Look what Aetna sent out to their brokers! A road map for delaying the inevitable effective dates of the Affordable Care Act provisions in order to squeeze all of their ill-gotten gains to the very last drop.

Aetna Email to Insurance Brokers

Aetna is encouraging their brokers to go to clients and renew their existing policies with an off-calendar effective date in order to delay the minimum policy requirements, premium limitations and pre-existing conditions provisions which take effect on January 1, 2014 or the renewal date of the policy. By changing the policy year to something other than December 31st, insurers will delay the effective date to the renewal for the year beginning in 2014 and ending in 2015.

Of course, this won't affect their large corporate clients, but only small businesses and individuals. What a surprise! Even less of a surprise is the more-than-obvious effort to make sure everyone is angry, the economy is slagged because small employers are slammed with higher premiums than before, and just in time for the 2014 midterms, too!

Did I mention that they're going to load up the costs to those employers for benefits they're not providing?

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Dear Senior Citizens,

I know you think Glenn Beck is the new Jesus and the black guy in the Oval Office is a Muslim pretender, but for the love of all that's holy, turn off Fox News and pay attention.

That ad at the top of this post? They LIE. They are LYING TO YOU. Don't believe me? How about Politifact? Or if Politifact doesn't do it for you, how about your own pocketbooks?

Yes, your own pocketbooks. Because in addition to the donut hole closure, those of you who are enrolled in Medicare Advantage will see your premiums drop next year. That's right. Your premiums will go down in 2011.

Medicare officials said they had held down premiums and co-payments by negotiating with insurers, which sponsor the Medicare Advantage plans.

The law, signed by Mr. Obama in March, gave officials new power to negotiate and to reject bids, as they did in a few cases.

“We negotiated more aggressively than in the past,” said Jonathan D. Blum, deputy administrator of the Medicare agency. “As a result, some plans changed their bids to produce more value for beneficiaries.”

“On average,” Mr. Blum said, “Medicare Advantage premiums will be 1 percent lower in 2011 than today. Medicare Advantage plans project that enrollment will increase by 5 percent in 2011.”

Yes, you senior citizens claiming your Medicare is being "cut" need to quit listening to your heroes at Fox News and pay attention to facts. While the rest of us suck up big increases because we don't have the benefit of the federal government negotiating on our behalf, YOU and YOU ALONE will see your premiums go down.

I'd better not see you with a sign saying for government to keep their hands off your Medicare after this. That will make it very difficult for me to respect my elders.

Also, a question for the "repeal and replace" crowd. Who will explain why you want to take premium reductions away from seniors?

One would like to think that this will be interpreted in favor of the policyholders, but you never know, do you?

WASHINGTON — Millions of Americans could lose some important benefits of the new health overhaul law depending on how the Obama administration chooses to interpret one term: "grandfathered."

Under the law, existing, or "grandfathered" health plans are exempt from several consumer protections, including a requirement that beginning as early as September prohibits health plans from charging co-payments and other cost-sharing for certain preventive health services such as immunizations and cancer screenings.

The issue has touched off a debate over how grandfathering is defined, with some consumer and employer groups squaring off. Consumer groups say that if the definition is too lenient, many Americans won't get the full benefit of the law. Meanwhile, some business groups say that if their plans have to forfeit their grandfather status, they'll be subject to all the new rules that raise costs and premiums.

Congress included the grandfather provisions in the bill to give employers and insurers time to transition to the new law. The law is mostly vague, though, on exactly what constitutes a grandfathered plan. For example, does a plan lose its grandfather status if it increases employees' deductibles or changes prescription drug coverage? Plans that give up their grandfather status must abide by all the consumer protections in the new law.

Some state regulators are confused. "What's not clear to me is actually how we are going to define a grandfathered plan," said Beth Sammis, the acting insurance commissioner for Maryland.

The grandfathered plans are subject to some consumer protections in the bill, including a requirement that plans provide dependent coverage for children until age 26; a ban on pre-existing condition exclusions for children this year and everyone in 2014, and a prohibition on lifetime insurance limits. In addition, grandfathered health plans will be blocked from retroactively canceling coverage after a policyholder gets sick.

Grandfathered plans also will be exempt from some consumer protections, however, including one requirement that health plans cover certain treatments associated with clinical trials, and another that limits annual out-of-pocket costs. In addition, grandfathered plans won't have to meet new rules limiting how much premiums can vary based on age and tobacco use.

The Obama administration, which is writing the regulations that implement the new law, is expected to issue its guidance soon on how it interprets the grandfathering clause.

Clearly, passing this health-care bill is just the beginning, because it doesn't really contain strong regulatory powers. It was pulled under reconciliation rules, and Obama reportedly will try to introduce it later:

WASHINGTON -- A Democratic plan for new federal power over health insurance rates was dropped Thursday from the final health care bill, squeezed out by the way the Democrats are pushing the bill through Congress.

