insurance issues,Principles & Solutions and tips *trik tax: July 2017

Monday 31 July 2017

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Last month, we reported on the increasing number of counties across the fruited plain that will have no carriers from which to buy insurance.

Now comes news, via FoIB Ʀєfùsєηíκ, that folks here in the Buckeye State may be getting a slight reprieve:

"Ohio Department of Insurance Director Jillian Froment today joined five major Ohio health care insurers to announce that health insurance options have been restored on the federal exchange in 19 Ohio counties following the withdrawal of other insurers earlier this year."

The carriers include Buckeye Health Plan, CareSource, Medical Mutual of Ohio, Molina Health Care of Ohio and Paramount Health Care, which is great news for folks in those counties, for certain values of "great." As co-blogger Patrick reminds us:

"Molina's nearest physician in Findlay, OH (Hancock County) is 22 miles away. Closest hospital 23 miles away. Great 'option'."

And a reminder, as well, that these plans are available only on the Exchange, which is nice if one is eligible for a subsidy, not so much if not.

So, one step forward....

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For those folks still on the fence about whether or not ObamaCare has always been about getting to government-run health "care", well:

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Friday 28 July 2017

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BREAKING: Charlie Gard, UK baby at the center of dispute over hospital treatment, has died - Daily Mail http://pic.twitter.com/rgxAkFMyre
— Reuters Top News (@Reuters) July 28, 2017

Dayan HaEmet; may his memory be for a blessing.

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Courtesy of FoIOB Scott M:

[click to embiggen]

"Opting out" ≠ "Losing"

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Thursday 27 July 2017

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Well, it was only a matter of time. After all, we noted exactly 3 months ago that:

"NHS bosses are planning a massive expansion of the controversial rationing that forces smokers and obese patients to wait months in pain before they can have surgery"

That's how government-run health "care" works, after all: limited resources controlled by unaccountable bureaucrats. And if the threat of such rationing isn't enough, well:

"NHS units impose surgery ban on obese and smokers ... including an end to the routine funding of hip and knee operations for patients with osteoarthritis"

Sorry (not sorry), grandma!

It gets squirrely from there, though:

"In one area of England obese patients must wait two years for hip and knee replacements while another area plans to deny surgery for smokers, including heart and brain operations."

Might pay to move, no?

But again, this is what happens when you put the DMV (or IRS) in charge of health care.

Worth noting, again, that this is the explicit end-goal of ObamaCare.

Sleep tight.

[Hat Tip: @Ʀєfùsєηíκ‏]

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Not sure how this stayed under my radar, but thanks to FoIB Bill M we learn that the estimable Cleveland Clinic is about to jump into the individual medical insurance pool. And they're partnering with New York-based Oscar Health to do it:

"The venture, called Cleveland Clinic | Oscar Health ... will be available on the public exchange, off the exchange or directly through Oscar."

The catch?

They'll only be available in 5 counties in northwest Ohio.

Which, perhaps not so coincidentally, is also the home base of Medical Mutual.

Interesting. Particularly because of this:

"The Cleveland Clinic network now only is available on the exchange through a broad network offering provided by Medical Mutual of Ohio"

Hunh.

To be sure, Oscar's had its own issues:

"[F]or every dollar of premium Oscar collects in New York, the company is losing 15 cents. It lost $92 million in the state last year and another $39 million in the first three months of 2016"

As their CEO noted at the time, this is not "a sustainable position.”

Anyway, the product itself will apparently rely pretty heavily on the telehealth model, which seems like one area that carriers are starting to really embrace as an effective cost-containment strategy.

No word yet on whether or not they'll have any kind of marketing agreement with insurance agents (but smart money is on "no").

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Wednesday 26 July 2017

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Heh:

[Hat Tip: FoIB Scott]

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Tuesday 25 July 2017

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■ FoIB Avik Roy makes a point about the ~~Emperor's New Clothes~~ CBO scoring fiasco:

"73% Of Coverage Difference Between Obamacare & GOP Bills Driven By Individual Mandate"

Okay, but what does that mean? It's actually pretty simple: not forcing folks to buy something doesn't mean they won't, anyway. And it certainly doesn't "strip" anyone of coverage, either (another popular meme).

