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Curmudgeon's Corner

cur-mud-geon: anyone who hates hypocrisy and pretense and has the temerity to say so; anyone with the habit of pointing out unpleasant facts in an engaging and humorous manner

More ACA Details Becoming Available & They're Troubling

U.S., Quality of Life, Politics, Healthcare

We are beginning to learn about some of the issues that are now cropping up with regards to people who enrolled in health plans offered under the Affordable Care Act.  If you recall, the double-checking of things people reported was not being done in ‘real time’ given the problems with the HealthCare.gov website and everyone was assured that this would not be problematic.  People were taken at their word.  Premiums were subsidized based on what people said they earned versus on what the government’s records showed…since there was no immediate access available to see what those records showed given the problems with that website.

The Associated Press (AP) has now reported that “at least 2 million” people who enrolled for taxpayer subsidized private health insurance have “data discrepancies” that, if unresolved, could affect what they have to pay for health plans or even their legal right to those benefits.  And, the report states this number could well be higher than the “at least 2 million” mentioned earlier.  Since we were told that 8 million enrolled, that means that at least 25% of those enrollees could have some problems.  That is a tremendously high error rate when you typically think that something in the tenths of 1% is high.

A “discrepancy” wasn’t going to be any problem but now the AP reports that “a discrepancy means that the information they supplied, subject to perjury laws, does not match what the government has on record.”  The data discrepancies involve “conflicts involving important details on income, citizenship and immigration status, which affects eligibility and subsidies.”

The government has set up a system to “turn off” benefits for anyone who is found to not have qualified.

Think about the repercussions of this whole fiasco.  These people enrolled to obtain healthcare for a reason.  They had no coverage and they needed coverage to get treatment for whatever ailed them.  It stands to reason that as soon as they received their health plan ID cards, they made appointments and received the services they needed.  Many are probably still receiving services and the billings are piling up at the health insurance companies as the claims are filed by the providers.

The people who didn’t qualify will see their policies cancelled retroactively and the insurance companies will return the claims that were filed unpaid, will take back money already paid incorrectly, and the health care providers will get stiffed because chances are very good these folks had no money available with which to pay for the services they had delayed receiving in the first place.  Never mind that the IRS will go after the improper subsidies.  The folks who can’t afford to pay for the health services are likely to be unable to pay back any improper subsidies they received while insured.

The government tells us to not be worried about all this because “most of the time” the “inconsistencies” just mean that more up-to-date information is required and this will result in the problems going away.  I cannot help but think this is not going to be the case.  People would have tried to get bigger subsidies meaning they’d have said their income was lower that it really was.  If anything, there will be bigger issues than these and they won’t just go away when accurate data is given the HHS and the IRS.  By the way, remember that there were reports that some of the paid ‘enrollers’ were encouraging this kind of behavior to get more people in for better coverage since that was going to make the Affordable Care Act an even greater success.

This isn’t going away.  It may get swept under the carpet, but it isn’t going away.

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