Tuesday, December 03, 2013

Obamacare, a Teachable Moment

At InsureBlog we have not tried to hide our feelings about Obamacare. Quite simply, it is an ill conceived plan that is unpopular, unwanted, unworkable and under-funded. 

But other than that . . .

Among the horror stories there are also good ones. I have several clients that, under current rules, are uninsurable. One has a severely arthritic hip that needs to be replaced. The other was recently diagnosed with cancer and needs an operation.

Both need surgery sooner, rather than later.

Both have surgery scheduled for early January, thanks in part to Obamacare.

That brings us to Bev Veals, a North Carolina cancer patient whose coverage will be cancelled early. DC needs the money spent on PCIP, a workable program, so they can build a website for Obamacare.

Perhaps she liked her plan. The president's promise not withstanding, she won't be able to keep her plan.

Coping with advanced cancer, Bev Veals was in the hospital for chemo this summer when she got a call that her health plan was shutting down. Then, the substitute insurance she was offered wanted her to pay up to $3,125, on top of premiums.
It sounds like one of those insurance horror stories President Barack Obama told to sell his health overhaul to Congress, but Veals wasn't in the clutches of a profit-driven company. Instead, she's covered by Obama's law — one of about 100,000 people with serious medical issues in a financially troubled government program.
On the surface, this sounds bad. Real bad.
At first I thought someone missed their facts. Obama did in fact pull the plug on PCIP funding but those plans were supposed to end 12/31/2013.

However, some plans, including the NC PCIP, ended early. Unfortunately for Bev Veal, she lived in one of 18 states that elected to manage their own PCIP. When DC decided to cut funding the powers that be turned their plan over to the feds to run.

Unfortunately for Bev, changing plans in the middle of the year means a new deductible and more out of pocket.

As a result of the hand off from NC PCIP to the feds, Mrs. Veal will have to come up with another $3000 out of pocket to finish the year under her "new" PCIP plan.
They had already met their deductible in the North Carolina plan, and also reached their annual out-of-pocket maximum of $6,250.
With the federal plan, they would have another deductible of $1,000 for the rest of 2013, and a total of $3,125 in out-of-pocket costs before reaching that plan's catastrophic limit. Deductibles and copayments shift some financial responsibility to patients.
"We are paying 18 months of deductibles and out-of-pocket cost for one year's worth of coverage to two insurance companies," said Scott Veals.
That's not right.
This puts the promise of "If you like your plan you can keep it" in a whole new light.

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