Category Archives: Healthcare/Insurance

Illogical Response to Simple RTK Request – Pennsylvania DPW Digs in on Healthy PA

HealthyPA

Healthy PA is Pennsylvania Governor Tom Corbett’s idea for unconventional optional Medicaid expansion that would require a waiver from the Federal Government.  As part of the process the Department of Public Welfare held a series of hearings around the Commonwealth, soliciting public comment via strictly limited three minute turns at the microphone.  Written comments were accepted at the same time or separately through January 13, 2014.  This video is the Power Point presentation that preceded public comments at each meeting.

I was able to get a total of nine minutes to comment by attending three of the eight hearings.  At two of the hearings I spoke unscripted and at the Harrisburg hearing January 9, read a prepared script which I then left as a written submission.

My intention was and is to publish some observations on the hearings.  I took notes but made no recording, especially since the presenter’s comments were being transcribed either by manual input or voice recognition and appeared on a large screen facing the audience in real time.  DPW says they intend to publish a summary of the comments with responses prior to the waiver request submission, but I wanted the verbatim account in the transcripts, both to read comments of others and publish my own unscripted remarks as they were presented.

I called DPW to let them know what I wanted.  They said I would have to go through Right to Know to get records they never suggested do not exist.  So that is what I did in a simple straightforward request.  Today, within the required period, I got an answer.  My request is being delayed for up to 30 more days for the following reasons:

    • Your request is under legal review to determine whether a requested record is a “public record” for purposes of the RTKL
    • The extent or nature of the request precludes a response within the required time period.

I simply cannot buy either of these excuses.  How can they solicit public comment, which anyone had the right to record, obviously make a direct transcription of it, and then suggest it may not be part of the public record?  Then too, why would it take longer than a week to give the records to anyone who properly requests them?  Would the fact that they know me to be a detractor from Healthy PA have anything to do with their response?

Also I wonder why any of this should be necessary.  Yes, I did have a right to record the event but chose to not do it.  That said, how much trouble would it be to require all public meetings to be voice recorded (if not video also) and posted within hours online so anyone unable to attend in person could listen?  It seems that would be a very easy but very significant improvement to our Sunshine Act and Right to Know laws, greatly improving transparency, as well as saving costly clerical efforts in situations like this.

While I’m waiting for bureaucratic determination involving legal experts, what follows is my prepared text I read at the final Healthy PA hearing in Harrisburg on January 9.  Among what mostly amounted to various interest groups slithering up to the Federal money trough, or those objecting in favor of unaltered Medicaid expansion, or those complaining of any suggestions whatsoever of personal responsibility (as exist in Healthy PA), or even one arguably socialist Republican house member passionately pleading to not delay grabbing Federal money one more day, there was this:

Comment to PA DPW hearings on Healthy PA

Despite its good intentions Healthy PA is a misguided and dangerous additional step in the direction of fiscal insanity.  First let’s think about the insidious lure of “Federal” money.  Federal money IS our money.  It comes from the pockets of Pennsylvanians or is imposed as a crushing debt on our children. 

While Healthy PA is not exactly an expansion of the existing failed structure, we know there are better approaches to the entire Medicaid program.  We can see the results of situations where people are empowered with ownership of accounts they control.  We know how spending one’s own money can control overuse, encourage wise use, and reduce fraud.  Healthy Indiana showed how money can be saved by giving it away-such is the power of ownership! Knowing this we should insist that any expansion only be considered after first changing how we run the existing system, using savings wrung from it, except in this “partnership” arrangement the rules only go in one direction, from the Federal Government top down.

We also know of suggestions to boost the number of and participation in free charity clinics, where doctors can operate outside the crush of burdensome regulations.  We’ve passed Act 10, and HB1760 sits in our Health Committee and would not need a Medicaid waiver.

While any state would put itself at an extreme financial disadvantage by exiting the Medicaid program entirely, we also know that if every state did so we would all be better off.  The added layer of Federal bureaucracy and administrative expense could be used to treat needy sick people. 

