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.


  1. Posted on the website:
    Ellen says:

    February 13, 2014 at 8:05 pm (Edit)

    I thought NO ONE could be turned down??? Meh.

  2. A couple of comments from Michael Saltzman that were posted on the website:

    Michael J. Saltzman says:

    February 15, 2014 at 1:15 am (Edit)

    I shot the sheriff, but I didn’t shoot no deputy.
    Do not resort to violence.

    Michael J. Saltzman says:

    February 15, 2014 at 1:20 am (Edit)

    You have the patience of a saint.
    No one wants to be a patient without health insurance.
    Is it true that will be nominated for website of the year?

  3. From The Website:

    Philip Sharp says:

    Sounds like the old HR Block “interpretation” of the earned income credit. Some well meaning dolt at apparently thought they could help the family by having the spouse file for her own coverage under Medicaid to pay nothing. Too bad that is an incorrect interpretation of the law; they are married and it is supposed to be a family policy. This isn’t the corporate world where both spouses work for different employers that offer health care coverage; which de-facto forces both spouses to be on their own plans, with one spouse covering the dependents.

  4. Phil:

    I wish. That would imply that it is an easy mistake to fix. No, this is a programming error. We have lots of people erroneously sent to Medicaid. Last week I received a call from a woman who had been deemed subsidy eligible but her two kids were sent to Medicaid. They were, of course declined by Ohio. She reapplied through the federal exchange and the kids were, again, dumped on Medicaid. She is stuck in a loop. She can't afford to pay the new, much higher premiums and she can't get the subsidy due to the programming error. AND NO HUMAN BEING IN WASHINGTON CAN OR WILL HELP HER.

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