Cherry Picking the Healthy Inside the Exchanges - Blue Cross' Model

Insurers are experimenting to find out what to offer in the exchanges. Answer: the healthy buy on price; the sick want full coverage and access to a full range of providers. ... 

The research is shaping Blue Cross’s decisions. The company is initially selling a “tiered” plan that requires consumers to pay more to see certain health-care providers, and next year it will roll out a new design with a smaller network, both approaches that can hold costs down. [Thereby appealing to the healthy risk they want.] 

The insurer also isn’t offering any platinum plans to consumers, partly because the simulation showed they tended to draw people with significant health needs, a particular concern if it’s the only competitor with a platinum product. [Emphasis added]... 

Source: WSJ.  Hat tip: John Goodman. 

Looks Like the Love Affair Between ObamaCare and Unions is Over

As reported from Avik Roy at Forbes: 

Labor unions are among the key institutions responsible for the passage of Obamacare. They spent tons of money electing Democrats to Congress in 2006 and 2008, and fought hard to push the health law through the legislature in 2009 and 2010. But now, unions are waking up to the fact that Obamacare is heavily disruptive to the health benefits of their members.

Last Thursday, representatives of three of the nation’s largest unions fired off a letter to Harry Reid and Nancy Pelosi, warning that Obamacare would “shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.”

The letter was penned by James P. Hoffa, general president of the International Brotherhood of Teamsters; Joseph Hansen, international president of the United Food and Commercial Workers International Union; and Donald “D.” Taylor, president of UNITE-HERE, a union representing hotel, airport, food service, gaming, and textile workers.

“When you and the President sought our support for the Affordable Care Act,” they begin, “you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat…We have been strong supporters of the notion that all Americans should have access to quality, affordable health care. We have also been strong supporters of you. In campaign after campaign we have put boots on the ground, gone door-to-door to get out the vote, run phone banks and raised money to secure this vision. Now this vision has come back to haunt us.”

‘Unintended consequences’ causing ‘nightmare scenarios’

The union leaders are concerned that Obamacare’s employer mandate incentivizes smaller companies to shift their workers to part-time status, because employers are not required to provide health coverage to part-time workers. “We have a problem,” they write, and “you need to fix it.”

“The unintended consequences of the ACA are severe,” they continue. “Perverse incentives are causing nightmare scenarios. First, the law creates an incentive for employers to keep employees’ work hours below 30 hours a week. Numerous employers have begun to cut workers’ hours to avoid this obligation, and many of them are doing so openly. The impact is two-fold: fewer hours means less pay while also losing our current health benefits.”

What surprises me about this is that union leaders are pretty strategic when it comes to employee benefits. It was obvious in 2009 that Obamacare’s employer mandate would incentivize this shift. Why didn’t labor unions fight it back then?

Regulations will ‘destroy the very health and wellbeing of our members’

The labor bosses are also unhappy, because of the way Obamacare affects multi-employer health plans. Multi-employer plans, also called Taft-Hartley plans, are health insurance benefits typically arranged between a labor union in a particular industry, such as restaurants, and small employers in that industry. About 20 million workers are covered by these plans; 800,000 of Joseph Hansen’s 1.3 million UFCW members are covered this way.

Taft-Hartley plans, they write, “have been built over decades by working men and women,” but unlike plans offered on the ACA exchanges, unionized workers will not be eligible for subsidies, because workers with employer-sponsored coverage don’t qualify.

Obamacare’s regulatory changes to the small-group insurance market will drive up the cost of these plans. For example, the rules requiring plans to cover adult children up to the age of 26, the elimination of limits on annual or lifetime coverage, and the mandates that plans cover a wide range of benefits will drive premiums upward.

But the key problem is that the Taft-Hartley plans already provide generous and costly coverage; small employers now have a more financially attractive alternative, which is to drop coverage and put people on the exchanges, once the existing collective bargaining agreements are up. That gives workers less reason to join a union; a big part of why working people pay union dues is because unions play a big role in negotiating health benefits.

