March 29th, 2014

More Obamacare woes

Please read this to hear about one woman’s struggles with getting health insurance post-Obamacare, in a state (New York) that has the Medicaid expansion. An excerpt:

In fact, I started this process in October. And only today did I receive an email that my eligibility had been determined and I should log on to the site and choose a plan.

A detailed timeline of the actions I’ve taken proactively and reactively over the past 5 months would be mind-numbingly boring to recount, much less to read…

I have now spoken to three representatives today.

No one can actually explain the relationship between Medicaid and these various plans. (One is “primary” and one is “secondary,” although the representatives have differed on which is which, and do not seem to know what those characterizations mean in practical terms anyway.) The site does not have any explanatory content on the subject. The plans (when the page does load, perhaps once every half hour) are indistingishable to me.

One representative listed the insurance provider names (Health Plus, Emblem, bla, bla) and said “just pick one and I’ll put it in for you.” But how am I supposed to distinguish between them, I asked?

She told me I should write them down and Google them.

One representative has told me I must choose a plan by Monday or it will not take effect until the next eligibility round in November.

The next representative tells me vehemently that this is not true…

You have to read the whole thing to get the full flavor, but that will do for an introduction.

These stories do not seem to be limited to the usual slowness and frustrations of dealing with most government bureaucracies. They seem to involve huge chasms in the law itself, combined with lack of communication, combined with true confusion on the part of officials and their representatives in understanding the law. If they don’t understand it (does anyone?) how could they ever communicate clearly on the subject to the consumer?

My own experience trying to get information about Obamacare for a relative in California has been similar, and Medicaid isn’t even involved. Every time I call, it’s a crapshoot in terms of the answers I will get to the very same question I keep asking over and over: are the networks the same if you buy the same policy from the same company on-exchange vs. off? I’ll spare you the details, but suffice to say I’ve been working on that (and some other questions) since December of 2013 and have probably put in close to 100 hours on the subject, and still don’t really know the truth. My current working theory, based on pooling all the answers I’ve gotten from Covered California plus the insurance companies themselves, is that the companies’ networks for the “same” policies on and off exchanges are the same de jure but not de facto.

21 Responses to “More Obamacare woes”

  1. Geoffrey Britain Says:

    The more I hear and read, the more convinced I become that ObamaCare was never really expected to be viable. It seems likely that many of the people involved in creating ObamaCare hoped it would ‘somehow’ work out but no one ever had such a grasp of all the factors as to be able to say with informed confidence, that it was a viable proposition.

    I suspect the default position of those who created this debacle simply thought that it was a win-win, either it would work and take us closer to single payer or its failure could be blamed with the assistance of the MSM, on the ‘evil’ insurance companies and republican ‘obstructionism’.

    And the deaths and shattered lives that ObamaCare will leave in its wake, merely the necessary if unfortunate, collateral damage and sacrifice needed to take us to a fully socialized health system. They are monsters and, as many of the Nazi’s did, they justify and rationalize their monstrousness…as progress. Truly examples of the ‘banality of evil’.

  2. Ann Says:

    More and more with Obamacare, it feels as if we’re trapped in the movie Brazil. And I once thought that the height of surrealism.

  3. J.J. Says:

    This law is a lot like Prohibition. It is creating much more damage than anyone foresaw. There is also much civil disobedience (as there was during prohibition) – people are not signing up or can’t sign up or don’t even know they are supposed to sign up. It also looks like the back-room mechanics to find out who is signed up are not working. Thus, the law is unenforceable. I see a figure of 1 million of the those who have signed up are people who had no insurance before. That leaves 34 million or more who didn’t have insurance and still don’t have insurance. In other words, the law is a joke. The problem is the dems and the President don’t realize it. And will never admit it.

    Repeal and workable reform is the only way ahead. There is an article in Barron’s today about the way the private system where employers are providing insurance is rapidly morphing into a system where the employee picks and chooses from a range of companies and benefits so that they, in effect, get a custom designed insurance program, not a one size fits all monster. This model, since it includes such a large number of users, could become the model for all health insurance. More choice and custom design – what’s not to like?

    Congress needs to do is make all insurance premiums tax deductible as they are now for the employers and enact some tort reform. Let the states set up high risk pools and manage them for those who want insurance and can’t get it. Then get out of the way.

  4. Matt_SE Says:

    One word springs to mind: Kafkaesque.

    The proponents may have thought it would be win-win, but their mendacity and incompetence have guaranteed that it will be a loser.
    Still, it was an unavoidable step on the path to righting this country.

