April 23, 2025

High & Low Finance: Court Ruling Against Banks Lets MBIA Benefit From Splitting Up

Imagine, for a moment, what a court might say if state regulators allowed an insurance company, facing huge losses because of Hurricane Sandy, to separate itself into two companies. One, thinly capitalized and in clear danger of not being able to pay all claims, would insure the areas hit by the hurricane, like the beach towns of New Jersey and the Rockaway area of Queens. The other, with plenty of capital, would carry all the policies that were not likely to have large claims.

Of course, no regulator would do that. And any court confronted with such an act would search for reasons to overturn it.

Now imagine an insurance company split up with the clear purpose of discriminating against a set of policyholders who were the subject of overwhelming public scorn rather than public sympathy — perhaps the people who had caused the catastrophe that led to the losses.

Just such a case was decided this week. And the state regulator’s decision was upheld by a judge who concluded that the regulator was entitled to the widest possible latitude in making its decisions. If the regulator had not bothered to verify calculations in the insurance company’s financial projections, and those calculations turned out to be wildly inaccurate, that was fine with the judge.

That case did not concern a hurricane, of course. It instead concerned the financial storm that sent the world into recession and led countries to bail out the banks that had made bad loans that led to the disaster.

The insurance company was MBIA, a company that prospered insuring municipal bonds, almost all of which were safe anyway. It then made the huge mistake of deciding to also insure structured financial products, like collateralized debt obligations and commercial mortgage-backed securities. It did little investigation of what actually backed those securities, explaining later that its low fees made such investigations too expensive. Instead it relied on the ratings agencies and on the banks that had put the securities together.

That reliance was misplaced, and MBIA is now in danger of being unable to pay claims on those securities.

In 2009, with the blessing of its regulator, the New York State Insurance Department, MBIA decided to split in two. On one side, fully protected, were the insurance policies issued to muni bond investors in the United States. On the other side were the structured finance policies, which would mostly benefit the banks that had bought such products. A group of banks sued to overturn the breakup.

Justice Barbara R. Kapnick of the New York State Supreme Court — a trial court despite the lofty title — listened to lawyers argue for 13 days over whether the case should proceed to trial. She decided there was no reason for a trial. The insurance department had wide latitude to approve the split with or without much investigation, and she would not second-guess it.

Anyone from the Securities and Exchange Commission who might read Justice Kapnick’s opinion will be envious. The S.E.C. has to contend with a court — the United States Court of Appeals for the District of Columbia Circuit — that instinctively throws up roadblocks to any rule the commission passes. The S.E.C. jumps through whatever hoops the court established in its last decision but, somehow, it never quite manages to live up to what the D.C. circuit requires in its next ruling.

Justice Kapnick, on the other hand, is not bothered by the fact that the state insurance department relied on MBIA financial filings that turned out to be very inaccurate — not just later but at the time that the filings were made.

The banks, she said, “fail to provide any legal authority to support their argument that this court can annul the department’s decision based on claims that MBIA concealed or withheld potentially damaging information” from the department.

She quotes from a deposition by Michael Moriarty, the deputy superintendent of the department and the man who signed the letter approving the split. When considering MBIA’s request, he said, “the department did not, nor do they usually, verify the financial condition of a company.” Since that was the policy, the judge concluded she had no authority to question it.

The New York Insurance Department has since been combined with the state banking regulator in a new body, called the Department of Financial Services, and that body seems to be very worried about MBIA’s ability to meet its obligations in the structured finance unit.

An interest payment that MBIA owed on a junior security it had sold to investors was not paid in January, because the department would not allow it.

Floyd Norris comments on

finance and the economy at nytimes.com/economix.

Article source: http://www.nytimes.com/2013/03/08/business/court-ruling-against-banks-lets-mbia-benefit-from-splitting-up.html?partner=rss&emc=rss

Staying Alive: How Did You Get So Lucky With Renewal Rates?

Staying Alive

The struggles of a business trying to survive.

Thanks to everyone who commented on my last post about the most recent decline in my health insurance rates. As always, you raised a number of interesting questions. Here are a few I think warrant further explanation:

…it sounds like the monthly insurance prices show what coverage under your company plan costs you as an individual — or is that what your COMPANY pays per month to the insurance company per employee?