So the labor leaders are demanding that their workers with employer-sponsored coverage also gain eligibility for ACA subsidies. Otherwise, their workers will be “relegated to second-class status” despite being “taxed to pay for those subsidies,” a result that will “make non-profit plans like ours unsustainable” and “destroy the very health and wellbeing of our members along with millions of other hardworking Americans.”

‘The law as it stands will hurt millions of Americans’

The leaders conclude by stating that, “on behalf of the millions of working men and women we represent and the families they support, we can no longer stand silent in the face of elements of the Affordable Care Act that will destroy the very health and wellbeing of our members along with millions of other hardworking Americans.”

President Obama, of course, pledged that “if you like your plan, you can keep your plan.” But the labor leaders say that, “unless changes are made…that promise is hollow. We continue to stand behind real health care reform, but the law as it stands will hurt millions of Americans including the members of our respective unions. We are looking to you to make sure these changes are made.”

Delay of employer mandate ‘troubling’

These aren’t the union leaders who have been critical of Obamacare. Kinsey Robinson, president of the United Union of Roofers, Waterproofers and Allied Workers, said in April that their concerns “have not been addressed, or in some instances, totally ignored,” and that “in the rush to achieve its passage, many of the act’s provisions were not fully conceived, resulting in unintended consequences that are inconsistent with the promise that those who were satisfied with their employer-sponsored coverage could keep it.”

Richard Trumka, head of the AFL-CIO, is unhappy with the White House’s one-year delay of the employer mandate, calling it “troubling.” But it’s the employer mandate which is responsible for all of the disruptions that Trumka’s labor brothers are complaining about. If we repealed the employer mandate, we’d get rid of the incentive that restaurants and other employers have to cut the hours of part-time employees.... 

Gutless and Dishonest: the Politics of the Individual Mandate

Democrats are horrified to mention the individual mandate and Republicans waive it around like a flag but the reality is that it has been blasted repeatedly with a double barrel shotgun so many times that it is going to fine less than 2% of the population in 2015 with its twenty exemptions and can't be effectively enforced in 2014 anyway. (Link)

But rest assured, elected bureaucrats will waste plenty of our tax dollars fighting about it.  

This is from Politico and Jason Millman: 

...Poll after poll has found that Americans don’t like being told they have to get insurance or face a penalty. So the groups doing outreach don’t plan to draw much attention to it.

“For the most part no, because [the mandate] doesn’t apply to very many people at all,” said Ethan Rome, executive director of Health Care for America Now, citing government estimates that only a small proportion of uninsured Americans would actually face a penalty by 2016.

The early stages of the enrollment push have been all honey and no vinegar. Organizing for Action, President Barack Obama’s advocacy group, has released two ads focusing on the law’s benefits. Other advocates are counting on Mom to get their adult kids to sign up. Oregon’s exchange released its first ads this week, featuring – what else? – indie musicians strumming on guitars for the “Live Long Oregonians” campaign.

No mention of the “m” word.

The GOP has no such compunctions. Republicans reclaimed the individual mandate as an attack line this month, vowing to put it on hold for at least a year now that the White House has delayed until 2015 a parallel requirement for businesses. Putting off one set of rules while forging ahead with another just isn’t fair, say Republican lawmakers, who’ll force House votes on each mandate Wednesday....

Kentucky: a Preview of What is About to Occur on Jan. 1 When We Expand Medicaid by a Third Nationwide

This is from Jenni Bergal writing for Kaiser Health News and the Washington Post: 

...Ever since Kentucky rapidly shifted patients from traditional Medicaid to private health plans that manage their care for a set price, problems have been widespread.

Patients complain of being denied treatment or forced to travel long distances to find a doctor or hospital in their plan’s network. Advocates for the mentally ill argue the care system for them has deteriorated. And hospitals and doctors say health plans have denied or delayed payments.

Experts warn that what happened in Kentucky should be a cautionary tale for other states that rush to switch large numbers of people in Medicaid, the state-federal program for the poor and disabled, to managed care in hopes of cutting costs and improving quality. Nearly 30 million Americans on Medicaid now belong to a private health plan, as states move away from the traditional program that paid doctors and hospitals for each service they provided.

