Obamacare Jackpot

CMS (Center for Medicare Services) is responsible for Obamacare oversight.

This includes everything from reviewing carrier health insurance plans and compliance to managing the (still dysfunctional) healthcare.gov website.

Now we hear the HHS OIG (Health and Human Services Office of Inspector General) notes that for the EIGHTH TIME in less than a year they found that CMS is incapable of accounting for the distribution of taxpayer subsidy funds.

CMS relied entirely on data from health insurers to verify whether enrollees had paid their premiums and were eligible. Unfortunately, this data was insufficient - insurers provided payment information on an aggregate rather than enrollee-by-enrollee basis, making verification all but impossible.  

"CMS had not yet established computer systems to enable marketplaces to share confirmed enrollment data; therefore, CMS did not verify that QHP issuers were returning APTC overpayments to Treasury." - ATR

But hey, it's only money.

#ObamacareFail

Obamacare and Small Business in 1000 Words

[click pic to embiggen]

If I like my plan I can keep it?

$2500 savings?

3000% rate reduction?

#Obamacarefail

Veddy Interestink

So we've been reporting on various carriers' unilateral decision to stop paying commissions, and wondered:

"Since it will no longer be paying commissions, will [carriers] now refund the portion of [their] clients' premiums that represent that cost?"

Blue Grass State honchos have weighed in, and the answer is (pleasantly) surprising:

"Kentucky has published an Advisory Opinion to clarify inquiries regarding the non-payment of commission payments to agents for certain products ... Failure to pay commissions in accordance with the rate filing will be considered a violation of the Insurance Code."

And this edict applies specifically to health insurers (both individual and group).

Now, it affects only carriers and agents in Kentucky (for now), but it will be interesting to see if other jurisdictions will hop on board.

So, some good news for a change.

Thursday Morning LinkFest

■ From the Everything Old is New Again Department:

Way back in Aught-Six, we reported on a groundbreaking plan called PACE, a self-funding option for small group:

"ACMG has developed a unique new product that brings the benefits of ERISA plans and the “stability” of fully insured plans to the small group market."

Almost a decade later (yesterday, to be precise), FoIB Jeff M alerted us to a "new" program called Level Funded Health:

"Level funded health plans appear like a hybrid between a traditional group health insurance plan along with a form of self-insurance."

LFH is available for groups with as few as 5 employees; being self-funded also means being able to duck some major ObamaTax requirements (which should help to keep the price down).

Methinks these types of plans will become more and more attractive as small group plans keep getting squeezed in the marketplace.

■ From the Annals of the MVNHS©:

"Tumors force 11-year-old boy to undergo mastectomy"

Turns out, this young lad apparently had several benign tumors in his chest, and recently became "the first child in the country to undergo a mastectomy."

He seems to be making a speedy recovery.

■ From the Medicinal Alcohol & Yogurt Department:

"A craft beer made with ingredients from kefir — a fermented milk drink that resembles yogurt— may sound a little gross. But drinking it could bring health benefits"

What benefits, you ask?

Well, reduced stomach inflammation and ulcers, for starters.

The bad news is that its effects have so far been tested only on rats, who apparently have no problem with the mixture.

Tastes great, less ulcers?

Obamacare Meets Social Media

The #ObamacareFail project is not only creating problems for consumers (who can't find

AFFORDABLE health insurance) and agents (who can't make a living selling this crap) but now has invoked the wrath of policyholders.

Allow me to introduce you to #onholdwith, a consumer-centric site where policyholders can express their frustration with health insurance hold times and cheesy elevator music ......... sometimes in Spanish.

Today's target is the soon-to-be-eaten-by-Aetna health insurance giant Humana.

But all is not lost.

Humana is the Jimmy Carter of presidents. Before Obama was elected, Mr. Carter was deemed the worst president in recent memory.

Now that title belongs exclusively to the number one gun salesman in the country, Barack Hussein Obama.

In the case of Humana, they would be deemed the worst carrier if not for an even bigger foe named Blue Cross.

Humana is counting their blessings.

Like Eyegore (Marty Feldman) said in the grave digging scene from Young Frankenstein, "Could be worse. Could be raining".



#ObamacareFail  #HumanaFail  #BlueCrossFail

Win some, Lose more

As Bob noted this past November, "Ocare was supposed to eliminate medical bankruptcy. At least that was the campaign promised."

So how's that working out?

Oh:

[click pic to embiggen]

According to the folks at the Kaiser Family Foundation, folks who had employer sponsored health plans (ESI) fared even worse than those who were uninsured.

And as an aside, 5+ years in, and there are still uninsured? Thought that was the whole point of the ObamaTax. Hunh.

And also note that it doesn't seem to matter what type of plan design either (high vs low deductible). Of course, the deductible is only part of the story: the total out-of-pocket will also include co-insurance and premiums.

Talk about #ObamaCareFail.

[Hat Tip: Larry Levitt]

ObamaTax D'unh!

So The Grey lady has finally figured out what we've known pretty much all along:

"Many See I.R.S. Penalties as More Affordable Than Insurance"

No kidding.

As we've long noted, most recently this past October:

"If you're not getting a subsidy, there's no plan at any age that's going to be [as low as the penalty tax fine]."

We already know that the first wave of the most recent Open Enrollment season was an unmitigated disaster, with far fewer victims enrollees than either predicted nor necessary for sustainability. This of course has a major dampening effect on insurers, who need the influx of the mostly healthy folks that wisely opt out to help offset huge claims losses.

Sucks to be them.

[H/T Gabe Malor]

Pigs at the Trough

Obamacare was created in backroom deals with legislators that have long since retired or died. Hailed as bi-partisan even though it became law without a single Republican vote.

Five years later we have carriers that have bailed on Obamacare, some hit the eject button before the new rules hit the market. Over half of the health insurance co-ops created by the DC bottomless money pit are either on life support or have already pulled the plug.

Predictably, when free money is readily available, pigs will gather at the trough to get their share.

Cigna Inc., the insurance giant that backed out of the Florida’s federal insurance marketplace in October because of an “exponential increase” in fraudulent drug testing claims in treating addicts has uncovered another type of fraud — lying about Florida residency to get insurance. 

“For example, one broker was found to have enrolled nearly 100 customers — none of whom appear to have had any prior connection to Florida — at an apartment that was connected to a relative of the broker,” wrote Cigna spokesman Joseph Mondy in an email response to questions posed by The Palm Beach Post. “In other instances, customers enrolled using the address of a substance-abuse treatment facility as their claimed residence. - Palm Beach Post

Oink, oink.

#Obamacare #HealthInsuranceFraud