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Morning Jolt
. . . with Jim Geraghty
January 13, 2014
Those Newly-Insured Know They Have to Pay the Premiums, Right?
Ahem. I know that Bridgemageddon is the new obsession of the Washington press corps and the Sunday shows, and most of the mainstream media has grown tired of covering Obamacare, but lots and lots of the new insurance "purchasers" not paying their bills is kind of a big deal:
As of last Friday, only 8 percent of customers slated to have coverage effective Jan. 1 had been recorded in Anthem's system as having paid their premiums, said Kevin Counihan, CEO of Access Health CT, the state's health exchange. That figure includes people who bought plans through the exchange and those who purchased them outside the exchange.
This is a story that ran Friday, so perhaps "last Friday" means January 3. But still . . . 8 percent?
By contrast, about half of ConnectiCare Benefits' exchange customers already paid their January premiums, a company official said earlier this week. And about a third of people signed up with HealthyCT, a new insurer, had paid their bills by Jan. 1.
Er . . . yay? So the good news is that half of the new customers at one insurer have paid? That's the successstory? Because in most businesses, if half your customers don't pay, it's a disaster.
Some Anthem customers who signed up through the exchange have said they tried to pay their bills multiple times over several weeks, but have not had their checks cashed or credit cards charged. The Mirror has asked Anthem about potential payment processing issues but has not received an answer. Members have until Wednesday, Jan. 15, to pay their January bills to receive coverage retroactive to Jan. 1.
Give the New York Times a bit of credit; some of their reporters and editors recognize that people signing up for coverage, and paying for coverage, and then not being able to get care is news:
Paul D. Donahue and his wife, Angela, are among more than a million Americans who have signed up for health coverage through the federal insurance exchange. Mr. Donahue has a card in his wallet from his insurer to prove it. But when he tried to use it to get a flu shot and fill prescriptions this week, local pharmacies could not confirm his coverage, so he left without his medications.
Similar problems are occurring daily in doctors' offices and drugstores around the country as consumers try to use insurance coverage that took effect on Jan. 1 under the Affordable Care Act…
In Los Angeles, Hilary Danailova, who is almost eight months pregnant, said she had to pay $630 for an ultrasound on Thursday after failing to get an ID card or any confirmation of coverage from her new insurer, Anthem Blue Cross. Ms. Danailova, 38, said she signed up just before Christmas and sent her first month's premium of $410 by overnight mail on Jan. 3. She has repeatedly tried to reach Anthem to see whether the company has processed her payment.
"At this point I am facing the cold dread of not knowing whether Anthem ever recorded my enrollment at all," she said.
Meanwhile, CNN shares the troubles of patients who paid . . . and who still are being told that they can't see the doctor because of paperwork issues:
Patterson's journey started New Year's Day, when she landed in the emergency room for a stomach ailment. The Independence policy number she received didn't work and the hospital required her to sign a form saying she would pay for care herself, though it agreed to bill her later. She then received an ID card for her HMO plan in the mail a few days later, so she made an appointment with her primary care doctor and a gastric specialist for follow up.
But when the 59-year-old went to her doctor last week, she was told he couldn't see her because she hadn't designated him as her primary care provider. If she wanted to be treated, she'd have to pay for the visit and lab work and request reimbursement. She spent an hour on hold with Independence trying to fix the problem and left the office without care.
Patterson, who has previously always had insurance, said she was not told she had to designate a primary care provider in Independence's system before seeing the doctor. When she got home, she went online and did that, but learned she'd have to wait until February to make an appointment.
This is what happens when you force lots of people to change their policies, and move to new policies, and then you change the rules, dependent upon the approval of state commissioners, right before the deadline. This is why we're wary of any grandiose policy reform that begins, "First, everyone in America will be required to…"
When millions of health-insurance plans were canceled last fall, the Obama administration tried to be reassuring, saying the terminations affected only the small minority of Americans who bought individual policies.
But according to industry analysts, insurers and state regulators, the disruption will be far greater, potentially affecting millions of people who receive insurance through small employers by the end of 2014.
While some cancellation notices already have gone out, insurers say the bulk of the letters will be sent in October, shortly before the next open-enrollment period begins. The timing -- right before the midterm elections -- could be difficult for Democrats who are already fending off Republican attacks about the Affordable Care Act and its troubled rollout.