Think then where we are today.  Here we stand asking a powerful central authority to give us permission to do what should be the absolute right of free sovereign states and people under a constitution unique in the history of the world.  This is America upside down.   This is a great nation in decline.  Healthy PA is further participation in that decline, and it’s time we stop allowing it to continue and expand. 

Rather than making a stand for commonsense solutions we do understand, by becoming leaders for freedom, educating our citizens to what really would work to the extent they understand and demand it, we succumb to expediency, dare I say, political expediency, in an election year.  It’s time we act like the sovereigns we are and end this bowing to a powerful central authority in Washington DC that is changing the fabric and face of America.  Thinking beyond ourselves to generations yet to come we would set Healthy PA aside and choose a different path.

Submitted January 9, 2014

Todd Keefer, York County

Note: This article shared to WatchdogWire-Pennsylvania 1/27/14

Open Letter to PA Insurance Commissioner Michael F Consedine

Michael F Consedine
Commissioner
Pennsylvania Insurance Dept
 

In an October 31 article I questioned whether states could cross the line and offer non qualified health insurance policies along side those conforming to the Affordable Care Act.  I argued a prohibition of this amounts to an assault on freedom to enter into contracts, protected by Article 1, Section 10 of the United States Constitution, and Americans should not be strictly bound to accept only contract terms dictated by a strong central authority in Washington DC.  I noted a long-standing tradition of state regulation of insurance under McCarran-Ferguson 1945.

Only rarely prior to Obamacare had the federal government stuck its nose into insurance regulation, and as far as I know, that only involved health insurance, never any other form.  Insurance regulation was something understood to be handled by the states.

Then Obamacare stood everything on its head.  The federal government would now decide what proper health insurance must look like, that is until this past week when they realized they were in over their heads with an avalanche of policy cancellations and a failed exchange website, upon which they said, in effect, the states are once again good enough to take the reins, if only to bail us out for a while, attempting to shift the focus of public frustration somewhere else.  We broke it.  Now you can fix it.

Prior to realizing the magnitude of the crisis they created, the feds assured us their new policies were somehow better than those “inferior” policies being cancelled, providing more “coverage” that would cost less (after applying money taken from others).  In my mind this is just more lies on top of the big “you can keep your coverage and your doctor” lie.  Yet the biggest insurance lie may be the one we tell ourselves.

As Commissioner of a state insurance department, Mr. Consedine, you should understand the commonly held public misconceptions surrounding the purpose and use of insurance, the notion that somehow low or no deductible, low or no copay, cover everything policies are, in reality,  anything more than costly third party prepayment schemes that benefit no one more than the company that sold it.  Yes, I do mean those dressed up Yugos we call Cadillac plans, as the most extreme example.

You should know that the purpose of insurance is not “coverage” but limitation of risk, to protect assets and provide protection beyond the ability to afford otherwise, and that any attempt to “insure” the ordinary, everyday, or expected is a fool’s game that only insures the incentivized overuse of others will be in your premium.  Yet the warm and fuzzy feeling provided by the illusion of free or almost free when one gets theirs, blinds many people to the fact they are paying for everyone else’s overuse when not getting theirs. It truly is a costly false comfort based in feelings rather than facts.

Indeed, if there is blame for the insurance companies, it is their failure to disclose that what most people say they want is not in the best interest of the vast majority of those saying they want it.  This is the price of a nation poorly educated in personal finance and basic economics.  It is also the challenge of ever hoping to attain real reform.  Insurance companies will continue to maintain their silence as the low end false insurance part of their business is to them as slot machines are to casinos, providing a license to predictably print money thanks to huge numbers narrowing the range of possible outcomes.  Is not insurance, after all, a business based in statistics and probabilities?

Crazy talk?  Then check out Paul Hsieh’s op-ed, “The Only Obamacare Fix Is For Obama To Legalize Real Health Insurance”, published by Forbes this past Sunday.  It is essentially everything I’ve been trying to tell you.  Obamacare thus, rather than fixing anything, only takes a problem and makes it worse!  You should realize these facts, because, after all, you are a Commissioner of insurance.

