Normal is not a cure for HIV

One night coming back from a Board Meeting of a nonprofit in the Castro I snapped this photo through the window of the Duboce Cafe. Normal. All those bottles of pills behind the glass, which over a year cost more than a new BMW, that is the price of normal for someone with HIV.

I thought about using this photo last year when Anthem Blue Cross announced that it was requiring all HIV / AIDS patients they insure to obtain their drugs through a mandatory Mail Order program. Buy from one supplier, get the maximum price discount, make sure the prescription never runs out. Seemed like a good idea when it was thought up in a cost containment meeting. But, before I could Blog away Anthem allowed for an opt out for it's insureds and life returned back to "normal".

In our country there are 1.1 million people, just slightly less than the population of Dallas, with HIV. Many of these people do not get regular care, get medicine, have regular access to doctors. The Affordable Care Act and Medicaid expansion is supposed to close this gap. Not every state opted to expand Medicaid, removing the requirement of total disability to qualify for benefits. For an HIV patient, total disability means waiting until the illness progresses to AIDS. Not a good option.

The Affordable Care Act mandates a certain level of benefits. Now every insurer can only offer four Metallic Plan choices (think Henry Ford and black cars). The only cost containment options are to limit the network of Doctors and Hospitals and the Prescription Drug choices. In order to protect themselves from the high cost of these drugs, insurers limited drug choices and assigned high Co-Pay's for the treatment of HIV /AIDS.

Drug companies have been able to combine multiple HIV / AIDS drugs into a single tablet under the thought that it's easier to remember to take a single pill. A one month supply runs over $2,000 (Stribild, Atripla, Complera), far above the premium the insurer will be able to charge. Multiply this over many, many newly insured HIV / AIDS patients and you get the picture. Antacid dispenser in the Actuaries lounge.

Which brings me to the news this week when Blue Cross and Blue Shield of Louisiana announced it would reject checks from a Federal Program (known as the Ryan White HIV AIDS Program) designed to pay premiums for HIV /AIDS patients to enroll in the Affordable Care Act. The concern they have stems from statements from the Centers for Medicare and Medicaid Services (CMS) that it had significant concerns about this, citing the risk of fraud. 

AIDS advocates in Louisiana "were enrolling anyone and everyone" in the state exchange. The folks at Blue Cross and Blue Shield no doubt are pretty nervous about all of this and the CMS provided them a four lane highway to escape the potential of huge adverse selection (think stacked deck). The CMS is now doing a massive back pedal to cover it's rear end and allow these checks to be used. 

Maybe it was just wishful thinking by the artist, there is no true "Normal" for someone diagnosed with HIV /AIDS. 

What Don Draper knew 50 years before CVS

It had been so long since I had seen one of these machines that I had to photograph it. I was in Atlanta for the NAHU convention last summer at a restaurant and right after I took the photo someone asked me why I took it. "These are almost extinct", I said, thankfully.

I remeber a time when these were everywhere, living in California, where you can't smoke anywhere, this is a thing of the past. When the MadMen episode where Don Draper writes his fictional "Why I'm Quitting Tobacco" advertisement he states the obvious, "people can't stop themselves from buying it". It was the convenient placement of these machines that acted as a reminder to all of those smokers to keep on puffing.

So yesterday, when CVS Pharmacy announced they were going to stop selling cigarettes in their pharmacies, it was if another of these machines just disappeared. The familiar Ka-Chung sound of the lever followed by regular or menthol, soft pack or box, right there at the fingertips.

Reports estimate that CVS will loose about $2 Billion in revenue from this decision from the loss of tobacco sales, but the goodwill is just overwhelming. They changed the profile picture on all of their social media sights to this no smoking avatar just to drill their corporate goodness home.

In a real world application this is not completely earth shattering, there are still many, many places to purchase cigarettes, but at least now you won't be able to stop and pick them up along with your lung cancer medication.

There are roughly 480,000 people who die each year in the US from tobacco, roughly the population of Fresno or Sacramento. It's $132 Billion in medical care cost (think about that next time your health insurance premium comes due). That a national pharmacy believes that the goodwill will out weigh the lost revenue is pretty significant.

In 1965 when the fictional Don Draper penned his missive saying, "We knew it wasn't good for us but we couldn't stop", he was on to something. In the 50 years since, smoking rates have dropped from 42% to 18% of the population.

We all know that smoking has become less socially acceptable. The kids of smokers are smarter than their parents in many cases and have resisted the urge to light up. Like many great changes in our world it just gets pushed along slowly over time. You did a good thing yesterday CVS, I hope their decision helps someone you love let go of cigarettes and maybe our children won't see cigarette machines anywhere in their lifetime.

