insurance

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...