I have, of course, been going into great detail to explain t he relationship between Highmark and MedExpress , and to lay out what appears to be the Highmark plan for establishing a monopoly on health insurance and even health care in Delaware . This is apparently worrisome to some of the leaders of Highmark Delaware, who appear to have become new followers of this blog, like President/CEO Timothy Constantine and (this title is not only a mouthful but quite unintentionally revealing) Senior Vice President for Provider Strategy and Integration Paul Kaplan . Well, I always welcome new readers, even aggrieved new readers. It is important right now to step back and take an even broader look at the overall Highmark empire, to include specifically the parts of that empire that impinge on Delaware. I will warn you at the outset that this is a long, LONG post, but if you actually care about free-market competition, monopolistic business practices, or government corruption, you need to...

Don't get me wrong:  I love free market competition. But the current incestuous relationship between Highmark Blue Cross Blue Shield and MexExpress urgent care clinics is a classic example of government utterly failing at "regulating" a market. To begin with, let's go back and recall that Senator Patti Blevins and Insurance Commissioner Karin Weldin Stewart teamed up to exempt Highmark from the Attorney General's authority to require the insurance company to set aside $175 million in reserves for a foundation to benefit taxpayers. This was Highmark's condition for entering the Delaware market--$175 million plus multiple other exemptions and exceptions to existing insurance law.  If you bother to go look at either Blevins' or Stewart's campaign donation pages at the Delaware Commissioner of Elections page , and you take the 2-3 hours necessary to trace down the bewildering array of PACs and healthcare related donations that each woman received in...

So here's the math: The current population of Delaware is estimated to be 917,092. Of that, 225,426 are already on Medicaid.   That's 25%. There are also 157,289 Delaware citizens on Medicare.   That's 17%. There are 15,348 children on CHIPs. There are 11,500 personnel at Dover AFB who receive their healthcare via the Federal government. VA pensions and disability claims patients account for another 11,500. The Medicaid expansion is expected to add another 30,000 patients. This totals 465,332 Delawareans receiving their health insurance via the Federal government--or 51% of our State population. In other words, we are already apparently teetering at, or just past the tipping point for effectively having single-payer health care in Delaware. Don't hold your breath. Below the fold I'm going to explain to you why Delaware will not go across the tipping point.

You should have been able to see this coming. First, think about those healthcare exchanges, those Federal and State-run marketplaces for low-cost insurance.  In case you forgot, here's the promise from a Health and Human Services spokesperson: "When the marketplaces open on Oct. 1, plans will have to compete side by side, and consumers will be able to choose the one that best fits their budget and needs," said Joanne Peters, a department spokeswoman. Plans may be competing, but insurance companies?  Not so much. As they say--the Devil (Highmark) is in the details (Obamacare).  Read on.

I can't yet verify that MedExpress is the only urgent care clinic in Delaware with this neat new practice, but I'm pretty sure that the partly owned functional subsidiary of Highmark introduced it. When you go to a MedExpress and give them your insurance card, you also have a co-pay, right? So you pay your $10 or $25 co-pay for the visit with your credit or debit card. What you probably don't know is that you are also signing a pre-authorization agreement that allows them to bill the full cost of the visit from that card if the insurance company turns down the claim. Without any further notice to you ... Now we aren't talking after the insurance company turns down the claim and you appeal it and then they turn it down again. No, as soon as MedExpress receives the first turn-down they charge your card. If you want the money back, then you have to collect it from the insurance company yourself. This is particularly convenient when the largest insurer in th...

I found it fascinating that the last time I wrote about MedExpress and Highmark BCBS the trolls came out to denounce me.  I did make one error--MedExpress is not wholly owned by Highmark, but has invested at least $50 million, but neither entity is willing to specify the exact investment or the precise relationship between the companies. That having been said, it is instructive to look at the strategy being pursued by Med Express in Delaware and project what the future holds based on what MedExpress (and Highmark) have done in other states. To begin with, let's understand what MedExpress intends to do in Delaware.  The original plan (as MedExpress execs communicated it to officials at Christiana Care and other physicians) was to open eight new urgent care centers north of the canal, and eight more centers in Kent and Sussex.  This would double the number of urgent care centers in Delaware, and even the MedExpress execs in these meetings admitted that the market would ...

Why is it great to be a "supposedly non-profit" corporate giant in the land of government-subsidized corporate welfare ... ... or why Federal anti-trust laws apparently do not apply to entities like Highmark no matter how horrible the corporation's conduct is ... Here's two new examples: 1.  Obamacare allows many procedures to be paid at a much higher rate if they are done in a hospital.   Get a stress test in a cardiologist's office?  Using exactly the same machine, the ACA says the cardiologist receives only about one-third the pay that a hospital would.  This is why most cardiology groups in Delaware have sold out to hospitals.   So what does the hospital do?  The hospital leaves the cardiology office open (the machine's already there, right?) and calls the building "a hospital clinic" so that it can continue to charge higher rates to insurance companies and Medicare than the original doctors could.  Got it? So the same thing happens with...

