Windy City Treat: Connecting the Dots

Back in the day (well, a few short months ago, really), the University of Chicago Medical Center undertook to reduce its exposure to the costs associated with treating the uninsured. In particular, the neighborhood in which the Center was located, which boasted a particularly high percentage of these folks. Curiously, they also happened to be predominantly poor. And did I mention, black?

Now, one might suppose that this would have resulted in a hew and cry from that community's leadership, which also happened to share some of those demographics. After all, if you're a hospital turning away black people, one would think there was a problem, no?

As it turns out, one would be wrong:

"Michelle Obama...helped create the program, which aims to find neighborhood doctors for low-income people who were flooding the emergency room for basic treatment."

For those in the dark on this, Ms Obama's other job is currently First Lady. Interesting also is the involvement of David Axelrod, currently serving as Senior Advisor to President Obama. His PR firm was given the task of "selling" the program, dubbed the "Urban Health Initiative" to the public and in particular, the folks who live in the neighborhood surrounding the UCMC.

Does anyone else see a disconnect between the stated goals of the new administration (more access, better care) and a program designed to save a particular hospital money by turning away those most in need?

Maybe it's just me.

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Health Advice from Auntie Beeb

The BBC is an excellent resource for a number of topics and their Health section is no different. The site features a comprehensive database of information on a wide variety of conditions and treatments. For example, the Women's Health page features a breakdown of common health issues affecting the female population including breast cancer, eating disorders, heart disease, depression and fertility. There are also excellent guides on Nutrition, First Aid, Allergies and Men's Health. We would highly recommend that you take this time to visit these pages - you may even gain an insight into where your healthcare habits could be improved.

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More ARRA/COBRA Confusion

[Welcome Industry Radar and Wall Street Journal readers!]

Received in the mail this morning a letter which included the following:

"...small employers that are exempt from COBRA (e.g. employers with less than 20 employees) but subject to state continuation laws [ed: "mini-COBRA] will have to comply with the new subsidy requirements..."

Which we already knew, but:

"The new rules require employers to send out special notices and to allow certain individuals who originally declined coverage a second opportunity to elect to continue coverage." [emphasis added]

Now, this is from a noted expert on COBRA (in fact, he's one of our favorite CE instructors on the subject), so one might presume that this could be taken as "gospel."

Not so fast.

Let's back up a moment: as we've discussed, the Spendulus included some radical changes to COBRA, one of which extended the "subsidy" to smaller groups. From what we've learned so far, this applied only to the "subsidy" itself, not the notification requirements. Until now, Ohio (for example) had none: it was up to the (former) employee to seek out that coverage continuation. COBRA requirements in that area, however, are onerous, and almost always contracted out by employers. This is cost-effective for a larger group, but prohibitive for smaller ones.

If true, this new notification requirement would be a severe blow to any small employer's budget: under COBRA, the penalties for screwing up notifications are severe and not just applicable to the employer, but to the hapless employee who was assigned the task. So many groups (and most of the smart ones) contract with a COBRA administrator to handle this chore. That's probably not an option for a group of, say 10 or 12 employees, so the temptation to do this in-house will be great.

And unwise.

I'm still not convinced that this is the new law of the land, however. We've been keeping a very close watch on this issue, and haven't seen this particular item come in, except for this letter. So I called the Department of Insurance to see if they knew about it.

They did not.

In fact, their response was to "stay tuned" because the Department of Labor (the federal agency tasked with overseeing COBRA) was still ironing out details. Better yet, I clicked on over to the DOL, and found a brief FAQ about the new rules, none of which addressed the notification issue at the state level. Ditto at the dedicated COBRA site.

So, is this fact or urban legend?

At this point, no one seems to know. We'll keep you posted.

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Email of the Day

From FoIB Brian D, comes this breaking news from Washington. We're proud to have scooped the MSM on this important, ground-breaking new program:

The Americans With No Abilities Act

Washington , DC - (Dateline March 3, 2009) President Barack Obama and the Democrat controlled Congress are considering sweeping legislation that will provide new benefits for many Americans. The Americans With No Abilities Act (AWNAA) is being hailed as a major legislative goal by advocates of the millions of Americans who lack any real skills or ambition.

"Roughly 50 percent of Americans do not possess the competence and drive necessary to carve out a meaningful role for themselves in society," said California Senator Barbara Boxer - Democrat. "We can no longer stand by and allow People of Inability (POI) to be ridiculed and passed over. With this legislation, employers will no longer be able to grant special favors to a small group of workers, simply because they have some idea of what they are doing."

In a Capitol Hill press conference, House Majority Leader Nancy Pelosi – Democrat, and Senate Majority Leader Harry Reid – Democrat - pointed to the success of the U.S. Postal Service, which has a long-standing policy of providing opportunity without regard to performance. Approximately 74 percent of postal employees lack any job skills, making this agency the single largest U.S. employer of Persons of Inability.

