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Apparently not considered an "emergency-emergency:" https://t.co/iDMsfODxQL � Surgery Center of OK (@SurgeryCenterOK) August 30, 2018  From the article: " A patient waited 62 hours for an ambulance, while four trusts took more than 24 hours to respond to 999 calls, new figures have shown " Care worth dying for? 

So, lots of pixels being spilled over the newest "shiny thing," Association Health Plans (AHPs). These are a subset of MEWAs ( Multiple Employer Welfare Arrangements ) with a twist: by creating a new method of forming an AHP, some businesses (and self-employed individuals) may find obtaining coverage easier. But I want to focus on two pieces that I think are currently flying below the radar: First, under the new rules, an AHP may form with the express purp ose of purcha sing insurance.  Previously, groups such as this had to have a pr imary business purpose. This flies in the face of Insurance 101 tha t it's against public policy (and hence, the law) to form an association for the sole purpose of obtaining insurance (well, maybe not all "associations" ) . One wonders how the states (which have ultimate authority on these plans) will handle this. The National Association of Health Underwriters , provided a helpful presentation on these new rules, includ...

'Nuff said: Average Canadian family paying more than $12K to fund public health care: study | CTV News https://t.co/NBPwfSI3AJ pic.twitter.com/XhNZ7MnOLn � Sally Pipes (@sallypipes) August 19, 2018

We've long maintained that the true, over-arching goal of ObamaCare was to usher in single payer; after all, we've heard that directly from its creator's mouth . But it has, as we've come to learn, another even more obvious purpose. I'll let our friend Rich Weinstein explain: Thanks, Rich!

In case you missed it, five states that had sued the previous administration over an illicit tax have finally been vindicated, to the tune of almost a billion dollars: " Texas Attorney General Ken Paxton [led] a five-state coalition that on Thursday won an $839 million judgment against the federal government ... joined by Indiana, Nebraska, Kansas, and Louisiana " The states had sued because even though ObamaCare explicitly exempted states from this tax, his administration capriciously imposed it. The suit itself took several years to wend its way through the judiciary, and the plaintiffs were duly re warded for their patience: " Judge Reed O�Connor ... agreed on the statutory issue (the APA claim), striking down the Obama HHS rule because it violates the plain language of the ACA law. " It's interesting to me because this doesn't seem to have anything to do with the whole Medicaid expansion kerfluffle, which has also been a problem from the outset. In a re...

Amazing: "A bill being considered in New York would make it illegal for pet insurers to deny coverage on the basis of preexisting conditions." Surely a mandate, subsidies, and ban on cheaper alternative sources of care for relatively-healthy pets would be needed to make this work? https://t.co/vJbZh3ORFd � Chris Pope (@CPopeHC) August 24, 2018 These are, to be sure , excellent points: After all, fair is fair. And it's worked so well with people insurance. Actually , let's take this to its logical conclusion: since pet insurance falls under the category of P&C, not life and health, this same logic would dictate that auto insurers could no longer deny coverage to folks who've just totaled t he ir uninsured car s , or home insurance to those whose houses are currently on fire . What could possibly go wrong?

As President Reagan famously observed, " if you want more of something, subsidize it ." The result of this, of course, is that it then costs more. We see this every year with increased health insurance costs (which is not to say that the subsidies and risk-corridor payments are the sole causes), and of course we've seen it at work for decades in the world of higher education. Still there are doubters out there who need more concrete evidence of this (perverse?) relationship, and we're happy to oblige. Meet The Monied Morticians: " Predatory funeral homes have been accused of cashing in on Chicago�s relentless crime wave by taking advantage of a taxpayer-funded scheme that pays $7,500 in funeral expenses for homicide victims� families ." Leaving aside the root cause of this issue, it's hard not to see the direct and obvious correlation: when the government is paying for your groceries, you're going to be eating a lot more steak. And when it's p...

Health Wonk Review co-founder Julie Ferguson hosts this month's round-up of health care policy and polity. This one's a lot "meatier" than some of the more recent versions, lots of great posts.

