Well, well, well:

"Late [Friday] afternoon, the Seventh Circuit granted an emergency injunction against the HHS mandate � preventing its enforcement against an Illinois business and its owners."

The business, Korte & Luitjohan Contractors of Highland, Illinois, is a "family-owned, full-service construction contractor." In this case, the court disagreed with the recent Hobby Lobby decision, and went ahead and stayed Ms Shecantbeserious from enforcing the mandate for birth control convenience items. This court's take is that the mandate itself is coercive, and in direct contravention of the First Amendment.

Interesting opinion. Hopefully, it's just the beginning.

» Read More...

As major proponents of consumer-driven health care, this post at Avik Roy's place is a treat:

"[Author Regina] Herzlinger describes the health care system of Switzerland as a case study in consumer-driven health care ... Switzerland, the only developed country with a long-standing consumer-driven health care system, provides broad evidence and important lessons about its efficacy ... in Switzerland, it is the consumers themselves who purchase their health insurance."

Gee, what a novel idea.

Seriously, read the whole thing.

ADDENDUM: While I do like Avik's analysis, and the discussion in the comments (definitely see the ones from folks currently living under the Swiss health care regime) is enlightening, I wonder about its usefulness. After all, the American people has reaffirmed its desire for socialized health care, which is now (becoming) the law of the land.

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A year ago:

"Seventeen million young Americans would lose promised access to health insurance if the Supreme Court strikes down [ObamneyCare�]"

Oh the irony - it burns. Today:

"WellPoint and competitors have made concerted, well-publicized efforts to sell health coverage to the "Young Invincibles" ... who are not quite sure why they should buy health coverage."

But they have to - it's the law!

Really? It's a surprise that young people, inherently rebellious in nature, might not be too keen on paying for something they believe they'll never need? Hunh. Here's a clue, DC:

"A senior fellow at the National Opinion Research Center ... talked about "Calculated Risk Takers" -- uninsured, employed individuals ages 18 to 34 who have incomes over 400 percent of the federal poverty level ... If large numbers of healthy young adults fail to buy coverage, that could expose them to huge medical bills when they do get sick, and it could deprive health plans of premium revenue from young, generally healthy adults who could help offset the claims that older, sicker enrollees file." [emphasis added]

Let's translate this, shall we:

"Healthy young people would prefer to keep their own money rather than pay for their sick neighbors' medical insurance and care."

Sounds about right.

As we noted yesterday, however, Golden State politicos are in a quandary about how to implement their ObamaTax Exchange; they need the "yutes" on-board (the yutes' money, that is):

"Calculated Risk Takers are by far the least likely to purchase a plan compared to other groups"

Ooops.

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But in a good way:

"Expressing Anger Can Add Two Years to Person's Lifespan ... found that exhibiting self-restraint and holding back negative emotions could have serious repercussions for a person's physical and mental well-being."

Jerks.

» Read More...

Student loan consolidation combines all of your student loan debts into one, lower-interest loan. When you consolidate student loans, you can lock in low, fixed interest rates, reduce monthly payments, and/or lengthen the amount of time you have to repay the loan. You can consolidate student loans using federal or private consolidation loans. You can apply for both right here on our site.

The benefits of consolidating your student loans are substantial. Almost anyone with student loans can benefit from a consolidation loan. With most student loans, your interest rates can rise considerably unless you lock in a fixed rate with a consolidation loan. Here are some of the reasons you might want to consolidate student loans:

* No credit check required for federal consolidation
* Apply online
* Combine all student loans into one easy monthly payment
* Lower your monthly payments by up to 50%
* Get up to 20 years more to repay your student loans
* Get a low, fixed interest rate that lasts for the life of the loan
* No cosigner necessary for federal consolidation
* No origination or application fees
* No prepayment penalty

Interest rates and payments

Consolidation loans have longer terms than other loans. Debtors can choose terms of 10–30 years. Although the monthly repayments are lower, the total amount paid over the term of the loan is higher than would be paid with other loans. The fixed interest rate is calculated as the weighted average of the interest rates of the loans being consolidated, assigning relative weights according to the amounts borrowed, rounded up to the nearest 0.125%, and capped at 8.25%. Some features of the original consolidated loans, such as postgraduation grace periods and special forgiveness circumstances, are not carried over into the consolidation loan, and consolidation loans are not universally suitable for all debtors.

Top consolidation lenders ranked by total FY 2006 consolidation loan originations

Lender name	# of loans	Amt of loans ($)
Federal Direct Student Loan Program	1,169,110	$19,197,268,873
Sallie Mae	866,295	$19,841,423,841
Citibank	232,126	$4,843,119,089
Nelnet	198,624	$4,796,065,812
NextStudent	89,284	$3,320,024,025
JP Morgan Chase	115,777	$2,668,451,098
Goal Financial, LLC	111,426	$2,494,856,673
College Loan Corporation	75,360	$2,245,128,826
AES/PHEAA	166,730	$2,037,618,548
Student Loan Xpress	114,790	$1,880,997,383
Wachovia Education Finance	80,174	$1,674,979,763

» Read More...

Student loans influence your future financial decisions and your credit. When student loan debt has exceeded eight percent of your income, it can be seen as bad credit when assessed for further loans such as home loans. This may not seem very important right now, but student loan consolidation can have a positive impact on your financial future.

Two Approaches In Reducing Your Student Loan Debt

1. You could eliminate or reduce the primary balance.

2. You could reduce the monthly total payment. Given that debts are measured by comparing your income to the loan payment, if your payment is reduced, it can help you in improving your credit.

