Archive | State Health Exchanges

Look Out for the ACA’s ‘Double Whammy’

Some small businesses are facing a potential “double whammy” in 2016 from the Affordable Care Act, one expert warns. By 2016 the employer mandate will kick in for companies with between 50 and 100 employees, and they will be moved into the “Small Group Market” for insurance coverage.

  • While they are currently exempt from the employer mandate to provide insurance and not considered part of the “Small Group Market”, small businesses with between 50 and 100 employees will find that all that changes for the worse in 2016.
  • In the Small Group Market, insurers charge higher premiums, not least because, it’s cheaper to insure 200 people under a single contract than it is to insure 40 groups of five under 40 contracts, or 200 individuals.
  • By 2016, those with between 50 and 100 employees will be pushed into the Small Group, where the rates are higher. They need to think about it now, or they will be facing rate shock.
  • While the group had previously been for companies with 50 or fewer employees, the ACA raised the limit to 100 employees — though the increase was put off to 2016 because the law gave states the option to postpone, which they all took.
  • The reason they’re forcing these people into the Small Group Market is to expand the actuarial base and to absorb some of the expected losses. At the same time, Small Group premiums are likely to rise even more because of the benefit requirements in the ACA, which limit deductibles and don’t allow insurers to turn down those with pre-existing conditions.
  • Worse yet states may eventually merge the Small Group Market with the markets for individuals. If states don’t get the enrollment of young people that they expect [to make state insurance exchanges viable], then the likelihood of states combining the Small Group and individual markets will go up.
  • If the two are merged, premiums will likely rise even more. Among other things, individual deductibles tend to be higher, but the ACA caps deductibles.
  • These rules don’t apply to the Large Group Market – and to companies that are self-insured. Virtually every large company in the country is self-insured. They insure them themselves, but work through an insurance company.

*Modified from a article


Moody’s Downgrades Health Insurers on Obamacare Fears

The rocky rollout of Obamacare and the uncertainty surrounding its future has a major credit ratings firm nervous about health insurers. Moody’s Investor Service downgraded its outlook for the U.S. health care insurance sector to negative from stable on Thursday.

  • The move comes just days after contract documents between the Department of Health and Human Services’ and IT firm Accenture details the continuing shortfalls of If changes are not made to the sites’ back-end technology by March, the documents warn the entire health-care system may be in jeopardy.
  • Moody’s Analyst Steve Zaharuk, who authored the report, says it would take positive news regarding the implementation of the Affordable Care Act for the firm to upgrade the industry back to stable.
  • “We would need some positive enrollment numbers, the back-end problems with the exchange fixed and the regulatory environment, where changes are being made ad-hoc [stabilized]. Positive news would help the situation,” Zaharuk says.
  • The true test of how the ACA will impact insurers will come at the end of March, Zaharuk says, when the administration releases its final enrollment report. So far, 2.2 million people have enrolled on both federal and state exchanges, by only 24% are between ages 18-34, falling far below the 2.7 million young and healthy the administration had originally projected for year one of the ACA.
  • Ramifications from the ACA will likely have a ripple effect on the health-care industry for years to come, Zaharuk says. “It’s the law of the land now; a long-term thing. If it works right, it can have positive impacts for the insurance company.”
  • “The first test comes in March when we will see what enrollment looks like, if the back-end issues are fixed, if people are getting access to health care and what the costs and efficiencies are,” Zaharuk says. “IF these things don’t work, it may have a longer and more detrimental effect on the industry as they struggle under the new law.”
  • Fitch Ratings’ outlook for 2014 for the health-care industry is stable, acknowledging challenges for insurers, but claiming the industry is “up for the challenge.”
  • Similarly, S&P has maintained its outlook for the industry as stable, according to Martin Arrick, managing director of the non-profit hospital sector.

