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Obamacare Is A Disaster: Co-Op Insurers Across America Are Collapsing, And Now T


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2015 Oct 31, 9:30am   10,414 views  21 comments

by mell   ➕follow (9)   💰tip   ignore  

http://www.zerohedge.com/news/2015-10-30/obamacare-disaster-co-op-insurers-across-america-are-collapsing-and-now-there-fraud

Two weeks ago we reported that in what at the time was still a rather isolated incident, Colorado's largest nonprofit health insurer (aka co-op), Colorado HealthOP is abruptly shutting down, forcing 80,000 Coloradans to find a new insurer for 2016.

At the time, we said that the health insurer had been decertified by the Division of Insurance as an eligible insurance company because the cooperative relied on federal support, and federal authorities announced last month they wouldn't be able to pay most of what they owed in a program designed to help health insurance co-ops get established.

In other words, one of the 24 co-ops funded with Federal dollars and created to give more policyholders control over their insurers - especially those who wished to stay away from various corporate offerings, had failed simply because the government was unable to subsidize it: the same government that spends $35 billion in global economic "aid" but can't support its most important welfare program.

Fast forward to today, when we learn that another co-op, this time New York's Health Republic Insurance - the largest of the nonprofit cooperatives created under the Affordable Care Act - is not only shuttering, but was engaging in fraud.

The fate of Health Republic Insurance was first revealed a month ago when the WSJ reported it would shut down after suffering massive losses "in the latest sign of the financial pressures facing many insurers that participated in the law’s new marketplaces."

The insurer lost about $52.7 million in the first six months of this year, on top of a $77.5 million loss in 2014, according to regulatory filings. The move to wind down its operations was made jointly by officials from the federal Centers for Medicare & Medicaid Services; New York’s state insurance exchange, known as New York State of Health; and the New York State Department of Financial Services.

In a statement, Health Republic said it was “deeply disappointed” by the outcome, and pointed to “challenges placed on us by the structure of the CO-OP program.”

Health Republic has about 215,000 members, with about half holding individual plans and half under small-business coverage, a spokesman for the insurer said.
Today we learn that not only was this largest Co-op insolvent, it had also committed fraud. According to Politico, the collapsing insurance company that is creating headaches for hundreds of thousands of New Yorkers, misled state and federal officials about its finances, and will not be able to remain in business through the end of the year as originally hoped.

Because incompetence is one thing, but corruption: now that's real government work, right there.

The accelerated wind down is clearly a problem: the more than 200,000 customers insured with the co-op will lose their coverage Dec. 1, and must find a new plan by mid-November, according to the state and federal government. Health Republic insures about 20 percent of the state's individual market.

As Politico adds, the plan had been for Health Republic to make it through the end of the year. As recently as last week, company officials said there was enough in cash in reserve. But that apparently wasn't true.

Health Republic's finances are "substantially worse than the company previously reported in its filings," according to the state Department of Financial Services, which oversees insurance in New York, and the Centers for Medicare and Medicaid Services.
One wonders just how much of the over $100 million "lost" in under two years was due to incompetence, and how much due to pure embezzlement by the co-ops operators. Somehow we doubt we will find the anwer where this taxpayer money has gone.

This does, however, lead to a more serious question: the implosion of Health Republic is merely the latest in what has become an epidemic of governmental failure. In fact, there are a total of ten co-ops, all of which were created by the Affordable Care Act and seeded with billions in federal funding, that have now failed, leading to questions whether the entire business model underpinning Obamacare is unsustainanble for everyone but a select few corporations.

For some more thoughts on this disturbing, if perfectly predictable epidemic, we go to Forbes' Edmund Haislmaier who answers "Why Obamacare Co-Ops are failing at a rate of nearly 50%"

Cooperative health insurers (or co-ops) created under a federal grant and loan program in the Affordable Care Act seem to be falling like dominoes.

