Open or Not Open (health enrollment) / UPromise INFO

Can I get health insurance?

I'm still helping clients understand WHETHER OR NOT they can get health insurance, now that OPEN ENROLLMENT has closed. The health insurance companies are telling everyone 'no': Closed until November for 2015 enrollments.

But the truth is quite different. It turns out there are quite a few EXCEPTIONS. One of those exceptions is whether your income has changed. If you are Native American, you can change plans EVERY MONTH! So the rules are different depending on who you are, and whether you belong to a tribe.

That's because the geniuses at the federal government thought that the best way to get MORE people to buy MORE insurance was to RESTRICT WHEN it can be purchased. That's right; only 6 weeks out of the year. Unless you have one of several exceptions. Confused? You're not alone.

Businesses, of course, can buy health insurance any day of the year (it seems like only a few months ago that consumers could buy health insurance year-round too). The limitation is only on INDIVIDUALs. Businesses also get a delay on the mandate to buy insurance; individuals do not get a delay.

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Open enrollment is...

Open enrollment is... 

still open in California. 

Just talk to a Certified Insurance Agent. Your agent can even help you find a plan that is off-exchange. But only for the next 13 days!!

The Government figures that the best way to get fewer uninsured is to make it IMPOSSIBLE to get health insurance 10½ months out of the year.

But Certified Enrollers--including Certified Insurance Agents--have until April 15th to get you enrolled.

April 15th is a good day. Nothing else is happening that day that is government related.
So, what genius at CoveredCA decided that that was the day to have another crush of sign-up activity?

Go figure.

If you qualify for subsidies, this is the last chance this year to cash in. If you don’t qualify for subsidies, you still have the same deadline even for policies that are not on the exchange. Genius alert: let's make it ILLEGAL to buy private health insurance EXCEPT during an open enrollment period. What a terrific idea?!?!

On Monday, May 31st (the ostensible deadline), there were hundreds of people lined up, taking off work, waiting for hours, to get their government health care taken care of. If only they would have known that have the whole first half of April to take care of it. Could at least some of them have managed to fit in the enrollment without disrupting their work schedule???

Speaking of geniuses in government...

The Administration says that 90% of people who “enrolled” in Obamacare have paid their premium. Really?

 

What kind of dream world do they live in?

It calls into question all the other unbelievable things they have been saying. Yet again.

Is this a joke?

If only...

Another day, another arbitrary extension of a key deadline. And this extension comes with the added attraction of adding ‘the honor system’ to those who seek coverage after the deadline.

John Boehner: is-latest-obamacare-adjustment-a-joke?

So everyone is knocking themselves out trying to meet the government-mandated, arbitrary deadline of March 31, 2014; and now you can apply later--but only if you really, really tried to get started before the deadline.

• What does that mean?
• How can it be verified?
• Which states will follow this new guideline?
• Does this only apply to the 37 states using healthcare.gov?
• Can other states adapt their software to even offer this?

I have been booked to help out a local clinic: all day Saturday, all day Monday. Monday was supposed to be the LAST DAY for sign-ups. Now, who knows?

It varies based on where you live

The states that run their own extensions make their own rules. For example, California says it’s residents have until midnight on April 15th. Oregon goes until April 30. NY isn’t budging from March 31. The Feds aren’t willing to give a date and time.

Here’s the whole story:
cbsnews.com/news/obamacare-deadline-fluid-depending-on-where-you-are

It seems like only last year...

Just last year, a person could sign up for health insurance WHENEVER THEY WANTED. Now you have to sign-up during a very brief ‘open enrollment period’. The whole rest of the year... nothing. Imagine: it is ILLEGAL to buy health insurance in May or June. UNLESS you qualify with a special exception (get married, get divorced, get a kid, lose job) . And UNLESS the government decides to ALLOW late sign-ups. In this case, on the honor system.

And the impact on insurance companies and state exchanges...

