By now, it's becoming increasingly apparent that hundreds of thousands of people, if not millions, with individual or self-employed health care plans could lose their current plans come January. Despite administration spin on this topic that the plans people may get will offer more benefits, greater protection and lower prices, the harsh reality is that both the prices and scope of the plans on the exchanges are coming as a shock to many forced to scramble for new plans on the balky, trouble-prone exchanges.
I'm one of them -- and in my advocacy journalism, I've been supportive of the Affordable Care Act and the Obama administration. So I was disturbed to learn that President Obama's repeated promises that I and millions of others took for granted -- "If you like your insurance plan, you will keep it. No one will be able to take that away from you" -- haven't turned out to be true.
In fact, my company and plan, Blue Cross/Blue Shield's DC HMO Open Enrollment plan, will allow for a one-year extension if you manage to wade through a complicated letter sent by mail -- not email -- explaining your options and then only if your re-enrollment is postmarked by Oct. 31st, tomorrow . That's an enrollment deadline you may be facing this week that's nowhere clearly and obviously mentioned in any emails, its home page or letters from the company. Nor have any state or federal regulators stepped in to give customers extra time to re-enroll as Blue Cross steams forward with their plans to drop hundreds of thousands of customers across the country on January 1.
Blue Cross officials weren't available for comment at the time article went to press, so it's not clear what portion of their 76,000 individual health plan customers in D.C., Maryland and Virginia who will lose coverage next year have the option to re-enroll for a temporary extension. While working on other projects, I attempted to alert well-established health care reporters and a few health advocacy groups in the last week or so about this deadline-specific Oct. 31st issue, but since I haven't seen it addressed publicly so far, I felt I had no choice but to write about it myself.
Conservative pundits and right-wing media have been pushing the broader dropped-coverage story stronger than most mainstream or progressive outlets, but that's starting to change with today's front-page Washington Post article: "Canceled policies spur furor over health-care law." Even so, some liberal organizations are insisting on echoing the administration's talking points . These include the arguments that the changes were expected, are no big deal and will lead to better, less expensive coverage for most. So far, most media outlets and liberal organizations are taking the administration claims at face value without independently examining the plans to see if they're, in fact, not compliant with the Affordable Care Act or that the exchanges offer a better deal; these supporters are also not addressing at all the upheaval of having to find a new doctor if the exchange plans don't include your current one. My personal experience, explained in more detail below, seems to indicate that the administration spin simply isn't accurate for many people facing cancellation notices.
Moreover, the administration and its progressive allies -- and I consider myself one -- aren't facing up to the PR disaster emerging from both the balky healthcare.gov website and how millions of people are facing cancelled coverage they now have. No matter how it's explained away or packaged, the prospect of dropped coverage impacting possibly millions of people simply doesn't square with repeated assurances from Obama and his allies that, essentially, no one would lose their current coverage. Most of the people offering reassurances that finding new plans on the exchanges isn't such a big deal are salaried employees of organizations, news outlets and companies that pay for their insurance; they might feel otherwise if they had to search for comparable plans that provide coverage for themselves and their families as the January 1 deadline approaches. It also could directly hurt many of the independent, freelance workers, influential creative people and self-starting tech and small-businesses entrepreneurs who could serve as a loyal base for Democrats in the years to come, but who may feel betrayed by what appear to be some broken promises on health care by President Obama.
My perfectly decent -- if over-priced -- plan I'm currently on has far more generous benefits than I can get for a comparable price on the exchange with my current company, Blue Cross. My current plan's relatively high cost of about $530 a month in premiums, I was surprised to learn, well more than doubles on the exchange for a Care First plan with comparable benefits
Just because the Tea Party extremists and their right-wing media allies have spewed essentially nothing but lies and distortions since Obamacare was first proposed, still doesn't mean that the critics are completely wrong about the dangers these changes could pose. As the old saying goes, even a broken clock is right twice a day. The Washington Examiner reported,:
CareFirst BlueCross BlueShield is being forced to cancel plans that currently cover 76,000 individuals in Virginia, Maryland, and Washington, D.C., due to changes made by President Obama's health care law, the company told the Washington Examiner today.
That represents more than 40 percent (emphasis added) of the 177,000 individuals covered by CareFirst in those states.