Medicare premium costs for Part A are "prepaid". Most people have qualified for "free Part A coverage based on past Social Security earnings. Medicare Part B standard premiums in 2018 are $134. If your MAGI is above the threshold you may owe a tax in addition to your Part B Medicare premiums. This tax is an IRMAA tax. Medicare Premium Costs In addition to your Medicare premiums, you may incur additional costs for supplemental coverage, prescription drug plan or a Medicare Advantage plan. Most people pay nothing for Medicare Part A if they have at least 30 quarters of earned income and paid Medicare taxes on those earnings. Popular Georgia Medicare supplement plan premiums start around $100 per month in 2018. Popular GA Medigap plans limit your out of pocket expenses to the Medicare Part B deductible ($183 in 2018). Other Premium Costs Medicare Part D monthly premiums are as low as $12 in 2018. Many people do not pay a monthly premium for Advantage plans but that does not...

Well, hopefully , anyway: " Blue Cross and Blue Shield of North Carolina says premiums paid by Affordable Care Act customers in the Triangle will decrease more than 21 percent on average next year because of a new partnership with UNC Health Care ." By teaming up, the health insurance company and the health care provider seem to be blurring the lines between the two health care components, which may actually turn out to be a very good thing: " We no longer want to be in an adversarial relationship " A strange take on their current situation; perhaps there's a clue here? It's basically a modified capitated plan, where Blue Cross pays UNC a set fee per insured, with a mechanism to increase that for folks with more serious (or, perhaps, chronic) conditions, and an emphasis on quality of outcomes versus quantity of care. So far, it's set up as a pilot program available only in a select market of 10 counties, and premiums will be based on the insured's ...

As expected, the sale of Short Term Medical plans is abo ut to be banned in The Golden Sate: " The California Legislature has passed a bill banning the sale of short-term health insurance plans " These plans offer reduced premiums (and, of course, benefits) and have proven to be a popular alternative to expensive ObamaPlans, partly because they're partially underwritten and priced according to actual risk. But the folks in Sacramento think they're a bad deal, and have decided to deprive their citizens of choice in the health insurance marketplace. Of course, it's those citizens who elected these officials, so they really have only themselves to blame (or credit). The bill awaits Governor Brown's signature, which we presume will be forthcoming shortly, and the law will take effect this coming January. [Hat Tip: co-blogger Bill H ]

Medicare Part D, a prescription drug program for seniors on Medicare, was first suggested by President Clinton in 2000. Under the Bush administration the new drug plan became part of the 2003 Medicare Modernization Act and finally went live in 2006. One would think a government program 6 years in the making would have worked like a charm. But not only do gears grind slowly inside the beltway, but most of the big ideas are crafted by attorneys who lack real world experience. The PDP (prescription drug program) in 2018 is one of the most complex and misunderstood parts of Medicare. Not only is it confusing to the consumer, but many agents can't fully explain it. The result is, the most popular plan is often the one with the lowest premium and no deductible. And then there is this . . . Stable Premiums, Rising OOP Costs According to a NYT article, 73% of Medicare beneficiaries have a drug plan. Since 2006 premiums have remained mostly flat. Yet the cost of the drug program has rise...

In Part 1 , we reviewed the basic facts of the case of The Gilderhaus Family versus the Mayo Clinic [ ed: autoplay warning for that link ]. We left off at the concept of � the medical-legal establishment .� So what is it? Take it away, tsrblke: " I t�s the notion that through a partnership with the state we�ve granted a whole bunch of powers (either directly or indirectly) to medical professionals, and sometimes they actually use them. In this case we see it with the judgement of capacity. Yes, in theory, to have someone declared incompetent you need to go through the courts and show it. Practically speaking, however, judgements of capacity are made all the time by medical professionals and unless someone challenges it (and has the resources to do so) those professionals are usually taken as being correct. In this particular case we see how that can go horribly awry. Mayo didn�t just say Ms. Gilderhaus lacked capacity: they accused her mother of having a mental illness (even not...

Readers may be aware of a recent story from Minnesota [ ed: aut oplay warning for that link ] involving a young woman with a brain injury, her parents, and the famed Mayo Clinic. The gist is that she and her family were (allegedly) unhappy with her care, and sought to obtain it elsewhere. The Mayo docs put the kibosh on that, so the young lady's parents devised a plan to arrange her "escape." The folks at Mayo and those at CNN are at odds about what really happened; it seems to me that the latter have more credibility here than the former (yeah, I know). But the reason for this post is to present a primer on the medical ethics involved in disputes such as this. Regular reader and FoIB tsrblke has a doctorate in this discipline, and offers this explication: " Out of Minnesota we have an interesting case of a patient who left Mayo Clinic �against medical advice.� Was she kidnapped, or did she run away? Well that depends on whether you�re the family or the doctors ...

