Breaking: District Judge shoots down Halbig

We've been following this case, championed by Cato's Michael Cannon, for a long time. Briefly, the suit seeks to enforce the actual law [ed: how quaint] regarding which states' citizens are actually eligible for ObamaTax subsidies.

This afternoon, U.S. District Judge Paul Friedman said "nyet;" the plaintiffs plan to appeal.

We'll keep you posted on how that goes.

Who is Using Obamacare?

Another day, Another ObamaTax "Issue"

As we've previously noted, one of the major problems with the 404Care.gov site is that folks are being indiscriminately, and often incorrectly, shunted off to Medicaid. This is actually two problems:

First, if one is found to be eligible for Medicaid, even if one chooses not to actually enroll, one is barred from receiving any subsidy when purchasing an Exchange plan.

Second, and this is the more serious problem (as we'll see in a moment), is that many folks are being enrolled in Medicaid who a) aren't actually eligible and/or b) don't want to be enrolled in the first place. Here's why that's the more serious issue:

"...you cannot cancel this plan. You have been enrolled in a state Medicaid program. If you disagree, you must file an appeal with the state.”

Previously insured Carol Sauers made the mistake of signing up at the 404Care.gov site so that she could find what choices might be available for her family. Her (then-)current insurance was set to increase by up to 100% (Yikes!), so she thought it might be a good idea to check out her other options. And that proved to be a major error on her part:

"It took more than a dozen attempts to get an online application filled out ... Basically I had to start over each time from scratch." When she was finally able to do so, she was informed that she (and her family) might be eligible for Medicaid. She knew better (their income was too high), but by then it was too late: she was enrolled and that was that.

And thus began her incredible journey through the labyrinth of state and Federal bureaucracies, trying to find some one to help her get disenrolled, but to no avail.

One wonders how many other "Carol's" are out there now, languishing in Medicaid limbo.

Service with a smile...

Last week, at 11:55, I thought I'd try CoveredCA's on-line help...





12:24 PM

12:26 PM

12:43 PM

1:07 PM

1:54 PM

1:55 PM

Just a brief update...After waiting for another hour on the phone, I managed to talk to one of their internal customer service reps.  It took a while, but he managed to get my client switched from Anthem to Health Net.  I have to say that every interaction I've had with CoveredCA personnel has been good.  They're friendly, helpful and basically have bent over backwards to answer questions and get things fixed.  If the web site didn't have so many rough edges, their job would be a lot easier.  (Bumped to add some new information...)

On Death Panels, the ObamaTax, and the MVNHS©

From the annals of the Much Vaunted National Health System©, another glimpse into our own newly revised one:

"A grandmother has been ‘left to die’ by the NHS after being refused life-saving chemotherapy - because her cancer is not ‘exceptional’ enough."

Really? And what do our Cousins Across the Pond consider "exceptional" enough to be saved?

Here's a clue:

"Each case is considered on an individual basis and has to meet set criteria, which includes exceptional clinical circumstances"

Well, when you put it that way...

Mrs Stanton, the 69 year young grandmother of four doesn't fit whatever double-top secret criteria on which the MVNHS© has chosen to rely. She now faces the prospect of having to sell her house to pay for the £40,000 ($65,000+) treatment.

Perhaps she should have bought a Private Medical Insurance policy.

Back on track

We've been following the harrowing tale of California insurance agent Glenn Neasham for almost 2 years (our most recent report was this past October, when we learned that his conviction had been overturned.)

Today comes news that Mr Neasham's insurance license has been reinstated, and that he may once again ply his chosen trade.

Congratulations, Glenn!

My new article is up...

At Answers.com:

"The loss of a key employee can wreak havoc on a company's productivity, profitability and ability to stay in business. A life insurance policy on that key employee can guarantee that sufficient funds are available, in a timely manner, to help mitigate that loss."

If there's a particular insurance topic you'd like me to cover, please let me know.

Obamacare Batting .080 in CT

Obamacare isn't doing well in Connecticut. Their batting average is fitting for a pitcher but if you

are only batting .080 you better have a wicked curve ball.

As of last Friday, only 8 percent of customers slated to have coverage effective Jan. 1 had been recorded in Anthem’s system as having paid their premiums, 

CT Mirror

For every 100 that put a plan in their shopping cart, only 8 checked out and paid for their order.

Pathetic.