With student loan consolidation, you can merge all of your loans into a single loan with one payment per month.

When interest rates of loans fall, your education loans could be consolidated or refinanced.

There are many kinds of student loan consolidation plans offered today. When students do not consolidate their student loan debt, this will result in the inability to acquire future mortgages, car loans, credit cards, and other kinds of credit in many cases.

5 Benefits Of Consolidating Your Student Loans

1. Easy to maintain, single payments per month.

2. Enables you to have manageable repayments of your student loan after you have graduated, especially if you had huge student loans.

3. Student loan consolidation is also beneficial to those students who have graduated; but find that they're still having difficulties managing the payments of all of the student loans they acquired to cover their college fees.

4. A more organized and cost effective plan, with lower interest rates will help you save some money.

5. A long term plan to paying your loan, giving you a longer time frame to pay for your loan. A longer payment plan also means a lower monthly payment, which gives you more flexibility

It is very simple to apply for a student loan consolidation. While your application for student loan consolidation is being processed, it’s important that you continue to pay for the existing student loans.

The lending institution would pay all the existing loans if you qualify. You would then make the payments for your consolidated student loans.

If you are looking for an efficient and cost effective way of managing your student loans, then student loan consolidation may be the right option.

By getting a student consolidated loan today, you gain more financial freedom and you can save money through lower interest rates and at the same time improve your financial future.


Dean Shainin is a consultant specializing in student loan consolidation. Get valuable resources, tools, information and more articles on student loan consolidation, visit this site: http://www.studentloanconsolidationtips.com


Get free valuable online tips for debt consolidation from his: Student Loan Consolidation

website.

Article Source: http://EzineArticles.com/?expert=Dean_Shainin

http://EzineArticles.com/?Student-Loan-Consolidation---Thinking-About-Your-Financial-Future-Today&id=230848

» Read More...

Student Loan Consolidation Explained with Play-Doh

Advice and Tips on Getting a Mortgage Loan

» Read More...

Risking the wrath of the Mayan Gods, Van Mayhall has outdone himself with a terrific collection of risk-related blogetry.

What makes Van's Cavs so delightful is that he's obviously read through the posts, and includes his own take on them.

Do stop by (and don't miss the great Mayan digs).

BTW: We still have some slots available for early Spring 2013 - just email us to claim yours.

» Read More...

As in "The Golden State:"

"California officials are concerned that the federal government might scale back its share of the costs under [the ObamaTax] ... state officials fear that the Obama administration won't cover as much of the law's costs as initially planned."

What's so amusing about this is that the ObamaTax's official name includes the word "Affordable" yet California pols are only just now coming to understand that it is no such thing. They went ahead and (foolishly) set up their own Health Insurance Exchange, without fully realizing that the rules keep changing, and that they're going to be on the hook for implementing it.

As a direct result of how the ObamaTax is structured, "California is expecting a massive surge in its Medicaid rolls" which, of course, will be paid for (or not) by the state's citizenry.

As FoIB Patrick P (who tipped us to this story) puts it, "talk about a sure sign that the health care law is bad, even Moonbat Jerry Brown is worried!"

I'm thinking of a word...

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All this talk of the fiscal cliff is enough to drive you crazy. While the idiots in DC that can't balance their checkbook continue playing the blame game, it seems falling off the cliff may be a good thing for states in financial crisis.

In an example of federal and state tax law interaction that gets little notice on Capitol Hill, 30 states next year could collect $3 billion more in estate taxes if Congress and President Barack Obama do not act soon, estimated the Urban-Brookings Tax Policy Center, a Washington think tank.

The reason? The federal estate tax would return with a vengeance and so would a federal credit system that shares a portion of it with the 30 states. They had been getting their cut of this tax revenue stream until the early 2000s. That was when the credit system for payment of state estate tax went away due to tax cuts enacted under former President George W. Bush.

CNBC

Not only is DC ready to rob from the rich, but so are several states.

Merry Christmas.

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Thanks to FoIB Holly R, here's an interesting story about the confluence of medical tech and health care, with a dash of privacy and frugality thrown in:

"Those of us trying to lose some pounds after overindulging this holiday season can get help from a slew of smartphone apps that count steps climbed and calories burned ... technology lovers are testing homemade do-it-yourself devices on people eager to measure their mind and body."

Back in the day, pedometers were the go-to method for determining how far we'd walked on a given day, and (presumably) how many calories we'd burned by doing so. Now, their descendants are linked to GPS and other devices capable of tracking a slew of different metrics.

Which is all well and good, up to a point:

"[S]ome experts worry that the data collected could be used against users in the long run ... Two years ago, some users of a leading self-tracking brand, Fitbit, were logging their sexual activity as exercise and found the sex logs somehow popping up on Google searches."

Of course, anyone who still believes that we truly have any real privacy anymore (especially on-line) is sadly mistaken.

There's another facet to these new devices, as well:

"Chang raised $9 million for a new kind of tracker that he promises is "the world's first very accurate heart rate monitor on just a wrist watch � no chest strap, no other device" ... if the company turns a big profit ... it will be from selling the data aggregated on a smartphone app and analyzing it for you, the user."

After all, the raw data won't likely be of much help to most of us. But I can  foresee a metaphorical brick wall ahead: who, ultimately, will own that data?

Reason I ask is this:

"The small box inside Amanda Hubbard's chest beams all kinds of data about her faulty heart to the company that makes her defibrillator implant ... it apparently doesn't prohibit Medtronic from seeking to make a buck off that data."

It's possible, one supposes, that the User Agreements that come with the new apps will cover this, but how many of us actually read these?