Sheesh.

■ A few years ago, we blogged on the sad case of insurance agent Glenn Neasham, who ran afoul - quite by accident, it seems - of California insurance regulators and was sentenced to jail for selling an elderly woman an (as in one) annuity.

It appears that Mr Neasham was merely a piker:

"Prosecutors in California have accused Shawn Heffernan, a retirement planner and insurance agent, of persuading five older clients to surrender annuities and replace the contracts with new annuities"

To the tune of nearly half a million dollars, of which just shy of $300,000 (allegedly) went into Mr Heffernan's pockets.

Yikes.

■ Finally, our good friend Bob Graboyes dares to tell the ugly truth about all those nifty preventive care initiatives:

"[P]reventive measures generally increase rather than decrease costs."

Ooops.

Which is not to say that we should stop encouraging their use, just that we need to back off on the cost-savings-panacea talk: "we shouldn’t spend time dreaming up ways to spend the savings that will result" (because we're going to be very disappointed).

Reminds me of something...

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For many years, Willard Scott would announce each morning those lucky folks who'd hit the 100 year marker in life. They likely didn't know, however, the impact that reaching such a milestone would have on any "permanent" life insurance they owned.

Wait just a minute there, Henry: what's with the "scare quotes?"

Glad you asked.

Recently, co-blogger Bob V tipped me to this article by insurance industry heavyweight Joseph Belth:

"For decades, life insurance carriers ... sold permanent universal life insurance policies, marketed as "insurance for life," utilizing outdated mortality tables that did not take into account the fact that Americans were, and are, increasingly living to and past the age of 100."

In his book "My Life in Court," the late, great litigator Louis Nizer wrote of a case where a young man was killed when the train he riding on his daily commute crashed and he was killed. The court originally based his lost and future wages on an older mortality table which showed generated a relatively modest settlement; Mr Nizer was able to show that this was a grave injustice due to more recent tables, and won a more substantial settlement for the young widow.

Now, what does a 1950's-era train wreck have to do with a centenarian's life insurance policy?

Well, it turns out that the life insurance industry seems to have been playing fast and loose with that word "permanent." The case at hand concerns a Universal Life policy, but this issue would appear to affect Whole and Variable Life plans, as well.

The problem is that when plans "mature" (end) at age 100, they aren't permanent:

"The life insurance industry has left its customers (who faithfully paid their premiums with the expectation that they would have coverage for the remainder of their lives) uninsured."

And it gets better:

"These terminations have exposed customers to adverse tax consequences that are in direct contradiction to the guarantees made when these policies were purchased."

One of the great benefits of cash value life insurance (another industry term of art, perhaps much more useful in this discussion) is that the equity in the policy grows with no taxes due if the policy is paid out as death benefit. Insureds that do cash in their policies early may have a tax liability if the amount they receive is greater than the premiums paid in. But what if you've paid your premiums in the expectation that the plan would pay out whenever it was that you shuffled off this mortal coil, only to learn that, upon reaching that wonderful milestone you'd be uninsured and, adding insult to injury, owe a potentially astronomical tax bill?

Now, some (many?) carriers have addressed this by issuing policies that go to age 120 (or 121). But that's only good for folks who've bought plans from these carriers in recent years. The vast majority of folks, I daresay, don't fall into this category.

And frankly, I'm a bit nonplussed that this issue has been so long under the radar. Why's that you ask?

Well:

"The United States currently has the greatest number of known centenarians of any nation with 53,364 according to the 2010 Census"

Of course, not all of them own life insurance, but even a small percentage means thousands, perhaps tens of thousands do.

What then?

Mr Belth proposes a class action lawsuit. My own understanding of these is that they generally benefit the lawyers that file them much more than the plaintiffs themselves. Still, if that's the clue-by-four my industry needs to address this, well...

