Showing posts with label health insurance exchanges. Show all posts
Showing posts with label health insurance exchanges. Show all posts

Thursday, January 30, 2014

Are You a Potential Plaintiff in an Anti-Obamacare Lawsuit? Please Respond by January 31, 2014

alert-black-red

Nationwide Alert

By: C. Steven Tucker
Gulag Bound – Cross-Posted at the NoisyRoom and AskMarion

TheTruthAboutPreexistingConditions.com

The Illinois Policy Institute has teamed up with the Liberty Justice Center to seek plaintiffs for a lawsuit against the PPACA – Patient Protection and Affordable Care Act – a.k.a. “Obamacare”. It will take every legal and legislative avenue at their disposal to stop Obamacare. Your information will be totally confidential, and there is no cost involved.

They’re looking for people to join a lawsuit that will challenge an IRS rule that extends Obamacare health insurance subsidies and the Obamacare “employer mandate” to states like Illinois where they shouldn’t apply because the state government hasn’t established its own insurance exchange.

As a result of this unlawful IRS rule, many people who would otherwise be exempt from the Obamacare individual mandate will be forced to buy insurance they don’t want. You may be eligible to participate in their lawsuit if you:

    • Are a resident of Illinois or any of the following states: AL, AK, AZ, AR, DE, FL, GA, ID, IN, IA, KS, LA, ME, MI, MS, MO, MT, NE, NH, NJ, NC, ND, OH, OK, PA, SC, SD, TN, TX, UT, VA, WV, WI, or WY;
    • Are ineligible for Medicaid;
    • Have not been offered Obamacare-compliant health benefits from an employer;
    • Are a nonsmoker;
    • Have a household income between 100% and 400% of the federal poverty level in 2014 ($11,490 to $45,960 for a single person — see this chart for other household sizes); and
    • Do not want to buy insurance for 2015 or, if you are 30 or over, either do not want to buy insurance or plan to purchase a catastrophic plan for 2015.

If you meet these criteria and are interested in helping us take our case to court — at no cost to you — please call Jacob Huebert at 312.263.7668, extension 219 or email him at jhuebert@libertyjusticecenter.org.

Fill out this short survey to get started. Please respond no later than Friday, January 31, 2014

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State-based exchanges and federally facilitated exchanges

Section 1311 of the PPACA describes state-based health insurance exchanges. That section outlines the powers granted to the IRS to provide APTC – “Advance Premium Tax Credits” (a.k.a. ‘subsidies’) that will be used to artificially lower the high cost of health insurance offered in a state-based exchange. Tied to those APTC’s is also the power granted to the IRS to levy a $2,000 or $3,000 excise tax (non-tax deductible) on all employers with 50 or more full-time employees (first 30 employees waived) if they do not provide PPACA approved health insurance. This is a lot of new power granted to the IRS and this is the primary reason the IRS is hiring thousands of new agents.

Section 1321 of the PPACA describes federally-facilitated exchanges and state-federal partnership exchanges – like the exchange the state of Illinois has chosen to establish. In these types of exchanges, the IRS is granted no authority to provide APTC’s or to levy excise taxes on any employer in that state for not providing PPACA approved health insurance. Since the crafters of the PPACA assumed that every state would willingly establish a state-based exchange, there was no money appropriated for federally-facilitated exchanges. Thus far 34 states have chosen not to open a state-based health insurance exchange.

The illegal action taken by the IRS

Here’s the kicker, in order to ‘fix’ this legal ‘opt out’ that section 1321 provides to states that choose not to open a state-based exchange. The Internal Revenue Service finalized a proposed rule on the 2 year anniversary of the passage of the PPACA that offers APTC’s -Advance Premium Tax Credits – through exchanges “established under section 1311 OR 1321 of the PPACA. Those six characters—”or 1321?—constitute an unconstitutional and as such illegal rewriting of the statute. By issuing tax credits where Congress did not authorize them, this rule also triggers APTC’s “subsidies” and imposes excise taxes on employers with 50 or more full-time employees in all 50 states with either a state-based, state-federal partnership or federally facilitated exchange. Since the IRS is not a Legislative branch, this action was an illegal action not authorized by Congress and it must not stand.

Worse yet President Obama is following that new proposed rule that was written by the IRS as if it was codified law. This illegal action and President Obama’s support of it has prompted Oklahoma Attorney General E. Scott Pruitt to amend his lawsuit to include a section that sues the IRS for illegally writing new law and granting itself power that it was not granted in the PPACA as originally written. Read more about Mr. Pruitt’s lawsuit here. Mr. Pruitt sat down with Fox News’ Sean Hannity to discuss the progress of his pending case against the IRS on December 6, 2013. Watch the interview below:

Video: OK Attorney General Scott Pruitt on Fox News "Hannity"

As of May 28, 2013 here’s where the numbers stand:

  • Committed to a state-based exchange: 17 states and Washington, D.C. (described in section 1311)
  • Planning for a partnership exchange: 7 states (described in section 1321)
  • No to state-based exchange. Defaulting to Federal Exchange: 27 states (described in section 1321)

I recently commented about this illegal action taken by the IRS for Champion News talk radio on Chicago’s AM560TheAnswer radio:

 

Video: The IRS and Obamacare - 3

Friday, January 17, 2014

Obamacare Open Enrollment is ending soon. If you have pre-existing conditions you need to understand the new rules…

C. Steven Tucker: Today is January 15, 2014 and today is the last day to enroll in an individual (non employer sponsored) health insurance plan with a February 1, 2014 effective date. After tomorrow, the next available effective date will be March 1, 2014. In fact the first national “open enrollment” period is quickly coming to a close. The last date to enroll in any individual major medical health insurance plan will be February 15, 2014 for a March effective date. So, if you have a preexisting condition or are one of the 6.3 million policy holders who have lost your plan because of the PPACA (Obamacare) you need to start familiarizing yourself with how “open enrollment” works now, not later now.

The old rules are gone

The old rules pertaining to purchasing health insurance in the individual major medical market are now gone. You can no longer purchase individual major medical health insurance coverage whenever you want, all year long. There are now specific time periods where this kind of coverage will be available in 2014 and in subsequent years. Those periods are called “open enrollment” periods. Outside of those “open enrollment” periods individual major medical health insurance coverage will not be available for sale. This means that you will not be able to get coverage for preexisting conditions.

This is why it is essential that you understand the new rules for they will affect you and everyone you know who has a preexisting condition or has lost their health insurance because of Obamacare. This is especially true because our existing state run high risk health insurance pools which provided guaranteed issue coverage for those who were declined health insurance coverage for decades before Obamacare are now being dissolved.

Buying insurance on and off the Obamacare exchange

It is important to know that you do not have to purchase health insurance at Healthcare.gov. All products sold on and off the new Obamacare HIX – “Health Insurance Exchange Marketplace” will be guaranteed issue products during the two national “open enrollment” periods. They are:

Open Enrollment Period One: 1/1/14 – 3/31/14

Open Enrollment Period Two: 11/15/14 – 1/15/15

This means that you can not be denied coverage and no exclusion riders can be placed on your policy whether you buy the product on or off the Obamacare HIX but only during these two time periods. After these two time periods you can be denied coverage. In fact, individual major medical products will not be offered between these two national “open enrollment” periods. If insurance carriers continued to offer guaranteed issue coverage all year long it would lead to adverse selection. As it did in Massachusetts.

