No Health Insurance? Blame Bevin

Fucking over defenseless Kentuckians is not the only reason Bevin took away the health insurance of hundreds of thousands of Kentuckians.  Now he gets to run for president on the platform of actually killing Obamacare in Kentucky. 

John Cheves at the Herald:

Gov. Matt Bevin’s administration says it expects a smooth transition Nov. 1 as open enrollment begins for health insurance and Kentuckians looking to buy coverage in 2017 switch from the state exchange, which Bevin is closing, to the federal exchange.

However, health care advocates worry that some people will be left behind. They say the state’s Kynect.ky.gov was a one-stop website that allowed people to shop for insurance and either be approved for a private plan — possibly with tax credits to make the plan more affordable — or be enrolled in Medicaid if they were near or below the poverty line, usually in one sitting.

The federal website HealthCare.gov could require multiple sessions and an indefinite waiting period while applications are processed, and applicants will be sent to a state-run public benefits website, Benefind.ky.gov, if they are found to be eligible for Medicaid.

“What we’ve seen in Kentucky is tremendous success with Kynect,” said Emily Beauregard, executive director of Kentucky Voices For Health. “It’s not going to be nearly as simple with HealthCare.gov. Delays with application transfers and error messages have been a significant problem in some of the states that have been using HealthCare.gov already.”

Advocates also praised Kynect because it came with an advertising campaign to promote it and employed more than 500 navigators, called Kynectors, who went into communities and walked people through the application process.

Read more here: http://www.kentucky.com/news/politics-government/article110773902.html#storylink=cpy

Health Insurers Throw Tantrum Because Profits Not Obscene Any More

Poor babies.  Obamacare exchanges reduced their profits to merely outrageous and disgusting. How will they ever survive?

By bitching and pissing and moaning and holding their breath until they turn blue in the hopes somebody will kill off that health-care-for-everyone Affordable Care Act and let them get back to fucking over everybody who is not a healthy 25-year-old and making obscene profits at the expense of working people.

Governor Shitting His Pants to use this corporate fraud to justify killing off the last vestiges of kynect, along with the hundreds of thousands of Kentuckians who depend on it to keep them alive, in 3, 2, 1 ....

TPM:

Aetna’s announcement comes after UnitedHealth said in April it would be cutting its marketplace involvement significantly, and Humana has also signaled a retreat from ACA exchanges. All three decisions have prompted Republicans to declare that Obamacare is failing and that they were right all along. But experts say some of the criticisms miss the nuance on what is actually driving the cutbacks.

“It’s not a statement that the marketplaces can’t work or that they aren't working," Linda Blumberg, a healthcare policy fellow at the Urban Institute, told TPM. "It’s a statement that these insurers are by and large not terribly competitive the way they came in, and if they are going to make money in this market they're going to have restructure and re-orient to the characteristics of what the consumers want.”

SNIP

Not every carrier is struggling on the exchanges, and consumers’ willingness to shop around for deals has benefited insurers that offer plans that are on the cheaper end.

“There are insurance companies that are doing well and those are companies that have experience serving a low-income population,” Cox said.

Many of those carriers offer plans with narrow provider networks, while big insurers like Aetna and UnitedHealth have tended towards broader provider plans, which offer consumers more choices but at a higher cost.

“What consumers are showing time and again on these marketplaces is that they are very willing to trade a broad choice of providers for a low price, and the carriers that figured that out early are the ones that seem to be doing well,” said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University's Health Policy Institute.

There is the possibility that the big insurers who are now pulling back will re-enter the marketplaces once they're better equipped to meet its demands. UnitedHealth, for instance, kept its new, more boutique-style subsidiary, Harken Health in the Indiana and Georgia exchanges where the insurer was otherwise withdrawing. It has signaled it could expand Harken Health to Florida.

"I would expect that, in a lot of those areas, they'll come back in. But they'll come back in with different looking products that are more similar to the ones that are competing well,” Blumberg said.

It's called competition, motherfuckers. 

California Common Sense

From Firedoglake:

- Officials in California stated all insurance companies must include abortion as a part of their plans; Good news for women in the state

"Wellness" programs just one more way for the bosses to steal your pay

At my job, Humana health insurance - which as a corporation is just slightly less evil than Microsoft and way more evil than BP - runs our lives.

You literally cannot purchase affordable health insurance unless you quit smoking, quit drinking, quit eating like a normal human being and quit driving half a mile over the speed limit.

I am not exaggerating. To receive health care coverage from Humana, you must complete a "Vitality Assessment" including questions that are nobody's fucking business, including a physician's.

Just what "wellness" objective is served by minimum-wage teenaged dropouts giggling over the answers to questions like "How often do you feel life is not worth living?"  Again, I am not kidding.

The only exercise for which Humana gives you credit is exercise recorded by specific devices sold by - surprise! - Humana. Buy hey, what single mother of three making minimum wage doesn't have $50 lying around to buy the official pedometer her job now requires.

Humana even forces you to buy food from Walmart - food that is poisoned by pesticides in third-world hellholes - and refuses to give you credit for buying genuinely healthy food from local farmers' markets.

This is not Obamacare.  This is not the Affordable Care Act. This is motherfucking corporate assholes like Humana taking advantage of the confusion over the ACA to force workers into an Orwellian dystopia of privacy denial.

Erik Loomis at Lawyers, Guns and Money:

Not at all surprising that employee wellness program shifts responsibility for unhealthy workplaces off of the employer and onto the employee:

“Many of the individual behaviors you are focusing on in your health and wellness programs [such as] stop smoking, eat better, exercise more, are in fact the consequences of the environments in which they [employees] are working,” Pfeffer says. “If you work people to death, of course they are going to smoke more, drink more and eat worse.”