Beginning in January, millions more people will become eligible for Medicaid under the federal health law, and many will be placed in managed care. Thirty-six states and the District of Columbia have enrolled some or all of their Medicaid population in private health plans, which last year cost the states and federal government about $108 billion....

The 33 States with Federal Exchanges Are Over a Year Behind Where They Need to be to Open

This is from Dr. John Goodman: 

• In states that have been aggressively setting up their own exchanges, there has been a great deal of back-and-forth communication between the exchange managers and the insurance companies to make sure everything works right. But in the 33 states where the federal government will be running things, there has been no communication at all.
• As far as the technical specs are concerned, the insurance companies need a lead time of about 15 months — 12 months to get their systems designed and about three months to beta test them. So the industry needed these specs from the federal government one year ago. They still don’t have them.

PPACA Fees For Your Health Plan May Be Due By July 31 | New IRS Form 720

The Patient Centered Outcomes Research Institute (PCORI) is an organization established by the Patient Protection and Affordable Care Act (PPACA) aimed at giving patients a better understanding of the prevention, treatment, and care options available, and the science that supports those options.  PCORI will be funded by fees paid by health insurance issuers and employers who sponsor self-insured group health plans.  [Some] plans must begin paying this fee by July 31, 2013.  The following ... discusses which self-insured plans must pay a fee, how to calculate the fee, and how to pay the fee. 
  

Self-Insured Plans Subject to PCORI Fees

Generally, any plan established or maintained by one or more employers for their employees that provides accident or health coverage, any portion of which is provided other than through an insurance policy, is a self-insured plan subject to PCORI fees.  This includes the following employer-sponsored self-insured health plans:

• medical and prescription drug plans;
• dental plans, vision plans, and health FSAs that are not excepted benefits under HIPAA;
• retiree-only plans; and
• employee assistance programs (EAPs) and wellness programs that provide “significant” medical benefits.

PCORI fees will not apply to HIPAA-excepted benefits, stop loss policies, or plans designed to primarily cover expatriates.

If an employer sponsors more than one self-insured arrangement, those arrangements may be treated as a single plan for purposes of calculating the PCORI fee, but only if the plans have the same plan year. 

Excepted benefit test (such as for dental): If there is a separate fully insured contract for the plan, then it is an excepted benefit. For self-funded plans, the plan must meet two tests to be an excepted benefit. The participant: 

1. must be able to elect the benefit separately; and
2. if elected, must pay an additional premium for the coverage. 

Thus, 100 percent employer-paid dental plans do not qualify as an “excepted benefit” and the PCORI Fee will apply to such plans.  In both situations, coverage must be limited to treatment of the mouth.

Calculating the PCORI Fee

The first plan year ending between October 1, 2012 and September 30, 2013 is the first plan year for which a PCORI fee is being assessed.  For this first year, the PCORI fee equals one dollar times the average number of lives covered under the plan.  The PCORI fees will increase over time as follows:

Year                           Fee

First Plan Year          $1 x average covered lives

Second Plan Year      $2 x average covered lives

Thereafter                  Indexed with increase in per capita nation health expenditures

Employers generally may determine the average number of covered lives in one of three ways:

• Average the number of lives covered each day of the plan year.
• Average the number of lives covered on one day in each quarter (the date in each quarter must be selected in accordance with IRS rules).  The average number of lives on any day may be determined under either of the following methods:
  • Count the actual number of lives covered; or
  • Sum the number of participants with coverage that is not self-only times 2.35 and the number of participants with self-only coverage on that date. 
• If the plan’s 5500 will be filed by the date the PCORI fee is due:
• For a plan offering self-only coverage, average the number of participants reported on the 5500 at the beginning and end of the plan year; and
• For a plan offering coverage other than self-only coverage, sum the number of participants reported on the 5500 at the beginning and end of the plan year.

However, for plan years beginning before July 11, 2012, and ending on or after October 1, 2012, employers may use any reasonable method to determine the average number of lives covered. 

