Really? If true, that explains the lowered expectations for the federal exchange and HHS performance. KPIX aired this segment of Covered California’s Peter Lee telling Congress that all is well — and on the praise heaped on a program that KPIX itself reported amounted to a “bait and switch”:
Californians forced into Lee’s system will have a much different take than lawmakers in Washington, especially once they start trying to find providers that will take them as patients. That’s what prompted the “bait and switch” accusations, and most enrollees still have yet to test their networks. Of course, we still don’t know how many of those who signed up in the exchange actually have enrolled at this point, but Washington lawmakers apparently are not terribly concerned with that issue, either.
When one raises these media-reported issues, inevitably they get dismissed by ObamaCare supporters as “anecdotal” — as if the fierce urgency of now for a government-controlled health-insurance overhaul didn’t get argued by anecdote as well. With that in mind, though, one regular Hot Air reader wanted to share his story with us. The names and some of the details have been changed to preserve his public anonymity, and I’ll preface this by noting that I have not tried to run down confirmation of the tale. When you read this, you will see how it’s nearly impossible to confirm anything other than contacting the family to ensure their story is consistent — which I did, and it has been. Plus, earlier reports from other media sources indicate that these are not singular instances for Covered California customers.
Think of this as a very lengthy letter to the editor from someone who has had personal experience with this “crown jewel,” in order to put Lee’s testimony and Washington’s praise into some perspective.
“Gregory Smith”: Covered California is a colossal catastrophe
We are a family of six – two parents and four children – who, because of a rough year in 2013, had to apply for subsidized healthcare coverage under the new Obamacare rules. Yes, count us among the 7.1 million that Kathleen Sebelius is currently claiming are active Obamacare signups. We live in Orange County, Southern California, so our coverage comes through the state exchange, Covered California. As of the date of our application, on December 23, 2013, we had one child, age 24, out of college and working on his own; another two children age 22 and 18, both in college; and our youngest was 10 and in 4th grade. Note that no one in our family had been without medical coverage for even a single day, since birth.
My wife and I both work and but 2013 was a very tough year. My home business, focused on consumer product sales, was losing money and I was desperately trying to get out from under a mountain of debt. Then, late in the year, my wife’s contract at the school she worked at was not renewed. Her severance and healthcare coverage ran until the end of 2013. While we were both looking for new employment, we were adamant that we spend not one day without healthcare, especially with children. [Note: our oldest has healthcare coverage through his employer so I will not address his situation anymore.]
Our choices for medical coverage were either COBRA, which would cost us $2,000 per month, or the state exchange, which would be subsidized. I was chagrined at having to accept subsidized healthcare, paid for by our neighbors, but we didn’t have the $2,000 monthly cashflow to pay for COBRA. Our choice was clear and I signed up for Covered California. That’s when this roller coaster began.
It took me 8 hours to finally get signed up on December 23, 2013. Eight hours. The system was constantly crashing, pages were freezing, and it took 5 minutes for each page to load. So getting through 12 pages of application required an hour. Getting through 6 pages followed by a system crash wasted 30 minutes before having to restart.
All the while, I was reading and watching online that Peter V. Lee, the Executive Director of Covered California, was proclaiming to the media that “Covered California is working fine.” This statement was manifestly not true, and I was living proof. As I watched online videos of Lee, that infamous quote from Groucho Marx came to mind: “Who are you going to believe – me or your lying eyes?” I concluded that Lee is no doubt a blood brother to HHS Secretary Kathleen Sebelius and Carolyn Lawson of Cover Oregon, one of which is already indicted and the other whom hopefully will be indicted, or fired, someday.
At the end of that long day, however, I finally finished the application and selected a Healthnet Silver Plan for the family. Healthnet told us coverage would be effective January 1st, 2014, although we would not hear from them until the first or second week of the year. So, in spite of the difficulty enrolling on that challenging day, I was relieved. Our family would not go a single day without healthcare coverage.
Several weeks later, in mid-January, I began calling Healthnet asking why I had not received written confirmation from them. During the first call I was counseled to be patient, but during the second call I discovered that our family was not going to get a traditional healthcare plan but would be placed on Medi-Cal because, at the current time, our income was zero.
For those of you not familiar with matters in our state, Medi-Cal is state insurance for the indigent. It is hard to find doctors who accept Medi-Cal, especially in middle-class neighborhoods. Some studies have shown that only ¼ of medical practices in California accept Medi-Cal, and these are concentrated in the poorer parts of each county.
Being poor and destitute was not our situation – we were just without income and without savings. I asked how to appeal this decision, and Healthnet steered me back to Covered California. And, surprise – I also learned from Healthnet that, because Covered California redirected the entire family toward Medi-Cal, our coverage was not effective yet. I thought, naively, that we would have “quality, affordable healthcare” with no gap in coverage when we applied to Covered California. Silly me. It’s now January 25th, and my family has gone 25 days so far without healthcare coverage.