Full disclosure. Sort of . . .

Some Anthem customers who signed up through the exchange have said they tried to pay their bills multiple times over several weeks, but have not had their checks cashed or credit cards charged. The Mirror has asked Anthem about potential payment processing issues but has not received an answer.

They tried to pay but Anthem didn't have a way to accept their money?

Seriously?

Obamacare can't even make an AAA team. They are not ready for the majors. Perhaps they need steroids.

¡Hola, 404Care!

One of the most (unintentionally?) humorous things I ever saw on TV was back in the 70's: The Streets of San Francisco paired an older, experienced detective (Karl Malden) with a younger partner (Michael Douglas). In one episode, they arrive at the storefront of a Latino business, only to see a sign on the door: "El Close-o." (Really!)

I was reminded of this by the news that the Spanish-language version of the train wreck website isn't any more well designed or implemented than the English one. In fact, well, it was apparently written by Adam Sandler:

"The site, CuidadoDeSalud.gov, launched more than two months late. A Web page with Spanish instructions linked users to an English form."

Not only that, but the translations themselves are straight out of 'Spanglish:'

"...the name of the site itself can literally be read "for the caution of health."

On second thought, that may actually be a case of truth in advertising.

Thought for the Day

Consider this. Those who complain the most about #Obamacare seem to be Democrats. Many want to blame Republicans for this mess, yet nary a single Republican voted for Obamacare.

Humana says "Ruh Roh"

Forbes' Avik Roy notes that Humana has expressed concern over the mix of business in its Exchange plans. Specifically, that young and/or healthy consumers are staying away from these plans in droves:

"Humana “now expects the risk mix of members enrolling through the health insurance exchanges to be more adverse than previously expected.”

That's worrisome for a number of reasons, not the least of which is the so-called "risk corridor," which is essentially a giant re-insurer or, in English, "thee and me." Briefly, if carriers suffer significant losses as a result of the Guaranteed Issue/No Pre-Ex Exclusion nature of the ObamaTax, you and I get to bail them out.

How lovely for them.

That Humana is signalling so early that this is already a probability does not bode well for those of us who actually pay taxes [ed:and, as Bob correctly notes in the comments, premiums].

My new article is up...

At Answers.com:

"Making informed and economically rational choices in planning for retirement income can be challenging. Using Pension Maximization to insure the greatest possible retirement income stream for both you and your surviving spouse can make it easier."

Barn Doors and Horses

Four months after the disastrous roll-out of the 404Care.gov site, Ms Shecantbeserious appears ready to cut ties with the rocket surgeons who developed and implemented it:

"The Obama administration has decided to jettison CGI Federal, the main IT contractor that was responsible for building the defect-ridden online health insurance marketplace and has been immersed in the work of repairing it"

That's the good news (for a certain value of "good"); the bad news is that the Feds managed to blow through almost $680 million in taxpayer funds in the first place.

It seems that, having apparently had a change of heart about using a Canadian company to build and run an American portal, Ms Shecantbeserious has chosen Accenture, "one of the world’s largest consulting firms, [with] extensive experience with computer systems on the state level, [including] California’s new health insurance exchange."

For real?

That Golden State Health Insurance Exchange?

Oy!

Cream, sugar and pediatric dental care

From FoIB Jeff M:

My new article is up...

At Answers.com:

"Partnership-complaint Long Term Care insurance plans can be a valuable tool in protecting one's hard-earned assets, while providing access to government-funded care."

Queen City Drama Update - Early '14 edition

Hard to believe, but we've now been tracking this story since 2011:

"Retired city of Cincinnati workers argued in court Tuesday that City Hall is obligated to provide them for the rest of their lives with an extremely generous health coverage plan"

Last year, the city's Solicitor reported that the Ohio Supreme Court was taking a pass on even hearing the case, so it seemed like that was the end of the story.

Turns out, not so much:

"The city of Cincinnati can change its medical benefits for retirees and those benefits are not considered “vested,” an Ohio appeals court has ruled ... the court has reconfirmed the city’s position that retiree medical benefits are not vested and are subject to change"

This appears to finally put the issue to rest, but this case seems to have more lives than a video game hero.

[Hat Tip: FoIB Holly R]

Cavalcade of Risk #199: New Year edition

Michael Stack presents this year's very first Cav, with posts from risky places for cancer treatment to medical child abuse (a term that's new to me). Do check it out, and Happy New Year!