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Monday 24 July 2017

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Courtesy FoIB Bill M:

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No, not that RC; RC as in Risk Corridor. Regular readers may recall that these were payments promised to insurers to help mitigate the extraordinary claims wrought by ObamaPlans, and which were woefully underfunded.

Back in 2015, HealthyCT (that state's now-defunct Co-Op) received "more than $128 million and covered only 6,094 people – more than $21,000 per enrollee." And that still wasn't enough: they went under last summer.

But in a surprising (well, to me) development, Juris Capital (a "litigation funding firm ") is offering to infuse over $10 million "to the estate of HealthyCT." First, I've never heard the term "estate of" used in the context of a health insurer, but it really does work, no?

And second, why they're throwing money down that particular hole is pretty interesting, as well: the failed insurer is still due over $30 million in RC funds; if those actually come through, well, nice payday for Juris Capital (of course, that's a big "if").

And they're at the mercy of two different government entities: Constitution State insurance regulators who are suing the Feds. Not an appealing notion, but best of luck to Juris Cap.

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Steve Anderson hosts this month's eclectic collection of health care wonkery. From teamwork to Siri to ransomware, it's all interesting.

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Friday 21 July 2017

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So, got this in email today from Sally and Dave:

"Due to the cost per month now with [carrier], we are looking at one of the medical cost sharing programs. If we finalize this, when do I need to notify [carrier]? Our renewal date is August 1. Thank you."

I replied:

"Don’t blame you. I actually know someone who’s in one of these and is pretty happy with it. He lives in another state, but presume is similar. Would you like me to connect you?

Also, whenever you do pull that trigger, just have to notify [carrier] to cancel. I can help with that when the time comes. It’s not a big deal."

Sally responded:

"Thanks for the info. Just wanted to make sure I didn't miss anything. I will call them. I am close to finalizing with Medishare, so I don't think I need more info, but I appreciate the offer! Thank you so much!"

I thanked her and Dave for their years as clients, and my hope that they'll keep me in mind for future insurance purchases.

So, what's the lesson here? Well, this family has, as a direct result of ObamaCare, lost there coverage It was a plan that fit their needs at (for a while) an acceptable cost. But now, they can no longer afford it, and a new ObamaPlan would cost even more, with even higher out-of-pocket exposure.

Of course, they'd still get "free" ~~birth control~~ convenience items and maternity coverage, something no late-50's couple should be without.

Sad, really.

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Thursday 20 July 2017

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■ First up, FoIB Dana Beezley-Smith has a really powerful post on her blog about the actual, real-world impact that ObamaCare has had on the individual insurance market. While various pundits and pols criticize (often justifiably) on the Republican's latest attempts, they seem to have missed the ACA's "trajectory of higher premiums and costs” and “fewer, if any, coverage choices.”

Read the whole thing.

■ Co-Blogger Bob V has the latest from the annals of the Much Vaunted National Health System©, where a "nurse has revealed she was charged £80 for parking, on top of parking fees already docked from her wages," all because she overstayed her shift to provide actual, you know, care to a cardiac patient.

But hey, gotta pay for that "free care" somehow.

■ And today's new word comes from FoIB Holly R: "Buurtzorg," Dutch for "neighborhood care." And it's not just a fun tongue-twister, it "allows nurses to act as a ‘health coach’ for their patients, advising them on how to stay healthy, caring for their needs and using their initiative."

And the results are impressive, allowing the Dutch "healthcare system to reduce costs by around 40%, while the time it takes to administer care has been slashed by a staggering 50%."

Maybe worth a look here?

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Wednesday 19 July 2017

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Tuesday 18 July 2017

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Courtesy of co-blogger Bob V, "2018 Projected Health Insurance Exchange Coverage Maps." Here's the latest:

[click to embiggen]

As Bob notes, would suck to be in Nevada.

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Monday 17 July 2017

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For those unfamiliar with the term, a Tweetstorm is a series of short messages posted in a string (a function of the Twittter's 140 character per message limit). These are often annoying, but two recent 'storms' are really great reads. Both are from Friends of InsureBlog, and both have important insights into the health insurance/health care debate.