*Modified from a article


Exchanges See Little Progress on Uninsured

Early signals suggest the majority of the 2.2 million people who sought to enroll in private insurance through new marketplaces through Dec. 28 were previously covered elsewhere, raising questions about how swiftly this part of the health overhaul will be able to make a significant dent in the number of uninsured.

  • Insurers, brokers and consultants estimate at least two-thirds of those consumers previously bought their own coverage or were enrolled in employer-backed plans.
  •  An Ohio-based insurance broker said he has dismantled about 50 small employer-backed plans, some of which are steering workers to the new marketplaces.
  • An insurance agency that enrolled around 7,500 people in exchange plans, said 65% of its enrollees had prior coverage. Around 10% were dropping out of employer coverage, either because the employer stopped offering its plan or because they could qualify for subsidies on the marketplaces. Fifteen percent had previous individual plans canceled, and 40% decided to switch into coverage bought through an exchange from previous individual plans.
  • The data, based on surveys of enrollees, are preliminary. But insurers say the tally of newly insured consumers is falling short of their expectations, a worrying trend for an industry looking to the law to expand the ranks of its customers.
  • Only 11% of consumers who bought new coverage under the law were previously uninsured, according to a McKinsey & Co. survey of consumers thought to be eligible for the health-law marketplaces. The result is based on a sampling of 4,563 consumers performed between November and January, of whom 389 had enrolled in new insurance.
  • One reason for people declining to purchase plans was affordability. That was cited by 52% of those who had shopped for a new plan but not purchased one in McKinsey’s most recent sampling, performed in January. Another common problem was technical challenges in buying the plans, which 30% mentioned.
  • At Michigan-based Priority Health, only 25% of more than 1,000 enrollees surveyed in plans that comply with the law were previously uninsured, said Joan Budden, chief marketing officer.
  • The trend underscores a central test for the health law, whose marketplaces are meant to steer a broad cross section of new paying customers to private insurers. “One of the intents of the law was to address the uninsured problem in our country,” said David M. Cordani, chief executive of insurer Cigna Corp. Cigna doesn’t yet know what coverage its health-marketplace enrollees previously held.
  • Many health plans and providers are looking for the expansion of coverage to fuel growth. Insurers need to draw healthy uninsured people to offset costs, given that plans can no longer deny coverage to people with pre-existing conditions.
  • Department of Health and Human Services officials have said they don’t yet know the number of people who have signed up for coverage through the exchanges who had insurance at the time of their enrollment.
  • The health law is chipping away at the number of uninsured consumers in other ways. At least four million people are expected to join Medicaid rolls in the coming months.
  • But so far, health-plan executives say, subsidies to buy insurance in the marketplace, and broader changes to the law, seem to be encouraging many already-insured people to seek better rates.
  • In addition, some small companies are cutting back on coverage now that their workers can buy through the marketplaces, insurers and brokers say.
  • At Priority Health, about 25% of health-law customers had employer-supported plans last year, Ms. Budden said, while 50% bought their own coverage last year. Of the latter group, about half are getting subsidies.
  • “I don’t know we’re growing the number of people with insurance here, so much as we’re just adding complexity,” said Geoff Bartsh, vice president for policy at Medica Health Plans in Minneapolis.
  • It isn’t surprising that some percent of new purchasers of private health insurance are people who had insurance before. About 66% of people buying new individual health plans in early 2011 were covered by employer-backed plans in late 2010, according to a Kaiser Family Foundation analysis of federal survey data prepared for The Wall Street Journal. About 20% of enrollees in early 2011 were previously uninsured, the analysis found.
  • There is “massive churn in the individual market, and always has been,” said Larry Levitt, senior vice president at Kaiser. “It wouldn’t surprise me if many [health-law enrollees] were insured in the last year,” he said, but “that doesn’t mean they wouldn’t have ended up uninsured if not for the exchanges.”

