david-sipress-what-about-business-which-branch-is-that-new-yorker-cartoonThe education of Alabamians on Obamacare has begun, about 2 1/2 years to late. Up until now, Obamacare has been used to differentiate conservative congressional candidates from REALLY conservative congressional candidates

 a congressional candidate in Alabama is shown in an ad released Tuesday comparing President Obama’s new health care law unfavorably with the Bible and Constitution.

as well as a source of pride regarding voting record (from Congresswoman Roby’s website)

 “Despite the Court’s ruling, a significant number of Americans continue to oppose Obamacare and they are encouraging Congress to take immediate action. Americans and their doctors, not federal bureaucrats and politicians, are in the best position to determine which health care options best meet their individual needs.”

but with the exception of the Medicaid expansion, the law itself has received very little coverage. The “go live” of the insurance exchanges has woken Alabamians from their state of torpor. Just what is in the law? Has anyone read it? Will Blue Cross get to keep its monopoly in Alabama? Since the government seems uninterested in providing guidance, some citizens have taken on the educational mantle on their own.

I participated in an orientation for the public to the insurance exchanges and the Affordable Care Act put on by Alabama Arise. This is a citizen’s group “united in their belief that low-income people are suffering because of state policy decisions.” I was invited specifically to discuss our Medicaid expansion (or lack thereof) problem, and we had a good discussion. The group was introduced to the “5 minute speech” designed to provide an Obamacare introduction. The first talking point was “If you like your insurance, you get to keep it.”

Unfortunately, the group got kind of hung up on that point. It seems that Blue Cross of Alabama has recently been sending letters out to some current policy holders saying that because of Obamacare their policy will no longer be in effect. Blue Cross does say they will be “happy” to write you a new policy – at twice the price.

Why is this? It turns out that a lot of people liked their “Individual Blue” policy because it was cheap. Didn’t cover what it should have, but did so inexpensively. How is that?

First, there was no guaranteed issue. Obamacare (subsidized individual insurance through private companies) requires that folks who qualify (American citizens, no insurance through job, not eligible for government coverage, make over 133% but less than 400% of poverty) get a subsidized policy regardless of their current or past illnesses. Blue Cross made money, in part, by cherry picking  folks to sell policies to that were least likely to need them. Diabetes, no way. Able to run marathons, sure. Under Obamacare, this business practice no longer legal (part of the reason for the mandate). Though I’ve not seen it in writing, I suspect our unwillingness to accept the Medicaid expansion has made them a little jumpy as well at the threat of poor, sick people making $25,000 a year and qualifying for a policy. Thus the higher cost after January 1.

Secondly, there were no essential benefits. Reading the fine print on an insurance policy was not something people did for fun. Most people assumed their policy covered their illness, until it didn’t. Some people could predict which conditions they might have. Guys might not buy maternity coverage for example. Tee-totalers the same for substance abuse coverage, In fact, 51% of plans sold nationwide did not meet what is now the minimum. 62%, for example, did not include maternity. 34% did not cover substance abuse.

Beginning in January, Obamacare defines now defines what is covered (listed below)

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including  behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

So, it turns out, the President told us a little white lie. What he should have said is “If your insurance complies with good policy, common sense, and furthers the goal of making the American health care system more efficient and effective, you can keep it. If it doesn’t meet this criteria, not so much.”