  5. Jenk Says:

    IMO one of the real monkey wrenches thrown into this whole ghastly thing was the Medicaid expansion–states which might have resisted were lured in by the prospect of more federal dollars for them to spend instead of their own funds. Alas, Pennsylvania is one of them.

    As a PA welfare caseworker my specialty is Medicaid. State-funded Medicaid (General Assistance) is fee-for-service and requires the medical provider to bill the state directly for reimbursement for each procedure, unless the person qualifies for ongoing Medicaid coverage (relatively few do). Then the person is enrolled with a health insurance provider which again bills the state for the premiums that person would otherwise pay and any other medical costs.

    People who qualify for federally funded Medicaid outside of TANF-related categories must be referred to Social Security due either to age or permanent disability. In the former case the person probably already qualifies for Medicare; Medicaid sets them up with an HMO responsible for billing the feds but only after Medicare has been billed.

    In the latter case the person is again set up with a health insurance plan until he or she qualifies for Medicare; the difference being that the Medicare insurer is the primary biller of the federal government.

    Those who do not qualify for Medicaid are referred to the ACA exchanges, which determine eligibility and then send the applications to us to be processed. Since that work falls to the state and the ACA approved insurers become the primary carriers, just as if Medicaid had been approved, all this Faustian bargain accomplishes is to increase the Welfare Department’s workload and dump more people onto a limited number of insurance companies. Not to mention the headaches it causes for those enrolled in plans they might otherwise not have chosen….

  6. Mike Says:

    I have no sympathy for anyone who tries to get “Government Insurance”. That means they are getting me to pay their bills. Will they pay mine? I have a few to send them.

    Anyone who signs up is cooperating with evil. I wish them what they signed up with.

  7. Beverly Says:

    RUN, people. Run like hell! before it’s too late.

    Thank God I didn’t proceed with the NY registration. I’ve already heard enough horror stories about people getting signed up for MedicAID against their will, and being unable to escape, and rendered uninsurable by any other entity/plan by that fact.

    Here’s Ann Coulter’s scathingly funny account of HER experiences: she’s in Connecticut, has to sign up because she’s an independent contractor, and … well, let Ann take it away. (This was so hilariously awful that Rush read it on his show yesterday.)

    “I’ve been thrown off my health insurance — THANKS, OBAMACARE! — and have spent hours and hours over the past month trying to figure out my options now that the Democrats have made my old plan, which I liked, “illegal.” (I prefer to think of my plan as “undocumented.”) ….

    As one of the few Americans not granted a waiver, I’m here to tell you: You have no idea what’s coming, America.

    … I discovered the premier plan — the “platinum,” low-deductible, astronomically expensive plan that might be accepted by an English-speaking doctor who didn’t attend medical school in a Hawaiian shirt and board shorts — does not include treatment at any decent hospitals.

    That’s sort of unfortunate because THAT’S THE ONLY REASON I WANT INSURANCE! That’s the only reason any sane homo sapien wants health insurance: to cover health care costs in the event of some catastrophic illness or accident — not to pay for Mickey Kaus’ allergy appointments. But my only options under the blue-chip plan were hospitals that also do shoe repair.

    I called Blue Cross directly to ask if its most expensive insurance plan covered the only hospital I’d ever go to in an emergency. Since that’s all I wanted to know, that’s what I asked. (I like to get to the point that way.)

    But — as happens whenever you try to ascertain the most basic information about insurance under Obamacare — the Blue Cross representative began hammering me with a battery of questions about myself.

    First my name. (Does that make a difference to what hospitals its plans cover?) Then my phone number. By the time he got to my address, I said, CAN YOU PLEASE JUST TELL ME IF ANY OF YOUR PLANS COVER XYZ HOSPITAL? I DON’T EVEN KNOW IF I WANT TO SIGN UP WITH YOU!

    Finally, he admitted that Blue Cross’ most expensive individual insurance plan does not cover treatment at the hospitals I named. Their doctors are “out of network” (and the person who designed this plan is “out of his mind”).

    This was the rest of the conversation, verbatim:

    ME: None of your plans cover out-of-network doctors?


    ME: Why is it called “Premier Guided Access WITH OUT-OF-NETWORK PLAN”?

    BLUE CROSS: Where did you see that?

    ME: On Blue Cross’ own material describing its plans.

    BLUE CROSS: Oh. I don’t know why it’s called that.

    ME: None of your plans cover (the good hospital)?


    ME: I don’t know who you are, but I have a very specific set of skills that will help me find you. And when I find you, I am going to kill you. (Click.)

    True conversation. Except the last sentence. That was my fantasy.