Pfeffer outlined his concept of “social sustainability,” where companies invest more in making their human capital sustainable.

“Work organizations ought to be measuring the health of their workforce,” he said in his keynote speech. “Just as many places today measure carbon, renewables and environmental impacts, we ought to measure human sustainability just as much as we measure environmental sustainability.”

When determining well-being and longevity of workforces, Pfeffer said that most company wellness programs – which conventionally promote individual health and wellness, biometric screenings and smoking and drinking cessation programs – do fall short of really instituting change. Indicators such as work-family conflict, lack of job control, perceived fairness at work, as well as layoffs and economic insecurity, all play a huge role in workforce health, he added.

“The higher you are [in the organizational structure of your company] the more control you have; the lower you are, [the] more flows down hill,” Pfeffer said, while noting that low control over one’s work increases a person’s likelihood of having a cardiovascular event.

That this Stanford researcher told this to a conference of employers means I’m surprised he wasn’t howled down on the spot. If companies can charge workers higher premiums if they don’t live up to their standards of health, even more money stolen from workers!

On October 1 last year, kynect navigators were overwhelmed by Humana-enslaved Kentucky state employees begging to be freed from a "wellness" system that cut short our very lives from stress. The navigators - who do not work for Humana - often choked up themselves when they had to tell us that not only are workers with employer-run health plans not eligible for the ACA, but that even if we were, most of the ACA plans available in Kentucky are run by - you guessed it - Humana.

Well, stressing us to death before we have a chance to retire is one way to solve the pension crisis.

KY and Obama Calliing Insurance Companies' Bluff

Now this is the kind of thing we expected from our poker-playing President.

From the Herald:

Gov. Steve Beshear directed the Kentucky Department of Insurance on Thursday to comply with President Barack Obama's edict that could allow some 280,000 Kentuckians to keep their current insurance policies, at least for another year.

Beshear said the decision ultimately will be left to insurance companies, many of which he said have already invested heavily into developing coverage plans that meet the requirements of the Affordable Care Act and may not want to reverse course.

SNIP

In Kentucky, about 130,000 people with individual insurance coverage face discontinuation of their policies in the months ahead, as do about 150,000 people with small group policies.

No mention of the fact that the vast majority of those individual and small group policies are shitty plans that lead directly to bankruptcy in the case of actual medical costs.

Also no mention of the fact that the President's edict cuts the legs out from under the repugs and cowardly dems in Congress who are trying to repeal Obamacare.

Ed Kilgore at Political Animal:

Since there’s been a lot of confusion about the impact of Fred Upton’s bill (due for a House vote Friday) to let insurers sell non-ACA-compliant individual policies under the rationale of “relief” to people freaking out over cancellations, here’s a succinct description from TNR’s ever-excellent Jonathan Cohn about why it could represent a catastrophe:

[T]he Upton bill doesn’t seek simply to leave existing policies in place for people who have them. It would also allow insurers to sell the policies to new customers. That goes way beyond grandfathering, because the cheaper, skimpier plans would siphon off the healthiest enrollees—and do so in perpetuity. This (probably) makes it worse than the (still objectionable) proposal Democrat Mary Landrieu has proposed in the Senate. If the Upton bill passed, Obamacare’s reforms of the market might become effectively meaningless. In short, the Upton bill is a not-thinly-disguised effort to repeal the Affordable Care Act.

That’s also the conclusion the anti-ACA writer James Capretta reaches at the Weekly Standard in calling the Upton bill “an escape from Obamacare, not a fix for the fatally flawed legislation.”

It’s possible, as Brian Beutler has suggested, that insurers might not take advantage of the Upton bill, minimizing its disruptive effect. It’s also possible state insurance regulators could thwart it. And were it to survive into a House-Senate conference committee, Democrats would almost certainly try to limit its scope to insurance renewals rather than new policy sales, which, again, would minimize its operation as a wholesale “escape from Obamacare” for the individual insurance market. But there’s no question the idea behind Upton is profoundly destructive even as it purports to be some sort of “relief” measure, and that’s why so many Republicans are embracing it.

And why President Obama cut them off at the pass.

Kevin Drum:

I think Obama's main goal here is to remove this handy excuse. He's basically daring insurers to go ahead and reissue the old policies. If they don't do it, it means that Obamacare was never really responsible for the cancellations in the first place. And if the insurers see that their bluff is being called and decide they don't want to take the PR hit, then the old policies get reissued and everyone is happy. It's a win-win for Obama.

All You Have to Lose Is Your Shitty, Expensive, Fraudulent Non-Coverage

This must be the repug propaganda that Anonymous in comments believes:

Health care overhaul means about 280,000 Kentuckians will lose current insurance coverage

Wow, Roger Alford - you're as bad as Ron Fournier in your desperation to blame Democrats for repug obstruction and sabotage.

No, 280,000 Kentuckians are not losing current insurance coverage. 280,000 Kentuckians are about to escape the trap of useless, fradulent, fake insurance that costs the earth and doesn't cover a fucking thing.

Talking Points Memo explodes the myth:

Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies' own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces -- which could lead to people like Donna spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked.

The extreme lengths to which some insurance companies are going to hold on to existing customers at higher price, as the Affordable Care Act fundamentally re-orders the individual insurance market, has caught the attention of state insurance regulators.

The insurance companies argue that it's simply capitalism at work. But regulators don't see it that way. By warning customers that their health insurance plans are being canceled as a result of Obamacare and urging them to secure new insurance plans before the Obamacare launched on Oct. 1, these insurers put their customers at risk of enrolling in plans that were not as good or as affordable as what they could buy on the marketplaces.

