Christmas light show

I enjoy and am amazed by Christmas light shows and this one from 2010 is wonderful:

Holdman Christmas Lights

Merry Christmas, everyone.

Slow Cooker Bourbon Breast of Chicken

This is not a Christmas or New Year or holiday recipe in any traditional sense; the only holiday-ish thing about it is the bourbon. However, it is a wonderful recipe to put together before heading out to lunch and a day of shopping or gift returning - or any afternoon activity. I only found a couple of references to it on the Internet (a little different from my version) which really surprised me because we love it.

I was told this recipe originally appeared - in some version - in Crock Cookery by Mike Roy (Ward Ritchie Press, 1975) but I can’t swear to that.

I make the recipe as is for 2 chicken breasts to yield a lot of sauce. When I make this with 4 chicken breasts, I double all the sauce ingredients (from onion on down), but don’t use all the liquid from the tomatoes/mushrooms - it’s too watery.

Slow Cooker Bourbon Breast of Chicken

Ingredients:

4 chicken breast halves, skinless
2 Tablespoons oil (I use olive oil)

1/4 cup flour
1/2 teaspoon paprika
1 teaspoon salt

2 tablespoons chopped onion
2 tablespoons chopped fresh parsley (or 2 teaspoons dried)
1/4 teaspoon dried chervil (or substitute 1/4 teaspoon of dried parsley)

One 4-oz. can mushrooms, undrained
One 10-oz. can tomatoes (I can’t find this size can so I use about 2/3 of a 15 ounce can; the whole 15 ounces is too much for this recipe)
1/8 teaspoon Lawry's Season Salt
1 teaspoon salt
1/4 teaspoon pepper
1/4 cup bourbon

Directions:

Heat oil in skillet.

Mix flour, paprika, and 1 teaspoon salt in brown paper bag.

Add chicken breasts one at a time and shake to coat breast with flour mixture.

(You can also mix flour, paprika, and salt on a plate or in a wide bowl and dredge the chicken.)

Saute chicken breasts on both sides until lightly browned (about 5-6 minutes per side).

Remove chicken breasts to slow cooker.

Add onion, parsley, and chervil to skillet and cook for just a minute or two. Turn off heat under skillet.

Add tomatoes, mushrooms, Season Salt, 1 teaspoon salt, and pepper to skillet. Stir to scrape up brown bits.

Stir bourbon into skillet.

Pour skillet contents over chicken in slow cooker.

Cook at low for 6 to 7 hours.

Serve over noodles.

Define "overpaid" - or "underpaid" for that matter

This is an about an old proposal to let consumers buy health insurance directly from insurers and let the insurers estimate the appropriate subsidies. Whether something like this is still on the table, I don’t know but I suspect some variant of it is probably in the mix somewhere, ready to be re-considered if January 1 arrives with millions of formerly insured still left uninsured.

Here’s how the Washington Post described this proposal when it was first floated:

On their own, insurers can help consumers through almost the entire enrollment process, but they need to rely on the federal online system for people to enter their incomes and find out whether the government will pay for part of their health plan. Since the enrollment period began Oct. 1, insurers have not had access to that feature — and, as a result, some have a lineup of potential customers unable to choose a plan and complete their purchase.

Part of the discussions lately between insurers and administration officials has been about what to do if that function is not fixed soon. One idea circulated within the insurance industry would be for HHS to approve a method to estimate subsidies and give preliminary tax credits based on those estimates — with the accurate amount determined later, once the system works better.

According to several people familiar with these conversations, insurance industry leaders have said that they would insist on a guarantee that they would be compensated for any underpayments — and that they have asked to keep any overpayments. Said one health-care consultant who is knowledgeable about insurance exchanges and who has been in touch with administration officials: “The concern is: Who bears the risk?”

Here’s how that plan from the Washington Post story was interpreted by Peter Suderman at Reason:

So the insurers have suggested a temporary measure: Let the insurers estimate the subsidies on their own. Any estimates that are too low would be reimbursable, and any estimates that are too high, the insurers would get to keep. In other words, the federal government, backed by taxpayers, would be on the hook for their bad estimates.