    I decided to approach it from the opposite direction and called one of the nation’s leading hospitals to ask which plans it accepted. The woman listed a series of plans, but she couldn’t tell me if I was eligible for any of them. For that, she said, I’d have to go to the Obamacare website.

    Does Obamacare cover suicide?”

  8. Richard Aubrey Says:

    Back in the day, of the Arab Oil Embargo, we had some problems. The late James Schlesinger, first secretary of energy, admitted after it was over, that we’d pretty much had the oil, it was just that the government didn’t know how to distribute it. So, while the shortages for people who needed it were real, there was no shortage in the sense of…not enough oil.
    Home heating oil–more folks used it then than now–was going to be short. Wear a sweater. Wear two. Bunk in with relatives. Don’t use a charcoal grill indoors.
    But to keep the economy going, there would be plenty of diesel for trucks, tractors, trains, etc. #2 diesel is home heating oil. So the local distributors bought extra–it was available– #2 diesel and sold it as home heating oil. Worked.
    Point is, when the government creates an unnecessary crisis, figuring out a way to live with it is a crime.

  9. Sorta Blogless Sunday Pinup » Pirate's Cove Says:

    [...] neo-neocon has more Ocare woes [...]

  10. Ymarsakar Says:

    Beverly, the out of network doctors are only for the rich, the politically connected, and Congress type pols.

    Some of us mentioned that health control was a form of rationing, to keep the masses away from health care products. Now not only do they keep their doctors to themselves, but you get to subsidize that, even while your own insurance doesn’t cover the “quality” doctors.

  11. IGotBupkis, "Si tacuisses, philosophus mansisses." Says:

    }}} One representative has told me I must choose a plan by Monday or it will not take effect until the next eligibility round in November.

    The next representative tells me vehemently that this is not true…

    So THAT’s the job that incompetent IRS “tax specialists” find to do!!

  12. IGotBupkis, "Si tacuisses, philosophus mansisses." Says:

    }}} Anyone who signs up is cooperating with evil. I wish them what they signed up with.

    Wasn’t that already pretty much established by its association with Obama?

    I can’t tell for certain if the current admin is simply inept or malicious, but either way, the end result is — when the chips are down — evil.

  13. Mr. Xyz Says:

    Short version of my NY experience: I gave them honest info and was channeled to Medicaid. I became worried days later because the ambiguous agreement says they can take your money, if you are over 55.

    I went back through the process and gave them bogus info, so that would hopefully negate my confused sign up. This was all in Nov. . A week ago they told me I should go onto a paid plan but was not eligible for a subsidy, because I checked off that I didn’t want one. MY concern would be that they would claw the subsidy back because I wouldn’t really make the necessary $15.6k that I said I would.

    I spoke with a state senator’s aid about this. He was a very knowledgeable person on selling long term care insurance, but was surprised about the issues that were coming up. I’ve never heard back from them, and what with Obama’s lawlessness, what’s the point in pursuing the issue? They’ve got us pushing on a rope!

  14. waitforit Says:

    The more I hear and read, the more convinced I become that ObamaCare was never really expected to be viable.–Geof Meof the Gritty Britty

    Who benefits from chaos? Not those with Property. Or mostly so. So why would Property be behind this movement?

    Answer: Age old answer: When one class (progressives) wants (progressives) against another class (conservatives) and cannot obtain by honest competition, War is the Answer. And there is enough Property in the camp of the Progressives due to “environmental, governmental” and other drop basins, that Property is no longer accumulated by reason and supply and character. Obama, Reid, and Pelosi rose to supreme positions of power without any real accomplishment.

    The Outcome, as represented by Faith, does not necessarily mean the demise of Progressiveness. If they seize enough control, then a period of starvation and begging (have we not seen begging) will occur.

    Perhaps the dystopian future has been programmed into our future.

    It is very difficult to answer the demands of scientific conditional (design) probabilities with the apparent lack of Answers. Since nobody has the Answer, it is wise to be skeptic, but skepticism has less value against the full rush of the ongoing curve.

    We are or we aren’t. That is the question.

  15. Mr. Xyz Says:

    I’ve read the woman’s whole piece now and am reminded of an issue that’s been flying under the radar, that I alluded to above.

    She wonders about the differences between these Medicaid provided health plans. If she is over 55 there may be an important difference to her because believe it or not, they could claw back money, even if she receives no health care from Medicaid.