All insurance companies are greedy motherfuckers and pathological liars. Get on the exchange. Discover the truth.

Scott Lemiuex piles on:

This is a very important point:

The employer-based health-insurance system is much more popular than the individual market. It’s also much more redistributive. The 25-year-old male in the loading dock has to pay the same premiums as the diabetic 60-year-old in accounting. Is this injustice an important part of the political discourse? How often do you hear people complain about it?

Every iteration of an alternative conservative health-care proposal would impose far more disruption on the status quo than would Obamacare. Most conservative plans involve drastically curtailing the tax deduction for employer-based insurance. That would create cancellation notices for many times the number of people currently seeing them. Even the more modest plans to scale back Obama’s regulation of the individual market would run the GOP into a political minefield. Which regulations do they want to strip away? Discrimination against people with preexisting conditions? Discrimination against potentially pregnant women? Mental-health parity? Every single one of those changes creates millions of angry potential victims.

This is exactly why the actual Republican Party health-care plan is not repeal and replace, but repeal and cackle. Republicans are on strong ground exploiting fear of change. They have understood perfectly well that they must avoid having to defend a different set of changes to the status quo. They have kept their various replace ideas safely to the side for exactly that reason.

I’d also note that there’s nothing in the status quo ante that guarantees that you could keep your existing insurance. You could, for example, lose your job.

And this is also crucial. A lot of anecdotes about “cancelled insurance” aren’t actually going to pan out.

How Obamacare Will Lower Health Insurance Premiums

To the teeth-gnashing and wailing of conservatards, Kentucky is now fully invested in Obamacare, with exapnded Medicaid and our own health-benefit exchange.

Kentucky Gov. Steve Beshear announced the launch of a public-awareness campaign Wednesday for the state’s new health-benefit exchange.

The exchange, called kynect: Kentucky’s Healthcare Connection, creates an online marketplace for individuals and small businesses to compare coverage, provider networks and costs when shopping for insurance plans.

And we already have proof from Oregon that such exchanges actually do force price competition among insurers.

Kevin Drum:

Bad news about the implementation of Obamacare seems to pop up relentlessly. So here's some good news to balance it out. Once the exchanges get up and running, insurance companies for the first time will be offering similar products with very public prices, and in Oregon those prices vary from $169 a month to $422 a month for the same standard plan. Here's what happened last week when those prices went online:

On Thursday, a comparison of proposed 2014 health premiums became public online, causing two insurers to request do-overs to lower their rates even before the state determines whether they're justified.

The unusual development was sparked by a comparison that used to be impossible because plan benefits varied so widely. But under the federal reforms that take effect Jan. 1, health insurance is mandated and every insurer must offer certain standard plans.

....Providence Health Plan on Wednesday asked to lower its requested rates by 15 percent. Gary Walker, a Providence spokesman, says the "primary driver" was a realization that the plan's cost projections

were incorrect. But he conceded a desire to be competitive was part of it.
A Family Care Health Plans official on Thursday said the insurer will ask the state for even greater decrease in requested rates. CEO Jeff Heatherington says the company realized its analysts were too pessimistic after seeing online that its proposed premiums were the highest.

The news isn't all good. Overall, rates in the individual market are likely to go up because insurance companies have to cover those with preexisting conditions and are required to offer a minimum set of benefits. But transparency is also likely to drive prices of some policies down. That's competition, baby.

This is how capitalism and a free market are supposed to work, but usually only do when the government forces them to.

Kentucky Caves to Freakazoid Fraudsters

The issue here is not just the fraud - xians who trust other xians with their money deserve what they get - but the principle that thinking an invisible sky wizard protects you means you are exempt from government regulation.

From the Courier:

A Christians-only health care plan that had been banned in Kentucky could resume operations in the state next month, unless officials at the Department of Insurance opt to continue a decade-long legal fight
.
The Kentucky General Assembly passed a law that takes effect June 25 exempting Medi-Share, a Florida-based cost-sharing ministry, from regulations that apply to traditional insurance companies. That was done in response to Franklin County Circuit Judge Thomas Wingate's order barring Medi-Share from Kentucky.

SNIP

For the past decade, the Department of Insurance has been in the unenviable position of fighting against the Christian cost-sharing ministry in a Bible-belt state. The agency took the case to court because of concerns that some Christians might mistakenly believe they're paying into an insurance plan that guarantees coverage if they're hospitalized.

And when the inevitable crash happens and thousands of terminally ill Kentucky freakazoids are suddenly dumped into emergency rooms with no insurance, it's Kentucky taxpayers who will foot the bill.

One State With Its Head On Straight

Lucky citizens of Washington State: Olympic National Park, civilized Seattle, and a legislature of sentient, rational human beings.

Tara Culp-Ressler at Think Progress:

Across the country, about 21 states have restricted access to abortion by preventing insurance companies from covering the cost of the legal medical procedure. But lawmakers in Washington State are currently considering the opposite approach: legislation to mandate that insurance companies pay for abortion services as part of their plans’ maternity care. 

Washington has traditionally been a trailblazer when it comes to reproductive rights. In 1970, the state become the first to legalize abortion by a popular vote. Now, under the proposed Reproductive Parity Act, it may become the first to ensure that insurance companies aren’t permitted to segregate abortion care from the rest of the women’s health services covered under their plans:

The bill passed the state House earlier this month by a vote of 53-43, though it faces an uncertain future in the Senate. A similar bill in the New York state Assembly has been introduced each session for over a decade but has never received a public hearing.

“This is a core value for Washingtonians,” said Melanie Smith, a lobbyist for NARAL Pro-Choice Washington. “We should protect it while we still have it and not leave access to basic health care up to an insurance company.” [...]

