Government Takeover: White House Forces Obamacare Insurers To Cover Unpaid Patients At A Loss

[Teh One Who Knocks]

Avik Roy - Forbes


Of all of the last-minute delays, website bungles, and Presidential whims that have marred the roll-out of Obamacare’s subsidized insurance exchanges, what happened on Thursday, December 12 will stand as one of the most lawless acts yet committed by this administration. The White House—having canceled Americans’ old health plans, and having botched the system for enrolling people in new ones—knows that millions of Americans will enter the new year without health coverage. So instead of actually fixing the problem, the administration is retroactively attempting to force insurers to hand out free health care—at a loss—to those whom the White House has rendered uninsured. If Obamacare wasn’t a government takeover of the health insurance industry, then what is it now?

On Wednesday afternoon, health policy reporters found in their inboxes a friendly e-mail from the U.S. Department of Health and Human Services, announcing “steps to ensure Americans signing up through the Marketplace have coverage and access to the care they need on January 1.” Basically, the “steps” involve muscling insurers to provide free or discounted care to those who have become uninsured because of the problems with healthcare.gov.

HHS threatens to throw non-complying plans off the exchanges

HHS assured reporters that it would be “urging issuers to give consumers additional time to pay their first month’s premium and still have coverage beginning January 1, 2014.” In other words, urging them to offer free care to those who haven’t paid. This is a problem because the government has yet to build the system that allows people who’ve signed up for plans to actually pay for them. “One client reports only 15 percent [of applicants] have paid so far,” Bob Laszewski told Charles Ornstein. “So far I’m hearing from health plans that around 5 percent and 10 percent of consumers who have made it through the data transfer gauntlet have paid first month’s premium and therefore truly enrolled,” said Kip Piper.

“What’s wrong with ‘urging’ insurers to offer free care?” you might ask. “That’s not the same as forcing them to offer free care.” Except that the government is using the full force of its regulatory powers, under Obamacare, to threaten insurers if they don’t comply. All you have to do is read the menacing language in the new regulations that HHS published this week, in which HHS says it may throw otherwise qualified health plans off of the exchanges next year if they don’t comply with the government’s “requests.”

“We are considering factoring into the [qualified health plan] renewal process, as part of the determination regarding whether making a health plan available…how [insurers] ensure continuity of care during transitions,” they write. Which is kind of like the Mafia saying that it will “consider” the amount of protection money you’ve paid in its decision as to whether or not it vandalizes your storefront.

There are other services HHS is asking insurers to offer for free. The administration is “strongly encouraging insurers to treat out-of-network providers”—i.e., costly ones—“as in-network to ensure continuity of care” and to “refill prescriptions covered under previous plans during January.” But the issue of unpaid premiums looms largest.

It’s unconstitutional to force insurers to cover people for free

The administration could pay insurers to cover up for its mistakes. But that would lead to criticism—as it has in other instances—that the White House is lawlessly throwing taxpayer money at insurers to, well, cover up for its mistakes. So, instead, they’re asking insurers to pay for the mistakes.

But, of course, the cost of paying for those mistakes won’t end up being paid by insurers, but by consumers, in the form of higher premiums.

In theory, the Obama administration’s actions aren’t merely illegal—they’re unconstitutional. The Fifth Amendment of the Bill of Rights says that no one can “be deprived of life, liberty or property, without due process of law; nor shall private property be taken for public use, without just compensation.”

But it will be up to insurers to sue to protect their rights. Like battered wives, they are unlikely to do so. Companies like Aetna and Humana are so terrified that the administration will run them out of business that they are more likely to do what they’re told, and quietly pass the costs on to consumers. The chaos and recriminations have made insurers like UnitedHealth, who have largely stayed out of the exchanges, look smart.

In 2010, PolitiFact said that the claim that Obamacare was a “government takeover of health care” was its “lie of the year.” The Federal Register disagrees.