*Modified from a article


Another Obamacare provision for employers delayed

The Obama administration plans to delay enforcement of yet another Obamacare provision, according to a New York Times report. This line in the law would ban employers from discriminating “in favor of highly compensated individuals” when it comes to health insurance eligibility or benefits. Effectively, the provision prevents employers from providing their top executives cushy health benefits while low-level employees are given less optimal health insurance options.

  • The IRS will not enforce the provision in 2014 because they simply haven’t yet gotten around to actually writing the regulations that employers must follow, even though the Affordable Care Act was signed into law almost four years ago.
  • Obamacare originally required the IRS to enforce the health benefit “discrimination” ban just six months after the law was passed in March 2010. The Obama administration announced in 2010 that officials needed more time to write the rules, but assured Americans that the regulations would be finalized before Obamacare actually launched.

Years later, the IRS appears to still be grappling with the same questions about implementing the provision. IRS spokeswoman Michelle Eldridge denied in a statement that the agency had approved any new delay.

  • “The IRS has not announced any new or additional information on this issue,” Eldridge said. “The New York Times story refers to IRS Notice 2011-1, which was released to the press on December 22, 2010. That Notice stated that under Public Health Service Act, Section 2716 will not apply until after generally applicable guidance is issued, because the statute requires regulatory detail in order to operate properly.”
  • IRS officials appear to be stymied by the “regulatory detail” of the provision. For the IRS to mandate non-discrimination in health plans for employees with different compensations, the agency must decide how to quantify the value of employer-provided health benefits, how to define “highly compensated officials” and issue a final determination on what constitutes discrimination.
  • The tax agency has a series of scenarios made complicated by Obamacare’s structure that it will have to take into consideration before issuing guidance. Some low-earning employees may opt out of employer-sponsored health insurance in favor of increased subsidies via an Obamacare exchange, for example, while higher executives that aren’t privy to taxpayer subsidies for coverage do not. The IRS has yet to determine whether that employer would be discriminating even if the employer health plan has the same value for all employees.
  • Obamacare’s prescription for violating the ban is a $100 daily excise tax for each individual that was “discriminated” against.

*Modified from a article


Insurers under fire as Obamacare kicks in

New policyholders are having trouble confirming coverage, obtaining ID numbers and getting care. Obamacare’s biggest problem isn’t the troubled or the Covered California website anymore.

Consumers are easing up on criticism of government exchanges and turning their frustration and fury toward some of the nation’s biggest health insurers. All too often, new policyholders say, the companies can’t confirm coverage, won’t answer basic questions, and haven’t issued identification numbers needed to fill prescriptions or get medical care.

  • Day after day, people say, they contact insurance company call centers waiting hours at a time with no response. Meantime, insurers have already taken many customers’ payments for coverage intended to take effect Jan. 1.
  • But without proof of insurance, patients are having to pay hundreds of dollars out of pocket for medications and doctor visits, if they can afford it. Insurance agents say dismal service has become commonplace across many companies.

These industry problems pose the next major hurdle for what’s already been a flawed rollout for President Obama’s signature law. It could further sour public opinion on the overhaul and hamper enrollment efforts through March 31, when the first sign-up period ends.

  • Recent government changes to the law’s implementation and deadlines are impacting the timeline for us to process customer applications, issue billing statements, process payment and issue coverage ID cards.

Alan Sager, a health-policy professor at Boston University, said the insurance company fiascoes are another barrier to overcome after the government website problems. “There’s equal opportunity for incompetence by the public and private sector in administering such a large new program,” he said. “People are deservedly angry and resentful.”

Some insurers have begun to apologize this week, acknowledging a lackluster response amid an unprecedented surge of applicants for the individual insurance market. Nationwide, more than 2 million people enrolled in private health plans by the end of last year, either through or state-run marketplaces.

  • Industry officials say the disastrous launch of the federal exchange and the ever-changing rules from the Obama administration have complicated their job and contributed to the backlog.

“Health plans have gone above and beyond to protect consumers from disruptions caused by the ongoing problems with” and some state exchanges, said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, an industry group. “The last-minute changes to deadlines and rules have made the process more complicated and time-consuming.”