Thought so.

» Read More...

Health insurance is changing. In case you have been under a rock for the last (almost) 3 years, what you thought you knew about insurance, and Obamacare, is most likely 100% wrong. 

The idea of a free market with increased competition to bring down prices is a lie. There will be no free market. Prices will rise, not fall. This is not Burger King. You can't have it your way.

Government has long elbowed its way into these free exchanges, setting rules and regulations for how buyers and sellers must act. Yet there comes a point when government�s prescriptions are so great, that they distort markets beyond recognition. The actors in the exchange are really just carrying out government�s dictates, not responding to the needs and desires of potential customers at all. 

The health care exchanges are meant for exactly such a bureaucratic takeover. Consider that states that establish an exchange will have to monitor what types of plans are bought and sold via the exchanges. While markets should have free entry and exit, states will be telling certain insurance companies that certain plans cannot participate in the so-called �marketplace.� This will shut out (usually smaller and less politically connected) companies from competing, and will limit the choices available to exchange participants. That�s exactly the opposite of a true market. 

Forbes

The government will decide what kind of coverage you need, and they will set the price. Carriers are just puppets manipulated by a power hungry government.

 Americans should be concerned as government gets into the business of controlling this flow of information. After all, what�s to stop bureaucrats and politicians from more strongly highlighting the benefits of health plans offered by, say, an insurance company who happens to be a political donor?

That's some scary stuff.

Rather than offering free entry and exit, voluntary exchange, perfect information, competition and choice, the exchanges will simply offer more bureaucratic jobs to monitor the redistribution of tax dollars in the health system. And as Americans instinctively know, bureaucracies tend to fail; markets succeed.

So true.

» Read More...

Here in southwest Ohio, we're getting our White Christmas a day late. It's quite beautiful, if treacherous, and the added treat of thunder-and-lightning is a real joy.

In that spirit, then, here are some interesting (if disheartening) health- and health insurance-related tidbits:

� First up, co-blogger Bob shares this news on the anticipated growing costs (both financial and otherwise) of treating folks with dementia over the next few years:

"The fiscal climate may be challenging, but the Alzheimer's Association is estimating that, unless the country finds some way to prevent Alzheimer's disease (AD), cure it or substantially improve treatments for disease, the condition will cost the United States alone about $20 trillion over the next 40 years"

� And as if that's not scary enough, turns out that those great Electronic Health Records mandated by the ObamaTax aren't necessarily safe from prying eyes:

"Security researchers warn that intruders could exploit known gaps to steal patients� records for use in identity theft schemes and even launch disruptive attacks that could shut down critical hospital systems." 

� If you're one of those folks classified as "poor," you're about to get even poorer:

"[F]amilies earning as little as $19,000 will face a tax up to $2,085 if they don't buy health care under Obamacare by 2016 ...  A family of four will face the highest tax, a penalty of 8 percent to 10 percent." 

� Finally, lest the rest of us think we've gotten off easy, here's a handy list of many of the new ObamaTaxes arriving in '14:

"Upper-income households. Starting Jan. 1, individuals making more than $200,000 per year, and couples making more than $250,000 will face a 0.9 percent Medicare tax increase on wages above those threshold amounts" [ed: lest you think these are "elites," remember that a great many of those in that bracket are business owners who may well have to scale back their companies - and your job]

And of course there's more at the link.

Happy Holidays!

» Read More...

Not that I would ever question my academic betters but a quote from my previous post raised another question;

"Hadidi paid $40,000 in Baltimore for pediatric orthopedic surgeon Shawn Standard to do a procedure called core decompression with stem cell implantation, which is not approved in B.C. for any child with the disease."

Where does this $40,000 get accounted for, in US spending or Canadian? I tried finding out, with no luck, how our national healthcare spending is calculated. Best I can find they calculate/estimate  what healthcare providers collect in revenue then divide by the US population(just citizens or census?), I can not find any reference to adjustments for care provided to foreign nationals. When our average spending is $8,400 per person it doesn't take many visitors at 40K+ each to skew this number. Unlike Americans going to foreign countries for affordable care, people aren't coming to the US to save a penny. Maybe someone knows the answer to how these numbers used to brow beat our system are calculated.

http://www.msnbc.msn.com/id/19809557/ns/health-health_care/t/foreigners-fret-over-funds-us-medical-care/#.UNpQFHdhse4

"Mayo Clinic in Rochester, Minn., which treated about 8,000 foreigners last year at its hospitals, including several hundred children.

The federal government does not track how many of the millions of people who come here on tourist visas are seeking medical care."

One patient who doesn't count in the average...

"Years of lobbying convinced the New Zealand government to cover the $1.4 million cost of Matisse�s planned transplants."

Do we really spend twice as much per citizen as any other country or is it some really sloppy academic work, or just outright propaganda?

» Read More...

NHS has long denied treatment to patients that received non-approved care, often from the US where we are more aggressive in trying to save lives. Canada is following their lead.

http://www.cbc.ca/news/canada/british-columbia/story/2012/12/14/bc-specialistdenied.html

"An eight-year-old boy with a rare childhood disease has been refused care by at least one Canadian specialist because his mother took him to the U.S. for a treatment not approved in B.C.

�When it�s your child, you feel outraged,� said mother Sima Hadidi, of Surrey, B.C. �He needs to be monitored. And you just cannot punish people because they didn�t do what you suggested.�

The same people that will be first to berate our system for spending twice as much as Canada or England would also be the first to demand an eight year old get this treatment or any other that might add even a day to his life; no matter the cost.

