Ron Bliss: Flaws in the Affordable Care Act marketplace

I have been complimentary of the Affordable Care Act and how it has helped people who, otherwise, could not afford health insurance.

But any system is only as strong as its weakest link and, unfortunately, a major flaw has cropped up in recent months.

To qualify for a subsidy, those who apply, must present proof of eligibility – usually in the form of a birth certificate or drivers’ license. Most are also being asked to show proof of income.

Many of our customers have gone out of their way to follow what the letter asks, yet they are still having the subsidies taken away.

Some of the examples are glaring – especially one including a Carson City man whose wife sent in proof of income and proof of citizenship. Yet his subsidy was taken away and when the wife called to ask why she was told that he had failed to provide a letter from the Department of Welfare and Supportive Services saying he was not eligible for Medicaid.

The problem is that he has never been on Medicaid and has never even applied for it. The family of four makes $44,000 a year. We responded by resending the proof of income and citizenship (Naturalize certificates) and a copy of the letter – produced by the Health Marketplace – saying he does not qualify for Medicaid because he makes too much money. Duh!

For some reason, the Marketplace failed to look at its own findings and asked, instead, for a letter from the DWSS, which had no business producing such a letter for a non-client.

It doesn’t end there. Another client sent in her daughters’ birth certificate and Social Security card, but was told that was not sufficient – even though those were give as examples of what was needed to prove identity. When she called, she was told that they would also like a photo ID – though that was not specifically requested in any correspondence sent.

Another woman submitted the requested documents and received a letter back thanking her for her submission and was told no further action was needed and her eligibility for a subsidy would not change. Yet 10 days later, her subsidy was cancelled. When she called, she was told, “oh, and we would also like your Social Security card” – though that was never requested in the original letter or in the letter notifying her that her subsidy had been cancelled.

What we have here is not a flaw in the system, but a flaw in the way the system is being run. It is, pure and simple, a lack of communication between the Marketplace and its customers and one that is complicating a lot of lives. An immediate review is needed of how the system is being run and a much better job of communicating with clients needs to be done by the Marketplace. The change needs to be immediate.

A good 75 percent of my time has been spent getting subsidies back instead of helping new clients who qualify for health care. In essence, the system has been “clogged” by the poor efforts of those in charge of making sure proof is shown to qualify for subsidies.

Let’s hope the word gets out and the Marketplace fixes itself without causing further problems and angst among those who want and need health insurance.

While we have been focusing on helping our customers, we are still open to helping other customers who we did not originally write.

You can find us at 2307 North Carson Street, Carson City, NV or by calling us at 775-450-6769, 450-6867, 450-7754 or call me personally at 775-224-7169.

Ron Bliss is a former long-time sports writer who has been selling health insurance since 2009. He is certified on both the Nevada Health Link and Covered California and can also write major medical policies off the exchanges for those who do not qualify for subsidies. Affordable Healthcare Pros also offers a variety of low-cost Medicare supplements and other supplemental health plans, including dental vision and hearing insurance.