Claims And Issues

NO, actually, THEY are TAKING YOUR HEALTHCARE COVERAGE AWAY.

Before the Affordable Care Act was passed in 2010, this country and the availability of healthcare in it looked very different from the way it looks now.  Then, health insurance coverage was almost totally unavailable without excluding pre-existing conditions, placing limits on benefits every year and over a lifetime, and setting premiums so high that most people simply could not afford to pay them and so they famously visited hospital emergency rooms instead.

    The Affordable Care Act expanded access to health insurance in a number of important ways, including:
• Inventing and shaping marketplaces for private health insurance ;
• Stretching both the extent and the financial accessibility of health insurance coverage with a new requirement that health insurance plans offered to individuals and small groups include a minimum level of “essential health benefits” including emergency care, hospitalization, maternity and newborn care, outpatient services, mental health treatment, rehabilitative services and devices, prescription drugs, preventive services, and pediatric care, and
• Barring discrimination against individuals based on their health status, eliminating exclusions for pre-existing conditions, and mandating through a "guaranteed-issue provision" that health-insurance providers "must accept every employer and individual in the State that applies for such coverage."

    Congress has considered many bills since 2010 when the ACA was first enacted, which would "repeal, defund, delay, or otherwise amend the ACA—including legislation that would have repealed the entire Act." Although many bills were introduced during that time to repeal the individual mandate and even to repeal the entire ACA, they never had the votes. The substance remains unchanged through the time of this writing in 2020.

    And now it's on to the U.S. Supreme Court once again, and let's see if they have the votes there to "repeal, defund, delay, or otherwise amend the ACA."

To be continued tomorrow on Claims and Bad Faith Law Blog.  Adapted by the author from his new Chapter 18E forthcoming in the Spring of 2020 in the book, CATASTROPHE CLAIMS:  INSURANCE COVERAGE FOR NATURAL AND MAN-MADE DISASTERS (Thomson Reuters).  Please Read The Disclaimer. ©2020 Dennis J. Wall.  All Rights Reserved.

NOTE TO HARVEY, IRMA & MARIA: "FLOOD" INCLUDES BROKEN WATER MAIN.

A first-party property insurance policy containing both specified perils or multiperils coverages, and specified perils or multiperils exclusions, if you will, was not rendered ambiguous as a result, in Comley v. Auto-Owners Ins. Co., NO. 2016-CA-001305-MR, 2017 WL 4448528 (Ky. Ct. App. October 6, 2017; Stated Not Final And Not to be Cited As Authority in Kentucky Courts).

The facts of that case center around a water main outside the plaintiff's property.  The water main broke and inundated plaintiff's-policyholder's house and personal property with damage.  Kentucky's intermediate appellate court held that the water damage exclusion for a "flood" did not require natural causes in order for the exclusion to apply.

Accordingly, the policy at bar was not ambiguous and the policyholder's claimed damage was excluded "water damage," the Kentucky Court of Appeals held in that case.

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2018 OPEN ENROLLMENT RUNS FROM NOVEMBER 1 THROUGH DECEMBER 15.  READY?

If you or your clients do not have health insurance coverage, check out and sign up at www.healthcare.gov.

You may not have heard the word that health care coverage is available -- right now, today, even as you read these words.  It's your right.  It's the law of the land!

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

HEALTH CARE COVERAGE.

If you or your clients do not have health insurance coverage, check out and sign up at www.healthcare.gov.

You may not have heard the word that health care coverage is available -- right now, today, even as you read these words.  It's your right.  It's the law of the land!

Please Read The Disclaimer.  ©2017 by Dennis J. Wall.  All Rights Reserved.

MARCH 31 HEALTHCARE.GOV SIGN-UP DEADLINE.

Monday, March 31, 2014 is the current deadline to sign up for health care online.  It will almost certainly be worth your time, if you like saving money and having adequate health insurance.  OBAMACARE:  WHAT'S IN A NAME?  NOTHING.  LOOK IT UP.

 

P.S.  BREAKING NEWS!  MARCH 31, 2014 IS NOT THE DEADLINE FOR EVERYONE!  MAJOR SURPRISE ANNOUNCED BY OBAMA ADMINISTRATION FOR NEWEST SIGN-UP DEADLINE!

   Open enrollment was scheduled to end on Monday for all Americans. The White House had previously insisted that the deadline was firm and would not be extended.