What you need to know right now

Since time is of the essence (and their is nothing timely about purchasing health insurance on the exchange). You need to know the only reason to purchase health insurance inside the HIX – Health Insurance Exchange Marketplace (Healthcare.gov) is if you qualify for an APTX – Advance Premium Tax Credit – (subsidy) to artificially lower the high cost of the Obamacare “Medal” plans – Bronze, Silver, Gold and Platinum. In order to qualify for an APTX your 2014 total household MAGI – Modified Adjusted Gross Income – income after taxes and retirement contributions must be less than:

$46,960 for an individual
$62,040 for a couple
$78,120 for a family of three
$94,200 for a family of four
$110,280 for a family of five
$126,360 for a family of six

If your income is more than the aforementioned amounts, you should purchase your health insurance outside of the HIX. The same plans are available off the exchange and the application process is much faster and far more secure. Again, all major medical health insurance products purchased inside and outside the HIX will be guarantee issue (no preexisting conditions) during the two national “open enrollment” periods in 2014.

PLEASE NOTE: The cheapest 2014 Obamacare “Medal” plan is the “Bronze” plan equivalent. This plan will expose a couple or a family to $12,700 in out of pocket risk each year for in network claims. For single applicants, that risk will be $6,350. So you are better off purchasing the Silver, Gold or Platinum plans if they are within your affordable range.

For Illinois residents the best priced 2014 ‘Medal’ plans are insured and underwritten by Blue Cross Blue Shield of Illinois a Division of Health Care Services Corporation. Find the right health insurance plan for you by exploring all of the plan options, save plans that fit your needs in your Shopping Cart and return to apply for coverage when you are ready. Don’t forget the last day for the Affordable Care Act (ACA) Open Enrollment is February 15, 2014.

To shop for all plans on and off the Obamacare HIX in all 50 states click the banner below:

http://www.smedleyinsurancegroup.com/images/health-care-reform-quick-quotes.jpg

A cheaper option for those without preexisting conditions

If you do not have any serious preexisting conditions, you can save a lot of money if you purchase a Temporary health insurance policy for a period of one year. These health insurance policies do not cover preexisting conditions nor do they include all of the federally mandated “Essential Health Benefits” such as Maternity, Drug Rehab coverage and Pediatric Dental. This also means that they are not considered ‘Qualified Health Plans’ meaning that you will be subject to the 1% of your MAGI penalty in 2014 if you purchase one of these plans. That stated the premium difference between these plans and ‘Qualified Health Plans’ is significant. Far outweighing the additional fine you would pay to the IRS in most cases.

To run quotes for a Temporary health insurance plan off the exchange click the banner below:

If that Temporary insurance quote engine does not work in your state click the banner below:

http://www.smedleyinsurancegroup.com/images/health-care-reform-quick-quotes.jpg

Very Important Note: Since the PPACA mandates that all health insurance policies cover preexisting conditions during the first national “Open Enrollment” period from 1/1/14 – 3/31/14 and the second national “Open Enrollment” period from 11/15/14 – 01/15/15. You can now safely purchase Temporary health insurance knowing that when your one year Temporary policy ends you will qualify by Federal law for any ‘Qualified Health Plan’ regardless of preexisting conditions during the second annual “Open Enrollment” period in 2014. Outside of those two aforementioned “Open Enrollment” periods you will not be able to obtain coverage for a preexisting condition. For this reason you must not purchase the 6 month Temporary health insurance option.

Only the 12 month Temporary insurance option is acceptable at this juncture. If you purchase a 6 month Temporary policy your coverage will end in between the two aforementioned “Open Enrollment” periods and you will not be able to obtain another policy that will cover a preexisting condition that you may develop during the first 6 months of Temporary policy ownership. HHS may yet provide us with further guidance as to whether or not the loss of a Temporary health plan outside of “Open Enrollment” periods will qualify as a “Special Enrollment” period in 2014 so that one could obtain a “Qualified Health Plan” on a guaranteed issue basis outside of “Open Enrollment” periods. As of the date of this writing no such guidance has been received.

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Friday, December 13, 2013

Pray For Jim Hoft Over At Gateway Pundit

JoshuaPundit: One of the long time fixtures of the blogosphere is Jim Hoft over at the renowned site Gateway Pundit. He also, as an aside, is a pretty nice and decent human being...and now, a victim of ObamaCare:

In August 2013 I became very sick with what I thought was a cold. After a few days I lost vision in my left eye and I checked into the hospital. I soon found out that what I thought was a summer cold was actually Strep bacteria poisoning my blood stream. The bacteria blinded my left eye, ate a hole through my heart, caused five strokes on both sides of my brain and forced the removal of my prosthetic left knee.

Dr. Lee was the surgeon assigned to perform open heart surgery. What was originally scheduled to last four hours ended up lasting twelve. My heart was severely damaged. Dr. Lee later told me the surgery was one of the most difficult of his career. He also said I only had a few days to live without the surgery.

Thanks to the excellent insurance I carried I was able to receive life-saving medical treatment at St. Louis University.

This week I found out I am going to lose my insurance. The company that carried me is leaving the Missouri market. I will have to find something else.

I am one of the millions who will be looking for new insurance. God willing, I will be able to keep my doctors at St. Louis University. I trust them. They saved my life. Please pray for me and the millions of working Americans who are going through this same ordeal.

Why is our government doing this to us?

Well Jim, it's because they feel they can..and because they don't feel they're our government, but that we're their cash cow.

Simply disgraceful.

Rest assured Jim that prayers for a refuah shlemiah, a complete a total recovery addressed to the Maker of us all are a given...and I'll see what I can do to add to the prayer circle, because there are lots of us who care about you and wish you the best.

UPDATE: Jim Hoft is holding a Wheel-In Obamacare protest this Saturday between 11 AM CT to Noon at Senator Claire McCaskill’s St. Louis office, located at 5850 Delmar Blvd, Ste. A, St. Louis, Missouri 63112. Jim will be leading the protest in his wheel chair, with the theme, Why is Our Government Punishing the American People-Give Us Back Our Healthcare!”.

More info here. 

Doctor Retires due to ObamaCare 

James Carville: Don’t Blame Republicans; Blame Obama 

Cancer and Obamacare Survivor, plus His Hero Audited – Interview

New Obamacare Bombshell - Rpt: No System Yet For Exchange Payment - The Kelly File 

Attention Main Stream Media. Regarding Obamacare… I Told You So!

All I Want for Christmas

Tuesday, October 1, 2013

Anyone Who Is Buying That the Republicans in the House Are Unreasonable Needs to Read This… NR: 100 Unintended Consequences of ObamaCare

The Cleveland Clinic is slashing jobs due to the costs of ObamaCare mandates.

Companies, workers, retirees, students, and spouses all suffer from the law’s inflexible mandates.

By Andrew JohnsonNational Review:  Today, ObamaCare's October 1 launch date finally arrived. Ever since its passage, supporters of the law have made countless attempts to convince the American people of its viability, dismissing predictions of lost jobs, decreased hours, and rising costs, among others.

Yet from major corporations to local mom-and-pop shops, from entire states to tiny school districts, a wide range of companies and institutions have seen ObamaCare's negative impact on their workers, budgets, and production. Here are 100 examples of how ObamaCare is falling short of what was promised.