You can't make this stuff up. Highmark is now rolling out a new dermatology idea:  instead of actually being seen by a doctor, you photograph the affected area and send it in digitally.  Then the doctor decides whether or not you need to come in for a real appointment, or whether s/he will simply diagnose a picture. The cost for this "service" will be $69, because it is NOT a covered benefit on any Highmark Blue Cross Blue Shield plan. So let's get this straight:  instead of paying my Highmark co-pay (usually around $25 but never higher than $50) and having the opportunity to be examined by a real live dermatologist, I am now going to be asked to pay $69 NOT to be seen at all. Highmark is simply gushing over this new "service": "This new process makes it convenient for patients to access care," said Eric Starr, director of business innovation and development at Highmark. "They will just simply take a photo with a smartphone device o...

From the Pittsburgh Post Gazette : Highmark Inc. has not accumulated "excess profits" in violation of state law, and its executives make a "reasonable" salary, according to a judge's dismissal of a lawsuit that had been filed against the insurer.   The state's largest health insurer was sued two years ago by Philadelphians Herman Wooden and Thomas Logan, both former nonvoting "lay" members of a since-disbanded Highmark advisory committee serving the company's  board of directors .   Both of the plaintiffs argued that the $1.2 billion in profits that Pittsburgh-based Highmark had earned from 2005 to 2009 was excessive.   This month, Philadelphia Court of  Common Pleas Judge  Patricia McInerney also rejected arguments that Highmark shouldn't be able to reinvest money in its  for-profit  subsidiaries and that the company awarded improper bonuses to its executives.   In an Aug. 8 order, the judge wrote that the "plaintiffs' ...

Watching the future get ready to happen to us:  Highmark is delaying [not stopping, merely delaying with what they call "soft implementation"] a new policy that would limit its customers to no more than eight physical therapy or chiropractic visits per YEAR without specific insurance company authorization. I love the rhetoric: “Highmark believes strongly that this program will ensure more effective care for Highmark members. Highmark wants to make certain the member is getting the right care at the right time and in the right setting.” The reason that Highmark can do this in PA is exactly the same reason that Highmark will eventually be able to implement this in Delaware:  an artificially regulated market that prohibits competition, and is overseen by an Insurance Commissioner's Office that appears to have more interest in staying in the good graces of corporate leaders than in advocating for our citizens. But, hey, you can trust the government...

Whether you are a friend or foe of ACA/Obamacare, it is often difficult to keep score about what's happening because the news media (a) breaks up many of the stories into discrete chunks that do not let you "connect the dots"; (b) most coverage is ideologically rather than factually driven anyway; and (c) most people are only reading the stories that comport with what they already want to believe. Nonetheless, with an attempt at basic integration, here goes. First:  sign-up continue to be abysmal. Delaware originally predicted that 25,000-30,000 people would find private insurance in the marketplace, and that a similar number would receive coverage under expanded Medicaid.   As of today the numbers are far from projections:  1,145 people have actually gotten plans and paid a premium; 3,183 have signed up for plans but have not finished the process; and 5,732 have become new Medicaid clients.  Only 13% of those who have stepped forward have been younger people. ...

Highmark is whining: In Pennsylvania, Highmark has seen an enrollment of 1,665, while enrollment in West Virginia was 198 and enrollment in Delaware was 126. Enrollment data was of those who have been loaded into Highmark’s system as of Tuesday. Highmark is the only insurer on the marketplace in West Virginia, and the company said “in almost all situations in all of our markets, we offer the lowest priced health plans on the marketplace.” Highmark described the need as “urgent” to improve how the federal marketplace works. See, if it was really all about providing health insurance to either the indigent or those whose policies President Obama canceled, we'd be in trouble.  But since it's about gigantic corporate profits from sending Highmark, Aetna, and Coventry your tax dollars ... Expect a fix real soon.

Turns out that the division of corporate territories among insurance corporations by the ACA ain't working out quite congenially : When Westinghouse Electric Co., the Cranberry-based nuclear engineering giant, announced this autumn that it was jilting Highmark Inc. and handing its health insurance business to Aetna in 2014, Highmark responded with radio and TV ads implying that Aetna is an out-of-state carpetbagger, stealing business and jobs from Pennsylvanians.   While those Highmark ads are more indirectly targeted at local rival UPMC than at Aetna Inc., the Connecticut-based health insurer wants Pittsburgh to know that the carpetbagger suggestion is misplaced.   "That is just so far from the truth, [we] feel obliged to correct it," said Walt Cherniak, a spokesman for Aetna. So Highmark is whining because Aetna is cutting into its territory? Implications for Delaware, by the way, include the fact that Aetna is present on the local health insurance exchange .....