   Under the move planned by the administration, some people will be given a special enrollment period, beyond the deadline, if they can show they were not able to enroll because of an error by the federal exchange or by the Department of Health and Human Services. Federal officials allowed a special enrollment period, on a case-by-case basis, for some people who were unable to meet the Dec. 24, 2013, enrollment deadline for coverage starting Jan. 1 of this year.

Robert Pear, "U.S. to Extend Sign-Up Period for Insurance" (New York Times online, posted on Tuesday, March 25, 2014 for publication on Wednesday, March 26, 2014).

© 2014 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

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Related articles

Obamacare: What's in a Name? Nothing. Look It Up.

 

SO LEAD ALREADY, AMERICA'S HEALTH INSURANCE COMPANIES.

Sign 'em up, baby, sign 'em up.

           America's health insurance companies still have problems with the White House's website for health insurance, www.healthcare.gov.  See Robert Pear and Reed Abelson, "Insurers Claim Health Website Is Still Flawed / White House Praises Software Upgrades" p. A1, col. 1 (New York Times Nat'l ed., Monday, December 2, 2013).  Ms. Karen Ignagni, the current president of AHIP, "America's Health Insurance Plans, a trade group," is quoted in the linked newspaper report as saying:  "Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage."

          Relying on the website will not get you all those new premium dollars from potential new insureds, America's health insurance companies.  Now is the time to earn them.

Take the lead.  Many State websites are functioning, if needed.  Telephones, faxes and paper insurance applications have not stopped working.  Enroll people in new health insurance coverages now.  Use websites if necessary.

© 2013 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

Please Read The Disclaimer.

MEMO TO VALERIE JARRETT, RE: HEALTH COVERAGE.

          Valerie Jarrett is an adviser to President Obama.  She advises the president on many subjects including Health Insurance Coverage.

          It is unknown what if any particular qualifications or experience Ms. Jarrett has on Health Insurance.  It is known, however, that she is the featured participant at meetings on Obamacare even when the Obamacare meetings include Secretary of Health and Human Services, Hon. Kathleen Sebelius.  So far as is known, as well, these meetings have been held at the White House, not far from Ms. Jarrett's office, and not at HHS where Secretary Sebelius is in charge.  See, e.g., "'AS GOES OHIO' ... HOW GOES OHIO WITH MEDICAID, EXACTLY?" published here on April 3, 2013.

          Clearly, the latest deadline of Saturday, November 30th, for a working www.healthcare.gov website will not work. 

          The only important working reason, as distinct from political reasons, to want to make www.healthcare.gov work, is that the Affordable Care Act a/k/a Obamacare is an opportunity to make a contribution to people who cannot afford health coverage and who do not have health coverage.  That reason is enough to make the website work, but if the website continues to fail by Saturday, November 30th as it seems certain to do, there is still plenty of time and there are plenty of options to implement the law for the benefit of the people who need it to work.  See "FIVE DAYS LEFT," November 25, 2013, published here.

© 2013 by Dennis J. Wall.  All rights reserved.  No claim to original U.S. Government works.

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Say it, Say it, Say it AGAIN!

Mr. Obama, Build Up This Exchange, NOW! 

   Fussing about it will do no good.  Fretting and fixing blame won't do the job either.  Fix the Health Insurance Exchange which should have already been built during the past 3 years and which the Obama Administration is building by itself, NOW:  See how by Dr. Ezekiel J. Emanuel, "How to Fix the Glitches" p. A27, col. 2 (New York Times Nat'l ed., Wednesday, October 23, 2013).

Postscript:

Since this article was written, further reporting on the fiasco includes Michael D. Shear, "Health Site Woes Undermine Vow On Government" p. 14, col. 5 (New York Times Nat'l ed., Sunday, October 27, 2013); and Robert Pear and Sharon LaFraniere, "Target of Nov. 30 is Set for Fixing Health Care Site" p. A1, col. 6 (New York Times Nat'l ed., Saturday, October 26, 2013), published online under the headline "Promised Fix for Health Site Could Squeeze Some Users".

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Initial Health Insurance Exchanges: The Progress and the Planning.

     The extended deadline for the 51 States and the District of Columbia to each declare their choice from among the Health Insurance Exchanges authorized by the Affordable Care Act, was this past Friday, December 14, 2012.  The authorized choices were a State-run Health Insurance Exchange, a State-and-Federal partnership HIE, or an Exchange that is run totally by the Federal Government.