Obamacare Comes to Georgia

Obamacare comes to Georgia. Teachers Rally Against Georgia Insurance Changes

(T.R.A.G.I.C.) 

Obamacare coming to Georgia is not news, unless you are part of TRAGIC, a group of teachers that finally realized Obamacare means change for them.

The wife of a Cherokee County teacher is leading a statewide group against changes to the state employee health insurance plans that took effect Wednesday.

Within less than three days of being created, the group to bring awareness of 2014 changes in insurance for teachers and other state employees had already surpassed 1,600 members.

The group, “Teachers Rally Against Georgia Insurance Changes,” or TRAGIC, was created Thursday morning by Canton resident Ashley Cline, whose husband is a teacher in Cherokee County.

Marietta Daily Journal

Apparently some teachers failed to do their homework. While fellow Georgian's were losing coverage and seeing their rates skyrocket this group marched forward, oblivious to the fact their ox was about to be gored.

Local governments plus public school systems have the option of participating in the Georgia State Health Benefit Plan (SHBP) or securing their own coverage. Many of the public school boards simply default to the SHBP which makes their job easier.

Prior to 2014 the SHBP had two insurance carriers acting in a TPA capacity and charged with administering the plan for some 650,000 employees. As recently as 2013 there were over half a dozen plan choices including copay plans, HSA and HRA.

That all changed in 2014 when Blue Cross of Georgia was named the lone TPA and the plan choices were reduced to three Obamacare metal plans: Gold, Silver and Bronze.

Gone were copay plans. Your only choice now is a high deductible HRA.

Personal responsibility is the watchword of the day and those covered under the SHBP must now pick from a small pool of participating doctors and hospitals while at the same time becoming informed shoppers when it comes to health care.

The TRAGIC teacher group, along with many state employees apparently just came out from under the ether and realized what Obamacare means to them. Some did not understand how the plan worked until they actually USED their plan since January 1.

Now they know how we felt about pop quizzes.

TRAGIC has already led the charge to call the Governor's office to complain and they plan a rally on the Capitol steps on January 18, 2014.

However noble their cause may be, their efforts are targeting the wrong entity. Rather than complaining to the governor about the plan they should raise their voice to their employer. Their respective school systems, not the state, are the ones that decide on the group plan. Venting their frustration at the state level is a waste of time.

Ashley Cline and her group have already staked out their plan of action and are unwilling to consider that it will be ineffective. There are a few of their members that are astute enough to realize the change is part of the Obamacare train wreck, but most seem to be willing to pick up their torches and pitchforks and storm the Capitol.

Blaming politics and a Republican Governor seems an easy target.

I do empathize with them since my wife and I are also covered under the SHBP through her employer. The summaries provided during open enrollment were vague in some areas and with regard to the network, just flat wrong. Instead of the promised Blue Cross PPO broad network we found out weeks after open enrollment had closed that the material was wrong. Instead of the PPO we have a much smaller POS network.

Yet no one in TRAGIC seems to notice or understand what this means. They mistakenly believe their protests will give them back their old plan choices.

Sorry folks. There is a new sheriff in town and no matter how much you liked your old plan it is forever gone. Some 650,000 Georgians covered under the SHBP woke up on January 1, 2014 only to discover they, like millions of others across the land, have had their health insurance cancelled.

If you liked your health insurance plan and your doctor, get over it. The four year lie now impacts you.

Tragic.

Welcome to WallyWorld General!

Does your health care provider wear a stylish blue vest? No? Well maybe you should re-think your choices:

"[A] Washington Examiner comparison of the two health insurance programs found that Walmart's plan is more affordable and provides significantly better access to high-quality medical care than Obamacare."

Not only that, but it's cheaper than ObamaTax plans, "there are no income eligibility requirements," and unlike the ObamaTax, rates aren't tied to age. What's even better is that "[m]any top-rated Walmart hospitals — such as the Mayo and Cleveland clinics — are left out of most Obamacare exchange plans."

So: lower premiums, lower out-of-pocket (due to Walmart's Health Reimbursement Arrangements) and access to better hospitals and care centers. Could it get any better?

Why yes, yes it can:

"You will notice there are 9,837 doctors [under Obamacare]. But the larger [Walmart] network is 24,904 doctors."

