The Plan Under the ACA

NECA-IBEW-2014 Understanding health insurance and the Affordable Care Act (ACA) is as complicated as a Chinese typewriter. But, I admit it. I have benefited from the ACA in spite of my previous lamentations.

I have written many times about the frustration with my health insurance, presenting fictitious dialogs with Plan Admin, the name I gave to the administrator of NECA-IBEW Local 480 Health and Welfare Plan (The Plan). We are an International Brotherhood of Electrical Workers (IBEW) union employer, affiliated with the IBEW through the National Electrical Contractors Association (NECA). It is not a perfect relationship, as no human relationship to my way of recollection has ever been perfect; but it is a symbiotic one with both parties benefiting. In the construction environment, we NECA contractors furnish the work; the IBEW journeyman wiremen and apprentices actually do it with the jobs, materials, tools, and services we provide them. We both need each other, since without workers to do the work and capitalists to risk capital for the hope of gain to provide the work needed by others, there would be no work. Every link in the chain is critical…the need for construction services and the folks who finance them, the manufacturers and vendors who furnish the materials and their transportation, and the management to see that the works is done in an orderly fashion, and the skilled crafts people to execute the work…none of it can happen without all of it.

Mississippi is a right-to-work state, so unions are not necessary. We also fall below the threshold of the ACA wherein we would not be required to furnish health insurance for our employees even if the employer mandate had not been delayed twice by the Administration in advance of the approaching elections. But we furnish insurance for our union employees as required under the employer agreement we have with the IBEW and in the process, as employers, get to participate in the same health insurance plan.

The Plan is self-funded, administered by a third-party like many self-funded plans, portable from employer to employer as construction employee health plans must be and as recognized and allowed by the Taft-Hartley Act. It is also a grandfathered plan that received a Health and Human Services (HHS) Waiver from compliance with the ACA which were so freely granted, mostly to unions at first, but extended to others out of political necessity. That waiver allowed my plan to maintain its $100,000 per year annual maximum benefit. I found that a vexation of the highest order and wrote about it many times, vilifying Plan Admin, the plan, HHS, and everyone I could think of, all because of the personal motivation of the annual limitation. Try having cancer and going through chemotherapy with a $100,000 annual limitation. It ain’t easy. Had I had a type of cancer that also required extensive surgery and then needed chemo, it could have bankrupted me. It took extensive and concentrated cooperation with Hemosapien, Gooday, the cheerfully competent people at their offices, and my own intense efforts to manage this with minimal out of pocket expense since the chemotherapy drugs I required were terrifically expensive. They were also terrifically effective. I was fortunate that I never got so desperate that I was unconcerned with my wallet. As long as one’s wallet is a concern, things could be worse, since there is bankrupt, dead, and a simultaneous bankrupt deadness, which most folks would readily admit is the worst of the three. I didn’t approach any of them.

As it was, The Plan paid what it was supposed to pay and did what it was required to do, after all it is The Plan’s plan to do so. There never was any question of the The Plan doing otherwise. My beef was that the The Plan just didn’t go far enough. Had the chemotherapy not been effective and I needed a bone marrow transplant, I would have been on my own. No doubt, there would have been several musical benefits done on my behalf, and dozens and dozens of anonymous benefactors contributing to see that the transplant got done, for which I would have been extremely thankful, but as it was none of that was not necessary, which is another reason for thankfulness. It was never very far from my mind, though. With medical care costing what it does, we are all just one heart problem, cancer treatment, or slip and fall on our stairs in our own home from spending a quick, slick $100,000. Have you priced orthopedic surgery lately? Bypass surgery? Rituximab? Goodness, they are more expensive than a seaside villa in Monaco, or a chalet in St. Moritz.

Plan Admin never got a break from me, though he was never at fault. Plan merely administers The Plan; he is not a trustee of The Plan nor its actuary. But, being the administrator, he bore the brunt of my wrath many times even though I knew him to be innocent. Now, I must dis-revile him if I can make up my own word, since I doubt dis-revile qualifies as one. You may have noticed that I am very fond of making up my own words, or at least using words in unorthodox manners. You may find this a revolting revilement. If you do, I might suggest that you no longer revel in your relvilement and disrevile any previous revilementation. Decipher that at your own risk. Plan Admin needs some disrevilement. I am offering it here, not as an apology, but as an acknowledgement.