It started in February, when CoOportunity Health, which operated in Iowa and Nebraska, was ordered into liquidation. In July, Louisiana’s insurance department announced it was shuttering that state’s co-op. The following month brought news that Nevada’s co-op would also close. On September 25, New York ordered the shutdown of Health Republic Insurance of New York, which had the largest enrollment of all of the co-ops. Then, within the space of a week in mid-October, the number of failures doubled from four to eight, as state insurance regulators announced that they were closing the co-ops in Kentucky, Tennessee, Colorado, and one of the two in Oregon. Last week came news that South Carolina’s co-op will be closed, followed this week by the announcement that Utah’s co-op is also being shut down.

In sum, of the 24 Obamacare co-ops funded with federal tax dollars, one (Vermont’s) never got approval to sell coverage, a second (CoOportunity) has already been wound down, and nine more will terminate at the end of this year.

So what is behind this, so far, 46 percent failure rate?

To start with, the program was a congressional exercise in not merely reinventing the wheel, but doing a bad job of it.

Far from being a new idea, member-owned insurance companies—called “mutual” insurers—have a long history. For instance, life insurer Northwestern Mutual has been in business for over 150 years. Health insurers organized as mutual companies include, among others, Blue Cross plans in 10 states. Indeed, one of them, Florida Blue, converted into a policyholder-owned mutual company just last year. If having more health insurers owned by their policyholders was the goal, then there was no need for federal government action.

On the other hand, if the goal was to increase competition by stimulating the creation of new health insurers, then the ACA’s co-op program was, like other parts of the legislation, badly designed.

* * *

The program offered federal loans and grants to startup insurers but required that they be non-profits, not have anyone affiliated with an existing health insurer on their boards, and not spend any of their federal funding on marketing.

Co-ops are also subject to another provision of the ACA requiring all health insurers to pay out in claims at least 80 percent of premium revenues, or refund the difference to policyholders. By law, insurers can retain no more than 20 percent , out of which they must fund sales and administrative costs before booking any remainder as free cash. That significantly constrains a non-profit carrier’s ability to accumulate capital needed for growth, as it can’t raise funds through equity or debt offerings.

As if that wasn’t daunting enough, the law also required co-ops to focus “substantially all” of their activities on offering health insurance in the individual and small group markets—just as other provisions of Obamacare were thoroughly disrupting those markets by imposing new rules on insurers and complicated new payment arrangements for many of their customers.

Given all of the foregoing, 10 co-ops failing within two years is less surprising than the fact that 23 of them actually got to market in the first place.
As we pointed out two weeks ago, following this avalanche of failures, it will merely force even more individuals into plans offered by corporations, who as a result of the failure of their co-op competitors will have even more pricing power and premium hiking leverage.

Which means that "sticker shockers" such as the one below kindly informing them their health insurance premiums are rising by 60% crushing any desire to splurge modest "gas savings" on discretionary purchases...... will only get worse, as the premium increase even more with every passing year, as more Co-Ops fail, as more of the publicly-held insurers merge, and as a single-payer system, one which benefits not taxpayers but a select handful of shareholders, becomes the norm.

Haislmaier's take: "The bottom line: Obamacare has made health insurance costlier and the business of offering it riskier. To survive in that new world, health insurers need to be cautious, or even pessimistic, and hope that their customers can continue to pay escalating premiums. It’s not a pretty picture."

It isn't but what are customers going to do: after all the "Affordable Care Act" is a tax (one which "boosts" GDP every quarter no less) and you must pay it by law; sadly the Supreme Court forgot that when it makes a service mandatory, corporations can charge any price they want.

And that's precisely what they are doing.

#politics

Comments 1 - 21 of 21        Search these comments

1   Tenpoundbass   2015 Oct 31, 9:59am  

mell says

Obamacare Is A Disaster

No one was ever allowed to say that until July 15th of this year.

2   Tenpoundbass   2015 Oct 31, 1:22pm  

Here's the thing the premium raises this year, are even greater than the Obamatax.

Stupid Motherfuckers to the 1000th power.