Can you imagine having to hire and train THOUSANDS of workers to help MILLIONS of confused people trying to get things squared away. Some of these people are facing life-threatening conditions and specialized treatment regimes that could jeopardize their lives and livelihood. Oh, by they way, we only need you for SIX WEEKS.

The whole rest of the year you can find something else to do.

Unless the president changes his mind.

Video: Hitler Finds Out He Can’t Keep His Doctor Under Obamacare

Hitler Finds Out He Can’t Keep His Doctor Under Obamacare

Now all he can afford is ObamaCare Bronze level, with a 40% copay after a $5000 deductible.

 

I like how the worker-bees are sent out of the bunker room, but they can still hear the ranting and raving.

I had an interesting experience on Saturday. I was helping people evaluate their choices before the looming 3/31 deadline. After paying hundreds of dollars per month, one got NO COVERAGE or help with medical costs until AFTER he pays a $5,000 deductible.

That person shook his head and said: it's not worth it. I'll just pay the penalty.

I have to wonder who designed the 'metal tier' programs (Bronze, Silver, Gold, Platinum). The tiers are so similar, there aren't any TRUE low-cost choices (unless you qualify for taxpayer assistance). Maximum out-of-pocket, unlimited amounts, pregnancy coverage for males and females, no discount for not smoking (in California and some other states), all of the policies are loaded up with things people don't want to pay extra for. But insurers are PROHIBITED from offering lower-cost policies that have what people do want.

And if your income is TOO LOW, you get no premium assistance. You are forced into Medicare, whether you want it or not. The same is true for middle-income families with kids. The kids are forced into Medicare so they don't have the same coverage or provider network as their parents, or even their older siblings. The rest of the family (adults) could pay $1 a month for coverage, but the kids HAVE TO either take Medicare or pay HIGH, UNSUBSIDIZED premiums. Some choice.

It isn't free if your neighbor is paying your share.

Obamacare giveth and Obamacare taketh away.

Dazed and Confused

Typical website experience for the healthcare exchange. Pick a plan, but no way to make a payment.
Not at CoveredCA’s website, the insurance company’s website. Nothing.

AND then have to upload or fax in documentation on income and residency within 90 days.

• How many people will forget to do it in 90 days. 
• How many will be confused by what is being asked for?
• Could this be any more complicated?

True Sample

Here is a sample of documents requested for a 16-year-old high school student, daughter in a family that has conditionally qualified for Advanced Premium Tax Credit. 

Note how they ask for a “Copy of last year's federal tax return that accurately reflects current income” 4 TIMES!!! If she’s a full-time student and DOESN’T HAVE ANY OF THE THINGS on the list, what does she do? How do you upload a ‘no document’?

• Copy of last year's federal tax return along with federal schedule E that accurately reflects current income (1)

• Other documents to support Proof of Rental Income

• Receipts displaying gross profit and expenses

• Business records such as profit and loss statements

• Copy of last year's federal tax return along with federal schedule C. D, E, or F as appropriate that accurately reflects current income (2)

• Other documents to support Self Employment Income

• Court papers

• District Attorney/Family Support (DAFS ) records

• Copy of check

• Copy of pay stub

• Copy of pay stub showing garnishment specified for alimony

• Sworn affidavit from absent parent

• Other documents to support spousal income and child support

• Award letter or most recent cost-of-living increase notice

• Current bank statement

• Copy of the current benefit check

• Signed statement from the individual or organization providing the income

• Copy of last year's federal tax return that accurately reflects current income (3)

• Gift income letter

• Other documents to support Proof of Unearned Income

• Pay stub

• Copy of last year's federal tax return that accurately reflects the current income (4)

• Signed letter from employer that displays the gross income, payment frequency, and date of paycheck

• Affidavit

• Other documents to support Proof of Earned Income

• Form 1099

• Bank statement

• Investment account statement

• Payment records (notes and mortgages)

• Other documents to support Proof of Interest Income

• Lease or sales agreement

• Records such as gross rents and expense receipts
•  

Did I lose you somewhere in the above list?