... when Highmark follows through with its current strategy of imposing a health insurance/health care monopoly. This is what has happened to University of Pennsylvania Medical Centers after Highmark not only drove most competing urgent care clinics out of business, but then purchased its own hospital chain ... That's right--documents filed with the state indicate that in order to make its own hospital chain viable, Highmark has to use its clout as the state's largest insurance company to drive 41,000 patients away from UPMC hospitals. The situation is grave enough now in PA that even conservative Governor Tom Corbett has entered the fray : Corbett further said he has directed the state's insurance and health departments to create a task force to monitor the Highmark and UPMC ads and "maintain the state's role in protecting consumers." A task force to monitor Highmark's activities and protect consumers? Here in Delaware we can't even get t...

Yesterday we had hit the number of 100 policies canceled for each person who signed up via the new insurance exchanges. Today the number is 1,433 policies canceled for each person to sign up in the new exchanges. And that's just Highmak's announcement.  Conventry (your only other realistic choice in the "private" insurance market in the First State) has yet to make its announcement. Yes, eventually (some time before the years 2100) the technical glitches with the new exchanges will be fixed.  That won't be because of the overwhelming need to provide insurance, but because Highmark, Coventry, Aetna et al cannot access their profits via the massive Federal subsidies for over-priced plans.  Trust me, the entirety of Obamacare is being driven by the government engaging in the largest transfer of wealth from middle- and lower-class taxpayers to corporate interests that we have ever seen. Supporters of Obamacare continue to talk about not being denied coverage f...

I took some flak here about two weeks ago for reporting that local doctors had told me that Highmark is paying higher rates to physicians at (partly Highmark-owned) Med Express than it does to other physicians at other facilities providing exactly the same services. Now, in a lawsuit being heard in Pennsylvania, Highmark has admitted that such is its practice, by agreeing not to do it again for two years as part of a proposed settlement: Highmark would pledge not to give some medical providers higher reimbursements than others through 2014, thus enhancing competition, Mr. Hare said. So, we come back again to exactly what Insurance Commissioner Karin Weldin Stewart has allowed to begin happening in Delaware. But, one wonders, does anybody in the Markell administration or the General Assembly actually care?

See? MedExpress even has a guy in a Blue Hen costume to go along with bazillions in advertising. So by now you have seen or heard all the advertisements for MedExpress, the "neighborly place" to get urgent medical care . And as I have said elsewhere about them , Whenever you hear a corporation (banks also come to mind here) talking about being a good neighbor, you know you need to hold onto your wallet. But that's not specifically germane to the question of why our Insurance Commissioner should be interested in them. What's germane is that MedExpress is a wholly owned subsidiary of Blue Cross Blue Shield Highmark, the good folks who just bought out the BCBS franchise for Delaware.  So for many of us, if we go to a MedExpress, no matter how friendly and how neighborly they may appear to be, we are really going to a subsidiary of our own insurance company for treatment. This has some interesting implications, not just for patients, but also for other (some ...

How funny is this ? Democratic lawmakers will waste little time next week in going after Delaware Treasurer Chip Flowers.   The Senate Executive Committee, led by Senate President Pro Tem Patricia Blevins, D-Elsmere, will consider a bill to give an unelected board, not the popularly elected Flowers, the sole authority to make decisions on  how to invest  a $2 billion taxpayer portfolio.   Members of Gov. Jack Markell’s administration authored the bill last year, but lawmakers punted it on the final day of the legislative session in June after a behind-closed-doors meeting with Flowers and members of Markell’s cabinet. Let me count the ways: 1.  Senate President Pro Tem Patti Blevins (D-Highmark) is going to go after someone for bad fiscal management practices, and make them accountable.  This would be the same Senator Blevins who helped gin up the deal that in allowing Highmark to buy out Blue Cross Blue Shield of Delaware and establish a private ...

... is already being played out in Pennsylvania. Read this , and realize that today Highmark and MedExpress are after a monopoly on the urgent care market, but that tomorrow ... ... Christiana Care and BayHealth ... They are coming after you. Funny, I thought the point of having an Insurance Commissioner, an Attorney General, a Governor, and a General Assembly--you know, all those instruments of GOVERNMENT--was to protect the citizens of Delaware from predators like Highmark.

10.   The Federal government gave Delaware a $4 million grant to get people to sign up for insurance coverage.  We're hiring people to go out and convince people to pay money for premiums.  Ironically, that $4 million could have put another 526 Delaware children on Medicaid, but it won't. 9. In competition with itself, the Federal government gave yet another $550,000 grant to a Maryland-based company to help Delaware citizens "navigate" the insurance marketplace.  So 20% of the money for jobs signing up people in Delaware goes to a Maryland company? 8.  Everybody, from the News Journal to Rita Landgraf (DHSS Secretary) is emphasizing that they want to find everybody "eligible" for these "benefits" and "access."  Nowhere does anybody mention the stick with this particular carrot, that all of these wonderful eligible people will be charged $90/adult and $47.50/child if they don't sign up?  Congratulations, mom.  We're here to h...