This was all just a scam to extract money from those that know damn well will be too smart to pay for this. And wont have the same gripe as everyone about the inedequate cheatcare, because

My brother was in the hospital for about 3 days, he is insured. He got a bill for $7K that he has to pay out of pocket.
My neighbor accross the street had a heart attack they cracked his chest open put in a stent, sewed him up and threw him out onto the steet, all within 18 hours.

HIs bill as an uninsured indigent? Just a measly $10K
He would have paid more than that in insurance premiums for a year.

3   HEY YOU   2015 Oct 31, 5:03pm  

When ACA is gone,does that mean everyone can afford private insurance?

4   Tenpoundbass   2015 Oct 31, 5:20pm  

No it means next time it will be for real. A honest goodness Government ran Health and Medschool system.
People will say "Yeah well we tried that..."
The Next time these Cock suckers tries to sell us a Wallstreet Monopoly ran healthcare. Or any variation that gets us there.
National Healthcare and profits just don't mix.

There's too much at stake to just leave it up to the system we've become. From the Education that no modest income family can afford tuition for, to the Hospitals that bill using a blind seasonal menu, to the ghost Doctors that you never saw, but end up billing you, to the Collection agencies that can threaten you with Jail, to the run away premiums, to the 10's of the thousands of dollars that you're responsible for before you EVEN begin to claim. "Phew!!! alright! If anything happens now I'm fully coverd. Now that I've paid $20K out of my pocket already this year..."

You know what? When ACA is gone the insulting assult on our inteligence is gone.

If you get sick, you'll manage and make do. God you'll make do trust me. That's all Obamacare is already is just... "You better manage" care.

If you get sick, you better manage to have thousands to cover anything bigger than a bandaid.

5   indigenous   2015 Oct 31, 5:25pm  

I was talking to someone the other day saying that his premium for his family was going from $500 a month to $1500 a month.

6   zzyzzx   2015 Oct 31, 5:58pm  

It's all Obama's fault!!!

7   Tenpoundbass   2015 Oct 31, 6:14pm  

No Gruber was right it's the voters fault.

8   indigenous   2015 Oct 31, 8:17pm  

Not to mention how that is no longer going to be a non taxable benefit.

9   HEY YOU   2015 Nov 1, 10:38am  

ACA,just another big govt. program to benefit Rep/Con/Teas because they are entrepreneurial failures that can't pay cash for their loved ones healthcare.

10   Rin   2015 Nov 3, 4:59pm  

This is simple, have STEM PhDs and postdocs deliver health care, instead of working in their labs and fire the executives at both the hospitals and insurers ... prices across the board will drop like a rock.

11   MMR   2015 Nov 3, 7:31pm  

Rin says

This is simple, have STEM PhDs and postdocs deliver health care, instead of working in their labs and fire the executives at both the hospitals and insurers ... prices across the board will drop like a rock

Some people complain that docs make too much, but the reality is:

This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.

http://economix.blogs.nytimes.com/2008/11/14/do-doctors-salaries-drive-up-health-care-costs/?_r=0Rin says

fire the executives at both the hospitals and insurer

these are the a-holes that always want to reduce doctor compensation while trying to get the general public to ignore the elephant in the room.

12   MMR   2015 Nov 3, 7:36pm  

DieBankOfAmericaPhukkingDie says

counter-jihadi rituals of desperation.

What effect would that have on the number of jihadists in this country? Jihadi rituals that don't kill jihadists are a missed opportunity

HEY YOU says

ACA,just another big govt. program

a failed government program that hopefully leads to single payer and free med school like all the other countries that have better healthcare metrics than the US. I don't see healthcare costs going down...I don't see executive compensation in the healthcare sector or health insurance sector going down

13   lostand confused   2015 Nov 3, 7:38pm  

Wait till next year, when 25% of the working populace is hit by a 40% tax and companies make drastic changes in pay/benefits to come under the tax limits. Lets see if the dem supporters finally wake up.