Private Exchanges

I'm at the Choice Administrators road show for their private exchange product that has been writing multi-carrier health insurance for small business in California for 20+ years.

Mercer is all pumped up that their exchange has 52 employers signed up for 2014.  Big whoop.

I just love working with small business because they tend to have long term employees and are run like family. There is a desire to take care of employees and their families. CalChoice allows employees to pick the carrier (Anthem, Blue Shield, HealthNet, Aetna, Western Health, Sharp)  that has their doctor or the health plan or the health plan that includes docs (Kaiser). 

The difference between (besides the obvious apolitical superior customer service) private exchanges and the Government run (call centers full of employees trained in the ACA only) administrated exchange is that the public exchange (Covered California) seeks to 

enroll everyone regardless of doctor or coverage need.

While the private sector allows easy access and the services of a licensed health insurance broker, they also offer major medical and ancillary health carriers with their full superior networks of doctors and hospitals.

Employer based health care is moving from a “defined benefit” to a “defined contribution” format, where employers give employees a percentage or flat dollar amount. Your professional broker (like myself) helps educate and assists employees choose benefits that best fit their family situations. 

If you're a Califirnia employer that would like to learn more, I would be happy to assist.

The value of a health insurance broker.

It's the personal nature of health insurance that makes the need for human interaction so important. The purpose is to finance care and at times that comes in moments of fear and personal crisis. There isn't a website or “navigator" that can compensate for that.

Employers are more likely (20%) to offer medical coverage in markets with competing brokers. Broker competition is associated with lower premiums (13% less).

The government is throwing bushels of tax payer dollars at the concept that our service has no real value and unnecessarily adds to the cost of coverage. I beg to differ.

http://ow.ly/21xUV2

How Paul Bunyan and Babe will help the Affordable Care Act (and MNsure)

MNsure (Minnesota's health insurance exchange) has rolled out it's Ad campaign with Paul Bunyan and Babe, the Blue Ox, making the pitch that Minnesota is the land of 10,000 reasons to get health insurance. http://ow.ly/21ln6Z

Not that I plan on filling my Blog with  the commercials from every state exchange, but this is a witty and clever example of getting the attention of the uninsured (in Minnesota's case 1.3 million of them) that it's a good idea to have health insurance coverage. 

This rollout in states that have decided to create their own exchange is the one best chance for the law to gain traction with the American people enough to take it out of the liability column for the President and his administration. 

That in of itself is a tall order and will need a Paul Bunyon like effort to succeed with 40% of the population polling that they don't understand (or approve of?) the Affordable Care Act.

The New Health Insurance Marketplace

Ready or not, here it comes. I saw this HealthCare.Gov commercial at the end of The Charlie Rose Show on PBS last night http://ow.ly/216DZ7

Covered California has a budget of about $290 million taxpayer dollars to spend on educating the masses. Half will be in traditional media like TV and radio. 

You won't be able to commute to work without seeing their billboard or hearing their drive time radio spot. Once you get home the exchange will pop up during football timeouts and between housewives reunion shows.

The majority of the money into social media, data mining you on FaceBook and distracting the single folks fussing over their Match.com profiles.

I just hope their jingle is catchy and not annoying. 

Since I tweeted this out I had 40 clicks yesterday and another 46 today. Not Rock Star numbers but it has an audience of health insurance brokers staring at the reality that the product they've been selling with its myriad of options is being dumbed down to a row of cereal boxes. A sobering thought.

The video I link to is put out my a new co-op in Iowa and Nebraska and has their tag attached to the actual HealthCare.gov video. 

There may not be much reason to join a union. So much for the logo jackets.

This CNBC article outlines the unintended consequences of the Affordable Care Act for union members. The thought that the companies will decide that these plans are too expensive and drop the coverage and pay the fine, the average union guy is probably wondering "how can this be?" The loss of the tax incentives for employers tax subsidies for Taft Hartley coverage leaves them in a position where the cost of these plans becomes an issue. 

The big draw for joining unions has always been the rich benefits. Couple this with the possibility of scaled back plans due to the "Cadillac Tax" and union leaders are left with "not much". So much for the "If you like your plan, you can keep it" promises, that was talk for an election year.

I spent one summer home from school working as a Culinary and Bartenders Local member while cooking in a hotel. The "lifers" in the kitchen swore by it, but I saw a group that new it couldn't be easily fired, going for breaks when the kitchen got busy. You get the picture. For people at the bottom economically the revelation that their President brought them this law, well that must be disappointing.