But some consumers think big insurers had plenty of opportunity to get ready. “Insurance companies of this size should have been far better prepared. They knew it was coming,” said Katherine Kokko, 34, a public-health consultant in New Hampshire.

She easily signed up for an Anthem Blue Cross Blue Shield policy through on Dec. 20 and soon after paid her $325 monthly premium. But after waiting on hold more than 10 hours in all this week, a company representative said she didn’t have an identification number. As a result, Anthem wouldn’t authorize physical therapy she needs after knee surgery last month.

These problems are particularly acute for families with ongoing medical needs, such as cancer treatment, pregnancy and other chronic conditions.

Bill Strong of Santa Barbara has a 6-year-old daughter who requires 24-hour care for a rare disease, spinal muscular atrophy. The family’s previous plan was canceled because it didn’t meet all the requirements of the Affordable Care Act. The family enrolled with Blue Shield of California on Dec. 23 and paid its $1,000 monthly premium for a Platinum plan.

But Strong said he hasn’t heard anything from the company despite two weeks of phone calls. Strong already paid for one prescription himself, and his daughter is scheduled to get a $4,000 injection Friday. Also, his wife is nine months pregnant.

“The company is not set up to handle the volume coming through,” Strong said. “It’s creating a lot of stress on us we don’t need.” Blue Shield of California apologized to customers for its “unacceptable” performance on its Facebook page this week.

“While we anticipated and planned for increased traffic, the sheer volume of enrollments has swamped all major health plans,” the San Francisco insurer said.

WellPoint, the nation’s second-largest health insurer and parent of Anthem Blue Cross, has drawn the ire of many customers in California and 13 other states where it’s selling policies on and off government exchanges.

The company said it responded to more than 1 million customer calls over two days last week, equal to the amount it typically receives over an entire month. It said it has more than 1,000 employees answering calls.

Insurers say the inability of many people to enroll through in October and November, coupled with deadline extensions to get Jan. 1 coverage, created an unexpected bottleneck of applications in late December.

The wave of policy cancellations for millions of Americans this fall added to the upheaval, and industry officials have also complained about lost or delayed delivery of enrollment files from the federal and state exchanges.

Blue Shield of California said it is still getting applications for Jan. 1 coverage from the state exchange.

A spokesman for said “we have fixed most of the issues that may impact a consumer’s enrollment with a health plan.”

In light of the lingering problems, California’s exchange extended the payment deadline to Jan. 15 for coverage starting Jan. 1, and some insurers across the country have granted even more time.

Some consumers are demanding partial refunds on January premiums that were paid weeks ago. Jeffrey Morgan, a marketing consultant in Lakewood, said Anthem Blue Cross rejected his refund request after waiting on the phone more than two hours Thursday.

Morgan has paid his January premium of $1,200 for his family’s coverage, but the company erroneously sent him a member ID card showing his coverage isn’t in effect until March 1.

“I enrolled well before the deadline and paid well before the deadline and I need prescriptions that are critical to my healthcare,” Morgan said.

Even insurance agents say they can’t get through to the companies to assist their clients. This whole law is a gift to insurance companies, they owe us good customer service.

*Modified from a article


Hiccups persist in California health insurance exchange

Covered California is still sorting through paper applications for health insurance starting Jan. 1, and some people are having trouble related to invoices, coverage confirmation or online payments.

Paperwork and computer glitches are still tripping up some eager consumers who are seeking coverage through California’s insurance exchange and its 11 health plans.

  • On Monday, the Covered California exchange said that all the applications it received online for coverage starting Jan. 1 have been sent to participating insurers, but that it is still sorting through an unspecified number of paper applications for that time period. In light of that delay, last weekend the state exchange extended the payment deadline for January premiums by nine days to Jan. 15.
  • A week into the new year, some people are still waiting to get an invoice or confirmation of coverage. Other enrollees have run into problems trying to pay online and long hold times when calling to get answers from their insurer or the exchange.