Here’s another question:
What do you do if your federal tax return from last year doesn’t reflect current income?
The enrollment period is ALWAYS before the tax filing date. Which means in March 2014, people still haven’t filed their 2013 taxes. Which means they need their 2012 tax return. What if the 2012 tax return doesn't accurately reflect their 2014 income?

And for self-employed people and entrepreneurs: what if they won’t even know their 2014 income until they file in October of 2015? Oh, that’s right--you can’t wait that long to file taxes and get the Advanced Premium Tax Credit. Yet another way self-employed people are at a disadvantage with this law.

But I am using a 2012 tax return to gauge 2014 income which I won't know for sure until the middle or end of 2015. What if I’m wrong?

If you guess high, you'll get more of a tax refund--the government sat on your money for 16 to 22 months. If you guess low, you’ll owe more: about 9.5% of any additional income. That’s quite a tax ON TOP of self-employment tax of 15.3%. [That makes a combined self-employment/health insurance tax of about 24.8%!!!] And that’s before state and federal taxes.

But that was being optimistic. 

There are some very common scenarios where your kid earns $2000 by working a part-time job over the summer, and you (the parent) now owe ALL OF IT in additional taxes on your health care program. That’s in addition to payroll taxes (FICA, state and federal unemployment, etc) your kid pays.

Obamacare giveth and Obamacare taketh away.

Wanna date Mila Kunis?

Workers at Covered California have time on their hands...

Check out these posts to their ‘official’ twitter account.
These tweets were posted by highly-paid cubicle workers. One tweet was posted during an unplanned system outage (crashed website) that lasted for days, denying access to tens of thousands of Californians worried about the upcoming deadline (March 31).

Wanna date Mila Kunis?

 

I'm glad those pesky website issues were resolved. Oh wait... 

           KCRA covered-california-website-remains-offline

Turns out that while the website was crashed (down for 5 days!), the staff was posting these helpful tidbits on how to pick up women at bars. I’m not making it up.

Here’s the link to the GQ article referenced in the above tweet:

           www.gq.com/pick-up-lines-work-on-mila-kunis-health-insurance

 

See. The Obama administration said they were going to bring out the big guns and get celebrities involved in pushing healthcare enrollment.

Some quotes from the KCRA article...

"Well I think they better get their act together," said Gayle Vaughn. "Somebody is just not doing their job."
Howard said Covered California engineers worked around the clock to restore service and that customer data was not compromised. [Unless ‘compromised’ means the 37,000 people who think they have coverage but won’t until they start over. From scratch.]  

Update--Sacramento Bee: covered-california-software-glitch

Overall, about 37,000 Californians were affected by a software malfunction that led officials to ground the enrollment portal for five days. Those who submitted updates between Feb. 17 and Feb. 19 may have to start over.

Read more here: http://www.sacbee.com/2014/02/28/6198839/covered-california-software-glitch.html#storylink=cpy

“There are some inconveniences that have taken place, but it's not a case where people aren't getting health insurance,” said Howard.

[Howard, that’s EXACTLY what it means when your website keeps people from enrolling for 5 days. Unless you’re willing to extend the DEADLINE by 5 days to make up for YOUR system outage. 
I didn’t think so.]

Next comes the ‘ethnic targeting’...

One poster is wondering whether these are legals or illegals. Undocumented immigrants are EXEMPT from the requirement to have insurance. They don’t have to pay premiums, they don’t have to pay a penalty. Do they still get treatment? They get the same medical care they have always had, courtesy of super-expensive hospital emergency rooms.

The poster then wonders why the need to pick an ethnic group. That’s a good question. It mostly has to do with the fact that in their quest to include almost a dozen languages, Covered California gave Spanish-speakers short shrift. As mentioned in an earlier blog post, the languages on the website are NOT ALPHABETICAL, and Spanish is near the end of the list.

Enrollment among Latinos has been very disappointing.