Yet President Obama refused to work with the House in delaying the launch of ObamaCare by one year to work out the glitches and improve the measures that most Americans oppose.  Instead he allowed a shutdown of the government, possibly to hide the problems of the healthcare launch, and spent the morning giving the most divisive and un-presidential imaginable.

(Note: Some items on this list came via Investor’s Business Daily and the Heritage Foundation.)

Corporations

1. IBM
Earlier this month, the computer giant, once famed for its paternalism, announced it would remove 110,000 of its Medicare-eligible retirees from the company’s health insurance and give them subsidies to purchase coverage through the ObamaCare exchanges. Retirees fear that they will not get the level of coverage they are used to, and that the options will be bewildering.

2. Delta Air Lines
In a letter to employees, Delta Air Lines revealed that the company’s health-care costs will rise about $100 million next year alone, in large part because of ObamaCare. The airline said that in addition to several other changes, it would have to drop its specially crafted insurance plans for pilots because the “Cadillac tax” on luxurious health plans has made them too expensive.

3. UPS
Fifteen thousand employees’ spouses will no longer be able to use UPS’s health-care plan because they have access to coverage elsewhere. The “costs associated with the Affordable Care Act have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost,” the delivery giant said in a company memo. The move is expected to save the company $60 million next year.

4. Caterpillar Inc.
In the law’s first year, the machinery manufacturer estimated before its passage, ObamaCare would add more than $100 million in health-care costs. “We can ill afford cost increases that place us at a disadvantage versus our global competitors,” a Caterpillar executive wrote lawmakers, saying that the law would not meet the goal of providing good, inexpensive health care for all Americans.

5. SeaWorld
SeaWorld used to let part-time employees work up to 32 hours per week, but the company is dropping the limit to 28 hours to keep them under the 30-hour threshold at which it would be required to provide health insurance under ObamaCare. More than 80 percent of the company’s thousands of employees are part-time and/or seasonal.

Medical-Device Tax

6. Stryker Corp.
Stryker Corp., a Michigan medical-device manufacturer, laid off about 1,000 employees earlier this year due to the Affordable Care Act’s 2.3 percent excise tax on medical devices. The company estimated that the tax would cost it approximately $100 million next year. “Stryker remains significantly concerned with the upcoming medical device excise tax and its negative impact on jobs and innovation and will continue to work with Congress to try to repeal the tax,” said the company’s CEO.

7. Welch Allyn
The manufacturer announced that it will have to cut approximately 10 percent of its 2,750 employees, 275 in all, because of the medical-device tax. The company also plans to consolidate manufacturing centers, moving some operations from Beaverton, Ore., to its facility in Skaneateles Falls, N.Y.

8. Smith & Nephew
The British company informed nearly 100 employees at its Massachusetts and Tennessee facilities that they would be laid off “in order to absorb [the] cost burden” of the tax on medical devices.

Hospitals, Nonprofits

9. Cleveland Clinic, Ohio
One of the world’s best-known hospitals announced in September that it would slash jobs and up to 6 percent of its annual $6 billion budget in anticipation of costs associated with ObamaCare's implementation. A spokeswoman for the clinic announced that approximately $330 million would be cut, but she did not say how many of the 44,000 employees the clinic would let go. The Cleveland Clinic is Cleveland’s largest employer and the second-largest employer in Ohio.

10. Wake Forest Baptist Medical Center, North Carolina
Last November, the Wake Forest Baptist Medical Center, in Winston-Salem, announced that 950 full-time-equivalent positions would have to be eliminated in order to make up costs from the health-care law.

11. Orlando Health, Florida
In that same month, the Orlando Health hospital system announced the biggest staff reduction in its almost century-long history, as part of a “broader effort” to manage the effects of ObamaCare, according to the Orlando Sentinel. Orlando Health will cut as many as 400 jobs across the system, in areas ranging from administrative departments to children’s hospitals.

12. Louisiana State University Hospitals
In the same article, the Sentinel noted that LSU hospitals would cut nearly 1,495 positions in order to save $150 million, apparently because of expected reductions in Medicare and Medicaid payments.

13. Delaware Hospice
Due to new interpretations of the rules for reimbursing for hospice services, Delaware Hospice, the Ocean State’s only not-for-profit hospice provider, had to let 52 employees go earlier this year. “It’s really health-care reform in action,” a spokeswoman said. “This is affecting hospices across the country. We’re working through dramatic changes in terms of the hospice-care benefits.”

14. Lawrence + Memorial Hospital, Connecticut
The New London hospital announced earlier this month that Medicare cuts programmed into ObamaCare had led to the firing of 33 employees. “L+M and other hospitals are contending with massive structural changes that are happening very rapidly,” the hospital’s president and CEO said.

15. Clifton Springs Hospital, New York
Fifty-eight non-clinical employees were let go from Clifton Springs Hospital in Rochester as the hospital prepared for the changes spurred by the Affordable Care Act. “No one really knows what the impact will be because it really is a very new way for reimbursing for health care,” the hospital’s CEO told a local news station. “So I think everyone is trying to prepare for a change, and a change with less revenue.”

16. Anthem Blue Cross Blue Shield, New Hampshire
The state’s only insurer approved to offer plans on the health-insurance exchanges in New Hampshire has cut the number of hospitals that will participate in the plan from 26 to 14 in order to reach “affordable premium levels,” according to the New Hampshire Union Leader.

17. Mexican American Opportunity Foundation, California
The nonprofit, which looks after 1,100 pre-K children at its eight Southern California child-care centers, has had to reduce the hours of dozens of employees who used to work 30 to 40 hours per week. “We’re fearful it’s going to be hard to negotiate health care in any contract,” one local labor leader said. “Overall [ObamaCare] is a positive step, but on a micro level it’s not all roses.”

18. Carnegie Museum, Pennsylvania
A Pittsburgh news station reports that the Carnegie Museum “reluctantly” scaled back the hours of 48 of its 600 part-time employees to less than 30 hours a week to sidestep the mandate to provide health-care coverage.

19. Fort Smith Area Agency on Aging, Arkansas
The nonprofit revealed that all of its health aides and drivers will work a maximum of 28 hours a week, and that the plan it would offer to its remaining full-time employees would be “bare bones.” To make up for additional ObamaCare costs, the organization is asking employees to take steps to save money, such as changing vehicle oil after 5,000 miles rather than 3,000.

20. Emory Healthcare, Georgia
A news station in Atlanta reports that Emory Healthcare, the state’s largest health-care system, will lay off more than 100 employees, in part because of ObamaCare.

21. CoverTN, Tennessee
Thousands of Tennesseans will lose their coverage under the state’s health-insurance program because it does not meet Affordable Care Act standards for yearly expenditure caps. CoverTN, which was used mainly by small businesses, had a $25,000 yearly benefits limit. “It was all I had,” one Nashville small-business owner said.

State and Local Governments

22. State of Virginia
In February the General Assembly affirmed Governor Bob McDonnell’s decision to limit the state’s part-time employees to 29 hours per week.

23. Township of Middletown, New Jersey
Middletown has also cut the hours of 25 part-time public employees. “Any of those expenses [for insurance] are going to be passed along to the taxpayers, and so in order to avoid having to do that, we chose to modify the work hours,” said the township’s administrator.

24. Brevard County, Florida
Brevard County’s insurance director told a local television station that the county’s 300-plus part-time employees will be “capped at something less than 30” hours to save the county about $10,000 per employee in health insurance.