We can't expect the same cost outcome when we also insist on providing twice the care.

» Read More...

Interesting Christmas toast:

"When Ronald Aldom developed ventricular tachychardia, or an unusual heart rhythm, doctors decided to treat it a little unconventionally.Doctors gave a shot of neat alcohol, or pure ethanol, via a catheter"

As we learned at the beginning of the month, straight hooch has some incredible medicinal properties:

"Auckland City Hospital intensive care medicine specialist Tony Smith said administering ethanol was a well-established treatment for methanol poisoning."

Cheers!

» Read More...

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Under Obamacare, the federal government wants to rein in costs for Medicare and Medicaid patients. Starting in 2013 they will do this with a carrot and stick approach that rewards hospitals with "good" outcomes and penalizes those with "poor" outcomes.

All this sounds wonderful in principle, but what does it really mean?

The program is one of several Medicare is launching to make hospitals and doctors accountable for quality and more careful stewards of public money. In October, Medicare also began reducing payments to 2,217 hospitals because too many of their patients ended up back in their care within a month. Medicare already gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.

The way the program works is that Medicare is reducing payments to all hospitals by 1 percent, estimated at $964 million. It then calculated a score on how much money each hospital deserved to get back based on the quality of its care. While every hospital is getting something back, almost half aren't recouping the 1 percent they forfeited and thus are net losers.

Kaiser Health News

Studies like this have been tried before but I question the relevancy.

Under such a system, hospitals with the sickest patients would receive the lowest scores while those who treat individuals that are just sick enough to be in the hospital but don't really require specialty or acute care will have more positive scores.

If you read the article

New York-Presbyterian in Manhattan and Massachusetts General Hospital in Boston, both dominant hospitals in their cities, will have their payments reduced.

These large facilities handle a lot of high risk patients which can naturally skew their results towards the negative.

Treasure Valley Hospital, a physician-owned, 10-bed hospital in Boise, Idaho, that is getting a 0.83 percent increase in payment for each Medicare patient

I am sure this is a very good hospital, but what kind of patients are treated in a hospital that has fewer beds than a Motel 6? I can't imagine they are folks who need a high level of specialized care.

All this begs the question. If you operate a hospital that is in danger of being penalized because you handle a number of high risk patients, do you suppose they might have a tendency to "cherry pick" the healthier patients and let someone else take the really sick folks?

Seems like a way to ration care while maximizing profits.

» Read More...

Having lost round one of religious rights vs Obamacare, the founder of Hobby Lobby vows to take his battle to the next level.

A federal appeals court on Thursday refused to shield Hobby Lobby Stores from the Obama administration's contraception mandate -- and the fines that come with it for not complying -- in a blow to the largest employer to challenge the ObamaCare rule. 

In response, the Christian-owned company vowed to appeal the case to the Supreme Court. 

CEO David Green, who had taken his case to the appeals court after losing in a lower-court ruling, had argued that his family would have to either "violate their faith by covering abortion-causing drugs or be exposed to severe penalties." 

Fox News

We posted on this earlier, prior to the election.

That was then, this is now and it seems obvious that a country founded on the principle of religious freedom will be bulldozed over by the federal government's desire to control and dictate every aspect of our lives.

Apparently a woman's right to "free" contraception medication trumps our rights to religious expression.

If the Supreme Court takes up the case, it would only be deciding narrowly on whether to give Hobby Lobby a temporary reprieve, as opposed to ruling on the merits of the mandate itself. 

There are currently more than 40 cases pending against that rule, though the Supreme Court has not yet stepped into the fray. 

Which court will show up?

The one that blessed the Obamacare mandate but also decided it was a tax, or the court that says our rights as individuals shall not be trampled upon?

Thanks to Henry Stern

» Read More...

The Insurance Information Institute (I.I.I.) has some good advice: make sure your expensive holiday gifts are properly insured. Whether it's that beautiful engagement ring or shiny new HD television set, thieves and winter storms pose a risk.

A good place to start is a home inventory, and keep it updated regularly:



And don't forget to call your insurance agent to make sure that new piece of art or set of golf clubs (such a deal!) are covered for the right risks, and the right values.

» Read More...

If you've ever seen Elf or the Rudoph movie, you know that Santa's workshop isn't exactly a state-of-the-art manufacturing facility. Nevertheless, he and his hard-working assistants do face some daunting challenges, not the least of which include reindeer and elf injuries, potential mid-air collisions, and more.

According to risk management biggie Lockton, the big red guy will need "about $1.2 million to pay for insurance coverage.That will buy him peace of mind and about $1.175 billion in coverage for all of the exposures his workshop faces in the making and delivery of toys to children around the world."

Click on through to see all the other exposures the big guy may need to address.

[Hat Tip: FoIB Julie Ferguson]

» Read More...

Van Mayhall hosts the last Cav of 2012 next week. Entries are due by Monday (the 24th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

� Your post's url and title
� Your blog's url and name
� Your name and email
� A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

We've started scheduling 2013 Cav's, and need hosts for March and April. Just click here to grab yours!

Thanks!

» Read More...

As our existing health care system winds down, it's worth noting how even the most vulnerable among us benefited from it:

"[D]uring my wife�s pregnancy with our second child ... this fight changed from political to personal. This is Zoe�s story.The doctors examining the ultrasounds consistently made unwelcome suggestions during the pregnancy. They would find something �abnormal� on a test, and request another scan. At the rescan, they would rule out the first concern, but find another."

Sad, yes, but a story that's told many times every day, due in large part to the incredible advances we've made in medical tech and the like.