After an ungodly time on hold – over 60 minutes — I reached Covered California to revise, over the phone, our family financial picture. I provided them with some estimates of 2014 income, and also excluded my business losses. The Covered California rep informed me that making these revisions were legitimate and reasonable under the circumstances. This now moved us above the Medi-Cal threshold and allowed us to get a Healthnet Silver HMO Plan.
10 days later, during early February, I received health cards from Healthnet. But, there was a surprise. There were only three cards, not five. Did Healthnet forget about my two younger children? I called them and they professed ignorance about my two younger kids. “We have no record of your two younger children, only your 22-year old son.” They referred me to Covered California for questions.
I spent another 75 minutes on hold and I learned from Covered California that my two younger kids were not overlooked from our Healthnet plan but excluded – because Covered California rules require that anyone 18 years of age and under must be on Medi-Cal. So my two younger kids will have different medical coverage than I, my wife and my 22-year old son. No one at Covered California told me that during the previous two hour call. Let me restate this – if you apply via Covered California for subsidized private insurance, your children will be dumped into government-run Medi-Cal, California’s version of healthcare for the indigent. This decision cannot be appealed.
This was especially galling because none of the top-level advertising by Covered California makes this little detail clear. A FAQ video posted at Covered California’s website features a woman named “Sarah” who describes Covered California and the private insurance companies featured by the plan. But nowhere in the video is Medi-Cal mentioned, nor does the video indicate that children under 19 are dumped into Medi-Cal. [This video may be viewed at Covered California’s website under FAQs, “What Kind of Health Insurance Does Covered California Provide?”]
I then called Medi-Cal and learned that my two younger kids are not covered until their eligibility is determined – meaning, while my wife, son and I already had medical cards from Healthnet, my younger kids’ coverage is indeterminate until further investigation. Meaning, I suppose, a state bureaucrat at Covered California sends our application to other bureaucrats in Sacramento and elsewhere, who then forwards the message to a county bureaucrat in Orange County, for review. This process takes 45 days. And the start date for the investigation is not December 23rd, the date I first applied, but the date of the revised application, January 25th. So, according to Medi-Cal, I will not receive confirmation of my younger children’s medical coverage until March 9th. There is no way to hasten this process.
I then reorient my mind back to Healthnet. I look into doctors in my community who accept Healthnet’s Covered California plans. The number is remarkably small. I also learn that all Healthnet HMOs plans are not the same, and this is important: a traditional Healthnet HMO (paid by an employer) has better doctor access than a Healthnet Covered California HMO (subsidized by taxpayers). This means, I conclude, that there are four tiers of physician and hospital access in our state: PPOs, HMOs, Covered California, and Medi-Cal.
So, for my family, three of us will have “tier 3” medical access, and my younger children will have “tier 4” access. So this business about “quality healthcare,” and “if you like your doctor you can keep your doctor,” is a pile of horse manure. Fact: my wife and I are jobless and get subsidized, albeit tier 3, private insurance, while our children are transitioned from healthcare for the middle-class to healthcare for the poor, with access to only ¼ of the doctors in the state. Wow.
Nevertheless, I select a Healthnet doctor for my wife and me, and contact the office on February 8th. The clerk tells me that I am not eligible for coverage until March 1st according to the computer system. What??!? I call Healthnet immediately and they confirm to me, “correct — your coverage is not effective until March 1st.” How might I appeal this, I ask. Healthnet says they can do nothing, and I must call Covered California.
Another 70 minutes on hold and I am told by Covered California that they naturally assumed, during the phone call in late January, that I would want coverage effective March 1st. I implored them to make it effective February 1st – they hadn’t asked me anything about an effectivity date during that January 25th call! The rep said she understood my problem and would refer my situation to a “special case committee of senior Covered California staff” who would render a fast-track decision – presumably from on high, like proclamations from Mount Sinai – within 3-5 days. My family is now 39 days without healthcare coverage.
A week passed, and I called Covered California again about that fast-track appeal. 75 minutes on hold. Did the special committee approve our request? The rep told me that the request was still pending. I spent all that time on hold for nothing. Now the five of us have spent 46 days without healthcare coverage.
Another week passes and there is still no word about our appeal by either email or phone. Only one additional week remains until March 1st so I don’t bother calling Covered California again – it’s not worth the 75 minutes spent on hold. It’s now 53 days without healthcare coverage for my family.
March 1st arrives. Now three of us are covered but my two younger children are still not. My 22-year old son, at a state university in Northern California, visits a doctor for a routine matter that first week in March. The medical office finds no record of him in the online system. I call Healthnet about the computer problem and they say those dreadful words: “call Covered California.” Why, I ask. Because Healthnet can’t even make the slightest change to a Healthnet policy because it really isn’t a Healthnet policy. It’s a Covered California (e.g., government) policy with Healthnet window dressing.
After 75 minutes on hold, and 10 minutes of discussion, I learn that someone at Covered California had made a keystroke error nine weeks earlier, and entered my son’s birthdate incorrectly. 85 minutes of time wasted during working hours to correct a birthdate. Wonderful.
On March 9th, I called Medi-Cal about the coverage for my two younger children. It has been 45 days since my updated application on January 25th. I learn that the paperwork hasn’t even been sent to the county office yet. Many profuse apologies from the Medi-Cal rep; I wonder: can they transfer some of the customer service people to the application review department? The current tally is 68 days without coverage for my two younger children.