Rolled out with fanfare just weeks ago, the Democratic plan was a response to double-digit rate increases proposed by health insurance companies in California and elsewhere.

It was first proposed by Sen. Dianne Feinstein, D-Calif., then picked up by President Barack Obama.

It would have given the federal government the power to reject proposed rate increases. It also would have allowed the secretary of health and human services to order insurance companies to give back part of premiums if the government decided that the companies spent too much of their incomes on salaries or advertising.

Alan Grayson came to the House Floor today to introduce the Public Option Act, which would allow all Americans to buy into Medicare at cost. The bill is 4 pages long, and calls for an unsubsidized option for any American to choose Medicare over private insurers.

The bill would require the Secretary of Health and Human Services to establish enrollment periods, coverage guidelines, and premiums for the program. Because premiums would be equal to cost, the program would pay for itself.

“The government spent billions of dollars creating a Medicare network of providers that is only open to one-eighth of the population. That’s like saying, ‘Only people 65 and over can use federal highways.’ It is a waste of a very valuable resource and it is not fair. This idea is simple, it makes sense, and it deserves an up-or-down vote,” Congressman Grayson said.

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I can't say it's a surprise that congressional Republicans think it would be great to start over with health care, or that they're in favor of "incremental" changes. (I'd love to see them get "incremental" health surgery.)

And I can't say it's a surprise that they had virtually nothing useful to offer.

What I realized, though (and maybe this is the driving force behind Obama's puzzling, sometimes infuriating compromises) is that to many Republicans, their illogical fantasies are akin to a child's night terrors. We know there aren't any monsters under the bed, but your child doesn't. So you go through the motions of shooing the monsters away so your child can sleep.

We know that tort reform has such small influence on malpractice premiums that it's virtually meaningless. Any rational person who looks at the research knows this. What you have are a lot of people making what they claim are factual assertions that are nothing more than an intellectual construct to support their emotion-driven conclusion.

We know that selling insurance across state lines doesn't solve the health care crisis, either.

We know that the fastest increases in costly diseases are being driven by environmental pollutants and contaminants, so eating right and exercising doesn't solve the health care crisis, either.

But we're left with a Congress where roughly half of them believe their fairy tales. And since the ideological wars are driven by true believers, we simply don't have the time to convert each of them, one by one, to the realities we face.

Which is simply my long-winded way of saying that Harry Reid needs to shove good healthcare legislation through using reconciliation, right now. No more waiting.

People are dying, every single day. President Obama, we don't need any more to die while you patiently reassure the Republicans about the monsters under the bed.

Get. It. Done. NOW.

In October 2009, here's how Sen. Jay Rockefeller described the Medicare Advantage plans:

"It's a wasteful, inefficient program and always has been," Sen. John D. Rockefeller IV (D-W.Va.) said at a recent hearing. At its core, Rockefeller added, Medicare Advantage is "stuffing money into the pockets of private insurers, and it doesn't provide any better benefits to anybody."

Yes, the for-profit add-on plans the Republicans pushed through under Bush heavily subsidize services. (So much for "pay as you go," huh?)

A study released yesterday by a major consulting firm found that premiums for Medicare Advantage plans offering medical and prescription-drug coverage jumped 14.2 percent on average in 2010, after an increase of 5.2 percent the previous year. Some 8.5 million elderly and disabled Americans are in the plans, which provide more comprehensive coverage than traditional Medicare, often at lower cost.

Lee Durrwachter, a retired chemical engineer from Grand Marais, Mich., said his premiums more than doubled this year - even though he switched plans to try to save money. "It doesn't bode well," he said. "It's unaffordable."

The Medicare findings are bad news for President Obama and his health-care overhaul that is bogged down in Congress. That is because the higher Medicare Advantage premiums for 2010 followed a cut in government payments to the private plans last year. And the Democratic bills pending in Congress call for even more cuts, which are expected to force many seniors to drop out of what has been a rapidly growing alternative to traditional Medicare.

Republicans have seized on the Medicare Advantage cuts in their campaign to derail the health-care bills, and seniors are listening. Polls show seniors are more skeptical of the legislation than the public as a whole, even though Democrats would also reinforce original Medicare by improving preventive benefits and narrowing the prescription-coverage gap.

From McJoan at DK:

The Obama administration has already sent a sternly-worded letter to Anthem Blue Cross over the company's excessive rate increase for individual policy holders in California. How excessive? Up to 39 percent. But that's not all. Anthem Blue Cross and Blue Shield also informed their customers that they are changing their practice of adjusting rates annually, and as of now are reserving the right to raise premiums basically whenever they feel like it.

You got that? They want to do exactly what the credit card companies were doing.