The first is from Dave W, posting at Ace of Spades blog (mild language warning). A sample:

The other is from Cato's Michael Cannon. And a sample of his 'storm:'

Good stuff, all.

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Courtesy ForAmerica:

[click to embiggen]

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Friday 14 July 2017

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Enough of the BS already. Obamacare can't and won't be repealed without 60 votes in the Senate. Any Republican alternative claiming to replace Obamacare that takes away money from states won't pass either. Instead of trying to do the same thing over and over while expecting a different result why not simply implement what President Obama signed back on March 23, 2010?

Members of Congress - on both sides of the aisle - have two objectives, protect themselves and find a way to get reelected. Full implementation will put both of these objectives at risk.

Want to know the perfect place to start? Eliminate Congress' illegal status as a "small business" and force all 12,000+ members, staffers, and their dependents to purchase insurance legally as the law was written. Anything less would be uncivilized.

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"US doctor will travel to UK to assess ill infant"

That's the good news. The not-so-great news is that he isn't scheduled top head there until next week, so who knows if Charlie will still even be alive then.

Still, small miracles...

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Wednesday 12 July 2017

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We've been writing about who owns our medical data for a long time. For example:

"Hugo Campos has [an ICD] buried in his chest to help keep him alive. But he has no idea what it says about his faulty heart ... what if Mr Campos wants to see that data for himself?"

An interesting question, no?

Here's another: what if that information was relevant to a crime?

Think that's far-fetched?

Well, thanks to FoIB Holly R, we have the case of Ross Compton:

"A judge says data from the pacemaker of a man accused of setting his Ohio house on fire in 2016 can be presented as evidence at his trial."

His attorney had argued that use of the data "violated Compton's constitutional rights."

Maybe, but the judge didn't agree, saying that "the individual data is no more private than other things."

What "other things" isn't clear, but the message certainly is.

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Tuesday 11 July 2017

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■ First up, courtesy of FoIB Holly R:

Just released USA Today poll on Obamacare:
11% keep it
42% fix it with major changes
44% repeal
— Ben Ferguson (@benfergusonshow) July 10, 2017

■ Next, our friend Allison B at ThinkAdvisor piles on:

"Individual Health Enrollment Falls 11% ... Plan withdrawals and rising premiums led to a sharp drop in individual and family major medical plan use in the first quarter" of the year.

But hey, if you like your plan....

■ And finally, FoIB Ʀєfùsєηíκ tips us that "The number of U.S. adults without health insurance has grown by some 2 million this year."

Which seems unpossible, since the entire point of ObamaCare was to eradicate this plague.

Hunh.

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As we've previously noted, the qualification process for triggering a Special Open Enrollment have gotten tougher as carriers have been hot with ever higher claims:

"Perhaps the most egregious is the fact that no one in government seems to care about the massive fraud being perpetrated right under their noses during this time."

Our friends at Medical Mutual emailed us a slideshow of the new, tougher Special Open Enrollment process, available here.

One that immediately jumped out was this:

"Beginning in Summer 2017, new applicants ... who attest to certain types of SEP qualifying events will be subject to the SEPV process of pre-enrollment verification. Eligible consumers must submit documents that confirm their SEP eligibility before they can enroll and start using their Marketplace coverage."

Quite different than before, where one was given a certain period of time after enrolling in (and, perhaps, using) a new plan. Under the new system, no policy is issued until the verification paperwork is submitted and approved.

Which would seem to be a challenge for carriers, but fret not:

"When submitting business ON Exchange please submit verification documents directly to the exchange. Medical Mutual cannot process/accept anything that is submitted directly to us."

Can't say as I blame them.

NB: I reached out to our rep wbho confirmed that MMO would continue to process this info for off-HIX plans.

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Monday 10 July 2017

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A few years ago, we reported on a "widow" who tried to collect on her husband's life insurance policy. The challenge? He wasn't dead, and the woman was charged with fraud.

But at least the perp had her paperwork in order.

