When Swedish health care "professionals" aren't out trying to score hot nurses, they're apparently turning away fellow citizens who've suffered broken necks:
From the lips of Ms Shecantbeserious:
An offshoot of Obamaneycrap is the battle over how much regulation can be imposed on insurance carriers that operate in a free market. One of the side battles addresses premium rate increases.In its ruling, the Supreme Judicial Court said that Maine’s insurance superintendent had “properly balanced the competing interests” in arriving at an approved rate increase of 5.2 percent. The insurer, a unit of Wellpoint, the nation’s largest insurer, had sought a 3 percent profit margin as part of an overall 9.2 percent increase in health insurance rates for policies sold to individuals in 2011. It argued that state regulators’ decision to grant a 1 percent profit margin violated state law and the U.S. Constitution by depriving the company of a “fair and reasonable return.”
“This is great news for consumers because it reaffirms that a state insurance regulator, when they have the authority, can do a balanced, comprehensive review of rates,” Kofman, now a researcher at Georgetown University’s Health Policy Institute.
Chock up another one for our prescience. Some 3 1/2 years ago, we discussed the possibility that young boys would also be given this tried-but-untrue panacea. Now comes word that "the American Academy of Pediatrics is fully recommending that boys get the shots as well."
Launched last summer, a $77 million computer system to stop Medicare fraud before it happens had prevented just one suspicious payment by Christmas. That saved taxpayers exactly $7,591.Lawmakers had expected the system to finally allow Medicare to stanch a $60-billion-a-year fraud hemorrhage. Now they’re worried that cautious bureaucrats lacking a clear game plan will compromise its performance.
Medicare officials say it’s unfair to grade the new technology on a single statistic.
Maybe it's just me, but I would expect a bit more for a $77 million computer.
Time to break out that new standard, Days of Wine and Rosemary. Last week, we reported on the newest study touting the benefits of an occasional libation. Today, we learn that one of my favorite herbs has similarly beneficial effects on one's intelligence:
In a missive to parishioners on the first Sunday of Lent, Cardinal George warns that the Catholic Church will shut down its hospitals, clinics, and charities before submitting to the mandate — and provides a little history lesson as well:What will happen if the HHS regulations are not rescinded? A Catholic institution, so far as I can see right now, will have one of four choices: 1) secularize itself, breaking its connection to the church, her moral and social teachings and the oversight of its ministry by the local bishop. This is a form of theft. It means the church will not be permitted to have an institutional voice in public life. 2) Pay exorbitant annual fines to avoid paying for insurance policies that cover abortifacient drugs, artificial contraception and sterilization. This is not economically sustainable. 3) Sell the institution to a non-Catholic group or to a local government. 4) Close down. …Since 1915, the Catholic bishops of the United States have taught that basic health care should be accessible to all in a just society. Two years ago, we asked that whatever instruments were crafted to care for all, the Hyde and Weldon and Church amendments restricting funding for abortion and respecting institutional conscience continue to be incorporated into law. They were excluded. As well, the present health care reform act doesn’t cover entire sections of the U.S. population. It is not universal.The provision of health care should not demand “giving up” religious liberty. Liberty of religion is more than freedom of worship. Freedom of worship was guaranteed in the Constitution of the former Soviet Union. You could go to church, if you could find one. The church, however, could do nothing except conduct religious rites in places of worship-no schools, religious publications, health care institutions, organized charity, ministry for justice and the works of mercy that flow naturally from a living faith. All of these were co-opted by the government. We fought a long cold war to defeat that vision of society.
One of the good things about Obamacare, perhaps the only good thing, is PCIP. The Pre-existing Condition Insurance Plan, should be a god-send for those that are too sick to qualify medically for health insurance in the open market.Those who have enrolled in the program are projected to have significantly higher medical costs than the government initially expected. Each participant is expected to average $28,994 in medical costs in 2012, according to the report, more than double what government-contracted actuaries predicted in November 2010. Then, the analysts expected that the program would cost $13,026 per enrollee.
The costs also are significantly higher than those of similar high-risk pools that many states have operated for decades. States spent an average of $12,471 on enrollees in 2008, according to the National Association of State Comprehensive Health Insurance Plans.
Best estimates are the plans are paying out $3 for every $1 in premiums taken in and if the above projections bear out it will hit $5 in claims for every $1 in premium.
Then there is the case of Alaska. KHN reports the frozen state isn't doing a very good job of recruiting folks in to PCIP and the ones they are attracting are very expensive to treat.
A high risk pool set up under the federal health overhaul to help the uninsured who have pre-existing medical conditions expects to spend $10 million this year to cover about 50 members. That’s about $200,000 per person.
Bykerk said the high risk pool has attracted all types of high risk patients, ranging from women who were pregnant and unable to get traditional insurance to children who needed a heart transplant.
Alaska isn't the only state operating in the red.
Colorado has covered 1,087 people in its high risk pool and fears its $90 million allocation will not be enough. “Our claims experience indicates the population covered in this program have significantly higher medical needs than the general insured population,” said Kayla Arnesen, a spokeswoman for the Rocky Mountain Health Plan, which administers the high risk pool.
Kind of makes you wonder how well Obamacare is going to work in 2014. How much money will Obamacare REALLY cost once it is rolled out for everyone?
PCIP is a great deal for the insureds.