Supporters of Washington state’s proposed abortion insurance mandate are careful to stress that it wouldn’t lead to a dramatic uptick in abortions or require carriers with a religious bent to cover the procedure. They also note that a pair of federal plans that will be sold on all 50 state exchanges will be barred from covering elective abortions.

“It’s not expanding abortion coverage,” said Democratic Rep. Eileen Cody of West Seattle, the bill’s primary sponsor. “It’s ensuring the rights of women to get what they’re paying for now and to continue their freedom of choice.”

The bill has been hotly contested, particularly as conservatives have argued it represents an affront to the religious liberty of individuals who oppose abortion and don’t want to purchase plans that cover it. But Obamacare already requires at least some plans in the state-level insurance marketplaces to exclude abortion coverage. And, as Rep. Cody notes, the legislation wouldn’t actually significantly change the current landscape in Washington because all of the state’s major insurers already cover abortion.

But it would prevent new insurers entering Washington’s insurance marketplace from adopting the same kind of anti-abortion policies that have been sweeping the nation over the past two years, as states across the country have rushed to block access to abortion coverage. Elizabeth Nash, the state issues manager for the Guttmacher Institute, told the New York Times that the bill’s passage would be a “watershed event” regardless of its immediate impact on the insurance market. “It would be a model for other states to follow,” Nash explained.

According to the Guttmacher Institute, only about 12 percent of the abortions across the country are paid for by insurance providers. But in states that have enacted roadblocks to abortion coverage, women who seek abortions are often forced to pay large out-of-pocket costs in order to make their own medical decisions. The average cost of a first-trimester abortion is about $470, and an estimated 42 percent of the women who seek abortions have incomes that fall below the federal poverty line.

Law Trumps Freakazoids in Kentucky

No, you can't break the law no matter what your imaginary invisible sky wizard says. Not even in Kentucky.

Roger Alford at AP:

 A judge has ordered a Christians-only health care ministry to cease operations in Kentucky unless it can get approval from the state Department of Insurance.

Franklin County Circuit Judge Thomas Wingate entered that ruling Tuesday against Medi-Share, a Florida-based cost-sharing ministry that helps pay medical bills for churchgoers who pledge to live Christian lives that include no smoking, drinking, using drugs or engaging in sex outside of marriage.

Medi-Share has continued to operate in Kentucky a year after the state Supreme Court ruled that it is subject to the same regulations as secular health care plans.

The Emergency Room Is Not Health Insurance

Twice in the last two years I've had to go to a hospital emergency room on a weekend with a condition my personal physician could not treat, even if his office had been open.

 

I did not realize just how extremely fortunate I was to be able answer "yes" to the admitting nurse's question: "Do you have health insurance?" Because if I'd said no, I might still be waiting to be treated.

 

Susie Madrak at Crooks and Liars:

Not only do I still owe approximately $33,000 from last year's emergency room treatment (including $1000 for the ambulance ride), I was misdiagnosed -- possibly on purpose, to avoid surgery. Who knows? All I know is, life without health insurance is a very risky proposition, and that fact that Mitt Romney doesn't even seem to know why it is tells me that he either has the worst memory in the world (you'd have to think he was at least aware of these problems when he was a governor working on on his health care plan) or that he simply doesn't care about health care for the uninsured. Either way, it's not very flattering. I wonder if he could at least be interested enough to watch this documentary:

Eric Morgan, in his 20s and planning to get married, arrives at Highland Hospital's emergency room, shaken that he has been diagnosed with a testicular tumor that is likely cancer.

Surgeons at a private hospital have turned him away for lack of insurance but tell him it's "urgent" he get care.

Demia Bruce -- out of work for a year -- anxiously waits in the same ER with his 5-year-old daughter, her face swollen and burning with fever.

Carl Connelly has overdosed on drugs and alcohol, and Davelo Lujuan can't bear the pain of his spinal bone spurs. They, too, wait.

A provocative new documentary, "The Waiting Room," is a snapshot of Highland Hospital in Oakland, Calif., one of the nation's busiest safety-net hospitals, which is stretched to the limit with 241 patients a day, mostly uninsured, who need medical care they can't afford.

The film, directed by Peter Nicks and getting Oscar buzz, opens at the IFC Center in New York City on Wednesday, Sept. 26 and in the greater Los Angeles area at Laemmle Theaters in Santa Monica, Pasadena and Claremont on Friday, Sept. 28, before showing around the country. "The Waiting Room" will also be aired by PBS in 2013.

Nicks follows 24 hours in the lives of artists, small business owners, factory workers and unemployed parents who have been hit hard by the economy -- and hit harder still by a healthcare system that has left them out.

"Bring your breakfast, lunch and dinner -- everything honey," an African-American patient who has been waiting for days to see a doctor, tells a new arrival.

They take a number and they wait, sometimes coming back two or three days in a row. It might be months before they can get a doctor's appointment. With only one operating room, the most urgent cases go first and the rest wait. A man with a survivable gunshot wound has waited two days to be seen.

"It is the place of last resort," said Nicks, 44, whose wife is a speech therapist at Highland Hospital and came home with stories of patients' troubled lives.

No, Mitt Romney and the rest of your overprivileged parasite billionaire friends, emergency rooms are not the poor people's version of health insurance. Emergency room "treatment" of the uninsured is the final proof of how desperately we need Medicare For All, if not VA-style Socialized Medicine.

More Drug War Stupidity in Kentucky

This stupidity will not stop one single person from getting prescription drugs illegally.  It will, however, bankrupt thousands of Kentuckians while enriching already obscenely wealthy insurance companies and the drug-testing companies they own.

Not to mention hacking another major limb off our Constitutional rights.