Private-sector industries with good records of non-discrimination against the Inept include retail sales (72%), the airline industry (68%), and home improvement warehouse stores (65%). At the state government level, the Department of Motor Vehicles also has an excellent record of hiring Persons of Inability (63%).

Under AWNAA, more than 25 million mid-level positions will be created, with important-sounding titles but little real responsibility, thus providing an illusory sense of purpose and performance.

Mandatory non-performance-based raises and promotions will be given so as to guarantee upward mobility for even the most unremarkable employees.. The legislation provides substantial tax breaks to corporations that promote a significant number of Persons of Inability into middle-management positions, and gives a tax credit to small and medium-sized businesses that agree to hire one clueless worker for every two talented hires.

Finally, the AWNAA contains tough new measures to make it more difficult to discriminate against the non-abled, banning, for example, discriminatory interview questions such as, "Do you have any skills or experience that relate to this job?"

"As a Non-abled person, I can't be expected to keep up with people who have something going for them,"said Mary Lou Gertz, who lost her position as a lug-nut twister at the GM plant in Flint , Michigan , due to her inability to remember rightey tightey, lefty loosey."This new law should be real good for people like me," Gertz added. With the passage of this bill, Gertz and millions of other untalented citizens will finally see a light at the end of the tunnel.

Said Senator Dick Durbin (Democrat-IL), "As a Senator with no abilities, I believe the same privileges that elected officials enjoy ought to be extended to every American with no abilities. It is our duty as lawmakers to provide each and every American citizen, regardless of his or her inadequacy, with some sort of space to take up in this great nation and a good salary for doing so."

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No Patients Left Behind

[Welcome Industry Radar and Kaiser Network readers!]

LBJ conceived the Great Society to eliminate poverty and racial injustice.

George H. W. Bush created the No Child Left Behind to provide quality basic education to all children.

Obama is promising there will be No Patients Left Behind as part of his master plan to save the USA from economic collapse.

We still have poverty, racial inequity and students in public schools are still failing. So will the Spendulus Bill with promises to end inequity in health care and provide universal coverage succeed? Will there be No Patients Left Behind?

Let's see what Cassandra Kelsey has to say about that.

Cassandra lost her job with Verizon in January.

Kelsey walks with a cane and lists a litany of ailments, including degenerative arthritis and hypertension. For her, going without health insurance is unthinkable.

COBRA became law in 1986 and provided, among other things, a way for employees to continue their group insurance plan for up to 18 months (in most cases), providing them a way to bridge over to their next job with benefits. For the last 22+ years employees have had an option to assure they would not be without health insurance after leaving their job. So how many have prepared for that situation?

Very few.

Outside a District of Columbia career center on a recent morning, Kelsey clutched copies of her COBRA invoice, clippings from a newspaper about the stimulus bill, and a form letter she received from the White House after writing to President Obama.

Kelsey knew about the reduced premium and said it would bring her COBRA costs below $200 a month. But when she called her benefits department, she was distressed to learn that she would not be able to get the reduced cost immediately, probably not until May.

"I can't take advantage of it now, which I think is totally unfair,"

Unfair? As much as I empathize with Ms. Kelsey I fail to see how this burdensome new program from the O.G.M. (Office of Government Meddling) is unfair.

As part of the Spendulus Bill, employers are now required to subsidize 65% of the COBRA premiums for severed employees for up to 9 months. Supposedly they will get a credit against future payroll taxes to offset this cost but the program has only been in the air for a few weeks and already some employers are considering dropping their group coverage as a way of avoiding the financial burden of paying for benefits for laid off employees.

A $25 billion provision in the stimulus plan aimed to cut COBRA's price tag, reducing its cost 65 percent for workers laid off as far back as Sept. 1.

That's $25 billion out of $787 billion to spendulate the economy. If Congress really wanted to help those out of work you would think they would allocate more to COBRA subsidies and find a way to make it less onerous for employers who are already struggling.

Instead, Congress deems it better to spend $1 million on Mormon Crickets in Utah, a total of $41.5 million to renovate libraries for 3 dead presidents, and another $1.8 million for Swine Odor and Manure management.

In the big scheme of things, when you are talking about spending billions of taxpayer money, allocating $300,000 for GoGirlGo is not a lot of money. But somehow I don't think Ms. Kelsey will agree that it is better to support mormon cricket research and pig farts is more noble than helping out people who are unemployed.

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Grand Rounds 5:24

FoIB David Williams, proprietor of the Health Business Blog, hosts this week's roundup of great medblog posts. Once again, it's obvious that David's taken the time and trouble to actually read each submission, and it shows in the recaps of each post.

Well done!

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