A surge of applicants in late December has created bottlenecks at government-run exchanges and insurers nationwide trying to implement the Affordable Care Act.

Overall, more than 400,000 Californians have signed up for private health plans so far through the state exchange. About 100,000 of those people enrolled in the final four days before the Dec. 23 deadline to have coverage in effect Jan. 1.

“We did receive a flood of applications before the deadline, so we are working at top speed to process all those and get them through the pipeline,” exchange spokeswoman Anne Gonzales said. “We understand people are waiting, and we are going as quickly as possible on our end.”

She said the exchange had to follow up with some applicants to get additional documentation before sending those files to insurers. Gonzales said she didn’t have a figure for how many applications for Jan. 1 coverage are still pending.

Insurers said some problems are inevitable because enrollment deadlines were repeatedly extended to help more people sign up in time for Jan. 1 coverage. The original deadline was Dec. 15, and Covered California was letting people finish applications as late as Dec. 27 after several extensions.

Insurers “are making every effort to ensure people are enrolled if they have made a good-faith effort,” said Nicole Evans, a spokeswoman for the California Assn. of Health Plans. “This kind of volume at one time in the individual insurance market is unprecedented.”

San Francisco resident Marin Perez, 29, tried for days to pay his $211 monthly premium to Anthem Blue Cross, a unit of industry giant WellPoint Inc. He and other consumers have said the company’s online payment system wasn’t working in recent days.

So, Perez said, he called the company, waiting on hold twice Friday for more than two hours apiece with no success. “It was a complete nightmare,” said Perez, content manager for a technology start-up. He hasn’t had health insurance since leaving his previous job about three months ago.

“It seems the private sector should be a little more savvy about managing this,” Perez said. “I thought many times, just forget it, I’m going to take my chances” without insurance. Perez said he was able to pay Monday only after contacting an Anthem official directly.

An Anthem spokesman said the company’s online payment system has gone down “intermittently” and the company “continues to increase its stability.”

Los Angeles resident Sandy Ragan, 60, was able to pay her premium for a Bronze plan with L.A. Care Health Plan on Dec. 9. But she’s frustrated because she hasn’t received a membership card or any other information from her insurer. She said she has asthma and high cholesterol and would like to see a doctor using her new benefits.

A spokeswoman for L.A. Care said it takes consumer complaints seriously and it is always looking to improve its service.

Healthcare giant Kaiser Permanente said exchange enrollees can make medical appointments and get care even if they haven’t yet received an invoice or paid their first premium. Anthem Blue Cross said its enrollees needing care can file a claim and get reimbursed later, subject to the terms of their policy.

Modified from a article


Obamacare may get sick if young Americans don’t sign up

Now that more than 2 million people have signed up for private insurance plans created by President Barack Obama’s healthcare law, a crucial next check-up for the new marketplace will be to see how old customers are.

  • Early data from a handful of state exchanges shows the administration needs more young adults to sign up in the next three months to help offset costs from older enrollees and prevent insurers from raising their rates.

Critics of Obama’s Affordable Care Act say the market won’t attract enough young people to keep it financially viable, putting more pressure on government funds to compensate for any insurer losses.

  • Data from seven states and the District of Columbia, which are running their own marketplaces, show that of more than 200,000 enrollees, nearly 22 percent are 18 to 34 years old, according to a Reuters analysis.

The administration had hoped that over 38 percent, or 2.7 million, of all enrollees in 2014 would be 18 to 35 years old, based on a Congressional Budget Office estimate that 7 million people would sign up by the end of March.

“The whole insurance relationship is counting on them signing up,” said Dale Yamamoto, an independent healthcare actuarial consultant. “Otherwise rates will have to increase.”

