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June 2012
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STRANDED Coverage appeals process is latest ACA horror story

Should the government run the health care system? Sen. Majority Leader Harry Reid turned a lot of heads last summer when he said on a PBS program in his home state of Nevada that such is the ultimate goal of Obamacare.

President Obama, Reid and numerous other Democrats have made clear their view of the ultimate solution for American health care - a "single-payer system" in which the payer is the government, and the private health insurance market is an historical footnote.

Private health insurers have done their part over the years to make this concept appealing to some Americans. Most of us at one time or another have experienced frustration with efforts to get a routine claim paid or a non-generic prescription approved. But for those who may think government could ultimately do a better job, the continuing horror stories from the dysfunctional HealthCare.gov website provide an object lesson.

Consider a report last weekend in the usually administration-friendly Washington Post concerning the federally operated enrollment system's appeals process. The Post reports that about 22,000 people have filed error appeals with the government, and to date all are gathering dust because there is no mechanism to deal with them. The appeals assert errors such as being overcharged for insurance bought through the online marketplace, being overcharged on deductibles, being steered into the wrong insurance program or being denied coverage entirely.

"For now, the appeals are sitting, untouched, inside a government computer," the Post reports. The newspaper says those who have tried the more direct route - calling the agency that staffs the website - are being told the computer system does not allow federal employees to access the enrollment records and fix them.

It's not just an issue of inconvenience, says the Post. The Affordable Care Act requires timely hearings under a due process provision for people who believe they have not received the proper coverage or subsidies. But at this juncture - more than three years after the ACA was passed, no system exists for processing the appeals and providing legally required due process hearings. And that won't change anytime soon. The Post quotes government insiders as saying it's simply not a priority. Rather, efforts now are focused on other parts of the computer system that do not work, such as the part that allows insurers to get paid and the part that lets people with new babies add the newborns to their policies.

For consumers who don't want to wait around to see if the government ever does follow the law with regard to appeals, the agency overseeing HealthCare.gov offers this advice: Start over. More specifically, file a new application for coverage.

Why? Because, says an agency spokesperson, now that the HealthCare.gov system is working better, it may not make the same mistakes and if one is lucky, this time they will get the right coverage.

As the Post article points out, that solution is not much help for people who have already bought insurance and are being overcharged. They are simply at the government's mercy.

While much of the media has moved on from the initial frenzy over the HealthCare.gov rollout disaster, the failures of both the system and the government's attempt to implement the ACA continue to compound.

It's testimony to the fact that while government does a few things well - maintaining road and river transportation, providing for a national defense - once it ventures beyond its core responsibilities and starts trying to interfere in the free market, average citizens usually get hurt.

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