"In May, we were blessed with a beautiful baby girl. Three of her fingers were fused together ... We have met with various medical professionals to discuss treatment options. There were several possibilities discussed, and we were able to weigh these options for the best fit: Zoe�s surgery is scheduled for the day after Christmas."

So, a happy ending, no?

Well, for baby Zoe perhaps, but not her siblings or cousins yet-to-be:

"There will certainly be appointments before and after treatment that include the specialist and the primary care physician. Both offices are reporting that access to doctors is becoming more difficult. Both offices are reporting decreased options for medical services and for drug therapies. There is now a two-week wait for the doctor"

Wait a minute, Henry, this all sounds very familiar. Why is that?

Ah, so glad you asked:

"A seriously ill baby was forced to wait in an Accident and Emergency ward for more than 12 hours because there were no suitable beds available anywhere in the UK."

This is "health care" under a government-run  system. And it's only going to get worse in Jolly Ol' as "specialists yesterday warned the Department of Health about a national shortage of intensive care beds for children this winter."

Welcome to OUR future.

» Read More...

Come join Julie Ferguson as she hosts a holiday-themed edition of the Health Wonk Review. If you've ever wondered why Rudolph's nose is red, well you'll learn about that, too.

On a serious note, don't miss Jaan Siderov's very timely post on balancing privacy rights, Electronic Health Records and mental illness.

» Read More...

While I certainly appreciate the sentiment, I fear that stunts like this are counter-productive:

"South Carolina state Rep. William Chumley, R-Spartanburg, S.C., has prefiled a bill, H. 3101, that could make trying to implement PPACA in South Carolina a felony punishable by a fine and imprisonment."

Five other states have proposed similar legislation, but enforcement may be...um, problematic.

In this instance, it seems pretty clear that Federal law trumps state (although anyone with actual citations to the contrary is welcome - nay, encouraged - to share them in the comments).

The problem with this strategery is that it sucks needed oxygen from the far more viable efforts to derail the ObamaTax via Fed-run Exchanges. While the intent is certainly praiseworthy, these legal maneuvers are actually counter-productive.

» Read More...

 As many are aware, there is a serious ongoing dispute between the Obama administration and employers - particularly religious employers such as churches, hospitals and schools - over the issue of mandated coverage of contraceptives in medical insurance plans.  These employers have filed many lawsuits based on the First Amendment.

Within the past 2 weeks, the Obama administration has suffered two separate defeats in court.

Yesterday, December 18, in Wheaton College v. Sebelius, the U.S. Court of Appeals for the D.C. Circuit ordered that the Obama administration must rewrite its regulation:

"Health and Human Services Secretary Kathleen Sebelius cannot enforce the Obamacare contraception mandate as it is written, but must follow through on a promise to rewrite the rule to accommodate religious liberty".

This order was reported in the Washington Examiner here.

The Examiner also reported on this previous decision on December 7th.  In this decision, the United States District Court for the Eastern District of New York dismissed a DOJ challenge to Archdiocese of New York v. Sebelius.  The dismissal thus allows that lawsuit to proceed.  The Archdiocese of New York is contesting the same contraceptive mandate. 

In the earlier decision the trial judge noted that the president promised to accommodate the concerns of religiously-affiliated institutions - even while HHS went ahead and finalized the proposed regulation without change. The judge mocked the administration in his opinion, stating "�There is no, �Trust us, changes are coming� clause in the Constitution.�

» Read More...

Co-blogger Bob, FoIB Rick B and I have been engaged in an email discussion about carriers using their reserves to "buy down" current premiums. The uncertainties inherent in the ObamaTax make it even more complicated.

Rick got the ball rolling by posing this conundrum:

"When ObamaCare starts, how will carriers be assured of enough reserves to cover all the pre-ex that they�ll be paying?  You know there will be an obamaload of claims in the first few months."

Bob was quick to reply that "for certain they will get all the sick folks, just like what happened with PCIP. It won't take long for claims to exceed premiums. Of course the $63 per head reinsurance premium will help . . . . some. I doubt that money will flow quickly enough to really matter.

Reserves are for claim fluctuations and runoff claims. My guess is the carriers will start a new block for Guaranteed Issue (2014 business and later) and will run that as a separate line of business. Reserves will be established from excess premiums (ha-ha) and those reserves will be used to cover as much of the influx of big claims as possible. They can do some internal shifting of funds as needed, but in order to collect the reinsurance I am certain they will have to show losses.

A lot depends on the exchanges, subsidies, etc as to how much backlash there will be over being forced to give up the plan you had and the new premium levels.

I still maintain the feds don't have the money to pull this off nor will they have the mechanism in place to monitor everything, calculate subsidies, etc.

It will be interesting to say the least."

I was invited to join the fray, and wondered if there would actually be any reserves left. After all, it's not unreasonable to predict HHS Secretary Shecantbeserious mandating their use to subsidize costly new premiums.

Bob quickly jumped on that prediction:

"If HHS demands carriers use reserves to stabilize premiums, it is game over for the carriers. Statutory reserves are set by the states and designed to protect the policyholder (as well as the state guaranty fund). If reserves are depleted for this nonsense it jeopardizes the entire system."

[He says that if as if it's a bad thing, from Mme Secretary's point of view]

"Internally, carrier reserves are not one big pool but are separate accounting blocks. Statutory reserves by line of coverage, reserves by block (including closed books), claim stabilization reserves. There is nothing prohibiting the carrier from borrowing from one reserve block to shore up another but it is rarely done. States will conduct audits of carriers from time to time and if the reserves do not meet state guidelines the carrier is put on a watch list."