What you may not realize is the developing movement by physicians to direct pay cash only practice models, such as AtlasMD, a pioneer three physician concierge practice in Wichita, Kansas that offers a family of four unlimited primary care for $120 per month, plus access to wholesale prices on medications and laboratory services.  With the overhead and hassle of third party payers removed, they limit their patient load and offer same or next day appointments that average half an hour and even provide home visits!  This can likely be the future, especially with the availability of low cost catastrophic “real” insurance to compliment it, so long as it can be found.

That’s where you come in, Mr. Consedine.  I know you’ve been complicit with Obamacare from the start, even favoring Pennsylvania’s setting up its own exchange.  Your attitude has been that it’s now the law and we must follow it.  I don’t agree because of the magnitude of the intrusion of Obamacare on our freedom, but respect your view.

Under that same law, though, it is perfectly legal to pay a tax and do absolutely nothing in protecting others from ourselves.  Can it make any sense then, that those same people willing to pay the tax and even forgo the subsidy, should not be able to do something significantly more than nothing in protecting their neighbors from having to pick up for them?  How can anyone argue against that?

As Insurance Commissioner along with our legislators, Pennsylvania should make a stand and tell the federal government that in our state, we will offer qualified policies as required, but also non qualified policies for those who prefer them.  How can doing nothing to protect others be legal but doing something more be illegal?  That makes no sense whatsoever.

Finally, if you don’t think you can make a stand for choice, freedom, truth, limited central government, and local control, then please resign so we can find someone who will.

Thank You

Todd Keefer

Note: This post shared to WatchdogWire-Pennsylvania

Can Obamacare’s “Barrycades” to Insurance Freedom be Crossed?

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Gettysburg Battlefield Aug 13 2013

Not so unlike the fences, signs and traffic cones used to unnecessarily block Americans from their open space national treasures during the recent Federal Government shutdown, similar “Barrycades” to healthcare and insurance freedom are limiting Americans’ ability to freely enter into contracts on terms they decide are right for them.  As the millions having their health insurance policies cancelled are learning, there is currently not an option to simply pay the tax, if necessary, and even forgo the subsidy for those willing, in order to keep a health insurance policy they may have owned for years.

While the freedom to contract, as provided in Article 1, Section 10 of the United States Constitution may seem clear to many, who likely consider it one of our foundational rights, it has endured a surprisingly rocky history in our courts, and as such, provides no guarantee of support against the impositions of the Affordable Care Act.  In America today, Obamacare is erecting barriers to contract freedom by attempting to restrict terms of health insurance policies to those dictated by powerful government bureaucrats, in total disregard of individual choice or basic considerations of sound personal finance.

Especially hard to understand is that a tax can be paid to legally remain completely uninsured, yet plans not deemed “qualified” are not supported as better than nothing (and in many cases completely adequate) in relieving others of ever having to pick up for those without the resources to fend for themselves.  Wasn’t that the stated goal all along?  Like so much of Obamacare, this makes no sense and can only be about elitist control, a step into socialism Americans used to think only happened elsewhere.

Also, with a growing healthcare freedom movement by doctors to eliminate third party payers entirely, from at least primary care, by the establishment of direct pay cash-only pay-per-use or concierge practice models, other options will be needed for those who choose this interesting, and so far, legal alternative.  The use of still available critical illness insurance, as a proxy for unavailable pure high deductible insurance that would make much more sense in these situations, has been suggested.  Dr. Merrill Matthews, of the Institute for Policy Innovation, in a recent article in Forbes, shows how being wrapped in a cloak of life insurance has allowed the critical illness insurance option to survive, and may be a good choice, if not ideal, for many.

As I wrote in a post last December, the curious Miscellaneous Provisions, Subtitle G, Section 1555 single paragraph in the Affordable Care Act clearly says that issuers of health insurance are not required to participate under the act, nor can fines or penalties be imposed for choosing to not participate.  When this is combined with the option for states to regulate insurance, as has been tradition under authority of the McCarran-Ferguson Act of 1945, questions arise as to what states may still be able to do.

