Covered California the culprit, again

Covered California the culprit, again

When last we checked in with America’s Obamacare poster child, state media were crying foul over some cooked numbers from Covered California’s management, and new customers couldn’t get hold of either the Covered California service representatives, or the private insurance companies, to figure out where to send their first payments.

We’re now two weeks into the new year, and the new deadline for Covered California enrollment is tomorrow (15 January).  How are things going?

Culprit alert

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In a Pants on Fire Report in November, we noted that all the 2013 policy cancellation letters were being sent out to Californians because Covered California required contracting insurance companies to cancel existing policies – contrary to the “bad apple” allegation made by President Obama against the insurers.

Now we learn, from insurance specialist Ed Persike, that it’s also Covered California policy that has forced hundreds of thousands of worried customers to enter all the information for their insurance through the exchange interfaces, rather than directly with the insurer.

Blue Cross, Blue Shield, Kaiser and others have been successfully processing insurance applications for decades. They have been receiving and processing tens of thousands of health insurance applications every single month and medically underwrite them. Doesn’t common sense tell you they would be able to handle an application? Other than the Democrats’ desire to build a political infrastructure, my colleagues and I cannot fathom why each company issuing coverage was not made the primary party responsible for gathering the data and issuing the insurance contracts. Instead, an unwieldy system has been created because elected government officials and appointees felt they were smarter than private enterprise. At this point, it’s obvious they were wrong.

But wait – there’s more (emphasis added):

All conventional insurance products require a “binder” to be able to offer valid coverage. What this means is that virtually all insurance companies require a check or credit card payment at the time of application. From there, the process is simple. Once the policy is approved, it is issued because the binder is in force.

Covered California decided against the binder process. Thus, each and every new applicant must be contacted by the issuing insurance carrier, the insured must write a check and communicate back to the company before the policy is placed in force. By designing a nonconventional payment system, the system is crumbling under its own weight, requiring multiple contacts between Covered California, the insurance carrier and the individual. Multiple steps create greater chance of a foul-up along the way.

So, to summarize:  Covered California made a conscious decision NOT to set it up so that new customers could pay promptly and have evidence of coverage immediately – although the latter is the industry standard.

All those Californians out there, unable to verify that your payments have gone through and that your insurance coverage is in force?  Your pain is Covered California policy.

Medi-Cal: A lot more new enrollments than private insurance

And the customer problems appear to continue apace.  See here, here, here, and here, for starters.  (Make sure to scroll down to the comments, which are almost uniformly negative.)

State officials report over 499,000 enrollments in Covered California as of 31 December, although of course that doesn’t mean anything like that many people now have working insurance.  Of those nearly half a million, 85% of enrollees will receive subsidies.  52% are 45 years of age or older; 25% are between 18 and 34 years of age.

Little noticed alongside the enrollments in private insurance policies, however, has been the surge of enrollments in Medi-Cal, California’s state version of Medicaid.  That surge appears to be around 1 million in the last year – to a current high of nearly 9.2 million enrollees – as reported by health-affairs correspondent Emily Bazar in the Bakersfield Californian.  Ms. Bazar points out that that puts 1 in 4 Californians on Medi-Cal.

Never end with a ballad

Because it’s the land of fruits and nuts, there’s at least an Onion-type satire to go with all this.  If your emergency-room wait happens to be getting a little tedious at O’Connor Hospital in San Jose, there’s a time-waster for that.  The Health Benefits Resource Center, “just down the hall from the ER,” has been beefed up to take advantage of the natural Covered California clientele that often shows up in an emergency room:

“I think the emergency department waiting room is one of those places where you have low-hanging fruit,” says Renee Hsia, an associate professor of emergency medicine at the University of California, San Francisco. “They’re not the sickest of the sick, because at least someone, the triage nurse, has deemed them stable enough to wait. And if they’re waiting, they might as well be filling out some application form, or at least learning about the process.”


J.E. Dyer

J.E. Dyer

J.E. Dyer is a retired Naval Intelligence officer who lives in Southern California, blogging as The Optimistic Conservative for domestic tranquility and world peace. Her articles have appeared at Hot Air, Commentary’s Contentions, Patheos, The Daily Caller, The Jewish Press, and The Weekly Standard.


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