John Cheves at the Herald:

To curb prescription drug abuse, Kentucky started in July requiring people with long-term prescriptions for controlled substances to submit to urine testing. The tests determine if patients take their drugs, rather than sell them, and if other, unprescribed drugs are in their systems.

In Lexington, retired nurse Cynthia Burton grudgingly followed the rules Aug. 14 by urinating into a plastic cup so she could get a refill of her insomnia medicine. Her husband did the same for his anxiety medicine.

Last week, Burton's insurance company, Bluegrass Family Health, sent her a letter. The urine tests at LabCorp cost $533 each, and because they were not medically necessary, the insurer said, it won't pay for her husband's test. She's still waiting to hear if it will pay for hers, but she's not optimistic given that it was the same test for the same reason under the same plan.

"More than $1,000 is pretty damn big to us. We're both retired, so it's a lot of money," said Burton, 61, "What I don't like is that, under this law, we're considered guilty until proven innocent. We're having to prove our innocence at considerable expense."

Call your state legislators and tell them to fix this abomination.

Read more here: http://www.kentucky.com/2012/09/27/2352733/drug-tests-required-by-new-law.html#storylink=cpy

Single-Payer Closer and More Inevitable Than You Think

The not-even-close-to-socialist Obamacare is not destroying the private health insurance industry anywhere near fast enough. But scientific progress is.

Zandar:

Ezra Klein makes the convincing argument that sub-$1,000 human genome sequencing procedures means the end of the health insurance industry as we know it.

At the moment, our understanding of the genome remains relatively crude, and our ability to predict future health risks based off of genomic sequencing is limited. But we’re getting better at it. For instance, women in families with a high rate of breast and ovarian cancer can have themselves tested for alterations in the BCRA1 and BCRA2 genes. If they test positive, it means their risk of developing breast or ovarian cancer is significantly higher.

As we sequence more genomes, mine more data, and conduct more studies, we’ll find a lot more of these connections. Eventually, genomic testing will be a powerful predictor of future illness. And it raises the potential that young people will get themselves tested and then purchase insurance based off the result. So those with a clean genomic result might go for a cheap catastrophic plan, while those with a high risk of developing pricey illnesses will opt for more comprehensive insurance.

The result would be, in insurance terms, an “adverse-selection death spiral,” as the healthy opt out of expensive insurance, the sick opt into it, and premiums spin out of control.

So yes, regardless of what thick-headed Republicans think about the HORRORS OF SOCIALIST OBAMACARE, the reality is that widespread accurate and cheap genetic testing will be the norm in about a decade or so, give or take a few years. Insurance companies will insist on knowing what's in your genetic cards before you get insured, and so will employers, potential spouses, etc.

Before he left office, Dubya signed GINA, the Genetic Information Nondiscrimination Act, into law. Literally everyone in Congress voted for it except for Ron Paul. GINA says that genetic information cannot be used to deny coverage or raise insurance rates on people. What it means is smart people will get tested and then buy appropriate insurance. Since insurance companies exist to guess rather than know, and they can't use that knowledge to set your insurance coverage, they're suddenly in real trouble if all the folks with the genetic predisposition towards disease buy insurance and all the less likely folks buy cheap stuff because they know they won't need it. That's going to bury the insurers and they know it.

So no, it doesn't actually matter what happens to the PPACA. It's not going anywhere, really. Neither is GINA. But insurance companies? They're going somewhere.

Straight down the crapper.

In case it's not obvious, there are two and only two choices in the absence of private health insurance: the repug dystopia in which only rich people who can pay cash get medical care at all and everyone else gets none, or single-payer (which is the highly efficient and hugely popular VA healthcare for all.)

Make your choice when you vote in November.

Death of Private Health Insurers Approaches

We knew tobacco companies had seen the writing on the wall back in the '70s when Reynolds started buying up every non-tobacco company they could find. Guess who's following that script today?

From karoli at Crooks and Liars:

Aaaaand, the fuse has been lit. Insurers are not happy. Not even a little bit. What they feared most about the Affordable Care Act -- more than insuring people with pre-existing conditions, more than leaving children on their parents' policies until age 26, more than having to lift lifetime caps, more than any of those things -- was the limited Medical Loss Ratio (MLR).

The PPACA limits the "padding" between actual claims paid and premium collections to 15% for large groups and 20% for individuals and small groups. Any excess the insurer has must be refunded to insureds by the end of the year for which the MLR is determined. Everyone scoffed at the time over these limits, figuring the regulations would be broad and wide enough for insurers to run through the loopholes.

But no. Final rules were issued last week and insurers didn't get anything they wanted. Via Rick Ungar at Forbes:

This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most.

Ungar's logic at the end is a little bit wrong. The current MLR, just for perspective, is about 40-45%. That means for every dollar paid toward health coverage, only 60 cents or so goes to actual health costs. The rest is considered overhead -- agents' commissions, big CEO salaries, and of course, that shareholder profit that benefits those with the money to actually buy shares in these companies. Medicare, on the other hand, has a very low overhead attached to it -- about 7-8%, because it is in the business of providing medical benefits, and not making a profit or paying CEOs handsome salaries.

The only reason for insurers' efforts to deny benefits was simply to boost up the bottom line, and in many cases, the only reason for big premium hikes was also to boost that bottom line and the profits distributed to shareholders. Now insurers will find themselves in the business of actually paying for medical benefits. The regulations, by the way, do not allow them to include agents' commissions in their "medical expense" column.

Ungar does, however, ask the right question toward the end of his post:

So, can private health insurance companies manage to make a profit when they actually have to spend premium receipts taking care of their customers’ health needs as promised?