Not so much for the taxpayers supporting it.
The folks at KHN give us a bit of clarification on what is, and what isn't preventive contraception.1) Are male-based contraceptive methods, such as vasectomies or condoms, covered by the rule?
An HHS official said on Friday that women’s preventive services guidelines apply to women only.Sounds like someone is playing the gender card. Is it because the HHS Secretary is a woman? Does she have something against men?
2) Are over-the-counter products like female condoms, spermicides, sponges covered by the rules and, if so, will they require a prescription and how will insurers reimburse policyholders for purchases at retail stores?
Products that must be covered without cost-sharing include over-the- counter contraceptives when they are prescribed by doctors, the HHS official said FridaySo if a woman considers a relationship "sponge worthy" she must make a doctors appointment and get a prescription to buy an OTC birth control device.
3) If a hospital stay is required for surgical procedures, such as when a women gets her tubes tied, would the procedure be covered without cost sharing?Sounds like the free colonoscopy debate.
Insurers say it is not clear if hospitalization or complications that might occur from surgery would be covered without the patient paying a co-payment or a deductible because they are not considered preventive.
5) Who will be covered for contraceptives without co-payments?Some groups, such as Catholic affiliated organizations, get a pass. But Obama said if an employee of a Catholic organization wants a free contraceptive the carrier must provide it for her.
The package of women’s preventive care benefits must be offered in all new insurance policies sold to individuals and employers starting Aug. 1, as well as in most policies that renew afterwards on the date that they renew. There is an exception for insurance provided by certain nonprofit religious employers who object to birth control.
Bertolini said an amalgamation of regulatory, demographic and economic factors were driving this change. The Affordable Care Act in particular, with its ban on medical underwriting, had made the traditional health insurance business model untenable in the long term, he said.Bertolini offered a strong endorsement of the accountable health organization model, positing health insurers as uniquely suited to usher in an era of coordinated care. “We need to move the system from underwriting risk to managing populations,” he said.
A Cayce man has been charged with insurance fraud after another man’s hand was chopped off.
Thirty-four-year-old Gerald B. Hardin faces six charges, including mail fraud for a 2008 incident in Sumter County where a man’s had was cut off with a pole saw.
Federal indictments state that Hardin and another person used a saw to intentionally cut off the hand of a third person in an insurance fraud scheme. The indictment says the men submitted claims under a homeowner’s insurance policy and three accidental death and dismemberment polices.
It says the men received more than $670,000.
Class warfare now includes Obamacare. Michael Cannon at Cato posits about Mitt Romney's wealth and wonders if he has health insurance.If Romney does not enroll in Medicare, it would again look bad that he who forced others to purchase health insurance is opting not to obtain health insurance himself. But if he does enroll in Medicare, it’s worth asking whether the 99 percent should subsidize people like him.
■ First up, our friend Bob Graboyes of the NFIB explains how the ObamneyCare© tax-credit is nutty:
So let’s turn to the real story of the low costs of the first year of the ACA and what has occurred while cost increase have mitigated:At what cost?
1) 2.5 million young Americans are now covered on their parents plans
2) 54 million Americans with insurance got an array of preventive care services with no copay or out of pocketOf course we know that preventive care isn't really free, so someone has to pay for it. Annual exams at a par provider, exclusive of immunizations and anything other than routine lab, cost the insurance carrier about $250 per visit. Of course you have to run that through the MLR machine, which means the premium must be increased by $300 - $315 to cover the cost of the "free" exam.
3) Seniors saved over $4 billion in drug costs due to the donut hole closingGotta admit, I have no idea how to calculate this one, but for chuckles and grins let's just use the $4 billion figure and not even add any overhead costs.
4) 32 million seniors got an array of preventive care services with no copay or out of pocket saving billions moreHere we go again with the free preventive stuff. No reason to deviate here, although at this point MA plans and Medigap are not subject to MLR. Their loss ratios are actually richer than plans subject to MLR, so the 80% figure is being generous.
5) Medicare Advantage premiums are flat to down for the first time ever even though subsidies to these private insurer plans lost a 14% subsidy that will save Medicare $500 billion over 10′ yearsWhile it is true that many MA plans did not raise premiums, there were quite a few plans that withdrew from the market place, especially in rural areas. Many seniors either transitioned to Medigap plans or simply returned to original Medicare and will pay their out of pocket costs when they can afford it.
6) Medical loss ratio rules will result in nearly $2 billion in rebates to employers and consumers. Billions more is being saved from rate increase being subject to review in all 50 states thus discouraging insurers from being able to do whatever they want in increasing rates without justifying them publicly.Again, we are playing games here.
7) Medicare fraud enforcement saved a record $4.6 billion in recovered payments and the ramped up enforcement team likely reduced ongoing fraud even further by deterring criminalsAh yes, the perennial waste, fraud and abuse argument.
8) Annual and lifetime maximums no longer exist which will save many families over time from medical bankruptcy.Medical bankruptcy is a fraud proven many times over. The additional premium for removing annual and lifetime caps is nominal, not even worth factoring in to the cost of Obamacare.
9) Children no longer face pre ex restrictions and that will apply to all of us in 2014True, but then children in most states can not obtain insurance on their own. "Child only" plans no longer exist in almost every state, even for perfectly healthy children.
