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Life Health > Health Insurance

On the Third Hand: P-rays

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In 2001, the 9/11 attacks suddenly cast everything around me in a spooky, interesting new light. Suddenly, the police standing by the subway station were interesting. So were their guns. So were their German shepherds. For me, Monster Storm Sandy had a similar effect. The day after it hit, whether or not an ATM had cash or a gas station was open was banner headline news.

Now, for excitable people like me with an overly close relationship with the Patient Protection and Affordable Care Act (PPACA), PPACA is having a similar effect, flooding the benefits market with P-rays. From now until, maybe, the end of January, the P-rays are creating the illusion of a fantastic health insurance landscape in which everything – even the name of the tax form employers are supposed to use to report how many full-time equivalents they employ – matters. Any utopian vision is possible, and any dystopian nightmare is possible.

Everyone could end up with health insurance, a great doctor and a puppy.

The Republicans could stop PPACA cold and replace it with … nothing. Or a Not-PPACA World that’s almost exactly like PPACA World, except that the Republicans have their names on the Not-PPACA bill.

Or maybe the aliens that have been controlling President Obama from the caverns under Area 51 will give up the comforting illusion that we’re in control and make it clear that their little PPACA project is just an effort to produce a higher grade of human meat for their home world supermarkets.

You never know.

Editors look at my copy and tell me, gently, “Readers might not want to know the full name, tracking code and hidden PDF formatting information for Employee Benefits Security Administration draft guidance on the appropriate fonts and font sizes for PPACA benefits summaries.”

I look at them with glazed eyes and a panicked heart, thinking, “But the readers NEED TO KNOW that benefits summaries have to be created with at least 12-point type, and they have to know about how to install the new Times New Roman Navajo fonts, and what a SHOP exchange is, and what a stand-alone HRA is, and what an integrated HRA is, and that the new model privacy notices come with a cute picture of file folders with built-in zippers, and…and…”

But I bite my tongue and keep silent.

The gulf between the people who are seeing the world colored by P-rays and the world that healthy, normal people see is too great. Of course, once the exchanges really start up, and really start enrolling people in the qualified health plans — or the Republicans succeed at killing the exchanges dead — the P-ray effect will vanish.

We’ll go from a Dante-esque world of wonders and horrors to the usual world in which plenty goes wrong, some things go right, most people muddle through, and insurance professionals try to figure out how to cut through all of the institutional nonsense and solve problems.

The exchange plans — or the brutal death of the exchange plans — will increase competition in some markets, make dominant players more dominant in others, and make the variations between the health market rules in effect in different states smaller but more exasperating than they were before. In the reddest of the red states, Republicans will suddenly be giving a large block of poor, sick people who have avoided voting a huge incentive to vote — to protect the federally-run programs that supply their health insurance, or to punish the officials who failed to take the Medicaid expansion money while the getting was good.

On the one hand, the fading of the P-ray effect will probably make the world a little less colorful for anyone involved in health insurance who has found that, for the first time in their lives, friends and relatives are interested in what they do at work.

On the other hand, once the P-rays fade, insurance professionals may find they have an urgent, difficult-to-satisfy need to figure out how to get past those infernal exchange contact centers.

On the third hand, whatever happens, confusion seems likely to increase. That bodes well for insurance professionals.

For more from Allison Bell, see:


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