Affordable Care Act – Insurers leaving the Exchanges

bottom line, PreferredOne’s policies were loss-leaders to sucker people in, they didn’t have the business competence to service their policies plus their actuarial projections sucked… so of course it’s Dayton’s / Obama’s fault… fkers
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Insurers leaving the Exchanges Posted by Richard Mayhew at 10:18 am Sep 182014

Some drop-outs are more important than others.

Weve seen some insurance companies drop out of the Exchanges this year. My take on a New York drop-out was that it was good news as the enrollment was miniscule and the products were not reasonably priced. The insurer was just too small to compete and there was minimial hope for significant membership gains to cover their back end costs:

384 people are too few people for an insurance company to offer a commercial or commercial like product for two significant reasons. Either reason is a good enough reason for a company to get out of this market segment.
From a policy point of view, unpopular and comparatively expensive plans exiting the marketplace is a good thing in states with deep markets and significant participation. It sucks that 384 people will need to find new policies next but they are highly likely to get better and cheaper policies instead.

This is not the case in Minnesota. A major insurer is dropping its participation from the Exchange on both the individual and SHOP side of the equation.

The insurer with the lowest rates and most customers on Minnesotas health care exchange is pulling out
According to a company statement, MNsure policies make up only a small percentage of PreferredOnes entire enrollment but take up a significant amount of resources to support.
PreferredOne had 59 percent of the individual market for MNsure enrollees as of Aug. 6.

This is a significant disruption to the Minnesota market. It is not shocking though.

I am eyeballing the pricing for a 35 year old non-smoker in the Twin Cities on Health Sherpa and platinum plans without subsidy are cheaper from this provider than most baesline Silver plans. I think a few things are happening.

PreferredOne either was amazingly over optimistic on their acturial modeling or had decided to engage in an extremely aggressive loss leader pricing strategy to build membership. If this was a loss leader strategy, than it may have been too effective as the low cost platinum planss would have been very attractive to people with significant pre-exisiting medical conditions or known medical risk. People with high utilization and high complexity of cases are expensive on the medical side as they go to doctors/hospitals a lot AND they are administratively costly as they are calling in for help and care coordination on a frequent basis.

Secondly, the back-end infrastructure to support Exchange is extensive, especially as the risk spreading mechanisms such as risk adjustment require significant technical support. Building that type of infrastructure from scratch is painful and expensive. PreferredOneseems to have been only a commercial group insurer with a small staff before it decided to dip its toes into the water for individual Exchange. It had no pre-exisiting model it could rip off to modify for Exchange.

It had aggressive pricing, a population that is higher need than normal, and not a lot of administrative/technical depth. On a quick glance at these basic facts, dropping Exchange makes sense. It sucks for the people who have to re-enroll in new plans at higher price points but 2014 was always a beta test year, and we know that companies would be entering and leaving different markets which is why the markets were never expected to stabilize until the 2016 open enrollment period. Preferred One is not the only significant exit, as Hawaii lost a large provider for the SHOP exchanges for the same basic reason

Drought Map for September 16 2014

Artificial Sweeteners Implicated in Dangerous Gut Changes

Certain gut bacteria may induce metabolic changes following exposure to artificial sweeteners

Date: September 17, 2014 Source: Weizmann Institute of Science

This image depicts gut microbiota.

Credit: Weizmann Institute of Science

Artificial sweeteners — promoted as aids to weight loss and diabetes prevention — could actually hasten the development of glucose intolerance and metabolic disease, and they do so in a surprising way: by changing the composition and function of the gut microbiota

Artificial Sweeteners Induce Glucose Intolerance By Altering The Gut Microbiota

Nature (2014) doi:10.1038/nature13793

Received 27 March 2014 Accepted 28 August 2014

Published online 17 September 2014

Abstract

Non-caloric artificial sweeteners (NAS) are among the most widely used food additives worldwide, regularly consumed by lean and obese individuals alike.

NAS consumption is considered safe and beneficial owing to their low caloric content, yet supporting scientific data remain sparse and controversial. Here we demonstrate that consumption of commonly used NAS formulations drives the development of glucose intolerance through induction of compositional and functional alterations to the intestinal microbiota.

