Over the past few months, we've been featuring videos from the folks at Mutual of Omaha, which in turn feature some of that carrier's senior Long Term Care insurance underwriters. They're an opportunity to peek "under the hood" at how carriers assess and price risk.

In this final installment, MoO's Director of Underwriting, Allen Gregoire, "discusses the effort his LTC underwriting team puts into quick turnarounds, and wonders how the future of insurance underwriting, especially concerning genetic testing and cognitive diagnoses like Alzheimer's and dementia."

We've touched on genetic testing before, and all I can say is that we'd better be aware of just how insidious its inclusion in the underwriting process would be.

Here's Allen:

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You have GOT To Be Kidding Me

Because of course, let's just pretend there are no rules (because clearly there aren't: 

"CMS Statement on Health Insurance Exchange Open Enrollment Extension 

In an abundance of caution, to accommodate consumers who attempted to enroll in coverage during the final hours of Open Enrollment but who may have experienced issues, starting at 3:00PM EST today, December 16 we are extending the deadline to sign up for January 1 coverage until 3:00AM EST December 18."

Oh for crying out loud. This has nothing to do with "caution," and everything to do with number padding. Those final ACA sign-up tallies must look truly awful.

#Disgusting

[Hat Tip: Health Agents for America]

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Top of the Week Roundup

#1: Golden State heads' up:

Californians Without Health Insurance Will Pay A Penalty — Or Not 🤔https://t.co/iqNtoEsHGy

"Californians must have health insurance starting next year or face a HEFTY tax penalty. But..."#California #Healthcare #Obamacare pic.twitter.com/MNMlW1Gd44

— Steve Downey (@DowneyInsSvc) December 16, 2019

We previously covered this at the beginning of this year, when California "enacted legislation that permanently establishes different enrollment dates within the state, both on and off-exchange."

Hunh.

#2: Across the Pond, the Much Vaunted National Health Service© continues swirling:

"Nearly half of [NHS] cancer patients in Wolverhampton are being kept waiting to start treatment for longer than the recommended two months." https://t.co/2gt5NuzbXC

— AssocAmerPhys&Surg (@AAPSonline) December 15, 2019

As we've long noted, this is a fuatire, not a bug.

#Mediciad4All

#3: Finally, as we wait for final numbers from Open Enrollment v7.0, this interesting observation from FoIB (and actuary) Greg Fann:

Only 1 of the 3 ACA individual market population groups has had an enrollment increase from 2017-2020, and it did so in the two years that outreach funding declined. We need to concern ourselves with other aspects that drive enrollment results. https://t.co/Vi1plXTIxU

— Greg Fann (@greg_fann) December 3, 2019

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Sharing is Caring - Or maybe not

Over the years, we've written pretty extensively about Health Care Sharing Ministries (HCSMs), both their advantages and their flaws.

On the one hand, they are ACA-compliant, which means that they technically check the Mandate/Tax/Penalty-avoidance box. And, they are typically far less expensive than comparable ObamaPlans.

On the other hand, they are underwritten, and they are not insurance, which means that there are few (if any) consumer protections available for folks who enroll (notice that we can't call them "insureds"). They often have religious restrictions, as well, which could be problematic for some.

Back in August, we noted that Washington State insurance regulators were taking a hard line against Aliera's HCSM arrangement:

"The top insurance regulator in Washington state is accusing a high-profile health care cost sharing ministry, and its program manager partner, of trying to avoid state insurance regulation by wrapping ordinary health insurance in a health care sharing ministry wrapper."

Fast forward to now, and co-blogger Bob tips us to this item from the Peach State:

"... health shares marketed by Georgia-based Aliera, the company through which Greer bought his plan, exemplify those risks, with the company under investigation or ordered to stop selling plans by regulators in at least four states."

I can sympathize with Alierra's clients: as anyone who's recently shopped at the 404Care.gov site can attest, plans are increasingly expensive, both in premium and potential out-of-pocket, even with subsidies (tax credits). So it's easy to understand the allure of alternatives like health sharing, while overlooking the very real pitfalls.

I must say, I'm not sure how insurance regulators think they have the authority to ban an explicitly non-insurance product, but maybe that's just me.

#CaveatEmptor

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MVNHS© & Medicaid4All: A Study In Health "Care"

As we've long noted, when health care is a "right" bad things happen:

"Quebec’s health minister said Thursday he would sign a ministerial decree to block dentists from withdrawing from the public health system amid a bitter standoff over contract negotiations."

Here, of course, we have the 13th Amendment.

For now.

As we've also long noted, Britain's Much Vaunted National Health System© (which is based on that premise) continues to prove my conclusion true:

One of the worst nights in A&E

It’s not safe

It’s not fair

Not fair on patients

And it’s not fair on staff

Im so angry because this hasn’t ‘just happened’

Result of decisions by politicians, who ignored warnings

They need to take responsibility
Start taking this seriously pic.twitter.com/XCnclzNE9t

— Dr Sonia Adesara (@SoniaAdesara) December 7, 2019

And that, dear readers, is what awaits us with #Medicaid4All.

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Google vs Privacy

"I'm the Google whistleblower. The medical data of millions of Americans is at risk - Anonymous"

Hunh?

Well:

"I didn’t decide to blow the whistle on Google’s deal, known internally as the Nightingale Project, glibly. The decision came to me slowly, creeping on me through my day-to-day work as one of about 250 people in Google and Ascension working on the project."

The challenge, of course, is how we define privacy these days. As co-blogger Kelley recently pointed out about this very story:

"In America only one State (New Hampshire) stipulates in its laws that the patient owns information in the medical record. In all other States it either stipulates that the Provider (Hospital and/or Physician) owns the medical record or there is not such stipulation."

And when we use devices, we've given explicit permission about what the folks on the other end may do with it.

From 4 years ago:

"[I]f a person receives a wearable device through their hospital or doctor, the healthcare data that device collects is covered by HIPAA. At least, the data HIPAA defines as protected healthcare information (PHI) is safeguarded."

And we've seen how well that's worked out.

[Hat Tip: FoIB Shari G]

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Weird 404Care.gov Tricks

Working with a new (to me) client on an Exchange plan, husband and wife, $28,000 annual income (2020). Very vanilla, no real issues. Plug in their demographics, hit the button, and see that they qualify for a fairly substantial subsidy tax credit. The only 'off' thing is that the income is 100% from hubby (this comes into play in a moment).

So continue on to the quote screen, see that they can buy a $5,250 deductible HSA-compliant plan for about $50/month (total for the two of them, after applying $1,250 subsidy). Nice.

Yesterday, Suzy stopped in to pull the trigger, and we went to sign them up. We carefully went through each screen, and confirmed that we'd entered all the relevant personal info for both of them. But when we got to the "checkout lane," the premium had gone from $50 to almost $80, and - weirder still - it seemed to only list Suzy.

Hmmm.

So, we call the 404Care.gov hotline, and sure enough, they were only showing her as on the plan; keep in mind, we both saw me click the buttons to include hubby. Okay, no big deal, nice guy at the other end got us all hooked up, hubby added and, lo and behold, a miracle:

Instead of $80 for Suzy alone, it was $40 for the two of them.

And yeah, I'm thinking this, too.

Apparently the gummint also works in mysterious ways. How else to explain why it's half the cost to insure both of them?

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