be that rates for everyone will skyrocket as carriers seek to find a way to balance these competing forces. It's just not a sustainable model.<br /><br />One of our commenters also observed, based on his own experience, that "<i>this leads to healthier groups dropping out, and eventually the unhealthy groups are paying even more than they used to</i>." And since the (Evil) Employer Mandate is currently on hiatus, there's really very little that can be done to stop this from happening.<br /><br />Now, there <b>is</b> one potential reason for those older/sicker groups to take the plunge: Health Savings Accounts (HSAs). That's because, under the ObamaTax, these plans are effectively outlawed (or at least rendered much less effective) after this year. So depending on how important a given group deems its HSA to be, they may well consider keeping it (vs a lower premium) a good trade-off. We shall see.</span></div>
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The Rate Game

Patrick's post yesterday about small group renewal rates seems to have touched a nerve, and I think it's worthwhile spending some...

8:06 AM

Death of Small Group Insurance - One Chart

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January 1, 2014. Community rating, narrower age banding, guaranteed issue, and other fun parts of the law will begin on this date. In preparation, our agency has been meeting with major health insurance carriers on the impact PP<strike>AC</strike>A will have on our employer sponsored plans with less than 50 employees. For my accounts the results have been staggering:</div>
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49 employer groups, 4 with decreases of 20%-30%, 4 with 0-10% increases, 20 employers with 30% or more increases. How will businesses absorb/pass on the cost increases? Drop coverage. With no penalties for not offering why wouldn't they?</div>

Death of Small Group Insurance - One Chart

January 1, 2014. Community rating, narrower age banding, guaranteed issue, and other fun parts of the law will begin on this date. In prep...

8:38 AM

Flawed thinking on ObamaCare, giving it a shot has consequences

Reading the comments to an <a href="http://www.nytimes.com/2013/07/24/us/politics/as-clock-ticks-fierce-turnout-effort-for-health-law.html" target="_blank">article in the NYT</a> on the Obama Admin's implementation of ACA, I came across a very common response:<br />
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<i>"Corkyjon it seem to me that you speculate in the negative; the best  thing that we can do for ourselves is to let  Obama care play itself  out. It's meant to work  by getting all the uninsured to get coverage or  suffer a penalty id they don't, and to offer coverage despite  pre-existing conditions, Sounds good . . . will it do what's expected of  the program ? that's to be seen"</i></blockquote>
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What I never see mentioned or discussed by these individuals is the consequences or aftereffects of giving it a shot. They make it sound like giving it a shot is a free sample.  That is not in anyway accurate. If it doesn't work we are looking at:<br />
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<li>Hundreds of billions (if not trillions) of additional debt.</li>
<li>Individuals being kicked off insurance with no place to go</li>
<li>Employers having exited the market and possibly not willing or able to get back in</li>
<li>Shopping habits and expectations for insurance altered </li>
<li>Carriers having exited the market and possibly never returning</li>
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If this fails we just don't pick up where we left off before. The stimulus was a failure, that doesn't mean we don't have to pay the trillion dollar bill. ACA's failure could easily dwarf that. That is why you don't half-ass complete overhauls of major segments of the economy like this.  <br />
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Flawed thinking on ObamaCare, giving it a shot has consequences

Reading the comments to an article in the NYT on the Obama Admin's implementation of ACA, I came across a very common response: "...

8:38 AM

The ObamaTax Subsidy Cheat

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<span style="font-family: Arial,Helvetica,sans-serif;">As we noted almost 2 years ago, the ObamaTax specifically forbids folks in states with Federally-run Exchanges from receiving any subsidies (and this would include those hybrid State/Fed models, as well). Of course, a little thing like the law is of little consequence to the folks in Capital City, and so the IRS has stated unequivocally that <i>"it determined that Congress intended for subsidies to be available in both state- and federally-run marketplaces</i>," thus greatly expanding the scope (and, of course, the <b>cost</b>) of the subsidies.<br /><br />Now come two House committees (finally) looking into this egregious decision:<br /><br />"<a href="http://freebeacon.com/house-investigating-obamacare-subsidy-expansion/" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">Two House committees sent a letter to Treasury Secretary Jack Lew ... the law explicitly allows the subsidies to only be applied to purchases made on an exchange “established by the state</span></i></a>"<br /><br />As we were saying (seven months ago).<br /><br />Since only 16 of the 58 states would legally be eligible for these subsidies, this represents a pretty significant chunk of ObamaChange. The Sooner State (one of those with a state-run Exchnage) "<i><span style="font-family: Times,"Times New Roman",serif;">is now the plaintiff to a lawsuit arguing that the federal government cannot legally provide subsidies to federally run exchanges</span></i>."<br /><br />Here's wishing them well.<br /><br /><span style="color: red;"><u><b>ADDENDUM</b></u></span>: Meanwhile, Motor City seems intent on further exacerbating the ObamaTax Subsidy budgeting challenge:<br /><br />"<a href="http://www.nytimes.com/2013/07/29/us/detroit-looks-to-health-law-to-ease-costs.html?partner=rss&emc=rss&_r=2&" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">[T]he city is proposing a controversial plan for paring some of the $5.7 billion it owes in retiree health costs: pushing many of those too young to qualify for Medicare out of city-run coverage and into the new insurance markets that will soon be operating under the Obama health care law</span></i></a>."<br /><br />Yup, hundreds (thousands?) more unemployed folks hitting the Exchanges. And remember, thanks to the now-delayed roll-out of the Data Hub verification system, most if these folks will be climbing on board the subsidy gravy train.<br /><br />Your tax dollars hard at <strike>retirement</strike> work.</span></div>

The ObamaTax Subsidy Cheat

As we noted almost 2 years ago, the ObamaTax specifically forbids folks in states with Federally-run Exchanges from receiving any subsidies...

