Way back in October I went through what is called Connect for Health Colorado, our state's on line website and module, we wanted to see if the ACA Exchange offerings might be better for our family than my wife's local school, employer-administered plan that simply has gotten worse and worse in both its service delivery (the pharma mail order is criminally incompetent) and the offerings, all of which are compounded by the annual increasing costs of both employee contributions and then the plan's co-payments and higher deductibles.
(Note, last year when speaking to its former board president I told her that we view the increased costs for healthcare and the fact that she had to provide two furlough days, plus, as a non exempt employee they have now redefined lunch as the moment the clock hits a point, not when they are off-duty, (at least 5 minutes lost per day because they are permanently short handed), plus the fact that she has not received a raise in two years before this year---that---that my wife, has lost 9% in overall compensation---all I got in response was a blank stare with a smile to frown (a now common response when one confronts local politicians who are supposedly on my partisan side and asking for my support but are caught between maintaining their current desired social status and demonstrating genuine integrity and courage). Then the non specific excuse that everyone had to take a hit to balance the budget. I recall replying, then why not the management and administrators, they continue to get their raises, is it because they have direct access to tell you how invaluable they are despite they actually do not deliver the services? Purse lips from someone asking for my campaign support is not responsive.
Our family's status as we are beginning to find out what many Baby Boomers are realizing, is that we have been devastated by the government policies of the last thirty years. I currently work as a temp on what I describe in generic terms as a perof perpetual series of assignments designed to avoid any and all paid benefits, too old to be hired outright, but too valuable when they are in trouble to discard, and they are always in trouble. Our two adult children, both living with us, not unlike many American families at this stage of life, rely on us to continue to provide them the support to get on with their lives, which is okay. One just recently graduated, although finishing at the top of his two majors (and class) at the U of CO, he is now looking for his first post-graduate job to little avail. The other, our oldest, is one course short of graduating, now 25, she also is Type I (juvenile) diabetic and works part time. Thank you Obama and the Dem team, we are eternally grateful that you passed the ACA that extended the age to cover our children on our adult plans to 26. (That then begs the question, why arbitrarily 26, why not 30 or 65 for that matter, I could see the logic of 23 if a child was enrolled full time in college, but why stop short of 26 if the goal actually is to cover all adults in the US?)
more below the cannabis inspired swirls
Anyway, like many I suspect living in the 15 states that had set up their own HC Exchanges and devastated by RW governing policies last October I ventured online to peak into the healthcare options, though didn't know that it began as an online version of a Medicaid application. I weathered that process where it was determined (duh) that we (meaning my wife and I) didn't qualify as we made too much money. But since our daughter was no longer a tax dependent was not part of that tax household there was consideration she might qualify. When that application process was completed the online website told us now to telephone what we found out to be a navigator.
Over the phone the pleasant and hopeful/helpful navigator told us that we didn't meet the criteria for tax credit subsidies if we went through the exchange. On the second call another finally told us why. If you have an employer-provided health plan, to qualify for tax credit subsidies the plan's employee contribution must exceed more than 0.095% of the employee's gross income as to single coverage, regardless of the contribution cost for a spouse or family coverage. This provision knocked us out by less than 0.0095%, but it really hurt my sister-n-law household, whose husband works for Home Depot and the coverage of spouse is exorbitant but not for their dependent. She works as a religious education director so her church (employer) has no health care insurance, (though the ministers have an national association that provides coverage for them). All this exposes the continued menagerie of attempting to provide social welfare policy through the self-interest of private enterprises---this model does not work.
Later last October my wife and I received official notifications of denial for Medicaid but not for our adult children. For over month we didn't hear a thing until on December 10th we received an official notice that our children had to provide "official proof of citizenship" by December 19th otherwise their applications would be denied. The letter did not state what that constituted official citizenship, (as one has to prove such status to get a driver's license or for Pell Grants and U of CO in-state tuition or even voter's registration) and further the return address did not specify a person or specific address to send, said documentation except something called Maximus, PO Box ....
Fortunately that week I had a snow day so I got on the phone at 8 AM and waited on hold for 1 1/2 hours until I got a person. The crabby live person told me in a condescending manner that we needed to provide a "certified copy" of either a passport, or, a copy of an official birth certificate and also proof of identity with corresponding local address. When I inquired what constitutes a certification I was told to go to the local county HR Services Department office, bring in the children with their identifications and then have a clerk make a copy, and then they have a signed verification/certification stamp (actually sticky-label) where you then send these very sensitive forms to a (black box) mail drop. (Talk about cavalier attitude to protect someone from ID theft!).
When talking about the requirements to a former Democrat National Committeeman of Byzantine-like proof of citizenship when other forms of documentation were met he said that the Republican strategy was to make this as arduous as possible, hoping that at each stage people will drop off reducing those enrolled regardless of qualifications. That simple, placing in the law that physical verification is required it eliminates a segment of society, no different than voter's registration, but voter's registration is not proof of citizens even though you have to prove it to be registered.