Can this possibly be legal? Can the administration seriously be considering this idea, which is potentially costly and politically disastrous? Imagine how Democrats will feel about turning over the central operations of the health law to insurers. Imagine how Republicans will react to a plan that could cost more, and will serve as an implicit admission that the exchanges simply won’t work without a major overhaul.

This doesn’t make sense to me, not because it seems like an insane idea but because both the Washington Post story and the Suderman take on it imply that somehow the insurance companies are going to end up being overpaid for the health insurance policies they provide. There’s no way that can happen.

Let’s say I want to buy a particular health insurance policy from Acme Insurance. Whether I buy that policy directly from Acme or buy it through the HealthCare.gov website, the premium Acme charges for the policy will cost the same; let’s say $500 per month. Now let’s say the HealthCare.gov website remains difficult and/or untrustworthy so the Obama Administration decides insurance companies can calculate the probable subsidy for someone buying a policy directly from them.

I promptly give up on trying to buy a policy through HealthCare.gov and buy one directly from Acme. I tell them my income information, they run it through their subsidy calculator, and they decide I should get a $250 per month premium subsidy. They bill me for $250 for my first month’s premium; I pay them. They bill the Federal government for the other $250 for that first month’s premium; the Feds pay them. Acme has now received $500 for my first month’s premium so I’m all paid up. The same thing happens for the second month of my health insurance contract, the third month, the fourth month. Then, finally, HealthCare.gov is working correctly. The insurers and the Feds begin the process of running people like me through the website to be sure everything has been calculated correctly.

First scenario: When the Feds check on my subsidy, they discover it has been calculated incorrectly. Rather than being subsidized to the tune of $250 each month, I should have been subsidized $300 each month. I’ve paid $200 more for my insurance than I should have and the Feds have paid $200 less for my insurance than they should have. However, Acme has not been either overpaid or underpaid; they’ve received exactly the $2000 they were due for my four months of insurance coverage. The needed adjustment is between me and the Federal government: the Feds owe me - not Acme - $200.

Second scenario: The incorrect calculation was in the other direction; rather then being subsidized to the tune of $250 each month, I should have been subsidized only $200 each month. I’ve paid $200 less for my insurance than I should have and the Feds have paid $200 more for my insurance than they should have. Once again, however, Acme has not been either overpaid or underpaid; they have still received exactly the $2000 they were due for my four months of insurance coverage. And, once again, the needed adjustment is between me and the Federal government: under this scenario I owe the Feds - not Acme - $200.

What about going forward once the error in the subsidy calculation is discovered, for the fifth, sixth, etc., months of my policy? What should happen under the first scenario is that Acme should start billing me for $200 each month and billing the Federal government for $300 each month; in other words, my monthly bill should go down by $50 each month. Under the second scenario, Acme should start billing me $300 and the Federal government $200 each month; in other words, my monthly bill should go up by $50 each month.

Neither the first or the second scenario results in Acme Insurance being overpaid or underpaid; Acme always gets the $500 monthly premium amount, no more, no less. There are no “underpayments” for it to be “compensated for” and there are no “overpayments” for it to “keep”. So what were the insurance companies asking for?

My guess is that they did not want to be in the middle of any adjustments that should be taking place between a policy holder and the Federal government. In my first scenario, where I’ve overpaid by $200, I imagine the insurers were unwilling to refund that $200 to me and then bill the Feds for it; they probably wanted the Feds to reimburse me directly. While this scenario doesn’t involve a lot of financial risk for the insurers, it does involve what is essentially a cash flow delay: they would have been paid “late” for $200 worth of premiums.

When a policy holder has gotten a larger subsidy than he should have, things can get really ugly. So in the second scenario, where I underpaid by $200, I can’t imagine the insurers would have been willing to give the Feds back the $200 over-subsidy and then try to get that money from me. This involves a huge financial risk for them as well as a huge public relations risk. If the Feds want that money back, the insurers would insist the government go after it directly.

I also wonder if the insurers wanted any over-subsidization to continue even after HealthCare.gov was straightened out and correct subsidies could be calculated. While the insurers would be delighted to tell the me from the first scenario that my monthly premium would drop by $50 a month, I’m sure they would resist strongly telling the me from the second scenario that my monthly premium was going to increase by $50 a month. So I imagine they asked that policy holders who were under-subsidized start receiving the correct (larger) subsidy while those who were over-subsidized continue to receive the incorrect (larger) subsidy.