I am an employee of the S corporation that I own, which means that the costs that I listed are the same for me and my employees. But in case I didn’t make it clear, the numbers in the chart were the prices of insurance for each employee or family. In 2012, our bill from Keystone HMO was $7,595.35 per month. Of that, $1,066.50 is for me and my own family. That leaves $6,528.85 for employees who are buying coverage. They pay a third of that ($2,154.52) as a deduction from their wages. The company contribution to employee health insurance is $4,374.33 per month, or $52,491.96 per year. This money, if not spent on health insurance, could be used for any number of things. I could put it in my own pocket. Or I could pay down debt. Or I could invest in new machines, or more advertising. Or I could pay it to my employees as additional wages.

Are you saying that if you didn’t purchase the insurance yourself, you wouldn’t add to their salaries in order to purchase their own insurance? My understanding is that most economists believe that the costs of employer provided health care are actually borne by the employees, but your comment suggests that is not the case.

Economists believe all kinds of things that are contrary to how the real world works. This is one of them. If I understand this idea correctly, the economists are saying that the wages that employees can expect is somehow fixed, and that a portion of it is diverted, presumably by mutual agreement, from cash wages to health benefits. This is contrary to my experience.

Costs at most small companies are really borne by either the customers, whose purchases should cover all activities, or by the owners, who might have to reach into their own pockets to cover shortfalls. Once money enters the company, it is up to the boss to allocate where it goes. And wages are also decided by negotiation between the boss and the employee. I have hired more than 100 people and have never had one ask me how much the health coverage cost me. As far as I could tell, they were just happy that we offered coverage.

I see health insurance as an additional expense that is required to attract and keep good employees. Just like heating the shop, and providing good tools for them to use. If I skimp on any of these, it will have a negative effect. How much I choose to devote to any aspect of worker welfare is my choice. The money devoted to health insurance is not theirs by right.

If I decided to stop providing health insurance — and didn’t drop prices to my customers proportionally — I would PREFER to use the extra money to pay down company debt. However, I might need to pass some or all of it through to my people in order to retain them. How much would be determined by whether we were making a profit (in which case the extra money isn’t critical to surviving) and what my competitors were doing. Here’s some game theory to run past those economists: If every employer were to drop health insurance at the same time, none of them would need to increase wages to compensate, because the employees would have no reason to change jobs for a better deal. There would be no better deal.

Obviously, even though all employers would be better off if they did this, it won’t happen. But some number will be tempted to do so. I know I would, and here’s why: It would eliminate a bureaucratic headache and also eliminate the uncertainty of rapidly changing costs. It would be one less thing for me to think about. I could concentrate on my business instead. If I decide to keep offering it, it will be because of the drastic cost difference between individuals buying for themselves and the rates offered to employers. This is how the health insurance market operates now. Exchanges are supposed to fix that. But we’ll see how they play out.

From 2005 to 2013 a 50% increase amounts to an average annual rate of increase of about 5.5%. Is that out of line with other business expenses over the same period?

Take the $606.01 I was paying per month for family coverage in 2005. Using data from this calculator, the cost today, if it had risen at the overall rate of inflation, would be $717.77. This is actually a much larger increase than many of my expenses over that period. For instance, a sheet of cherry plywood that cost me $99.91 in 2007 cost me $71.25 last week. This kind of price drop holds for many of the materials I buy, in part because demand has never recovered from the 2008 meltdown. My rent has gone down by 20 percent. My labor bill has gone up, but that’s because I hired a bunch of people, not because of wage inflation. Business insurance costs have been steady. So, no, my business costs have not risen at the same rate as my medical costs.

Wow. How’d you get so lucky that your insurance rates dropped?

That’s a good question, so I asked our benefits administrators whether costs had gone down for just my company or in general. Here’s the answer I got:

Dear Mr. Downs,

It was about your group in particular (not the AIA as a whole) and that overall for the last 12 months your group ran well.

What that means is that what the carrier paid out on behalf of your group in medical/rx claims did not exceed the amount they charged you in premium.

If this is true, it’s pretty scary. This is confirmation that demographics of the people I hire directly drive my health costs. The system is incentivizing the hiring of younger, healthier workers (I have written about this previously), and giving me a perfectly rational reason to turn down older, potentially sicker applicants. That should be fixed.

I don’t know what Obamacare is going to bring, but I really doubt it is going to reduce health care costs {or} health insurance costs.