14   MMR   2015 Nov 3, 7:55pm  

HEY YOU says

When ACA is gone,does that mean everyone can afford private insurance

only chance is if the anti-competitive barriers are removed and people could actually purchase health insurance like car insurance and also if health insurance status isn't tied to employment.

Lot of the states that expanded medicaid have far higher percentages of uninsured after ACA than before because . More than three million people in 19 states remain stuck in a “Medicaid gap,” too poor to qualify for subsidies in the new marketplaces, but unable to get into a government program.

The rate of uninsured went up dramatically in the southwest in states that expanded medicaid from 2014-2015. California, Nevada, Utah, Arizona, New Mexico, Colorado, Texas, Oklahoma, Missouri, South Dakota and Montana all went downhill. Texas, Oklahoma and Montana did not expand medicare though.

All the southern states that didn't expand medicaid didn't see a noticeable difference from 2014 to 2015.

Mid-atlantic and Northeast states seem to have done the best in getting the uninsured levels down, as well as the midwest

http://www.nytimes.com/interactive/2015/10/31/upshot/who-still-doesnt-have-health-insurance-obamacare.html

15   Indiana Jones   2015 Nov 3, 8:31pm  

mell says

the Supreme Court forgot that when it makes a service mandatory, corporations can charge any price they want.

Correction: The Supreme Court did not "forget" anything. This theft is completely intentional.

16   curious2   2015 Nov 4, 12:31pm  

Indiana Jones says

mell says

the Supreme Court forgot that when it makes a service mandatory, corporations can charge any price they want.

Correction: The Supreme Court did not "forget" anything. This theft is completely intentional.

Yes, and the legislation is operating as designed.

mell says

In sum, of the 24 Obamacare co-ops funded with federal tax dollars, one (Vermont’s) never got approval to sell coverage, a second (CoOportunity) has already been wound down, and nine more will terminate at the end of this year.

So what is behind this, so far, 46 percent failure rate?

It was by design, to promote proseletyzing for the new Cult of Obamneycare. Co-op evangelists who co-opted liberals on behalf of the legislation "were the ones hitting the streets and talking about the value of coverage and getting people insured. And in some ways, we were a very cheap way to be able to do that." In their naive idealism, the co-op evangelists failed to see through the legislation, and failed to game the system. With the legislation enacted and operating, the co-ops can now be liquidated.

mell says

ACA requiring all health insurers to pay out in claims at least 80 percent of premium revenues, or refund the difference to policyholders. By law, insurers can retain no more than 20 percent , out of which they must fund sales and administrative costs before booking any remainder as free cash. That significantly constrains a non-profit carrier’s ability to accumulate capital needed for growth, as it can’t raise funds through equity or debt offerings.

NO NO NO NO NO!!!!! I keep dispelling this ignorant myth and it keeps returning. As creationism is to Old Tyme Religion, the MLR accounting tool is to the Cult of Obamneycare. People seem allergic to math, but I promise the arithmetic is very simple and clear. Consider a "non-profit" HMO like, well, let's not call it Kaiser HMO, let's call it Fuhrer HMO. (OK, Godwin's Law: it was inevitable.)

1) Hypothetical Fuhrer HMO is "non-profit" so it pays no tax. It charges $5,000/year premiums.
2) Fuhrer HMO operates a "non-profit" hospital, which pays no tax because it is "non-profit."
3) Fuhrer Hospital rents space to Fuhrer C-T Scanning Lab Inc., an expressly for profit corporation.
4) As many patients as possible who are brought to Fuhrer Hospital are C-T scanned as often as possible.
5) Fuhrer C-T Scanning Lab Inc. charges $5,000 per scan, of which more than $4,900 consists of profit.
6) Fuhrer C-T Scanning Lab Inc. is free to "donate" any part of the $4,900 to Fuhrer's "non-profit" marketing partner, the Fuhrer Family Foundation.
7) Fuhrer Family Foundation pays commercial "news" to publicize push polls and phony studies touting purported benefits of making its revenue model mandatory.
8) If Fuhrer HMO books a "loss," it can claim reimbursement from the Obamneycare "risk corridor" fund, even while the scam continues making huge profits.