25. Township of Berkeley, New Jersey
The Sandy-hit Jersey Shore town said it will “take a hard line” in union negotiations in limiting part-time employees’ hours, because additional health-care costs “are out of the question.” “If it came down to shaving hours to save substantial dollars, that’s something that would have to be considered,” the township administrator said.

26. Chesterfield County, Virginia
An administrator with this southern Virginia county told the Richmond Times-Dispatch that “several hundred” part-time employees could have their hours cut back to 28. Most of the employees affected would be from the Department of Mental Health Support Services.

27. City of Lynchburg, Virginia
About 40 percent of the city’s part-time work force saw cuts to their weekly hours to ensure that their totals come in below the 30-hour threshold, according to the local News & Advance. The city’s human-resources director said some departments do not have the financial resources to add employees or raise wages to make up for the lost work time.

28. City of Mason, Ohio
Cut hours for 200 part-time workers or take a $3.4 million hit: That was the decision the southwestern Ohio city faced when it started weighing ObamaCare's impact. It opted for the former. Part-timers had regularly worked more than 30 hours, but the city manager told the JournalNews that their weekly workload has been reduced to 20 hours.

29. Township of Toms River, New Jersey
Government workers in Toms River pushing the 30-hour threshold will be bumped down to “below 25” to ensure that they are considered part-time employees, according to the Asbury Park Press. “I think this was not very well thought out,” the township’s business manager said of the Affordable Care Act. “There was this fallacy that the law provisions didn’t apply to municipal government. It sure does.”

30. Lee County, Iowa
Lee County “could be out a lot of money,” a local newspaper reported a supervisor saying, if the county doesn’t stick to its new policy of holding part-time workers to 28 hours.

31. City of Faribault, Minnesota
Employees working 30 to 38 hours per week with the Minnesota city will be bumped down to part-time status to avoid penalties and costs associated with the mandate.

32. Kansas Turnpike Authority
Three eight-hour shifts per week: That’s the new maximum schedule for part-time toll collectors in Kansas. While the state’s turnpike authority previously had part-time employees who worked more than 30 hours a week, a new policy will limit them to the new schedule.

Education

33. University of Virginia
Because of an additional $7.3 million in health-care costs next year, the University of Virginia alerted some of its employees that it will no longer offer health insurance to their spouses.

34. Community College of Allegheny County, Pennsylvania
The Pittsburgh-area community college informed about 400 part-time employees that they would see a reduction in their hours starting in January of this year to comply with ObamaCare regulations. The school had to make this change a year before the law went into effect because ObamaCare stipulates that the federal government must look back one year to determine an employee’s status.

35. St. Petersburg College, Florida
To avoid paying an additional $777,000 per year, St. Petersburg College told 250 adjunct professors that their hours would be cut back for upcoming terms. “I never thought it would impact me directly,” a math teacher told NBC News Investigations. “I was stunned when I got the email. . . . I love teaching at St. Pete College, but that is a significant cut.”

36. Hillsborough Community College, Florida
Hillsborough Community College may have to cut the hours of nearly 10 percent of its part-time work force, according to the Tampa Tribune. By keeping those employees under 30 hours per week, the college can avoid an additional $863,500 in total costs for health plans.

37. Hamilton Township School District, New Jersey
Substitute teachers will see their time in the classroom limited to four workdays per week, the cap set in place in June by the school district . The “strict limits” went into effect at the beginning of this school year. According to a report by the Trenton Times, other nearby districts also could consider similar provisions.

38. Purdue University, Indiana
Despite “pretty radical changes” to the university’s health-care plans for its roughly 27,000 employees, Purdue University still won’t be able to skirt $2.8 million in additional costs brought on by the Affordable Care Act.

39. Oneida Special School District, Tennessee
Most of the non-certified personnel in the Oneida Special School District, such as teacher assistants, janitors, and cafeteria workers, will not be allowed to work more than 29 hours a week.

40. Central Michigan University
Some of the 5,700 students hired as employees by Central Michigan University will be barred from working more than 25 hours a week. While students have said the new limits “will sting a little bit” and make it “increasingly harder” to pay for various expenses, CMU’s human-resources vice president told a local news station that the move would “align us with other schools” making similar adjustments. Without the limits, CMU would have to pay as much as a $5 million penalty for not offering student workers health-care coverage.

41. University of North Alabama
Graduate-student workers at this school in Florence, Ala., will be barred from working more than 29 hours a week.

42. Arizona State University
Associate faculty members will be limited to teaching six credit hours, or two classes, per semester as part of an effort to more clearly define full-time versus part-time faculty, according to the Arizona Republic. “It’s like getting a punch in the stomach,” said one religious-studies teacher. “For some people it’s a major financial setback.”

43. Ivy Tech Community College, Indiana
Ivy Tech Community College, where 60 percent of the professors work part-time, will limit its part-time professors to less than 30 hours per week.

44. Maricopa Community Colleges, Arizona
The Phoenix community-college system notified almost 700 adjunct professors and 600 other part-time workers of a new policy that will prevent them from working more than 30 hours a week. An adjunct professor said the changes would affect his personal finances, and he warned that “this is going to come back to bite us” because instructors won’t be able to fill in for one another due to the cap on hours.

45. Granite School District, Utah
Facing at least $14 million in additional health-care costs, the Salt Lake City–area school district, which operates 92 schools, reduced the hours of as many as 1,200 part-time workers. In a letter, the district warned that employees who violate the 29-hour limit for part-time work could be terminated.

46. Alpine School District, Utah
“I would have to look for another job, or we would lose our house,” a school-bus driver told Provo’s Daily Herald after the school district said hourly employees could no longer work more than 27.5 hours per week. “If they cut our hours to 27, we will be up the creek,” another driver said.

47. Fort Wayne Community Schools, Indiana
In May, 610 part-time teaching aides and cafeteria workers were informed by the Fort Wayne Community Schools that their hours would be cut to keep FWCS from having to provide health insurance to those employees. “It’s something that almost all employers with part-time employees are trying to resolve,” a district administrator said.

48. Papillion–La Vista School District, Nebraska
The Affordable Care Act would have added $2.5 million in new health-care costs — or $3.4 million in penalties — to the Papillion–La Vista school district if 281 part-time employees’ hours had not been limited to fewer than 30 a week.

49. University of Akron, Ohio
Already facing a budget deficit, the University of Akron will ask 230 of its part-time faculty members to accept a cut to their work hours to avoid having to provide health insurance.

50. Youngstown State University, Ohio
The university warned part-time faculty members that they will be fired if they surpass the new 29-hour-per-week restriction. “If you exceed the maximum hours, YSU will not employ you the following year,” the school said in an e-mail. “We will have no recourse.”

51. Tredyffrin-Easttown School District, Pennsylvania
In June, the district announced that it would have to “restructure hours” to avoid cost increases to health-insurance plans. A local newspaper detailed a handful of options for the district; almost all resulted in fewer hours for lower pay.

52. Southern Lehigh School District, Pennsylvania
The Lehigh Valley–area district reduced the hours of 51 part-time workers to comply with the 30-hour threshold. The cuts will affect employees across the district, including custodians, cafeteria workers, secretaries, health-services support-staff members, and special-education support employees.

