An Obamacare Anecdote - Abuse or Purpose?

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   GA Andersonposted 10 years ago

   Here is an Obamacare story I was personally involved in through trying to help a relative.
   
   Is it an example of abuse of the system, and American taxpayers, or is it proof of the purpose of the ACA.
   
   The state is Maryland.
   
   A relative, suffering from depression, has a substance abuse problem. It is primarily alcohol, but there have been instances of prescription drug abuse.
   
   The are understandable circumstances for the depression. Let your own opinion of how to deal with depression be your guide.
   
   The relative has Medicaid coverage, and that has covered 2 rehab stays, one 14 day stay, and one 28 day stay, which the relative bailed out of after 7 days. It was also paying for staying at a halfway house - after coming out of the first rehab.
   
   Medicare has paid for multiple hospital trips via ambulance, (drunk to the point of discovered passed out and concerned about alcohol poisoning)
   
   Relative also has multiple psychiatric-type prescriptions; anti-depression, anti-anxiety, etc. etc. 5 or 6 different pills to take.
   
   Rinse and repeat above, and with tremendous family support - relative still grabs the bottle whenever our backs are turned.
   
   Now the Obamacare part:
   
   Relative is willing to try rehab again, long-term, as in 28 days in-house, followed by indefinite supervised halfway house. Md. Medicaid would pay for it - again.
   
   But, relative wants to get out of state - finds a facility in North Carolina - but needs private healthcare insurance to go there.
   
   Bingo! Calls an insurance broker, finds relative meets a particular requirement that allows enrollment, (normal circumstance enrollment is closed until November).
   
   Determined by relative's desire to go to a NC rehab, agent determines the best plan choice is a top tier Platinum level plan. Premium is $354 p/mth, has $0 deductible, and $1800 max. out of pocket expenses. (take a pill Wilderness, I know this must be tweaking your nose)
   
   Relative has no job/no income - has to pay the full load. (reality is Dad will pay the bill) When asked about subsidy, insurance agent says if relative had $16,000 income, premium would drop to $190. Bingo! again. Relative will get a job after rehab, so ins. agent, plugs in the numbers, cautions relative that income will be verified at tax time (not at enrollment approval) - and a penalty could occur.
   
   No worries, relative will receive notice of acceptance within a week, (almost guaranteed according to agent), and in 30 days relative will be off to a new rehab effort in another state - thanks to the ACA and American citizen's support.
   
   Is this an example of the purpose of the ACA, or is it an example of abuse?
   
   Of course I have my opinion, but would be interested in yours.
   
   GA

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      Old Poolmanposted 10 years agoin reply to this

      Of course there will be abuses just as there is now with dead people still receiving SS checks, welfare fraud, and on and on and on.
      Our government just doesn't have the ability to monitor any program for fraud, except of course the IRS.  They will spend thousands to collect a hundred buck they feel they were cheated out of.
      When the Obamacare launch failed so miserably, what makes anyone believe they will be able to administer the program in the future?

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         GA Andersonposted 10 years agoin reply to this

         But is this an example of abuse, or the way the system was intended to work?
         
         I am torn. This relative can use help. But in my opinion is unwilling to help themself and is looking for the "magic pill" that will do what they are unwilling to do on their own.
         
         In this case, "help" is available in-state, via state medicaid coverage, but a 'desire' for out-of-state treatment is accommodated by the Obamacare mandate. Is that the purpose of the ACA?
         
         ps. It is my understanding that the lack of detail verification is a national occurrence, not just a Maryland problem.
         
         GA

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            Old Poolmanposted 10 years agoin reply to this

            Almost all government run programs run this way.  They are great at getting it to the launch pad no matter how much it costs.  Once it is launched they could care less where it goes and nobody is held responsible for keeping it on course.  I don't believe it was planned, they just can't successfully run anything and would fail miserably in the private enterprise world.

