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An author of no particular popularity

Jay Lake
Date: 2013-11-18 06:52
Subject: [politics] Obamacare and open enrollment windows
Security: Public
Tags:family, health, healthcare, personal, politics
One thing I haven't seen discussed in the enrollment figures for ACA (or if it has been, I missed it), is the ludicrous mismatch between the ACA enrollment period and the open enrollment windows in most corporate insurance plans, including COBRA participants.

I'm terminally ill with advanced metastatic colon cancer, and expect to pass away by next summer unless I get very lucky with a clinical trial. Over the past five and half years, my insurance carrier has covered over $1.3 million in medical billing, most of it at a 25% contract discount rate, to keep me alive. In other words, they're in for close to a million bucks on my already. The rest of my life will cost somewhere between $50,000 and $250,000 more, at an educated guess.

So you can imagine my keen interest in the ACA rules, specifically the elimination of lifetime spending caps which came along just in time to keep me from having to pay for my treatments out of pocket. A spending level you may rest assured I could not possibly meet on my resources. Likewise the elimination of restrictions on pre-existing conditions, which in my situation is obviously an enormous issue as well. Other family members on my coverage have pre-existing conditions also, so this problem exists for me long after my impending death.

I'm on COBRA now, as part of my exit from the workforce on Long Term Disability. COBRA is pretty pricey for me. I was very interested in ACA plans in my home state of Oregon, through the Cover Oregon program. But in order to retain my COBRA coverage, I had to respond during an open enrollment window in early November, which just ended. Meanwhile, in Oregon the ACA plans are not fully configured or priced, so I had no way to evaluate whether my replacement coverage through Cover Oregon would meet my very substantial end-of-life healthcare needs, let alone the more ordinary needs of my dependents.

I suspect there are tens of thousands, possibly hundreds of thousands or more, people like me nationwide either trapped in expensive COBRA plans or in substandard employer-sponsored plans, who would have loved a shot at ACA enrollment. Had the law brought the enrollment window forward to Q4-2013 instead of Q1-2014, we could have done an apples-to-apples comparison and shopped accordingly, in conformance with good conservative free market principles. But the timing of the ACA means anyone with a mandatory open enrollment window in this last quarter of 2013 had to give the ACA a pass for 2014.

That right there would have made a huge difference in the Obamacare enrollment figures.

I'm pretty sure this is the kind of oversight you get when the people who write the rules never have to live by them. But it's a very damaging one from a policy perspective, and a very annoying one from a personal perspective.

Don't even get me started on how the disability system works, btw. It's literally a racket, protected by law, that steals from people in their hour of greatest need.

For my own part, I'm just happy the lifetime spending caps are gone. There is no conservative plan for healthcare that involves anything for me other than "go ahead and die already", so even though I cannot enroll in an ACA plan, I remain a strong supporter on a purely personal level as well as in line with my long held liberal-progressive principles.
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User: nicosian
Date: 2013-11-18 14:57 (UTC)
Subject: (no subject)
I know a few people are having issues with the site ( no surprise) a few have been successful and are happily insured now, and more than a few who are playing the "wait and see" game.

And one or two who have simply decided that it's just not gonna work so why even bother. ( they spend more time whining and being mis informed rather than trying to access the system or get informed.)

I get it, change is scary for people and this is a big change. but for the majority of the people I know, all the reforms and the market thing is turning out pretty good for them.

I do question how they determine subsidy because a few people I was sure who'd qualify, don't.
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Jay Lake
User: jaylake
Date: 2013-11-18 15:05 (UTC)
Don't get me wrong, I am all for this. But the timing sucked for anyone with a mandatory open enrollment period. I realize we weren't the primary market for ACA, it was the uninsured and those on open market plans, but it's still a large untapped constituency.
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User: nicosian
Date: 2013-11-18 15:10 (UTC)
Subject: Re:
I'm from canada and I'm honestly amazed that any healthcare reform in the US got this far in the first place. And I'm all for it. Most of my friends couldn't afford insurance any other way. A few have found plans now. Its a relief. I like my friends alive and cared for. Its a thing.;D

I suspect when we went single payer in '66 that there were hiccups too. And sometimes we have issues, like underserved specialties and regions, and ye old "we lost your paperwork" sorts.

It is one of those things that will need time to unfold, and I'm a bit surprised people are crying failure when something of this magnitude is bound to be a bit less than perfect. We are a society of "I want it now, I want it my way and I want it perfect."

I hope your disability claim issues clear with a quickness. I really am astounded at the system there, Its purpose built for maximum cruelty.
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Jay Lake
User: jaylake
Date: 2013-11-18 15:14 (UTC)
Subject: Re:
I hope your disability claim issues clear with a quickness. I really am astounded at the system there, Its purpose built for maximum cruelty.

That is an excellent description of the US disability system. What it's really built for is preservation of capital on the part of disability insurers, of course. Maximum cruelty is merely an irrelevant side effect.
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User: joycemocha
Date: 2013-11-18 15:27 (UTC)
Subject: (no subject)
Any chance you can switch over to a portability plan instead of a COBRA, which will transition into an ACA plan? When DS aged off of our health plan, we were shocked at the price difference between portability and COBRA plans. However, the portability might have been a Kaiser thing....
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User: cathshaffer
Date: 2013-11-18 20:44 (UTC)
Subject: (no subject)
Oh, you can cancel your cobra plan by simply not paying the premium. Or call and notify them if you want to be nice. Generally true of any insurance. You need open enrollment period to sign up or make a change, once your insurance is established, but you can quit any time. Good luck!
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Geri Sullivan
User: gerisullivan
Date: 2013-11-18 23:47 (UTC)
Subject: (no subject)
Yes, this. If there's a Cover Oregon plan that meets your needs, you should be able to enroll in it during its Open Enrollment period and discontinue your COBRA coverage at that time.

Also, people experiencing what are called "Qualifying Life Event Changes" can make benefits changes outside the Open Enrollment period. The timing on that is limited to 31 days of the Qualified Life Event, which can be hard on people who are grieving and already dealing with a lot of other things, but it's available.

ACA Q&A on COBRA coverage.

The fact that you can change insurance over to an ACA/Cover Oregon plan doesn't mean it will be worth the time, effort, or implementation realities of doing so. Health care insurance coverage in this country is improving in some ways, but it still sucks, as you've already found all too often along the road of collecting benefits from it.

Note: I am not a lawyer, benefits administrator, employed by any companies offering health insurance, or involved in implementing the ACA. I have, however, been doing layout of employee benefits and open enrollment materials for major companies and public utilities for the past 25 years.
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User: mmegaera
Date: 2013-11-19 00:10 (UTC)
Subject: (no subject)
I had to contact my state legislator to get enrolled in my state exchange here in Washington. Their website really did not like the formation of my name, which is first initial middle name last name (as opposed to first name middle initial last name), and I couldn't get through on the phone after calling daily for three weeks (not even just a long wait time, but a "we're so busy we can't take your call try again later" message), so I emailed my legislator because I was beginning to wonder what was going to happen on January 1st when my current plan doubles in price which I can't afford. Bless him, he got someone from the exchange to call me in less than two days, in spite of being a Republican [g], and the lady I spoke with set everything up with my correct name formation and even filled the forms out for me.

I will be richer by almost $300 a month starting in January, with a much lower deductible and better coverage.

I was for Obamacare from the beginning, and even after (especially after) this experience I still am. Everything has birthing pains.
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