The picture from the initial state data is likely to change, since it mostly includes people who enrolled only through November, before a year-end surge of sign-ups for people wanting coverage effective Jan 1. Many experts speculate the early enrollees were more likely to be in urgent need of coverage, and therefore more likely to be older or sicker.

A recent survey by The Commonwealth Fund, a healthcare research foundation, found that 41 percent of those who had shopped at the various state marketplaces by the end of December were ages 19 to 34, up from 32 percent from an October survey.

One marketplace with current data, the District of Columbia, said on Friday that of the 3,646 enrollees in private plans through Thursday, about 44 percent are young adults.


  • The Affordable Care Act, popularly known as Obamacare, prevents insurers from charging people more if they have a health problem. Age is one of the few factors that can affect the price, with insurers allowed to charge up to three times more for a 64-year-old than someone in their early 20s.

But the healthcare costs for a 64-year-old on average are nearly five times as much as a 21-year-old, according to a study of claims from three large insurers Yamamoto conducted for the Society of Actuaries.

“The more that the marketplace is able to attract a broad mix of enrollees including the young and healthy … the more that costs will be sustainable and premiums will be more affordable,” said Robert Zirkelbach, spokesman for America’s Health Insurance plans, a trade group for insurers.

Other factors may be as crucial, if not more, in determining the stability of the new market, including the health status of enrollees, regardless of their age, and how that lines up with what individual insurers had projected. But those details will only become clearer later in the year based on the medical claims filed by the newly insured, making age the best early proxy about whether the market is sustainable.

The Centers for Medicare and Medicaid Services, which oversees the marketplace for 36 states, has yet to provide any demographic data about enrollees. CMS is expected to release an enrollment report later this month.

Data may come sooner from insurers as they discuss their recent financial performance with investors in the next few weeks. Humana Inc said on Thursday that the mix of enrollment in its marketplace plans were likely to be “more adverse than previously expected.

  • But healthcare experts say insurers need a better mix of enrollees than seen in the early data.

“If a quarter or more of the enrollees are young adults, I would think that’s an encouraging sign, particularly for the first half of the open enrollment period,” said Larry Levitt, senior vice president at the Kaiser Family Foundation healthcare think-tank.

By the end of March, “if it’s lower than that, I think there would be some cause for concern,” Levitt said.

Levitt and colleagues at Kaiser analyzed a scenario that they deemed “worst case” in which young adults represented 25 percent of enrollees. They found that costs then would be about 2.4 percent higher, but insurers would retain a very slim profit margin. As a result, the Kaiser authors projected the companies would raise premiums by a commensurate amount, but not enough to destabilize the market.

Using the same data as Kaiser but different assumptions, Seth Chandler, a law professor at the University of Houston who specializes in insurance, said costs would be 3.5 percent higher, should only 25 percent of enrollees be young adults.

  • “If we see fewer than 30 percent of the enrollees being in that 18-to-34 age bracket, that’s a warning sign that there are problems,” Chandler said. “If the demographics come in poorly, insurers are going to lose money.”

Chandler is a skeptic of the healthcare law and writes a blog called “ACA Death Spiral.” Such a spiral is thought to occur if insurers facing higher costs raise premiums, so only very sick people buy coverage, leading to even higher premiums with the pattern continuing until the insurance market either disappears or shrinks to the point that it is not sustainable.

*Modified from a Reuters article


New ObamaCare fees coming in 2014

Here comes the ObamaCare tax bill. The cost of President Obama’s massive health-care law will hit Americans in 2014 as new taxes pile up on their insurance premiums and on their income-tax bills.

Most insurers aren’t advertising the ObamaCare taxes that are added on to premiums, opting instead to discretely pass them on to customers while quietly lobbying lawmakers for a break.

But one insurance company, Blue Cross Blue Shield of Alabama, laid bare the taxes on its bills with a separate line item for “Affordable Care Act Fees and Taxes.”