Paying the PCORI Fee

The PCORI fee for each plan year is due by July 31 of the calendar year immediately following the last day of the plan year.  This means that if a employer sponsors a plan with a plan year ending between October 1, 2012, and December 31, 2012, the first PCORI fee is due on July 31, 2013.  Employers must pay the PCORI fee by filing IRS Form 720.  Although this form is for quarterly federal excise tax returns, employers need to report and pay PCORI fees only annually.

Link to full publication:  Employers, Have You Paid Affordable Care Act Fees For Your Health Plan? They May Be Due By July 31—Are You Ready?

Link to IRS Q & A and Form 720 to pay the fee: 

http://www.irs.gov/uac/Patient-Centered-Outcomes-Research-Trust-Fund-Fee:-Questions-and-Answers 

California Bill Would Force Insurers to Disclose Reasons for Rate Increases

Finally, a Bill from Mark Leno that doesn't repulse me. That is exciting.  We sorely need this kind of law in California.  It is the sort of legitimate use of government necessary to assist in the free market-ization of an oligopoly.  

Despite opposition from insurers, the Assembly Committee on Health last week approved a bill designed to lower health insurance premiums by requiring plans to disclose more information about their rates.

SB 746 by Sen. Mark Leno (D-San Francisco) would require insurers selling coverage to employers with 50 or more employees to provide more detailed information about how and why they raise health insurance rates.

Leno said the bill was prompted by a recent dust-up between San Francisco unions and Kaiser Permanente. Union officials asked Kaiser for data and reasons for rate increases. Leno indicated he has not been satisfied with the insurer's response.

Leno said greater transparency from insurers could help drive down costs because the public release of insurance costs on the Department of Managed Care website would open up avenues for the public to ask more detailed questions about rate hikes.

"The need for the transparency, of course, is for us to better control the ever-escalating costs of health care in this country," Leno said. If the state can better understand the reasons for rate increases, Leno said, it would mean the state and consumers could pressure health plans to modify those increases.

"This bill would require all health plans to publicly disclose aggregate information about the rates for large purchasers," Leno said.

Health plans pushed back, arguing that determining why rates are going up is complicated. 

[I dare you to re-read this sentence aloud slowly and not laugh out loud.  Rate increases are complicated so we should be forced to try and explain them.] 

Charles Bacchi, executive vice president of the California Association of Health Plans, called the bill unnecessary and expensive.

"Health care plans are in the middle of implementing the most important changes to our health care system since Medicare," Bacchi said. "There's much to be done. We're focused on getting that done and we think we should be spending our time focusing on the Affordable Care Act."

The ACA, he said, didn't require rate review on large group coverage," so Bacchi said he sees "no urgency why we need to amend California's rate review law today as proposed."

Leno pointed to a previous bill he authored, SB 1163, passed in 2010, which carried similar requirements -- but only for small business and individual health insurance plans.

"We know that transparency works," Leno said. "[SB 1163] required that, before plans increase rates, they had to notify the [Insurance] Commissioner and give their reasons for doing so. We're told that within the first two years, as a result of that bill, over $300 million has been saved."

"This bill would do the same thing for large purchasers of health insurance," Leno said.

Teresa Stark, a legislative advocate for Kaiser Permanente, said Leno's proposed bill would unfairly single out Kaiser.

"Make no mistake, this bill is all about Kaiser Permanente," Stark said at the July 2 committee hearing. "This bill is trying to get us to behave like an insurance company."

Stark pointed out Kaiser's role as both a hospital group and an insurer.

"When we say we are different, we really mean we are different," she said. "We are an integrated health system -- we're not just a health insurer. We have hospitals, we have professional medical staff, we pay salaries, we build hospitals, we buy land. So because of that, we budget and plan and forecast more like a provider and as a health care delivery system."

Stark said Kaiser should not be required to report information about rate increases in the same way as other health insurance plans.  

[Yeah, not for profit health plans should not be forced to explain why they ask for double digit rate increases!  Question, if the increases are justified by legitimate business needs, why all the resistance to explaining them?] 

Trying to "force us to report information in the same fashion as other health plans, which is what this bill would do, basically breaks us apart at the seams," she said.

[Translation: if the public sees how this sausage is made they surely won't want to eat it any more.] 

