Monday, February 10, 2014

Victims of Bureaucracy

Boot Key Harbor, Marathon, Florida

Usually it is me that whines about encounters with bureaucracy. But I'm not alone.  This time is Jen is the victim.   Below is her story.  I think I have the essential facts right, but I'm not certain.

Jen's Cobra medical coverage ran out, so she was in need of a replacement.  It seemed that Obamacare came along at just the right time.   Vermont is one of the stated that did its own health care exchange, and also one of the ones where the implementation was a huge fiasco (not a federal fiasco but a state one).   Jen wisely waited until the dust settled a few months before attempting to use the web site.

When she did try, she succeeded, or so she thought.   She entered her data.  She was quoted a subsidy.  She selected a plan, pushed the BUY button, and sent a check for the first month's premium.  Sounds pretty successful.  Beyond doubt, Jen's case is one that the state would count as "successful" as they gather statistics about their own performance.

But then she got a call from the Vermont state government. They said that she was eligible for Medicaid and thus ineligible for Obamacare.  Therefore they cancelled her subsidy.  Therefore the money she sent was not enough to purchase insurance with no subsidy, so they cancelled her Obamacare insurance. She had no coverage at all.

WTF??? Everthing I read in the national news about said that the major functions of the exchanges was to coordinate Obamacare/Medicaid eligibility and to enroll each person in the appropriate kind.  Even if Medicaid enrollment was not automatic, it should have told her what to to.  Even if they didn't do that, it should not have calculated and applied an Obamacare subsidy for her if she was not eligible for that.   It's failure at least three levels deep.

Next step.  Jen asked about her refund the money she paid.  The state employee said, "Sorry.  We haven't even issued specifications for the part of the system to process refunds.  We can't say anything about how long that might take."  Ay ay ay, Excedrin headache #22.

Next she got an email from the state saying that there was an important document online requiring her attention.  She went back on the web site, but it refused to let her look at the document.

Next she called the state about the document problem.  They finally looked at the document themselves.  It was a dunning notice saying that she was late paying for the second month of that Obamacare insurance.   It was the same Vermont state agency telling her that they cancelled her insurance, and dunning her for payment of same.

So, where does that leave Jen?  It's not clear if she needs to start over to apply for Medicaid.  It is not certain that Vermont Medicaid will accept her if she does apply.

Worse, there have been news reports that some states require Medicaid recipients to repay subsidies paid by the state should their income increase in the future.  They have seized people's houses to go after their equity assets.  No such repay obligation exists for Obamacare.  Could accepting Medicaid jeopardize Jen's primary financial asset in this world -- her house?  If so, they would surly warn her in advance, right?

We have no idea if Vermont is one of the states demanding repay or not.  Hopefully, they are not.  Even if they are not, there is nothing preventing them from changing the law in the future to require repay of all subsidies for any purpose with retroactive effect.

A good and sufficient reason for being libertarian is the belief that American governments f**k up almost everything they attempt.  Regardless of good intentions, the end result is often worse than if government never got involved in the first place.


  1. You should read about the early days of social security. I believe that was deemed a mess as well. Big changes take time to get right. I never hear about any people opposed to too much government giving up their social security checks in protest, or turning down disaster relief. We let the free market dictate our health care costs, and look at what happened. Health care is out of reach for most of us. I say we give it time and support it. If after 5 yrs it looks bad, we try something else, but we can't afford to do nothing.

  2. There are few people over 65 who want to give up on medicare. Its far from perfect but the reality of insurance coverage costs if it didn't exist would leave most uninsured during the years of most need.

    I am not trying to defend the flaws showing up but a medicare type plan for all would be much better.



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