Some may recall the tragic story of a star-crossed love affair that ended tragically on the Hudson River on a Spring afternoon in 2015: " [Angelika Graswald] pulled the drain plug on Viafore�s kayak while they were paddling on the Hudson River in 2015 and watched him drown ." This seems to have been as cold-blooded a murder as I've ever read of, and compounded by the fact that she and the victim, Vincent Viafore, were actually engaged to be married. He had apparently named her as one of the beneficiaries of his almost half a million dollar life insurance policy. Okay, we know that criminals aren't allowed to profit from their crimes: arsonists don't get their houses paid off, murderers don't collect on their victim's life insur.... Wait, what's this? " A woman dubbed the �kayak killer� -- who drowned her fianc� by pulling the plug on the couple's small boat -- was awarded a portion of his $491,000 life insurance payout Monday ." How coul...

For certain values of "success," of course. Friend of mine ( Canadian ex-pat) just posted this on Twitter*: " My cousin just called. She was diagnosed with thyroid cancer in March, was put on the urgent list for surgery. It�s mid-August. �Oh well I just have to wait�, she says. Every day untreated means progression of disease. #CanadaWaits #socializedmedicinekills " Then : " It�s �a good cancer to have�, in that typically they can just cut out the affected organ. But who knows if, in the ensuing time, it�s affection other systems? " " I am so angry that people are treated like this. Six months almost with no surgery date. In a first-world, technologically advanced country ." From another friend in response : " I�ve had arguments online w/Canadians about how this kind of thing doesn�t happen & I�m a stupid American & don�t know what I�m talking about. A friend of a friend came to the US for hernia surgery because he was in excruciati...

Back in July, I posted my skepticism of a claim by Life Settlement industry players that insurers were ( surreptitiously ?) raising the cost of insurance in viaticated policies: " Some life settlement companies have responded to universal life cost-of-insurance increases by suing the life insurers  that issued the policies " Of course, they're free to pursue their own interests, but I suspect that they'll have quite the uphill battle. Why's that, Henry? Well, as I noted in that previous post, there's no mechanism for singling out specific policies for increases. For another, policies themselves have specific, stringent definitions on how, why and when these internal costs may be raised. I took the liberty of screencapping the relevant verbiage from one such policy I recently wrote (and which I believe to be fairly typical):    [click to embiggen] As one can plainly see, the cost of insurance (COI) is pretty well locked down, and applies to only a few specifi...

Medicare Open Enrollment. Not to be confused with Obamacare Open Enrollment. Time to review you Medicare Advantage or Medicare drug plan. Medicare supplement plans do NOT have annual enrollment periods in most states. Medicare open enrollment begins October 15 and ends at midnight December 7. Medicare Open Enrollment Pre-Planning Before enrolling in Medicare at age 65 for the first time, or planning your next move during Medicare open enrollment, there are things you need to do first. Make a list of all doctors including name, address, phone List all area hospitals, especially the ones you have used Make a list of all medications including dosage, refills, prescribing doctor and pharmacy Be aware of the donut hole and look for ways to avoid that trap Make use of generics and off plan purchases Look for FDA approved generics and ask your doctor before making a change If renewing, get your drug list ID and password date from your last drug plan finder If renewing, study your ANOC for cha...

In a promising development, a new kind of weapon in the fight against cancer is about to be deployed: " His oncologists delight in observing that if you saw Rulli on the street, you�d never guess he was sick. At 66, he still is 6-foot-1, still 215 pounds thanks partly to golf-course beer, still an easygoing husband and father of two children, now rejoicing in granddaughters " In 2013, Bob Rulli was diagnosed with a glioblastoma, a rare but extremely nasty brain tumor. I know, because I lost my baby sister to one a few months ago. These are almost always a death sentence, and difficult to treat; the average life expectancy is about a year and a half. Now, thanks to some true medical adventurers, there appears to be a real reason for hope, and so far it also appears to have few (if any) side effects): " On that day in September 2016, for the first treatment, Rulli spent the day at UC with Wise-Draper and Morris keeping vigil for bad reactions. He had none. He felt fine ....

So, FoIB Michael Bertaut offers 1,000 words on how Medicaid really reimburses providers, and its implication viz both Medicare and commercial health insurance: [click chart to embiggen] Money quote: " Every time she scans anything, the price drops dramatically. That $4 gallon of milk goes down to $2. That $10 worth of ground meat down to $5. That $2 loaf of bread to $.50!! ... The only other way out would be to raise your prices enough on everyone else to cover your SNAP shortfall ." Now apply this to health care. And by the way, co-blogger Mike wrote something similar a dozen years ago - great minds do think alike!