53. Zionsville Community Schools, Indiana
One hundred instructional aides, coaches, and substitute teachers in the Indiana district saw their weekly workload restricted to 29 hours.

54. Spartanburg Community College, South Carolina
Adjunct faculty members taught more than half of the community college’s classes, and all but 23 of the 400 to 500 such faculty members will see their hours slashed to meet the part-time requirement. Otherwise the college would face the choice of paying penalties of up to $2,000 per employee to whom it didn’t offer health coverage or paying up to $1 million for insurance.

55. Finger Lakes Community College, New York
The upstate New York community college has set the maximum weekly work hours for adjunct faculty members at “under 30.”

56. Mount Ephraim School District, New Jersey
At a school-board meeting this year, the district announced that the cost of benefits will rise by 18 percent because of the Affordable Care Act, and the increase will be passed on to taxpayers.

57. Minocqua-Hazelhurst-Lake Tomahawk School District, Wisconsin
The northern Wisconsin school district took steps to ensure that its part-time employees work fewer than 30 hours per week, a local news station reported.

58. Rock Valley College, Illinois
As of July, the two-year Rockford school now hires new employees to work a maximum of 25 hours per week.

Big Labor

59. Teamsters, UFCW, and UNITE HERE
The heads of the International Brotherhood of Teamsters, the United Food and Commercial Workers, and UNITE HERE wrote to Democratic lawmakers in July to warn that ObamaCare would “destroy the foundation of the 40-hour work week that is the backbone of the middle class.” While the labor leaders acknowledged their past support for the law, they remarked that their decision had “come back to haunt us.”

60. AFL-CIO
In an interview with Al Jazeera America, AFL-CIO president Richard Trumpka conceded that the Affordable Care Act “does need some modifications to it” because companies are “restricting their workforce to give workers 29 and a half hours so they don’t have to provide them health care.”

Restaurants and the Food Industry

61. Cheesecake Factory
The chain restaurant’s CEO warned that while his company already covers its employees who work at least 25 hours, he expects the new law to “be very costly” for most companies. He predicted that if Cheesecake Factory has to expand coverage, the costs will be passed on to consumers with price increases or a lower level of service.

62. Papa John’s Pizza
After causing a stir among ObamaCare supporters by suggesting possible price increases and/or cuts to jobs and hours, Papa John’s Pizza CEO reiterated: “It’s common sense. That’s what I call lose-lose.”

63. Buca di Beppo
Buca di Beppo employees across the country say managers told them in June that they would see their weekly hours reduced to less than 30. The founder of the company that owns the restaurants distanced himself from the comments, but employees insist that the Affordable Care Act is the root cause: “I guarantee you it has to do with what’s going on with our country and decisions being made with ObamaCare,” said one worker.

64. Fatburger
The CEO of the burger-joint chain announced that franchises have begun making efforts to keep employees under the 30-hour threshold, including some franchises’ engaging in “job sharing.” For example, an employee at one Fatburger could work 25 hours a week at one location, and another 25 hours at a different location with a different owner, without falling under the ObamaCare mandate.

65. Wendy’s
An Omaha Wendy’s franchisee alerted almost 100 non-management workers that their hours would be reduced to 28 per week in order to comply with ObamaCare mandates.

66. Subway restaurants, Illinois
Employees at 15 Subway restaurants in central Illinois have begun to see a reduction in their hours. “We don’t like doing that,” the owner said. “But if we were to have to pay for everyone to have health insurance or pay the full penalties, we would be out of business.”

67. Subway restaurants, Maine
The owner of 21 Subway franchises in Maine told 50 of his workers that their hours would be reduced to a maximum of 29 a week. “To tell somebody that you’ve got to decrease their hours because of a law passed in Washington is very frustrating to me,” he told NBC News Investigations.

68. PoFolks restaurant, Alabama
The restaurant’s owner told a local news station that he will have to cut the number of full-time employees from 16 workers to four to meet the “great challenge” ObamaCare poses to the company.

69. Joe Bologna’s, Kentucky
In order to limit employees’ hours and save money, a Lexington businessman has closed his restaurant on Mondays. He told a local news station that additional costs, which could be as high as $20,000, probably would have to be passed on to customers.

70. Five Guys franchises, North Carolina
The owner of eight Five Guys franchises in the Raleigh-Durham area said he will have to use all the profits from one of his eight stores just to cover “any added costs [that] are going to have to be passed on” by the health-care act.

71. Charco Broiler, Colorado
The Fort Collins restaurant informed three full-time employees that they would drop down to part-time work to keep the company under the 50-employee threshold, above which employers must insure all full-time employees.

72. Shari’s restaurant, Oregon
A Portland-area waitress told a news station that she has struggled to pay her bills after Shari’s relegated her status to part time due to one of the law’s mandates, cutting her schedule by almost ten hours a week.

73. Russ’ Restaurants, Michigan
Non-managerial employees are no longer allowed to work more than 25 hours per week.

74. Burger King, Washington, D.C.
“I’m not sure if Congress understood the devastating effect that this will have on businesses and on employment,” said a human-resources officer for the Maryland-based company that owns Washington, D.C.’s largest Burger King franchise. From the beginning of this year, the company has hired only part-time employees, who are “guaranteed no more than 29 hours per week.”

75. Taco Bell, Oklahoma
No employees at the Guthrie Taco Bell will be allowed to work more than 28 hours a week, resulting in a $200 reduction in one employee’s paycheck. “Several of the other people I work with, some of them are single parents, and we do the best we can, and 28 hours a week just isn’t going to cut it for the bills,” the worker said.

76. A Virginia Beach restaurant, Virginia
The owner of a Virginia Beach restaurant and catering company told Bloomberg that he has stopped hiring people to work full time and is even drawing back on part-time employees’ hours. “I can’t afford health insurance for everyone,” he said.

77. Jim’s restaurants, Texas

The San Antonio restaurant chain might be required to pay as much as $1 million more annually after ObamaCare takes effect. In response, Jim’s, like many other companies, is considering a reduction in employees’ hours so it won’t have to provide them with insurance.

78. CiCi’s Pizza restaurants, Texas
Bob Westbrook owned the state’s three top-performing CiCi’s Pizza franchises but calculated that the costs of providing health care under the employer mandate would leave him about $78,000 in the red at the end of the year. Ultimately, Westbrook figured, it was most cost-effective for him to sell his franchises, after nearly 20 years.

Grocery Chains

79. Whole Foods Market
The CEO of Whole Foods may not know exactly what changes will take place when the Affordable Care Act is fully implemented, but he’s sure it will negatively affect workers. While he would like his company to continue offering health insurance to its employees, he said there might have to be a tradeoff in the benefits equation: “That just means there’s less we can pay for wages.”

80. Trader Joe’s
Even though it has previously provided health-care coverage for its part-time employees, an uncommon practice in the industry, next year Trader Joe’s will give employees who work less than 30 hours a week $500 to purchase a plan in the upcoming ObamaCare exchanges. With federal subsidies and possible earnings from other employment, the company said, workers can find coverage that will be just as good. One employee described her soon-to-be lost coverage as “one of the best parts about the job,” and her reaction to hearing it would be dumped was “pure panic, followed quickly by anger.”

81. Wegmans
The New York–based grocery chain announced in July that part-time employees will no longer receive health-care coverage due to ObamaCare. Wegmans previously offered insurance to part-time employees working at least 20 hours a week.