I sort of agree. The only thing that will bring costs down is a broad consensus by the voters that the system has to change. Politicians won’t lead the way on this. They get too much money from the various interest groups that benefit from the current system. If employers take advantage of the Affordable Care Act to get out of the health insurance game, a much larger number of people will be forced to confront the entrenched special interests (by which I mean insurers, doctors, and hospitals — I believe they are all in cahoots on this).

Then we might get change we can believe in. But I doubt this will happen. I suspect that most employers will be unwilling to confront their employees with such a drastic change. It’s really, really hard to look your people in the eye and tell them that you are taking away an important benefit. In the past, I have provided insurance to my people because I believe that everyone needs it, and our system put that responsibility on me. The new law provides an alternative path for people to buy their own policy, allegedly at reasonable rates. If that turns out to be true, I might pull the trigger.

Bosses: what would it take for you to do this?

Paul Downs founded Paul Downs Cabinetmakers in 1986. It is based outside Philadelphia.

Article source: http://boss.blogs.nytimes.com/2012/11/27/how-did-you-get-so-lucky-with-renewal-rates/?partner=rss&emc=rss

Bucks Blog: The $650 Doctor’s Bill

Paul Sullivan writes this week, in his Wealth Matters column, about turning in desperation to a pediatrician who specializes in babies with sleep problems after many nights of trying to get his infant daughter to sleep for at least a few hours at a time.

The pediatrician quickly figured out what was causing the problem. But the pediatrician, who had driven up from Brooklyn to Paul’s home in Connecticut for the diagnosis, doesn’t take insurance. His fee was $650, and Paul’s insurance company ended up paying nothing on the claim.

Other doctors have also stopped dealing directly with insurance companies, Paul found, mostly because the whole process was frustrating and time-consuming. They argued that their time could be better spent with patients. This switch is mainly affecting primary care doctors and internists, whose reimbursement rates from insurance companies are the lowest among doctors.

With all the changes in health care and insurance, has your doctor gone this route, too? If so, what has been your experience — both with the care and with your insurer?

Article source: http://bucks.blogs.nytimes.com/2012/11/23/the-650-doctors-bill/?partner=rss&emc=rss

Blue Shield of California Won’t Cover Breast Cancer Drug

Blue Shield, with 3.2 million members, is apparently the first large insurance company to end payments since a federal advisory committee unanimously recommended in June that the Food and Drug Administration rescind Avastin’s approval as a treatment for breast cancer, saying the drug did not really help patients.

The F.D.A. commissioner, Dr. Margaret A. Hamburg, has not made a final decision, so Avastin retains its approval for now.

Because it is an emotional and politically contentious issue, with some women saying the drug is keeping them alive, many insurers have said they will wait until a final decision from the F.D.A. before re-evaluating their coverage policies. And Medicare has indicated it will continue paying for the drug even if the F.D.A. revokes the approval.

But Blue Shield decided not to wait. In a note posted on its Web site, it said reimbursement would end Oct. 17, though “exceptions may be considered on a case-by-case basis.”

“We agreed with the F.D.A. panel,” Stephen M. Shivinsky, a spokesman for Blue Shield, said on Friday. He said the insurer would continue to pay for the drug for women who were already using it.

Because Avastin, which is sold by Genentech, is approved to treat other forms of cancer, it will remain on the market even if its approval for breast cancer is revoked. So doctors could use the drug to treat breast cancer even if it were not approved for the disease.

But some patients and doctors say that insurers would be less likely to pay for such off-label use. That would put Avastin, which costs about $88,000 a year, out of reach for many women.

A spokesman for Genentech said the company was aware of three other insurers that had decided not to pay — Regence, which operates Blue Cross Blue Shield plans in the Northwest; Excellus BlueCross BlueShield in Rochester; and Dakotacare in South Dakota.

The spokesman, Edward Lang Jr., said those insurers acted before the F.D.A. advisory committee meeting but after the F.D.A. first announced its intention to withdraw the approval last December.

“We believe women should have access to the medicine and that insurers should cover it,” Mr. Lang said.

In a final appeal, Genentech, which is based in South San Francisco, Calif., and owned by Roche, asked the F.D.A. in August to retain approval, at least for women with the most aggressive forms of breast cancer and the fewest treatment options, while the company conducts another clinical trial in an effort to prove the drug works.

In the most recent clinical trials, Avastin did not prolong the lives of women with breast cancer but it did delay the progression of the disease by one to three months. Whether that is a meaningful benefit, especially in light of some dangerous side effects, has split patient advocacy groups and the medical community.