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            rhamsonposted 10 years agoin reply to this

            It is my understanding that if services are not available in another state and not available in their home state, then the use of facilities outside the state would be acceptable. But with the mountains of paperwork and policy I would hazard to guess I am totally wrong. The other question is who has evaluated this dilemma and is your relative really ready to sober up? I understand addiction only too well and sometimes a change of location is a good thing as it gets the addicted away from bad influences and friends. I have lived in Maryland for thirty years and understand the clunky mess that the bureaucrats practice here so I am amazed anything has gotten done for your relative in this unusual circumstance.

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            1. 82

               GA Andersonposted 10 years agoin reply to this

               I certainly have thoughts and opinions about the relative and the addiction issue, but nothing about me qualifies those opinions to be any more valid than any Joe Blow on the street, so I will keep them to myself, and stick with the topic question.
               
               Except for this point... all the services available out-of-state are also available and covered by Medicaid in-state.
               
               When I asked about this, and what was thought to be gained by going out of state, the reply was just as you stated above - to get away to new surroundings.
               
               So maybe there is a possible benefit, I hope so, but I am doubtful. I still consider it abuse of the purpose of the program, but you make a good point.
               
               GA

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   PrettyPantherposted 10 years ago

   As long as the rules are followed and no laws are broken, it is not abuse.  Is it abuse when a person or company can use multiple tax breaks to pay little to no taxes?

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      GA Andersonposted 10 years agoin reply to this

      Hmm... the topic is Obamacare... you choose to bring in a tax comparison...
      
      The question wasn't one of legality, it was a question to the purpose of the program. Is it your perspective that as long as no laws were broken it can't be abuse?
      
      ps. If the question was one of legality, then I believe a case could be made that knowingly submitting false information to obtain something from the government - the subsidy, could be judged a bit illegal. And that info was included in the OP, but it isn't important that you missed it because the question wasn't about legality.
      
      I do appreciate that you made the effort to reply, but maybe you should start a conversation concerning your perspective on our tax laws. I promise to stay on topic if you do.
      
      GA

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         PrettyPantherposted 10 years agoin reply to this

         My point, and perhaps I didn't make it clear, is that when poor people "game the system" it is often called "abuse."  When other people "game the system" it is often called "smart money management."
         
         Now, I believe the agent who projected future income to receive the subsidy was gaming the system.  I don't know if it was legal, but since he said the income would be verified at tax return time, I assume it was.  I'm no expert, but doesn't that apply to anyone is applying for insurance under Obamacare? 
         
         To answer your question clearly, no, I don't believe it was abuse.  I believe it was a person working the system to gain the best advantage for themselves, something certain segments of our society are praised and idolized for.

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            wildernessposted 10 years agoin reply to this

            Out of curiosity, would you consider the "welfare mama", popping out and endless stream of babies for the sole purpose of gaining total support for her life to be abuse?  Or working the system to her best advantage?
            
            Sounds like you've defined "abuse" as illegal actions; that anything done legally, whether intended or not by the system, is fair game?

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               PrettyPantherposted 10 years agoin reply to this

               To answer your question directly, yes, I consider that abuse.  However, I find it alternately amusing and revolting, but mostly revealing, that some people choose the easy target (the poor, uneducated, or just plain stupid) to criticize for gaming the system while the affluent gamers are praised for their brilliance in analyzing all the angles and taking advantage of every break--using means that frequently harm the working poor or take advantage of the easily duped--because a few million is just not as good as a few million more.  Those people are hailed as brilliant strategists, prudent investors, and smart money managers.

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                  wildernessposted 10 years agoin reply to this

                  Unlike those "some" I consider the poor that are gaming the system for all they're worth pretty darn smart, too.  I don't have the knowledge to do that (not interested) and can acknowledge the skill/brilliance/knowledge of those that do.
                  
                  It doesn't make them less of a scumbag any more than it does the rich doing the same thing, though.  Rich or poor, those taking advantage of things intended to help those less fortunate are to be despised.

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                     PrettyPantherposted 10 years agoin reply to this

                     Isn't the relative described in the OP one of the "less fortunate"?

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                        wildernessposted 10 years agoin reply to this

                        Unfortunately for that idea, the "relative" has been helped once, by medicare.  And would be again, but that isn't good enough for him - instead he will game the system to provide him with a free move to another state in a move never intended by Obamacare.  Almost by definition, he is working the system for benefits never intended by even the ACA and is to be despised for it.

