Category Archives: markets

Obamacare Blocking People from Getting Coverage?

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A Better LA, a decade-old Los Angeles nonprofit, said last week it was signing up 50 low-income people for health plans in California’s health-insurance marketplace.  The charity, which said it has the blessing of the state agency overseeing the marketplace, will pay $50 to $100 a month to cover the share of the people’s premiums not already financed by federal subsidies.

Nonprofits, including some hospitals, say paying premiums would ensure coverage for people currently uninsured who can’t afford even a small monthly payment for health insurance.

But.  There’s always a but. This but is this, from Karen Ignagni, President and CEO of America’s Health Insurance Plans, the health-insurance industry’s trade group (who, incidentally, declines to explain the claimed logistics problem of reissuing health insurance plans that were in force just a month ago):

It is a conflict of interest for hospitals and drug companies to pay patients’ premiums and cost-sharing for the sole purpose of increasing utilization of their services and products.

Of course, Ignagni has no conflict of interest herself.  Mm, mm.

And

[The] HHS unit that is implementing the health law said it would “discourage” hospitals and other commercial entities from paying premiums.  It asked insurers to reject such payments and warned that it would take further action if necessary.

HHS has significant concerns with this practice….

The Democrats and the insurance companies in cahoots with them pretended to concern about the poor and the elderly sick being unable to afford medical care because they couldn’t afford health insurance.  Now those same worthies are moving to block those poor and elderly sick from getting exactly that coverage solely because they’re not getting coverage in the way those Democrats deem acceptable.  Apparently, the Democrats’ concern had nothing to do with the welfare of the poor and the elderly sick and everything to do with getting their votes.

The insurance companies?  It’s time to cut out the coddling and dump them into a free, competitive market place.

The Idiocy of Lawlessness

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Leaving aside the lawlessness of HHS’ new “rules” demanding that their new subjects, the insurance companies, govern their businesses according to HHS diktats, following are some examples of the utter stupidity flowing from that lawlessness.

“asking” insurers to take a flexible approach about their rules when patients refill prescriptions or see their existing doctor in the early days of the new year in case new health plans haven’t kicked in.

Never mind that the old plans, that included those doctors and drug coverages, are illegal under Obamacare, and so no legal coverage exists for them.  This also ignores the mechanics of the insurers getting paid, eventually, by the patient, and by the Federal government when subsidies are involved.

“encouraging” insurers to begin coverage in the new year even if applicants miss the deadline by a few days.

Never mind that, especially with the failure of ObamaMart to deliver necessary enrollment and sign-up data to the insurers, those insurers have no way of knowing that those claiming coverage actually are covered, neither do those claiming coverage have any way of knowing they’re actually covered, and neither do the doctors and hospitals have any way of knowing whether they’re included in the claimed plans.  Just try to sort out the fraud from the honest mistakes from the utter failures in this environment.

requiring that enrollees who pay their first month’s premium by Dec 31 be given coverage starting the next day.

Never mind that ObamaMart can’t even tell the insurers who has enrolled.  Never mind that, even when information flows as it should, insurers have no hope of reacting that quickly, even in an on-line world.  Thus, see above about who knows what and how to sort out fraud from….

“calling on insurers” to refill through January prescriptions covered under previous plans.  …insurers should continue covering at standard rates patients’ visits to doctors they had seen under their old policies, even if those doctors weren’t part of a new plan’s network.

“strongly encouraging” insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes.

Never mind that those plans are illegal, the coverage under them non-existent by government decree.

Never mind that the insurers have no hope of reimbursement for any fraud that occurs, nor any expectation of timely—if any at all—payment of subsidies due, since ObamaMart’s software is wholly incapable of determining who’s eligible for subsidies, much less how much any particular Obamacare welfare recipient might be due.

Keep in mind that when the Federal government “asks” for something, it’s largely indiscriminable from a demand.  See the IRS’ treatment of government-disapproved groups of Americans, HHS Secretary Kathleen Sebelius’ treatment of insurance companies who objected to Obamacare while it was being developed, Congressman Henry Waxman’s (D, CA) treatment of companies who laid out the early costs of Obamacare.

The Administration of Stupid just keeps rolling along.

The Progressive View of the Law

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We’re well familiar with President Barack Obama’s view of the law: it’s just a political guideline, which he’ll enforce—or not—at convenience.  See Obamacare and its Employer Mandate and Cancelled Insurance Policies, for instance.

Here’s another example.  Covered California, California’s state-run ObamaMart, has given out personal contact data—names, addresses, phone numbers, email addresses—on tens of thousands of Californians who went to the CC site just to check out coverage possibilities.  None of these browsers had given permission to release these personal data in any way, shape, or form.  Nevertheless, these data were given to insurance brokers, among others, so those brokers could cold call this additional list of sales pitch spam victims.

For what purpose this egregious invasion of privacy?  Covered California Executive Director, Peter Lee, insisted with a straight face that “insurance” buyers needed help making the 23 December deadline for coverage that begins 1 January, and that he knew better how to do that—no need to obey privacy laws in the face of his higher purpose (although Lee insists that no privacy laws were harmed in the making of this move).

Lee did this while also saying

I can imagine some people may be upset[.]

Well, NSS.  But never mind about that.  Lee and his Progressive-controlled State Government employer know better (he is, after all, still on the payroll after this; that state’s government plainly agrees with his move); privacy laws are just guidelines.