Shortly after the F.D.A. advisory committee’s negative vote, a panel of breast cancer doctors convened by the National Comprehensive Cancer Network, an organization of major cancer hospitals, reaffirmed that Avastin was “an appropriate therapeutic option for metastatic breast cancer.”

That is important because Medicare and UnitedHealthcare are supposed to pay for drugs listed in the cancer network’s guidelines.

Only last week, on Sept. 26, Avastin was approved as a treatment for breast cancer in Japan.

Blue Shield of California in March dropped plans to sharply increase rates for individual policies after coming under fierce criticism from consumers and regulators. In June, the nonprofit insurer said it would cap its profits and return any excess to policyholders.

Article source: http://feeds.nytimes.com/click.phdo?i=6bc974bc0b216f7eb0040594e953ba69

Bucks: Same-Sex Spouses in New York Will Get Health Insurance

What if You're Gay - Your Money - Bucks Blog - NYTimes.com

Getting health insurance should become easier for gay couples who decide to marry and live in New York, which recently became the sixth state to legalize same-sex marriage.

Couples that marry will gain a variety of other legal and financial benefits as well, but the ability to add a spouse to an employer’s plan may be one of the more significant. When we calculated the extra costs that gay couples incur because of their inability to marry, health care expenses were certainly among the most onerous — not all employers offer domestic partner insurance, for instance. And even when they do, workers are often taxed on the value of those benefits.

Though the legalization of same-sex marriage in New York won’t entirely level the playing field with opposite-sex married couples, it will certainly help matters. Not only will the same-sex spouses of state workers be eligible for spousal coverage, but the same goes for many employees who work for private employers. According to the state insurance department, an employer that provides coverage to spouses must now also extend that coverage to same-sex spouses who were legally married in New York.

In fact, since New York State already recognized same-sex marriages performed elsewhere, gay couples who were married have been eligible for spousal coverage for some time. The New York State Insurance Department issued guidance in 2008 clarifying its position, noting that same-sex spouses were indeed to be treated as spouses for health insurance purposes (and other insurance matters as well).

Still, there could be some instances were spouses may not be eligible for coverage. Employers who don’t contract with an insurance company but instead pay for health benefits out of their own assets — so-called “self-insured plans” — are not subject to the state’s insurance laws. Instead, the plans are governed by a federal law, the Employee Retirement Income Security Act, known as Erisa, which is likely to rely on the federal definition of marriage (one man and one woman).

So an employer with a self-insured plan could choose to cover same-sex spouses, but it’s not required, said Todd Solomon, a partner in the employee benefits practice at McDermott Will Emery and author of “Domestic Partner Benefits: An Employer’s Guide.”

And since the federal government still doesn’t recognize same-sex marriage, workers with same-sex spouses will continue to owe federal income taxes on the value of their spouse’s benefits, unless they’re considered a dependent. (Heterosexual married couples aren’t subject to the taxes because they’re viewed as an economic unit in the eyes of the federal government.) While more employers have begun reimbursing their workers for those extra costs, it’s still a relatively small number that do.

But now that same-sex marriage is legal at the state level, employees will no longer owe state income taxes on the value of those benefits, according to a spokeswoman for the state department of taxation.

Do you know of any employers with a self-insured plan that do not cover same-sex spouses? And how much extra do you have to pay for health coverage since same-sex marriage is not recognized by the federal government?

Article source: http://feeds.nytimes.com/click.phdo?i=b42cd40c5ec8b70e4a6e49ae06e69f97

Annuities: What You Need to Know

Here are the basics of annuities.

TYPES In its most basic form, an annuity is a contract with an insurance company that makes payments at regular intervals for a set period of time. The classic fixed-annuity provided people a set payment for however long they lived — from a few months to decades. An insurance company’s actuaries took their best guess on your life expectancy while you hoped to outwit them and collect a check into your 90s.

Few annuities are structured this way anymore. One reason is people have realized that a static payout is not great. For one thing, it does not account for inflation: $1,000 a month today will probably not buy as much in 10 or 20 years.

To make annuities more appealing — and to bring in more money — insurance companies created more sophisticated types of variable annuities.

Many of these annuities offer the option of a higher payment if the value of the underlying securities rises yet lock in a minimum payment if they fall.