"This bill is meant to send a message to Kaiser Permanente," Stark said. "The message is: 'Kaiser, you're doing it wrong. You're not communicating with your customers appropriately and you're not communicating with your regulators, and we have a better way for you to do it.' That message is very disturbing to my company."

Although SB 746 may have been sparked by complaints about Kaiser, Leno said it applies to all health insurance plans covering 50 or more individuals in a group plan.

"This bill will no longer target any particular health plan," Leno said. "Instead, it provides health plans with options providing greater transparency in health insurance costs for large purchasers. That's really what this bill is all about -- transparency."

Specifically, the bill would require all large group insurers to disclose in an annual report to the DMHC specific reasons why insurance rates are raised. It would also require large insurers to provide more detailed information about products they're selling.     

And SB 746 would force large group health plans to hand over details about changes in the utilization and cost of health insurance products -- data that health plans use to raise rates....

The Assembly health committee approved SB 746 in a 12-6 vote. The bill moves to the Assembly Committee on Appropriations, where it likely will be heard sometime in August after the summer recess.

Via Insurers, Legislators Clash Over Premium Disclosure Bill - California Healthline 

Promoting Obamacare in the Outhouse

Alas, we have a fitting place to promote PPACA with your tax dollars.  

In Connecticut, selling Obamacare involves airplanes flying banners across beaches. Oregon may reel in hipsters with branded coffee cups for their lattes. And in neighboring Washington, the effort could get quite intimate: The state is interested in sponsoring portable toilets at concerts.

The advertisements, developed with political consultants and communications firms, illustrate the ability of the health-care law’s supporters to pinpoint the precise group they want to sign up for Obamacare — young and healthy Americans who won’t weigh down the system with high medical bills.

However sophisticated, the outreach also underscores how states have become willing to try almost anything to make their pitch in the face of a poorly informed and politically divided public. With 82 days left until the insurance marketplaces open for business, public awareness remains low. Most polling data suggest that few Americans are aware of how the Affordable Care Act works — or that it even exists....

Full story from Sarah Kliff in the Washington Post:  Q: What do porta-potties, coffee cups and airplanes have in common? A: Obamacare.

Laundry List of the Gutting

Handy list of Obamacare's current failures and postponements from the folks at InsureBlog: 

• 1099 provisions repealed
• CLASS Act repealed
• FBHPO BASIC plan delayed until 2015
• Co-op plans de-funded
• PCIP terminated early due to lack of funds
• SHOP multi-choice options delayed until 2015
• Waivers . . . . (the list is endless)
• Cadillac tax delayed until 2018
• Contraception mandate delayed (legal battles)
• Early retiree reinsurance plan ran out of money in 2011
• Employee free choice vouchers repealed April 2011
• Clawbacks altered when 1099 provision eliminated $22 billion in new taxes
• MAGI (used to determine subsidies) redefined to include SS benefits
• Medicare Advantage cuts rolled back (March, 2013)
• W-2 reporting delayed until 2013
• Automatic enrollment of groups (200+ lives) delayed until 2015
• Employer notices regarding exchange eligibility delayed
• Employer penalties delayed
• Income verification for subsidies delayed
• Employer insurance coverage delayed
• Postponed tobacco surcharge due to issues with exchange system

With all this gutting is there a reason to continue this fiasco?

Full post

ObamaCare Stategy: Hemorrhage Cash and Hand Out Subsidies Indiscriminately to Addict Recipients and Block Repeal

This is the best, practical, plain language summary I have seen on the plethora of practical issues and political motivations surrounding the employer mandate debacle.  It is from Megan McArdle (link).

...The employer mandate may simply be too technically difficult to ever implement, at least as envisioned in the Patient Protection and Affordable Care Act. As long as employers are allowed to set their own eligibility rules, verification will be time-consuming and difficult to automate–not impossible, technically, but difficult and intrusive and expensive, which means that it might be impossible, politically and financially.