I went to see Hemosaipen this week. Other than this crud/flu-like/unknown viral infection I have wrestled with for nearly a month now, I was doing pretty good. All my blood numbers looked tolerable except for those which were slightly out of whack because of the infection in my own body and the methotrexate I am taking that has its way of working its own malefaction on one’s blood components as a side effect while accomplishing the purpose for which it was intended. With medicines, there is no free lunch. You give up something for each and every benefit they bring you.

So, despite all my caterwauling about the ACA, and I will likely continue to caterwaul about it, on January 1, 2014, I started seeing some benefits that were of a great personal importance to me. I did not understand how appalling an annual limitation was until I exceeded it. Like most people, the thing that really gets me motivated is an invasion of my wallet. Humans are funny like that. Maybe Margaret Thatcher had it right when she said that the problem with socialists is that they eventually run out of other people’s money. We all prefer to spend our own money in the manner we see fit. In the case of The Plan, I fought for every dollar to see that it was spent prudently, declining some treatments and tests that were recommended that I might conserve my annual insurance pool, proceeding only when my physicians persisted in their recommendations after my protests; I figured than that they were serious.

At this moment, while I recognize that things could change under arbitrary and capricious politically expedient waivers, delays, postponements, and regulation invention and revision, I have what one might refer to as a Cadillac health insurance policy. The only grandfathered limitation is for substance abuse programs which I am extremely unlikely to need anyway. There is no guarantee, though, that what we have today under the ACA will be available to us tomorrow. If that turns out to be the case, you will hear me vilify Plan, again, though he is not likely to be the one needing vilification.

I call up The Plan and get Plan on the phone on my first try, which I thought was unusual.

This is Plan Admin,” he said. “How may I help you?”

Hello, Plan. This is Chris,” I said into the phone. I could hear him suck in his breath, no doubt waiting for one more excoriation which was not to come this time.

Yes, Chris. Good to hear from you,” he lied. “What can I do for you today?”

Nothing,” I said, “Not a thing. I just wanted you wish you a good day.” He was really suspicious now, saying nothing, waiting for the softly whispering arrow that must be flying through the air to strike its mark. There was no arrow fired, nor one nocked on the bowstring; absolutely nothing.

Well, thanks,” he said, sounding a bit suspicious, adding, “Are you sure you don’t need anything? I’d be glad to help you any way I could.”

Nope. Just have a good day. Thanks for your service to everyone on The Plan. Keep up the good work. Tell The Plan actuary I said to try and develop a sense of humor. Goodbye.”

Goodbye,” he said. I hung up the phone. I was thinking of the actuary, who really does have no sense of humor. No actuary does. They live in a mysterious world of statistics, probabilities, and formulas too complex for anyone but those who hold numbers higher in esteem than social skills. They can’t help it. I would hope The Plan actuary has access to the same mental health coverage that is available to me under The Plan.

Plan Admin, on the other hand, was wondering just what sort of hell was fixing to break loose on him. He checked the day’s mail, scurrying through to make sure there was not a letter from me. Nope. He wondered what might be coming in the mail tomorrow. He worried himself to near distraction wondering just what sort of trap I was baiting for him. About two o’clock that afternoon, he was exhausted with fretting. He told The Plan secretary that he had a headache and was going home for the day. She just shrugged her shoulders and went back to playing Barnyard Blitz on her computer.

Later on that evening, I crawled in the bed and slept like a rock. Plan, on the other hand, paced the floor needlessly all night long.

The Plan actuary? That evening at home, he was working on an extremely complex algorithm that would likely result the revelation of the need for a significant increase in The Plan premiums resulting in the relinquishment of TheChinese typewriter Plan’s grandfathered status, which might just trigger a waiver from HHS allowing a reintroduction of plan limitations. All of this was being developed and put into process while I was sleeping soundly and Plan was pacing the floor, and the actuary was joyfully and gleefully manipulating numbers in a manner that would have been as complicated as a Chinese typewriter to the rest of us.

Have you ever seen a Chinese typewriter? I wonder what a Chinese equivalent of an old manual Underwood typewriter would weigh? A half-ton?

Whew! Thank goodness that is all I have to worry about right now.

©2014 Mississippi Chris Sharp

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