The View From Your Obamacare, Ctd

A reader has a jaded view:

It’s nice to see some of the stories you post about how much the ACA has helped people. The President Obama Visits Boston To Talk About Health Carestories where people mourn for those who refuse it and need it are sad. Allow me to present you with a third type, the people who aren’t eligible due to system bugs.

Yep. Jack and shit for my family. I tried to sign up, since my wife and kids’ coverage ended in May and the ACA won’t cover them. We aren’t rich. We’re lower-middle class, according to the federal poverty line, but out of red state Medicaid income levels. I tried the site – nothing but errors. I spent an hour or more on the phone and neither the persons I spoke to or their supervisors understand why they can’t process it for us. I could call my senator or congressman, but I doubt Lindsey Graham or Trey “Benghazi” Gowdy will investigate.

I’m disabled and currently get Medicare. Prior to May, my wife, two small kids and I all received Medicaid.

It was my secondary provider and the only coverage for my wife and kids. My wife had been in school full time and started working two jobs at the end of last year – one ultra low-paying factory job and another seasonal government position. A few months later she was offered a permanent position at the government agency. Our income went from close to the poverty line to significantly higher than that. Not wealthy or even upper middle class, but not subsistence level either. Our income increased and I didn’t want to accept benefits fraudulently, so I called up Medicaid and told them about the income change (not easy to do since the state has minimized the number of social workers) and they set coverage to end that month.

Next I use the ACA website calculators and make sure we are eligible. I try to process an application and there are tons of errors. This is on the federal site. My state (South Carolina) didn’t do anything regarding ACA exchanges. I then call up the ACA support line. He walks the app through the same way I just did and it says my family isn’t eligible. Nothing. He puts me on hold for long periods to consult supervisors. Nothing. My family’s coverage ended, we meet all criteria for coverage, we are all US citizens – born and raised here. Nothing.

No explanation. No assistance. Nothing. They couldn’t figure out why. We are eligible to get coverage outside of the yearly switch period due to loss of coverage according to the rules and staff. So we meet the requirements but the computer hates us.

Anyway, glad it’s working for someone I guess. Must be nice.

Update from a reader:

I’m confused about one notable detail – the writer mentions a wife who recently started a permanent government position. If this is a Federal position, the writer and the kids would almost certainly be eligible under the FEHB (Federal Employees Health Benefit program) – the full family coverage is more somewhat more expensive than individual plan, but very likely a pretty reasonable deal out of the wife’s paycheck.

If this were a state position – or certain (fairly common) local government positions – I think the family would be eligible for the different options available under the South Carolina’s Public Employee Benefit Authority coverage. It looks to me that the deals here are a bit more expensive than the options under the FEHB options, but that’s a pretty quick peek.

Only wrinkle I’d be able to imagine seems a little bit arcane/improbable to assume: if the wife were divorced and there were a former spouse that had a divorce decree requiring the wife to provide coverage, that might be an issue, since SCPEBA only allows one spouse to be covered, and the divorce decree’s mandate might trump the current spouse’s coverage.

In any case, I think that the wife checking with her benefits administrator about expanding coverage from individual coverage to full family coverage would be a more economical strategy than trying to insure the spouse or spouse and children under a separate ACA plan. Hopefully, this sort of request would be pretty common and straightforward for the wife’s benefits admin.

The original reader follows up:

Those options for federal workers don’t apply because it’s a union job and the contract provides for some weirdness. She can join the union any time but can’t get healthcare until she’s been working her contract for a year. Even then she wouldn’t be eligible for most of the other normal federal benefit programs like life insurance until she is “converted” to a career position.

Welcome to the new United States Postal Service. Career-track mail clerks and carriers begin in a position that pays similar to career posts or even more, while having virtually no other benefits except annual leave (paid time off). The USPS will pay for a large portion of our insurance premiums come next year, but until then we are out in the cold.

The family is in great health with the exception of me (here’s a plug for CIDP – Chronic Inflammatory Demyelinating Polyneuropathy – similar to MS). We were broke with insurance and now we’re less broke with the possibility of being broke again if a medical situation arrises.

It’s disappointing, but hey, my 2nd grader was doing algebra two years ago and his little sister is on the same path. They’ll be in college by 12 or 13. I can still type, knock on wood. Sometimes you win, sometimes you lose. I count myself lucky if anything this nation manages to do is actually aimed at helping me. If it doesn’t hit the mark, at least Obama tried.

(Photo by Yoon S. Byun/The Boston Globe via Getty Images)