GELFAND ON … WHAT HAPPENED WHEN I TRIED TO SIGN UP-"Nobody asked me my height and weight." This was the first reaction of a newly enrolled participant in California's new health insurance system. [www coveredca.com/] I watched and listened to the application process, and I can attest to the fact that it is easy. All of the personally invasive questions that have been a feature of applying for health insurance on the individual market have gone away.
They don't ask you if you have an as-yet-unborn illegitimate child. I'm not kidding about this. I was asked that question one time. They don't pry into whether you ever had asthma or suffer from some gynecological problem. They just ask your age, address, and income, and then offer you a selection of insurance policies.
"You know, we have just experienced a small miracle," was the next reaction to what had just gone down.
The reason it is such a miracle, and why it will carry such a powerful political impact will be discussed below, but I'm here to tell you that in California, the system is working, and it's a vast improvement for millions of us.
The only reason this is a story at all is because the Obama haters have found a tiny nail to hammer into the new Affordable Care Act. It's not even a legitimate nail, because it doesn't have anything to do with the rules or policies themselves. It only has to do with some difficulties in getting people registered in a bunch of states which have resisted joining the new system.
The website run by the federal government to enroll people in health insurance under the Affordable Care Act (aka "Obamacare") has been seriously deficient. It will get fixed. People will get enrolled. But meanwhile, it's the scandal du jour for the right wing noise machine.
California isn't one of the states that resisted Obamacare. It has labored in good faith to develop a state run system. In spite of all the dire warnings that the insurance companies would exit in droves, we have now discovered that the major systems -- Blue Cross, Blue Shield, and Healthnet -- have signed on. Not only that, but the pricing is pretty much in line with what was available through large employers before, and is decidedly better than what was available to individual purchasers.
For those who are eligible for some kind of subsidy, the pricing can be remarkably low. For the Bronze tier, which is in essence catastrophic coverage, a person without a lot of income can get into the system for a nominal two dollars a month. I'll get back to why this is actually a useful thing, but I wanted to share with you the actual process of enrollment in the new system, as witnessed by me personally.
I already have health coverage, but a friend of mine is about to hit the Cobra limit. If you don't know that word "Cobra," you are one of the lucky ones, because it is the system that allows somebody who had insurance through his job, but is now out of work, to continue coverage for another 18 months.
I was invited to watch the enrollment process. We went to www.coveredca.com and the site popped up on the computer screen. Covered California takes the information I mentioned above -- age, income, and zip code -- and tells you what your monthly payment will be, depending on what level of coverage you choose.
The website offers the opportunity of enrolling online or using the phone. My friend chose to try the telephone number. It's an 800 number, and we called in the early evening. Anybody who has tried to do business with the phone company would be expecting a long wait and a series of irritating, electronically driven choices, but a real live person picked up the phone on the other end. The first small miracle.
Our applicant was then asked various questions which ultimately came down to the ones I have listed above -- age, address, and family income. A reasonable first approximation for income will probably be what your tax return calls the adjusted gross income, otherwise known as line 37 on your form 1040. The man on the other end of the line asked a few more questions which seemed to involve whether there were other sources of income, and ultimately came up with a number that was in fact very close to the number on line 37. There were no surprises, no intrusive questions, and no drama. Another small miracle.
The Covered California representative then explained the sorts of coverages that were available, ranging from the lowest (Bronze) and going in increasing order through Silver, Gold, and Platinum. The price goes up for each level, but the coverage also improves. A Gold package has a higher monthly fee but costs less out of pocket if you end up in the hospital.
What was particularly interesting was that for the tiers that provided eligibility for the federal subsidy -- Bronze and Silver -- the major insurers were listed, including Blue Cross and Blue Shield. Even Healthnet was in there, and at a considerably lower price.
With that information, it was possible for my friend to make a decision on a plan. He did. At that point, there were two options. He could either elect to get off the phone and enroll using the website, or he could stay on the phone and complete an application by talking to the agent. He was warned that this process takes around 45 minutes, but much of this time involves the Covered California agent reading off the required disclosures. He decided to complete the application right there, over the phone.
