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An ‘Obamacare’ Success Story

AFA [1]Insurers, Too, Must Be Held Accountable

Our friend Stephen in NYC, who has contributed good ideas to this blog before, shares his experience in enrolling with an insurer. Stephen makes the very important point that the news media (including us bloggers) would serve the public interest if we would “start reporting on the incompetence of the health insurance companies and their technologically defective systems for enrollment, rather than putting all the blame for the recent mishaps of health insurance enrollment on the ACA rollout. My own experience is a case in point.”

One week after his old health-insurance policy lapsed, and three weeks after he mailed his application (with payment) to a New York health insurance company—and after speaking to eight customer service representatives and supervisors at the new insurance company over the past week—he was finally enrolled in the policy he had applied for (retroactive to Jan. 1), perhaps moved along by the threats he made earlier that day to alert the New York State attorney general, U.S. Senator Kirsten Gillibrand, and WOR-TV’s “Help Me, Howard” if his policy was not in effect within 24 hours—in addition to the letter that he had sent to The New York Times the day before, which is copied below.

To the Editors:

The NY Times and most other (all other?) news organizations have been covering the mishaps of the ACA rollout and ascribing them entirely to the incompetent programming of the new fed health-exchange website and some state health-exchange websites. I’d like to suggest, from my recent experience trying to get a 2014 health-insurance plan by enrolling directly with a NY health-insurance company (i.e., NOT through an exchange), that much of the incompetence is with the health-insurance companies themselves and has nothing to do with ACA. I’m still trying to get my new health-insurance company, Emblem Health, to actually enroll me in their 2104 health-insurance plan (as opposed to theoretically enrolling me)—and I applied directly through their own system, not through the fed or state health exchange.

As of today, Jan. 7, I still don’t have health insurance (my 2013 plan lapsed on Dec. 31), even though I sent my application for enrollment, along with a check for payment, by mail on Dec. 16—and it was received there on Dec. 19. Since then, I have called Emblem Health numerous times and have spoken to seven customer representatives and two supervisors, and was assured on Dec. 31 that my enrollment was in fact being processed, and that I would receive an e-mail affirming that I would be enrolled shortly and that my coverage would be retroactive to January 1. I have received nothing. I called Emblem Health again today and spoke to another customer representative, who searched on the Emblem Health system and found that my name was not on it yet. Tomorrow, I will be calling the supervisor to whom I spoke on Dec. 30 AND ON Dec. 31 (when I stayed on the phone continuously for 3 hours), to ask her why I have not heard from her about my enrollment nor received the e-mail confirming my imminent enrollment and retroactive coverage. (It’s a good thing I’ve had no health emergencies during this past week.)

So when I read or hear news reports of how bad ACA is, I’ve decided to be skeptical, and I’d like the NY Times to demonstrate some of that same skepticism, and to report on the effectiveness (or lack thereof) of the insurance companies and what appears to be their technologically defective systems for enrollment. I would be happy to share with a NY Times reporter more details of my frustrating experience trying to enroll for a health-insurance plan outside the exchange.

Well done, Stephen. Congratulations. But note how much time and effort he had to expend—time he had to take from his freelance work, which means a loss of some potential income. It should not have to be so difficult.

Dear readers, we encourage you to share your experiences in enrolling with health care providers under the Affordable Care Act. You can also share your stories—success stories, we hope—on Facebook at ACA Success Stories [1] (facebook.com/acasuccessstories). Bloggers, reporters, hold the companies accountable, too, as well as the elected officials and pundits who are obstructing progress and exaggerating glitches and malfunctions for political gain.

We would also recommend that readers take a look at Rachel Maddow’s emphasis on the slow start of ‘Romneycare’ in Massachusetts (TRMS [2] 1/2/14). This healthcare coverage expansion program, now regarded as a success for the people of Massachusetts, is roughly the template on which the Affordable Care Act was designed.

Despite Successes, 47 Million Americans Lack Health Coverage

Josh Marshall of Talking Points Memo finds [3] that some 9 to 10 million people have gained health care coverage because of the Affordable Care Act, and that about 5 million “currently do not have coverage because individual states decided not to opt into Medicaid expansion.” By the end of 2013, more than 1.1. million Americans had signed up for healthcare coverage through Healthcare.gov. (One Charles Gaba has been compiling data [4] on the number of people who have enrolled for healthcare coverage through the 14 states that have exchange sites.) Still, the Kaiser Family Foundation reports, some 47 million [5] Americans are without healthcare coverage.

For political reasons, of course, Republicans want the president’s healthcare expansion initiative to fail.

While we’re “redistributing blame” for the ACA’s rocky start, let’s look also at what Steve Benen calls “the scourge of the wingnut hole [6]” (the term “wingnut hole [7]” was coined by Ed Kilgore). Whenever the totals of people enrolled in healthcare insurance programs under the Affordable Care Act are given, Benen says, “it’s worth remembering that the coverage totals would be far greater were it not for “red” states refusing to accept Medicaid expansion”—5 million greater, as Josh Marshall reports above.

In a related article, Ryan Cooper at the Washington Post’s Plum Line [8] points out: 

About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America. . . . The court effectively left it up to states to decide whether to open Medicaid, the federal-state program for the poor and disabled, to more people, primarily poor working adults without children. . . .

Twenty-five states declined. That leaves 4.8 million people in those states without the health care coverage that their peers elsewhere are getting through the expansion of Medicaid, according to a Kaiser Family Foundation estimate. More than one-fifth of them live in Texas alone, Kaiser’s analysis found.

Expanding healthcare coverage has been, and will continue to be, a struggle. But it is the good fight. It’s our hope that the circle of coverage will expand steadily, eventually to include all Americans, and that the insured will be able to have their policies in good health (that is, not to need them for anything too serious).

Further Reading

Healthcare.gov [9]

Kaiser Family Foundation [10]

Healthcare coverage at Think Progress [11]

Healthcare at Mother Jones [12]

Healthcare at The Nation [13]

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