On the one hand (nine years ago): " Medical Mutual of Ohio, recently completed a study with the University of Michigan's Health Management Research Center; the study concerned MMO's own employees' experience with company-sponsored wellness programs ... Medical costs increased less year-over-year for employees who participated in Wellness for Life activities compared to non-participants ." On the other (6 years ago): " Workplace wellness programs sound like a win-win: Employees get discounted gym memberships or help quitting cigarettes, and their company gets a healthier staff and lower insurance rates ... Actuarial studies covering thousands of employees over the last 25 years or so don't bear that out.All these incentive programs really do is reward those with healthy lifestyles rather than forcing them to subsidize the additional cost of insuring obese tobacco users ." NTTAWWT . On the Gripping Hand (a few days ago, as tipped to us by FoIB Holly R)...

So the rocket surgeons at EBA (which, ironically, touts "benefits" in its very title) continue to double-down on the stupid: " Here�s one option advisors can help them explore: health savings accounts. These accounts, which are offered in combination with high-deductible health insurance plans " First of all, they keep conflating "High Deductible Health Plan" with "HSA-compliant" plan, thereby confusing laypeople (and irritating us pro's). As we pointed out o n Monday : " [U]ntil the age of ObamaCare, HDHP's meant HSA-compliant true Catastrophic coverage, no bells or whistles, just policies that paid for the truly disastrous claims (think cancer or brain surgery, for example) ." And second, they seem oblivious to the fact that HSA contributions are down for a very good reason: with premiums and out-of-pockets continuing to soar, who the heck has extra cash laying around to put in the account? They even offer proof of this in the...

So it seems that Britain's Much Vaunted National Health Service� has some competition in the race to the bottom . From our friend The Political Hat : " Canadian Hospital Pushes Euthanasia on Disabled Patient " As we've oft-noted, killing off pesky, expensive patients is a sure-fire way to rein in out-of-control health care costs. (And by the way: have we noticed yet that even nationalized schemes have been unable to keep health care costs in line? Just wondering) And it seems to be becoming a pretty routine, if final, "solution:" " Foley tells the man that he�s �always thinking I want to end my life� because of the way he�s being treated at the hospital and because his requests for self-directed care have been denied ." This is far form Dr K's assisted suicide apparatus: no matter what one thinks of that process, at least it was (ostensibly) voluntary. This is full-blown actively pushing for the patient to pull his own plug not for his own be...

We've long maintained that this notion of health care being a 'right' is fraught with peril: " The noble-sounding idea that "health care is a right" doesn't even pass the smell test: health care must be delivered by a provider, so if it's a "right" then that person is being forced to provide that care whether or not he or she is remunerated for doing so ." But it goes even further: if health care is a 'right' then, by extension, the government can force health care professionals to provide their service regardless. Think that's far-fetched? Well, our Neighbors to the North� are about to put that into practice in real-time: " Vowing to maintain public dental services in the province, Quebec�s health minister said Thursday he would sign a ministerial decree to block dentists from withdrawing from the public health system amid a bitter standoff over contract negotiations ." Now, I have no idea how much force of law t...

Medicare For All (M4A) has been front and center in health care news this past couple of weeks. Charles Blahous of Mercatus Center performed a study showing that the cost to move to this program would be $32 Trillion over 10 years. In his analysis he used some very favorable assumptions that the law would hit all of its targets - including dramatically reducing payments to health providers, reducing drug prices, and lowering administrative costs. Senator Sanders countered with a Tweet claiming that the study shows that our country will save $2 Trillion dollars in moving to M4A. He thanks the Koch brothers and Mercatus for "proving" that his plan will work. So where does the savings and funds to pay for the government program of Bernie's? If you read the media reports it will come from higher taxes, elimination of the insurance industry, and pay cuts to doctors who will accept 40% less at Medicare reimbursement. On top of the likelihood that M4A will have to double tax r...