Of course there are certain race-based aspects to the law as well. American Indians and Alaska Natives can switch plans every month and have no co-pays. Why isn’t that available for all?

The “fix” is in

The “fix” is in

Isn’t it intriguing how a law can be changed without additional legislation to benefit a political party? The president can, on his own, decide to enforce or ignore, implement or delay, whatever is needed for his political purposes.

Extra-constitutionality.

Here are 2 examples.

1) Obamacare rule eased in states with website difficulties.

Because 3 1/2 years isn’t enough time to put together a functioning website. It’s interesting to note that the states that benefit from this rule change have governors who are Obama-supporters. Hmmmm.
www.cbsnews.com/news/obamacare-rule-eased-for-states-with-website-troubles/

2) Obamacare's "keep your plan" fix to be extended

www.cbsnews.com/news/obamacares-keep-your-plan-fix-to-be-extended/

Officially labeled as the top political “lie of the year” (politifact 1 and 2 years in a row?) the promise that voters could keep their doctor has caused much political grief for the administration.

I would generally give the president kudos for trying to keep a promise (as if he had a choice), except...

It’s a half-baked attempt at a fig leaf. 

He extends the ‘fix’ for a little while (1 year). Then he extends it again to get past the next election cycle (clearly with a self-serving political motive). Why not just honor the promise, (“period”). 

And why do California officials get to ignore the extension? Because it’s not a legal requirement to do so. And they choose not to do so. Why? Because it doesn't fit their economic model. Because anyone who chooses to keep their doctor and their health plan isn't part of the new slush fund.

It’s not just a lousy law--it is applied unevenly. 

There are so many exemptions and special favors. Members of congress voted to subject themselves to the law. But when they realized the impact and cost on their staffs, they choose to add extra subsidy of 75% (reducing the cost for congressional staffers to 1/4 of what you or I would pay).

Some individual employers received ‘waivers’ for provisions of the law. Some states received ‘sweeteners’ to basically buy their representatives’ vote to pass this close and contentious legislation.

The law even applies unevenly based on race. Certain races get to change their plan every month, not once a year like everyone else. And they have no co-pays. Wait, what?

Even when the law works as intended, the results can be incomprehensible and infuriating. But that is a story for another day.

We'll Be Back Soon

We'll Be Back Soon

“Covered California is experiencing technical difficulties with the enrollment website, which led to an unplanned system outage beginning yesterday. “

At least when Arnold was governor, we could have some fun with the whole “We’ll be back”/“I’ll be back” thing. But this isn’t fun at all. In fact, people’s lives and access to health care on a timely basis are in jeopardy. If we can’t trust them to run a functioning website, how can we trust them to get us an insurance card, or to have the doctor’s office get paid properly, or tell the emergency room it’s OK to treat a child who was shuffled into Medi-Cal?

 

They say the website went down ‘yesterday’, but that is only because they don’t update the ‘We’re sorry’ page. This is actually day #3. I was in the middle of helping a client get coverage when the above message appeared. Since then every attempt to log in to the site was met with the message below...

 

Today’s message

 

Yesterday’s message

At first they had the announcement about ‘maintenance’. I was wondering what kind of lame organization pulls down their MAIN WEBSITE for maintenance in the middle of a workweek. And not just any workweek. With CoveredCA’s myriad of government-imposed deadlines, clients have to PAY for their coverage before Tuesday of next week. Otherwise they have to wait AN ADDITIONAL MONTH for coverage to start.

As mentioned, at first they had the announcement about ‘maintenance’. Now they are calling it an ‘unplanned system outage’. What? No backup server? No shadow site so they can test and upgrade on a rapid basis? Nope. Portal’s down, might as well call it a day.

Good enough for government work.

Day #3 and counting.

 

Covered California reaches out to girls

Covered California: It’s super-cool to have insurance. Totes.

Check out this recent tweet from Covered California.

Covered California ‏@CoveredCA      Feb 6

The next best thing to a cute boy: affordable coverage. Call a Certified Enrollment Agent: http://bit.ly/1bu9pDx  pic.twitter.com/mkSpMlNeIh

The next best thing? Really?