Even under Obamacare currently, states may add to the essential minimum benefit requirements of insurance needed to “qualify”.  So states are still involved in their health insurance regulation, if only to a much reduced degree.  A question is how far that authority goes the other way.  Could a state right now, in answer to the current mess of cancellations along with a failed exchange website, exploit the crisis to require the suspension and reversal of all policy cancellations within its borders until the exchanges are fixed?  Could they allow and even require companies that want to sell health insurance in their state to offer the choice of non qualifying plans along side or in place of (Section 1555) Obamacare compliant plans, sold off the exchange, now and in the future?  Could states take charge of the situation to the point that, if Obamacare cannot be eliminated, there could remain legal alternative insurance options apart from Obamacare, even if the federal tax would be due and subsidies not available?

Senator Ron Johnson of Wisconsin has made an attempt to settle this question at the Federal level, at least for currently existing plans, with the introduction of what he calls the “If You Like Your Health Plan, You Can Keep it Act“.  Current political reality makes actual passage unlikely, of course, returning to the possibility that states could act on their own.

One of those I respect most in the Obamacare debate, Michael F Cannon, at Cato Institute, told me the Supremacy Clause would make my suggested state actions illegal, however one of the attorneys on a panel event I attended at Cato was less dismissive of my suggestion of what states could possibly do.  Adding further speculation is the answer I got from ehealthinsurance.com when I questioned them about a month ago.  Their first contact representative, told me they expect to see some states “go rogue” and attempt to offer non Obamacare compliant choices in the future.

As with the shutdown “Barrycades”, when free citizens defiantly crossed the lines and prevailed, will there arise states that tell the Federal Government they have gone too far and we the people have had enough?

Note: This post shared to WatchdogWire-Pennsylvania

An Inquiry into Healthcare.gov’s “Special Enrollment Periods”

So here we are, the first day the Obamacare exchanges or marketplaces or whatever are open for business.  I think of it more as the day America stepped across the threshold to possibly inescapable socialism.  That’s just me.

I had a rough day as I realized an error in my last post and had to insert an update and correction to my assertion that guaranteed issue would allow waiting to buy health insurance until the onset of serious illness.  This still could be true but only if it would occur in a subsequent open season, the part I had missed.  Even though I had remembered hearing talk of no limits, the open season requirement went past me because I went with what I thought I had heard without checking it out.  Confession.

I should have questioned this because employer provided insurance is provided guaranteed issue and they generally limit enrollment to open seasons, with exceptions for certain life events.  I knew this.  Of course with employers there is an initial screening based on who they hire so they are never looking at people too unhealthy to work or apply for the job.

In my ensuing gloom I decided to poke around the Healthcare.gov website.  I was just visiting to see what it looked like and learn what I could.  Sure enough I stumbled on this part about not missing the open enrollment period:

OpenEnrollment

Just as with an employer there was the exception for “qualifying life event” and, being curious, I clicked the link and found this:

QualifyingLifeEvent

That example “moving to a new state” jumped off the page.  I sensed fun with that one!  In seconds I hopped on the phone and dialed the toll free number at the bottom of the page.  After a surprisingly short dance through options and with almost no wait I was speaking to a live representative.

My question was brief and to the point.  According to what I had seen, could I choose to remain uninsured, pay out of pocket and then, if I experience a serious illness, simply move to another state to buy a policy outside the open season?  If I could just cross that state line would I be good to go?  These sound like silly questions, and my gut tells me that this exclusion would only apply if I had owned a policy before moving.

The representative though, did not explain or answer my question to satisfy my gut.  His response was, what I can only guess, outside the box of his training.  “Well, I guess so, if that’s what it says,” was his answer!  Duh!

And no, I still cannot believe this representative’s response was correct, because if it was then I should further revise and update “Is Paying the Obamacare Tax a Better Choice for the Young and Healthy“, my last post to this blog.

Screen grabs were off of the Healthcare.gov website.

Note: This post was shared to WatchdogWire-Pennsylvania

Is Paying the Obamacare Tax a Better Choice for the Young and Healthy?

Urgent Update and Correction:

Just as with this article at Business Insider, I missed the fact that enrollment in the exchanges is limited to open enrollment periods.

