Drafted Health Care Application: Summary of a Doozey

applicationThe drafts (yes, plural) of the ACA (a.k.a. Affordable Care Act), has been released and boy is the longest one a doozey! It’s sixty draft pages (the “short” form is 21 pages) long, is sprinkled with bad grammar (“Based on your best guess, do you expect your total household income be less than”) and one of the first things you see on the application is this:

 “This document (the “questionnaire”) represents each possible item that may need to be asked for successful eligibility determinations.”

and a few paragraphs later:

“Most applicants will need to complete less than one-third of these items.”

 Well, that’s good news! Now let’s take a look at what kinds of “one-third” we’ll be forced to answer.

 Note: On the draft form, your Social Security number in the first section is listed as “(optional)”. Have you ever seen that on a federal form administered by the IRS? And, of course, that “optional” goes away in Section VII, where it becomes mandatory if you’re applying for health insurance. If you’re not applying for health insurance, then you don’t have to provide your Social Security number; but why include the person at all if they’re not applying?

 Under section IV A, is this question:

 “2. Do you want to find out if [you/your family] can get help paying for health insurance?”

 And its explanation:

 “The next two questions are only asked if the person checks that they don’t want to apply for financial assistance in the item above. The idea is to capture a couple of items to assess whether it may be worth their time to apply anyway. These items serve the purpose of trying to promote the use of the financial aid application for people who initially may not think they qualify. These questions aren’t an actual determination of eligibility.”

 So they don’t just ask if you’re eligible or want it, they just push financial aid.

 They also ask about the state of your marriage, as in:

“Does [Household contact] live with this spouse?”

 They get very specific about what sort of household make-up you have. I’m not talking about Revlon here, I’m talking who is living in your house with you. There are a total of twenty-eight possibilities, from spouse to “collateral dependent” (What in the world is that?). That is information they want for everyone in the house: they want specifics, darn it! Oh, and if you have children who don’t live with you, you will have to know about the filing status of the people your child does live with. So if your ex remarried, or is living with someone else and the two of you don’t talk, you will now! (Ah… the federal government bringing families back together!)

 Note on the application that they ask questions about the future. “Does [the applicant] plan to…” is asked for several items. Section XX is “Review and Sign” in which we’re told that the information is used for the next five years in determining eligibility and we find the following:

 “I’m signing this application under penalty of perjury. This means I’ve provided true answers to all the questions on this form to the best of my knowledge. I know that if I’m not truthful, there may be a penalty.”

 The problem with that “do you plan” question is that Title 18 of the US Code, Section 1001 makes it a federal crime to lie to the government:

even if you:

· made the false statement without the obligations of an oath,

· didn’t receive warning of the law or its consequences,

· were not trying to cheat the government out of money,

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· or lied about something that was not materially influential to government matters.”

So if you say that no, you didn’t plan to and then later changed your mind, or your circumstances changed and with them your plans, would that be considered a lie in their eyes? Could they cancel your healthcare insurance plan because your plans changed? Even if they don’t cancel your insurance plan, what else could they do? It’s something to think about, n’est-ce pas?

The form says that our citizenship status will be verified with our SSN:

“Yes (If selected and citizenship is verified with SSA, skip to C [“Parent/caretaker relatives”]. If selected and citizenship isn’t verified with SSA, continue to item 2.)”

 What about how many SSNs are being used by people to whom it was not issued? Identity theft is rampant; illegal aliens and others use SSNs that are not theirs all the time. If the identity thief using your SSN applies on November 1st, and you apply on December 15th, will you be considered the person who is not verified?

This is supposed to be a healthcare insurance plan for American citizens, right? Then why are there fourteen other options for those who are not citizens to be able to designate what kind of ID they’re using to file for healthcare?

Section VII D (page 23) is all about “Ethnicity and Race”. (Wonderful.) It is optional, but:

“This information will be used to help the U.S. Department of Health and Human Services (HHS) better understand and improve the health of and health care for all Americans. Providing this information won’t impact your eligibility for health coverage, your health plan options, or your costs in any way.

 How can knowing everyone’s ethnicity and race help improve health insurance coverage? If we’re all the same inside, as the old saying goes, what difference does the outside make? Why bother giving the four options for “ethnicity” and the fifteen options for “race”?

 They also ask if anyone has a disability, is a full-time student, if the student’s parents live in the same state, if anyone is pregnant, or if you’re “American Indian or Alaska Native “, if anyone was ever in foster care and how old that person was while they were in foster care!

 They ask you to forecast your income for what you think it will be next year (crystal ball?). Then they ask you what the combined income for you and your spouse will be next year. Section XI is about “Current monthly income” and they ask about how often you get a check from your sources, what type of work you do, if you get income from the State, SS Disability, retirement, etc.

Here is where they also go into their records and get your previous IRS filings and show you your information. (Here’s why the IRS is so involved: to keep you “honest”.) They ask about whether your hours at work have decreased recently or if you’ve had a salary cut. They ask about your pension plan, if you have capital gains income (how much, how often, etc.), rental or royalty (book sales, etc.) and investment income. They even get down to pay from jury duty! Not just a little intrusive: a LOT intrusive! They ask if you have any “other” income, apparently looking for something you haven’t mentioned on the IRS forms from previous filings. If you answer “Yes” here, can they get you for IRS fraud from previous years?

They ask about whether you already have insurance through an employer and what the employer’s information is and what kind of plan you have through them. They ask about the costs of the plans available and how often you would be required to make your payments (nosy, aren’t they?). They ask if you’ve been denied health insurance, or recently gotten married, adopted a child, changed immigration status, moved or gotten out of jail recently.

Some are stating that the form asks you about your sexual proclivities, or about gun ownership. Those questions are not on these forms, but that doesn’t preclude them from being asked elsewhere. However, there is an additional item that bothers me. The form asks (Section XX D):

“5. Would you like to register to vote?”

 Voting is done locally. Why is the federal government getting involved in this on a form that covers immigration status, etc.? That makes me say, “Hmmm….”

 A funny thing to note is that this is being distributed for review. That’s sixty pages (ignoring the 21 page alternate offering) going to how many people in how many offices? But at the bottom of every page except the cover page is this:

 “Single Streamlined Application for the Health Insurance Marketplace: Items in Online Application for Comment – Paperwork Reduction Act (PRA) Appendix A Revised: 01/18/2013 [my bolding]”

 Irony, anyone?


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