Substantially better than twice as many under Sam Walton than Kathy Shecantbeserious. Sweet.

This makes sense, of course, when you consider what co-blogger (and Certified Medical Office Manager) Kelley observed two years ago:

"Wal-Mart will succeed because Medicine is a business. Back in 2009, I wrote that “physicians, like all technicians, understand the art of medicine, that is their training, and they are effective in their art. However, medical schools do not teach physicians how to relate to the enterprise of medicine or to the business of medicine.” Wal-Mart will succeed because they appreciate the patient and they can offer low prices"

Kelley was discussing health care but the principle holds: Walmart is a business and adheres to profitable business principles. One of those is providing value for dollars spent, whether for lawn furniture, dish soap, vacuum cleaners or insurance.

I wonder if they're hiring agents....

Budget Buster

Every business wants to plan for their future. Budgets, forecasts, sales projections, expenses, and hopefully profits. For a small insurance agency whose focus is on employee benefits this is a challenge. Especially with PPACA constantly changing.

After wages, health insurance is my second highest cost for employee compensation. We have two employees and this year I will pay $22,000 for a plan with an 87.1% actuarial value. We are very close to a Platinum plan but not close enough according to the law. Come next year I can't keep the plan that we like. Instead we must either purchase better benefits or reduce the benefits we currently offer. This means raising deductibles, copays, coinsurance, and out of pocket maximums. I don't want to offer a lesser plan, so I have been leaning towards the better insurance.

That all changed when I ran new premiums last week. Losing our plan is peanuts compared to the new premiums that we are going to see.

Because of the new rules Obamacare forces upon us I will see my rates go up in 2015 by a minimum of $16,000. Let me repeat that, starting next year my group rates will go up by a minimum of $16,000. All because of Obamacare.

According to the US Census Bureau (latest data - 2008) there are 5.3 million businesses with less than 20 employees. In total they have payroll for 21.5 million people. Many who offer health insurance to employees as a part of their compensation package will face the same dilemma that is highlighted above.

We haven't heard about it in the MSM yet. Just wait, though: before long small businesses will start getting these outrageously high renewals. For most they will see these renewals between September and November. Just in time for a reminder as to who voted for this law right before elections.

Called. It.

The mask slips:

"For-profit health insurance is on some level morally offensive ... I consider it a deceptively sneaky way to get the health care system both of us really want."

So says Noam Scheiber, senior editor at The New Republic. And what, exactly, do he and Mr Moore "want?"

Ah, glad you asked:

"In wonk terms, progressives are likely to get their beloved public option one way or another, and probably not too far in the future."

The "Public Option" is a euphemism for Single Payer, the obvious end-game for the ObamaTax from the get-go.

And how do we know this?

Well, our own Mike Feehan called it over 4 years ago:

"The administration still intends to control medical costs by ... a single payer mechanism"

Now if I could only convince him to get me those pesky winning lottery numbers...

[Hat Tip: FoIB Holly R]

The ObamaTax/Medicaid Shanda

I've been reading recently that a lot of folks trying to sign up for a plan at 404care.gov are being unceremoniously (and involuntarily) dumped onto Medicaid, and that it's well-nigh impossible to dis-enroll once that's happened. Turns out, that bug has now bitten the family of Sen Rand Paul (R-KY):

"At least one member of the Paul family is, though, albeit erroneously. The Kentucky senator held up the Medicaid card his son received through the Kentucky exchange. We didn’t try to get him Medicaid, I’m trying to pay for his insurance,” Paul said"

But at least that's just an isolated incident, right?

Um, no.

As our friend David Adams reports from The Bluegrass State:

"Since Kentucky started taking applications for ObamaCare and forcing most applicants into Medicaid, the Kentucky Health Benefit Exchange has been excluding disability payments from income used to determine Medicaid eligibility ... That means potentially thousands of applicants to Kentucky ObamaCare who were placed into Medicaid were put there erroneously."

Not to worry, though: the folks who run the Medicaid program have things well under control.

Right?

Well....

"The [North Carolina] state Department of Health and Human Services issued a written release saying that new Medicaid cards for nearly 49,000 children were mailed on Dec. 30 to the wrong people."

Top. Men.