  • The new taxes on one customer’s bill added up to $23.14 a month, or $277.68 annually, according to Kaiser Health News. It boosted the monthly premium from $322.26 to $345.40 for that individual.
  • The new taxes and fees include a 2 percent levy on every health plan, which is expected to net about $8 billion for the government in 2014 and increase to $14.3 billion in 2018.
  • There’s also a $2 fee per policy that goes into a new medical-research trust fund called the Patient Centered Outcomes Research Institute.
  • Insurers pay a 3.5 percent user fee to sell medical plans on the Web site.

ObamaCare supporters argue that federal subsidies for many low-income Americans will not only cover the taxes, but pay a big chunk of the premiums.

But ObamaCare taxes don’t stop with health-plan premiums.

  • Americans also will pay hidden taxes, such as the 2.3 percent medical-device tax that will inflate the cost of items such as pacemakers, stents and prosthetic limbs.
  • Those with high out-of-pocket medical expenses also will get smaller income-tax deductions.
  • Americans are currently allowed to deduct expenses that exceed 7.5 percent of their annual income. The threshold jumps to 10 percent under ObamaCare, costing taxpayers about $15 billion over 10 years.

Then there’s the new Medicare tax.

  • Under ObamaCare, individual tax filers earning more than $200,000 and families earning more than $250,000 will pay an added 0.9 percent Medicare surtax on top of the existing 1.45 percent Medicare payroll tax.
  • They’ll also pay an extra 3.8 percent Medicare tax on unearned income, such as investment dividends, rental income and capital gains.

Modified from a article


Will Insurers Ever Say Enough’s Enough To Obamacare?

How can anyone run a business this way?

Modified from an article by Greg Scandlen, December 27, 2013 on website

Will Insurers Ever Say Enough’s Enough To Obamacare?   As an insurance guy, I liked that it was moving insurers away from their misguided notion of being the big boss in health care and back to the role of financial protection.

But the industry didn’t much like that aspect of it. Sure, they would sell the products because employers demanded it, but they were losing control as banks entered the market to manage the first few thousand dollars of expenses of a patient’s contract. The banks were still focused on financial protection and didn’t have ambitions to become health care managers.

  • So when Obama came along with an offer to require all Americans to buy their products, it was an offer they couldn’t refuse. Especially when the products he had in mind were comprehensive, cover-everything health plans. No more bank involvement. We’ll really be in the catbird seat now!

I’ve been working professionally in health policy since 1979 when I was hired by the Blue Cross Blue Shield plan in Maine. Before I left the Blues I was heading the state relations department for the national association in Washington. Then I went on to organize a trade association of health insurance companies that were interested in promoting free market solutions in health care.

What has happened to the insurance industry has me stunned.

Now, I am no apologist for the industry. I have been one of its biggest critics. Its dalliance with Managed Care was an enormous mistake that took its mission away from financial protection into health services management – something it was never qualified to do.

  • The industry not only did a poor job of it, but it alienated and embittered the only people who really matter in health care – doctors and patients.

Granted, Managed Care pleased employers for a few years. It restrained their costs in the mid-1990s. But employers don’t really know anything about health care, either.

  • What they do know is the morale of their workers, and Managed Care was the biggest morale-killer ever. Employees were furious that care was being denied by insurance company bureaucrats in Hartford, Connecticut, and they let company HR departments know it.

Employers started looking for other ways to restrain costs while preserving patient choice, and came to embrace “consumer-directed” health care (CDHC) in the early 2000s. This approach has been enormously successful and it has lowered costs and increased patient involvement in health care decision-making.

The naivety I had witnessed during the Clinton Wars was still in force. Many of us tried to warn the industry that they would regret this arrangement. Yes, they might be assured of modest profits, but the cost of sacrificing their autonomy would be far too high. They would become little more than public utilities. They would lose all control over benefit design, marketing practices, and rate setting. They would have no idea of the risks they were enrolling and would have to set premiums blindly.

