Monday, November 09, 2015

New Republic vs EPC

"The Equal Protection Clause of the 14th amendment of the U.S. Constitution prohibits states from denying any person within its jurisdiction the equal protection of the laws."
Reason I bring this up is because of the recent shuttering of the Empire State's New Republic (NR) CO-OP. Most of the time, there's a "cushion" between the time a plan is told to shut down and when folks actually lose coverage. This isn't the case with NR: coverage for its insureds ends on November 30th, period. This leaves them with a couple of challenges:

First, obtaining new coverage for December. The state has figured out a way to "auto-enroll" these folks in a new plan with intact carriers. One supposes that they could also choose a Short Term Medical plan (assuming those are still available in New York). And, of course, losing coverage in this manner is itself a Special Open Enrollment trigger (as regards December coverage).

The problem is that some (many? most?) of these folks will have met some or all of their 2015 deductibles (and, perhaps their entire maximum out-of-pockets). These are not going to be acknowledged by their new carrier; that is, they'll have an entire new annual out-of-pocket for December then again starting January 1st.

This is truly a bummer.

And it's also not legally correctable.

Here's why:

There is no way to compel the new carrier to credit expenses covered by a previous one, regardless of when they were incurred. So the fact that these poor folks are left high-and-dry for December is too bad, but there's nothing that can legally be done to resolve that. If the state (or the Feds, for that matter - CO-OPS are purely an invention of the ObamaTax) were to grant this kind of relief to victims previous NR insureds, they'd have to do that for everyone who's been in that situation.

And who would those folks be?

Well, anyone who lost employer coverage in, say July (or March, or a week ago) and had to obtain a new plan with another carrier. Or anyone else who's been recently eligible for a Special Open Enrollment and had (or chose) to switch carriers. If the NR folks are entitled, then everyone else in similar straits are, too.

Thanks, EPC!
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