    Reportedly, 17 of the 51 'States' elected to implement State-run Health Insurance Exchanges.  Robert Pear, "Majority of Governors Refuse to Set Up Health Exchanges" p. A13, col. 1 (New York Times Nat'l ed., Saturday, December 15, 2012).  After due and diligent research, no list has been located identifying the 17 States which have reportedly elected to implement State-run Health Insurance Exchanges.  However, the following 9 'States' have been identified as making the choice of State-run Health Insurance Exchanges in the past week:

• Colorado.
• Connecticut.
• District of Columbia.
• Kentucky.
• Maryland.
• Massachusetts.
• New York.
• Oregon, and
• Washington.   

 Press Release, "Progress Continues in Setting Up Health Insurance Marketplaces," Centers for Medicare & Medicaid Services, Friday, December 14, 2012.

    It is also reported that in this initial year of Health Insurance Exchanges, "more than half the states" have apparently elected to have the Federal Government run the HIEs in their States.  Again, no list identifying such States has been found as yet.

    To reiterate, "[t]he exchanges are online supermarkets where people can shop for private health insurance and obtain federal subsidies to help defray the cost.  The Congressional Budget Office has estimated that 25 million people will eventually receive coverage through the exchanges.  Federal officials an federal contractors will set up and run the exchange in any state that is unable or unwilling to do so."  Robert Pear, New York Times, supra.

    In any case, the States' choices among the authorized HIEs are not choices which are set in concrete by any means.  All States have the choice each year to implement any Health Insurance Exchange they may choose.  See Dennis J. Wall & John K. DiMugno, "Health Insurance Exchanges and Deadlines Under the ACA:  Part 1 of 2:  What are the Choices?" posted on Westlaw Insider Blog on November 27, 2012, and id., "Part 2 of 2:  What are the Deadlines Now?",  posted on Westlaw Insider Blog on November 29, 2012.

 Please Read The Disclaimer.

Federal INSURANCE Laws to Preempt STATE Insurance Laws.

     State regulation of Insurance has been the norm almost exclusively.  Insurance Companies are rarely subject to specific Federal regulation.  See generally DENNIS J. WALL, 2 LITIGATION AND PREVENTION OF INSURER BAD FAITH § 9:16, "Statutory Preemption of the Common Law and of Other Statutory Causes of Action" (Third Edition and 2012 Supplement, West Publishing Company).

    That is about to change.

    Federal multistate Health Insurance Plans will be regulated by Federal Health Insurance standards.  This is a new development.  Federal Insurance Law will preempt conflicting State Health Insurance rules.  It is not a new development for Federal Law to preempt conflicting State Laws; it is a new development for there to be such a thing as Federal Insurance Laws.

    Federal Health Insurance Plans will be eligible for the new Health Insurance Exchanges being set up in the States under the Affordable Care Act, regardless of whether the Federal Plans meet State Health Insurance rules.  Robert Pear, "U.S. Prepares to Sponsor Health Insurance Plans" p. 23, col. 1 (New York Times Nat'l ed., Sunday, October 28, 2012).

    The Federal multistate Health Insurance standards have not, however, been made public.  The National Association of [State] Insurance Commissioners, or "NAIC," has publicly announced its concern over these unknown rules.   See generally the Health Insurance and Managed Care (B) Committee page on the NAIC website for general information about the Committee formed by the NAIC for this purpose.  The Office of Personnel Management ("OPM") is the Federal agency empowered to issue the new rules.  OPM has not released them.  See the OPM Healthcare and Insurance page, for general information offered by OPM on those subjects without specifics addressing the new Plans.

    However, it is publicly reported that:

• OPM will negotiate the premiums and benefits.
• OPM is "the agency that arranges health benefits for federal employees." 
• The Federal multistate Health Insurance Plans will be offered "to individuals and small employers" through the Health Insurance Exchanges being set up in the States under the Affordable Care Act.

Robert Pear, "U.S. Prepares to Sponsor Health Insurance Plans" p. 23, col. 1 (New York Times Nat'l ed., Sunday, October 28, 2012).

    This may not be the same thing as the public option for Health Insurance.  We do not know.  We may know more when the OPM issues Federal rules and regulations for comment, which ought to describe these Federal multistate Health Insurance Plans with more details than we have now.

Please Read The Disclaimer.