John Locke Update / Research Newsletter

A Pre-New Year’s Hangover

posted on in Health Care

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2013 has probably triggered a pre-New Year’s hangover for those keeping up with the ever-evolving Obamacare.  Just within the past month, a plethora of White House power-grabs have been imposed upon insurance companies, providers, patients, and taxpayers. 

A quick recap:   

Earlier this week, America’s Health Insurance Plans, a trade group representing 95% of the industry along with nearly all Blue Cross Blue Shield plans, agreed to the Obama Administration’s urgent request to extend premium payment deadlines for federal exchange consumers.  Individuals seeking coverage through the exchanges have until December 23rd to enroll in a plan and were required to pay their first month’s premium by December 31.  But now, the first month’s payment deadline has been extended to January 10th.  What this means is that individuals can gain access to coverage now and pay later.  Yuval Levin with National Review Online sums it up pretty concisely:

They are asking insurers to pay claims for consumers who haven’t paid their premiums, to treat out-of-network doctors and hospitals as though they were in-network, and to pay for prescription drugs not actually covered by the plans they offer.

Essentially, the retroactive payment decision largely results from a failing healthcare.gov, the federal health exchange website that has only been 60-70% built.  Insurance applications are still not processing correctly — enrollment files (known as 834s) are either not transferring from the website to the insurer, being sent in duplicates, or missing data.  Meanwhile, of the 365,000 individuals nationwide who were able to make it across the application process finish line, insurers report that only 5-15% of selected plans have been paid for.  9,000 North Carolinians have completed the process thus far.         

The extension does intend to alleviate significant concerns of individuals purchasing plans on the exchange who cannot risk major coverage gaps and gives time for insurers to scramble around and find out who they will actually be covering.  

All this figuring will be even more challenging since President Obama urged insurers to extend "subpar" policies for individuals for another year.  Blue Cross Blue Shield of North Carolina has gone forward with this decision.

And most recently, Health and Human Services Secretary Kathleen Sebelius wrote a letter to senators saying that catastrophic plans are now available for all individuals, not just those under the age of 30.  The letter further stated that any individual whose plan has been canceled and who self-attests that they cannot afford an exchange plan may now purchase catastrophic coverage.  But this breaking news won’t necessarily alleviate an individual’s affordability problem — in some cases, catastrophic plans cost just as much if not more than bronze plans.

This is a crystal clear admission from the White House that the Affordable Care Act is not affordable for many.  It is bad policy.  But this negative energy can be channeled towards achieving positive outcomes for the future of health insurance reform.  Since Obamacare already has set up exchanges, why not pivot towards private exchanges?  Private exchanges have been around since before Obamacare was conceived.  There are three types of private exchange models: group, individual, and individual in group clothing.   

Private exchanges in the individual market would allow individuals to build their own health plans without being forced to purchase insurance that must include the federal health law’s 10 essential benefits.  Furthermore, the Liazon Corporation reports that a private exchange’s inventory of supplemental products grants the consumer the ability to purchase an inexpensive health plan while adding specified coverage:

In this case, the consumer may be paying less for an insurance package that provides a specified level of comprehensive coverage as opposed to purchasing a more expensive plan that may offer benefits and services the consumer does not want or need.   

This approach is just one method through which consumers and patients can take charge of their health insurance preferences, not Washington. 

Click here for the Health Update archive.

Katherine Restrepo is the Director of Health Care Policy at the John Locke Foundation. Before joining the John Locke Foundation, she interned at the Cato Institute under the direction of Michael Cannon, Director of Health Policy Studies. Katherine’s… ...

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