Come for the politics, stay for the snark.

And now I have baud making fun of me. this day can’t get worse.

A sufficient plurality of insane, greedy people can tank any democratic system ever devised, apparently.

Wow, you are pre-disappointed. How surprising.

A last alliance of elves and men. also pet photos.

They fucked up the fucking up of the fuckup!

And we’re all out of bubblegum.

I’m only here for the duck photos.

Consistently wrong since 2002

Peak wingnut was a lie.

Fuck these fucking interesting times.

This has so much WTF written all over it that it is hard to comprehend.

We are aware of all internet traditions.

Hot air and ill-informed banter

Perhaps you mistook them for somebody who gives a damn – Nancy Pelosi

This is all too absurd to be reality, right?

Where tasty lettuce and good mustard aren’t elitist.

The cruelty is the point; the law be damned.

Nancy smash is sick of your bullshit.

Everybody saw this coming.

It’s always darkest before the other shoe drops.

We can agree to disagree, but i’m right.

‘Forty-two’ said Deep Thought, with infinite majesty and calm.

This is a big f—–g deal.

It’s the corruption, stupid.

You are here: Home / Archives for Healthcare / COVID-19 Coronavirus
“COVID-19 is a novel disease for which treatment protocols are evolving and remain imperfect. With the internet’s eternal tropism towards bullshit, there will be plenty of false or misleading claims about ways of preventing, enduring or “curing” COVID-19 infections. Please don’t amplify them here. If you do have knowledge or experience you feel is of interest to the jackaltariat, please make sure you make it clear where that information comes from: sources, expertise, and so on.  It’s easy to get stuff wrong in a crisis and mistakes can create real harm. So be careful out there…and in here.”

COVID-19 Coronavirus Updates: Friday / Saturday, July 30-31

by | 59 Comments

This post is in: ,

show full post on front page

COVID-19 Coronavirus Updates: Friday / Saturday, July 30-31Post + Comments (59)

Risk rating

by | 40 Comments

This post is in: ,

David Fud raised a good point in comments yesterday on how we decide to price premiums:

I have to say that I really believe that insurance premium differentiation should broadly apply to risky behaviors. Drive fast with a meter in the car? Higher automobile premiums. Don’t take vaccines? Pay a higher premium. Have a gun? Have to insure it/higher premium/no coverage for gun related health problems.

I realize that these are taboo costs in American society. However, if someone started a pool of folks who were up front about their cheaper behaviors (speeding, guns, vaccines, whatever), you would think it could bifurcate the insurance market between the two risk pools and force the increases indirectly on the more expensive pool.

What he proposes is to use risk-rating and experience rating to price health insurance.  This is wicked common in the entire US insurance system.

As a teenager, I was a truly shitty driver, even relative to my peers who, as a class, were shitty drivers.  My auto insurance premiums were horrendous.  Now that I have not caused a claim to be filed in the past twenty years and I’ve aged into a far less likely to generate claims group, my risk and experience rated car insurance rates are far lower now than in 1998.

Car insurance is a risk and experience rated product.  And we, as a society, think that this is just.  The economists will argue that this is an efficient allocation as it removes moral hazard where people would engage in destructive or bad behavior if they don’t bear the full costs of bad behavior.

In health insurance, we aren’t often making that same decision that experience and risk rating is just.  We, as a society, think that there is a significant component of luck that is randomly distributed that is highly correlated with costs.  And if we think that luck matters a lot and that the provision or non-provision of affordable and useful insurance produces lots of suffering that we don’t want to see, then pure risk rating goes out the door.  We’ve mostly made the decision as a society that pure risk rating produces bad things in the healthcare setting.  So we don’t allow pure risk rating in large group health insurance via HIPAA, we don’t allow risk rating for Medicare or Medicaid except in the sense that very ill individuals may more easily qualify for coverage than healthy, low cost folks, and with the ACA we don’t allow for pure risk rating in fully insured individual and small group markets.  We allow pure risk rating in products that fill gaps and live in the cracks between payment systems.