It's Catastrophic

So it's 9:00 PM on Thursday, December 19th, and President Obama magnanimously announces that ACA-compliant Catastrophic ("Cat") plans, heretofore available only to those under age 30, will now be available to folks who can't be trusted 30-and-up. As I pointed out the next day:

"With roughly 84 hours left on the clock - and a weekend taking up most of that - carriers are supposed to price these plans for people aged, oh, 35 or 45 or 55. This, despite the fact that rates have already been reviewed and approved (or not) by the 58 different states' departments of insurance, which will now also have to review and approve (or not), these new rates."

Fast forward a couple weeks, and here's email from Aetna:

"The government recently announced Catastrophic Plan eligibility changes for members whose plans were cancelled with the implementation of the Affordable Care Act (ACA).  We want to update you on these changes and explain how we are modifying our Catastrophic Plan application process.

Previous to this modification, Catastrophic Plans were intended only for members under the age of 30.  With the government announcement, we are now offering two age categories for Catastrophic Plan eligibility.

1. Under 30 years old

2.30 years and older whose pre-ACA plan is not being renewed."

Co-blogger Pat and I have been discussing this, and have come up with some observations:

■ In checking the various quoting sites (and my own General Agent), there don't seem to be any actual rates for such plans. Which makes sense: as I noted last month, even if carriers wanted to sell these plans, they still have to price and file them with the 58 states' departments of insurance, and then feed these rates into their quoting engines (and that's just from the carriers' side: heaven only knows how 404care.gov will handle this).

■ The original announcement seemed to imply that anyone whose pre-ACA plan had been cancelled could buy one of the (allegedly) less expensive Cat plans. Sadly, this is not true: one must also file for, and be granted, a Hardship Exemption. This isn't quite as simple as it sounds. This 6-page form outlines the 14(!) different criteria under which one might qualify, including "You were homeless ... You had medical expenses you couldn’t pay in the last 24 months ... You received a notice saying that your current health insurance plan is being cancelled, and you consider the other plans available unaffordable."

And of course, it's not as if they'll simply take your word for it; no, most require additional documentation.

■ Once you've completed and submitted the form (via snail mail, phone, or the famously functional 404care.gov site), you then have to find a carrier in your geographic region that actually sells them. And good luck with that: thus far, there don't seem to be any carriers offering these plans to the 30+ crowd.

■ And speaking of which: why should they? Think about it from the carriers' perspective: as noted above, you have to price and file it, wait for approval, and then feed it into your quoting engine. And for what? The small group of folks who actually meet one of the criteria and might be interested in a quote? Uh-hunh. 

■ And about those quotes. Since there are no actual rates available for 30+ Cat plans, I ran numbers for a 27 year old. Here's the good news:

PPO Cat Plan w/$6350 deductible, then 100% (also: $40 PCP co-pays): $169/month
 

PPO Bronze HSA (!!) w/6000 deductible then 100% (but $6350 maximum out-of-pocket): $201/month

Not hateful, but not exactly bargain-basement, either.

As Pat pointed out, though, that's only part of the story:

"I wonder what they look like at different ages. Because of the age I can see carriers writing lower premiums based on the low likelihood of health risk [at younger ages]. Expanding the CAT plans to age 64 would have to change the entire Actuarial Value and rating process. CAT plans can lower the rates knowing that the risk pool will only comprise of 20-somethings who are in good health. Any unhealthy person under 30 will be better off with more robust coverage. Moving to offer these plans to a totally new demographic with the 3 to 1 premium factors for age will most definitely increase costs to policies for 20-30 year olds in order to cover the price point for a 61 year old."

Ooops. So much for that idea.

It's almost as if the folks in Capital City have no idea what they're doing.

Is Obamacare Your Pimp?

Is Obamacare your pimp? Who is your baby daddy? In many cases it is #Obamacare. If you bought a

subsidized  health insurance plan from the Obamacare  exchange working taxpayers are funding  a portion of your premiums. When you bring a baby into the world you need to tell the insurance company and Obamacare.

Why?

Because Obamacare is your pimp and your baby daddy.

With regular private insurance, parents just notify the health plan. Insurers will still cover new babies, the administration says, but parents will also have to contact the government at some point later on.

Yahoo News

Working taxpayers, by way of the federal government, are providing tax breaks (premium subsidies) so you can afford to have health insurance. Since we are paying some of your bills we need to know when you have a baby (or adopt). We become your pimp. We are your baby daddy.