Not so with this rocket surgeon wannabe:

"A newlywed accused of soliciting her firefighter husband's killing to collect $100,000 in insurance money has been convicted of aggravated murder in a scheme that was flawed from the start: His ex-wife was still the beneficiary of his policy."

Ooops.

Oh, and it gets better (for certain values of "better"): she'd recruited her teenaged daughter and her boyfriend to do find a someone to actually do the deed.

But wait, there's more:

The boyfriend thought it'd be a good idea to "keep it in the family," and reached out to his cousin to pull the trigger. Be sure to click on over for even more twists.

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Friday 7 July 2017

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Via RedState:

"In an abrupt shift, a London hospital said on Friday that it would reconsider its decision to turn off life support for Charlie Gard, a brain-damaged and terminally ill British infant, in light of “fresh evidence” about a potential treatment."

More as (if?) this develops.

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Interesting query from a reader:

"My sister went to the doctor because of some symptoms she's been having (memory loss, moodiness and headaches). She's a cyclist, and used to race competitively, and suffered concussions in the past. The doctor thinks she could possibly have CTE. She hasn't done any testing because from what she knows there's no treatment for it.

She does have health insurance through her spouse's employer, but wants to know if she gets this testing and it's in her records that she has CTE could that hurt her in the future for insurance purposes? Like if she has to switch insurance companies etc.

I know right now it wouldn't matter because of ACA. But what if things change if/when they repeal it? The way I always understood pre-existing conditions before ACA was that you could not have a gap in coverage. So if you have insurance and you're diagnosed with a condition you are covered. If you switch insurance and there is no gap in coverage it can't be considered a pre-existing condition. But if you do have a gap in coverage it could fall under pre-existing conditions. Is that how it worked before? Who knows how insurance is going to change in the future. She's just trying to figure out if she should just not do it and wait and see."

First, Thank You for a really outstanding, well thought out query. There's a lot to unpack, so I'll try to be as thorough as possible.

Here's the thing: we really don't know what's going to happen (or when, or even if) ACA-wise. If we go back to something that looks like pre-ACA, then yes, this is a legitimate concern. But the cat's already out of that bag:

"went to the doctor because of some symptoms she's been having"

Assuming new applications look like pre-ACA, then she's going to have to answer yes to at least one of the questions ("have you consulted a physician"). It may not be explicitly CTE, but it's likely going to be an issue, although I have no idea how much of one. But: this presumes a new app. Again, assuming something that looks like 2009, as long as she keeps continuous coverage group-to-group (or COBRA), no problem. However: that only really worked individual-to-group, or group-to-group, not group-to-individual (or individual-to-individual).

From what I've read, CTE is kinda like Alzheimer's in that it's only truly diagnosable at autopsy. While alive we're only able to infer its presence. So test or not? I don't know, but I would suggest taking the insurance element out of the equation, and look only at pro's/con's of "knowing."

Hope this helps, and best of luck to your sister-in-law and her family.

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Thursday 6 July 2017

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■ Our friends at Cornerstone have an update and explanation of the Social Security Number removal initiative (SSNRI), part of 2015's "“Medicare Access and CHIP Reauthorization” (MACRA).

The bottom line is that CMS will begin issuing new kinds of ID for Medicare beneficiaries, in an effort to hold down identity theft.

Also known as: major headache for providers.

■ As co-blogger Patrick reported this past Spring, the Small Business Health Options Program (SHOP) has been a resounding .... flop:

"Turns out SHOP enrollment is extremely cumbersome, there are less plan options compared to the off exchange market, and that tax credit, well it hasn't been worthwhile for most employers"

Ooops.

Well, the folks at Medical Mutual just emailed us to say "adios,muchachos:"

"Beginning January 1, 2018, Medical Mutual will no longer offer plans through the Small Business Health Options Program (SHOP) marketplace. Coverage will terminate for affected groups on their renewal date."

But hey, if you like your group health plan...

■ From the "You Don't See This Every Day" Department:

"Zurich American Life Insurance Company is offering to buy back some of its annuity contracts ... it is making the offer partly because it believes some annuity holders' needs may have changed over time, and partly because it wants to exit this segment of the variable annuity business"

To sweeten the deal, they're offering an "enhancement amount."