I don’t think any of this is out of line for the insurance companies to ask for - there’s no reason they should bear the financial and public relations risk for the government’s incompetence - or insane for the government to consider - desperate times call for desperate measures. And, contrary to what the Washington Post article and the Suderman post seem to imply, there is no way an insurance company would end up overpaid for a particular policy. The premium amount is the premium amount, wherever the premium payment comes from.

There is, however, a danger in this that Megan McArdle notes as follows:

The potential abuses are obvious; the insurer with the most erroneous subsidy calculator gets all the business!

Well, yes. If Acme Insurance tells me I qualify for a $250 subsidy and Xenon Insurance tells me I qualify for a $400 subsidy, I’m buying from Xenon - and so is everybody else. Xenon isn’t going to make any more per policy than they would without this kind of plan but they will sell a lot more policies. Of course, there is a simple fix for this danger: whatever method HHS approves for quick and dirty subsidy calculations must be the same for all insurance companies in a State. Just one more little task for the State’s insurance commissioners.

As I said, this is an old proposal and appears to be dead in the water. I wanted to walk through it, however, because that’s how I clarify my thinking about topics and especially about the tangle that is ObamaCare. In particular, I believe it’s important to think carefully about the relationships among the Federal government, the insurers, and the policy holders. Despite the appearance that there are two bilateral relationships - Federal government with insurers and insurers with policy holders - the fact is that the relationship between the Federal government and policy holders is quite real and quite important. When the Federal government subsidizes a policy holder’s purchase of a health insurance policy, the government is not giving money to the insurer; the government is giving money to the policy holder.

The other ObamaCare orphans

My posts about ObamaCare have focused on those who have health insurance now but will lose their current plans as a result of the implementation of the Affordable Care Act. They are (we are) people who have gone along, taking care of our insurance needs, and are now getting a raw deal.

However, there is also another group of people who are getting a raw deal from the structure and implementation of ObamaCare: the people who have not been able to afford or not been able to get health insurance, and who were promised they would be able to get it as of January 1, 2014. It’s easy to say that they won’t miss what they’ve never had but I can imagine the worry, frustration, and heartbreak of those who are ill or, worse, have sick children; thought they would finally be able to get health insurance; and are now discovering they can’t afford the premiums or can’t afford the deductibles or simply can’t get through the websites to discover what’s available to them. And even those among them who don’t have illness in their family but believed the time was coming when they didn’t have to lie awake at night terrified that one of their kids would fall ill, must be bitterly disappointed.

This was all so unnecessary. There are many, many ways to help those who can’t afford health care. Ways that don’t require a huge, complex government mechanism; that don’t require a competent Administration; that would spend money on getting people health insurance - and health care - rather than on websites and administrative overhead. Ways to help that would actually help those who need it rather than serving the goals and ambitions of politicians and bureaucrats and ideologues

For the government to have made so many people’s lives worse is unforgivable. But for the government to have made promises it must have known it couldn’t keep to the most vulnerable among us is shameful.

Clear as mud

According to Sarah Kliff at the Washington Post’s Wonkblog, “Obamacare’s deadlines are changing. Again.” :

With deadlines fast approaching and some HealthCare.gov shoppers still stuck, the Obama administration is proposing new ways to guarantee coverage to those hoping to gain insurance in January.

Health and Human Services announced Thursday some additional flexibility for those still hoping to buy coverage -- and many more steps that the agency urged, but did not require, health insurers to take.

Here’s the stuff that the Administration is doing unilaterally:

1) People will still have to enroll by December 23, 2013, to have coverage as of January 1, 2014, but they can delay paying their first month’s premium until December 31, 2013.

2) The high-risk pools established by ObamaCare, which were due to end as of December 31, 2013, will stay open until January 31, 2014.

Here’s the stuff that the Administration is urging (or “encouraging”) health insurers to do:

1) Allow people who sign up for coverage after the December 23 deadline to still start coverage on January 1. It’s not clear how late the Administration would like people to be able to sign up for coverage that begins January 1.

2) Allow people to pay for policies that start January 1 after the first of the month. It’s not clear how late the Administration would like people to be able to pay for coverage that begins January 1.

3) Keep paying to refill prescriptions that were covered under a previous policy.