82. Trig’s Supermarkets, Wisconsin
Sixty-five percent of the 1,100 workers at the Wisconsin supermarket chain will see their hours reduced to below 30 per week. “Doing nothing was not an option,” an executive with the company said. “Within a year, it would have put us out of business.”

83. Waldbaum’s, New York
At least one of the New York City–area supermarket chain’s stores has told employees that they will now be part-time workers, with some seeing a reduction of 20 hours or more from their usual weekly total. Some of Waldbaum’s 100 employees affected by the change are now seeking second or third jobs, according to a local newspaper.

84. Royal Farms, Maryland
The company’s 146 convenience stores in Delaware, Maryland, Pennsylvania, and Virginia are transitioning to an almost entirely part-time work force, reducing even full-timers to fewer than 30 hours a week.

Small Local Businesses

85. Southern Hearth & Patio, Tennessee
Health-insurance costs have more than tripled under the Obama presidency, said the owner of Southern Hearth & Patio in Chattanooga. He’s had to offer smaller bonuses and lower pay raises because of the Affordable Care Act.

86. Tsunami Surf Shop, North Carolina and South Carolina
A manager for Tsunami Surf Shop told a local news station that the company will “have to control the shifts” from now on in order to ensure that employees are working fewer than 30 hours a week.

87. Kerns Trucking, North Carolina
The family-owned trucking company had to cut insurance benefits for 81 workers to avoid having to pay an additional $100,000 under the law’s tax.

88. AAA Parking, Georgia
Next year, AAA Parking will move half of its 500 full-time hourly employees (out of a work force of 1,600) to part-time employment. “Our executive team has spent extensive time evaluating the impact of this mandate, and the financial impact for AAA Parking is dramatic,” a company memo explained.

89. Circle K gas station, Georgia
An employee at the Savannah gas station told a local news station that a supervisor informed workers that they would now work a part-time schedule due to the mandate.

90. Maritz Research, Missouri
The business-research firm informed its 300 employees in July that, starting next year, the company would have to “proactively manage average hours worked on a weekly basis” and enforce a 25-hour threshold.

Premium Rate Increases

91. California
Individual-market premiums in the Golden State could jump as much as 146 percent, according to an analysis of the state’s exchange program by Avik Roy of National Review and Forbes. For example, the cost for a nonsmoking 25-year-old in California who purchases the second-cheapest plan on the exchange would go from $92 to $205.

92. Colorado
Colorado’s cheapest health plans, which are generally geared toward younger people, are expected to rise dramatically in price next year, according to The Hill. Consider a nonsmoker under 30 years old. This year, this Coloradan could have purchased the cheapest catastrophic plan for $56 per month; next year, the cost is expected to climb to $135.

93. Florida
Florida regulators say the average premium for individuals will increase by 30 to 40 percent. For small businesses, the rates will be between 5 and 20 percent higher.

94. Massachusetts
According to a study by the Massachusetts Association of Health Plans and Blue Cross Blue Shield of Massachusetts, well over half of the state’s small businesses will see a rate increase, with some prices potentially doubling.

95. New Mexico
In a study conducted by the Manhattan Institute for Policy Research, by a team including our own Avik Roy, New Mexico was rated the state that would see the largest average hike in premium costs, at 130 percent.

96. Ohio
The cost of the average health-care plan in Ohio is expected to nearly double under ObamaCare, according to state insurance regulators. The Hill reports that an 88 percent increase will ultimately mean the cheapest plan on the market after the law goes into effect next year will cost about $280 a month.

97. Oklahoma
In all but one of the insurance plans offered to Oklahoma state employees, premiums will go up by as much as 12 percent; the one plan that does not have an increase is the “cheapest, most basic health plan,” according to The Oklahoman. According to an administrator with the state’s Office of Management and Enterprise Services, a tax associated with ObamaCare has led to an increase in the plans’ cost.

98. Rhode Island
According to the state’s health-insurance commissioner, the rate increase for large employers for 2014 will be about 10 to 12 percent, twice as high as the increase this year.

99. Washington
The analysis by Avik Roy and the Manhattan Institute indicates that Washington State residents across all age groups will see significant increases in their rates. Twenty-year-olds will see an average increase of 80 percent; 40-year-olds 50 percent; and 64-year-olds 59 percent.

100 Wisconsin
The state’s health-insurance regulators determined that “premiums will increase for most consumers” in Wisconsin when the law goes into effect in 2014. Young residents will see an estimated 125 percent increase, while seniors will pay as much as 45 percent more.

— Andrew Johnson is an editorial associate at National Review.

 

Ten states where ObamaCare wipes out existing health care plans

The Daily Caller ^ | 9/28/2013 | Sarah Hurtubise:

President Barack Obama famously promised, “If you like your health care plan, you can keep your health care plan.” He later got even more specific.“If you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have,” Obama said.But as ObamaCare's rollout approaches, we have learned this is not true. Here are the ten states where consumers may like their health care plans, but they won’t be able to...

Contact your senators:

Beck is talked about this on the radio today. Once this happens (Today) these people will be forced into the ObamaCare exchanges:

1. California: 58,000  -  The leading State Senator here in CA (Steinberg) supports this 100%, as well as the Fed Senators. They want gov’t-controlled single payer. CA is hopeless!
2. Missouri - 13 hospitals including the St. Louis Children’s Hospital — will not be covered
3. Connecticut: Aetna, the third largest insurer in the nation, won’t offer insurance on the ObamaCare exchange
4. Maryland: 13,000 individuals
5. South Carolina: 28,000 people
6. New York: Aetna pulled out of New York’s exchange in late August in an effort to keep their plans “financially viable,” said Aetna spokeswoman Cynthia Michener.
7. New Jersey: 1.1 million Aetna customers are at risk in New Jersey
8. Iowa: Wellmark Blue Cross and Blue Shield, Iowa’s largest health insurer, decided not to offer plans in the ObamaCare exchange
9. Wisconsin: Two of the three largest insurers in the state won’t offer plans on the exchange.
10. Georgia: Just five insurers are participating in Georgia’s ObamaCare exchange. Medical Mutual of Ohio left

Kentucky ObamaCare: Your private details may be handed over to foreign powers  

Don't already have a Kentucky Online Gateway Citizen Account?

WARNING NOTICE: This is a government computer system and is the property of the Commonwealth of Kentucky. It is for authorized use only regardless of time of day, location or method of access. Users (authorized or unauthorized) have no explicit or implicit expectation of privacy. Any or all uses of this system and all files on the system may be intercepted, monitored, recorded, copied, audited, inspected, and disclosed to authorized state government and law enforcement personnel, as well as authorized officials of other agencies, both domestic and foreign. By using this system, the user consents to such at the discretion of the Commonwealth of Kentucky. Unauthorized or improper use of this system may result in administrative disciplinary action and/or civil and criminal penalties. The unauthorized disclosure of Data containing privacy or health data may result in criminal penalties under Federal authority.

(Excerpt) Read more at ssoexternal.chfs.ky.gov ...

Cross-Posted at Ask Marion

Wednesday, August 7, 2013

Blue Cross, Aetna, United, Humana Flee Obamacare Exchanges

CBSNews: Major health insurance companies – Blue Cross, Aetna, United, Humana – have fled the Obamacare health care exchanges in various states, which are scheduled to start on Oct. 1st, 2014.

