Series: Obamacare and You: The Rollout of the Affordable Care Act

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Ian Morrison is a health care
futurist.

Companies, trade groups and nonprofits call on him to speak about
trends in health care and offer prognostications of what the future brings.
I’ve heard him speak a few times and his knowledge and sense of humor drew me
in right away.

Last
Friday, I tweeted a story
written by Anna Gorman and Julie Appleby, friends at Kaiser Health News, about
hundreds of thousands of consumers receiving cancellation notices from their
insurance companies on account of the Affordable Care Act.

I was surprised to
learn that Morrison was one of them.

I
emailed him to find out more. This is what he told me: Until 2011, Morrison
paid for his health coverage from a company on whose board of directors he
served. The company was sold and he was insured through COBRA until this March.
As he tells it, Blue Shield of California “didn’t want a badly behaved 60 year
old Scotsman,” so he got coverage through a preferred-provider organization
offered by the insurance company Health Net through a Farm Bureau program.

“No
kidding,” he says, he’s no farmer.

Two
weeks ago, he said he received a letter canceling that plan. He subsequently
applied for coverage—not through Covered California, the state’s new health insurance
marketplace, but directly through Blue Shield. Because of the Affordable Care
Act’s ban on discriminating
based on pre-existing conditions, the insurer must take him.

Here’s
a Q&A I had with Morrison by email (edited for clarity with his approval).

Q.
So Ian, you were dropped by your health plan. How did that feel? Did the
company cite the Affordable Care Act?

A.
I expected it and had always planned on getting insurance via guaranteed
issuance [the law’s prohibition on discrimination based on health status] or
through an exchange for 2014.  The Farm Bureau thing seemed totally bogus
to me. I do not know how Health Net did it, but it had me covered.

Q.
Did you try the health insurance exchange—in your case Covered
California—to find a new plan? Why or why not?

A.
Yes, and here is the key: California and Washington and other state-run
exchanges allow for anonymous shopping.  Just age, zip code and estimated
income allows you to see rates and compare.  [The federal marketplace did
not allow consumers to do such window shopping.] This is a stupid, fatal flaw
of healthcare.gov that was totally politically motivated to prevent rate shock.

Q.
So you ended up getting coverage from Blue Shield outside the exchange? Why?

A.
I applied outside of the exchange via Keenan, a broker who simply sent me to
the Blue Shield website.  I could have just as easily gone direct to Blue
Shield, but the broker pointed to the key point that the doctor and hospital
network in the exchange might not be as good as outside the exchange…I knew the
Shield Plan in the exchange was the only exchange plan that covered Palo Alto
Clinic where I go.  Most normal humans can’t figure that out because the
provider directory tools aren’t up on the California exchange website. 
But I did use the exchange to compare prices; Keenan just verified what I knew.

Q.
I’m sure you’ve been following the glitches and whatnot with the rollout of the
health insurance marketplaces. You’re a health care futurist. Is this the
future?

A.
I am telling groups the metaphor is the Wright Brothers, not the Indianapolis
500.  Let’s just get this sucker up in the air before we declare that
flying is a bad idea.  I just heard a panel of exchange execs say
Massachusetts enrolled only 5% of its first year total in first month. 
The Washington state exchange is on that run rate.  Everyone needs to
chill out and see where we are by November 2014 when the election happens, not
November 2013.  The press frenzy is making this worse.  Would you
like to be fixing code under this scrutiny and pressure?

Q.
Is there a way for this thing to work out in the short time frame before
coverage begins in January and penalties kick in a short time later?

A.
Having said all that, there are some big problems that you, Ezra Klein, Sarah
Kliff et al have covered magnificently about healthcare.gov.

  1. No anonymous shopping. That could be fixed by a few kids in Silicon Valley in
    an afternoon if they just wrote a separate chooser tool.  Linking it to
    the Federal hub may be like the moon shot. [The federal website appears to have
    added such a tool in the past couple days.]
  2. No lead contractor. Someone needs to run this and own this, not fingerpoint.
  3. Inadequate testing
  4. Back end may be worse than front end. That’s what scares the shit out of
    industry insiders.
  5. It was starved from birth and there are lots of cheerleaders pointing to
    failure of government run anything.