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ACA Running Thread

This is text from a facebook post of a Wake alumnus from my class who is dealing with heart complications from Covid 19. If you know who this is, please don't post their name.

"Well guys. I’m royally screwed beyond belief. Last week I got a call from the cardiologist I saw that my health insurance didn’t go through despite when I called to make the appointment and when they saw me it was active. I called Hilton to sort it out and they told me that they went back and cut off my health benefits from March 31st forward since I hadn’t paid for the premiums that normally were taken out from my paychecks. Our hotel has been closed and we didn’t have access to the website where we can update the info for our mailing address. They were sending mail to an old address in CA so I didn’t get the notices for how to pay for my premiums and of course I’ve been preoccupied trying to get my health and life back in order. I told them I would pay whatever I owed in the premium amount that normally would be taken out from my paycheck but that I need the benefits badly to be covered since I’ve gone to the doctor 5x to the ER 2x and used an ambulance 1x and saw a specialist after being infected with covid. They told me they’d file and appeal to reinstate my benefits from April 1st - June 30th. Today I got notice that my appeal was denied and that the benefits are not able to be reinstated. Now I am going to owe tens of thousands of dollars for the services I received these past three months. I was covered! Now they took it away! How is it legal?! I said I would pay back anything I owed them which was way less than how much I will now owe being a self pay customer for all of those visits 😭😭😭😭😭😭😭😭😭😢😢😢😢😢😢😢😢😢😢😢😃😃😃😃😃😃😃😃😃🤯🤯🤯🤯🤯🤯🤯🤯🤯🤯🤯🤯😡😡😡😡😡😡😡😡😡😡😡😡 Thank you so much Cigna and Hilton. Like for real. Thank you for nothing!"

If you support the existence of the American Health Insurance Industry, you support things like this. You support inscrutable and cruel coverage rules, where a mailing address problem or a loss of a job can *RETROACTIVELY* cancel your health insurance coverage.
It's a cruel and inhumane system and there's no excuse for it.
 
Sorry about your friend. If they didn't him about this before doing it, he may end up owning the hotel.
 
That does not seem legal and i would have your friend contact an attorney or contact somebody to ask why he isn't covered under Cobra coverage. Basically when you've been terminated you can retroactively have Cobra health coverage and then decide later if you need to pay for it. When I left public accounting to start our Consulting practice my wife was pregnant and we kept Cobra for her for pregnancy cost and I just kept insurance for me and then let it lapse and never paid for it during the period.


Have any of the COBRA notice, election and premium payment timeframes been relaxed due to the COVID-19 outbreak?

Yes.  An emergency regulation issued April 29, 2020 by the DOL, IRS and Treasury requires group health plans to disregard the “Outbreak Period” for purposes of COBRA premium payment deadlines, COBRA election deadlines, and deadlines for individuals to notify the group health plan of a qualifying event or disability determination.  In addition, group health plans and their sponsors and administrators may disregard the Outbreak Period for determining the date for providing COBRA election notices.  The “Outbreak Period” is defined as the period beginning on March 1, 2020 and ending 60 days after the announced end of the COVID-19 national emergency or such other date announced by the agencies in a future notification.  For more information, see our companion post
 
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It's been more than 60 days since she was retroactively terminated. She didn't know that she had been laid off. Because the hotel she works at never reopened her employment termination was backdated to her last paycheck. This type of thing has occurred all over, because businesses were so desperate to alleviate payroll tax and benefits as soon as possible, so employees UTO and PTO quickly and surprisingly turned into being laid off. If my clinic hadn't gotten a PPP loan then I probably would have been laid off.
 
Once March 1st 2020 hit the 60-day clock stopped until the end of the outbreak. So she would have had to have been terminated more than 60 days before March 1st 2020 for her Cobra election window to expire is what I am reading.
 
Once March 1st 2020 hit the 60-day clock stopped until the end of the outbreak. So she would have had to have been terminated more than 60 days before March 1st 2020 for her Cobra election window to expire is what I am reading.

You could be right, but there may be some other circumstance or stipulation we're un aware of. People replied to her with that Cobra information and she responded that she had already applied for Cobra and been rejected.
 
It's been more than 60 days since she was retroactively terminated. She didn't know that she had been laid off. Because the hotel she works at never reopened her employment termination was backdated to her last paycheck. This type of thing has occurred all over, because businesses were so desperate to alleviate payroll tax and benefits as soon as possible, so employees UTO and PTO quickly and surprisingly turned into being laid off. If my clinic hadn't gotten a PPP loan then I probably would have been laid off.