Insurance companies like Aetna and United have said, “thanks, but no thanks” to the public health insurance marketplace set up under the Affordable Care Act (ACA), or Obamacare, which will facilitate government subsidies to individuals and small businesses to buy approved health plans to comply with the law.

The ACA requires every American to have health insurance, or pay a penalty.  Individuals who are not covered by their employer can enroll in the state or federal government-run health care “marketplace,” which will provide subsidies to individuals between 100 and 400 percent of the poverty line.

Aetna, a fortune 100 company with $34.2 billion in revenue, has pulled out of public exchanges in three states, and will not be part of the individual health insurance exchange in its home base, Connecticut.

Founded in Hartford, Conn., in 1850, Aetna withdrew its application to participate in the state on Monday, due to high rates proposed by state regulators, the Hartford Courant reported.

“We have spent considerable time identifying those states in which we can be competitive and add the most value to the market,” Aetna said in a statement.  “As a result of our analysis, we have reluctantly concluded that we will withdraw certain Individual Exchange filings for 2014, including filings in Connecticut, Georgia and Maryland.”

“This is not a step taken lightly, and was made as part of a national review of our Exchange strategy,” the company said.  “Unfortunately, we believe the modifications to the rates filed by Aetna will not allow us to collect enough premiums to cover the cost of the plans and meet the service expectations of our customers.”

California

Aetna will also not participate in California’s exchange, and a spokesperson told CNSNews.com that the company never intended to do so.

Blue Cross, Aetna, United, Humana Flee Obamacare Exchanges

(AP Photo)

“We did not withdraw exchange plans in California, as we never planned participation nor filed [Qualified Health Plans] QHPs to participate in the California exchange,” a spokesperson said.

Anthem Blue Cross has withdrawn from its bid to participate in the state’s small business exchange, as well.

United Health Group, the largest health insurer in the United States, has also taken a pass on the Golden State’s individual insurance market under Obamacare.

As a result, roughly 8,000 policyholders will be left searching for new insurance.

Aetna will stop selling individual insurance policies in California all together, leaving nearly 50,000 existing policyholders to find new coverage by January.

‘If You Like Your Doctor,’ Hope Your Insurer Is Participating in the Exchange

“No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor, period,” Obama said on June 15, 2009.

“If you like your health care plan, you will be able to keep your health care plan. Period," he said.  "No one will take it away. No matter what.”

That promise, however, has been revised by the Department of Health and Human Services (HHS), which now says, “you may be able to keep your current doctor” in the health insurance marketplace.

“Most health insurance plans offered in the Marketplace have networks of hospitals, doctors, specialists, pharmacies, and other health care providers,” HHS said on its website for the health reform law.  “Networks include health care providers that the plan contracts with to take care of the plan’s members.”

“Depending on the type of policy you buy, care may be covered only when you get it from a network provider,” they said.

obama health care

President Barack Obama signs the Affordable Care Act (Obamacare) into law on Mar. 23, 2010. (AP)

With insurers opting out of state-run health exchanges, individuals are left with less options.

Only three companies remain in Connecticut’s “Access Health CT” exchange, following Aetna’s departure.

Similarly, only five plans are participating in the exchange in Georgia, after Aetna and Coventry Health Insurance dropped out last week.

The Savannah Morning News noted that this will “leave residents of some parts of the state with limited choice.”

Two of the three largest health insurers in Wisconsin will also not participate in the state’s online marketplace under Obamacare, it was announced on Wednesday.

Though they will not participate in at least four state-run exchanges, Aetna said they “appreciate” the opportunity to work with state regulators on complying with the ACA.

“We have appreciated the chance to work with the regulators in each state for the past months on a variety of key issues regarding ACA implementation,” Aetna said in a statement.  “We will continue to work with them, and various Exchange leadership teams, as we evaluate exchange participation in future years.”

CNSNews.com is not funded by the government like NPR. CNSNews.com is not funded by the government like PBS.

**More and more politicians, unions, insurance companies and people who have read the bill are calling ObamaCare a ‘trainwreck’.

Saturday, November 24, 2012

Real Danger of “Obamacare”: Insurance Company Takeover of Health Care

Militant Libertarian - by Nomi Prins:

Election rhetoric shuns the big picture in favor of the bigger platitude. Now that The Show is over, we are left with the equivalent of a Sunday morning hangover following a binge of promises and lies. We leave the theatre of political spectacle on steroids for the real world of unstable economy, a globally and publicly subsidized financial sector, and increased costs of living on everything from food to education to health-care; outpacing declining median incomes. The average cost for health insurance for a family is $15,745 per year vs. a median income of $50,502, or about half post-tax take-home pay.

“Obamacare” is the name commonly used for the Patient Protection and Affordable Care Act (PPACA) of 2010. The very moniker is indicative of how name-and-image-centric our world has become; Medicare was never called “Johnsoncare” when President Johnson signed it into law in 1965 and Johnson was not exactly a man of small-personality. At any rate, Obamacare or the PPACA ranks as one of the most misrepresented issues from the campaign, by both sides of the ever-slimming aisle.

The Tea-Party Conservative types get it embarrassingly wrong when they call it a “government takeover of health care.” Likewise, Progressive Obama-supporters are deluded in accepting it as the most sweeping healthcare reform since Medicare. (Side note: I wish the word ‘sweeping’ could be retired from politics until it actually means -sweeping.)

Here’s why. The PPACA does nothing to restructure the health insurance industry, anymore than the Dodd-Frank Act restructures the banking industry. This means everything else it attempts to do, positive or negative, will be vastly overshadowed by an industry accelerating to morph itself into a acquisition machine in order to circumvent anything that even smells like a restriction, including laws that exist and ones to come.

How? By doing the same thing energy and telecom companies did after they were deregulated in 1996, and that banks did after they were summarily deregulated (after moving that way for decades) in 1999. They are merging, consolidating, eliminating competitors, and controlling their domain. They are manufacturing power.

Investment bankers are roaming the world to exploit this hot new opportunity. That’s one reason insurance companies don’t even call themselves that anymore. Now, they are ‘managed health care’ companies. Call yourself a managed health care company, and you can buy everything from other insurance companies to hospitals to clinics to doctors. The more consolidation, the more fees bankers rake in, and the more premiums and medical reimbursements and health care procedures, each company can control.

The result of 1996 energy deregulation was a glut of crime-spawned bankruptcies like Enron. Likewise WorldCom led a pack of telecom degenerates in the production of tens of billions of dollars worth of accounting fraud. The final repeal of Glass-Steagall ignited a merge-fest of investment and commercial banks, their linkages ensuring that taxpayers, whose deposits have been protected since the New Deal, provide a safety-net upon which they can mint toxic assets loosely based on over-leveraged home mortgages, and engage in risky, speculative activity; big banks don’t go bankrupt when they fabricate values or lose big on stupid bets, they get federally subsidized in all sorts of ways.

You know who else is similarly too big to fail? The insurance industry. UnitedHealth Group, the nation’s largest health insurer covers 50% of the insurable population in over 30 states. Blue Cross-Blue Shield, covers 100 million people through a constellation of 38 sub-companies. They, and other insurance companies are growing in breadth. When companies consolidate, the result is less transparency, less competition, and more possibility for fraud and shady behavior. Every. Single. Time.

