As a journalist I’ve covered the Affordable Care Act on and off since it was a gleam in President Obama’s eye. The melodrama of the fierce legislative fight; the subsequent relentless attacks against it; the Supreme Court case; and the catastrophic rollout of healthcare.gov — good times for the news media, though not necessarily the American public.
But of course, the difference between covering something as a journalist and experiencing it as a citizen is substantial. Last year, in part for health reasons, I gave up my full-time job with KQED News. No more long hours: check. No more crazy deadlines: check. No more health insurance: check … my blood pressure. Because our COBRA costs were going to be astronomical, like 40-percent-of-income astronomical. And my health history rendered me uninsurable on the individual market. At least, on the old insurance market.
All of this made me one of the many poster-children for Obamacare, under which insurance companies, starting Jan. 1, would be required to insure my middle-aged ass, and the government was going to help pay for it to boot. Whether this is a victory for common sense and decency, the end of democracy as we know it, or simply a bad idea, I couldn’t say — and still can’t. I only know that the only rational financial decision, personally, was to try getting an exchange plan through Covered California.
Which I did. But not without a fair amount of anxiety due to delays and quirks in the system.
But where’s my premium reduction?
The website experience, though not as smooth as buying a plane ticket or TV online — as the president once promised — for the most part worked at expected. The most immediately noticeable advantage: In the past, when shopping for insurance on the individual market, I’d had to call up each potential provider and carefully take notes on rates, deductibles, etc. Here, all that information was laid out so I could quickly compare across plans.
My first unwelcome surprise, however, came when I input all my information, including my estimated income, and was told by the system that my premium wasn’t going to be reduced through a federal subsidy, one of the key components supposed to make Obamacare affordable. I knew this didn’t make sense, because my income estimate was well within the range that would make me eligible to receive federal money.
I called up an insurance agent who had sent me an email offering to help me sign up, part of an outreach program by Covered California. But he had no idea why the system wasn’t giving me a subsidy. Nor did he know why I had received a letter from the exchange asking me to provide the social security cards for every member of my family.
So I waited a half-hour on hold to get through to Covered California, and the customer service person was pretty patient and knowledgeable, except for the fact that she too was mystified as to why the system wasn’t taking into account the subsidized premium reduction. After she tried various fixes, I suggested it might have something to do with my status as a COBRA participant. (I had read something about COBRA and subsidies.) After some fiddling on her end, the system finally recognized my premium reduction.
The problem, as I have since learned: Active COBRA participants aren’t eligible for subsidies. But if you time your COBRA insurance to end just before your exchange plan begins — always my intent — you are eligible.
“If someone has COBRA currently and it’s still open enrollment, they can cancel their COBRA and enroll in a Covered CA plan with federal subsidies, if otherwise eligible,” Covered California spokesperson Anne Gonzales wrote me. But, she said, “It’s very important to tell consumers that they cannot have COBRA and federal subsidies at the same time. They have to time it just right.”
So that’s what I did. But the enrollment process I went through seemed to make no provision for that maneuver. Which makes me wonder if there have been people trying to transition out of COBRA who have decided not to purchase an exchange plan because they erroneously thought they were ineligible for a subsidy.
As for the request for copies of my family’s social security cards, the customer service rep informed me I didn’t actually need to provide them, which was a relief because I’d lost mine. She said the correspondence I had received was a “form letter” and that if I looked at my account online, the actual card wasn’t one of the documents I needed to complete my enrollment. (Some enrollees may indeed need to scan or fax in a copy of their card, says Anne Gonzales.)
The long, slow wait: “I guess we have insurance now?”
After completing my enrollment, I felt a sense of measured relief. Why measured? Because I realized I’d never received a confirmation email from either Kaiser or Covered California letting me know that I was in the system. With headlines about the “train wreck” that was Obamacare, this left me uneasy. What if I only thought I was covered? “I guess we have insurance now?” I said to my wife, not exactly a slogan for an Affordable Care Act campaign.
At that point I waited. And waited some more. I called Kaiser, and they said they still hadn’t received any information from Covered California. I went in person to the Kaiser business office to check it out. When I told the woman there I had a question about Covered California, she gave me a hard stare and shook her head like I had just asked her to explain the meaning of life. There were a lot of people confused about just what was going on, she said. She looked me up in Kaiser’s system and said they had no information on my signup from the exchange but that things were so backed up I should be patient and keep checking.
Which I did. And did some more. Meanwhile, over at Covered California, all they could tell me was that I had indeed signed up and that Kaiser would eventually get the data they needed. Before Jan. 6, the deadline to make your first payment? (Later extended to Jan 15). “Uh …. yeah… hopefully,” the rep said, in so many words. I called up Kaiser and asked what if they didn’t have my invoice before the deadline? Would they still consider me insured if I had signed up through the exchange? “We’ll cross that bridge when we have to,” I was told. (Last week, a spokesperson for Kaiser told me it would not withhold care due to processing delays. Anne Gonzales said all participating insurance companies would do the same if there was “a good faith effort by an enrollee to start an application by Dec 23,” which was the deadline to enroll in a plan.)
As New Year’s approached, I tried another tack: maybe the online chat help at Covered California had some new info on the matter. After waiting in an online queue about a half-hour, I finally was connected with someone on the chat line. Only her answers to my questions, while making a sound on my computer, didn’t actually render as text. More frustration.
On Jan. 2, I tried Kaiser again to see if my number, as it were, had finally come up. I got a brief recorded message telling me to try later due to high caller volume. Then, on Jan. 3, after 35 minutes on hold, I finally connected with a rep. And she told me, yes, I was in the system. Eureka! Before she had a chance to change her mind, I whipped out my credit card and paid by phone, making sure to get a confirmation number.
It took roughly five weeks between the time I enrolled in Covered California and the time Kaiser processed my info so that I could actually pay, which is at least the emotional demarcation point between believing you’re insured and knowing you’re insured. (Kaiser researched my particular delay and told me Covered California did not transmit my enrollment information until Dec. 27. Why? Who knows…)
Winners and losers
Nationally, the insurance-buying public can expect more problems, it would seem. The Guardian ran a story Sunday about how the administration’s enrollee numbers could take a big hit if consumers, either through processing delays or ignorance of the final date for payment, miss Wednesday’s deadline.
But if all goes smoothly from here on out, it is quite true that I, personally, am going to be one of the winners in the Obamacare game, receiving guaranteed insurance at a big cost savings. And by big, I mean about 60 percent, or thousands of dollars per year.
Not everyone is experiencing that, of course: Cancellations of individual policies that seemed to put the lie to the president’s now notorious “If you like your insurance, you can keep it,” message have been well-reported, as has the sticker shock when some of those cancelled customers shopped for a replacement policy on an exchange .
For me, though, I’d have to say the entire process was a little like my recent mortgage refinancing: frustrating and riddled with potential pitfalls at every step, but with a big financial benefit as the end result.
For others who have signed up for insurance through Covered California — or at least thought they were signed up — we’re interested in your experiences. Let us know in the comments below.