Ninety percent of everything has unspeakable problems, so, of course, 90 percent of anything to do with new Patient Protection and Affordable Care Act (PPACA) programs has unspeakable problems.

Various people will complain that, for example, a PPACA public health insurance exchange has problems with verifying whether applicants live in the right market to buy the coverage they want to buy, whether they’re citizens of the United States, or whether they actually exist.

The exchange (or other targeted entity) will often concede that it has verification system problems, then go on to add that the verification problem isn’t that big of a deal, because the insurance applicant, the exchange plan issuer, the exchange system services vendor, or other potential bad guy is subject to attestation requirements.

In other words, someone who could be lying has to swear, upon penalty of perjury, that he or she is telling the truth. Eventually, if he or she is lying, the Internal Revenue Service (IRS) or some other entity may use the kinds of verification systems the IRS now uses to catch problems with bank account interest reporting to catch PPACA perjury. The liars could end up being characters in a new, health-flavored sequel to “Orange Is the New Black” titled, “Orange Is the New Black: PPACA Perjurers Unit.”

See also: Feds may go after some ‘special’ PPACA exchange plan enrollees

On the one hand, the PPACA public exchange applications do require the people who fill out the applications to swear that they are giving honest answers, under penalty of perjury, and that they know they may be subject to penalties under federal law if they lie. I’m sure just about every other application or bidding process associated with PPACA has some kind of similar attestation process connected with it.

On the other hand, seriously: Perjury attestation provisions might work on insurance company executives, actuaries and information technology vendors, but what consumers read all of these Web agreements and perjury attestations that they’re signing? What percentage of the consumers, who, say, apply for special enrollment period (SEP) coverage have any idea what perjury is, even immediately after they finish reading a definition of perjury?

Typical consumers don’t even believe that lying on an insurance application is wrong. They think the entities trying to keep sick people from buying health coverage, or trying to keep sick people from getting free health care, are wrong. Just about the only people with the stomach to say no to seriously ill people are insurance company money managers who see how fast the cash is flying out the door and how quickly the till is likely to run dry, or health care providers who are exhausted from providing free charity care to patients who, in many cases, look as if they could have done a much better job of preparing to handle their own medical expenses.

Consumers with an inkling that they might have leukemia or lung cancer who see the perjury warning may well think, “OK, fine. What jury is going to convict me of a serious federal offense just for trying to get someone to pay for my obviously needed care? Even if a jury sends me to prison, am I going to live long enough to spend much time there? Would the prison hospital be all that much worse than whatever situation I’d end up in if I were uninsured?”

On the third hand, how else can the PPACA World minders apply the SEP system rules in a world in which most of us are ambivalent about making poor and moderate-income people spend large sums on health insurance, and in which we’re squeamish about punishing sick people?

What about … developing a network of intelligent, licensed, reasonably well-compensated professionals who have gone through a fingerprinting and background check process, know their local communities, and have the judgment and personal contacts to make a reasonable seat-of-the-pants guess about whether a SEP applicant is legit or not? Maybe these SEP application screening professionals could have brick-and-mortar offices. Maybe they could be, um, be reading this column…

See also: 

CMS: No PPACA exchange delays

GAO: HealthCare.gov lets fake people re-enroll

 

 

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