    These providers are paid a capitation fee by the state. She, or her estate, may be liable for that capitation fee. That could be why they make her join one! See this article from Washington Times:

  16. Richard Aubrey Says:

    The Medicaid “clawback” is not new. The original presumption of Medicaid was that it was for the poor. The poor don’t have estates, so it didn’t matter that there was a clawback.
    However, some aspects of elderlaw involved ways to be artificially poor–giving your money away to your kids, for example–in order to put your medical bills onto the taxpayer when you should have managed them yourself.
    So there are now new laws. Transfers and other moves “in contemplation of death” or other strategies are illegal and still others allow the government to get your estate back in order to, in effect, repay the taxpayers you screwed by pretending to be poor.
    There is an old story about a state–poss Nebraska–which assigned a ‘crat part time to do this. Figuring the part of his pay and other comp from his time in the effort as a unit, he was able to recover fifty units.
    Draw your own conclusions.

  17. Mr. Xyz Says:

    The clawback may not be new, but how it is handled is subject to change. Even though it was created by federal law, it is handled differently by each state.

    There are long term care policies which appear to protect you from this, but “this” is specified as “Medicaid Extended” coverage. That is long term care, not health insurance.

    People who signed onto such policies could not know that they would be forced into Medicaid for routine health because the government would push up those insurance costs by mandating coverage of things they could have no use for, maternity care for instance. People between 55 and Medicare age have been pushed into a new doughnut hole.

  18. Mike Says:

    “Draw your own conclusions.”

    Here’s mine: Obama is demonic.

    Since I begin there, I am never surprised by these so-called “horror stories”. We expected beelzebub to produce non-horror stories?

    There is, however, a solution. I saw it in the movies once, in a certain Transylvania.

    On the other hand, the reality of decimation, poverty, bankruptcy etc. may suggest its own solution to the problem. Imagine that – at this point our best case solution is one calamity slightly less calamitous than another.

    I am thinking of having carved on my gravestone – I didn’t vote for him!

    Historians of the future will know exactly what that means.

  19. waitforit Says:

    There is no clawback because the rich cannot take care of the poor.

  20. RigelDog Says:

    I want to jump off a cliff. After everything the linked-author has gone through and will continue to go through—she makes sure to state that she completely supports the ACA.

  21. RickZ Says:

    RigelDog Says:

    After everything the linked-author has gone through and will continue to go through—she makes sure to state that she completely supports the ACA.

    That moron is ‘stuck on stupid’. And as we all well know, ‘you can’t fix stupid’.

    My Country is sooooo boned.

Leave a Reply

XHTML: You can use these tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

About Me

Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.


Ace (bold)
AmericanDigest (writer’s digest)
AmericanThinker (thought full)
Anchoress (first things first)
AnnAlthouse (more than law)
AtlasShrugs (fearless)
AugeanStables (historian’s task)
Baldilocks (outspoken)
Barcepundit (theBrainInSpain)
Beldar (Texas lawman)
BelmontClub (deep thoughts)
Betsy’sPage (teach)
Bookworm (writingReader)
Breitbart (big)
ChicagoBoyz (boyz will be)
Contentions (CommentaryBlog)
DanielInVenezuela (against tyranny)
DeanEsmay (conservative liberal)
Donklephant (political chimera)
Dr.Helen (rights of man)
Dr.Sanity (thinking shrink)
DreamsToLightening (Asher)
EdDriscoll (market liberal)
Fausta’sBlog (opinionated)
GayPatriot (self-explanatory)
HadEnoughTherapy? (yep)
HotAir (a roomful)
InFromTheCold (once a spook)
InstaPundit (the hub)
JawaReport (the doctor is Rusty)
LegalInsurrection (law prof)
RedState (conservative)
Maggie’sFarm (centrist commune)
MelaniePhillips (formidable)
MerylYourish (centrist)
MichaelTotten (globetrotter)
MichaelYon (War Zones)
Michelle Malkin (clarion pen)
Michelle Obama's Mirror (reflections)
MudvilleGazette (milblog central)
NoPasaran! (behind French facade)
NormanGeras (principled leftist)
OneCosmos (Gagdad Bob’s blog)
PJMedia (comprehensive)
PointOfNoReturn (Jewish refugees)
Powerline (foursight)
ProteinWisdom (wiseguy)
QandO (neolibertarian)
RachelLucas (in Italy)
RogerL.Simon (PJ guy)
SecondDraft (be the judge)
SeekerBlog (inquiring minds)
SisterToldjah (she said)
Sisu (commentary plus cats)
Spengler (Goldman)
TheDoctorIsIn (indeed)
Tigerhawk (eclectic talk)
VictorDavisHanson (prof)
Vodkapundit (drinker-thinker)
Volokh (lawblog)
Zombie (alive)

Regent Badge