American Healthcare under the unamended, serially challenged ACA

I got a notice on Sunday from the New York State of Health, the state entity that administers the Affordable Care Act Marketplace in NYS, selling various plans and being the final arbiter of all things health insurance for millions of otherwise uninsured New Yorkers. It has been run, since its inception, by a marginally competent and apparently energetic Cuomo appointee named Donna Frescatore. Under her stewardship, you can get the New York State of Health to fix their own errors (if they result in denial of coverage or denial of the subsidy the law says your income provides for) only after arbitration, a process that takes just three months or so. I’ve had to do this twice over the years (while having no health insurance the second time). Fair is fair. Frescatore has been promoted for her excellent work at the NYS of Health and now also runs New York State Medicaid, because, why not? Albany is known as a corrupt town and Cuomo is suddenly looking every bit as obnoxious and autocratic as many of us long felt he is.

Anyway, because the New York State of Health gave me no notice last March that I needed to upload a document I’d forgotten to maintain my insurance coverage (though they sent a timely notice to my insurance company, informing them to cancel my insurance effective April 1) I found myself without affordable health care during the first full month of the pandemic’s initial surge in New York City, where I live.

I found out when a doctor’s office called me to tell me there was a problem with my upcoming visit, my insurance had been rejected. In disbelief, since I’d paid premiums for the entire year, I contacted my insurance company and learned it was true. This time, they informed me with regret, NYS had cancelled it. The insurance company apparently has no legal obligation to pass on such notice to the consumer under the PPACA. So sorry!

Infuriating, yes, scary too, particularly during a massive public health emergency that has now killed about 525, 000 Americans. Fortunately for me, I didn’t need to seek arbitration last April, and since I learned my insurance had been cancelled a few days before the deadline for getting it back in May, I was able to complete the ten minute on-line fix before the April 15 deadline for coverage in May. A friend advised me to go the the NY State of Health website and see why I’d be terminated. I uploaded the document they’d requested, the whole thing took a few minutes. If I’d had notice (NYS of Health claimed, falsely, that I had) I would have done this the day my insurance company was ordered by NYS of Health to cancel my insurance in 20 days. Last year my insurance was restored effective May 1. Slight harm, slight foul. I was glad to have health insurance again during lockdown.

When I went to renew my plan for 2021, in the weeks between Thanksgiving and Christmas, when all New Yorkers are required to re-enroll, I was surprised to learn that my renewal was not due until May 1, 2021 (or April 15th, I guess). I verified this, paid my first six months’ premiums and have had no problem with services under my insurance since.

I’ve often questioned why the overwhelmed NYS of Health makes everyone re-certify in these hectic weeks at the end of the year, when phone lines are jammed, mistakes are routinely made, the website crashes, instead of on a rolling basis, say, by birthdate which would allow everyone to be better served. One characteristic of a great, unaccountable bureaucrat is inviolable rigidity.

I had a notice from NY State of Health on Sunday night, in their typical opaque bureaurcratese it notified me:

I suspected it had to do with my obligation to re-certify before the fifteenth of the month prior to the first month of coverage, on pain of losing health insurance with likely arbitration looming if I wanted help paying for ongoing health care. The arbitration is great, by the way, after only a month or two wait, you get a formal hearing over the phone, where a lawyer/arbitrator grills you and you present your side of the story complete with all evidence you may want to submit. A few weeks later you receive an arbitrator’s decision in the mail. I’m two for two in these, although, in fairness to everyone, I practiced law for fifteen years or so.

I keep thinking of the tens of thousands of poor bastards who lose insurance or premium subsidies every year who may not be up to putting on a legal showing of NYS of Health’s errors resulted in their loss of affordable health care. An experienced lawyer who doggedly searched the law for months, calling every state and federal (and NYC) office I could fine, spending hours on-line, I never found the law my insurance company had violated when they’d illegally terminated my insurance the previous (and instantly restored it when I filed an on-line complaint at the NYS Department of Finance– of course it was DOF!). I think, what chance does the average low-income New Yorker stand against the opaque Patient Protection Act?

Typical of all fucking notices from the NY State of Health, they bury the lede, (after informing the reader in the annual notice of notice email that the customer may have received the message in error). The notice is usually many pages long, and what you need to do is often set out on page eight or ten, like they want to make sure to fuck your brain good and proper before coming to the point, informing you of your inviolable obligation. Of course, this could be succinctly stated at the top of the notice, but… what the hey? I assume Donna Frescatore (who does not allow her subordinates at NYS of Health to give out her name) has something to do with this oppressive approach to informing low-income citizens of their rights and obligations. What you need to do to keep your health insurance could be up top, on page one of the important notice, but, you know, fuck it.

Much as I despise her type, Donna probably had nothing to do with this next bit, which is surely part of the Patient Protection Act itself (the communist inspired one passed on a party-line vote by the last illegitimate president before the present illegitimate one, inserted after massive, obvious but unprovable fraud — the very worst, most insidious kind of fraud!!):

IMPORTANT: When you end coverage with one plan and start a new one in the same year, all
of your cost-sharing responsibilities start over. For example, any payments that went toward the
annual deductible for your old plan will not apply to the new plan. This is true even if the new
plan is with the same company.

Which only stands to reason, you know, because, why not? Corporations are people too.