It must be true. The tweet was RETWEETED 4 TIMES and FAVORITED ONCE! 

Not bad for a state of 38 million.

Twitter Feedback

And if that weren't enough, check out the feedback:

• Douchey!!!
• Target demographic?: Tweens don't buy their own insurance
• Degrading and sexist
• Why you hate lesbians?
• Beyond stupid.

Is it just me, or does it appear that absolutely no one has anything positive to say about the tweet. I would have thought that Covered California and their media machine (highly paid consultants) would be actively deleting snarky reviews. At the very least posting positive reviews from shills.

What’s going on at Covered California’s media center?

Either someone is asleep at the switch, or nobody monitors this stuff on weekends, or they are committed to honesty and fairness.

I'll let you pick.

8 Questions about the Obamacare Penalty

What is the penalty?
When does the penalty kick in?
How much is the penalty?
Who's exempt?
How else can I avoid the penalty?
How will they know if I'm uninsured?
How do I pay the penalty?
Can I be put in jail if I don't pay?
               No. They can only collect the penalty by reducing your future tax refunds.

 

WWII -vs- Obamacare website

Worth noting:

During the 3½ years of World War II that started with the Japanese bombing of Pearl Harbor in December 1941 and ended with the surrender of Germany and Japan in 1945, the US produced...

• 22 aircraft carriers
• 8 battleships
• 48 cruisers
• 349 destroyers
• 420 destroyer escorts
• 203 submarines
• 34 million tons of merchant ships
• 100,000 fighter aircraft
• 98,000 bombers
• 24,000 transport aircraft
• 58,000 training aircraft
• 93,000 tanks
• 257,000 artillery pieces
• 105,000 mortars
• 3,000,000 machine guns
• 2,500,000 military trucks

We put 16.1 million men in uniform in the various armed services, invaded Africa, invaded Sicily and Italy, won the battle for the Atlantic, planned and executed D-Day, marched across the Pacifric and Europe, developed the atomic bomb and ultimately conquered Japan and Germany.

It's worth noting that during the almost exact amount of time, the Obama administration couldn't build a functioning website.

ACA Winners & Losers

In Ponzi schemes there are Winners and Losers. Winners are the ones who get more than their money back. ACA is not a Ponzi scheme. It’s more like a shell game.  If you find the pea under the little cup, you’re a Winner. But just try to keep your eye on it as they move those little cups around.

ACA Winners & Losers

Winners: People with lots of kids (especially college age and unpaid service work)*

               Self-employed, 1099 independent contractors and others who control their own wage AND

               The business pays for a lot of their goodies (vehicles, gas, cellphone, electronics, etc.)

               Millionaires (millions in assets combined with modest AGI income)

Losers:  Single people

               Married, dual income

               W-2 employees  

                *Family Size of 5 or more gets subsidy even with a six-figure + income.                          

As I sit down with self-employed people with 2-4 kids still in the target zone (through age 26), average savings has been significant. About $700/mo to $1,000/mo! But I have to remind them, that it’s not savings; it’s cost shifting. It’s an Advanced Premium Tax Credit (APTC). So the taxpayers are paying it.

In many cases, the APTC is LARGER than the entire premium they paid last year. AND they pay their own additional premium this year too. So the cost is HIGHER, but it’s MASKED by this enormous TAX CREDIT.

The exception:

Single guy on disability: He is able to pick up a $768/mo plan for $305/mo. That seems like quite a savings! But if you look, you will see the $463/mo taxpayer credit.

Some of the Winners don’t even know it yet! 

AND a part of the cost savings for families comes from moving their kids from private insurance to Medicaid (in California it is Medi-Cal). So a guy owns a business, married to stay-at-home mom, vehicles include Super Duty truck, Range Rover, Dodge Viper and more. Other toys (boats) too. And we are moving his kids onto Medi-Cal. Really?!?!