After locating the documents that are rarely sought, we made the trip where we found this procedure to be kind of novel for the attendants, though they had the labels. We sent in the documentation well before the 19th. Our son then received notification that he was enrolled in Medicaid---Wow, thought the family didn't qualify. But our daughter was still pending, hmmm. Okay now my son who needs treatment for a chronic ankle pain/ailment called Medicaid about getting treatment and found that he was only enrolled until January 31st and that the family unit didn't qualify so he was only eligible for emergency care. Reason, they had not received proof of citizenship. WHAT?
Then my wife and I got the same notification for proof, so after work we trudged down to the local county facility, had them make certified copies, but this time we had a person's name and local address to send it too. I also officially sent a statement of appeal any and all decisions---this unearthed our first official telephone inquiry by a state or county worker, a voice mail. They acknowledged our proof of citizenship receipt and my appeal request but no date or time.
Now this week I had to take a non-paid sick day (where if I take three in a row I lose incentive pay, even though I am on my fifth year as employee-temp), and again sat on the phone this time 1 3/4 hours until I reached a person, this time a very nice and informative attendant. She looked up the entire case and found that Maximus (a contract agency through December as a clearinghouse for what was expected to be a deluge of applications to Medicaid, simply was a black box of incompetence) where our children's proof had not been recorded or forwarded appropriately. That it was probably certain that we sent it, but that until they can verify the proof, (and the burden is on you the citizen to cut through the system's failure) your children will be denied. And by the way, if you want them to qualify for February it must be in today, and your case manager will be leaving the building at 1:30 and you have to have the children come in person here, and it would be best to hand deliver it to the case worker. And further the attendant said she was going to have their supervisor call me back about the entire application because I was frustrated and (asking to many questions) and further dropped the State Representative bomb on them as I am friends of ours and two, truly he wanted to know how our process was going.
The nice supervisor called back and we reviewed the entire application which she kept saying that it was an online application, where I finally inquired, why the fuss about the online application? She explained that two things, they were not receiving all the information and two, one still has to verify all the information provided, so proof of income and citizenship etc., has to be verified. Now the good and bad news. They had made a mistake regarding our son who didn't qualify, our daughter was the one who should have received the one-month eligibility and then fully verify her situation going forward. (How does this happen? And we just bought three months supply of insulin and supplies, to the tune of a $150 co-pay.) I told the supervisor that they would be coming to the office and be there before 1:30, more like 11:30. The supervisor then told them to get the certified copies and then walk over to her and she would introduce them to the case worker and verify them. If she had proof of income last year it would further expedite the approval process.
Bingo! Government works. Our daughter who would be unable to continue receiving coverage from us sometime this year when she turns 26, was now on Medicaid. Her costs (and ours) greatly reduced for her diabetic supplies, (see above) and even better, they are going to assign a diabetic case manager and force her to see a doctor every three months, she doesn't like it but the co-pay is $1.00, and it will be the same doctor! They want to set her up for a pump, (cheaper and more reliable than even the pen needles) something our insurance denied twice, to the doctor's astonishment. More importantly, our daughter chosen profession at least now, is campaign work while she pursues nonprofit work or government staffer positions. She is taking the one course this semester so she needs to stay around here, and right now her work is part time, and will probably not make enough money to be off Medicaid for at least a quarter maybe half year. If she gets fully employed then she will have to either get an employer paid insurance (unlikely unless hired into a government position) or go through the HC exchange, which we looked and it was about $200 +/- a month for her.
Finally I got a final follow up call from the supervisor who inquired if everything was now in order, which I inquired what about those lost certified credentials? She told me that since Maximus had not processed most of those inquiries they were all shredded. Again why we should never hire contract services to a private temp agency who has no vested interest in doing a good job, but only receiving billing hours.
Final comment: This kind of shit, systemic stupidity will continue until we morph over 65 year Medicare into the entire population and have a single payer system. There still can be co-coverage through supplemental insurance (or private or employer paid but taxed as income). I will state I am happy with our state/county employees efforts and attitude but fathom the idea that because I happen to be off of work I had to sit on hold for over three hours to get simple questions answered tells me how much demand there is and short-handed they are. How many people give up because of time or frustration. Yes I know to place the phone next to me with the speaker on and wait, but come on! Lastly, the hell to those who don't want government to work effectively, because of government is of the people, than Reagan's axiom that government is the problem was bullshit, always was but now that revolution must be spiked---period.
For us the system worked. Never thought it would be perfect, but I bet it has worked better than designed because of people working it in those 15 states. And one more thing. A friend of mine who is a Native American says that the Tea Party and rich Republican RW Authoritarians now have the same attitude that much of America once had towards Native Peoples on Reservations. Their once was a belief that Native's were not really Americans, and now those who are not RWingers are not Americans in their eyes, so they can bestow the most minimal efforts and resources towaards them and then go less than minimal.