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November 23, 2013

Health plans in limbo: Obama’s reversal leaves both critics, backers bewildered

— (First of a two-part series on local effects of President Barack Obama’s Patient Protection and Affordable Care Act)


The botched rollout of the federal health care website and complications associated with President Barack Obama’s direction to reinstate canceled policies has insurance providers reeling and reform supporters scratching their heads.

“We don’t know anything yet,” Joe Fortunato said at his business, The Health Insurance Place in Richland Township.

Any canceled policy must be reapproved by the state Insurance Department, Fortunato explained at the 508 Luray Ave. office.

The Health Insurance Place, associated with Fortunato’s American Insurance Marketing in the same location, serves as a broker for about eight different insurance companies, including both western Pennsylvania giants Highmark Blue Cross/Blue Shield and UPMC Health Plan.

Highmark and UPMC leaders say they are working to expand health care through the federal Patient Protection and Affordable Care Act while waiting for the state Insurance Department provide direction on the canceled plans.

“UPMC Health Plan is in the process of evaluating and reviewing the comments by the president as well as communication from the Centers for Medicare and Medicaid Services at this time,” spokesman William Modoono said in a statement.

“UPMC Health Plan is also working closely with the Pennsylvania Insurance Division and is awaiting final guidance from the state to determine its next steps.”

Highmark has been working to move those whose policies were canceled into new

policies that meet Affordable Care Act requirements, the company announced after Obama’s Nov. 14 address.

“The president announced that the federal government would employ its discretion to delay enforcement of Affordable Care Act market reforms in 2014 for plans that are currently in effect,” the company statement said.

“It is unclear how these proposed changes can be put into effect.”

The Insurance Department is developing its plans to respond to Obama’s directive, Insurance Commissioner Michael Consedine announced.

“The Affordable Care Act has created unprecedented confusion in the health insurance marketplace,” Consedine said. “(The Nov. 14) announcement by the president has served to heighten that confusion and has created more questions.”

“We are evaluating the president’s proposed ‘fix’ for consumers who have had their policies canceled. However, as Gov. (Tom) Corbett has stated, we don’t believe the ‘fix’ represents a real or permanent solution to the problems caused by the ACA. It is also unclear whether or not the federal government had the executive authority to institute the delays.

“I have reached out to the CEO of every major health insurance carrier in Pennsylvania to examine what they are able to do to ensure that individuals are not left without coverage.”

The Insurance Department expects to have more information in the next few days, Consedine said.

The good news is that those whose plans were canceled can probably save money by changing to new federally approved plans available now, Highmark says.

“These individuals will benefit from having a new health-care reform compliant plan because it will have additional essential health benefits, and the plans, in almost all cases, will be lower priced,” Highmark announced.

The bad news is that it’s still difficult for those eligible for a federal subsidy to enroll in the new plans because of the website debacle at

Because of website issues, The Health Insurance Place in Richland has not enrolled any clients who may be eligible for federal subsidy, agent Bobbi Farabaugh said at the Luray Avenue office.

Subsidies can help most people with incomes less than

400 percent of the federal poverty level, which is $45,960 for an individual and $94,200 for family of four.

Farabaugh said she can help people determine if they are eligible for the subsidy, which would decrease the monthly premium. She also can show them what plans are available, with what benefits and what the monthly premiums would be.

“But if they are eligible for the subsidy, they can’t get the subsidy except through the website,” Farabaugh said.

The Health Insurance Place is compiling a list of those who want to sign up for subsidized policies and will contact them for enrollment when the website issues are resolved.

Another option may come as early as Tuesday, the federal government announced last week.

Julie Bataille of the Centers for Medicare and Medicaid Services, the agency that oversees the government’s online insurance exchange, told reporters last week that the “direct enrollment” option should be functioning. The option should allow consumers to bypass, sign up directly with companies such as UPMC Health Plan and Highmark and still receive the subsidized premium rate.

National reports show insurance companies are exploring the option. Neither Highmark nor UPMC has announced the enrollment option is available.

The continuing enrollment quagmire has frustrated even the most ardent health care reform advocates.

Dr. Matthew Masiello, director of the Centers for Health Promotion and Disease Prevention at Windber Research Institute, says the technology meltdown is inexcusable for a nation that prides itself as a leader in the digital realm.

“Needless to say, the most concerning of this whole thing is our technological inability to make this work,” Masiello said.

“That is very frustrating – especially with the overwhelming level of experience we have in this country – that we failed to make this happen.”

Opponents and supporters of the Affordable Care Act should be working together to solve the problems and work on improving the law, Masiello said, adding that political wrangling has confused the public about the new law’s actual requirements and benefits.

“Blame is on both sides, and they better accept the blame,” he said.

Randy Griffith covers health care for The Tribune-Democrat. Follow him on Twitter at

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