4) “Charge patients’ visits for acute conditions to out-of-network doctors as if the physician were part of the health plan.”

Here’s my take on these actions and urgings:

1) The Obama Administration is now flailing around like a sign-language interpreter in the midst of a schizophrenic episode.

2) Somehow, someway the Obama Administration must be planning to compensate insurers (and/or medical providers) for the losses they could and almost certainly will suffer based on all this. Let’s say I enroll in an ObamaCare Platinum plan and write a check for my first premium on December 31. The check bounces but by the time it’s bounced, I’ve seen 10 doctors and filled 20 prescriptions. The insurance company isn’t going to pay. Do the doctors and pharmacies just eat the loss? Are they going to come after me? I’m the one who just wrote a hot check, remember?

Or let’s say the company writing my ObamaCare plan gives me until January 8 to pay my first premium. I can get some serious surgery done in a week and then just never write the check. Who’s going to pay for that?

Or let’s say the Administration wants people to be able to enroll in policies starting January 1 up until January 8. Maybe I wasn’t going to enroll at all or maybe I planned on getting a Bronze policy but on January 2 a doctor tells me I have a serious or chronic condition. It’s Platinum all the way for me. The insurance company is going to eat that one and never even know they’ve done so.

3) I don’t understand how paying to refill prescriptions that were covered under a previous policy is going to work. I’m assuming this is only for people who have insurance now but lose it on January 1 and haven’t signed up for other coverage. So how long is this grace period going to last and what happens if the person whose prescriptions are being covered never signs up for insurance at all or signs up with a company other than the one that’s been footing the bills for his or her prescriptions?

And what if I have obtained new coverage but my old insurance policy gave me a better deal on my prescriptions? If my new policy is with a different insurer, what’s to stop me from just not telling my pharmacy or my old insurance company that I have new coverage and continuing to get my prescriptions filled by my older, more generous insurer for as long as I can get away with that?

4) I really, really don’t understand how this is going to work:

Charge patients’ visits for acute conditions to out-of-network doctors as if the physician were part of the health plan.

Let’s say I go see Doctor Adams. He’s in network for my insurer, Acme Insurance. This means he’s agreed that he will charge only as much as Acme allows for the medical treatment he provides. For the sake of this example, we’ll say Acme allows $45 for an office visit and I have a $30 copay. That means Doctor Adams will charge me $30 for an office visit and bill Acme for the remaining $15. So far, so good.

Now let’s say I go see Doctor Baker. She is not in network for Acme Insurance. This means Doctor Baker is free to charge whatever she wants for an office visit. Assume she charges $120 for such a visit. Doctor Baker is not going to take just $30 from me; she’s going to want the whole $120. Is the Administration suggesting that I should be able to pay just $30 and Acme will pay Doctor Baker the remaining $90 she charges? If so, and I were Acme (or Doctor Adams for that matter), I would be just a wee bit upset.

Or is the Administration suggesting that Doctor Baker should take the $30 from me and the $15 from Acme and write off the remaining $75? If so, I have a king-size picture of that.


The damage done to real, live people by ObamaCare is painful and enraging to watch. At the same time, the cascading fiascos and the scrambling responses provide a textbook lesson in how health insurance functions. It also makes crystal clear that the people who wrote ObamaCare, implemented it, and are trying so desperately to keep it afloat, know very little about health insurance and understand even less.

Unforgivable

The ACA Death Spiral blog:

... if 2 million obtain insurance through the Exchanges but more people (3.5 million is a prevailing estimate from sources ranging from Forbes to Jonathan Gruber) lose their current individual health insurance, that’s a net decrease in the number of insured.  And if we add in the loss of 100,000 or so people from the Pre-Existing Condition Insurance Plan that likewise is terminated or those who heretofore were in various state high risk pools, there is a serious risk that the Affordable Care Act will have decreased the number with private health insurance. [snip]

... it may well be that for every such success story apparently to be catalogued by paid grants from the government, there is another who had health insurance tailored to their needs (such as policies for the 50 and over set that did not cover maternity expenses) who now find themselves priced out of the health insurance market with its Essential Health Benefits requirement (section 1302 of the ACA).

Ace of Spades:

Just about 1.2 million people have gained health coverage through Obamacare, according to new federal data released Wednesday morning. Approximately 365,000 of those people have purchased private insurance and 803,000 have been determined to be eligible for the public Medicaid program.

