Last month, I fell through growing cracks in the health insurance system, right into the gears.
Health Republic of New York (HRNY) was the nonprofit health insurance cooperative which sold policies to more than 200,000 New Yorkers on the New York State of Health online exchange. This fall, it was announced that Health Republic was suspending operations at the end of November 2015. Sixty-five thousand members in Nassau and Suffolk counties alone rushed back to the online exchange to look for two new insurers: One for 2016 and one only for December 2015.
Promised infusions of federal cash never came through. Doctors and other providers are not going to be paid for many millions in legitimate claims made to HRNY.
The state and its exchange put in place some good protections and initiatives to help HRNY customers. Unfortunately, some of it took weeks to put together and most HRNY customers (about six in ten) weren’t eligible because of an enrollment technicality. The plan name on my insurance card included the phrase, “From the Exchange,” but the exchange computer didn’t consider me to be a client. When the state announced auto-enrollment in a backup health plan for HRNY customers on Dec. 1, and an agreement that previously-met deductibles would be honored for December 2015, it didn’t apply to over 100,000 New Yorkers.
There were problems I didn’t see coming.
My primary physician was not covered on my December 2015 policy, even though he’s right there in the provider directory. Turns out that the hospital group of which he’s a part no longer accepts any exchange plans from that insurer. They are not alone. Special approvals are now needed even for some popular, well-advertised drugs. Insurer and exchange computers can’t communicate well (my December 2015 payment was held up for weeks, locked up by glitches). The exchange itself has very serious usability problems.
I’ll be fine. I was trained from early on to push papers and speak Nameless Faceless Bureaucrat. Some tests were delayed until January, and there have been days when I was dealing with insurance problems almost full-time. Many don’t have that freedom, and I suspect thousands walked away in frustration, leaving benefits on the table.
After doing some half-baked algebra, I bet against myself. Turns out the pricier monthly premium with a higher deductible and lower co-payments will pay for itself, but only if I see a specialist and have lots of tests in 2016. If I’m unlucky and stay fairly healthy, I’m throwing money away.
Hopefully, I’m making the smart investment and will get pretty sick. Otherwise, I’ll just feel bad about myself for being such a sucker. A loser, our next President will call me, for making a bad business deal.
We are not the only country that has private health insurance companies. We are the only country that allows them to make a profit off a basic level of care. Insurers in other countries earn profits off of bells and whistles, but ours make profit off waste and inefficiency.
Last week, on the same day, I received both a reimbursement check and a cancellation notice from an insurer for a January premium I never paid for and never wanted.
State Senator Ken LaValle (Suffolk County) claims that New York “sacrificed a wonderful system” when it bought into Obamacare. Wonderful? More than 2.1 million New Yorkers have enrolled in a marketplace health plan as of early this year. Eighty-nine percent were uninsured when they applied.
But more problems are coming, like the federal tax on high premium plans which will start in 2018. Many Long Islanders’ health plans may be at risk.
Either we reign in profits for basic care and pharmaceuticals, or we open Medicare up to any American, with appropriate premium levels. We’re running out of choices, fixes and time.
Michael Miller (firstname.lastname@example.org) has worked in state and local government. He lives in New Hyde Park. The views expressed in this column are not necessarily those of the publisher or Anton Media Group.