This does change the risk dynamics of paying the tax rather than buying the insurance.  Any confusion caused by this oversight is regretted.  Even still, those with either few assets to lose or those with sufficient assets to carry them to the next enrollment period, may still want to take the risks as presented in the original post.  The availability of sensible catastrophic true high deductible “real” insurance that Obamacare prohibits and has not been offered in the states would be the answer to this dilemma.

Original Post (with slight unrelated edits):

The following discussion is in no way intended as specific advice as everyone’s situation is different and unique to them, but only as a guide to uninsured young and healthy individuals to understand their choice in whether to buy health insurance on an Obamacare exchange to avoid paying the tax or paying the tax to relieve them of the obligation to purchase the insurance.  The only mandate for the uninsured is to make this choice, not to do one or the other.

The other purpose here is to counter biased government efforts that will insist the only choice is which insurance exchange plan to buy and how to sign up for it, ignoring the possible benefit of paying the tax instead.  This government effort is substantial, as here in Pennsylvania alone, over $6 million of taxpayer money is being directed to one critical thing Obamacare success is dependent on, enrolling as many young and healthy people as possible.  According to Enroll America-Pennsylvania, on July 10, 2013 “health centers in Pennsylvania were awarded a total of $4,196,333 to provide outreach and enrollment assistance.”  They also indicate that an additional $2,071,458 is coming soon to organizations that will act as “Navigators” who will likely never discuss the non-insurance option that is also important for the young and healthy to understand in making their choice.

Young people need to know a few facts of Obamacare at the outset.  Because the law limits charging the old and less healthy more than three times what the young and healthy pay, this shifts more burden to the young.  Offsetting this are premium subsidies to make the insurance choices seem affordable, but as the young advance their careers and their earnings these subsidies fade.  Another important consideration is that shortsighted bureaucrats designed Obamacare to allow no exclusion for previously existing conditions, giving the opportunity to purchase insurance after the onset of a serious illness, even from a hospital bed. Update: Still true, but only if during a subsequent open enrollment period.

The pay-the-tax choice may be useful for young and healthy people who have the discipline to put aside the difference (compared to paying exchange premiums) for their basic normal medical needs, and especially if they then find one of a growing number of physicians offering much lower prices by casting off third party payment for a cash practice.  It must be understood that this choice is not without the risk of an occurrence of a sudden and severe medical condition causing total incapacitation.  This extremely rare event could prevent them from signing up for insurance on an exchange until they are sufficiently recovered to do so.  Update: So long as it is within or until the next open enrollment period.

Putting the sudden-and-severe risk in perspective though is important.  Everyday young healthy people take on huge amounts of student loan debt, with no guarantee of acquiring a job sufficient to easily pay it back, even as student loan debt obligations saddle the borrower for life because  they are not dischargeable in bankruptcy.  Medical debts, on the other hand, can be eliminated through bankruptcy should the highly unlikely occur.  This is where an option to pay the tax and buy a very low cost non-Obamacare compliant policy that pays nothing up to perhaps a $10,000 or even $15,000 deductible, then covers everything above that, would be so useful, but no such thing exists.  Such a plan would be good enough to prevent bankruptcy in most cases and leave substantially less obligation than many young people have willingly taken on with student loans.

It is thus important for young healthy people to see the big picture, understand all their options, then act in their best interest, in reaction to the rules presented to them by the Affordable Care Act.  This discussion has been meant as a guide in starting the navigation of that process.  Additionally, there is a wonderful new resource blog, The Self -Pay Patient, that unfolds a myriad of already available but little known alternatives to insurance, and I highly suggest a visit for anyone serious about learning the many other options available to them, since no government navigator will ever mention any of it.

Note: This post was shared to WatchdogWire

REINS Revolution as Ransom for Budget Resolution?

REINS

Herd mentality on issues is not something unique to the political Left or the political Right, but in either case populist tendencies can be downright dangerous, leading to unintended consequences.  No matter how good an idea seems at the outset, it is always good to ask what could go wrong.  Zealotry interferes with this basic question and places pressure on those who may doubt the wisdom of an idea, risking indignation from those they consider allies,  to remain silent.  Principled people will resist this temptation to go along to get along, making known their objections, explaining why, then letting the chips fall where they may.

