Monthly Archives: November 2013

How Does This Work?

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The CMS has a Request for Proposal out [emphasis added]:

Solicitation Number: RFP-CMS-RMADA-2014
Notice Type: Modification/Amendment
Synopsis: Added: Nov 20, 2013 1:17 pm

The purpose is to develop a Research, Measurement, Assessment, Design, and Analysis (RMADA) IDIQ [Indefinite Delivery, Indefinite Quantity contracting/procurement type] to respond to expanded needs of the Patient Protection and Affordable Care ACT (ACA) and Health Care reform ACT (HCERA).  The work awarded under the RMADA will involve the design, implementation and evaluation of a broad range of research and/or payment and service delivery models to test their potential for reducing expenditures for Medicare, Medicaid, CHIP, and uninsured beneficiaries while maintaining or improving quality of care.

Section C of this RFP has this expansion [emphasis added]:

…the [CMS] will award task orders (TOs) for a wide range of analytic support and technical assistance activities that support models and demonstration programs created or derived under the auspices of the Patient Protection & Affordable Care Act (ACA), and future health reform legislation where new delivery and payment reform models are enacted.  The demands of new reforms created under ACA have redefined the way CMS approaches and conducts research activities and demonstrations affecting Medicare, Medicaid, CHIP, and uninsured populations.  The role of state and private sector payers is also redefined as many of the new models include multiple payers working in collaboration with CMS to reform the care delivery system.  The RMADA will provide CMS with a robust tool to meet those challenges.  Some of the major activities this umbrella contract will address include the following: designing, maintaining and refining model/demonstration design and operations; monitoring model site implementations; designing and carrying out surveys and other data collection activities; obtaining and analyzing secondary data sources including Medicare, Medicaid and Children’s Health Insurance Program (CHIP), and private payer sources that support model design and evaluations.  Some other evaluation activities envisioned under the RMADA include reporting on formative and summative analyses, providing rapid cycle quarterly evaluation feedback to all model participants and CMS, and the creation of summative annual and final program findings.

Aside from only just figuring out that “The demands of new reforms created under ACA have redefined the way CMS approaches and conducts research activities and demonstrations affecting Medicare, Medicaid, CHIP, and uninsured populations” and “The role of state and private sector payers is also redefined…,” they’ve also just discovered HHS, or its CMS ObamaMart Project “Integrator,” hadn’t thought about doing these things from the jump.

As a result, now they want to spend an additional $7 billion of our money on their failure.  Probably, it’s too much to hope for any of these billions being committed to saving pennies will be committed to reducing the costs of all that added reporting and paperwork.  Or even that the entire $7 billion could be saved (and sent over to Treasury to reduce our national debt) with withdrawing this foolish RFP.

Obamacare: Year Two

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President Barack Obama, through his HHS Secretary Kathleen Sebelius, has decided to delay the open enrollment period for the second year of his Obamacare by a month.  Obama has said, through his Press Secretary Jay Carney, that the delay will give insurance companies more time to evaluate the results of this year’s enrollments and so to adjust their premiums for that second year.

A carefully anonymous “HHS spokesman” also claims

This change is good news for consumers, who will have more time to learn about plans before enrolling and an open enrollment period that’s a week longer[.]

Both of these claims, of course, are nonsense.  Manhattan Institute Fellow Yevgeniy Feyman pointed out Friday

You are delaying open enrollment [in 2014] for one month.  Premiums are submitted in April, so whether you have open enrollment on Oct 1 or Nov 1, those premiums are already set in stone.  People will just be enrolling a month later.

What else is happening then?  Let’s see….  Oh, yeah—mid-term elections, which has become a referendum on Obamacare as the program has its effects on Americans.  The delay puts enrollment, which would have begun in mid-October, some three weeks prior to the mid-terms, into mid-November—after those elections.

With the premiums already determined—some months prior—Obama’s plain hope here is that the American voter will remain ignorant of the costs of the policies they’re stuck with buying or stuck with renewing and that they will have forgotten the costs already inflicted over the current year from the  cancelations of policies that Americans wanted and the policies’ replacement with poorer policies that have higher premiums, higher deductibles, and “coverage” for things that aren’t wanted or needed.

This is Progressives’ politics at their ugliest.  Yes, even worse than Senate Majority Leader Harry Reid’s (D, NV) pernicious destruction of the Senate filibuster.

America’s Health Insurance Plans

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AHIP is “the national trade association representing the health insurance industry” according to their Web site.  As a leader in the health insurance industry I thought they might be able to shed some light on the widely posited difficulties of implementing President Barack Obama’s latest Obamacare “fix” of “encouraging” health insurance companies to stop canceling non-Obamacare compliant policies, as the law requires, and reinstate already canceled policies.  Accordingly, last week I sent an email to AHIP asking a couple of simple questions:

Gentlemen:
I’m a conservative blogger at APlebesSite.com; you can poke around the blog and see that while I’m unabashedly conservative, I try to write from facts and logic rather than simply from polemics.
To that end, I’d like to write an article on the logistics of reviving cancelled health insurance policies, and so I’d like to ask you some questions (and probably engage in some back and forth as new questions arise, so as to be sure I write accurately).
My questions center on two premises: first, the relevant state commissions already have approved the plans you wish to revive, and so they should not be a problem.  Obviously, they’re not always going to be cooperative (vis., Washington), and you have no control over that.  For this purpose, I’d like to assume the commissions are not a problem.  I’ll make clear in my article that I’m eliding state insurance commission matters.
The second premise is that you already have these policies built and archived–at the least you’d need copies of what you sold in case of later litigation, so that you’d not have to rely on plaintiffs’ versions.  Thus, there would seem to be no problem recreating the policies for further sale or for reinstatement with those customers who received cancellation notices.
Despite this, there has been a lot of publicity about how hard it is, logistically, to revive and resell these cancelled policies.  With all the publicity, though, there has been no commentary on the whys of that difficulty, only a long series of unsubstantiated claims.  I’d like to understand the logistic difficulty, so that I can write accurately.
Thus, as a start, please walk me through the process of recreating a typical health insurance policy that was cancelled and then offering it to customers, on the assumption that the states’ insurance commissions do not represent roadblocks.  As I said, I’ll likely have followup questions as I begin to understand the problems involved.  I don’t want to post my article until I have a fuller understanding than I do now.
Thank you for your time and patience.

It’s been more than a week, and apparently AHIP has chosen not to respond.  Which raises another question: why would a health insurance trade association not want to explain the difficulties in reviving and reselling already built and approved (with that status existing as recently as just a few weeks ago) health insurance policies?  Why would they not want to substantiate these claims?

The PRC’s Sea Grab

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The PRC has just announced its new East China Sea Air Defense Identification Zone.  An ADIZ is something that any modern nation does as it exercises measures to increase the safety of its territory.  An ADIZ is a device, well published, that allows a nation to identify approaching aircraft with enough warning time to be able to react should that aircraft have nefarious intentions.

As can be seen, though, the PRC’s new ADIZ carefully includes the Senkaku Islands, which are Japanese territory (although the Republic of China also claims them as the Tiaoyutai Islands).  What makes the PRC’s move especially…suspect…is its ongoing grab of the entire East China Sea, claiming this mostly international water as PRC sovereign territory.  This is a direct, deliberate challenge to Japan and to the US, who is a close ally of Japan, and it’s intended to be so, as the US fades from the global stage.

As an aside, this move also is a direct, deliberate challenge to the RoC, and to the US, who is a close ally of the RoC.  Recall that the PRC considers the RoC as sovereign PRC territory, too, and that the US, to our shame, long ago supported the ejection of China from the UN Security Council in favor of the PRC.

By contrast, here’s the US ADIZ:

We don’t extend our zone very far at all.  Peaceful nations, with no designs on territorial expansion, have no need of masquerading an identification zone as a territorial claim zone.

Some Thoughts on Freedom

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Daniel Hannan, Member European Parliament for South East England, has a few.  His book, Inventing Freedom: How the English-Speaking Peoples Made the Modern World, was excerpted by The Wall Street Journal a couple weekends ago.  Here are some of Hannan’s thoughts from that excerpt.

Asked, early in his presidency, whether he believed in American exceptionalism, Barack Obama gave a telling reply.  “I believe in American exceptionalism, just as I suspect the Brits believe in British exceptionalism and the Greeks believe in Greek exceptionalism.”

The first part of that answer is fascinating (we’ll come back to the Greeks in a bit).  Most Brits do indeed believe in British exceptionalism.  But here’s the thing: they define it in almost exactly the same way that Americans do.  British exceptionalism, like its American cousin, has traditionally been held to reside in a series of values and institutions: personal liberty, free contract, jury trials, uncensored newspapers, regular elections, habeas corpus, open competition, secure property, religious pluralism.

…

What made the Anglosphere different?  Foreign visitors through the centuries remarked on a number of peculiar characteristics: the profusion of nonstate organizations, clubs, charities and foundations; the cheerful materialism of the population; the strong county institutions, including locally chosen law officers and judges; the easy coexistence of different denominations (religious toleration wasn’t unique to the Anglosphere, but religious equality—that is, freedom for every sect to proselytize—was almost unknown in the rest of the world).  They were struck by the weakness, in both law and custom, of the extended family, and by the converse emphasis on individualism.  They wondered at the stubborn elevation of private property over raison d’état, of personal freedom over collective need.

And a warning:

There is, of course, a flip-side.  If the US abandons its political structures, it will lose its identity more thoroughly than states that define nationality by blood or territory.  Power is shifting from the 50 states to Washington, DC, from elected representatives to federal bureaucrats, from citizens to the government.  As the US moves toward European-style health care, day care, college education, carbon taxes, foreign policy and spending levels, so it becomes less prosperous, less confident and less free.

…

Which brings us back to Mr. Obama’s curiously qualified defense of American exceptionalism.  Outside the Anglosphere, people have traditionally expected—indeed, demanded—far more state intervention.  They look to the government to solve their problems, and when the government fails, they become petulant.

What he said.

Hannan’s book, from which this excerpt of an excerpt comes, can be found here and here.