Serious question. In this month's Texas Medical Association magazine, there is an article in which they warn providers that there is no way to know that a patient is actually covered by ACA insurance due to the premium payment grace period loophole. When the doctor and hospital call for eligibility, the insurer will say "Yeah, he is covered." The insurance is not required to mention that the patient is late with his last payment. The problem comes if the patient decides not to make last month's premium payment of $100 bucks after the surgery. If he never makes that payment, the health plan can then go back to the doctor and hospital and demand that all of its money be refunded. But before they take back the money they have to warn you "Your patient has not made a payment. Time is running out." If this happens, the article warns, doctors and hospitals are advised NOT to make the premium payment for the patient.
Why not? What happens if you pay the $100 bucks for the insurance so that you get to keep the $5000 that you earned?
That is a rhetorical question. I am pretty sure you get hauled into court, charged with committing some kind of fraud. i.e "The patient only stayed in the hospital and had the life saving appendectomy because the hospital agreed to pay his $100 insurance premium. Had they not agreed to pay that premium, he obviously would have walked out the door and died." Yes, it sounds stupid. But replace "appendectomy" with something elective like "chiropractic manipulation" and suddenly it sounds like potential fraud.
Forget about doctors and hospitals. What is to stop some entity that does not have a direct financial incentive to keep the patient insured from paying the patient's portion of the premium? Say, their community which just wants to make sure that the person does not die on the street from lack of health care? Or their church? Or their club?
Lots of rural areas can not keep doctors or hospitals, because their poor and/or self employed residents do not have health insurance. Is there any law that would prevent a rural county from coming up with the money to pay the additional premiums to buy all of its poor and uninsured citizens silver or even gold insurance under the Affordable Care Act?
How about large urban areas, which often spend a lot of money running public health clinics for the uninsured? Could they legally pay the patient's portion of the insurance premiums for a private insurer? Could the state do it? The feds are already doing it with their subsidies. But the extra portion, the $50 to several hundred dollars that folks have to pitch in to upgrade from a "bronze" $10000 deductible plan to a "silver-I can really afford to use this plan"---the fee that sounds small when you compare it to the cost of a hospital stay----that amount of cash may be hard to scrape up each month for folks living on a fixed income. Especially when they are sick and have not been able to get in to their minimum wage jobs, which is exactly the time they are most likely to miss a few premium payments---and exactly the time they are most likely to need their insurance. Can their employer make the payments? Can Wal-Mart do it? Can 7-11 do it?