On March 25th, I called Medi-Cal again. It is now 92 days since my original application and 59 days since my revised application. The Medi-Cal rep claims to have good news: “Your kids’ paperwork is now at the county office!” [Perhaps Medi-Cal uses the stagecoach to transmit information?] Only a government employee would get excited that paperwork has moved to another person’s inbox. Clearly, Medi-Cal is in no hurry to process healthcare applications for children in the state of California. It is also now 84 days without coverage for my younger children.
But there is a wrinkle that I hadn’t thought of yet, because my 18-year old daughter is in college in Arizona, out of state. So I ask this Medi-Cal rep a further question: does Medi-Cal cover dependents when they live out of state but their permanent address is still in California? The answer was no. No! I had told countless reps from Covered California and Medi-Cal that my two older children were in college and neither of them had told me that there were coverage restrictions if a dependent was in college out of state. Then, the rep warned me – if I made Medi-Cal claims for my daughter while she was “living” 9 months in college in another state, I would be prosecuted for fraud. It didn’t matter whether the claim was in the other state, or in California. To get coverage for my daughter, I would need to apply for a third policy, in Arizona. Why hadn’t they told me that in December, or January!
Today is April 1st, 2014, and here is what I learned and experienced during this unmitigated disaster:
• Covered California is a colossal catastrophe. The news media is filled with other accounts, but I personally experienced unknowledgeable staff, a worthless and crash-prone website, ungodly wait times to get anything done (hold times of 70 minutes or more), and promises for “fast-track review” that were lost in the bureaucratic ether and became slow-track bureaucratic sludge.
• Healthcare access via Covered California is not equivalent to private insurance but is only a step above Medi-Cal. Covered California is government insurance posing as private insurance. Someday in the future, the state will take over and directly administer all plans rather than keep up the façade that Covered California is subsidized private insurance.
• Medi-Cal staff are in no hurry to process the insurance application for our younger children and this is a foretaste of the future, when all subsidized plans are government-run. It will probably be 100 days before the application for our younger children is finally reviewed. During the past three months, my wife and I have lived in daily fear that one of them will be hit by a bus or break a leg during a game, and we will go to the hospital hat in hand, without insurance. If you like the wait times and indifferent staff the DMV, you’ll love the new and expanded version of Medi-Cal.
• For Covered California applicants, all children are forced into Medi-Cal, regardless of their parents’ wishes. A family will be on two different plans if the children’s’ ages are 18 and below, and the children’s healthcare will be the worst possible healthcare available in the state. It is especially galling that Covered California does not make this fact crystal clear in their advertising. I view this as a type of fraud, or dishonesty in advertising; yet I am not surprised because this type of duplicity is emblematic of Obamacare at the national level.
• Because one of our children is in college out of state, our situation meant that that family would need three policies to for my wife, me, and our younger three children — three of us with Healthnet Covered California, one with Medi-Cal, and one on a policy administered by another state. Not one single person at Covered California or Medi-Cal knew all the details; I had to figure it out myself 92 days after my initial application. So much for the simplicity of signing up at a single website. So much for the billions of federal tax dollars spent training community organizers to become Obamacare facilitators.
• I am convinced that the intent of Covered California, and Obamacare at the national level, is to get all Americans accustomed to getting their healthcare from government. That’s why children must be on Medi-Cal if they apply via Covered California. And, this government insurance will not be a “quality, affordable” version of the private insurance that most Americans have. Government insurance will be a morphed and rebranded version of plans like Medi-Cal that were designed as insurance for the poor and indigent. Re-read that point very carefully.
• There is no doubt in my mind that the reason for the clusterfark I have personally experienced is the complexity of Obamacare and that fact that it is being handled by bureaucrats in Washington DC, Sacramento, and local county offices. If you think that bureaucracy at Blue Cross is hard to work with, just remember that the alternative – in our case, working with three government bureaucracies – is far worse. My story, and countless others that are untold, are stark proof of this point.
All I wanted was for my family to have medical coverage effective January 1st. Such is what was promised by President Obama, Secretary Sebelius, Peter Lee, and a slew of other politicians. The truth is that my wife, son and I were not covered for the first 59 days of the year, and my two younger children remain uncovered as of the day of this writing, after 91 days. Our initial application via Covered California, on December 23, 2013, was 99 days ago. The Obamacare promise did not include a proviso to wait months before approval, while bureaucrats routed applicants to different offices, shuffled their paper, and convened their pointless special committees.
This story, however, does have a happy ending. My wife accepted a position at a local company with an excellent insurance plan. We are all covered effective April 1st, and this Covered California nightmare will come to an end. Kathleen Sebelius, please subtract 5 from that 7.1 million number of subscribers you are trumpeting to the media.
I truly extend my sympathies, and pity, to other Californian families who continue to live with similar nightmares. I pray that, someday soon, they too can find private insurance through employee coverage. Finally, I can only hope that a new Congress, and a new Administration, will right matters in future years.