Tag Archives: narrow networks

ACA Open Enrollment 2.0

The ACA open enrollment period for 2015 coverage ended on February 15.

Before the ACA, consumers could purchase health insurance 12 months out of the year. Now consumers are limited to an “open enrollment period.”

This is meant to increase access. Or something.

In any case, the federal exchange website continues to be pathetically bad.

It would not accept the login information I had recorded in my passbook. I tried the “forgot my password” options successfully implemented on thousands (millions?) of websites around the world. After hours of frustration over successive days of effort (it rejected all my answers to questions about my pet’s name, best childhood friend, favorite kind of food, etc.), I gave up and created a new account.

This did not end my problems. Every time I entered my Social Security Number, the system kicked me out. It knew, you see, that a person with that SSN already had an account (it just disagreed with me about that person’s favorite pet and best childhood friend). I was only able to create the new account when I skipped the first field asking for my SSN.

I then entered a mystifying cycle of being asked for my state, clicking the button to start the process, being delivered to a new screen where I was asked for my state, clicking the button to start the process, being delivered to a new screen asking for my state, etc. This went on, to the tune of “I Got You Babe,” until I made a snow sculpture with Bill Murray and started clicking random buttons to break the cycle.

After that, I answered a series of questions and viewed some options. Eventually, I was told that I had to enter a Social Security Number if I wanted to buy coverage. This seemed counter to what I know of the law, but I was simply grateful that I was able to enter the number at that point without getting kicked out for impersonating that other Sarah Baker with the same Social Security Number but a lesser predilection for Mexican food.

I successfully purchased (I think!) a health plan for 2015.

All in all, it took hours of effort over a series of months to complete this process. This is in sorry comparison to what could be accomplished on a website like ehealthinsurance.com before the federal government decided to “make things easier.”

I was not alone in experiencing continued glitches with this ridiculous website. Peter Suderman gets a money quote from a federal government employee who emailed him with frustrations over the process:

“Today’s some sort of deadline, they’re e-mailing me like mad,” he wrote. “I signed in to try and fix that and tell them that my [relative] already got insurance. I was able to log in, but that’s about all, there were buttons, I clicked them and nothing works. This is a solved problem, Amazon, Google, Facebook, hell every bank and probably 50% of small businesses have a more functional website than this.”

Anyway, now that we all have health insurance (except for the tens of millions who still don’t) let us not forget that having health insurance is not the same thing as getting health care. Being forced to buy the former in no way ensures the latter.

Premiums spent on high-deductible policies sap funds available to pay for actual care. Having insurance at all results in higher charges per visit, even when the patient is paying out-of-pocket for the deductible.[1] Narrow networks sometimes mean people cannot see the doctors they want or need unless they come up with the money on their own. Compounding the problem, providers are increasingly opting out of the lower reimbursement rates and higher headache rates associated with the plans.

The doctor shortage is not just an abstract problem. It is a real-world problem with real-life consequences for patients like Julie Moreno, who needed cataract surgery:

For three months after her November 2013 diagnosis, the 49-year-old Mountain View resident said, she tried to get an appointment, but each time she called, no slots were available. Desperate and worried, she finally borrowed $14,000 from her boyfriend’s mother to have the procedure done elsewhere last February.

When Noam Friedlander needed back surgery, she found that the surgeons who were covered by her insurance operated out of hospitals that were not—or vice versa:

Unable to match a hospital and a surgeon that were both covered, Friedlander started haggling between doctors for a cash price for the surgery. She chose a surgeon who wasn’t covered by her insurance but who operated in a hospital that was covered. … In the end, she had to take out two credit cards so she could pay $16,000 out of pocket.

The ACA’s defenders will argue that however flawed it may be, the system is an improvement over what came before. No one disputes that reform was needed. But the ACA fails to address the root cause of outpaced inflation at the point of service. It fails to address the medical school cartel and doctor shortages that push prices higher. It fails to repeal expensive employer mandates that drive health insurance (and health care) costs higher and incomes lower. It fails to deliver better tax treatment for out-of-pocket expenses or equal tax treatment for individual and employer plans.

In many cases it instead exacerbates these problems.

In short, it fails to take advantage of the myriad free market alternatives that might remediate the root causes of high health care costs and result in a truly better—and not just different—system.


[1] I discovered this strange phenomenon in 2014. For the nine years prior to that, I had the same plan, which I had purchased myself in the individual market. It was cancelled at the end of 2013 due to the passage of the ACA. For several reasons (the unworkable website and my rebellious nature among them), in 2014, for the first time in my adult life, I went without heath insurance. I was pleasantly surprised to discover that office visits were $50-$60 lower once I had no insurance, and more expensive procedures, such as mammograms, were hundreds of dollars lower.

Sarah Baker is a libertarian, attorney and writer. She lives in Montana with her daughter and a house full of pets.