This has, I pointed out, big fiscal implications: offering subsidies only to people who can’t get insurance through their employer saves the government a lot of money. Allowing people to apply for subsidies under the honor system, rather than actually verifying, probably means a lot of extra money going out the door–money which, I pointed out, turns out to be very difficult to get back if you realize later that you’ve paid too much. Under the new law, the IRS isn’t allowed to claw back overpayments or collect fines the way it normally does–slap a garnishment order on your paycheck, levy your bank accounts, and in extremis, seize your home or other assets. All they can do is take it out of any payments that they owe you.

But Yuval Levin, an ultrawonk who appears to have had the entire text of the PPACA tattooed on the inside of his eyelids for quick reference, emails to say that the government’s ability to recover overpayments is even more limited than I realize:

One thought on your point that “One suspects that income verification may be not far behind; they’ll let the IRS sort it out at tax time.” The Obamacare statute really limits the ability of the IRS to sort it out and recover overpayments at tax time. And this is not only because it can only recover payments by reducing people’s income-tax refunds (which not all people have of course). There’s a more explicit barrier: In section 1401, the statute limits the amount of excess tax credit that any person with an income under 400% of poverty would have to pay back. (That begins at the very bottom of page 116 and into 117 in this final text of the law, under the section “Excess Advance Payments). The original statute limited the amount that could be clawed back to just $400. Then in the Medicare extenders bill they passed at the end of 2010 (see the table at the very end of the statute), Congress  increased that amount and made it a graduated amount based on income, so it now ranges from $600 to a maximum of $3,500 for a family (half that for an individual).

CBO projects that the AVERAGE subsidy in the exchange would be worth $5,290. So the amount they’re able to claw back from people who have incomes below 400% of poverty but receive subsidies they shouldn’t (because they report a lower income than they have, falsely claim not to have been offered qualifying coverage by an employer, or report a higher income than they actually have in order to receive subsidies instead of Medicaid coverage) is likely in most cases to be significantly lower than the amount of excess payments.

“Delaying” employer reporting and income verification means more people are likely to do this and the IRS is less likely to know about it (they won’t know about people falsely claiming they don’t have an employer offer, for instance), so that even if the IRS collects back everything it possibly can at tax time, which is unlikely, there would be a major gap, and the risks people take by filing fraudulent applications are fairly limited (as you have noted before, the tools permitted to the IRS to go after excess payments are very limited). 

The potential for massively expensive fraud, or even massively expensive confusion, is just enormous. The system doesn’t make sense without some meaningful prior verification, but as you say it’s not clear that such verification is technically achievable.

The problem is that the law depends on it. I’ve frequently compared the law to a Rube Goldberg machine–all the parts have to work just so for the thing to come off–and this is a perfect example. In the comments to one of my healthcare posts, commenter BronxCobra is making perfectly reasonable suggestions for a corporate IT implementation–scale back the scope, don’t do the verification real-time and instead run daily or weekly or monthly reports to verify peoples’ income against the income they reported on the form.

But this is not a corporate IT implementation where you can patiently explain that we need to reduce the scope. There’s a law. With a lot of moving parts. And those moving parts were designed for real time verification.

In part that’s for political reasons. People getting subsidies in Massachusetts right now get Commonwealth Care, a limited set of managed care plans heavily overseen by the state and apparently partially funded by a federal Medicaid waiver. You apply for it the way you do for Medicaid–send off an application, and in a few weeks you hear back. As I understand it, they do manual verifications of eligibility–not a terrible process, because the uninsured rate in Massachusetts was low even before Romneycare passed.

For obvious reasons, the Obama administration did not want to tell folks that if they needed subsidies, they would be given access to a handful of HMOs. Nor that they would go onto the exchanges and be told to print out a paper application they could send to their state’s Medicaid office. That law would never have passed Congress, or the public. So they announced that everyone above 133% of the federal poverty line would get access to the same set of plans on a nifty exchange, with the government subsidizing the premiums to make it affordable for families making up to 400% of the FPL. The exchange would automatically calculate your subsidy based on the information you gave it, and enable you to purchase insurance at the subsidized price immediately. And the exchange would verify that you actually had the income you said you did, as well as a few other things, like whether you were a citizen or legal resident.