We currently see herd movement on the Conservative side, with the attempt to defund Obamacare by making it ransom for cooperation in passage of a continuing budget resolution in order to keep the Federal government functioning past September 30.  Looking around, there appears to be unanimity among the grassroots on this issue.  Freedom Works, Heritage Action, Tea Party Patriots are all on board, being led by Senators Ted Cruz and Mike Lee among others.  Ads on Hannity and Rush and the Blaze are all promoting defund.  A rally at the capitol has been planned for September 10 and busloads of protestors will be making the trek.  “Exempt America from Obamacare” is the cry.  Yet there are a small handful of dissenters, myself among them, warning of the potential foolishness of this approach.

Jennifer Stefano, head of the Pennsylvania chapter of Americans for Prosperity, minced no words in her August 9 op-ed for the Patriot-News and Pennlive.com.  She boldly said that those “pushing the ‘defund Obamacare or shut down the government’ fight are wrong.  One hundred and ten percent wrong” and to conservatives, “your government shutdown approach has got to stop.”

Following that, on August 14 Avik Roy of the Manhattan Institute, and one of the foremost opponents of Obamacare and defenders of market based healthcare reform solutions, published an op-ed in National Review Online.  Wasting not a second, his title read, “Obamacare’s Shutdown Shock-Jocks  Ted Cruz and Mike Lee have a plan-to make Obamacare permanent.”

Neither Stefano nor Roy suggest anything that might confound the atrocity of Obamacare is a bad idea.  Both do suggest, however, that tying defunding to the budget resolution has the potential to backfire big time.  They both point to polls showing little public support for shutting down the government.  Supporters try to say that it would be Democrats and Obama shutting down the government, not them.  Obama and the Left, of course, along with a complicit media, will rail against the Republicans and Conservatives in particular.  With the current political realities, a festering shutdown deadlock in the face of unfavorable polls would be  the likely outcome.  The implications of this would then likely carry a price, perhaps a heavy one, going into 2014.

So back to political leverage in connection with allowing the federal government to continue operating past the end of September: There is one thing on which conservatives could only win.  Tie any budget cooperation to passage of the REINS Act.  The what?  Exactly!  Use it as ransom for cooperation.  There are no illusions REINS would actually pass, and backing away short of a government shutdown would be necessary, but after weeks in the spotlight, everyone who pays even a small amount of attention to politics would have a good understanding of a brilliant concept, of which too many conservatives are still unaware.  That alone could be a huge victory.

Briefly, the REINS Act would put limits on an out of control trend toward legislation by regulation (or regulation as legislation), whereby departments and agencies can make things up as they go, despite the economic impact on those who must comply.  Under REINS any regulation with implementation impacts greater than $100million (including Obamacare) would require the consent (and accountability) of Congress.  This puts REINS in a very special class of ideas that seek to step away from an overly powerful central government, rather than stepping further into it!  In that respect it is a revolutionary tool of disengagement from bloated central authority.  Promoting such a concept, showcasing the REINS Act, would define and position the GOP going into 2014 as the party of limited central government in a way that may force a discussion the Left would rather not have or expect.  Contrast this approach with the risks of tying defunding Obamacare to the continuing resolution, especially when defund or delay can still be pursued (and should be) via general orders apart from any budget resolution.

Additionally, the Obamacare mess has been speaking badly for itself lately, to the extent that, along with parts that have already been delayed, even Democrats and disenchanted labor unions may find total delay palatable before long.  Avik Roy pointed out, because defund, even if possible, would extend only one year or the length of any budget resolution, it and delay are really the same.

A wonderful description and  history of REINS, followed by examples of federal government excesses that demand it, can be found in Phil Kerpen’s 2011 book Democracy Denied.

Originally introduced in the 112th Congress, REINS has been reintroduced in the current Congress as HR 367.  It passed the House on August 2, 2013 by a 232-183 vote.