Hunh.

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Our friend Jeff M sent along the link to this sad story:

"Owners and renters in North Carolina say they were left in the dark after a beach condominium community suddenly shut down. The condos were condemned Friday, after an engineering report found that the property has dangerous structural issues."

It's not clear whether the owners will be allowed to retrieve their personal property.

Okay Henry, that is a sad story, but what's the insurance angle?

Well, Jeff asked if the owners' condo policies would cover this situation. As usual in these cases, I turned to our good friend (and P&C guru) Bill M. Now keep in mind that his answers are specific to Ohio, but that it's likely that they'd also apply in other states.

Basically, the owners are out of luck.

Now, why is that?

Well, Bill taught me a new phrase, and suggested I use it whenever I'm looking at these kinds of (potential) claims: "cause of loss." That is, which circumstances are specifically covered, and which are specifically excluded.

So here's the relevant exclusion:

(4) (a) wear and tear, marring, scratching or deterioration; (emphasis added)

So the "cause of loss" is specifically excluded. Which is a double whammy: the owner now has no place to live, but the bank still wants their mortgage paid off, and there's not going to be a check from the insurance company to pay off the old place, or pay for a new one.

But what about their personal property (clothes, appliances, furniture, etc)? Well, they're likely outta luck there, too:

(1) Enforcement of any ordinance or law regulating the construction, repair or demolition of a building or other structure, unless specifically provided under this policy

The "cause of loss" here would be the government forbidding the owners to retrieve their belongings. So again, no insurance to pay for replacing them.

Yikes.

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Wednesday 5 July 2017

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Over at The Apothecary, Chris Conover makes a solid case that the ACA's Medicaid expansion doesn't actually save lives.

Now, we already know that the ACA itself has a body count:

"Mortality Rates ... equivalent to an excess 11,000 annual U.S. adult deaths relative to the pre-Obamacare steady state trends"

But Chris goes even further into the mess; he demonstrates that "the weight of the scientific evidence is that Medicaid expansion has not saved lives." Granted, that's not quite the same thing, but it certainly puts paid to the claim that folks are better off under Medicaid. He does this by looking at how many folks will likely lose coverage under the AHCA/BCRA (and what kind), and then unpacks the actual numbers which the Center for American Progress appears to have, well, misrepresented.

I really suggest reading the whole thing, but this piece is too good not to post:

"[UC San Diego’s Richard Kronick] found no statistically significant difference in the mortality risks faced by people who were uninsured compared to those with private coverage:"

[click to embiggen]

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We've discussed buy-sell agreements before (here, for example. And here), but recently Illinois Mutual posted a really helpful video explaining how they work, and why they're so important:

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Tuesday 4 July 2017

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Monday 3 July 2017

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The 56 men who signed the Declaration of Independence are just names to most of us. I dare say few could name any of the signers other than John Hancock.

Today those men who risked their fortune and lives to sign that Declaration are remembered not for what they did, but who they were.

Many were slave owners. Most were wealthy, part of what would today be considered the 1%. In spite of their station in life they would today be scorned.

Take a few moments to watch the video history lesson. It will give you a new perspective on the names that have been forgotten.

Good day.

#DeclarationOfIndependence #PaulHarvey

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Sitting around on a holiday weekend with nothing better to do than ask, "What are some of the largest insurance claims paid?".

Seems Google has an answer to that.

The Kentucky man threw his boomerang and ended up raking in $300,000 from himself. Larry Rutman caused bodily harm and damage through negligence and carelessness (to himself). Rutman even stated that it was for an event like this that he had been paying in so much. What goes around comes around? He said: “I paid all that insurance for a long time just in case something unforeseen like this ever happened.” The bodily harm and damage resulted in Rutman’s memory being affected and he being ‘oversexed’. Whatever will they come up with next? - Zero Hedge

Sounds like a possible Darwin candidate in the making.

But wait, there's more.

Engineers totaled two Bugatti Veyron's worth $800,000 each.

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