Such changes affect financial assistance available under the law, so the government has to be brought into the loop.

That new baby may mean your taxpayer funded subsidy amount will change. Your gross premiums will increase. That is a given. But your net (after subsidy) may also increase.

But wait. There's more.

It's not just having a new baby that could create bureaucratic hassles, but other life changes affecting a consumer's taxpayer-subsidized premiums. The list includes marriage and divorce, a death in the family, a new job or a change in income, even moving to a different community.

When you sign up for Obamcare the federal government needs to know more about your (formerly) private life. This includes marriage, divorce, children turning 19, moving to a new zip code  . . .

The role of the baby daddy is much expanded.

Insurers say computerized "change in circumstance" updates to deal with family and life developments were supposed to have been part of the federal system from the start.

But that feature got postponed as the government scrambled to fix technical problems that overwhelmed the health care website during its first couple of months.

"It's just another example of 'We'll fix that later,'" said Bob Laszewski, an industry consultant who said he's gotten complaints from several insurer clients. "This needed to be done well before January. It's sort of a fly-by-night approach."

No surprises here. Just more examples of incompetence in the Obama administration.

Just like many real life pimps, the Obama administration wants no part of actually taking care of matters. But they do want to know where you are and who you are seeing. Big on promise, short on follow through.

Obamacare will pimp your health insurance.

My new article...

(the first this year!) is up at Answers.com:

"Variable annuities offer consumers looking for tax-advantaged growth the opportunity for more direct control over how quickly their assets can accumulate. On the other hand, they lack many of the guarantees available in traditional fixed annuities, so one needs to be very careful when choosing one of these plans."

And so it begins (well, continues)...

To the surprise of very few (and certainly no one who's been actively following the train-wreck), the ObamaTax has certainly lived up to its hype:

"Hospital staff in Northern Virginia are turning away sick people on a frigid Thursday morning because they can't determine whether their Obamacare insurance plans are in effect."

Given the last-minute shenanigans played by the Obamastration and its chief henchcritter, Ms Shecantbeserious, it would be a wonder if there weren't health care delivery "glitches." Remember, too, that the 404care.gov site makes it well-nigh impossible to either pay for coverage, or to confirm that it is, in fact, in effect.

[ed: nor can folks add newborns, add or delete spouses, or account for pretty much any life cycle event that would impact their plan]

But it's not just hospitals, and it's not just in NoVa:

"The new year brought relief to some Illinois patients newly insured under the nation’s health care law. Others still weren’t sure whether they were covered, despite their best efforts to navigate the often-balky new system."

That's out of Chicagoland, where "[p]aperwork problems almost delayed suburban Chicago resident Sheri Zajcew’s scheduled surgery." Fortunately, her surgeon decided to go ahead and operate anyway, on the theory that he can obtain post-authorization.

Here's the thing: you can't really do that. Prior authorization is a pretty serious thing, and there's a likelihood that the carrier will decline to retroactively grant it.

"Oh, but Henry, they're stuck, too, surely they'll understand and work with the surgeon and the patient (their insured)."

Maybe, maybe not. But gambling that the insurance carrier, already facing incredible pressure from stakeholders and the folks in Capital City, will suddenly decide to go wobbly on established process is, at best, dubious. Remember, this was a "scheduled," ie elective, procedure, not an emergency.

Still wanna bet on it?

Cavalcade of Risk #199: Call for submissions

Happy New Year! Mike Stack hosts next week's Cav. Entries are due by Monday (the 6th).

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

You'll need to provide:

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

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

But mostly losers...

This morning, Nate posted about "happy ObamaCare enrollee ... Allena Ruszkiewicz," who was able to procure a shiny new plan to cover her GHB the date rape drug narcolepsy med Xylem. While that's good news for Ms Ruszkiewicz, it pales in comparison to what's happened to "Karri Kinder, a mother of two from Auburn, Alabama" whose policy, contra the President's explicit promise, was cancelled, and whose son's ADHD prescription just became prohibitively more expensive:

"His medicine is a life saver for him and helps him function like a normal seven year old, without it he can’t focus, his grades slip and his mind literally goes back to the mind of a three or four year old. When he was first put on his medicine his reading went up 20 points and he went from writing one to two sentences to paragraphs, all in the course of a week. He is a straight A student and very bright, but without the proper medical care that could slip away from him."