Not a chance-and they know it. Indeed, we are already seeing the parent companies who own these insurance operations fleeing into other types of investments. They know what we should all know – we are now on an inescapable path to a single-payer system for most Americans and thank goodness for it.

Whether you are a believer in the benefits of single-payer health coverage or an opponent, mark this day down on your calendar because this is the day seismic shifts in our health care system finally get under way.

If you thought that the Obama Administration chickened out on pushing the nation in the direction of universal health care for everyone, today is the day you begin to understand that the reality is quite the contrary.

He's right, particularly about what path this sets the nation on. What Republicans feared most was that insurers would lose their gravy train and jump off before having to actually buckle down and provide health benefits, leading states to adopt single payer plans one by one, until the entire nation had single payer health insurance. This is why Michele Bachmann wails about "Obamacare leading to socialism", and why they fought so hard against all of it. Because now they will have to not only limit their greed, but they'll also have to report it publicly for everyone to review. That was also part of the PPACA. Each year insurers will have to publish their full balance sheets showing what they have spent, how they have spent it, and what their actual MLR is.

There is no more effective way to drive the cost of health care down than to take the profit incentive away from insurers. As time goes on, we'll look back at the excesses of the past with a shiver, while insurers figure out other ways to take your money. They know the train has left the station on this one.

Consequences in the One Percenters' Paradise

This liberal moron got exactly what conservatards think he deserved for trying to save some melon-heads who don't even pay taxes. If he had a real job instead of being a hippie social worker, he wouldn't be in this fix he's in. Serve him right for not earning big bucks selling fraudulent mortgages.

Bon the Geek at Zandar's place:

JOPLIN, Mo. -- By all accounts, Mark Lindquist is a hero, an underpaid social worker who nearly gave his life trying to save three developmentally disabled adults from the Joplin tornado. Both houses of the Missouri legislature honored Lindquist, the Senate resolution calling him "a true hero and inspiration to others."

But heroism doesn't pay the bills. The tornado's 200 mph winds tossed Lindquist nearly a block, broke every rib, obliterated his shoulder, knocked out most of his teeth and put him in a coma for about two months.

Lindquist, 51, ran up medical expenses that exceed $2.5 million, and the bills keep coming. He requires 11 daily prescriptions and will need more surgery.

But he has no medical insurance. Lindquist couldn't afford it on a job paying barely above minimum wage. He assumed workers' compensation would cover his bills, but his claim was denied "based on the fact that there was no greater risk than the general public at the time you were involved in the Joplin tornado," according to a letter to Lindquist from Accident Fund Insurance Company of America, his company's workers' comp provider.

132 worker's compensation claims were filed, and only eight were denied. Lindquist is among those denied. He went above and beyond the call of duty, risking his life to protect those who could not protect themselves. He nearly died for his efforts, and deserves better than "at least you have your health." It's a bitter smack in the face to those who take their duty as caregivers seriously. His life will be forever ruined because of his act of greatness, and before the tornado he was like so many who cannot afford health insurance. On one end or the other, this poor guy deserves a break. However, he isn't likely to get one. And that, friends, is the reality of a hero in today's world.

So the lesson is:

Sell fraudulent mortgages to millions of working-class families, play roulette with billions in pension investments and bring the global economy to its knees, and get punished by receiving millions in bonuses from a taxpayer bailout.

Risk your own life to save others, and get rewarded with permanent, disabling injuries and hundreds of thousands of dollars in medical bills that will force you into bankruptcy.

Got it.

FREEDUMB!

When Even a Corrupt Senator Cares About Constituents

How stirring it was to see Mitch McConnell stand in the Well of the Senate and demand single-payer healthcare for the Eastern Kentucky communities ravaged by coal mining, because only single-payer is powerful and inexpensive enough .... oh, wait.

Kay Tillow at Firedoglake:

In 2009 when the Washington beltway was tied up with the health care reform tussle, Montana Democratic Senator Max Baucus, chairman of the all powerful Senate Finance Committee, said everything was on the table–except for single payer. When doctors, nurses and others rose in his hearing to insist that single payer be included in the debate, Baucus had them arrested. As more stood up, Baucus could be heard on his open microphone saying, “We need more police.”

Yet when Senator Baucus needed a solution to a catastrophic health disaster in Libby, Montana, and surrounding Lincoln County, he turned to the nation’s single payer healthcare system, Medicare, to solve the problem.

Baucus’ problem was caused by a vermiculite mine that had spread deadly airborne asbestos killing hundreds and sickening thousands in Libby and northwest Montana. The W. R. Grace Company that owned the mine denied its connection to the massive levels of mesothelioma and asbestosis and dodged responsibility for this environmental and health disaster. When all law suits and legal avenues failed, Baucus turned to our country’s single payer plan, Medicare.

The single payer plan that Baucus kept off the table is now very much on the table in Libby. Unknown to most of the public, Baucus inserted a section into the health reform bill that covers the suffering people of Libby, Montana, not just the former miners but the whole community—all covered by Medicare.

They don’t have to be 65 years old or more.

They don’t have to wait until 2014 for the state exchanges.

No ten year roll out—it’s immediate.

They don’t have to purchase a plan—this is not a buy-in to Medicare—it’s free.

They don’t have to be disabled for two years before they apply.

They don’t have to go without care for three years until Medicaid expands.

They don’t have to meet income tests.

They don’t have to apply for a subsidy.

They don’t have to pay a fine for failure to buy insurance.

They don’t have to hope that the market will make a plan affordable.

They don’t have to hide their pre-existing conditions.

They don’t have to find a job that provides coverage.

Baucus inserted a clause in the Affordable Care Act to make special arrangements for them in Medicare, and he didn’t wait for any Congressional Budget Office scoring to do it.

