Monday, February 24, 2014

The Patient Laughed

It was a scene that is played out daily in Greater Cleveland. The participants may change, but the message is always the same – The Rules Apply to Everyone But ME.

A physician, we’ll call her Dr. Peg, was discharging a patient from one of our local hospitals (Don’t ask me which one). The subject of insurance came up. The patient laughed and said that he had none. Dr. Peg suggested since the patient could now purchase coverage even with his preexisting conditions. He saw no reason to buy insurance. And if there is a penalty, he’ll just pay it.

Not only would the patient not waste any money on insurance, he also knew how much medication he could demand on his way out the door. Dr. Peg looked down in disgust at his paperwork. “Dave”, she later told me, “This guy lives in a nicer neighborhood than me!”

Did the sharpy get his discharge prescriptions? Absolutely. The hospital knew that the medications were cheaper than the malpractice suit.

One of the elements of the Patient Protection and Affordable Care Act (PPACA or Obamacare) is the Individual Mandate, the rule that everyone needs to have insurance. As anyone who has ever been hit by an uninsured motorist can attest, no law and no penalty, no matter how severe, will ever force everyone to be responsible. But that doesn’t mean that we shouldn’t try.

The Individual Mandate was a significant part of the Republican Party’s response to Hilary Clinton’s healthcare plan in the early 1990’s. The Individual Mandate reappeared in 2003 when the Republicans created Medicare Part D (Rx). Failing to enroll in Medicare Part D when first eligible may result in a lifetime penalty.

How much does the penalty (tax) have to be to force someone to be personally responsible? It may be a Risk / Reward issue. The upside of the PPACA has, for me, been the opportunity to easily insure the previously challenged. Sick? Injured? Doesn’t matter. One of my biggest frustrations has been my encounters with people who believe that insurance is for suckers. They think that it is our job, yours and mine, to cover their healthcare costs so that they can spend their money on fun stuff.

It is not our job.

Dr. Peg was really angry. “Obamacare was supposed to cure this”, she told me. And it might. But remember, every time you see a politician, TV ad, or internet spot discouraging young, healthy Americans from acquiring health insurance, we are institutionalizing this ME First / ME Always attitude. We need everyone in the system. And we need them now, before they meet Dr. Peg.


Thursday, February 13, 2014

I Fought The Law And The Law Won


I apologize for the wait Sir. Unfortunately, you are not going to like my answer.

That was, of course, an understatement. After three separate attempts to insure a young family through, after today’s efforts which had already wasted an hour and a half, after killing another twenty plus minutes on the phone with the national help(less) center – we were told that they I could see that we had not made any mistakes, but that the federal exchange had decided, for no apparent reason, to send the wife to Ohio Medicaid.

We can write subsidized coverage for the twenty-four year old husband and his infant son. But we cannot write a subsidized health insurance policy for his twenty-two year old wife.

The feds have submitted the young woman to the State of Ohio for Medicaid coverage. She will not qualify. We will eventually receive a letter from the State which will allow us to reapply with the feds. When the federal exchange turns her down, again, we will then be allowed to file an appeal. And since the feds have yet to address the appeals’ process, we are doomed to failure.

The good news, and yes, there is good news, is that the family currently has self-paid individual coverage. They will be paying hundreds of dollars per month more than they should, but they will be covered.

I’m really sorry Sir. Do you want to speak to a supervisor?

“No”, I told her. “I have no reason to doubt you. You have laid out our options. Spending more time to hear the same thing is counter-productive. Bouncing up to the supervisor for the purpose of yelling at someone for this mess is really counter-productive. I’m just really disappointed. We expected better than this”.

And that is the truth. We, the American people, deserve better. An experienced agent, I was able to cut through the crap and get to the root of the problem. My clients told me that they would have still been stuck in the application loop. And my clients, unlike many others in their circumstances, would still be uninsured and unprotected.

In a couple of hours on Tuesday, February 11, 2014, I fought the law and the law won.


Update – I took a single woman who has worked at the same job for years through today. 50 minutes from start to finish. Proof that it can be done. Further reason that we should expect this or better every time we try.

Tuesday, February 4, 2014

So, How Are We Doing? (The Update Post)

Pat Carr, the CEO of UnitedHealthOne, the individual health insurance division of UnitedHealthCare, had a goal. On Tuesday, January 21st, Mr. Carr sent an email to insurance agents in which he shared the news that his company had had a record-breaking December. His goal? He pledged that his company would try to have 90% of those applications through underwriting by February 1st. 90%!

UnitedHealthOne isn’t buried under an avalanche of applicants taking advantage of The Patient Protection and Affordable Care Act (PPACA or Obamacare). No, this deluge of new clients comes from individuals and families attempting to avoid the PPACA for at least another year.

Welcome to the PPACA, where much of what you’ve been told on TV is not quite true.

There were seven editions of Health Insurance Issues With Dave posted in the last quarter of 2013. At the same time I sent an additional seven separate PPACA updates to my clients. These updates have been more insurer specific and action oriented. Today’s post will merge these two communications, at least for this week.
  • UnitedHealthOne – Mr. Carr’s email is an indication of a new attitude of transparency. His company does not have an exchange policy in Ohio. Their emphasis is on Short Term Policies (more of that later) and off-exchange contracts.
  • Medical Mutual of Ohio recently sent an apology to its agents. The Cleveland-based insurer admitted that it has had significant service issues through the conversion and that it hopes to be back to normal soon. Based on today’s experiences, soon can’t come soon enough.
  • Anthem Blue Cross is overwhelmed. The clients and I have been underwhelmed.
  • The insurers and their websites were as unprepared for October 1st and the PPACA roll-out as the federal government. The timing, a national insurance revolution in the middle of the annual Medicare Open Enrollment and the time of the year that American businesses reevaluate their group health policies, over-taxed our system. This could not have been worse.
  • As reported in the Washington Post, over 20,000 Americans have filed appeals with the government over mistakes made by Overcharges, denial of benefits, and being sent to the wrong policies are just some of the problems cited. But the biggest problem is that the federal government has no way to correct the problems.
  • The upheaval we are witnessing overshadows the Medicare Part D (Rx) rollout of eight years ago. This mess is closer to the disaster of Y2K. And like Y2K, we will get through this, too.
  • There is no reason to go to unless you will qualify for a subsidy.
  • For those who will qualify for a subsidy, is working better. I say that even though I spent close to three hours on the site yesterday attempting to help two clients. We were not successful, and will be trying again later this week.
  • Applying for a subsidized policy through the insurers’ websites may still prove to be the easiest path.
  • The Medicaid Expansion will help millions of Americans access affordable care.
  • Will there be a tax / penalty for not purchasing a PPACA qualified policy in 2014? A lot of people are guessing, NO. Short Term Policies, once thought to be the victims of the new health care law, are having a revival. These are G-d forbid policies. They only cover accidents and illnesses that are new, big, and different. And, they are very cheap.
  • Many healthy Ohioans, even ones who may qualify for a subsidy, are finding that their old policies are cheaper. If you don’t need maternity, why would you change?
  • Unhealthy individuals and small employers who have been charged extra because of unhealthy employees are buying the new policies and saving a bundle. For now. $700 per month. $900 per month. $1,100 per month. It is incredible. Of course, if the only people rushing to purchase insurance are the people most likely to use it, the system will crash. Politicians may shade the truth, but numbers don’t lie.
The government is still making up the rules and regulations on the fly. The insurers are playing catch up. And the consumers, you and I, are trying to keep the whole thing straight. Almost 20% of our economy is devoted to our health care. This will get fixed.

We are all in this together.