Mike disagrees with my premise altogether:

"This is not going to happen.  A reserve isn't a stack of money lying around pretending it's not profit.  It's really just part of claims already incurred that the insurance company must eventually pay.  One can argue about the level of required reserve, but HHS will lose any battle to use reserves as a  . . reserve.  As I've already said, "reserve" is a lousy name and induces people to misunderstand what they are.  Reserves are already committed to pay claims.  Therefore they cannot be spent a second time."

He also points out that " the cost of pre-existing conditions for people who buy a new policy on or after 1/1/2014 will be a cost the insurance company has not previously insured and which its premiums do not currently reflect. And therefore the insurance company will reflect the higher cost of its new policyholders on and after 1/1/2014 in its premium rates. It is from this latter group of policyholders - not the already-insured group -  that the obamaload of pre-ex claims will emerge."

Which brings us to yet another challenge: what happens when carriers, forced to use reserves to subsidize premiums, lack the funds to pay claims? Typically, that's where the states' Guarantee Funds step in, but it's not entirely clear what will happen when multiple carriers go down the tubes.

Perhaps the Mayans were optimists.

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North Carolina's Pre-Existing Condition Insurance Plan (PCIP) is shutting its doors to new business:

Seems they've run out of funds, and the state legislature has closed the purse. Two classes of folks are "grandfathered in," however: folks who are HIPAA-eligible and those who are eligible for the Health Coverage Tax Credit.

Some observations:

First, I found it interesting that the Tar Heel state's program allows folks coming off of COBRA to sign up (even after February 1). Here in Ohio, one must be uninsured (no COBRA, etc) for at least 6 months before signing up.

Second, it's hard to imagine that this isn't just the first hole in the PCIP wall - once the other 57 states catch wind of this development, look for at least a few others to follow suit.

Third, I found this caveat chuckle-worthy:

"If you are currently enrolled as an Inclusive Health member, this does NOT affect you. Your coverage and your renewal, if applicable, will continue."

6 words.

[Hat Tip: Jeff M]

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A very good question here is whether Xanax will be covered under the ObamaTax:

"President Obama pledged repeatedly that his health care scheme would not touch the vast majority of Americans who are satisfied with their coverage ... "If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period."

As we have seen, these are all lies. And now, on the eve of the Exchanges, and of massive rate hikes, Americans are more anxious than ever about how badly they're going to be mauled.

Wonder if dog-bites are covered?

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Remember when our Glorious Leader promised that the ObamaTax would lower health insurance premiums by 3,000%?

Good times, good times.

Of course, FoIB Avik Roy just had to harsh our mellow:

"Last week, Aetna ... held its annual investor conference in New York, in which company executives laid out their detailed assessment of the post-election environment for health insurance ... In some markets,� said Aetna CEO Mark Bertolini, increases in premiums could �go as high as 100 percent."

Luckily we've got a roaring economy that can handle that kind of pressure.

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Obama promised our health insurance premiums would be (redacted) by (redacted). Now that we are almost three years in to Obamacare and our premiums have (redacted) rather than (redacted), do we feel like we have been (redacted)?

Will our premiums really (redacted) when Obamacare is fully (redacted)?

The healthcare law provides subsidies for most people who buy insurance through a new insurance exchange. The law envisioned each state operating its own exchange, but authorized a federally-run fallback in states that don't act.

The statute refers to subsidies flowing through a "state exchange" � which, to the law's critics, means subsidies shouldn't be available in the federal exchange. The IRS has said it determined that Congress intended for subsidies to be available in both state- and federally-run marketplaces, but Republicans have pressed the tax agency to back up that assertion.

Camp and Issa � respectively, the chairmen of the House Ways and Means Committee and Oversight and Government Reform Committee, said their staffers were allowed to view certain documents about the IRS's decision-making, but only with heavy redaction.

The Hill

Will they they get the skinny on this issue or will they be (redacted)?

Stay (redacted)

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Seems like these days everyone wants to be in the health insurance business. The folks in DC are scrambling as fast as they can to earn your business via Obamacare and now hospitals want to be your BFF when it comes to insurance.

Piedmont Healthcare and WellStar Health System, two powerful medical organizations, are moving into a new realm: health insurance.

The hospital systems intend to create a health plan that will offer Medicare Advantage and commercial insurance in 2014, as well as serving the two organizations� employee base that, with their families, exceeds 35,000.

The insurance plan follows the announcement last month that Piedmont and WellStar had formed a collaboration to develop health care delivery models.

Georgia Health News

By commercial insurance I assume they mean major medical coverage on a group or possibly individual basis. They may or may not be gearing up to offer coverage to more than just their employees. The article seems to hint they will target local (Atlanta) employers.

I find it odd that a hospital system would want to jump into the fray now, with Obamacare and exchanges a little more than 12 months away. Health insurance carriers are hesitant to do too much until they get more direction from HHS, so why would a hospital be in a better position to gear up for this new direction?

Adding Medicare Advantage plans is even more puzzling. Not only are there compliance issues at the state level but you must get approval from CMS as well.

Makes me wonder if they really understand what they are getting in to.

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What happens when hospitals buy up doc practices? Well, they're now called ACO's (Accountable Care Organizations), but it appears that the only "accounting" is in the increased cost of that care. FoIB Jeff M tips us that:

"Some routine cardiac tests cost more than twice as much in hospital-owned clinics as they do in independent cardiology offices."