This is a political and social decision.

Going to a broader sense of risk rating in health insurance is a political and moral decision.

It could work.

It could have consequences that we either do or do not want.

 

Risk ratingPost + Comments (40)

COVID-19 Coronavirus Updates: Thursday / Friday, July 29-30

by | 87 Comments

This post is in: ,

show full post on front page

COVID-19 Coronavirus Updates: Thursday / Friday, July 29-30Post + Comments (87)

Arkansas Governor Asa Hutchinson Does Not Seem To Understand What a Public Health Emergency Is

by | 71 Comments

This post is in: , , , , , , , ,

Earlier today and faced with not having a single free ICU bed available in Arkansas as a result of the delta variant sweeping through unvaccinated Arkansas like me at an all you can eat standing rib roast buffet, Arkansas Governor Asa Hutchinson declared a public health emergency.

Governor Hutchison is not running for reelection. Any presidential hopes he might have had died with the emergence of Trump. He is unlikely to have a senate seat open up to run for. Basically, other than a sinecure at a think tank or research institute, this is it for him in Republican politics. And yet, with all of that providing him a significantly large amount of political freedom, he is still unable to do the right thing for the citizens of Arkansas. There are only three ways to stop the delta variant wave: vaccination, enforceable mask mandates, and/or mandatory, enforceable social distancing. We’d all prefer every do the easy thing and just get vaccinated. But given that in Arkansas, and dozens of other states, that’s just not going to happen, then the only other ways to defeat the delta wave are enforceable mask mandates and mandatory, enforced social distancing.

Governor Hutchinson’s public health emergency declaration is not worth the paper that it is printed on because it doesn’t do a damn thing, other than announcing that something has been done, that will have any positive effects in regard to the delta variant wave sweeping through Arkansas.

Given that he was Secretary of Homeland Security, I’m surprised he didn’t change the color coding or Arkansas to tangerine or something to show he was really serious.

Arkansas Governor Asa Hutchinson Does Not Seem To Understand What a Public Health Emergency Is

 

Open thread!

Arkansas Governor Asa Hutchinson Does Not Seem To Understand What a Public Health Emergency IsPost + Comments (71)

Thursday Evening Open Thread: Field Trip!

by | 101 Comments

This post is in: , , , ,

Best thing you can say about the GOP Death Cultists’ middle-school-level performances: At least while they’re stunting for selfies, they’re not actively making other peoples’ lives worse…

Thursday Evening Open Thread: <em>Field Trip!</em>Post + Comments (101)

It’s a Job Seekers Market, They Say

by | 159 Comments

This post is in: 

So if you don’t want to get vaccinated, polish your fucking resume and get the fuck out:

President Biden’s expected announcement of a vaccine mandate for federal workers has splintered groups representing large numbers of employees, raising questions about compliance and enforcement as the White House attempts to arrest the spread of the coronavirus delta variant.

Some sectors of the federal workforce, including groups as disparate as law enforcement officers and postal workers, raised immediate concerns about the requirement, sending an early signal of looming problems.

The Federal Law Enforcement Officers Association, which represents more than 26,000 federal officers, has blasted the idea, saying that it believes requiring vaccinations represented an infringement on civil rights.

“There will be a lot of pushback. It’s going to be an avalanche,” President Larry Cosme said, warning that many of the group’s members at the Justice Department and the Department of Homeland Security would be opposed.

Ask me how many fucks I give about law enforcement whinging about their civil rights.

It’s a Job Seekers Market, They SayPost + Comments (159)

Medical underwriting and non-vaccinated COVID cases

by | 8 Comments

This post is in: ,

Anonymous at Work asked a very interesting question in comments yesterday:

I wanted to ask about whether ACA, Medicare/caid, etc. can allow vaccination mandates or treat vaccination as an unhealthy habit akin to smoking for purposes of coverage denial and pricing.  To what extent is that possible under existing law, vs. needing a new law passed?

