Again the Republicans are waving their Chicken Little flag and telling us that “The Sky is Falling.” What happened?
On July 5, 2013 as reported all over the place, the provisions of Obamacare regarding use of the HHS.gov website or the state exchange websites requiring individuals to supply evidence showing that they are eligible to use the health exchange and that they are perhaps eligible for subsidies and tax credits provided by Obamacare to help pay for health insurance premiums were suspended for one year, until 2015.
Anti-Obama factions are crying the end of the world as the suspension of these “fraud provisions” opens the door for individuals to lie about the availability of employer-sponsored health insurance, how much that insurance costs, or what kind of insurance is offered, and lie about their household income in order to get at the “free” money in the form of subsidies and tax credits.
Why did the Administration suspend the rules? Basically, everything is not in place, so we’re seeing suspension of provisions from the employer mandate to the verification process. Penalties for fraud and the requirement that amounts be repaid if an individual misreports their income are still in place. The law hasn’t changed, the Administration has effectively put off the effective date for implementing the verification process because quite frankly, they’re not ready to process that information.
Anyone who reads this blog knows that I am not pro-Obama, nor am I pro-PPACA in many respects. However, the hoopla over this latest snafu is, in my opinion, another instance of Republicans dramatizing the threat, overstating what these delays mean and trying to tie it into some general commentary designed to say, “We told you so.”
As is my response to all the dramatic hyperbole employed by Republicans when it comes to criticizing this Administration with the same intensity for everything from delay of this effective date to the deliberate misleading of the American people when it came to the provisions of Obamacare, this is stupid, and will do nothing more than underscore the mean-spiritedness already associated with Republicans. Not every misstep is worthy of Republican diatribe.
So, does it mean anything to YOU?
Were you eligible to participate in the health exchanges to begin with? In addition to checking with the website, and utilizing tools there, generally only those individuals who have no employer-offered insurance (fewer than 100 or 50 employees depending on state), those individuals whose employer-offered insurance premiums EXCEED 9.5 percent of their household income, or those whose employer-offered insurance is so crummy that it doesn’t even cover 60 percent of costs that are covered by the plan, in other words, worse than the bronze coverage under Obamacare are eligible to use the healthcare exchange.
Why? Because Obamacare is about getting people insured. If you are unemployed, Medicaid, is probably a better option which is why the PPACA tried to expand eligibility for Medicaid. You’ll have to contact your state’s Medicaid office to see whether you qualify for Medicaid as your insurance coverage.
OK, so, using the guidelines above and the resources of different websites including your state’s exchange or Medicaid site and HHS.gov, you’re figuring out whether you were or might have been eligible for subsidy or tax credit assistance from the Federal government. Only if you were or think you are is the “NEWS” relevant to you.
The application on health insurance exchanges requires employer verification and proof that your income level puts you within the ranges for eligibility. Now, the verification process will sort of be relying on your honesty, which in short, will make your application process easier if you’re honest and might tempt you to commit fraud if you’re not.
Only that small part of the eligible population, which is not everybody, who is applying for health insurance through the health exchange and decides to LIE in order to get at free money to pay for health insurance PREMIUMS is at issue.
Even if you are a liar, the penalties are steep for lying, so you’d have to be a lying risk-taker and assume that you wouldn’t get caught. And what’s at stake? Money that goes towards your PREMIUM payment, not your copayments or coinsurance responsibility (that’s an even lower income eligibility standard for tax credits) and if you earn more money by getting a better job during the year or another job, you’ll have to repay the amounts you received from the Federal government.
While no one can determine the amount of money that is drained from insurance companies and the Federal government that is due to fraud (obviously, unless it’s caught, it’s lost), the estimates are in the billions. HOWEVER, fraud by patient individuals as opposed to fraud committed by providers from institutions, to medical device companies, to physician practices and others are the largest contributors to this fraud. We know this because the biggest efforts to curb fraud involve appealing to patients to review their statements, report double-billing, et cetera.
In sum, if you are eligible to use health exchanges, your application process is simpler this year than it will be next year when you have to jump through the verification hoops. Be sure you are eligible because whether the “fraud prevention” is suspended or not, even absent fraud, you’ll be responsible for repaying amounts you receive that you shouldn’t have received.