All of this stuff had to be done up front, because one of the things they had to do in order to sell the bill was promise that the IRS would not be emptying out peoples’ bank accounts in order to reclaim excessive subsidies. Maybe that was a bad promise that shouldn’t have been made, but they did make it, and I’d argue that they had to in order to get the law passed. At this point, the IRS’ recovery abilities are so crippled that it would be folly to issue subsidies first and ask questions later.

And the subsidies have to be given up front; Folks making $50,000 a year cannot be mandated to buy a $1,000 a month insurance policy and told they’ll get their subsidy back at tax refund time.

But it’s starting to look like both of these things cannot happen, at least not in the near term. The alternatives are to delay the whole bill, or resign ourselves to hemorrhaging wads of cash. The IT expert’s instinct to hold things together with some inelegant intermediate kludge won’t work. All the elements of the law are so tightly coupled that pulling one out makes the whole machine go haywire.

Obviously, the preference of the law’s supporters is to hemorrhage cash. Just go ahead and hand out subsidies indiscriminately, the better to build political support to block repeal. But this seems . . . well, I’m struggling for kinder words, but I can’t find any. It seems wildly irresponsible. Not to mention a fundamental betrayal of the promises that were made to get the law passed in the first place.

 Visit McArdle's website

The world's largest Rube Goldberg Machine 

Study: Employees Pick Cheaper Health Plans When Given a Choice at Work

Sixty percent of employees allowed to choose between a traditional employer-sponsored health insurance plan and a cheaper, high-deductible or limited network plan opted for the lower prices, a study of employees released Tuesday shows.

The data from 2,503 employees in New York and New Jersey showed that 80% of people chose a plan other than their employer's traditional offering, even if the costs remained the same to the employee, said Alan Cohen, chief strategy officer of Liazon, which provides health exchanges to private employees.

The options included a traditional no-deductible plan, higher-deductible plans in conjunction with health savings accounts, and plans that limited employees to a care network built around one primary care doctor or a limited network around an accountable care organization....

Each plan's benefits were the same; just the payment structure differed. For example, Cohen said, if an employer had paid $600 a month in premiums and the employee $100 before, the employee could instead choose a plan that cost $400 a month with a lower employee premium but a higher deductible. The extra $200 a month from the employer could either go into a health savings account or toward another insurance policy, such as life, vision or dental. About half of the employees chose plans with health savings accounts.

"We've been seeing these results for more than five years," Cohen said. "People make completely different choices than what companies make on their behalf."

The number of people enrolled in health savings accounts (HSA) has more than tripled in the last six years from 4.5 million people in January 2007 to 15.5 million in January 2013, according to America's Health Insurance Plans, a trade association that represents health insurers.

"HSA plans encourage individuals to take an active role in their health care decisions while stretching their health care dollars," Karen Ignagni, AHIP president, said in a statement about the new numbers....

The data also shows that businesses could save money while providing their employees with more choices, he said. Some of those choices, such as closed-network programs or single primary-care physician-based programs, have been avoided in the past because the common wisdom is that people don't like being limited by what doctors they may see.

Full text from USA Today

The Dark Side of Artificial Sweeteners

...Consumption of sugar-sweetened drinks has been linked to obesity, type 2 diabetes, and metabolic syndrome—a group of risk factors that raises the risk for heart disease and stroke. As a result, many Americans have turned to artificial sweeteners, which are hundreds of times sweeter than sugar but contain few, if any, calories. However, studies in humans have shown that consumption of artificially sweetened beverages is also associated with obesity, type 2 diabetes, and metabolic syndrome as well as cardiovascular disease. As few as one of these drinks per day is enough to significantly increase the risk for health problems.

Moreover, people who regularly consume artificial sweeteners show altered activation patterns in the brain’s pleasure centers in response to sweet taste, suggesting that these products may not satisfy the desire for sweets. Similarly, studies in mice and rats have shown that consumption of noncaloric sweeteners dampens physiological responses to sweet taste, causing the animals to overindulge in calorie-rich, sweet-tasting food and pack on extra pounds.

Taken together, the findings suggest that artificial sweeteners increase the risk for health problems to an extent similar to that of sugar and may also exacerbate the negative effects of sugar....

Link to full story