1- At least 5 million people have lost coverage due to policies being cancelled thanks to ObamaCare. So that 365,000 number is insignificant compared to that. There will no doubt be more uninsured on January 1 than there were on October 1. Don't let them get away with pretending "1.2 million people who didn't have insurance have it now!".

Liberals will point to the new "enrollments" (and assume they will pay and become actual customers) while ignoring the previously uninsured who won't get coverage in time or be able to afford the new rates and deductibles.

The are simply redistributing health insurance from those who paid for it to those who didn't. This is a victory in their minds.

Sarah Kliff at the Washington Post’s Wonkblog:

These are Obamacare's biggest losers: People whose current plans have been canceled but who are having trouble getting through HealthCare.Gov to purchase coverage by Dec. 23 -- the deadline for buying insurance that begins Jan. 1.

The concern is particularly acute for patients with expensive medical conditions, who rely on their coverage for doctor visits and drug refills that would otherwise break the bank. [snip]

Those facing a potential coverage gap include an estimated 15 million people who purchase coverage for themselves on the individual market, many of whom received cancellation notices because their policies did not meet health-care law requirements.

Megan McArdle:

That means that in theory, almost 10 percent of the population of Vermont needs to sign up for insurance in the first three weeks of December, just to avoid losing coverage. Fortunately, Vermont is a small state, so that’s a small number -- fewer than 60,000 people. The bad news is that Vermont’s exchanges haven’t been working too well. The governor has belatedly unveiled contingency plans: Individuals can extend their 2013 coverage for three months, and small businesses can sign up directly with a carrier. So hopefully, most people won’t actually lose coverage. Nonetheless, for the state of Vermont, 2.5 percent of its population signed up represents a disastrous failure, not a roaring success. That figure means the state hasn’t even managed to sign up the people who already had insurance, much less cover anyone new. And if it can’t get things working better by March, when those temporary renewals expire, then Green Mountain Care will have resulted in a net loss of insurance coverage for the state.

ObamaCare orphans

Scott Gottlieb of the American Enterprise Institute is looking at people who lost their current insurance plans and either can’t afford ObamaCare plans or are getting worse coverage from ObamaCare plans or can’t get through the web portals to buy subsidized insurance. He suggests they be allowed to buy into the Federal Employees Health Benefits Program (FEHBP).

Brilliant idea. Just like it was when Bill Bradley came up with it fourteen years ago (although he made it way too complicated). Just like it was when I blogged about it more than four years ago. And again almost exactly four years ago when “Senate Democrats” started thinking about basing health insurance reform on the FEHBP.

Don’t get me wrong - I’m not claiming any particular intelligence in writing about this a few years ago. The instant Congressmen and Congresswomen started talking about exchanges, levels of coverage, and making sure health insurance plans are “adequate”, anyone with half a brain should have realized all that was already in place in the FEHBP. It’s kind of like re-using code when programming. If I knew I already had a program that, say, calculated profit/loss for one set of traders, how stupid would I have to be to write another program, from scratch, to do the same thing for a different set of traders? Hint: pretty darn stupid.

However, Mr. Gottlieb does seem to have missed some steps in his proposal. First, you can’t just dump ObamaCare orphans (a term I love) into the FEHBP; they have to go into a separate risk pool and that has a lot of ramifications. Mr. Gottlieb also doesn’t talk about whether his proposal includes any subsidies. It sounds like it doesn’t since he talks about using pre-tax dollars to buy FEHBP policies. The lack of subsidies can be a sticking point and why do the orphans who buy into FEHBP get to use pre-tax dollars while those who buy or bought the metallics don’t? I understand Mr. Gottlieb is trying to come up with something we can do quickly to help the orphans but not thinking things through is part of what got us into this mess in the first place.

If we must have a national health insurance plan then piggybacking it on the FEHBP is far more desirable than ObamaCare. I’d love to see it happen before January 1 - I feel somewhere between furious and heartsick thinking about people who will have health insurance on December 31 and not have it on January 1. But anyone who is proposing we move to that in the next 20 days needs to think carefully about how this will work. We’ve already wrecked the individual health insurance market; I’d hate to see us wreck the Federal employee health insurance market as well.