One popular annuity gives people a sense of flexibility by allowing them to withdraw some or, in certain cases, all the principal, if they need it. In living longer, people will require income for more time but they are also increasing their chances of contracting catastrophic illnesses, from cancer to Alzheimer’s, that carry huge medical costs. The guarantee of regular payments is comforting. But the need for a lump sum at a particular time can sometimes be more practical.

Other popular models are structured to continue after the original beneficiary’s death. A “joint-survivor” clause stipulates that if the husband dies first, the annuity continues to pay out to his wife through her lifetime, while another provision leaves some of the remaining principal to other heirs.

IMMEDIATE VERSUS DEFERRED These are two terms that are often used when discussing annuities. The difference is simple but often obscures the vast array of annuities being offered. With an immediate annuity, a person pays a lump sum and begins receiving income right away. That’s the immediate part. In the past, these were usually life-only annuities, meaning if you died a week later, that money was gone. Now, immediate annuities have all the variations mentioned above.

A deferred annuity has two phases — accumulation and distribution. Over a period of time, a person builds up the value of the annuity and then selects a time to start receiving payments from it. People who change jobs, for example, could opt to roll their Individual Retirement Accounts into an annuity and let the money grow there. Or they could make contributions to the annuity for a set period of time as they would with any savings plan. When they have accumulated enough to finance their goals, they can decide when they want to start receiving payments. They can start and stop the payments at will, though the idea is that they will wait until retirement.

ALLOCATION TO ANNUITIES Regardless of what type of annuity you select, the main question is how much of your portfolio should you put into one? The rule of thumb is to use annuities to cover your basic living expenses. Most providers recommend that you put no more than a third of your assets in annuities. Others limit retirees to 75 percent. Financial advisers not associated with insurance companies will generally argue for putting little in annuities: they feel they can get better returns through a diversified portfolio of securities. That’s a harder sell, though, after two rounds of huge losses in the stock market in one decade.

BENEFITS AND LIMITATIONS The benefit of putting a chunk of your nest egg into annuities is the guaranteed payment. Whether the economy is good or bad, an annuity pays a minimum amount of income every month. You may have to put a large part of your nest egg into the annuity to receive the amount you need to live on, but you know it will be there.

There are four main downsides to annuities. First, they are expensive. A fixed annuity typically pays out no more than 5 percent of the principal each year. That means you would have to put $100,000 into a fixed annuity to receive an annual payout of $5,000. Even the most frugal retirees would struggle to live on $400 a month. To receive, say, $2,000 a month, they would have to invest $500,000.

The other cost is the fees associated with the annuities. One rule of thumb is the more guaranteed features attached to an annuity — from inflation adjustment to joint survivor — the higher the cost. These costs, as with mutual funds, are embedded in the annuity itself. They do not come in an upfront fee but are hidden in the payouts.

A third problem is expectations. People who bought annuities with payments that grew as the underlying securities grew could be in trouble. Those payouts are not going up when the stock market loses 40 percent of its value in one year. Likewise, when government policy makers are more worried about deflation than inflation, payments that adjust for the cost of living are going to remain at the guaranteed minimum.

Lastly, the government taxes distributions from annuities as ordinary income, with rates that run up to 35 percent. Money put into a brokerage account is taxed at the capital gains rate, currently 15 percent. Under the current tax regime, if someone receives a payout greater than $32,500 a year, that would be taxed at a 25 percent income tax rate — higher than if that same amount had been paid out through a brokerage account.

The popularity of annuities waxes and wanes with the economic cycle. They had a resurgence in the years after the technology bubble burst in 2001 and 2002. The recession of 2008 could do the same, though insurance companies may be constrained: in response to previous demand, they underwrote so many annuities that credit rating agencies are questioning their risk management skills.

Like any part of a portfolio, annuities are best taken in moderation. They are a great way to guarantee a certain amount of fixed income in retirement. But if overdone, they could rob a portfolio of needed flexibility.

For more on annuities, the Securities and Exchange Commission offers some basic information on one part of its Web site and more specific guidance on variable annuities as well. The Insurance Information Institute’s annuity guidance is also useful. The Hartford, one of the leading sellers of annuities, offers a fair bit of good information here, and MetLife, another leading purveyor, presents its own guide to deferred and immediate annuities as well.

Article source: http://www.nytimes.com/2009/01/28/your-money/annuities/primerannuities.html?partner=rss&emc=rss