Kevin Knauss: Health, History, Travel, Insurance
Posts related to the implementation of the Affordable Care Act and potential changes to the rules, primarily in California.
In what has become routine for Covered California, they alerted agents to another CalHEERS enrollment website problem late on a Friday afternoon. The latest email notified agents that the system has been calculating the wrong Advance Premium Tax Credit (APTC) on submitted applications. While the Covered California email blast wasn’t real specific, it sounds like the APTC number is wrong when the applicant confirms the health plan purchase, but correct in the “Eligibility Results” page.
The Small Business Health Options Program (SHOP) from Covered California has unfortunately proved itself to be just as inept at processing enrollments as the individual and family plan side. What promised to be a stream lined and easy process for small employer groups to offer health insurance to employees through Covered California is beset with a dysfunctional enrollment website and poorly trained support staff. They make Anthem Blue Cross’ decision not to offer plans through SHOP absolutely prophetic.
Covered California has provided basic statistics and pretty pie charts on enrollment numbers into the ACA health plans that they offer. But what is left out is the statistical data that economists and demographers would like to have to ascertain if the Affordable Care Act is merely working or if it is actually fulfilling the promise to reduce health disparities in our communities with affordable health insurance.
Health Net notified all their California agents by a letter dated January 29th, that effective March 1, 2014, they will slash the sales commission by over 50% on four of their five individual and family plans offered in California. This further reduction in compensation for agents since the ACA was passed continues to make customer service oriented health insurance agents a “family of dinosaurs” who will quickly become extinct.
The Individual Mandate of the Affordable Care Act psychologically chafes folks who don’t appreciate the government telling them what they have to purchase. Count me in that segment. If one of the goals of the Individual Mandate is to make people take responsibility for expensive health care, an alternative might be an unforgivable tax liability on those people who have chosen to forego health insurance and incur large medical expanses that go unpaid.
When the insurance companies are having their risk for unexpectedly high health care expenses subsidized they should not have the luxury of creating tight doctor and hospital networks. The restrictions on network providers for cost containment purposes is exceptionally irritating when it is the plan members that are helping fund part of the risk reduction provisions by having to pay for the reinsurance fee on qualified health plans. Restricted networks and new EPOs are just a “work around” solution to allow health insurance companies to selectively limit health care like they have done in the past.
One of the hidden dangers of the Affordable Care Act’s Advance Premium Tax Credit (APTC) provision to lower the cost of health insurance is the possibility of having too much tax credit issued for the tax payer’s final income. If the ACA applicant doesn’t report increases to the household income during the year, which triggers a corresponding decrease in premium assistance, the tax payer will be liable to pay the excess back. Fortunately, there are limits to the repayment of excess APTC based on household income.
I’ve tolerated the many failures of Covered California until yesterday when they absolutely refused to help an applicant that has been left without health insurance. Miss B’s situation where her application has mysteriously become lost after allegedly being transmitted to the carrier is not unique to me or Covered California.
At a hastily arranged conference call for insurance agents to address a variety of issues involving new individual and family health plans for California, the Anthem Blue Cross Regional Sales Manager for Northern California announced they were extending the payment deadline until January 31st for policies sold through Covered California with effective dates of January 1st, 2014. This is the third time Anthem has extended the deadline for new enrollments.
Families that didn’t have their insurance cancelled by the ill-fated Covered California forced policy cancellation of December 31 are now wrestling if they should make their current health plan premium for January. The utter lack of communication between Covered California and the health plans has left many families without knowing if they do or don’t have health insurance.
