What’s happening with health insurance enrollment

The open period was supposed to start in October and go to Dec 31. That would allow the ins companies to get set for the 2015 year. The previous March deadline was set because they knew few people would sign up right away.
The rates for this year are going to be very high and a lot of employers will drop out. I am expecting a 25-50% rate hike and many people are going to lose their subsidies as the data gets cross checked with the IRS.
Overall the destruction of the health insurance industry is working quite well and there should soon be no other choice but what is offered by the government as in Medicare. Already the exodus of good doctors has started and health related businesses, like the Scooter Store, are going bankrupt and closing. This is going to be a big downturn of 16% of the economy.
Coventry is essentially already out, Aetna remains in a diminished capacity. Blue Cross Blue Shield of Delaware is gone, absorbed by Highmark. The Delaware Health Commission released its plan this week and it disingenuously presumes a constant insurance market which the State can control. The truth is everyone wants a single payer system, everyone also wants to BE that single payer.
And yes, doctors are quickly moving to drop Medicare and Medicaid and some insurance altogether. Many are simply retiring. Some of my close colleagues are retiring by this year’s end and all are younger than me, mostly family practice. Everyone assumes that when control is established  that doctors will just work for less, but to the contrary, they just won’t work. This is the consummate flaw in Ezekiel Emanuel’s thinking. He says that they will have to work as told, but the truth is doctors will not be forced to practice bad medicine and, by and large, they can afford to quit, so they are and will in droves.
On a national and local level, Walmart, Home Depot, Walgreens, and Target have all cut back health insurance for those working less than 30 hours/week. On a local level,  Highmark just had its premium increases cut dramatically by Insurance Commissioner Karen Weldin Stewart, which means that they will not offer some products. They cannot calculate the rates now because the sign up period has been delayed onset until after the election cycle. On good background I believe that Highmark will withdraw risky insurance products in the Delaware market.
On a very anecdotal level, one of my patients who employs 47 people has directed his human resource person to fire 5 people so as to be well beneath the 50 person threshold for ACA. This is just as a precaution, in case they 50 employee mark is hit inadvertently.
The White House Administration has declared a moratorium on data release from CMS and the Federal Exchange Website.  I do not find any reason to be optimistic about the landscape.

Dr. Casscells, Director

Center for Healthcare Policy

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Benefits of Rent a Captive Insurance

The desire for alternate risk financing has led to the creation of captive insurance. Captives are privately owned by businesses that front capital to protect themselves against loss. If an organization needs the flexibility of alternate coverage but cannot afford the expense of set-up and operation, rent a captive could be a viable option.


Structure of Coverage


The owners of a captive determine the structure of coverage, and can tailor it to specific needs. Premiums are invested for the benefit of the participants, providing capital gains for the members. Groups have access to reinsurance, and tax breaks are available for certain configurations. The result is more complete protection at a lower cost.


Renters in captives share in the advantages of individually structured insurance. It is especially helpful if they have been paying hefty premiums for policies that fall short of handling their particular requirements. More control allows coverage of uncommon or unusually high risks.


Risk Management Incentives


Instead of basing coverage on reported events in general, captive insurance addresses individual exposures and funds them in advance. Economic advantages of this system depend upon low frequency of claims. Participants in the group benefit from the members’ active measures to reduce incidents, as the results directly affect cash flow.


Alternative Solution


For a company with high insurance costs and limited capital, the alternative risk funding of rent a captive may be an optimal solution.


photo credit: Dwonderwall cc

If you were paid to brush your teeth, would you take the money?

CRI predicted years ago charity care would soon become a thing of the past. That’s because the Affordable Care Act, which just about everyone calls Obamacare, is set up to remove charity care from the equation.

Charity care is free healthcare many doctors provide as a service to the community. There is (or was) no financial incentive; a doctor did it because he or she believes in helping their fellow human beings. This was a way for very poor people and/or those who don’t have health insurance to receive healthcare they could not otherwise afford. Well, no more (in Delaware at least):

State to cut ‘charity care’ for near-poor

Delawareans pinching pennies near the federal poverty level – making from $16,100 for an individual to a maximum of $47,700 for a family of four – will lose health coverage through the state’s Community Healthcare Access Program (CHAP) starting Feb. 1, state officials said late Monday afternoon.