Take steps... get paid. Get sleep.... get paid. Repeat. Try the Humantiv App, earn Medit: https://t.co/HWesSt5wgl Bonus: $200 Medit just for signing up. pic.twitter.com/yOMypggIVY � Citizen Health (@CitizenHealthio) August 2, 2018 Hmmm. On the one hand, monetizing my health habits (or lack thereof) is appealing. OTOH: This smells so much of Big Brother. On the Gripping Hand: not sure how'd I'd be harmed even if the data were hacked. What say you, dear readers? (And would love to hear your thoughts on this in the comments) Humantiv App vs Fitbit: Yea or Nay

Medicare doesn't cover everything. Here is a partial list of what is not paid by Medicare. Routine dental care, dentures, crowns, bridges, routine eye exams, eyeglasses, contacts, cosmetic surgery unrelated to illness or injury, OTC vitamins and supplements, hearing exams, hearing aids, long term care, medical treatment outside the country. Most of these items were not covered by your employer group health plan either. Things like vision, dental and hearing were covered by insurance plans OTHER THAN your major medical. You probably had a separate plan for dental and another for vision care. Different policy. Different insurance carrier. Should You Buy Extra Insurance? In many cases you can purchase separate insurance coverage for the following. - dental care - vision coverage - hearing exams and hearing aids - international travel medical - hospital indemnity - cancer plans - critical illness The list goes on. But before spending good money on these kinds of insurance, ask yourself...

Tweet from EBA Magazine about Congress' current effort to expand HSA's: 3 things to know about Congress� effort to expand #health #savings accounts https://t.co/U6Gov4LJ18 #healthcare � Benefit Adviser (@EBAmagazine) August 2, 2018 Thing is, folks in the "benefits press" (for lack of a better term) keep referring to ACA-compliant "High Deductible Health Plans" as if this has any actual meaning. Okay, Henry, what the heck are you going on about? Well, until the age of ObamaCare, HDHP's meant HSA-compliant true Catastrophic coverage, no bells or whistles, just policies that paid for the truly disastrous claims (think cancer or brain surgery, for example). Not low cost maintenance meds, flu shots or simple primary care. In other words, what insurance should be . Now comes O'Care, with $6,000+ deductibles and $14,000+ out-of-pockets, but with a panoply of first dollar preventive care "benefits" (well, mostly just for women ), and premiums t...

From FoIB @dabz: If ObamaCare Is So Great, Why Do Its Backers Want To Block All The Exits? https://t.co/sWvWNaq7sR via @IBDeditorials � G�mm�nt H?althcar? ??f�s??�? (@dabzs) August 3, 2018 Well?

Well, it's that time of year again, when agents must decide whether or not to participate in ObamaCare Open Enrollment (this year: v6.0). For most folks, this year's festivities run from November 1 through December 15 for a January 1, 2019 effective date. I say " most folks " because DC and Golden State citizens have their own, quirky schedules: " California has enacted legislation that permanently establishes different enrollment dates within the state, both on and off-exchange. From now on, open enrollment in California will begin on October 15, and end on January 15. So for 2019 coverage, California residents will be able to enroll starting on October 15, 2018, and will have until January 15, 2019 to enroll ." Californians who sign up after December 15 will have February '19 effective dates. " [O]open enrollment in DC will begin November 1, 2018, and will continue until January 31, 2019. DC residents who enroll between December 16 and January 15 ...

Way back in 2013 #JohnHawkins had this to say about Obamacare. No one has a crystal ball but he got some things right, and some not so right. What he got right. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.�   Well, that promise turned out not to be true and I can tell you that from personal experience. - https://townhall.com/columnists/johnhawkins/2013/10/29/i-lost-my-health-insurance-because-of-obamacare-n1732782 Mr. Hawkins was notified he would be losing coverage well before the clock struck midnight ending 2013. It's difficult to blame my insurance company for that (cancelling his coverage). After all, it's hard for a service to be viable when the government forces consumers who buy it to pay a massive new tax for the privilege Yup. Currently, I pay $191 per month. That will go up to $274. That's nearly $1000 a year more for a service that I already have. In addition, the deductible ...

Our Betters in DC� have released their final regs on Short Term Medical plans. On the only piece that truly matters, they fall short (again): " Such coverage can now cover an initial period of less than 12 months, and, taking into account any extensions, a maximum duration of no longer than 36 months in total " The good news is that they've lifted the 3 month max, the bad is that they've left a potentially huge gap in that 365th day. Still, one should avoid letting the perfect be the enemy of the good, and this is at least a step in the right direction. As to why they've made this change, well, let's just say that ObamaPlan signups have been ... disappointing : " [T]he number of people enrolled in the individual market without subsidies declined by an alarming 20 percent nationally in 2017 ... Many state markets experienced far more dramatic declines, with unsubsidized enrollment dropping by more than 40 percent in six states " Ooops. Now, it's ...