Good luck figuring this all out on your own. Lulled by the President's reassurances, relatively few people have bothered to closely read the letters they're getting from the insurance companies and to find out what their best health-care options really are. Here's the sometimes broken link to the CareFirst re-enrollment form that isn't even labelled "re-enrollment." It is filled with bureaucratic snares and opportunities for errors that could deny you coverage , and the web page and pseudo-enrollment form only mentions in tiny print in the ninth step that you must complete it and get it to a mail drop in Kentucky postmarked by Oct. 31, 2013 -- tomorrow, Thursday. (Note: I originally reported that it wasn't found anywhere on the web page, but, after careful scrutiny, I discovered that it's listed in tiny print at the end of step 9. The primary letter advising customers of their right to re-enroll doesn't contain the deadline date of Oct. 31st, but, a spokesman for Blue Cross advises me, the date is mentioned in the "step-by-step" instructions accompanying the letter. The spokesman, Michael Sullivan, concedes, " I understand your point about its prominence.:)
It'salso possible that many other plans offer no such one-year extension. But how many people have bothered to find out while listening to the reassuring messages coming from the White House over the last three years?
As a customer, it took me two levels of assistance and nearly two hours before I found anyone at Blue Cross/Blue Shield who knew how to fill out the tricky "change request" form. If you do want to try to re-enroll, and send by United States Postal Service Express to a Louisville, KY mail drop or other mailing address -- as I did earlier this week -- Care First advises you: "Find the name of your current health plan... If you're not sure what plan you are enrolled in or need further assistance, please contact a Product Specialist at 855-300-7751." My Product Specialist didn't realize that my plan wasn't listed on the "change form" at all, so I had to get a supervisor to help me fill it out correctly.
In addition, CBS News has reported on all-too-common examples of "sticker shock" for a customer who had to pay ten times as much for an exchange plan:
In California, Kaiser Permanente terminated policies for 160,000 people. In Florida, at least 300,000 people are losing coverage.
That includes 56-year-old Dianne Barrette. Last month, she received a letter from Blue Cross Blue Shield informing her as of January 2014, she would lose her current plan. Barrette pays $54 a month. The new plan she's being offered would run $591 a month -- 10 times more than what she currently pays.
Barrette said, "What I have right now is what I am happy with and I just want to know why I can't keep what I have. Why do I have to be forced into something else?"
According to HealthCare.gov, Barrette is eligible for some subsidies, CBS News' Jan Crawford pointed out on "CBS This Morning." But Barrette told CBS News she has no idea what those subsidies would be because she cannot log on to the website -- an issue U.S. Health and Human Services Secretary Kathleen Sebelius is sure to be asked about when she testifies on Capitol Hill Wednesday.
At a press conference earlier this week and on social media, White House spokespeople are seeking to explain away the potential for many to lose their current coverage. As Politico reported in a sharply observed story:
The Obama administration is strongly pushing back Monday night on an NBC News report that the White House has known for years that millions of consumers would lose their insurance under Obamacare.
"NBC 'scoop' cites 'normal turnover in the indiv insurance market'. That's a) not new b) not caused by #ACA c) the problem #ACA will solve," White House principal deputy press secretary Josh Earnest said in a tweet....
"FACT: Nothing in #Obamacare forces people out of their health plans. No change is required unless insurance companies change existing plans," Valerie Jarrett wrote.
The issue leading to all the cancellations involves which plans are allowed to be "grandfathered" in --those created before March, 2010 -- with lesser benefits and guarantees than required by the Affordable Care Act. As Politico explained this complex proviso: "The law requires insurance plans to meet basic standards after 2014. If they don't meet those standards, insurers can no longer sell those plans unless they are 'grandfathered' - or they existed before 2010 and haven't changed at all since then."
The apparent intent of the provision was to require plans to offer benefits and cost savings that meet Affordable Care Act standards, but in the case of my plan and many others, minor technicalities that supposedly disallow my generous plan from meeting Obamacare standards means that , in practice, I'm being denied decent coverage by my company that I can afford. The spin being offered now is that the plans being cancelled by and large don't cover mental health or reasonably-priced medications or maternity care. But that's simply not true, as my plan's benefits indicate, excerpted below:
Advantages:
No medical deductible
No claim forms to file
No lifetime maximum- you'll have coverage throughout your membership with CareFirst BlueChoice
Predictable copays for primary care and specialist office visits and emergency room care, so you don't need to worry whether or not you can afford treatment
No balance billing when using participating providers or hospitals
Dental and Vision Care benefits and special discounts included with the plan
Preventive Care and Wellness Benefits:
Routine physicals and office visits
Well-child care and immunizations
Women's health coverage, including routine mammograms and Pap tests, with no written referrals required for routine gynecological and obstetrical care
Men's health coverage, including routine prostate cancer screenings.
So can someone in Blue Cross or the Obama administration please tell my why my current plan doesn't meet Affordable Care Act standards?
In truth, the main reason that Blue Cross officials told me, when I inquired as a customer, on why my plan didn't meet Affordable Care Act standards and that I had to be dropped from coverage was because I enrolled it in after March, 2010, the grandfather clause deadline. There was no mention of shortfalls in the plan's coverage itself.
