Peter LaFrance, a 57-year old Pennsylvania plumber, went to the doctor in early 2017 when his chronic shortness of breath got worse. His doctor immediately sent him to the hospital, where he learned he was having heart failure and also had type 2 diabetes. He was in the hospital for nearly a week. At least he had insurance, he thought. He thought wrong.
He got a bill for $35,000 from the hospital, denied by his insurer because his new diagnoses were pre-existing conditions. But wasn't Obamacare supposed to fix that? It was, and it did, except for one loop-hole: short-term, limited duration insurance, the kind of plan LaFrance bought because it was cheap. The plans were allowed under the Affordable Care Act to act as bridge policies for people for no more than three months. "They basically said I should have known I had diabetes and congestive heart failure. I should have been a doctor and diagnosed myself," LaFrance told The Philadelphia Inquirer. LaFrance wanted to save money, and found the Golden Rule Insurance plan online, at a cost of about $300 a month. What was harder for him to find was the fine print on what the insurance wouldn't cover.
That's an even bigger problem for people shopping for individual plans now that the Trump administration has expanded the plans to last for longer time periods. People looking on the federal marketplace website, HealthCare.gov, for insurance might be redirected to other enrollment sites, where brokers are selling the short-term plans. "The whole business model is signing people up for coverage and getting a cut of what they sell, and the place they're going to make their money is selling these short-term plans," said Nicholas Bagley, a professor of law at the University of Michigan. Many consumers "don't fully understand the lack of protections if they go over some annual or lifetime [insurance] limit. These plans don’t cover preexisting conditions."
The Trump administration is encouraging this bait and switch for Obamacare customers. The Centers for Medicare and Medicaid Services "has sent at least five emails so far to individual market consumers encouraging them to use outside brokers, including through a service called Help on Demand, to sign up for health insurance," The Washington Post reports, citing emails provided to it from a recipient of ACA market emails. Senate Democrats are not happy about any of this, and have written to CMS warning that "not only [is it] failing to conduct sufficient oversight to protect customers, but [it] is actively emailing consumers to encourage them to obtain coverage through third-party agents and brokers instead of the HealthCare.gov website."
The senators and Peter LaFrance (who has been in an ACA-compliant plan since 2018, and pays as much for it with his subsidy as he was paying for the junk plan) want everyone shopping for health insurance in the remaining 20 days of open enrollment not to be fooled by the Trump administration or insurance brokers. Get Covered America's open enrollment toolkit will help you avoid that potential disaster, providing all the information you need. And, as always, Healthcare.gov is the place to get started.
