And the winner is: Michael Cannon as he discusses ways to game PPACA open enrollment restrictions:
the Affordable Care Act creates so many incentives for enrollees to drop their coverage that maintaining those enrollment numbers may start to resemble something like pushing millions of people up a greased poll.
For Obamacare to work, people must enroll and stay enrolled. An estimated 20 percent of those who signed up have yet to pay their first premium, and as many as 5 percent stopped paying after the first month. If too many drop out, premiums could climb until the exchanges collapse.
Got to love “health policy experts” commenting on the individual market who don’t know shit about the individual market. Traditionally the individual market is a very high churn market. Most people only go on the individual market until something “better” comes along. That something better is either employer sponsored insurance, government insurance such as CHIP, Medicare or Medicaid, or getting on someone else’s plan.
Obamacare even more dramatically reduces the downside of going uninsured. For example, suppose the day after you cancel your health insurance, you receive a serious diagnosis like diabetes, or cancer. Pre-Obamacare, you would not be able to buy coverage for that illness. Under Obamacare, however, insurers are required to cover you at the same premium they charged when you were healthy. You may have to wait until January for that coverage to take effect, but even so the downside risk of going uninsured is much smaller.
If you’re young and invincible, it is likely that you’ll need major medical care from an accident than a big diagnosis. I don’t know about you, but I don’t plan on getting into a car accident this afternoon or being shot by an asshole who was until a moment ago a “very responsible gun owner”(tm) who does not know how to unload his weapon before cleaning it. Even for a big diagnosis that does not require care this afternoon, Mr. Cannon’s “ideas” are asinine or fraud:
If you live in one of the 25 or so states implementing Obamacare’s Medicaid expansion, you can get coverage immediately by reducing your income below 138 percent of the federal poverty level ($16,102 for a single adult). You can then restore your income when you enroll in an exchange plan in January — or even earlier, depending on how often your state verifies eligibility.
Impoverish your family (especially since his “advice” is for people who make too much for subsidies) instead of paying for insurance.
If you don’t live in a Medicaid-expansion state, you can move to one, as this Idaho family did.
Uproot your family and potentially commit fraud as some states have at least a thirty day period before residency is established. And it has been (thankfully) a while since I’ve moved, but I remember it to be a stressful and non-instaneous event. There is something about finding an apartment, signing a lease, and then getting the keys from a landlord. If I have a major diagnosis, this is time spent gaming the system where I am either not getting treated or I’m running up massive bills paying out of pocket.
The long form version of his “argument” has the sham marriage angle:
Newly married couples can enroll in an Exchange plan on their wedding day, with coverage starting on the first day of the following month, or even sooner. Happily married couples have been known get “Medicaid divorces” to qualify for Medicaid’s nursing-home coverage; we may soon see quickie “Obamacare marriages” formed solely to qualify people Exchange coverage. Websites could offer to arrange marriages between singles who share a sudden need for health insurance. Couples could divorce when they re-enroll in January.
Sure there is always the Vegas wedding route. However, if I remember correctly, marriage has a massive set (like 1,000 or more) of obligations, benefits, privileges and responsibilities bundled to that simple legal act. This only works if the sick person is single AND can trust the sham marriage partner. There is quite a lot of value of being the spouse of someone who has a good enough job and assets where they think it is cheaper to go naked than to get covered, and the divorce court judge would love to hear the explanation as to why alimony or support should not be given to the spouse as the marriage was intended to be just an open enrollment enabling sham. Before I met my wife, I had a long, beer fueled conversations with a college friend about being mutual back-ups/green card marriage partners if we were both single in our late 30s. That is a conversation worthy of college and good beer, not as a serious health policy.
The converse is also true — Obamacare divorces are a costly, and dramatic. A divorce, even if it is purely a sham, is time consuming. An individual receiving a diagnosis on Tuesday won’t be divorced on Friday and coverage won’t start anyways until at least the 1st of the following month anyways. There is a minimum 2.5 week gap between eligibility and coverage starts. In some cases, there is a 6 week gap.
Most states have a “cooling-off” period and even those that don’t, the courts don’t move that fast for amicable divorces. The Britney Spears 55 hour marriage before annullment due to diminished mental capacity and reduced decision making is not the norm. Furthermore, assuming there are either kids or common property involved AND the two people want to stay involved in each others lives, the non-marriage replication of rights and responsibilities through powers of attorneys, advanced directives, living wills etc is, as gay couples living in bigot states can attest, expensive, time consuming, and not guaranteed to work. So again, the divorce run-out period is time spent either not getting treated or running up massive out of pocket charges.
And then finally there is this gem:
Alternatively, you could fill the gap with …. the money you saved on premiums; credit cards; or by relying on friends, family, or the kindness of strangers.
The cheapest premium for a non-smoking 29 year old in one of the most expensive markets in the country (Southern Georgia) is $150/month for a Bronze plan. So going naked through-out your 20s and using Mr. Cannon’s “advice” saves an individual no more than $15,000 (as a 21 year old is cheaper to insure than a 29 year old). If that 29 year old lived in the cheapest markets in the country, their premiums would be 50% less. $15,000 is enough to get you in the door at a cancer center for the first round of treatment if you are paying out of pocket and are lucky. $7,500 in cash will be laughed at a major cancer center. And what is the probability that a 23 year old will put consistently put $1,000 a year into a HSA instead of spending it on rent, food, student loan debt or beer? Or the other option is to go into life crushing debt and beg to be considered the “deserving poor”
Mr. Cannon, you sir, are the Asshole of the Week.