I recently wrote an impassioned article about the philosophy that underlies the Obamacare and the way in which it was sold to the nation.
Its argument stands, but I have just learned that that article included an error – an error made because of problems with the WA Health Exchange site through which I purchased my plan.
My conscience requires me to write this follow-up – not just because I don’t want to be knowingly peddling half truths, but also, and rather more urgently, because my discovery of the error leads me to believe that thousands of families may be paying massively more than they have to for their insurance under Obamacare or may be unnecessarily going without health insurance altogether.
The sentence in my previous article that I have to revisit is this one.
A slightly worse policy [than the one I had before the ACA was implemented] (which I have purchased) costs me 20% more – presumably somewhat “subsidized” on account of my modest income.
It was wrong on two counts. First, the policy I bought under Obamacare was not slightly worse than the one I had pre-Obamcare – it was much worse. Second, that higher price I was paying for that policy included no subsidy whatsoever, despite the fact that I am, as I supposed, eligible for such a subsidy on account of my income.
Some time after my former health insurance provider cancelled my policy last year – and then informed me that the price of their nearest equivalent policy under Obamacare was so much higher that I could not afford to buy it – I reluctantly ventured onto the Washington State Health Insurance Exchange website and entered my details … and selected the cheapest policy available, which was, as per my earlier article, 20% more expensive than the one that had been cancelled.
My first premium payment cleared my account last month and I was enrolled in my new healthcare plan as of 1 January.
Although I figured I was eligible for a subsidy, when I purchased my new policy, the WA site provided no information about the amount of that subsidy, instead giving me just my final policy premium.
Three weeks later, I wrote my recent article on Obamacare. I sat on it for days while I made multiple attempts to call “customer service” at the State exchange to find out the exact amount of the subsidy I had been eligible for. Every time I called (I stopped counting after the fifth attempt), I would get a recorded message that told me that they’d “been receiving a large volume of calls” and that I should call back another time. Rather than wait any longer, I published the article.
But I remained curious about the exact amount of that subsidy – and continued to try to get through. (I even sent an email but no reply as yet.) However, in one of my attempts to pull the exchange’s website, I obviously made some error in the search field, and clicked on the site of an insurance broker with a similar URL.
Assuming that I was just on a newly updated version of the WA state exchange site, I called the number on the page. When I got through, I expressed surprise to the gentleman who picked up the phone and, realizing after a few seconds that something strange was afoot, I asked if I had gotten through to a private company accidentally.
I had. And it turned out to be the best mistake I have made since, well, Obamacare.
Vernon, my accidental new health insurance agent, was able to pull up the original application I had made through the state exchange website and answer my question, at last: the total subsidy that had been applied to my health insurance premium was … zero. But he could also see that I was eligible for a subsidy based on income, and quickly worked out why it had not been applied.
The reason is shocking because of its implications.
I had made the “mistake” of correctly answering two questions in my application as they were asked – but not as they were meant.
The first question was whether anyone in my household had any other insurance policy. I answered affirmatively since at the time of applying, I had a privately purchased policy. In fact, said Vernon, the system took an affirmative answer as indicating that I had an employer-provided policy, which makes me ineligible for the subsidy.
The second question was whether I had a passport. I answered affirmatively and entered the required details. Despite the fact that I had already told the system that I am a legal permanent resident (which makes me eligible for a subsidy), another glitch in the system, Vernon informed me, caused it to make me ineligible because my passport is not American.
It turns out that what the system really needed was my greencard number – but it never asked for that.
This is frightening: if it weren’t for the fact that I was a curious political writer who wanted to know exactly what subsidy I had been eligible for; that I had not been put off by the many times I had tried to get through to the exchange to find out that information, and that I typed in a wrong URL somewhere along the line and gotten through to a private health insurance broker, I would never have known that I didn’t have to pay anything close to the amount that I had already begun paying for my healthcare. Vernon sorted it out for me – but how many other Americans, I wondered, have failed to have the subsidy to which they are “entitled” applied to the cost of their premium? These are not small amounts.
But it was just as well that I didn’t enter a state of shock – because I probably wouldn’t have been able to get treatment for it under my new plan, as Vernon went on to explain.
As far as I could understand, the plan I’d chosen on the state exchange is administered by the same organization that provides Medicaid coverage, which pays doctors 25 cents on the dollar for their work. Most doctors and hospitals don’t want to deal with this so they refuse patients with coverage from this organization. Therefore, the policy that I was paying over-the-odds for has an extremely limited range of doctors, hospitals and treatment options. I knew my new policy was worse (in terms of deductibles etc.) than the cheaper one that had been cancelled – but I had no idea that the quality of care I could receive under it was significantly poorer than that supported by any other policy I could have chosen, including some only very slightly more expensive.
None of that critical information about the policies, obviously necessary to making any informed decision, was available on the State site. I ventured to Vernon that the whole thing was outrageous. He agreed, and told me that you shouldn’t expect the State to be able to broker healthcare.
Whether someone buys a policy on the State exchange, and then takes the subsidy that may enable them to undo the increase in cost of the policy under the Affordable Care Act, is up to him or her to decide, and I have been public about my philosophical issues with the whole thing. Nothing I say here changes my earlier argument – but a system that drives the cost of a product up, and then mandates purchasing it, is surely even worse if it fails to enable some people to enjoy the financial remedy to which the same system “entitles” them.
I know now that problems with the State and Federal exchanges are much more than glitches. They are serious errors that are causing unsuspecting individuals and families to pay massively more than they are legally required to pay for something they are forced to buy. And faced with this unnecessarily high premium, some families will decide not to carry insurance at all. This puts lives at stake.
There will be yet others who made the other mistake I made – of choosing a policy that looked like all the others on the website, without having any idea that when they need it, they’ll get massively worse care than they would have if they had spent just a few bucks more. They will make that mistake because the state site on which they buy their insurance is missing critical information. This state of affairs is frightening because a non-expert could never know what pertinent information is missing.
Consider this a public service announcement.
Please, for the sake of your family’s physical and financial health, do not do what I originally did and simply visit the website of your state exchange, buy a plan, and assume everything is fine. Find your own Vernon – an experienced private health insurance agent who is authorized to help you buy a plan, on the exchange if you so choose. He knows more about the glitches in the system and the plans on offer than you do.
Somewhat ironically, that’s because he’s had to compete in a real marketplace and would already be out of business if he couldn’t.