Some of the small-business cancellations are occurring because the policies don't meet the law's basic coverage requirements. But many are related only indirectly to the law; insurers are trying to move customers to new plans designed to offset the financial and administrative risks associated with the health-care overhaul. As part of that, they are consolidating their plan offerings to maximize profits and streamline how they manage them.
The individual plan Howard was paying for cost him $1,100 a month including dental, and his deductible was $3,500. Insurance would then pay the rest of the costs.
The plan offered to Howard through the Affordable Care Act would have increased his premium to $1,800 a month and did not include dental. It also would have increased his deductible to $4,500 and he still would have had to pay 40 percent of the rest of the medical bill.
"It's going to cost me more money this year for the same amount of care," Howard said.
The Lost Art of Taking Our Time
So why did the national press decide that Bridgemageddon will dominate several news cycles? How much time will we spend discussing toll routes and foul-mouthed e-mails this week, compared to, say, Afghanistan or long-term unemployment?
Christie is getting covered like he's a presidential candidate because the national press has decided he is a presidential candidate, even though any official announcement from Christie is probably a year away. Big, national, horse-race coverage is now a staple of journalism large and small, and the beast commands you to feed it. Those hours of cable news aren't going to fill themselves.
(Reader: " Hey, am I reading a complaint about horse-race coverage from the guy who writes 'The Campaign Spot'?" Well, yeah, but the point of my blog -- on its better days, at least -- is that there's always somebody running for something -- governor, Senate, House seats, there are special elections as lawmakers die in office or resign, etc. Campaign Spot doesn't cover everything, but I hope it manages to provide decent coverage beyond the presidential cycles. Besides, by the time somebody's running for office, they've been covered and profiled to death. On good days, this results in profiles of Marco Rubio back in August 2009, concluding "the smart money might be on Rubio" in a primary against Crist.)
This isn't about "conservatism" versus "liberalism." It's about the moderate tempo at which our institutions of governance need to move in order not to malfunction. As Greg Weiner explains in the overlooked study Madison's Metronome, our constitutional architecture is premised on the moral axiom that impulsive impatience breeds misrule. Rather than the anti-majoritarian fetish it is often mistaken for, "temporal republicanism," as Weiner calls it, simply intends to slow the pace of democratic decisionmaking to more deliberate—get it?—speeds.
Sadly today we hate that idea. Hate it. Everything else moves at the speed of light, why not politics? Because racism! Or classism, or old boy networks, or fat cats, or the corrupting influence of money on politics—anything answer will do, including correct answers, so long as they elbow out the one scandalous truth: a democracy conducted at light speed will twist our judgments and disfigure our justice. It will give us a government of weapons that kill instantly anywhere, computers that know everything everywhere, and money that can be printed at whim in any quantity. . . .
Why do we suffer such a lack of confidence in our private and public-sector elites? In our big State and our big Market? "For a reason of biblical simplicity," writesphilosopher and urbanist Paul Virilio, "confidence can never be instantaneous. It must be built, earned, over time. Instant confidence, like instant faith, doesn't work."
It's early. We don't know what the world is going to look like in January 2016, when Iowa holds its caucuses, much less January 2017, when the next president will take office.
The real mission for the next American president may be to persuade us that we can be Americans again. Not this easily-distracted, cynical, tuned-out, Balkanizing mob that hobbles along with an economy that hits 3 percent growth at the best of times, is growing acclimated to slogging along in a waste-deep bureaucratic morass, and endures a public discourse that alternates among the nasty, inane, and petty, punctuated by perpetual cycles of offensiveness and grievances of the offended. We deserve better than a government that falters and flails in the face of drug cartels and gang violence but that can come down like a ton of bricks on big sodas and incandescent light bulbs. The history of this nation was driven by those who overcame the siren call of acquiescence, the anti-rallying cry of, "What's the use?"
Humans are hope-fueled creatures. Anybody who gets up out of bed with a spring in his step does so because he's got some hope that the next day might be better than the last. Obama's 2008 campaign tapped into this with remarkable power (and an enthusiastically helpful press). But then again, so did the Tea Party, in its own way.
Entrepreneurs, pro athletes -- everybody starts by "envisioning a compelling future," as Tony Robbins, Oprah, and all the lifestyle coaches put it. Hell, even jihadists think that someday they're going to reinstate the Caliphate and everybody on the planet will think the way they do or be dead.
The Left probably has an advantage here, as their core philosophy is "yes, we can" build utopia, and our core philosophy is, "no, you can't, and you'll do a lot of damage trying."
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