New Orleans  As hope soars for the new Affordable Care Act and its coming coverage of the uninsured, some of the discoveries of the problems with the law produce a heavy heart.

            Yesterday we looked at one big healthcare company’s attempt to scam the system and rip-off their lower waged workers by trying to institute a low premium high-deductible plan.  The premium of less than $100 would technically make the plan, offered by the big insurer Anthem, affordable at less than 9.5% of gross annual wages for the workers making less than $20,000 per year, but to actually get any benefits a worker would have to pay $3000 in deductibles for anything but the most basic guaranteed package under the Act.  Paying more than $4000 per year to have any real coverage would suck up 25% of a worker’s income.  Could this possibly be a qualified plan when all of these workers would have been eligible for premium tax credits and potentially cost sharing if they could access the more affordable Marketplace created by ACA?

            Sadly, it seems that the answer is “yes.” 

I spent almost an hour yesterday on the live “chat” room at www.healthcare.gov trying to find a definitive answer to this question.  My first chatter got so depressed that after extensive researcher she simply bailed and Kayla, my second chatter, hung in despite how depressed we both were.  The only answers they could give after consulting with their supervisors was a sad, circular one.  Yes, the worker could still enter the Marketplace and buy their insurance there rather than through the company, but they would not be eligible for tax credits or cost sharing.

Effectively this company, ResCare, with its 45000 workers has instituted a worker rip-off with this Anthem plan which will effectively screw its thousands of lower waged workers and price them out of the healthcare coverage leaving most of them uninsured, when most would have been better under the Marketplace exchange.  They might argue that $3000 isn’t much if there’s a big hospital bill compared to one of the lower end plans in the Marketplace paying only 60 or 70% of the costs, which might cost the worker even more later, but that ignores the fact that one is paying a percentage of the total, while a deductible has to be paid upfront.  With the $1000 the company was willing to pay per worker applied instead to the worker’s premium, the worker could have bought the Platinum plan with 90% coverage for almost nothing.   But of course they would have also had to be willing to seriously bargain about it and actually been willing to spend the $1000, rather than knowing full well that most of their workers will pass on $90 per month and end up costing them nothing.  This selfishness by this company, which is in the healthcare field ironically, not only bars their 45,000 workers but also many of their dependents and spouses from the Marketplace.   Disgusting!

The other depressing call I took yesterday was from a member of the Musicians’ Union where I had spoken last week and tried to answer questions they had about Obamacare.  The woman calling was trying to figure out how to get affordable healthcare coverage for her husband, the musician.  She had job-based insurance but the premium there was too high for their budget, so she had been hoping they could either both go to the Marketplace or that at least he could do so.  She had talked to her human resources person on the job and gotten ridiculous advice about how costs were going to go rise, based on the HR staffer’s misunderstanding of how insurance actuarial systems worked, believing it had to do with income rather than risk.  Nonetheless, she also found herself caught in the well reported “gap.”  Sure, her husband could apply for insurance through the ACA Marketplace, but despite his qualifying income, he would not be able to get any assistance, so he was likely out of luck.   We ended up having a discussion about whether they should separately file with the IRS for 2013 in order for him to try to apply before March 31, 2014 and get qualified then with support of the Marketplace.   Hell of a note, but that’s what it might come to.

There are fixes that are desperately needed in Obamacare.  Not the ones the “de-funders” are talking about, but ones that will actually provide healthcare for people who need it, who are now caught by the law and heartless, greedy employers on the wrong side of technicalities.