Or to put it another way:

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Here's an interesting thing:

"[HHS Secrreatry Shecantbeserious] expected to be running zero exchanges ... Congress has not yet appropriated the money to let [her] hire exchange employees."

So, no money, no plan, and no transparency.

Rotsa ruck, Kathy.

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The founder of Domino's Pizza is suing the federal government over mandatory contraception coverage in the new health care law.

Tom Monaghan, a devout Roman Catholic, says contraception is not health care and instead is a "gravely immoral" practice. He's a plaintiff in a lawsuit filed Friday in federal court, along with his Domino's Farms, which runs an office park near Ann Arbor.

Monaghan offers health insurance that excludes contraception and abortion for employees. The new law requires employers to offer insurance that includes contraception coverage or risk fines. Monaghan says the law violates his constitutional rights, and he's asking a judge to strike down the mandate.

The government says the contraception mandate benefits women and their role in society. There are similar lawsuits pending across the country.

Read more: http://www.myfoxny.com/story/20350175/tom-monaghan-sues-feds-over-new-health-care-law#ixzz2F8e7WNis

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As noted in our sidebar, the new ObamaTax Exchanges are due to go online in about 10 months. That is, if all goes well. But how likely is that?

You be the judge:

"Only 15 states have told the federal government they plan to operate health insurance exchanges under [ObamaCare], leaving Washington with the daunting task of creating online marketplaces for two-thirds of the country."

What's so amusing about this is that I have some pretty good second-hand knowledge of how this will likely turn out. My better half is a highly successful Professional IT Project Manager. When I shared with her how and when this whole Federal effort was supposed to play out, she shook her head in disgust. You see, she's worked on projects of this nature many, many times, and understands what's necessary to implement them.

I was also discussing this remarkable (unprecedented?) effort with co-blogger Mike, who told me of a seminar he'd attended, years ago, that included both executives and IT-types. At one point, Mike told me, the "suits" asked "why cant you just build what we want?"

To which the IT guys replied: "because you don't ever TELL us what you want!"

And this was in the profit- and success-driven private sector.

Rotsa ruck with this in the not-so-driven gummint one.

[Hat Tip: FoIB Holly R]

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Earlier this week, we posted our take on a recent HealthBeat blog post decrying the idea of raising the Medicare eligibility age. Forbes blogger (and FoIB) Avik Roy also weighed in, with a thoughtful and provocative post at The Apothecary. His thesis is that raising the Medicare eligibility age would be a major step in the right direction:

"[I]n fact, raising the retirement age will help free up resources that could be used to achieve true universal coverage in the United States ...  Obamacare subsidizes health insurance for everyone under 400 percent of the federal poverty level�$60,520 for a two-person household�lower-income seniors would be protected under any increase in the retirement age."

That sounds right to me, and Avik offers several more on-target rebuttals to those who oppose the concept, including the fact that the "Congressional Budget Office projects that this would save $148 billion between 2012 and 2021."

I suggest reading the whole thing, but I want to focus here on some of the comments folks left.

Two in particular stand out:

"[T]he Republicans did everything within their power to protect the status quo with regard to the 44 million working and yet uninsured Americans."

The fact is, the ObamaTax, even if/when fully implemented, will leave some "30 million non-elderly Americans" without health insurance. By design. So who are the obstructionists here?

This one did provide a nice chuckle:

"You appear to be supporting cost shifting from government to everyone�s pocketbook"

Self-awareness: how does it work?

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Hank just referenced this LA Times article that is dramatically headlined �Blue Shield of California seeks rate hikes up to 20%.�  The article also suggests Blue Shield �. . . use some of its record-high reserve of $3.9 billion to hold down premiums.�

The headline and article are misleading about rates, and the surplus suggestion is a bad idea that won't go away.

The rate discussion in the article is another example of the sensationalism typical of most media reporting on medical insurance.  The Times actually does supply a little good info  - but you'll find it only if you read past the first few paragraphs. That's also typical of medical insurance reporting,

In the very first sentence Times says:  �Blue Shield of California wants to raise rates as much as 20% for some individual policyholders� I think it�s clear that the Times means fewer than half of these policyholders  The individual market makes up less than 10% of all policyholders.  So fewer than 5% of Blue Cross policyholders are getting a 20% increase.  That�s not sensational, so the Times spun its reporting the other way.

The article goes on to state �In filings with state regulators, Blue Shield is seeking an average rate increase of 12% for more than 300,000 customers.� (the article suddenly falls silent about whether these �customers� are individuals or groups).  OK, how reasonable is 12%?

You must read down to the 13th paragraph (!) of the Times article to find out:

�The insurer said its medical costs for this segment of the business grew 10.6% and what it actually pays is rising 12.5% after adjusting for its portion after customer deductibles.�

Other insurers not only in California but all across the US are experiencing similar rises in their annual medical costs.  So it seems to me an average premium increase of 12% is perfectly reasonable. LA Times chose to sensationalize these mundane facts.  I'm not saying a 12% increase is something anyone will like.  I am saying 12% is reasonable based on the cost of medical care Blue Shield is obligated to pay for.  Remember, medical insurance premiums are high because medical costs are high.  Medical insurance premiums rise because medical costs rise.

LA Times also sensationalizes its discussion of surplus.  It says there are calls for Blue Shield to �use some of its record-high reserve of $3.9 billion to hold down premiums."  Well, are we expected to check our wits at the door when confronted by terms such as "record-high" or big numbers like "$3.9 billion"?

The Times lead source for these calls is Laurie Sobel, a senior attorney for Consumers Union in San Francisco: "Blue Shield is sitting on a huge surplus that is beyond what is required or necessary," and she said "It should be used to hold down rate increases when it hits these extraordinary levels."