As to CC’s claims that no other data were released, one victim of a spam email from one of those brokers wonders “what other details on his application were shared with the agent.”  Indeed.  What else still is being covered up?

So much for rule of law in Progressive administrations.

Government and Legislative “Intentions”

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Halbig v Sebelius is a case that opened last Tuesday in the DC District Court that challenges the legality of Obamacare subsidies, and through that the applicability of the Employer and Individual Mandates, in states that have ObamaMart—Federal health insurance exchanges—rather than state-run exchanges.

The case hinges on what the Obamacare law says vs what Government says it says and what Congress’ “intentions” were.  Leave aside for now then-Speaker Nancy Pelosi’s remark that it was necessary to pass the law to know what was in it along with the admissions of most Representatives and Senators that they had not even read the 900-page law before they voted on it; following is the argument:

Judge Paul Friedman asked how far, and where, he should go to look for more information about what Congress actually intended with Obamacare.  Plaintiffs—Halbig, et al. (et al. consists of three more private individuals and eight businesses scattered across six states that have ObamaMart running because those states declined to set up state-run exchanges)—said the place to go was the law itself: what does the law say, explicitly, in its text.

Government, on the other hand, says to see the text of the law, but also go further and divine Congress’ intentions when it passed the law.

Which brings me back to Pelosi’s remark and those admissions.  Congress didn’t know what was in the law when it passed it; that information didn’t become available until after it was passed.  Not knowing what was in the law when it was passed plainly means that Congress cannot have known its intentions for the law when it passed the law.  Government’s insistence on divining intentions in this case, then, demands a level of mind reading that’s beyond even the talents of a Federal District Judge.  Or those of appellate or Supreme Court judges, which is where this case will go, no matter Friedman’s ruling.

Yet the question matters a very great deal: are citizens in states that have ObamaMart rather than state-run exchanges eligible for premium subsidies, and from that do the Employer and Individual Mandates apply in those states?  The text of the law says that subsidies are available only for those who buy policies through the state exchanges.  Government argues that those phantom intentions were that the subsidies were to be available for policies purchased through ObamaMart, also.

This matters because subsidies in the 34 states where ObamaMart operates in lieu of state-run exchanges amount to hundreds of billions of dollars of Federal (deficit, debt-building) spending, and those Mandates represent hundreds of billions of dollars (albeit fewer hundreds than those subsidies) of individual and business spending by non-subsidized purchasers of Obamacare policies in order to defray somewhat the costs of those subsidies (and, a separate significance, to pay “insurance” sellers artificially inflated premiums in order to support those sellers’ artificially depressed premiums for subsidized and elderly buyers)

What I Can See Now With ObamaMart

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President Barack Obama’s ObamaMart—that HealthCare.gov contraption—is up and running, or so Obama and his chief shill, HHS Secretary Kathleen Sebelius, claim (even though some very serious—dangerous—warts remain).  I decided to try it out and see what the Obamacare law itself would offer me in terms of plans that are cheaper and better than the ones I have through my wife’s employer (which, knock wood, still are legal…so far).

Aside from the dental plans still being required to offer newborn and maternity care coverage (scroll the top window to the second image), here’s what I found without having to give up “my information,” from a not particularly random walk through the ObamaMart erected here in Texas.  I looked for plans available for my spouse and me, ages 62 and 60.  For a baseline, my existing health plan, available through my wife’s employer, charges a $1,700/year premium, has a $3,000 deductible, covers 80% of our medical costs after the deductible, and it’s so far still legal.  We have this High Deductible plan because it’s required in order to have an HSA.

The first plan in the list that comes up in ObamaMart is Blue Cross Blue Shield’s Bronze “Blue Advantage Bronze HMO 006” plan.  This plan comes with a $9,800/year premium and a $12,700 deductible.  Bronze plans only cover 60% of post-deductible costs, though, so we’d be paying $22,500/year just to get to the point of BCBS picking up the next 60% of our expenses.  For that year.  Next year would be a whole new $22,500 before coverage began.  The financially astute will note that those annual costs approach the annual limit on a 401(k) contribution for my age cohort.  Hmm….

And what coverage do I get for that princely sum—besides “free” contraceptives, prenatal, newborn, and maternity care for us empty-nesters, I mean?  The DETAILS button does not have the answer.  Or even any details.  I get no information on what’s actually covered.  The Summary of Benefits and Plan Brochure links on the popup that appears under the DETAILS button just take me to PDF files that assure me that if we go outside the BCBS network, our coverage is zilch.  In truth, before Obamacare we had to talk to an insurance salesman to see a policy.  But I thought Obamacare was supposed to be better, as well as…cheaper….

It takes a Gold Plan to give us the 80% post-deductible coverage that our present plan has, though, so that’s the next look.  The top of the list here is BCBS’ “Blue Advantage Gold HMO 001” plan.  This one wants a $17,000/year premium, but it only charges a $9,750 deductible to make up for it, for a total annual cost of $26,750/year before coverage actually kicks in.  If I thought I could afford any part of a 401(k) under the Bronze plan, this Gold cost disabuses me of that foolishness.  The Gold’s DETAILS button is just as vague and useless as the Bronze’s, too.

Yeah, I’m better off, now that ObamaMart has been “fixed.”