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Life Health > Health Insurance > Health Insurance

On the Third Hand: Gaps

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Some people love the Patient Protection and Affordable Care Act (PPACA) and some people hate it.

Some people have what look like great arguments about why it will succeed or why it will fail. My bias in this area is: You never know.

Along the same lines: Actuaries, consumer advocates and others have great arguments for and against actually changing the PPACA exchange plan open-enrollment deadline dates.

The best argument for doing so is that it just seems really unfair for the U.S. Department of Health and Human Services, health insurers, state government officials and exchange program managers to push their problems onto the shoulders of consumers who had no ability whatsoever to figure how to comment on a proposed regulation, let alone affect exchange IT work.

The best argument against changing the deadlines is that doing so could throw off actuarial projections and undermine pricing that hurts the participating health insurers. If changes that seem small but, actually, are big hurt the exchange plan issuers, that could make the PPACA exchange program less sustainable than it otherwise would be.

At some level, whether the program is nice to consumers or not may be less relevant than whether it’s possible to make the books balance. Life is not fair; it is highly sensitive to profit and loss.

But I think it seems obvious that consumers who can come up with a receipt or certified document proving that they submitted something resembling a reasonably complete exchange plan application and an estimated premium payment through, an exchange agent, some other type of in-person assister, or registered U.S. mail by Dec. 15 ought to at least have some kind of temporary gold-level coverage in place Jan. 1.

Dec. 15 is the current enrollment period deadline for consumers who want to have coverage start on New Year’s Day.

When members of Congress ask HHS officials what will happen if the isn’t really ready for people to try to enroll in plans by the end of November, the officials recite canned non-answers about how the exchange will be ready by the end of November. It doesn’t seem as if anyone at HHS is being very clear about what will happen to consumers who do their best to get complete, clean applications in on time but can’t do so because state or federal exchange systems are still in the fritz.

In this situation, the exchanges really are the exchange plan brokers. If an ordinary broker mangled 2014 insurance policy enrollment because its computers were on the fritz, state regulators would probably holler at the broker and tell the broker it was financially responsible for the medical bills for consumers who incurred uninsured expenses mainly because of broker-caused coverage gaps.

If the broker went broke and couldn’t handle the bills, chances are the regulators would get the insurers that had done business with the broker into an electronic-cigarette-mist-filled room and strongly encourage them to make the consumers whole.

For purposes of 2014 exchange plan coverage, HHS should use guidance or some other strategy to ensure that HHS, the exchanges and the exchange plans will somehow take responsibility for any uninsured consumer medical bills that appear in early January because of exchange application intake system and application processing problems.

On the one hand, maybe doing that will be difficult, for some kind of statutory or political reason. Or maybe HHS rules already make this kind of solution a reality, and this blog entry is unnecessary. Maybe there’s just some public relations reason why HHS officials can’t talk about how this is a problem that’s already solved.

On the other hand, I think HHS officials either ought to make it very clear that a fix like this is already in place, and that consumers who do their best to get applications in on time will definitely have coverage in place Jan. 1, or they ought to talk about what they’re doing to get that kind of fix in place.

On the third hand, PPACA opponents may say they have no interest in allowing any kind of fix to take place, because they have no interest in seeing PPACA do anything but disappear. If PPACA opponents want to carry on a battle like that, OK, but structure the battle so that it’s another battle like the partial furlough battle, that mostly pits healthy adults against other healthy adults. Figure out how to take care of the bills of the sick people immediately, while the battle is going on, and get them out of the middle.

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