Obamacare and Accounting Fraud

By January 2014, the PPACA will require insurance companies to list their prices on competitive exchanges. In Obama-theory, this is supposed to reduce premiums via competition. But what if, say, only three companies control nearly all of the premiums? Consider the fact that it costs the same $3 to extract your money from a Chase, Bank of America or Citigroup ATM (if you don’t get it directly from the firm you bank at.) They constitute a monopoly that defies anti-trust inspection (thank you, Department of Justice.) What incentive would any of them have to charge less? None. That’s why they don’t.

Managed Health Care companies don’t just administer private, but government health insurance policies as well. The http://www.healthcare.gov website says that under the PPACA, the life of the Medicare Trust Fund will be extended to 2024 as a result of reducing waste, fraud, abuse, and slowing cost growth. President Obama promised to reduce Medicare fraud 50% by 2012 according to the site – but if he did, he forgot to mention it during the campaign period.

To supposedly combat price hikes, the PPACA calls for a new Rate Review program, wherein insurance companies must justify premium hikes of more than 10% to a state or federal review program. Given that banks aren’t supposed to hold more than 10% of the nation’s deposits in any one institution, and three do, this isn’t a comforting constraint.

While it is positive that the PPACA requires coverage of people with pre-existing conditions and prohibits lifetime caps, it can’t control what people pay for insurance, because it doesn’t limit actual premiums, which have risen 13% on average since the Act was passed.

The medical cost ratio limitation the PPACA instills; that 80% of premiums must be used for medical care in the case of individuals and small groups, and 85% in the case of large groups) to supposedly ensure companies operate on a more efficient premium in vs. premium out basis, is a joke. Its punch line is accounting manipulation. Call everything a medical cost; even buying another company, and the ratio is meaningless.

WellPoint got the Joke

WellPoint got that joke immediately. The largest for-profit “managed health care” company in the Blue Cross and Blue Shield Association, it began trading publicly on December 1, 2004. Depending on the state, it operates under Blue Cross and Blue Shield, Blue Cross or Anthem.

After the PPACA was passed, in March 2010, WellPoint allegedly reclassified certain administrative costs as medical care costs in order to meet the law’s new medical loss ratio requirements (which requires insurers spend at least 80% or 85% of premiums on health care services, depending on the type of plan, individual or group respectively.)

A month earlier, WellPoint announced its Anthem Blue Cross unit would raise insurance rates for some individual policies in California up to 39%. Federal and California regulators are still investigating this, but the premium hikes remained.

WellPoint is also one of Wall Street’s favorite “managed health care” companies; cause it keeps getting bigger through acquisitions that pay hefty fees to the bankers involved. On October 23rd, WellPoint got approval from Amerigroup’s shareholders to acquire Amerigroup, a Medicaid-focused health insurer, in a $4.9 billion cash deal. The deal makes WellPoint the nation’s largest Medicaid insurer, and provides it greater access to Medicaid patients who also qualify for Medicare.

It was the largest cash deal ever, and the largest premium paid for a company in the managed health care realm. As a result, Goldman Sachs (who advised Amerigroup) and Credit Suisse (who advised WellPoint) retained their top positions in the global healthcare deal advisory league table.

The value of Amerigroup, as a company, dropped 34% within two weeks of that agreement, in stark shades of what happened when Bank of America took over Merrill Lynch in the fall of 2008.

This summer, Amerigroup and Goldman Sachs faced a shareholder lawsuit filed by the city of Monroe Employees Retirement System and Louisiana Municipal Police Employees Retirement System. It alleged that Goldman advised Amerigroup to accept WellPoint’s offer quickly, rather than seek other bids, because the bank had structured a complex, and fee-heavy derivatives transaction on the back of the deal. The insurers resolved the suit by tweaking the deal parameters. All parties denied ‘any wrongdoing.’ But where there’s smoke in complex derivatives land, there is fire.

Other Mergers

After the Supreme Court upheld the PPACA, a spate of mergers rippled through the managed health care realm, to ostensibly cope with smaller profit margins and ‘compliance costs.’ But really, it’s because each firm wants to corner as much as possible of the market, in as many states as it can, to garner more premiums and control more disbursements and prices at the upcoming insurance ‘exchanges.’

In late August, the third largest insurance company in the US, Aetna announced it was buying Coventry Health Care for $5.7 billion. Coventry provides Medicare and Medicaid services, thus the takeover expands Aetna’s Medicare and Medicaid business. Being part of Aetna enables Coventry to grab more consumers on more state-run health insurance exchanges, reducing competition in the process. The Department of Justice is examining anti-trust issues surrounding the deal, but it’s still expected to close in mid-2013.

On October 17th, UnitedHealth Group issued $2.5 billion of bonds as part of its $4.9 billion acquisition of Brazil’s Amil Participacoes. Bank of America Merrill Lynch, Goldman Sachs, J.P. Morgan Chase & Co., Morgan Stanley, UBS and Wells Fargo Securities were lead underwriters on the deal.

They are not buying international companies in order to increase accounting transparency. Like other multinationals, they are doing so to move profits around and circumvent restrictions and tax laws. They are using cash, or raising extra debt, to do so, rather than to reduce premiums or increase disbursements to medical professionals.

And if you’re keeping score – billion of dollars are flowing from insurance companies – NOT to reduce premiums to patients and NOT to reimburse doctors and NOT to enhance the quality of care, but to simply expand nationally and globally. Meanwhile, their CEOs are doing quite well from all that non-health care related movement.

Total compensation for the bulk of health care company CEOs rose by 14.7% in 2011 by 14.7%, or $11.1 million, to $87 million. Cigna’s CEO David Cordani made $19.1 million. UnitedHealth Group’s CEO, Stephen J. Hemsley bagged $49 million in salary, stock options, and other compensation last year. The highest-paid CEO made 94 times the average compensation level of primary care physicians. And none of them had to pick up a single scalpel in the process.

Doctors as profit centers

Not just patients, but physicians have been bled steadily from the current state of insurance company controlled health care through diminishing insurance reimbursements, electronic medical records mandates whereby they spend as much time complying with Kafkaesque controls over their decisions on performing surgeries and providing care, and debt. New doctors are graduating with an average of $250,000 in debt, which, combined with diminishing disbursement and soaring costs, will keep many, underwater. Forever.

According to Dr. Michael H. Heggeness, President of the North American Spine Society, a group of 6500 global spinal and orthopedic surgeons (at which I delivered a speech last month), “The last people, that most of the population feels sorry for are doctors, yet they are in an economic crisis of their own. In 2002, 80% were in private practice, now 70% are in hospitals because they can’t afford to make a private practice work.”

Meanwhile the more hospitals are viewed as profit centers, the more their Chairmen will cut costs to maximize returns, and not care quality. They will seeks ways to sell underperforming assets, programs or services and reduce the number of nonessential employees, burdening those that remain. No doubt the private equity community will be getting more into this game, as insurance companies buy more hospitals, doctors, clinics, and perhaps drug companies, or vice versa, and ‘restructuring’ accelerates.

And if insurance companies can manage doctors directly, they can control not just costs, but treatment – our treatment. It’s not an imaginary government takeover anyone should fear; but a very real, here-and-now insurance company takeover, to which no one in Washington is paying attention.

Related:

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Nearly every major drug company convicted of criminal behavior in three-year, $11 billion sweep

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Full List of Obamacare Tax Hikes

Surprise! Audit uncovers rampant fraud in fed program