Thursday, December 12, 2013

Clear as mud

According to Sarah Kliff at the Washington Post’s Wonkblog, “Obamacare’s deadlines are changing. Again.” :

With deadlines fast approaching and some shoppers still stuck, the Obama administration is proposing new ways to guarantee coverage to those hoping to gain insurance in January.

Health and Human Services announced Thursday some additional flexibility for those still hoping to buy coverage -- and many more steps that the agency urged, but did not require, health insurers to take.

Here’s the stuff that the Administration is doing unilaterally:

1) People will still have to enroll by December 23, 2013, to have coverage as of January 1, 2014, but they can delay paying their first month’s premium until December 31, 2013.

2) The high-risk pools established by ObamaCare, which were due to end as of December 31, 2013, will stay open until January 31, 2014.

Here’s the stuff that the Administration is urging (or “encouraging”) health insurers to do:

1) Allow people who sign up for coverage after the December 23 deadline to still start coverage on January 1. It’s not clear how late the Administration would like people to be able to sign up for coverage that begins January 1.

2) Allow people to pay for policies that start January 1 after the first of the month. It’s not clear how late the Administration would like people to be able to pay for coverage that begins January 1.

3) Keep paying to refill prescriptions that were covered under a previous policy.

4) “Charge patients’ visits for acute conditions to out-of-network doctors as if the physician were part of the health plan.”

Here’s my take on these actions and urgings:

1) The Obama Administration is now flailing around like a sign-language interpreter in the midst of a schizophrenic episode.

2) Somehow, someway the Obama Administration must be planning to compensate insurers (and/or medical providers) for the losses they could and almost certainly will suffer based on all this. Let’s say I enroll in an ObamaCare Platinum plan and write a check for my first premium on December 31. The check bounces but by the time it’s bounced, I’ve seen 10 doctors and filled 20 prescriptions. The insurance company isn’t going to pay. Do the doctors and pharmacies just eat the loss? Are they going to come after me? I’m the one who just wrote a hot check, remember?

Or let’s say the company writing my ObamaCare plan gives me until January 8 to pay my first premium. I can get some serious surgery done in a week and then just never write the check. Who’s going to pay for that?

Or let’s say the Administration wants people to be able to enroll in policies starting January 1 up until January 8. Maybe I wasn’t going to enroll at all or maybe I planned on getting a Bronze policy but on January 2 a doctor tells me I have a serious or chronic condition. It’s Platinum all the way for me. The insurance company is going to eat that one and never even know they’ve done so.

3) I don’t understand how paying to refill prescriptions that were covered under a previous policy is going to work. I’m assuming this is only for people who have insurance now but lose it on January 1 and haven’t signed up for other coverage. So how long is this grace period going to last and what happens if the person whose prescriptions are being covered never signs up for insurance at all or signs up with a company other than the one that’s been footing the bills for his or her prescriptions?

And what if I have obtained new coverage but my old insurance policy gave me a better deal on my prescriptions? If my new policy is with a different insurer, what’s to stop me from just not telling my pharmacy or my old insurance company that I have new coverage and continuing to get my prescriptions filled by my older, more generous insurer for as long as I can get away with that?

4) I really, really don’t understand how this is going to work:

Charge patients’ visits for acute conditions to out-of-network doctors as if the physician were part of the health plan.

Let’s say I go see Doctor Adams. He’s in network for my insurer, Acme Insurance. This means he’s agreed that he will charge only as much as Acme allows for the medical treatment he provides. For the sake of this example, we’ll say Acme allows $45 for an office visit and I have a $30 copay. That means Doctor Adams will charge me $30 for an office visit and bill Acme for the remaining $15. So far, so good.

Now let’s say I go see Doctor Baker. She is not in network for Acme Insurance. This means Doctor Baker is free to charge whatever she wants for an office visit. Assume she charges $120 for such a visit. Doctor Baker is not going to take just $30 from me; she’s going to want the whole $120. Is the Administration suggesting that I should be able to pay just $30 and Acme will pay Doctor Baker the remaining $90 she charges? If so, and I were Acme (or Doctor Adams for that matter), I would be just a wee bit upset.

Or is the Administration suggesting that Doctor Baker should take the $30 from me and the $15 from Acme and write off the remaining $75? If so, I have a king-size picture of that.

The damage done to real, live people by ObamaCare is painful and enraging to watch. At the same time, the cascading fiascos and the scrambling responses provide a textbook lesson in how health insurance functions. It also makes crystal clear that the people who wrote ObamaCare, implemented it, and are trying so desperately to keep it afloat, know very little about health insurance and understand even less.

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