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As we head into the home stretch:

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Total plan selections are down from last week, which makes sense: at this point it's primarily fence-sitters finally taking the plunge. Ditto on new consumers, down by about 25%.

Will be interesting to see how this week, the final one of Open Season Enrollment '19, shapes up.

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Shot:

Rationing—in the form of waiting lists—has left hundreds or even thousands of Canadians to die without surgeries, the Vancouver Sun reports. #canada #healthcare https://t.co/p5gHucPziZ

— Texas Public Policy Foundation (@TPPF) December 5, 2019

Chaser:

“In the U.S., we already have a single-payer health care system, called the Veterans Administration Hospital system. A 2015 internal audit of the VA reported, ‘307,000 veterans may have died waiting for care.’” @DavidBalatHC @RightOnHC https://t.co/iZ80TcyO16

— Texas Public Policy Foundation (@TPPF) December 5, 2019

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Probably not, but still very promising:

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Sometimes Open Enrollment can be interesting. Case in point: Pastor Jerry.

Pastor Jerry is the newly hired clergyman for a local church, with a nice compensation package made up of three parts: a salary, a housing allowance, and a reimbursement arrangement for medical insurance. The salary and housing allowance are fixed, known costs, while the health insurance budget is "up to $2,000 a month." And therein lies the rub:

Based on his salary/housing allowance, his family qualifies for about $800 in tax credits (aka "subsidy"). Nice, but not the end of the story. The problem is that if his employer reimburses him for the premium and/or out-of-pocket expenses that increases his annual income and screws up the subsidy calculation. It's kind of chasing its own tail. I spent quite a bit of time in separate phone calls with the nice folks at 404Care.gov; the best advice (well, the easiest advice) was to just forgo the subsidy and avoid the whole mess.

There's a lot to be said for this: indeed, the KISS Principle holds much sway. But I really hate to leave (government) money "on the table," and wracked my brain trying to come up with a better way.

Lying in bed the other evening, it hit me: when choosing how much of one's subsidy to use, folks almost always pull the trigger for the full amount (which makes sense: results in lowest premium). But one can, in fact, choose to use $0 upfront, and just claim it the following April. This was a true epiphany: it means there's no real downside, nor is there any possibility of "clawback." Indeed, the worst case scenario is that he gets very little money back, but it's still better than having to cough it up in the following year's taxes.

Pretty nifty.

Oh, we also discussed precisely how to handle that out-of-pocket reimbursement, and decided on an HSA over an HRA. They'll be working with our friends at FlexBank on this.

Exit question:  given the facts above, what potential issue do you see regarding the employer's reimbursement versus the delayed tax credit?

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Co-blogger Bob V tipped us to this important, all too common story:

"My husband is my caregiver, and spending $45 a month on his life insurance means I won't be alone if he dies."

Rebecca Chamaa was diagnosed with paranoid schizophrenia, and relies on her husband as her primary caregiver and advocate. If he were to die, she would need to be able to afford a full-time nurse (or equivalent), which can get pretty spendy. Hence, the importance of life insurance:

"Like many people, my husband had a small life insurance policy at work, but that policy wouldn't cover our mortgage or provide enough cash for me to stay in our home, pay for funeral expenses, and arrange for someone to help me with household tasks, or at a minimum some caregiving activities."

Very moving, very timely.

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And we do mean waiting:

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Thanks to our friends at the Association of American Physicians and Hospitals, we learn that north of four-and-a-half million Brits are on waiting lists. For those keeping score, that totals out to almost "7 percent of the entire British population."

Talk about a 7 percent solution...

And it's not just in hospitals:

Girl, 12, dies after waiting for an hour for an ambulance@JoeSilverman7 https://t.co/FfH2fUTkGx @MailOnline

— Christopher Gaska (@ChristopherTodd) November 23, 2019

#Medicaid4All

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According to email from the Feds, "in week four of the 2020 Open Enrollment period, 703,556 people selected plans using the HealthCare.gov platform."

Of course, this just means that folks have added plans to their carts, the real numbers will be when (if?) they actually pull the trigger and send in a check.

In any case, here's last week's snapshot:

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Total plan selections are down about 7% from Week 2 (we missed last week dues to Thanksgiving travel). New consumers are down, as well, as are renewals.

This makes sense, however: we're already a month into the process, and (presumably) most of the folks who are going to make a choice have already done so. I do expect a slight uptick the final week as procrastinators make their choice.

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