So in that context it's worth looking again at the NBC News scoop that's causing a PR nightmare for liberals. The network reported:
The White House does not dispute that many in the individual market will lose their current coverage, but argues they will be offered better coverage in its place, and that many will get tax subsidies that would offset any increased costs.
"One of the main goals of the law is to ensure that people have insurance they can rely on - that doesn't discriminate or charge more based on pre-existing conditions. The consumers who are getting notices are in plans that do not provide all these protections - but in the vast majority of cases, those same insurers will automatically shift their enrollees to a plan that provides new consumer protections and, for nearly half of individual market enrollees, discounts through premium tax credits," said White House spokesperson Jessica Santillo.
On several fronts, these claims -- echoed throughout the liberal blogosphere -- simply don't hold up to close scrutiny, if we use my experience and my plan as an example.
Let's unpack these claims closely to see just how misleading or distorted they are:
1)White House: ...people [ should ] have insurance they can rely on - that doesn't discriminate or charge more based on pre-existing conditions.
Distortion: My plan doesn't discriminate based on pre-existing conditions even before the Affordable Care Act because I transitioned to it from COBRA, to a PPO plan, to the less costly HMO I'm on now, and the company certainly can't do so now under the ACA. It's possible that I may face higher costs for pre-existing conditions than I do now, but that hasn't surfaced yet as a threat -- while losing my current coverage next year is a clear and immediate danger.
2)White House: "... but in the vast majority of cases, those same insurers will automatically shift their enrollees to a plan that provides new consumer protections."
Distortion: Not so --and this is a critical point missed in all the news coverage so far. Since most people with individual plans are being dropped by January 1, 2014, they're not being automatically enrolled in anything by any organization or company-- in fact, as in my case, they have to go through several bureaucratic hurdles to find a re-enrollment form online and fill it out correctly by Oct. 31, 2013 for a one-year extension, or their coverage will be dropped on January 1, 2014. The hard truth is that shifting to another plan is not at all "automatic;" most people don't know they're being dropped; and can't under current circumstances find a better, more affordable plan with the same or more benefits on the balky, defective exchanges and websites.
3)White House: "... for nearly half of individual market enrollees,[ they will have] discounts through premium tax credits," said White House spokesperson Jessica Santillo.
Distortion: The sky-high premium prices on the exchanges for some plans -- up to ten times as much for comparable current individual plans, CBS News has reported-- that match many people's current plans won't be significantly off-set by any discounts or subsidies except for those with the very lowest incomes. In my case, the most comparable plans, I learned after speaking to Blue Cross officials, were over twice as much a month in premiums as my current plan. The lower-priced premiums were for plans that had much higher deductibles, out-of-cost payments, and a whopping 20%-30% co-pays for any medical expenses, including the tens of thousands one might owe for a car accident or cancer treatment, than my current plan.
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Here's the upshot of the issue, at least for some Care First individual plan customers:
The reality is that the major insurers appear to be be deeming some of their current, somewhat reasonable and generous plans that individuals are now enrolled in as non-ACA compliant if one enrolled in them after March, 2010, and then scheduling them to be phased out to force people into higher cost/lower-benefit plans on the hard-to-access exchange marketplace. All this actually seems to shaping up as yet another way for insurance companies to scam the public and make extra money.
Based on my interviewing officials as a customer, Blue Cross/Blue Shield apparently interprets the law to mean that anyone who enrolled in any individual or self-employment plan after March, 2010 is deemed enrolled in a non-ACA compliant plan. As a result, we're being told we must either re-enroll by this Thursday, tomorrow, Oct. 31, 2013 in the exact same plan by going through numerous bureaucratic hurdles, for a one-time extension of their current plan through November, 2014 -- or find our way through the failing and complex exchange marketplace to buy a comparable plan.
Or it could be that the administration and some of its progressive allies indeed are right about this issue, and there's nothing to worry about. Even some progressive news outlets are now treating the CEOs of insurance companies as credible sources to explain the changes underway:
During an appearance on NBC's Meet The Press on Sunday, Pat Geraghty, CEO of Florida Blue, put it this way, "[W]e're not cutting people, we're actually transitioning people. What we've been doing is informing folks that their plan doesn't meet the test of the essential health benefits, therefore they have a choice of many options that we make available through the exchange.
"And, in fact, with subsidy, many people will be getting better plans at a lesser cost. So this really is a transition. And in fact, the 300,000 figure is the entire year. So it's really 40,000 people for January 1, and we're walking them through that transition," he added.
Call it "transition" or "cancellation," most individuals will qualify for subsidies and will likely see savings in their new plans.
In other words, the administration's message boils down to the old Bobby McFerrin song: "Don't Worry, Be Happy:"