Gaming Obamacare: A loophole that will result in massive fraud and overload the system

Gaming Obamacare: A loophole that will result in massive fraud and overload the system

Gamers out there can expect a new triology to hit the market by spring of next year. Already in a late stage of development, the series is called “Gaming Obamacare.” Anybody can play, and there’s no reason to expect that everybody won’t.

Gaming, of course, is a domain of the young, which coincidentally is the same segment of the population that the health care law is counting on for participation if the law is to be spared the dreaded death spiral.

One game in the series that’s already been well-documented is called “The Enforcer, or Lack Thereof.” The title is a little wordy, but much less so than the idea it represents, which is that the government has no way of enforcing the non-compliance penalty for those who fail to buy health insurance.

Another game is called “Qualifying Life Events.” It’s an “out clause” for those who fail to sign up during an enrollment period but have an accident or become ill and need health insurance on the fly. As the law is currently formulated, these people are out of luck — and forced to go out of pocket for costly private coverage …  unless they can cite a qualifying life event, which gives them a waiver. QLEs include getting married, moving to another state, and experiencing a change in income. The game is a little more cumbersome than some of the others, but it’s doable in pinch.

The third game might be called “The Float.” The diversion derives from a little-known provision within the 11,000 pages of the Affordable Care Act that provides three months of free health care to individuals who default on their premiums. As Tori Richards of Watchdog.org explains, under Section 156.270 of the ACA, people who receive the federal subsidy will be allowed a three-month grace period after they’ve paid a premium for one month. Funds to cover the first month of the grace period come out of the insurance company’s pocket. Doctors and hospitals are stuck with the unpaid bills for the second and third months.

It’s all pretty insidious and underhanded — but no more insidious or underhanded than a law that forces young people to buy a product they don’t want so that some total stranger is able to get the same product at little or no cost.

Rep. Louie Gohmert, R-Texas, predicts the practice will “help break the system. This is a huge piece of evidence to show this can’t work, you will break the system and bankrupt people involved.”

Wesley J. Smith, a senior fellow at the Discovery Institute of Human Exceptionalism, takes an equally dim view, stating:

In a sense, it legalizes fraud. It legalizes putting your burdens on the insurance companies’ shoulders and never paying your premiums. The government wants people to be irresponsible and apparently they want the whole system to descend into chaos.

Richards notes that the California Medical Association has also sounded the alarm. C. Brett Johnson, the group’s associate director, wrote:

The more nefarious insureds may take advantage of HHS-acknowledged opportunities to game the grace period and get 12 months of coverage for the price of nine before simply enrolling in a new plan under [Obamacare’s] guaranteed issue requirements.

He goes on to paint a nightmarish picture of the sorts of abuses that await health care providers.

For instance, an oncology practice generally purchases the drugs to be used in a course of chemotherapy up front — which can run into the tens of thousands of dollars — and is then reimbursed by the payor as part of the medical service. Costs such as these are on top of the costs of displacing other patients with coverage.

With an estimated 48 million uninsured Americans soon to enter the system and a doctor shortage that has steadily worsened, the entire system is already likely to crash. Add in a fraudsters, and the process speeds up dramatically.

Who, other than Barack Obama, couldn’t have seen this coming?

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Howard Portnoy

Howard Portnoy

Howard Portnoy has written for The Blaze, HotAir, NewsBusters, Weasel Zippers, Conservative Firing Line, RedCounty, and New York’s Daily News. He has one published novel, Hot Rain, (G. P. Putnam’s Sons), and has been a guest on Radio Vice Online with Jim Vicevich, The Alana Burke Show, Smart Life with Dr. Gina, and The George Espenlaub Show.

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