There's little beyond sternly-worded letters that the administration can do, other than something like maybe advocating strongly for some kind of legislative remedy, say in the form of serious competition to private insurers in the form of a robust public option for health insurance. But there's something Congress can do, and that's put the insurers on the hot seat and investigate. From the Speaker's blog, The Gavel:

As Secretary Sebelius pointed out, WellPoint [parent company to Anthem Blue Cross/Blue Shield] reported a staggering $2,740,000,000 in profits for the fourth quarter of 2009 alone – eight times more than the last quarter of 2008 – and more than $4,750,000,000 for all of 2009. In fact, the company reaped these record profits even as it lost more than 1.4 million members.....

Today, Energy and Commerce Committee Chairman Henry Waxman and Subcommittee Chairman Bart Stupak announced that the Subcommittee on Oversight and Investigations will hold a hearing on February 24th regarding the premium rate increases.

The hearing, conveniently, will be held on February 24, the day before the bipartisan White House healthcare summit.

Watch the video - it's short, and it sums up why Krugman so often has a fresh perspective on issues, rather than an insular academic bent.

And speaking of, Krugman weighs in on the excise tax question in the healthcare reform bill, asking whether the tax-deductions for employer-provided health insurance should be limited:

The counter-arguments seem to run along three lines.

First, there’s the argument that many “Cadillac” plans aren’t really luxurious — they reflect genuinely high costs. That’s surely true. A flat dollar limit to tax deductibility has real problems. At the very least, the limit should reflect the same factors insurers will be allowed to take into account in setting premiums: age and region.

Second, there’s the argument that any reductions in premiums won’t be passed through into wages. I just don’t buy that. It’s true that the importance of changing premiums in past wage changes has been exaggerated by many people. But I’m enough of a card-carrying economist to believe that there’s a real tradeoff between benefits and wages.

Maybe it will help the plausibility of this case to notice that we’re not actually asking whether a fall in premiums would be passed on to workers. Even with the excise tax, premiums are likely to rise over time — just more slowly than they would have otherwise. So what we’re really asking is whether slowing the growth of premiums would reduce the squeeze rising health costs would otherwise have placed on wages. Surely the answer is yes.

He's right. When you put it that way, it's a lot more plausible.

The last argument is that this hurts unions which have traded off lower wages for better benefits. This would be a bigger issue than I think it is if the excise tax were going to kick in instantly. But it won’t, giving time to renegotiate those bargains. And bear in mind that this kind of renegotiation is exactly what the tax is supposed to accomplish.

A last general point: we really don’t know what it will take to rein in health costs, but that’s a reason to try every plausible idea that experts have proposed. Limiting tax deductibility is definitely one of those ideas.

Bottom line: the details of the excise tax should be fixed, but it’s on balance a good idea.

File this one under "Law of Unintended Consequences" and hope to God someone brings this to the attention of the relevant parties:

Where are the chips falling, so to speak, when it comes to the popular State Children’s Health Insurance Program (SCHIP)? The press ought to be finding out, and fast. Last week, the Children’s Defense Fund sent me an invitation for an informational call discussing SCHIP’s future: “If the Senate doesn’t take a stand for children in the next days or weeks, our worst fears could clearly come to pass.” The dire-sounding invite piqued my interest, especially since I had read in the House bill that SCHIP would be repealed. What was going on?

It turns out that the House indeed wants to repeal the program and require kids to get coverage via the insurance exchange, the government’s soon-to-be gigantic brokerage service. Their parents, of course, would be getting subsidies to help buy coverage, courtesy of the U.S. taxpayer. Rep. John Dingell, a Democrat no less, touted the advantages of dumping SCHIP. One advantage: the program wouldn’t be subject to the periodic and occasionally problematic Congressional reauthorizations that threaten its existence. Dingell said kids could have the same insurance as their parents—an incentive to force parents to cover their kids. (Sometimes parents, daunted by bureaucratic red tape, don’t enroll their children even if they are eligible.)

Another reason for killing SCHIP, some believe, is to force kids into the new exchange’s risk pool. Kids are usually healthy; bringing them into the pool may help spread the risk and keep premiums somewhat lower for the sick people whom insurers would have to cover.

But in return, kids would be hurt, says Alison Buist, director of child health at the Children’s Defense Fund. She told me that if the House provision were to take effect, kids might lose some valuable and comprehensive benefits now available to kids on Medicaid and SCHIP. If parents, strapped for cash, had to shop in the exchange, they might choose low-cost insurance with skimpy benefits and pay more out-of-pocket than SCHIP currently requires them to pay. SCHIP rules limit a family’s out-of-pocket costs to five percent of their income. States don’t even impose the five percent, Buist said, because they have found parents with low incomes couldn’t pay that much. So it seems that there’s a cost shift here—making poor families pay more so that sick (and most likely older) people buying in the exchange would pay less.

The more I see of this Frankenstein plan, the more I see we need single-payer universal coverage. Period.