Sometimes I forget how lucky I am. I have a wonderful job I love that pays me well and keeps me intellectually stimulated. I have health insurance paid, in part, by my employer. It isn’t fabulous, but it gets the job done, and I’m sure that if I ever wound up deathly ill, my family wouldn’t be financially broken.
Sometimes I forget to be grateful.
A friend of mine is an incredible intellect, who unfortunately lost his full-time job last year, and with it his health insurance coverage. The following is his account of his experience with healthcare.gov.
The website seized up four times, but finally we were able to make our application. We never got to the marketplace, because my salary as a part time adjunct was so low, we automatically qualified for Medicaid.
I want to stress this point. We never got to the marketplace because the system automatically booted us into the Medicaid application for our state. I will come back to this later.
So we got covered. Our kids got covered under Medicaid, and we got covered under Primary Care Network, which is Utah’s iteration of Medicaid.
And, it’s great! As good a coverage as I’ve ever had, low copays, no complaints.
Fast-forward to today. We get our 1095 form. It shows that our kids have been covered under Medicaid, which qualifies as full coverage under the ACA, but my wife and I, who have PCN, do not. PCN is apparently only a “limited” plan and does not qualify as full coverage under the ACA. We are now on the hook for penalties going back four months for not having adequate care under the ACA. And the enrollment period ended on Jan 31st, so we will be on the hook for the next year as well. We are talking thousands of dollars here.
This, understandably, sent my wife into a panic and tears. It’s money we don’t have.
I want to re-iterate: we went to the government website, which funneled us to a state website, where we got coverage, and NO ONE informed us that this did not comply with the law or that the coverage for us was not enough under the standards of the law. My wife and I are not dumb bunnies. This wasn’t an oversight. There was simply no way we could have known.
The website was worthless – an endless maze – so we worked the phones. We sat on hold for over an hour, but finally got a hold of a person, who admittedly, was very nice and helpful. We told her our situation, told her we acted in good faith, and wound up here anyway. She told us that since we make so little, we may qualify for an exemption. She gave us the info on how to apply for this exemption through the IRS, what forms to use etc. Part of this application for an exemption requires that we go to Healthcare.gov and look up and submit what the lowest bronze plan would have cost us.
But now you are probably seeing the first paradox: our income is so low, that the website automatically sent us to the Medicaid site without ever taking us to the exchanges. How do we get there to know what we didn’t know? She doesn’t have an answer.
Now comes the second paradox. Even if we get this exemption, how will we make sure we get adequate coverage in the future? My employment situation is unlikely to change in that time. How can we even get to the exchanges to get a plan we are REQUIRED to have when the website immediately redirects us back to the Medicaid application? Where do we go to buy into a plan we can’t even see because the application process won’t let us see it?
Again, she was very nice, but she didn’t have an answer. She thinks there might be a “tool” to help us on healthcare.gov. She suggests that we go to Healthcare.gov and search for “exemptions.” A search for “exemptions” on Healthcare.gov produces 50 hits, by the way.
Finally she suggested we talk to the local Medicaid office in Utah. Perhaps they can help. Maybe Utah offers a Medicaid benefit plan that has full coverage and qualifies under the ACA. So we do. The person at the Utah Medicaid office is very nice, but told us that there is only one full coverage Medicaid plan and it is basically only offered to invalids. PCN, which is, frankly, very generous (thank you, Utah taxpayers!) is what they offer to most of their clients.
It seems crazy that PCN somehow does not qualify under ACA, but here’s where the story gets surreal.
The person tells us that they have never been told whether or not PCN qualifies under ACA!
Let that sink in for a moment.
The ACA has been law since January, 2010 and been implemented since 2013. Six years in, and the state government Medicaid office STILL does not know if their main Medicaid program complies with the law. They still don’t understand the ACA. This is obviously the root of the confusion.
Is everyone on Medicaid in Utah in violation of the law? Are they all paying penalties or forced to go through the exemption process? Do they even know? The person, who again, is very nice, has no answers. Who does know? Again, no answers.
All of this happened this morning. We have been delivered into a system that is completely opaque, with a curtain of websites and applications processes that are nearly impenetrable, and been left at the mercy of bureaucrats who do not even know the full meaning of the law they expect us to live under.
This simply cannot stand.
I was speechless when I read this, and I asked if I could blog about it. The above is my friend’s post, unedited, other than small stylistic and grammar changes.
This appalling web of bureaucratic lunacy is brought to you courtesy of the Affordable Care Act. A man and his wife, whose takehome pay is so low right now, they qualify for Medicaid, are now being forced to pay thousands of dollars in penalties they cannot afford for turning to the government to get coverage that is now required by law.
The absurdity would be hilarious if a family’s livelihood wasn’t at stake!
And my friend’s story isn’t the only nightmare Americans have been experiencing. A Facebook page dedicated to ACA horror stories has been created, and the stories are heartbreaking.
FreedomWorks last year did an article of its own, detailing top ObamaCare horror stories, including that of a pastor diagnosed with stage three cancer of the esophagus who was told – just minutes before getting chemotherapy – that his treatment would not be covered.
Meanwhile, the left’s smarmy, arrogant, lying, biased, craptastic excuse for an economist Paul Krugman last year claimed the ObamaCare horror stories were “imaginary” – concocted by those who obviously just are too ignorant to know how FAAAAABULOUS ObamaCare and too stupid to know what’s good for them.
These are real people with real life problems, betrayed by politicians and pundits who couldn’t even begin to understand what it’s like to not know how your next grocery bill will be paid, or what it’s like to lose sleep, because the IRS says you owe them money you don’t have.
My friend’s dilemma is real. Imagine you’re so poor, you automatically qualified for Medicaid, but the state doesn’t offer a plan that meets ACA requirements, except to a few really sick individuals, so you have to buy more insurance… again… because you’re poor. And if you didn’t know you had to buy more insurance, you have to pay again. Because you’re poor.
File this under: Things politicians and the “Elite” couldn’t possibly comprehend.