I remind all Americans that this shit is an exclusively American sickness– advertising medications — “ask your doetor!”, excluding eyes and teeth from the definition of “health care”, buying health insurance rather than health care itself, a trillion dollar industry with a million wealthy middle men demanding Americans pay way more for health care than citizens of any other civilized, wealthy nation in the world. Every “moderate” Democrat in Congress will defend each of these self-evident things as right, just as ordained by Jesus Christ Himself.

Medicare, the popular health insurance program for Americans over 65, had many problems when it was first passed under LBJ. Those problems were addressed and many were fixed over the next few years. In contrast, the ACA, a highly conservative plan (brainchild of the Heritage Foundation — deniers of climate science, promoters of the myth of voter fraud and so forth) that left the profits of large health corporations intact, has been attacked by angry Republicans since its passage, many attempts to repeal it launched (recall, it was only the dying John McCain’s dramatic thumbs down that saved it under Trumpie) and so all of its original warts and infirmities remain. When it works, it’s fine. When you hit any kind of snag, you’re pretty much fucked, patient protections or no.

Now I’m going to go back to read the rest of the fucking thing, the informative and entirely reasonable gem above was on page three or four.

Whew, further down the notice we learn:

Please Note: Changing your coverage is different than ending your coverage. If you want to switch
plans and do not want to make any other changes to your account, call NY State of Health to find out if
you are eligible to switch plans and to pick a different plan. Enrollment in Child Health Plus and the
Essential Plan can be changed at any time during the year.

I just read all seven pages of this important notice (that may have been sent to me in error), doesn’t seem to be any action I need to take at this time. Here are just some of the other languages one can request this important document in:

Getting Help in a Language Other than English

This is an important document. If you need help to understand it, please call 1-855-355-5777. We can
give you an interpreter for free in the language you speak.

Español (Spanish)
Este es un documento importante. Si necesita ayuda para entenderlo, llame al 1-855-355-5777. Podemos proporcionarle gratuitamente un intérprete en el idioma que habla.

繁體中文 (Traditional Chinese)
這是一份重要文件。如果您在理解這份文件上需要幫助,請撥打電話:1-855-355-5777。 我們可為您免費
提供一名會講您的語言的口譯人員。


简体中文 (Simplified Chinese)
这是一份重要文件。如果您在理解这份文件上需要帮助,请拨打电话:1-855-355-5777。 我们可为您免费
提供一名会讲您的语言的口译人员。


Русский (Russian)
Это важный документ. Если вам нужна помощь, чтобы понять его, позвоните по телефону
1-855-355-5777. Мы можем бесплатно предоставить вам переводчика на ваш родной язык.

Kreyòl Ayisyen (Haitian Creole)
Sa a se yon dokiman enpòtan. Si ou bezwen èd pou w konprann li, tanpri rele 1-855-355-5777. Nou ka
ba ou yon entèprèt gratis nan lang ou pale a.

বাংলা (Bengali)
এ􀎜ট এক􀎜ট গুরুত্বপূণ ন􀎺িথ। যিদ এ􀎜ট বুঝেত আপনার সাহােয􀒝র প্রেয়াজন হয় তেব অনুগ্রহ কের 1-855-355-5777
এ কল করুন। আপিন􀎭য ভাষায় কথা বেলন আমরা আপনােক িবনামূেল􀒝􀎭স ভাষায়􀎭দাভাষী প্রদান করেত পাির।

اللغة العربية (Arabic(
هذه الوثيقة مهمة. وإذا كنت بحاجة إلى مساعدة لفهم الوثيقة، يُرجى الاتصال على الرقم 5777-355-855-1 .ويمكننا أن
نوفر لك مترجمًا فوريًا باللغة التي تتحدثها مجانًا.

한국어 (Korean)
중요 문서입니다. 이해하는 데 도움이 필요하시면, 1-855-355-5777번으로 전화하십시오. 귀하가 사용하는
언어의 무료 통역사를 제공해드릴 수 있습니다.

Français (French)
Ceci est un document important. Si vous avez besoin d’aide pour le comprendre, appelez le
1-855-355-5777. Nous pouvons vous offrir gratuitement les services d’un interprète qui parle votre
langue.


Polski (Polish)
Ten dokument jest ważny. Jeśli potrzebuje Pan(i) pomocy w jego zrozumieniu, proszę zadzwonić pod
numer 1-855-355-5777. Możemy zapewnić bezpłatne usługi tłumacza w Pana(i) języku.

􁤖हन्दी (Hindi)
यह एक महत्वपूण􁭅दस्तावेज ह।ै य􁳰द आपको इसेसमझनेकेिलए सहायता क􁳱आवश्यकता हो, तो कृपया 1-855-355-5777 पर
कॉल कर􁱶। हम आपको आप जो भाषा (􁳲हदी) बोलतेह􁱹उसम􁱶िनःशुल्क दभु ािषया सेवा प्रदान कर सकतेह।􁱹

اردو (Urdu(
یہ اہم دستاویز ہے۔ اگر آپ کو اسے سمجھنے میں مدد درکار ہے، تو براہِ کرم 5777-355-855-1پر کال کریں۔ ہم آپ کو
آپ کی زبان میں مُفت ترجمان فراہم کر سکتے ہیں

And I think to myself, what a wonderful world! It really is amazing how varied and adaptable we brilliant (and sometimes irrational and brutal) wise apes are. Can you say that in Urdu?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s