Read the whole thing.
And so all the supposed arguments against single-payer collapse. Senators, representatives, lobbyists and presidents all know the truth: only single-payer - Medicare for all - can solve our deficit-exploding national healthcare crisis.

Thus only one reason to oppose it: campaign contributions from Big Insurance.

Nailing These Big Insurance Bastards Would Make Up for a Lot

I am so old I remember when Blue Cross and Blue Shield were - you better sit down - non-profit insurance companies.

One of them covered doctors and prescriptions and the other covered hospital care. They merged and turned into a for-profit HMO during the Reagan crusade to corporatize America.

Before Reagan, HMOs were weird little experiments, trying to bring down healthcare costs by covering preventive care and encouraging healthy habits.

After Reagan, HMOs were Giant Rapacious Monsters, making profits not by encouraging good health but by denying payments to anyone stupid enough to actually get sick or injured.

They've been getting worse every year since. It does not surprise me to learn that Blue Cross/Blue Shield finally crossed the line from behavior that should be illegal to behavior that actually is illegal.

The surprising part is that the Obama Justice Department may actually prosecute the bastards for it.

Susie Madrak at Crooks and Liars:

If Eric Holder ends up indicting and convicting the Blues, I'll take back every snide comment I ever made about the Department of Justice:

The U.S. Justice Department is widening a probe into whether Blue Cross Blue Shield health-insurance plans are artificially raising premiums in several states by striking agreements with hospitals that stifle competition from rival insurers.

Federal investigators and some state attorneys general have sent civil subpoenas to "Blue" health plans in Missouri, Ohio, Kansas, West Virginia, North Carolina, South Carolina and the District of Columbia, according to people familiar with the matter.

The investigation is examining whether dominant health plans around the country are forcing hospitals to sign anticompetitive contracts that unlawfully inhibit them from doing business with their rivals.

The Justice Department's investigation comes as the Obama administration seeks to rein-in rising health-care expenses that threaten to drive up the government's costs for expanding care under President Barack Obama's health-care plan. Congressional Republicans and others have said the Affordable Care Act, Mr. Obama's signature domestic policy achievement, won't lead to lower insurance premiums. Showing that the administration can counter rising premiums by encouraging greater competition could help win support for the law from a skeptical public.

The contractual provisions under scrutiny are known as "most-favored nation" clauses. They usually stipulate that hospitals must charge the insurers' competitors equal or higher prices for medical services.

Such clauses aren't in themselves illegal—they can simply be guarantees to get the best pricing available. But they can violate antitrust laws if used improperly by a dominant company to hobble competitors.

Blue plans tend to be state- or regionally-based and therefore have the market clout to strike such deals with hospitals. While national plans such as UnitedHealth Group Inc. and Aetna Inc. tend to be larger, they are more spread out and typically lack the concentration of a Blue plan in a given local market.

A Justice Department spokeswoman said: "The antitrust division is investigating the possibility of anticompetitive practices involving MFN clauses in various parts of the country."

These insurance contracts are written with all kinds of unfair and non-competitive restrictions. Did you know that when doctors sign an agreement with an insurance company to accept their users, they also agree that they won't offer lower prices to patients who don't have insurance? So even if your doctor wants to cut you a break, he can't.

Imagine, just for a minute, that your insurance company were motivated not by squeezing every last dime of profit out of you but by giving you financial incentives to get and stay as healthy as possible.

It actually does happen, right here in America: At the socialist-medicine success of the Veterans Affairs health care system. For millions of seniors who rely on the single-payer Medicare system. And soon for every resident of the Great State of Vermont, whose legislators have just approved a single-payer system.

Have you talked to your Democratic neighbors today?

Freakazoid Health Insurance

It stumped me for a couple of seconds there. Why in the world would the Kentucky governor want to make it much easier for Big Insurance to fuck over his already poor and poorly-insured constituents?

Media Czech:

Get off their backs!

Gov. Steve Beshear's administration confirmed Monday that Kentucky is seeking a waiver from a portion of the federal health care overhaul that requires large insurance companies to spend at least 85 percent of premiums on medical care.

Insurance Commissioner Sharon Clark made the request in a letter to Health and Human Services Secretary Kathleen Sebelius earlier this month, saying she feared it will create a financial hardship on some insurers and insurance agents.

"Quite frankly, I just thought it was the responsible thing to do," Clark said Monday.

The intent of the federal regulation is to prevent insurers from using huge shares of premiums on costs associated with administration, marketing or executive bonuses.

Thank God Steve Beshear is not only standing up against Barack Obama's cruel persecution of King Coal and their right to pollute Kentucky's water without punishment, but also Obama's oppression of health insurance companies' right to spend their dough on TV ads and CEO bonuses.

Phil Moffett commended Gov. Beshear for the move, so hopefully this will give him some Tea Party mojo going into this November. Oh, and maybe some insurance company campaign contributions, that wouldn't hurt either!

Yes, Beshear's a moron for thinking the teabaggers will ever vote for him or that any amount of Big Insurance blood money would make a difference, but there had to be something more.

And there is. PZ Myers:

This country recently managed to pass a rather lame compromise on health care: there is now a mandate that requires everyone to have health insurance, even if it is from a hodge-podge of insurance companies, with the intent of fairly distributing the expense. Unfortunately, one group got singled out with an exception from this requirement. Can you guess who?

Yep, Christians.

Did you know that if you are a Christian you are exempt from the taxes, penalties and regulations imposed by the recently enacted health insurance law?

All you have to do is to affirm a statement of Christian beliefs and pledge to follow a code that includes no tobacco or illegal drugs, no sex outside of marriage, and no abuse of alcohol or legal medications and pay a monthly fee to join a religious health care sharing ministry plan, a plan that specifically does not guarantee the payment of your medical bills in any fashion and holds members solely responsible for payment of said bills.