And that's just the beginning of her family's nightmare.

I highly recommend clicking through and reading the whole article, but first, put down any sharp objects.

Winners or suckers?

One of the big problems with ObamaCare is that it doesn't really solve any problems as much as it either masks or nationalizes them. A great example out of NY:

"One happy ObamaCare enrollee is Allena Ruszkiewicz, 36, of Jackson Heights, Queens, who had been uninsured since July after quitting her job as a phlebotomist because she suffers from narcolepsy and other ailments.

Without benefits, she couldn’t afford the $5,000-a-month cost of the prescription drug Xylem to prevent daytime sleeping attacks.

Instead, Ruszkiewicz said, she relied on a home remedy of “Red Bull and really strong coffee, which really doesn’t work so well.”

Since signing up for a top-tier ObamaCare “platinum” plan, she’s paid the $462.69 monthly premium, and now feels like “a huge winner.”

The average price of this drug is actually closer to $8,000 a month, it increases around 7 times a year. What is really interesting about this very high cost drug; its a legal version of GHB, the date rape drug. Commonly made around the world in peoples' homes for a hundred dollars for a years worth. Jazz Pharmaceuticals had $0 R&D; they were awarded an exclusive right by our Federal Government to manufacture the otherwise illegal drug, Express Scripts has the exclusive right to distribute it. 

If you can buy the drug on the street for $10 a dose why is it selling for $263 a dose? Has ObamaCare really "solved" her problem or just perpetuated a major flaw? The OOP caps have actually increased the excessive profits companies like Jazz and Express Scripts make: Jazz used to write off  thousands of dollars a month in members' cost share, now (once the member hits the magic $6,350) insurance must pay them 100%.

Mark the Unhappy Liberal

Self employment has been good to my client Mark. He went from working for "the man" four years ago to building his own small business. Over those years times were tough for Mark and his family. Getting the business off the ground was tough and because of a prior medical condition Mark's wife was uninsurable. The good news was he was able to utilize COBRA and pay an "outrageous" premium of $798 per month for a $3000 single deductible CDHP plan. When it expired in 2011 the family was forced to make a decision. I had advised him with his COBRA decision and now he was calling again hoping to find cost savings and make sure that his wife had insurance.

The good news was we were able to insure the entire family and lower the deductible to $2500 single deductible. The new cost was $498. Mark and his family couldn't be happier. In their opinion it was all because of Obamacare. Fast forward to last month.

With an income of $95,000 per year and a plan that was no longer going to be available because it doesn't meet the law, I encouraged Mark and his family to take an early renewal option to avoid the high costs associated with community rating and new mandated benefits. His 2013 rate was $632 and an early renewal option would only increase the rates to $651. 

Against my advice he refused the early renewal. "You've been a great help but I believe in the Affordable Care Act. There is no way that the costs and subsidies will make me any worse off." So we went the other direction and started the process at goodluck.gov. Finally on December 20th we were able to get through the website and pick a plan. The results only shocked one of us.

Starting tomorrow he will have a new plan. It is with one of three insurance companies who are contracted with his wife's specialists but wasn't the lowest cost option. His benefit will be better with a $500 savings in his deductible and the family will get a subsidy estimated at $101 per month. 

The problem is the new premium. It will cost him $1142 per month and this includes his subsidy. $5892 per year more than if he had simply early renewed. Unfortunately for Mark and his family Obamacare didn't bring peace and joy this holiday season. Instead it left him with a big lump of coal.

One Step Forward(?), Two Steps Back

A not-so-Happy New Year for those of us for whom health insurance, and health care, are a priority:

"More than 4.7 million Americans had their health insurance canceled as a result of [the ObamaqTax] ... but [HHS Secretary Shecantbeserious] confirmed Tuesday that between federal and state exchanges, just 2 million Americans have signed up for (coverage)."

Not that this is a major surprise, mind you, just a reminder that the train-wreck continues to provide a lesson in how not to solve any supposed health insurance (or care) crisis.

But wait, it gets better worse:

"CNN's Jim Acosta asked Bataille if she could at least say with confidence that a "very high percentage" of those 2.1 million had paid."

Long time readers can already guess the answer....

"Bataille said, “We are confident that those consumers have selected a plan and know what the next steps are for them in terms of securing coverage.”

Which is a rather long-winded way of saying "no."

Par for the course.