As I have already said, there was nothing at all equivalent to the intrusive application forms that applicants for health insurance have been forced to fill out in the past. You know, the one where you are supposed to list every operation, condition, and past illness. Have you had cancer or a heart condition or bloody urine or gallstones? And you found out the hard way that if you had any of these, you would be rejected. That's one major reason why so many Americans have been living without medical insurance, skating the thin line between being lucky vs. going through a medical bankruptcy.
No longer.
My friend chose a plan that offers decent coverage at a rate that will actually beat the amount he has been paying for the Cobra plan. And he doesn't have to worry about it expiring a year and a half later.
He was told that a written confirmation will arrive by mail in about 4 weeks. And that was it. Another small miracle.
Let's pause a moment and reflect on what our country has accomplished.
The major achievement of the Affordable Care Act is to abolish the segregation of people who have preexisting conditions from those who have been incredibly lucky or are too young to have anything serious yet. It was always a mere theoretical point as far as the Republicans were concerned, but when you see the process in action, it's a remarkable revelation to understand that this ugly part of our history is now part of the past.
Our intrepid applicant spent a little time complimenting the agent for how helpful and professional he had been. The agent explained that it really felt good helping people out in this way. I broke in and asked a journalist-type question and was told that the state of California already has some 90,000 applications that need to be processed by their office, with at least a couple tens of thousands now completed.
From start to finish, from the time the call was answered, the total time was 59 minutes. This may seem like a lot of phone time, but when you compare it to the torments of applying on the private market under the old system, it's another one of those little miracles. Think about filling out those application forms, including looking up all the information they used to demand (name the type and year of all your previous operations), and you will realize that the new system is remarkably easy.
I promised to explain to you why it's useful for somebody to sign up even at the lowest level. When you listen to the description of the Bronze Tier, it sounds almost like having no insurance at all. There is typically a $5000 deductible and fairly high copays for normal office visits, and even more for a hospital stay. But there is a bit of gold buried in that bronze. To understand why, you have to think about some of the more serious failures of the current system.
For the uninsured, any interaction with the American medical care system is a nightmare. This is particularly true if you have a job or any assets. Try going to a doctor for the first time and you'll end up filling out a set of forms that are more akin to a mortgage application than a health history.
The real crime comes with hospitalization or any treatment for a serious condition. The definitive report came a few months ago in Time Magazine, (login required) in an article by Steven Brill titled "Why medical bills are killing us," where the story of hospital pricing was revealed in all its squalor. As explained in great detail, the hospitals have pricing books which demand unbelievably high payments from the uninsured. These price lists are ignored by the insurance companies, which have contractual agreements which include substantial discounts. That's why your Explanation of Benefits (aka EOB) shows the originally billed amount, what the insurance company has allowed (typically several fold lower), and how much the insurance company is allowing the hospital to bill you.
In other words, the insurance company ends up being your advocate in the billing process. It's still a lousy system considering how much the insurers take off the top, but it's the system we live under, and having that insurance benefit is several times better than not having anything at all.
So having even the Bronze level coverage is a big advantage because the price you can be charged by the hospital or clinic is subject to the same kind of discounting. It also puts a limit on what you would be required to pay in any one year. If you have some serious event, instead of looking at losing your house, you might be looking at a debt of a few thousand dollars.
One more thing about the new system under the Affordable Care Act. Even at the lowest tier, you can have up to 3 free doctor visits a year for preventive care. Again, this is hugely important because millions of people have avoided standard preventive measures because they couldn't afford them.
When you consider all of the benefits of the new system, starting from not being insulted by the application process, and continuing through the ability to buy insurance even if you have had asthma, and continuing further with the financial protections that the new system will provide, it is a collection of small miracles that together add up to a substantial amount of progress.
Why is this going to be such a political sea change? Because all of those people who are signing up under the new system are going to be reminded that the official policy of the Republican Party is to take it away from them. Come the fall of 2014, they will be getting phone calls reminding them that the Republicans have voted 40 times in the House of Representatives to abolish the Affordable Care Act. There will be millions of people with a vested interest in preserving the ACA, and Republican candidates know this. That's why they tried to kill it off. It's a wonderful thing that they have, so far, failed.
NEED TO KNOW:
● In California: www.coveredca.com or 1-800-300-1506
● Outside California: Click here
(Bob Gelfand writes on culture and politics for CityWatch.)
-cw
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CityWatch
Vol 11 Issue 85
Pub: Oct 22, 2013