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                           PrettyPantherposted 10 years agoin reply to this

                           Yes, but do you agree he is one of the less fortunate?  Do you understand how I might view this outrage over a guy getting the government to pay for his move to another state to be a bit trivial, given all the gargantuan and truly horrible ways the powerful game the system every day, resulting in things like, say, pensions being raided (legally, of course)?
                           
                           My outrage meter is barely a-flutterin'....

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            GA Andersonposted 10 years agoin reply to this

            Ouch! Although I do think it was an abuse of the purpose of the program, I think you have used a description that fits the situation perfectly - "Gaming the system." And your further comparison to "others" working other programs the same way is spot on too.
            
            Even if I weren't an Obamacare opponent, I think I would still see it as abuse, but I must admit your perspective is causing the shoe to pinch - just a little.
            
            GA

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   Kathryn L Hillposted 10 years ago

   Obama Care was not designed for those who can afford healthcare. Now, not only can no one afford health care, it helps no one.   
   Ironic:  "...event characterized by an incongruity, or contrast, between what the expectations of a situation are and what is really the case, with a third element, that defines that what is really the case is ironic because of the situation that led to it." Wikipedia.
   
   P.S. The story is an example of abuse.  Human nature needs checks. What is there to check such conniving desperation?
   
   I remember when Dr. visits were not as high as they are today.
   I remember when people did not rely on pharmaceutical drugs to the extent they do today.
   I remember when addiction was something to avoid at all costs.
   
   The anecdote illustrates how haywire things are today.
   On Purpose?
   
   (Words to the wise: If we do not listen to Mother Nature, she will box our ears.)

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      GA Andersonposted 10 years agoin reply to this

      Wow, if you remember all that you must be really really old.
      
      I see this anecdote as an example of abuse - and not the purpose of the program. This person already had free healthcare - Medicaid. But because they desired - not needed,  something not covered, they were able to "work" the system to get it.
      
      I also see this example as illustration of the idiocy of its implementation. Pure politics! How else to explain rolling it out without the mechanics in place to manage it?
      
      To me it is just another example of the old adage that the road to hell is paved with good intentions.
      
      GA

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         Kathryn L Hillposted 10 years agoin reply to this

         Yes, I am old. But only in years… not in body or spirit!
         And yes, I agree that road has been paved.

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   wildernessposted 10 years ago

   No need for a pill, GA; you are making the same point I did.  That Obamacare is worthless for the poor.
   
   Relative has no money and can pay neither the $354 monthly premium (actually, just his share of the premium) nor the $1800 out of pocket.  The insurance is worthless.
   
   Even if relative gets a job and earns $16,000 per year, he still owes $4080 per year ($190X12+1800), leaving him $12,000 to live on for a year.  Without other massive subsidies, the "insurance" is still unaffordable and thus worthless.  Which is what I found, and for the same reasons.
   
   And yes, relative is abusing the system; Obamacare, whatever it's other faults, was never intended as a free move to another state.

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      GA Andersonposted 10 years agoin reply to this

      I am glad you took that so calmly. And you were generous too. The $16,000 is gross earnings, so the net would be less than the already hard-to-survive-on $12,000.
      
      I think that what made this so hard to swallow for me was that the relative already had 100% free Medicaid coverage.
      
      GA

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         wildernessposted 10 years agoin reply to this

         *shrug* whether you and I pick up his bills via medicaid or pick up his private insurance premiums doesn't really make that much difference.  One way is full of fraud and theft, the other includes profit for private industry.  To us it probably balances out fairly close, although one will undoubtedly continue long past any cure.

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            GA Andersonposted 10 years agoin reply to this

            I thought about the irony that taxpayers were paying either way - maybe that is why I have such a problem with it... already getting needs filled, but now works the system to get desires filled.
            
            But I have to admit if the picture were looked at broadly, and not program-specific, her "gaming the system" comparison to others and other programs is pretty accurate.
            
            But remember what mama said, "Two wrongs don't make a right."
            
            GA

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