April 21, 2014
by James Wigderson
Special Guest Perspective for the MacIver Institute
In the age of Obama, sometimes who you know is more important than who you are. It turns out, that even works for the little guy trying to make heads or tails of Obamacare.
Vicky Hekkers is a resident of downtown Waukesha who worked in the health care field as a contract nurse. Now she has her real estate investments, a new internet venture to promote small cities, and her grandchildren to keep her busy.
Because of her age, Hekkers was in the state of Wisconsin’s “high risk” health insurance plan, HRISP. When she was told that it was ending as part of the changes in the state health care law to accommodate Obamacare, she wasn’t looking forward to the higher monthly premium costs and possibly losing her doctor.
Hekkers knew it was going to take a lot of time to sign up because it was such a mess. Hekkers also knew, “if you like your doctor you can keep him,” was not the reality for many people who were losing their insurance to be shifted onto Obamacare.
When she tried to sign up in December the system would not allow her to complete her application. Fortunately for her, Governor Scott Walker extended the state’s high risk insurance plan to April 1st until the Obamacare website mess could be straightened out. That was fine for Vicky, who only has a relatively short period of time until she turns 65 and qualifies for Medicare.
As the April 1st deadline approached, Hekkers again tried to sign up for Obamacare. Because Hekkers had been in the health industry, she knew someone at Wheaton Franciscan she could call to find out which Obamacare insurance carrier also had her doctor as part of the network.
When she signed up for the insurance plan, Molina, she thought it was odd how few questions she was asked by the insurance carrier on the Obamacare exchange website. “They didn’t ask about my health at all,” she said. “They didn’t ask a whole lot of anything. Which plan did I want and how much was I going to pay?”
But she was signed up and she sent her check to Molina, so she waited (somewhat nervously) for the confirmation to be mailed to her.
When she finally got her confirmation on April 7th, Hekkers was surprised to see she had been automatically assigned to a clinic. The clinic was not near her home in Waukesha, or even in Brookfield or Pewaukee. She was assigned to a clinic on 16th street in Milwaukee. Of course, that meant that even though she had picked an insurance plan that had her doctor as part of the network, he was no longer her primary physician.
Molina insurance requires their customers to designate a primary care physician. However, because the form on the internet did not have a space for picking her primary care physician, Hekkers was automatically assigned to the clinic on 16th street in Milwaukee.
“I wasn’t panicking. I just thought it just was ridiculous,” she said.
Hekkers was also surprised it was even an issue. “I had no idea that they were going to be assigning doctors and clinics.” She assumed that it was just going to be like an HMO, and as long as she was “in network” she would be fine.
When Hekkers contacted her friend at Wheaton Franciscan, she found out that the system was supposed to assign her geographically to a primary care clinic. However, there was a “snafu” and people were being assigned randomly.
Fortunately her friend was able to contact the president of the insurance company to straighten out Hekkers’ coverage. But had she not known someone behind the scenes, would she have been able to get her doctor situation fixed?
“Oh my god. Sooner or later,” she said. “But it would have taken a long time, probably, because it had to get to the top.”
Hekkers was able to keep her doctor only because of her connections in the health care industry. The alternative was to cross her fingers and hope that if she needed a doctor, the doctor assigned to her would be able to take care of her.
That’s not the kind of hope and change Americans were promised with Obamacare.