8:38 AM

Obamacare - Help Wanted

<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Need a job?    </span><br />
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Need a job with benefits?</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Keep looking.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgANi-Z-UyoshAXaqvDKOYp7NY5HMIflb2XZzn4oHCVot93hion_RUfJWixfOpTnhcQkfjInrBWiej8dj8Y_niXW1dR9J_NiUrpPfxJIZZLnkHEo82bxiHTVCzVxFM7hyphenhyphentxvHcRDX-xx1o/s320/Obamacare+screwed.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="237" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgANi-Z-UyoshAXaqvDKOYp7NY5HMIflb2XZzn4oHCVot93hion_RUfJWixfOpTnhcQkfjInrBWiej8dj8Y_niXW1dR9J_NiUrpPfxJIZZLnkHEo82bxiHTVCzVxFM7hyphenhyphentxvHcRDX-xx1o/s320/Obamacare+screwed.jpg" width="320" /></a><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In order to ensure Americans understand how to access the benefits available to them when many provisions of the Affordable Care Act go online October 1, the Obama administration <a href="http://www.nytimes.com/2013/06/25/health/us-unveils-health-care-web-site-and-call-center.html" style="color: #333333;">announced last month</a> that it is setting up a call center that will be accessible to Americans 24 hours a day. </span></i></blockquote>
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<i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">One branch of that call center will be located in California’s Contra Costa County, where, <a href="http://www.contracostatimes.com/rss/ci_23733819" style="color: #333333;">reportedly</a>, 7,000 people applied for the 204 jobs. According to the Contra Costa Times, however, “about <b>half the jobs are part-time, with no health benefits</b> — a stinging disappointment to workers and local politicians who believed the positions would be full-time.”</span></i></blockquote>
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<b><a href="http://www.nationalreview.com/corner/354556/obamacare-call-center-will-not-offer-healthcare-benefits-employees-eliana-johnson" target="_blank"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">National Review</span></a></b></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">That's gonna leave a mark.</span></div>
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Obamacare - Help Wanted

Need a job? Need a job with benefits? Keep looking. In order to ensure Americans understand how to access the benefits available ...

8:37 AM

Promoting the ObamaTax

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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgukY3PKDcNyhas4eaAo9ZYOVyj3r4JOBfoXISWDuCWTDfCeMQJGIN0b209UPKxPEtdg3fNZfRSjr6CERn7EOm2Ir_BiiwJWEeObxvZoITJNOPysZE24LaOoQdsIwo90xhRPhXqzf-i0oA/s200/X1.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgukY3PKDcNyhas4eaAo9ZYOVyj3r4JOBfoXISWDuCWTDfCeMQJGIN0b209UPKxPEtdg3fNZfRSjr6CERn7EOm2Ir_BiiwJWEeObxvZoITJNOPysZE24LaOoQdsIwo90xhRPhXqzf-i0oA/s200/X1.png" width="400" /></a></div>
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<span style="font-family: Arial,Helvetica,sans-serif;">We've been wondering for a while now, why - if the ObamaTax is such a grand bargain - is it necessary to advertise it so heavily, and to enlist everyone from Sheriff Andy to Michael Jordan to shout its praises from the rooftop. Not only have we received no answer, but Ms Shecantbeserious and her minions insist on doubling - nay, <i>tripling</i> - down.<br /><br /><u>Item the first:</u> A gorgeous, impeccably designed <a href="http://www.breitbart.com/Big-Government/2013/07/24/Dems-Offer-Free-I-HEART-ObamaCare-Bumper-Stickers" target="_blank">ObamaTax bumper sticker</a> (to compliment the Co-Exist one on your Prius). We've provided our take on this work of art above.<br /><br /><u>Item the Second:</u> In keeping with the whole "community organizing" spirit of the Obamastration, Ms Kathy has enlisted folks like <a href="http://news.yahoo.com/obamacares-foot-soldiers-train-enroll-masses-110615788.html" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">"Nahla Kayali ... among the first wave of 2,000 community organizers in California getting trained to persuade more than 1 million uninsured people in the state to sign up for [the train wreck]</span></i></a>." Since the success of the whole risky scheme seems to rest on the shoulders of young people (whose lower expected utilization is deemed essential in offsetting the costs of older folks), this seems a no-brainer [<i>ed: I see what you did there</i>].<br /><br /><u>Item the Third:</u> One of the biggest challenges to those first two may be this little tidbit:<br /><br />"<a href="http://washingtonexaminer.com/irs-employee-union-we-dont-want-obamacare/article/2533520?custom_click=rss" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">IRS employees have a prominent role in Obamacare, but their union wants no part of the law.</span></i></a>"<br /><br />Ooops.<br /><br />Turns out, even the folks tasked with enforcing the (Evil) Mandates aren't keen on participating. And who can blame them? After all, they're used to getting gold-plated (and low-to-them-cost) coverage through the Federal Employees Health Benefits Program. Wouldn't want to lose that, now, would we?</span></div>