2013-12-20

Eligible for a "catastrophic" plan?


I read last night that the twenty million people whose individual health insurance plans terminated because they didn't meet ACA requirements for a "comprehensive" health plan can now qualify for a "catastrophic" health plan - if they are "having trouble paying for a new plan".

Previously there were twelve criteria for "catastrophic coverage" eligibility listed at https://www.healthcare.gov/exemptions/:

  1. You were homeless.
  2. You were evicted in the past 6 months or were facing eviction or foreclosure.
  3. You received a shut-off notice from a utility company.
  4. You recently experienced domestic violence.
  5. You recently experienced the death of a close family member.
  6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
  7. You filed for bankruptcy in the last 6 months.
  8. You had medical expenses you couldn't pay in the last 24 months.
  9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
  10. You expect to claim a child as a tax dependent who's been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
  11. As a result of an eligibility appeals decision, you're eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren't enrolled in a QHP through the Marketplace.
  12. You were determined ineligible for Medicaid because your state didn't expand eligibility for Medicaid under the Affordable Care Act.

These criteria are bizarre! Note that some of them might be due to carelessness (utility shut-off notice) or not involve actual financial stress ("increases in necessary expenses").

But the new announcement adds a thirteenth and most bizarre criterion - bizarre because it acknowledges that ACA itself can create hardship from which only ACA exemptions can grant relief, and because the exemption hinges on an individual's belief:
    13. Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable.

"You believe other plans are unaffordable"? The ACA has turned into a faith-based initiative? Are thought police going to investigate beliefs?

My Kaiser coverage terminates at the end of the year because it doesn't meet ACA standards. I signed up for a new plan with Anthem Blue Cross and just mailed the check for my first premium. But I emphatically believe that Marketplace plans are unaffordable. I also think they are poorly designed and provide perverse incentives. But how can I block the plan I just paid for and switch to a "catastrophic" plan?

And just who is running this show, and how on earth do they think they can arrange things this way?

Update: I just received an e-mail from Representative Anna Eshoo trumpeting this latest enhancement to ACA. She included a link to the Hardship Exemption Form.

This form has somewhat different langugage: "You may qualify for a hardship exemption if you experienced one of the following:" ... "13. You received a notice saying that your current health insurance plan is being cancelled, and you consider the other plans available unaffordable." "Consider" rather than "believe." What kind of criterion is that for granting an exemption?

Predictably this form asks you to identify yourself as Hispanic/Latino (Mexican, Mexican American, Chicano/a, Puerto Rican, Cuban, or Other) or White, American Indian or Alaska Native, Filipino, Vietnamese, Guamanian or Chamorro, Black or African American, Japanese, Other Asian, Samoan, Asian Indian, Korean, Native Hawaiian, Other Pacific Islander, Chinese, or Other. This is beyond offensive! What does this have to do with deserving a hardship exemption?
 

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