CHAP is a state-run program that offers discounted medical services for those not eligible for Delaware’s Medicaid program. The state earmarked $478,000 in tobacco settlement funds for the program this fiscal year.

CHAP recipients are ineligible for Medicaid either because they are undocumented immigrants or make more than 138 percent of the federal poverty level, Delaware’s cutoff for Medicaid assistance. The federal poverty level is $11,670 a year for an individual.

State officials said they will offer an alternative to CHAP on a case-by-case basis, only for those who can prove they are ineligible for other plans or are exempt from the federal insurance mandate.”

Now some of those who were on this program were individuals not legally authorized to be in the country. However, some were and will no longer receive help, and even for those here illegally, most medical professionals will tell you their desire is to help everyone who needs it, no matter what, because it is their calling.

“This is charity care and charity care more or less will be going away based on the mandate that everyone must have health insurance,” said Rita Langraf, secretary of Delaware’s Department of Health and Social Services, referencing the 2010 Affordable Care Act’s requirement that everyone should have health insurance.

The department is taking that mantra seriously. Landgraf said the state will continue to offer coverage for the undocumented population past Feb. 1, but CHAP recipients who make up to 200 percent of the federal poverty level will need to find new coverage.”

This is another problem. DHSS Secretary Landgraf is saying the state will ensure those not authorized to be here will receive benefits not extended to American citizens. Why? Because ACA mandates that all citizens must have health insurance- note the bolded words.

The main reason charity care is disappearing is because the government will begin reimbursing doctors for care previously provided as charity. This means taxpayer dollars will flow into doctor’s pockets for services they were going to perform anyway. If you were going to do something you always did, say brush your teeth, and the government offered to pay you to do that, would you turn that offer down? Most people would not and thus the government is ensuring a larger budget deficit for a service they don’t need to pay for. The other thing this will do remove the “good samaritan” role of medicine, eliminating volunteerism in favor of “rent-seeking” from the government (seeking public money for private bank accounts).

The health insurance exchanges open on Saturday and we were now only hours away from knowing what the 2015 insurance rates will be. If you haven’t yet received a letter notifying you of your insurance status for 2015, you will get it very soon. On Thursday CRI will publish another article on healthcare breaking down the new rates, discussing what you can expect going forward, and discussing how you can Impact Delaware!


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Unless you’ve been off the planet or are living in a cave with Crocodile Dundee, you know today is Election Day 2014. Hopefully if you are reading this and you are an American citizen, you either a) voted already or b) are going to vote sometime today.

While we at CRI cannot tell you who to vote for, nor would it be in our interest to do so, we can encourage you to vote. The main reason CRI exists is to get people to make the different at the polling place. All of the white papers, articles, editorials, speaking engagements, radio appearances, newspaper quotes, and e-mail newsletters will make not one iota of difference if you don’t vote.

How will Delaware, or any of the other states, change public policy without your voice being heard? Politicians care more about today than any letter to the editor, blogpost, or tweet you could ever send out. Today is when change in our government becomes official. The only way to end the prevailing wage, repeal the ACA, provide Education Savings Accounts to all parents for their children (and grandchildren), pursue policies which reduce electric rates and make energy prices more affordable, eliminate the gross receipts tax, reduce personal income and corporate income taxes, and reduce the power of state agencies to make your life miserable through excessive regulation, is to vote.

We know it can be frustrating- you feel as though your vote is one of too many and it won’t matter. You feel as though no matter who you vote for things in government won’t really change. Maybe you even think elections are rigged (though we at CRI don’t believe this!) so you won’t bother showing up to the polls or casting an absentee ballot.

But if millions if people like you have that attitude, then only the most partisan voters or those with a lot to gain/lose directly will show up. They will reward politicians who cater specifically to the groups most likely to show up at the polls.

Therefore, if you haven’t yet voted, go out and vote this Election Day, and remember,


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