[FBD]

http://www.zerohedge.com/contributed...e-who-can-help

[12:28:00 pm]: Thanks for contacting Health Insurance Marketplace Live Chat. Please wait while we connect you to someone who can help.
[12:28:05 pm]: Please be patient while we're helping other people.
[12:28:39 pm]: Please be patient while we're helping other people.
[12:28:46 pm]: Welcome! You're now connected to Health Insurance Marketplace Live Chat.

Thanks for contacting us. My name is Diana. To protect your privacy, please don't provide any personal information, like Social Security Number, or any other sensitive medical or personal information.
[12:28:58 pm]: Diana
How may I help you?
[12:29:59 pm]: CALLER
It says to not provide any personal information to protect my privacy. Why? Can I not trust you?
[12:30:36 pm]: Diana
thats just how it is. How may I help you?



"thats just how it is."


Indeed. If we cannot trust our government to protect our privacy, then who can we trust?

[12:31:32 pm]: CALLER
I am trying to get a quote for my family. Will the quote be an estimate, or an actual quote?
[12:32:07 pm]: Diana
estimate
[12:33:07 pm]: CALLER
Do I have to buy the insurance to know what it actually costs?
[12:33:51 pm]: Diana
no you will have to do an application then it will let you know the prices.
[12:34:26 pm]: CALLER
How long does that take?
[12:35:26 pm]: Diana
if you do an application today over the phone they will be able to let you know the results the same time.
[12:35:54 pm]: CALLER
Can I do an application today online?
[12:36:10 pm]: Diana
yes
[12:36:15 pm]: Diana
Is there anything else that I may help you with?
[12:36:37 pm]: CALLER
How long if I do it online?
[12:36:51 pm]: Diana
the same

[12:37:05 pm]: Diana
Do you have any other questions that I can help you with?
[12:38:22 pm]: CALLER
If I wait until someone in my family gets sick, will I still be able to apply?
[12:38:46 pm]: Diana
You can enroll in a Health Insurance Marketplace plan from October 1, 2013, until the end of open enrollment. Open enrollment closes on March 31, 2014. During open enrollment, you can begin your Marketplace application and start shopping for health insurance plans. Your coverage will not begin until you make your first payment. If you enroll in a Marketplace plan and pay your first premium by December 23, 2013, your coverage will begin January 1, 2014.
[12:39:51 pm]: CALLER
Thanks, but that does not answer my question.
[12:40:23 pm]: Diana

Do you have any other questions that I can help you with?
[12:42:03 pm]: CALLER
Yes. The Blue Advantage Bronze HMO 006 Plan shows a $6,000 per person per year deductible. What is the co-insurance rate?
[12:42:33 pm]: Diana
i cant pull up that information im sorry

[12:43:59 pm]: CALLER
There is no pre-existing condition exclusions anymore, correct?
[12:44:28 pm]: Diana
yes correct
[12:44:36 pm]: Diana
Do you have any other questions that I can help you with?
[12:45:13 pm]: CALLER
So, I should just wait until someone gets sick, then apply, correct? And I cannot be turned down, correct?
[12:45:34 pm]: Diana
no
[12:45:43 pm]: Diana
thats not what i said
[12:46:16 pm]: Diana
there is a deadline to apply if you dont apply by that time there will be a fee. The fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. The fee for uninsured children is $47.50 per child. The most a family would have to pay is $285. Amounts go up after 2014. In 2015, the fee per person rises to $325 per person or $975 per family, or 2% of income, whichever is higher. For 2016, the fee per person will increase to $695 per person or $2,085 per family, or 2.5% of your household's income, whichever is higher. The fee for children will be half that amount, and there will be an overall cap for family payments. From 2017 on, the fee will rise each year with inflation. You will also have to pay the entire cost of all your medical care if you do not get health insurance.
[12:46:24 pm]: Diana
Is there anything else that I may help you with?
[12:47:34 pm]: CALLER
So, if I pay the fee, then I can wait until someone gets sick to apply, and I cannot be turned down?
[12:52:24 pm]: CALLER
Are you still there?
[12:53:16 pm]: Diana
yes you can do that if you would like but when you decide to enroll there will be a waiting period to apply
[12:53:35 pm]: CALLER
How long is the waiting period?
[12:54:18 pm]: Diana
I don't know yet you will have to wait until they say that open enrollment then you will be able to apply.



yes you can do that if you would like but when you decide to enroll there will be a waiting period to apply



For an illness, I can afford to wait.