These NAS-mediated deleterious metabolic effects are abrogated by antibiotic treatment, and are fully transferrable to germ-free mice upon faecal transplantation of microbiota configurations from NAS-consuming mice, or of microbiota anaerobically incubated in the presence of NAS.

We identify NAS-altered microbial metabolic pathways that are linked to host susceptibility to metabolic disease, and demonstrate similar NAS-induced dysbiosis and glucose intolerance in healthy human subjects.

Collectively, our results link NAS consumption, dysbiosis and metabolic abnormalities, thereby calling for a reassessment of massive NAS usage.

Ebola Infection control is not working ProMED-Mail Post

Ebola Infection control is not working
A ProMED-mail post
Date: 14 Sep 2014
From: Bjorg Marit Andersen

Infection control concerning EVD is not working, especially when more than 240 [now 300] healthcare personnel have been infected, and more than 120 workers have died. Guidelines used to control SARS in 2003 should be used, not “contact and droplet protection of 1-2 meters,” as is still recommended by WHO.

Personal protective equipment (PPE) for contact and airborne infections should be used because of
a) respiratory symptoms,
b) a big distance — up to 9 meters — for droplets when coughing and sneezing (Bourouiba et al. J Fluid Mechanics 2014;745:537-563.),
c) re-aerolization from the environment, bed clothes etc.,
d) long survival of the virus outside the body, and
e) high lethality.

Healthcare workers (HCW) and helpers should be protected with PPE as they were during the SARS epidemic. The SARS epidemic was an infection control success by the healthcare system of some countries in Asia in 2003. But WHO should not repeat the same failure as was done during the early phase of the SARS-epidemic by using “contact and droplet isolation.” Separate hospitals for EVD should be built, like in China (1000 beds in 8 days for SARS), and only patients with laboratory documented EVD should be cohorted. Suspected cases should be isolated separately.

HCW and helpers should be trained and especially observed concerning [putting] PPE on and taking [it] off. The observers should also use PPE. During the SARS epidemic, HCW were re-contaminated by not knowing how to take off PPE.

Exposed people and patients with other diseases should be treated in professional triages to reduce the population’s fear of being EVD-infected during contact with healthcare. Exposed people should be taken care of by professional helpers.

There is a need for a lot of resources, especially concerning infection control work.


Bjorg Marit Andersen, MD, PhD
Professor in Hygiene and Infection Control
Speciality: Medical Microbiology
Former chief, Department of Hospital Infections
Oslo University Hospital – Ulleval
Gaustadveien 1a 0372 Oslo, Norway

A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Drought Map for September 9 2014

Ebola epidemic = 100s of 1000s of cases n last years

stolen from slashdot…
Despite recent advances in medicine to treat Ebola, epidemiologists are not hopeful that the outbreak in west Africa will be contained any time soon. Revised models for the disease’s spread expect the outbreak to last 12 to 18 months longer, likely infecting hundreds of thousands of people. “While previous outbreaks have been largely confined to rural areas, the current epidemic, the largest ever, has reached densely populated, impoverished cities including Monrovia, the capital of Liberia gravely complicating efforts to control the spread of the disease. … What worries public health officials most is that the epidemic has begun to grow exponentially in Liberia. In the most recent week reported, Liberia had nearly 400 new cases, almost double the number reported the week before. Another grave concern, the W.H.O. said, is ‘evidence of substantial underreporting of cases and deaths.’ The organization reported on Friday that the number of Ebola cases as of Sept. 7 was 4,366, including 2,218 deaths.” Scientists are urging greater public health efforts to slow the exponential trajectory of the disease and bring it back under control.”
http://science.slashdot.org/story/14/09/13/1727208/us-scientists-predict-long-battle-against-ebola

at least half are likely to die… total cases into the hundreds of thousands over the next year… but the math models can’t predict what’ll happen when continent wide panic / hysteria grips 100s of millions of people… but, hey, look, over there – a just ginned up dandy little war to entertain y’all… n remember! Keep Shopping!!

here’s where they stole it from:

http://www.nytimes.com/2014/09/13/world/africa/us-scientists-see-long-fight-against-ebola.html?_r=0