As you can see, even one C-T scan at $5k consumes 100% of the annual premium. Anything else is in addition: the 10,000% markup on everything. There is no limit to the profits that can be wrung from the legislation under this system. "No lifetime caps." And, the same applies on the for-profit corporate side: substitute XYZ corp as the parent company, with subsidiaries XY Insurance Corp, YZ hospital Corp, and XZ Scanning Lab; move money from one subsidiary to the others, and book reimbursible "losses" on the insurance side while making profits on the provider sides.

Notice also, the C-T scan may provide no medical benefit; even when the radiation makes the patient worse off with no health benefit, it's covered. And, the C-T scan is only one example, among many.

I read with sadness the NY Times article on a Tea Party Republican winning the Kentucky Governor's race, becoming only the second Republican governor of Kentucky in more than 40 years. He is terrible, even posed with Kim Davis, but he had one crucial advantage: like most voters, he opposed Obamneycare. Kentucky voters saw that the legislation was doing the opposite of what supporters had promised; premiums were increasing, etc. (IOW, they saw it was operating as designed, not as advertised.) What made me most sad was the comments: instead of acknowledging the numbers and facts, the Obamneycare cultists became enraged, even wrathful, vowing that the Kentucky voters would be punished for opposing the sacred legislation, and saying those evil voters deserve their dreadful fate.

Honestly, the Obamneycare cultists sounded like Old Tyme "young earth" Fundamentalists when confronted with proof of evolution, geology, or anything else their doctrine requires them to reject. This legislation has reduced the Democratic party to its lowest point in more than a century. And, when the numbers prove the opponents' predictions, the cultists don't reconsider: they become angry, vengeful, wrathful.

The 2016 election looks like a battle between Old Tyme Religious Fanatics and the New Cult of Obamneycare. Each faction favors its own myths, becoming more angry rather than reasoning together. The Democrats hope for a battle of the sexes, since most voters are women and might hopefully vote against the Old Tyme Religious restrictions that Republicans insist upon. (The GOP has become the party of Paul the Enforcer, rejecting even the original Christian disciples.) At best, voters might choose the lesser of two evils, the frying pan vs the fire, but if they jump instinctively out of the frying pan then gravity will pull us all into the fire.

17   EBGuy   2015 Nov 5, 11:37am  

Our small business got a rebate check this year.

18   MisdemeanorRebel   2015 Nov 5, 12:12pm  

Thank you Curious for that excellent post. It's something like how Florida Charter Schools work to generate R/E profits.

19   curious2   2015 Nov 5, 12:53pm  

EBGuy says

Our small business got a rebate check this year.

I believe you, but I also believe Roseanne when she recounts her tale of being miraculously "healed" of a temporary injury in childhood, causing her whole family to convert for a while to the Moronic cult.

If you add up what your business and the actual people covered by its medical insurance policy are paying per person (be sure to include premiums, copayments, deductibles, and stuff that isn't covered by the policy so the people had to pay out of pocket), you will almost certainly find that you are paying more, even after the rebate. Nationally, the numbers are very clear: premiums and total spending have continued to increase faster than inflation, and faster than GDP, contrary to certain politicians' assurances that the legislation would make "all of our premiums go down" and the average family would save $2,500/year. The rebate check is the cultists' version of Roseanne being miraculously faith healed: although on that day she got better, that doesn't mean she got a benefit from the cult.

20   indigenous   2015 Nov 5, 5:52pm  

thunderlips11 says

Thank you Curious for that excellent post. It's something like how Florida Charter Schools work to generate R/E profits.

Your new avatar is of an Israeli soldier, what up with dat?

21   MMR   2015 Nov 5, 7:30pm  

indigenous says

Florida Charter Schools work to generate R/E profits.

Wonder who is mostly responsible for that fine use of taxpayer dollars?

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