And the reason for this exemption? According to the spokeswoman for the Senate committee responsible for writing much of the legislation, lawmakers granted the exemption out of respect for religious freedom.

That's a rather large loophole, and it's also preferentially sectarian. It's also non-surprising. What it means is that a few Christian scam-artists get to get richer, while lots of gullible Christians get screwed. The con is to set up a Christian "bill-sharing" cooperative in place of a real insurance plan; members send in monthly premiums, which can be quite substantial, but do not have to buy in to any other insurance plan, and then the bill-sharing program offers to help cover medical expenses, but "The payment of your medical bills…is not guaranteed in any fashion." It's a great deal for the Christian bill-sharing plan; if your medical expenses get so high that they cut into their profits, they can just elect not to pay, and then you have to go begging to join some other insurance pool.

Absolutely brilliant. Send me money now, and maybe, if I feel like it, I'll help you out with some bills later. But I am not obligated.

And this is such a profitable plan that they managed to lobby congress to support it, all under the cloak of Christianity.

It's even more insidious than that, PZ! By lifting the requirement that health insurers spend premiums on actual health care, governors like Beshear remove any temptation freakazoids might have to purchase secular insurance.

Thanks to moronic opposition to ACA, secular insurance is still as expensive-yet-worthless as freakazoid insurance.

Now that's a level playing field.

Have you talked to your Democratic neighbors today?

Mouth Meets Money on Repealing Reform

So, Tom Daschle admits that the White House threw the public option - and any hope for genuine health care reform - under the bus to please the insurance giants. Everyone who hasn't known this since the summer of 2009, stand on your head.

And now, those "good Americans" at the health insurance companies are thanking Democrats for that bailout by - you guessed it - pouring millions into repug election campaigns.

Kevin Drum:

Noam Levey has a wonderfully revealing piece in the LA Times today about the health insurance industry's hopes and dreams for a Republican Congress next year. The insurers, it turns out, like the new healthcare reform rules that force everyone to get health insurance, but they aren't so keen on all those other pesky regulations:

The insurance industry, attracted by the prospect of millions of new customers as a result of the coverage mandate, initially backed President Obama's campaign to overhaul the healthcare system. And insurers scored a key victory when Democrats abandoned plans to create a government insurance plan, or "public option." But insurers are increasingly balking at the myriad new directives in the healthcare law.

Among other things, the law prohibits insurance companies from denying coverage to sick children and canceling policies when customers get sick. The law bars insurers from placing lifetime caps on how much they will pay when their customers get ill. Many consumers will also get new rights to appeal denied claims and win new access to preventive care without being asked for copays.

"The health reform law did not deliver the uninsured in the way that insurers wanted," said veteran healthcare analyst Sheryl Skolnick, senior vice president at CRT Capital Group.

That final quote is priceless. "The health reform law did not deliver the uninsured in the way that insurers wanted." Apparently they wanted the uninsured trussed up and delivered to their doorsteps wallet first, but without any actual obligation on their part to provide decent service in return. And they know just how to get their wish: "The industry would love to have a Republican Congress," says Wendell Potter, a former Cigna insurance executive. "They were very, very successful during the years of Republican domination in Washington."

But this is creating a wee problem for everyone. You see, Republicans are loudly proclaiming right now that they want to eliminate the part of the law that forces everyone to buy insurance. But that's exactly the part of the law that insurance companies like. In fact, they want to see it strengthened. At the same time, they want to get rid of the popular parts of the law that keep insurance companies from figuring out ways to screw patients. But those are the provisions that Republicans say they'll keep if we turn over Congress to them.

And yet, the insurance companies are massively funding Republicans this cycle anyway. Why would that be? It's almost as if they're sure that Republicans are just blowing campaign smoke and will support their agenda once they're safely in office. They're so sure, in fact, that they're willing to put their money where their mouths are to the tune of millions of dollars.

So which do you believe? Republican mouths or insurance industry money? Decisions, decisions.....

Digby is more pessimistic:

It will be interesting to see how this all unfolds. If I had to guess, I'd think that the Republicans will relentlessly chip away at the funding mechanisms for the big medicaid expansion wherever they can, even if it requires changing the law the first chance they get a Republican majority w/president again. I would think the mandate will stand but that the mechanisms requiring that they keep prices manageable will be tweaked in such a way that the insurance companies will have much more latitude for charging customers. And they will be relieved from having to create comprehensive policies and will be able to go back to the old expensive premiums for crappy coverage model they love so much. In other words, it will take a while, but they'll probably be able to go back to some version of the status quo, only with a mandate that all citizens buy shitty insurance.

The proof will be in the pudding about a decade from now when the court cases all finish and whatever is left of the program is in place. At this point we are dealing with theoretical outcomes even if the plan is unchanged for the worse (and I am very skeptical that it will be.) Politically, this is not a winner for the Democrats or Obama because average people don't see any positive change and until full implementation it's likely they will continue to see their rates going up. But then, that was baked in the cake as well. It is what it is.

And we can guarantee one thing: all the talk of "improving" the legislation will be a joke if the Republicans get the chance to gut it before it ever gets going. That long window to implementation is a land mine that was set when everyone was still singing Kumbaaya about the Permanent Democratic Majority. It doesn't look so smart right now.

Have you made calls for your Democratic congressional candidate today?

The Phrase You're Looking for, Mr. President, is "Evil Fuckers."

As in, "Thank you, you evil fuckers, for being arrogant and stupid enough to hike insurance rates before health care reform was really, truly and completely dead."



Read the transcript here.