Damn good question.

The short answer is NOT REALLY FOR GOVERNMENT PROGRAMS.

Now let’s get to the longer answer.

The Affordable Care Act regulated insurance markets (individual Qualifying Health Plans (QHPs)) and fully insured small group have limited community rated, guaranteed issued pricing policies.  This is a technical way of saying that with limited exceptions, insurers have to cover anyone who submits an application at the same rate.  The ACA does allow for different prices to be offered on a few categories: geography, age and smoking status.  Prices can vary for the same plan in different parts of a state.  Prices can vary by up to three to one for 64 year olds relative to 21 year olds (this does interesting things to subsidized pricing) and prices can increase by up to 50% for people who attest that they are smokers.  The smoking penalty can not be paid for by federal subsidies.  Insurers are not obligated to charge a smoker surcharge  and if they do charge smokers more, the surcharge varies a lot.

The ACA does not allow for the exclusion of individuals on the basis of medical history.  Not being vaccinated against a potentially expensive and deadly infectious disease is part of a person’s medical history.  It is unlikely to be a wise decision but it is a decision that should not change the availability of insurance or its price.

Medicare, Medicaid and CHIP can’t deny coverage for pre-existing conditions or medical history.    Medicare supplemental coverage may be underwritten if it is purchased outside of the initial open enrollment period so this individuals on Medicare could see some incremental cost based on the lack of a vaccine in the future.  New legislation would be needed to impose vaccine history as a ratable factor for government programs. I have no idea how to get to 218-51-1 much less 218-51-1-5 to add vaccine history as a ratable factor.

Now, let’s talk about where it gets messy.

Individual insurance that is not regulated by the ACA is the Wild West.  Anything goes.  Underwriting happens.  Insurers could legally and quite conceivably decide to either deny coverage or increase premiums on the basis of vaccine history.  This means short term limited duration plans, Farm Bureau “we’re not insurance but we act like it” plans and Cost Sharing Ministries can YOLO their rates and coverage.

Now onto the ERISA regulated group markets of self-insured employers that use insurers for administrative functions there is a lot of wiggle room through the concept of a wellness program.  ERISA regulated plans have to offer community rating and guaranteed issue for similarly situated employees.  However there is a huge loophole.  Wellness programs can significantly change benefits and premiums.  Katie Keith at the Health Affairs Blog has more:

Wellness programs were initially authorized by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  HIPAA prohibited group health plans from determining eligibility or varying premiums based on health status. However, HIPAA regulations allowed premium discounts or rebates or cost-sharing modifications as incentives for participation in a wellness program that met certain requirements. HHS and the Departments of Labor and Treasury published final HIPAA wellness program rules in 2006, allowing wellness incentives to be tied to employees actually meeting specific biometric targets (such as losing weight or lowering your blood pressure). Under the 2006 rules, these incentives could be as high as 20 percent of the cost of group coverage. 

Those regulations became the basis for the ACA’s wellness program requirements, which offer a narrow exception to the ACA’s general prohibition on health status underwriting. These requirements are laid out in Section 2705 of the Public Health Service Act. Under Section 2705, employers must meet certain requirements to offer a wellness program that grants rewards or imposes surcharges based on an enrollee’s medical condition.

The ACA allowed health-contingent wellness incentives to be as high as 30 percent of the cost of coverage (up from 20 percent under HIPAA); federal regulators can increase this ceiling to 50 percent if they determine that such an increase is appropriate. 

I could see a large group employer start a wellness program where the absence of a large amount of neutralizing titers for COVID-19 would lead to a 30% premium surcharge.  I would not want to work in their HR or Comms department, but this is a perfectly plausible vehicle for uprating premiums based on medical history.

 

 

Medical underwriting and non-vaccinated COVID casesPost + Comments (8)