2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

This Is My Shocked Face #1: Many #ShortAssPlans suck.

This story got a lot of play a week or so ago, but I didn't get a chance to write anything up about it until today. Via Reed Abelson of the New York Times:

One Ohio resident paid $240 a month for health insurance that she later learned didn’t cover her knee replacement. Saddled with $48,000 in medical bills, she decided not to get the other knee replaced.

...A Kansas resident paid premiums on a policy for two years, then found out his insurance would not cover surgery for a newly diagnosed cancer.

The two policyholders have filed a lawsuit in federal court against Health Insurance Innovations, based in Tampa, Fla., accusing the company of misleading them about the kind of policy they were buying.

They say they believed they were purchasing Affordable Care Act plans that include coverage guarantees. But they were sold much less comprehensive coverage that left them vulnerable to tens of thousands of dollars in unpaid medical bills, according to the lawsuit.

Their complaints underscore problems with some types of cheaper health insurance alternatives that the Trump administration has expanded.

...“This isn’t real insurance,” said Jason Kellogg, one of the lawyers representing the individuals in the Florida case. They are seeking class-action status, estimating that as many as 500,000 people may have bought these policies.

...At the news conference on Wednesday, Ms. Belin and Christopher Mitchell, the plaintiffs in the lawsuit, said they had no idea they were buying junk insurance.

Ms. Belin, who was recently divorced, had been looking for an Obamacare policy in 2016. She spoke to a sales agent who offered her what she thought was an array of traditional health plans.

“He would find me a plan that would fit my budget,” she recalled being told. Instead, she was sold a limited benefit plan, which sharply capped what it paid for medical care.

...The lawsuit claims Health Insurance Innovations spent millions of dollars funding Simple Health and was intimately involved in the scripts its brokers used to sell these policies. Customers were told that they were getting a P.P.O. plan, a traditional policy that allows individuals to go to the doctor or hospital of their choice. Many of the websites that consumers visited implied the policies being offered were from brand-name insurers.

...With a reported $352 million in sales last year, Health Insurance Innovations specializes in online sales of policies and has benefited from moves by the Trump administration to allow people greater access to plans that do not meet the Obamacare requirements.

I want to be clear about something: I'm not saying that all short-term plans are scams. I'm assuming that many (most?) of them are perfectly legitimate, sold by insurance carriers which clearly state what services they do or don't cover; which portion of the expenses for those services are covered; and under what circumstances they do or don't cover them.

HOWEVER...there's also clearly a large number of fly-by-night, shady companies which sell these policies using lots of fine print, confusing language or, in some cases, outright lying to the enrollees about what they're being sold...which is of course one of the main reasons Donald Trump is pushing them so hard. These are exactly the type of outfits he loves. Health insurance is already confusing and complicated enough for most people to navigate even when dealing with actual policies sold by reputable companies...so it's no wonder that many people are easily taken in by sleazy pitches for junk plans.

This, by the way, is also one of the two main reasons why official, certified ACA exchange websites like HealthCare.Gov, Covered California, Access Health CT and so on were created as part of the ACA in the first place...to provide a trustworthy place for people to comparison shop only ACA-compliant policies sold by fully licensed/registered insurance carriers without having to wade through a bunch of crap along the way.

Related to this: I'm sure the vast majority of insurance brokers are honest and genuinely want their clients to get the best policy for their needs...but there's always the risk of being led astray by an unscrupulous type looking to grab a fat commission off of a junk plan. That's why the ACA created the "Navigator" program (official navigators don't accept commissions and aren't allowed to push one policy over anther, but to educate people about what ACA-compliant policies are available, what all the confusing lingo means, and to help them through the process of signing up, along with how to use their insurance once they're enrolled).

Naturally, the Trump Administration has slashed federal Navigator program funding by around 80% over the past two years, which is precisely why the House Democrats recently passed the ENROLL Act to restore that funding and ensure that it's used properly...and the Senate Democrats just introduced their own companion version yesterday. Of course, that bill will likely go nowhere since it'd have to be voted on by a Mitch McConnell-controlled Senate (and then signed by Trump...the very guy who slashed the funding in the first place), so that's not likely to happen until 2021 at the earliest.