Neither Attorney Sobel, nor Consumers Union, knows what level of surplus is the right amount, yet both are quite certain that present surpluses are too high.

Sobel also says the excess surplus �should be used to hold down rate increases�.  As Hank states, that�s a bad idea. It was a bad idea when Consumers Union touted it back in 2010.  It�s a bad idea now

Following CU�s lead, the Times swallows the notion that the BCA and regulatory minimum requirements are sufficient � ignoring the many changes in business conditions (including passage of PPACA and the MLR requirement as Hank notes) that have occurred since those minimums were established.  The shortcomings of the Consumers Union position were noted at InsureBlog back in 2010.

Consumers Union could do a better job of preparing when it advocates on this issue  - and so could LA Times.

One final comment.  One must read to the very end of the Times article  - the 24th and 25th paragraphs � to find this:

�Larry Kirsch, a healthcare economist in Portland, Ore said . . . "There ought to be a reasoned analysis for when is enough," Kirsch said. "There always seems to be a 'sky is falling' story. I say prove it to me."

Kirsch appears to be referring to insurance companies who claim the sky is falling.  But his comment applies with equal force to advocates like Consumers Union and the media who seem always show up with their own breathless claims that the sky is falling.  Kirsch is right though that analysis and proof are necessary to establish appropriate yearly premiums AND for the appropriate level of surplus each not-for-profit insurer should hold.  I�m certain Blue Shield provided a full analysis of their premium calculations in their rate filing with the State.   Perhaps it�s time for an industry-wide, rigorous update of surplus requirements.

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If you've been in an Ohio car or motorcycle accident, you'll soon meet up with an adjuster who wants to take a "recorded statement" from you. We typically advise our clients (or potential clients who call) not to give a recorded statement to the at fault party's insurance company (as we have discussed here), but for those of you who are contemplating giving one to the adjuster, the following guide may help you prepare for what you may be asked:

EXAMPLE OF A TYPICAL INSURANCE COMPANY RECORDED STATEMENT


NOTE: This was a recorded statement taken by our client’s own insurance company seeking information. The adjuster did not ask the client for a social security number because the client’s insurance company already had it on file.

These interviews are basically “scripted” and the questions are typical ones you’d expect to see in any initial “interview.” How do we know they’re scripted? In this case, for unknown reasons, the insurance company made the client go through two recorded interviews (both were given before the client hired us). Both interviews were essentially identical. The client’s answers have been deleted for obvious reasons.

1. Could you please state your full name?

2. Do you understand that this interview is being recorded?

3. Is it being recorded with your permission?

4. If I need to share the information with another adjuster, may I do so?

5. What is your address and telephone number?

6. What is your date of birth?

7. What is the year, make and model of the vehicle you were driving?

8. Are you the registered owner of that vehicle?

9. Were you using the vehicle for any type of business or government use?

10. Were there any minors or passengers in the vehicle with you?

11. What was the date of your accident?

12. Around what time?

13. How many vehicles were involved?

14. What street did this happen on?

15. Was the weather a factor in the accident?

16. Was the traffic light, moderate or heavy?

17. What happened?

18. What type of damage was done to your vehicle?

19. Do you know what type of damage was done to the other vehicles?

20. Was there any type of evasive action that was able to be taken to avoid the accident?

21. Were you under the influence of drugs or alcohol?

22. Were you using a cell phone or any other electronic devices?

23. Was anything obstructing your vision?

24. Do you know how fast the other party was going?

25. Do you know what the speed limit is on that road?

26. Was your vehicle towed?

27. Were you wearing your seatbelt?

28. Did your airbag deploy?

29. Were the police called to the scene?

30. Was there a report taken?

31. Do you have the report number?

32. Was a ticket or citation issued?

33. Were the vehicles moved before the police arrived?

34. Did the police take statements from the drivers?

35. Were there any witnesses that saw the accident?

36. Do you have the witnesses’ contact information?

37. Was there property damage to street signs, poles or anything else?

38. Were you injured in the accident?

39. What type of injuries did you sustain?

40. At the moment of the impact, were you thrown forward, backward or sideways?

41. Did any part of your body make contact with the vehicle?

42. Was there any ringing in your ears or popping in your jaw?

43. Did you have any deep cuts or lacerations?

44. Was there any emergency treatment performed at the scene?

45. Were you taken to the hospital?

46. What hospital did you go to?

47. Were you transported by ambulance?

48. What treatment have you received since the accident?

49. Do you know the name of your doctor?

50. What type of treatment plan are you currently on?

51. Are you taking any medication?

52. If you can rate the pain that you feel now, 10 being the worst, 1 being the least, how would you rate your pain?

53. Did you have any prior injuries that could have resurfaced because of the accident?

54. Do you know the total amount of your medical bills to date?

55. How much time did you miss from work?

56. Where do you work?

57. What is your position there?

58. Are there any physical requirements for your position?

59. What is the name of your immediate supervisor?

60. Do you know a phone number for your supervisor?

61. Are you paid hourly or salary?

62. How many hours do you work per week?

63. What is your salary?

64. Do you make any type commissions or bonuses?

65. How long have you worked there?

66. What type of medical benefits do you receive?

67. Do you know if any of the other parties in the other vehicle were injured?

68. Is there anything in reference to the accident that you would like to add that we have not discussed that we should know about?

69. Have you understood all these questions?

70. Is this recording true and correct to the best of your knowledge?

71. Has this recording been made with your knowledge and consent?

72. Would you state your name again please?

  

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