Wednesday, May 28, 2014

No? Did You Say No? Thank You!


February 11th. The young family applied for health insurance on the government’s exchange on February 11, 2014. It was a frustrating experience that resulted in the young husband and his child being invited to apply for health insurance. They were even offered financial assistance. The 22 year old mom? The feds thought that she’d be better off with Medicaid. We tried to fix this. No luck. Nothing could be done about this error until the State of Ohio reviewed her case and ruled that she was not eligible for Medicaid. We applied for the subsidized health policy for the father and son. We kept the woman on her existing coverage. The notice was dated Sunday, May 4, 2014. Ohio, swamped with over 300,000 new Medicaid enrollments since last fall, finally got to my client’s paperwork and declined her. She is now officially eligible for the subsidized health insurance that she should have been able to purchase months ago.

No, for once, is the answer you want to hear.

My clients are responsible people who have always had insurance and always will. They found a way to put the monthly premium into their budget. But what if they couldn’t? This is a huge problem that has not been resolved. I am still having clients incorrectly shipped off to Medicaid. And what if the client has any ongoing health or financial problems? Then he is screwed. In the last month I have had numerous conversations with CMS and federal exchange employees, Senator Brown’s staff, and our elected officials in Columbus. Our main topic was how to make The Patient Protection and Affordable Care Act (PPACA) work better. Some of what I’ve learned was told to me in whispers. Some of what I’ve learned from experience has been grudgingly confirmed. And of course, there are glitches and problems that no one will acknowledge.
  • works best when using all capital letters and your Chrome browser.
  • Do not show a husband and wife earning the same exact monthly income. It throws the system.
  • has a big problem with large families.
  • Ditto newborns.
  • Unofficially, part of’s problem is that there was this assumption that it would be serving the uninsured. The government’s exchange defaults to Medicaid. You must qualify OUT of total assistance to earn a subsidy.
  • Undertrained, unprepared, and overworked, the call center workers shouldered a huge part of the burden. They are now fielding fewer, but more intense calls. Sitting in a cubicle, forbidden to use paper or pen to take notes, and unable to email for help, the call center assisters are totally overwhelmed by service issues. I have talked with veterans (8 months!) who are willing to try trial and error to solve problems. I’ve also had them hang up on me.
This is my work environment. The State of Ohio has just about cleared its back log of Medicaid applicants. Many of our citizens have recently learned that they will now have access to the health care that they need.

And a few of my clients will get the letter they really want. They will be declined for Medicaid and will now be able to buy an affordable policy.


Saturday, May 17, 2014

Stuck Between The Stairwell and The Men's Room


Room 113. The name plate on the massive wooden door identified this room, located down a hallway in the Statehouse, stuck between a stairwell and the men’s room, as the William Henry Harrison Room. Our ninth President, who served a little more than thirty days, merits the honor of a room, just not a really good one.

So much of our politics resembles Room 113. Style vs. Substance. The appearance of action attempting to replace actually doing something.

I was in Columbus to meet with Members of the Ohio House and Senate. It was our annual Day at the Statehouse, an event organized by the Ohio Association of Health Underwriters. Our task is the same every year – how can we help our lawmakers to make it easier for Ohioans to get the health insurance they want and need.

The last few years have been more challenging. We, the State’s insurance agents, are uniquely qualified to explain how the Patient Protection and Affordable Care Act (PPACA) has helped and hurt Ohioans. We know where Ohio laws and regulations have protected our clients. We also know where our State’s laws and regulations have made the acquisition of insurance more difficult or even nearly impossible.

Our annual visit to Columbus has become more difficult. Democrats are loathe to admit that the PPACA needs to be tweaked, lest that admission be perceived as a sign of weakness. And Republicans are afraid to acknowledge that anything, ANYTHING, good came from Obamacare. Republicans control the House and the Senate. Governor Kasich is a Republican. More and more of them are beginning to concede, albeit quietly, that the law is here to stay. But moving to make the law more functional is still tricky. And with the Republicans controlling the House, the Senate, and the Governor’s Office, it is up to them if anything is to be done.

Roaming the halls of our Statehouse, I met legislators from both parties who honestly, sincerely want to have a positive impact on the lives of average Ohioans. I met aides clearly aware of pending legislation in both chambers.

So this was a good year. But there are still lots of members, from both sides of the aisle, that have no interest in details, regulations, or functionality. Instead, every issue for them boils down to the lowest common denominator of Us vs. Them.

And while they are busy scoring points, we are stuck waiting for the State to make it easier for Ohioans to get health insurance. Eleven and a half million people stuck in Room 113.


Coming soon: No? Did you say No? Thank you!