It has become much, much worse than I ever imagined. Obamacare is not even fully in effect yet and already we are seeing the President playing with the carriers like a toddler plays with toy trucks –

  • Employers will be mandated to buy your policies for 2014
  • (Oops, employers are angry)
  • Employers won’t be mandated until 2015 – if then
  • Small employers will give workers a choice of health plans through the SHOP program in 2014
  • (Oops, we can’t get the web site ready in time)
  • Small employers won’t have to offer a choice of plan until – sometime later
  • You must cancel these individual policies
  • (Oops, public backlash)
  • You must reinstate these policies
  • (Oops, many insurance commissioners won’t allow it)
  • You must continue to cover providers and drugs even for cancelled policies
  • The deadline for enrollment will be December 15, 2013
  • (Oops, web site problems)
  • The deadline for enrollment will be December 23, 2013
  • (Oops, too much traffic)
  • The deadline for enrollment will be December 24, 2013
  • Never mind, there is no deadline
  • First month’s premium must be received by December 31, 2013
  • (Oops, back-end problems with the web site)
  • First month’s premium must be received by January 8, 2014
  • Make that January 10, 2014

How can anyone run a business this way? This is worse than being a federal agency. No federal agency would be expected to stop and start on a personal whim like this. These aren’t rules, they aren’t regulations, they are dictates based on nothing more than Kathleen Sebelius’ momentary feelings.

  • These are only the “glitches” that have been made public. God knows what orders and threats are being issued in closed-door meetings.

How long will the insurance industry abide being treated like shoe shine boys? Mr. Obama will not be in office forever. His regime is already coming to an end. What will these companies do then? He will no longer be around to grant or withhold bailout (“risk corridor”) money.



Many who enrolled in health plans still await confirmation

Anxiety grows as health plan delays could leave some customers without a policy by January 1st.

Some people who picked a health plan as far back as October through the Covered California exchange say insurers are telling them they still have no record of their enrollment. As a result, bills haven’t gone out and consumers can’t pay their initial premium to ensure coverage takes effect in less than three weeks.

“There are certainly some people who have enrolled or think they have enrolled and haven’t received confirmation,” said Paul Markovich, chief executive of Blue Shield of California. “It’s our version of Black Friday right now and that is what we are coping with.”

In California, insurers are working with the state exchange on how to address the potentially thorny problem of patients who applied in time but don’t have proof of insurance when they need to visit the emergency room or get a prescription filled in early January.

Insurance companies typically won’t cover any medical bills until a customer pays the premium. The deadline for payment was recently extended to January 6th.

Thousands of Californians have overcome long waits and website glitches to sign up for Obamacare insurance, but now enrollment snags may prevent some of them from actually having coverage starting January 1st.

Consumers’ anxiety has grown as they endure long waits on the phone, computer errors and conflicting answers from the state and insurers about their coverage.

The average wait time at the state’s call centers climbed to 36 minutes last week, and California is still trying to clear a backlog of paper applications filed in October and November.

State officials acknowledge there have been delays, but they say the vast majority of people are enrolling smoothly and getting their first insurance bills. The state said it didn’t have exact figures on how many customers are still waiting for proof of insurance.

Thursday, Covered California said more than 156,000 people had enrolled in private health plans through December 7th. An additional 179,000 Californians have qualified for an expansion of Medi-Cal, the state’s Medicaid program for the poor.

The stakes are big for people with chronic health conditions and serious medical issues. The loss of coverage could pose significant problems for them financially and for their health.

Lee, head of Covered California, said exchange employees are working overtime to process applications, and the state’s call centers will be open the next two Sundays to help meet increased demand. He said the exchange is sending customer files daily to the 11 insurers participating in the state marketplace.

The separate federal exchange for 36 other states has been trying to fix errors in the customer files it has sent to insurance companies. In contrast, the California Assn. of Health Plans, an industry group, says the information from Covered California has had a “high rate of accuracy.”

*Modified from a article