Column 105 - Moving Forward with the ACA: Employers and individuals.

Moving Forward with the ACA: Employers and individuals.

The Kaiser Family Foundation (KFF) is a fascinating resource.  It is a non-partisan organization that provides a wealth of technical information on health care issues including cost information and policy data, as well as opinion polls.

In last week's column I made a comment about how costly these votes to repeal the Affordable Care Act (ACA, also known has Obamacare) have been to the taxpayers.  This column is not designed to give my opinion about the politics of the actions, but rather to provide a perspective from "in the trenches".  While this has clearly been a "wild ride", it does seem to be a less bumpy ride these days.

I was intrigued by a recent KFF poll regarding the SCOTUS decision in King V. Burwell.  This was the action that basically allowed individuals to obtain subsidies in both state and federal exchanges.  I thought I would share the results here.  

1)     Majority in favor of the decision:  *62% approve*32% disapprove  

2) It's still a political issue, divided down party lines, but the noteworthy response is from independents! Democrats: 82% approve, Independents: 61% approve, Republicans: 29% approve 

3) 78% think there will be future ACA battles

4) 51% say the debate should continue, 44% are tired of it and want the country to focus on other issues

That is not to say there aren't lots of challenges still.  Groups of 50+ are going to be in for some big shocks in the coming year.  We are doing what we can to help prepare them.  They simply cannot keep their heads in the sand.  They must start preparing now!  Summer is a good time to do so. 

For one, these employers have to decide how they are going to treat Variable Hour employees (the new description of part-time employees).   They also have to look at options for renewal that might postpone some of their pain in going back to the small group market.

Those who buy their health insurance in the individual market continue to have their own sets of challenges.  CoveredCA, our state's exchange still has many glitches to work out with their website.  I chuckle every time I hear Peter Lee pat himself on the back for all their success.  I confess I almost choked when I heard he received a big cash bonus.

Having seen a functioning exchange such as California Choice, I know how good it could have been.  Instead, they have run an inferior web portal with inferior technology.  Further, their own executives don't seem to know enough about the insurance business to have much foresight about issues that they need to address.  

For example, if an individual is between jobs and goes to the CoveredCA to apply, they will likely be put into MediCAL immediately.  This is because they are showing no current income.  To avoid this, the broker or applicant may have to "rig" the system and estimate their 2015 income at some imaginary number to keep them out of MediCAL.

Of course, MediCAL has at least a month or two of back-log so the individual is in limbo for a couple of months and could well have a job by the time they actually get on MediCAL.  The system needs to be repaired to accommodate this.

Covered CA points fingers at MediCAL and says it is out of their hands.  That is simply not acceptable.  Certainly Peter Lee and his staff should be held accountable for fixing this issue.  These two agencies need to find ways to better integrate their systems.

The other big issue for the individual market is narrow networks.  This simply still has not been resolved.  The websites are not up-to-date in identifying physician status, which creates a serious problem for individuals who must choose a provider for care.