Sunday, June 28, 2015

Celebrations - Both Public And Private


The Supreme Court had reached a decision. The excitement grew in intensity as news of the ruling spread across the capitol. Washington was awash in celebrations, both public and private. Private because this was news that some could only appreciate, secretly, among their closest friends and compatriots. The Supreme Court codified a reality some of us have recognized for years.

The Patient Protection and Affordable Care Act (PPACA) is here to stay.

Thursday, June 25, 2015 was a wonderful day for politicians. Big wins across the board. You, Joe and Jane Public, will be OK. We are always OK. Some of us have been helped by the legislation. Some of us have been hurt by it. But we will, at worst, survive. The biggest winners were our politicians.

This blog has long contended that the PPACA was a poorly written law. The Supreme Court has now made that official. In an effort to make health insurance affordable, the law included Tax Credit Subsidies which would be based on an individual’s income. The catch was that you had to apply through an Exchange, in essence a government run online marketplace. The PPACA seems to have limited the access to the Tax Credit Subsidies to those applying through an exchange “established by a State”. In other places within the law it appears that any government run exchange would do. Many of us viewed this, in 2010, as part of the law’s efforts to force the states to participate. States controlled by Republican governors and legislators took the challenge and refused to create exchanges. The federal government gave us and moved forward. Now we have millions of Americans across the country covered by subsidized insurance. That was the reality the Supreme Court faced.


The number one place for clear-eyed Supreme Court analysis is SCOTUSblog. Here you will find brilliant articles arguing both sides of the issues facing the Court and the minutia that will find its way into totally unrelated cases 50 to 100 years from now. The posts following this decision are fiery and passionate. Don’t let the legalese fool you. These writers are playing for keeps.

Our politicians are the polar opposite. Democrats and Republicans aren’t searching for intellectual discussions. Both sides are too busy mining our emotions, mostly our deep pools of fear and resentment.

Our Democratic friends will tell us how hard they have had to work to protect us from ruin and the Republicans. We will be told that any flaws in the PPACA are due to Republican recalcitrance to progress and the new law. NOW, now that the Supreme Court has fended off the last real challenge, all of the promises of the PPACA will be realized. And when they aren’t? When premiums continue to increase and more and more businesses choose to drop their employer sponsored group policies, there will still be plenty of Republican resistance to blame.

Our biggest winners were the Republicans. This blog noted on November 3, 2010, the day after the Republicans won the House, that the GOP had no real interest in repealing the PPACA. We have had over 50 cynical show votes since then. Repeal the law and they would own the problem. Resist the law and the Republicans are free to complain, with a total absence of intellectual honesty, about the specific provisions of the law without any obligation to provide an alternative.

There have been some readers who doubted this last assertion. Privately they championed one Republican leader or another who promised to reveal an all-encompassing alternative to Obamacare much the way Richard Nixon had a secret plan to win the war in Vietnam. King v. Burwell forced the GOP’s hand.

No one knew how the Supreme Court would rule on King v. Burwell. It could have gone either way. As it was, Chief Justice Roberts was forced to perform intellectual somersaults to author this decision. He was absolutely correct in his assertion that the elimination of the subsidies for most of the country would have destroyed the insurance market. We would have sunk into a death spiral. That makes him the most important insurance commissioner in the country. And to the extent that the country might be better off with the law than with the chaos we would have endured, I am pleased with the decision. But I couldn’t have predicted it. No one could. So the Republicans were forced to plan for either decision.

Senator Ron Johnson (R-WI) and his plan were the subject of the May 11th post of this blog. I found it to be the most realistic because its main goal was to do nothing. Senator Johnson wanted to leave the subsidies in place but eliminate the employer and individual mandates until after the next election. You know when you are in trouble when doing nothing is your best option.

The Washington Post published “Your pocket guide to Obamacare replacement plans” last Tuesday, two days before the ruling. The Post highlighted the top 6 Republican options. They thought that Senator Johnson’s plan had the best chance of moving forward. Now all of those plans can be tossed.