What if I have an accident? No Insurance? No money? No identification?



No problem...



In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.



http://www.cms.gov/Regulations-and-G...TALA/index.htm...



So, if every uninsured person in America is entitled to receive emergency treatment at any major hospital, and can sign up for Obamacare for major illness after the onset of the major illness (like cancer), then it seems obvious that paying the one-time annual penalty, and not the monthly premium, will be the best economic option (especially considering the high deductibles like $6,000) for many young and healthy people in America (notice I did not say Americans or citizens) that are unlikely to get sick or injured, because even if they do, Uncle Sam is going to take care of them!



[12:54:51 pm]: Diana
Do you have any other questions that I can help you with?
[12:56:29 pm]: CALLER
We are a very healthy family. We don't get sick, and are in good condition, medically and physically. Are we entitled to a discount?
[12:57:48 pm]: Diana
you will have to do an application to find out
[12:57:55 pm]: Diana
Do you have any other questions that I can help you with?
[12:59:01 pm]: CALLER
So, the premiums are based on our health?* That is good news!

*True. Fat people and smokers pay more...



Overweight and obese employees may now face staggering financial penalties of up to 30% of the cost of their health plan, and up to 50% of the cost of their health plan if they smoke.



http://ebn.benefitnews.com/blog/ebvi...ess-incentives...

[12:59:21 pm]: Diana
Do you have any other questions that I can help you with?
[1:00:18 pm]: CALLER
How much can the premium go up next year? IS it limited?
[1:01:12 pm]: Diana
I don't know you will have to wait and see.
[1:02:09 pm]: CALLER
If I like this insurance, will I be able to keep this insurance?
[1:03:05 pm]: Diana
it depends what offered next year.
[1:03:48 pm]: Diana
Do you have any other questions that I can help you with?
[1:04:50 pm]: CALLER
I don't understand. What if I like my current insurance plan. Can I keep it?
[1:05:41 pm]: Diana
it all depends if its still offered next year.
[1:05:45 pm]: Diana
Do you have any other questions that I can help you with?
[1:06:42 pm]: CALLER
No, my current plan I have had for several years. Can I keep it, or do I need to change to an ACA plan?
[1:07:20 pm]: Diana
you will need to see if they still offered it for next year.
[1:07:26 pm]: Diana
Do you have any other questions that I can help you with?
[1:08:20 pm]: CALLER
Just a moment. You are very helpful, and this is confusing stuff.

[1:10:19 pm]: CALLER
Is there a medical savings account option, so if we don't use the coverage, then some of the money we pay rolls into next year?
[1:11:00 pm]: Diana
you will need to contact the insurance directly to see if they offer that.
[1:11:49 pm]: Diana

Do you have any other questions that I can help you with?
[1:12:14 pm]: CALLER
Is it true that I will have to pay a fine to the IRS if I don't sign up for 2014, but the big businesses will not?
[1:13:38 pm]: Diana
i sent you the fees sir if you dont sign up.
[1:13:46 pm]: Diana
Do you have any other questions that I can help you with?
[1:15:02 pm]: CALLER
That does not answer my question, but I think that is the case. That is all for now. Merry Christmas!
[1:15:22 pm]: Diana
Thank you for contacting Health Insurance Marketplace Live Chat. We are here to help you 24 hours a day, 7 days a week.
[1:15:23 pm]: 'Diana' has left the chat session.
[1:15:25 pm]: Your chat session is over. Thanks for contacting us, and we hope we've answered your questions. Have a great day.
[1:15:25 pm]: 12/17/2013



"i sent you the fees sir if you dont sign up."



We must pay a fee to not sign up; they don't even have the balls to call it what it is, a tax.



Finally, 'Diana' refers to CALLER as, "sir." It is a chat session, not a phone call. How does she know the sex of CALLER?