Like Chris said, she should call an attorney. Or the local TV station and tell them the story. If she is near a major city, the story will go national. Someone will look into how many people were treated like this. It could have a hugely negative impact on Hilton at a time when they can't afford it.

As the old saying goes, she needs to make a federal case out of this.
 
There are avenues to challenge this with DOL & the COBRA provider. That is where I would start. There is an 800 COBRA # on their website.
 
The "Opt in" option sounds good for "liberty", but actually think about the population who are going to "Opt in" - the poorest and the sickest. How is the government going to compete with private health insurance, as a payer, when they are servicing all the cast off sick people that were driving up the costs of private health insurance in the first place?! The math doesn't add up, RJ. Socialized health care requires healthy working people pay taxes to cover sick people. Are you talking about those same healthy working people.paying their premiums AND paying the tax increase to cover the public option?

You and likely will never agree on health care policy but to your question above, private medicare plans (Medicare Advantage) tend to have sicker members than original medicare does (and they sorta compete). In fact, many MA plans want sicker members as there is more opportunity to create shared savings (shared between the providers, plans and the feds bases on how MA math works) from managing chronically ill people like diabetics, etc. On this note, it will be very interesting to see how payers manage ESRD members now that they can enroll in MA plans starting in January (some cool payment innovations coming here too). Medicare's FFS track record is pretty meh IMHO in managing these costs. MACRA was supposed to help this but was somewhat of a joke IMHO.

Needless to say, I'm a huge fan of payment innovations which private payers not Medicare are largely driving. It also why we see both Red/Blue states moving to managed Medicaid and the growth of other special needs type plans.
 
You have to decide whether or not a hypothetical "public option" is simply just expanded access to Medicare, as it currently works, or is a new all encompassing system as has been discussed in the primary. As far as I'm aware, Joe Biden's "public option" replaces Medicare and Medicaid.
 


One policy option is to expand eligibility for Medicaid. By reducing the uninsured population, Medicaid expansion increases hospital service volume and reduces the potential demand for charity care. We found that CAHs in states that expanded Medicaid eligibility experienced better median overall margin in 2017 than they did in 2011, while those in the states that did not expand Medicaid eligibility experienced worse median overall margin during the same period. The median overall margin of rural non-CAHs declined in both types of states, but to a greater degree in states that did not expand Medicaid eligibility. Therefore, Medicaid expansion benefits rural hospitals financially, especially CAHs. However, Medicaid expansion would not fundamentally solve the excess capacity and low efficiency problems in rural hospitals.
 
No matter how "innovative" they are, no matter how efficiently they are able to "control costs", industries and corporations are not your friend - their goal is to make profit for their shareholders. Any political measure that threatens their profitability will be fought, tooth and nail.
https://m.startribune.com/phrma-sues-to-stop-state-s-new-insulin-affordability-program/571582452/

*This* is the law that insulin manufacturers are suing to stop:

"The measure will provide a safety net for the roughly 10.5% of Minnesotans — more than 466,000 people — who have diabetes, according to American Diabetes Association estimates.

Diabetics can get a 30-day supply of insulin if they meet certain requirements. The bill also mandates that manufacturers offer continuing patient assistance programs, which are more restrictive. Families or individuals are only eligible if they earn less than 400% of federal poverty guidelines, or $104,800 for a family of four.

People can only qualify for emergency insulin once a year."

"...Gov. Tim Walz and other backers of the program gathered Wednesday to celebrate its implementation expressed frustration at the lawsuit. The Alec Smith Insulin Affordability Act was named in honor of a man who died because he was not able to afford his medication."
 
I mean that's the purpose of a company, provide something and in exchange make money. I suppose the only way to eliminate drug manufactures from operating along those lines is for the government to own them.
 
Or make them negotiate like every other business does. If we had one major buyer who could negotiate, Americans wouldn't be paying 5-10 times as much for insulin as Canadians do.
 
I mean that's the purpose of a company, provide something and in exchange make money. I suppose the only way to eliminate drug manufactures from operating along those lines is for the government to own them.

If those are the only 2 options, then government ownership is necessary. People dying from lack of insulin is unacceptable.
 
Are there any countries in the world where adequate insulin is guaranteed and the government doesn’t own the means of production?
 
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