Instead of having to deal with details and numbers, we will be treated to Senators, Congressmen, and most vociferously, by Presidential candidates discussing patient centered care, the free market system, and the holiness of the doctor-patient relationship. Yada Yada Yada.

All Sizzle and No Steak

The Patient Protection and Affordable Care Act is a poorly written law built more upon good intentions than a solid foundation of how insurance works. Nothing changed this past week. The Democrats will focus on the victories. The Republicans will highlight the failures.

Does anybody feel like celebrating?


Photo credit - ME!

Sunday, June 7, 2015

Another Note From The Department Of Gobbledygook

I got my first call last week from my client Wendy who is not only a talented real estate agent, but also someone who reads all of her mail. She recognized the correspondence "from" Medical Mutual of Ohio as possibly another letter from our frustrated novelists at the department of Health and Human Services. She was correct. Worse, it appears that HHS sent the same badly worded, scare tactic laden missive that was sent last year. MMO, like last year, was forbidden from changing even a comma. In that spirit I give you the same response I published last year.

Mayfield Heights-20140626-00340


The calls started coming in last week.

Dave, I want to keep my current policy.

Well of course you do. We had this conversation in October.

Yeah, well I got a letter that said that I had to call in to Medical Mutual if I want to keep my policy, so I called you.

You got a letter? I wasn’t copied. I have no idea what you’re talking about. Would you read the letter to me?

The client read the letter to me over the phone. It was long and rambling and sounded more like a request for him to dump his old cost effective policy in favor of a new contract than anything else.

That came from MMO?

Yes. It came in today’s mail.

Do me a favor. Scan and email it to me or fax it over.

The letter had, in fact, been sent by Medical Mutual to the client. Identical letters were sent by the insurance companies to all insureds with non-grandfathered policies. Identical. The letters were prepared by the Department of Health and Human Services (HHS). The insurance companies were forbidden to move a comma. If the objective was to confuse and/or frighten the people who have to this point avoided the government’s website, then they have finally managed to find an achievable goal.

Some Americans are well-served by the new health care law. If you are purchasing insurance for yourself and your family and you
  • Need maternity coverage
  • Have preexisting conditions
  • Would qualify for a premium subsidy
You might benefit from a new health insurance policy. But if you are healthy and/or don’t qualify for the subsidy, you probably want to keep your old policy.

A surprisingly large number of people want to keep their old policies.

The initial pushback resulted in the Obama Administration granting Transitional Relief, the ability to keep certain existing, non-grandfathered policies for 2014. The Centers for Medicare and Medicaid Services (CMS) announced in March that we were getting another 2 years and possibly more.

The Good News – My current policy is $400 per month less than a comparable 2014 plan. I am not alone.

The Bad News – Allowing the healthy to avoid the Patient Protection and Affordable Care Act (PPACA) for another couple of years spells higher rates for those in the system.

So to avoid upsetting millions of people the President and CMS are letting you keep your current policy. To avoid upsetting millions of people with ridiculous rate increases HHS is trying to get you to voluntarily dump your old policy. Hence the letter. If you give up your current policy, as opposed to having it taken from you, then you are part of the system by choice.

Don’t Do Anything

If you get the letter, the one that tells you that you can keep your current plan and then lists eight bullet points of what you are missing by not switching to a new health plan, you don’t need to do anything. Nothing. You will still get your renewal notice in a timely fashion. You will have the opportunity to keep your current policy and pay the new 2014/2015 rate. Or you will be able to shop for a policy under the new rules. There is no need to do anything today. That especially means that there is no need to get nervous or aggravated today.

The government’s website, the national frustration number, and letters like this prove again that the people in charge really didn’t know what they were doing when they invaded my business. The purpose of insurance is twofold – money and peace of mind. You write small checks to the insurance company so that if, G-d forbid, you get really sick or injured we’ll write the really big checks to the doctors and hospitals. And peace of mind, the knowledge that this will all work.

There is no gobbledygook on the path to peace of mind.