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When a diarist presents extraordinary claims, extraordinary proof must be provided to support them. This has been a long standing rule around here, and one that has kept this website in the mainstream of the reality based world.

The only way we continue to be a part of a reality based world is if we continue to demand proof of claims. Like the one contained in  Law of Unintended Consequences Bites Red States in the ACA that made the recommended list this morning. In it, the diarist claimed that hospitals like Parkland in TX are now taking out insurance on their poorest patients, depressing the insurance pool and forcing these insurers to leave the state. Multiple links were provided backing up these assertions.

Apparently, the kossacks who read this diary didn't bother to click on a single link. Had they done so, they would have been unable to find a shred of evidence to support the diarist's thesis or conclusion.

Because it didn't exist.

The diarist presents a problem that AIDS patients were encountering in states that refused the Medicaid enhancement. Premium payments from RyanWhite were being declined in states, like Louisiana, based on a 2013 CMS guideline. Link provided. And the story backed up this claim. The original CMS guideline advised against accepting 3rd-party premium payments for health insurance purchased through the ACA exchanges. This is what the article says:

BCBS claims to have made its initial decision based on 2013 guidance from the Centers for Medicare and Medicaid Services (CMS), which cited the risk of fraud as a concern in accepting third-party payments. However, a spokesperson for CMS has clarified payments from the Ryan White program should remain acceptable.
So far so good. The diarist quotes part of the CMS clarification:
This interim final rule requires issuers of qualified health plans (QHPs), including stand-alone dental plans (SADPs), to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, other Federal and State government programs that provide premium and cost sharing support for specific individuals, and Indian tribes, tribal organizations, and urban Indian organizations.
But then comes the step onto the stair that isn't there:
It does allow a government body or charitable organization to pay the insurance premiums for anyone it chooses---including someone with severe, chronic medical conditions and medical expenses so high that even the means adjusted premiums of the ACA may put “affordable” insurance out of reach.
And then:
Now that the hospital can pay $50 to $150 a month to get comprehensive coverage for patients whose monthly medical bills may be in the thousands of dollars, this is deal that is too good to pass up---
This claim is not supported by anything contained in any of the links the diarist provides.

Here is what happened:

In October of 2013, Texas Hospitals like Parkland, expressed interest in paying the premiums for their indigent patients under the ACA which would have saved them a ton of money.

CMS said no. Emphatically:

Q: Are third party payors permitted to make premium payments to health insurance issuers for qualified health plans on behalf of enrolled individuals?
A: The Department of Health and Human Services (HHS) has broad authority to regulate the Federal and State Marketplaces (e.g., section 1321(a) of the Affordable Care Act). It has been suggested that hospitals, other healthcare providers, and other commercial entities may be considering supporting premium payments and cost-sharing obligations with respect to qualified health plans purchased by patients in the Marketplaces. HHS has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces. HHS discourages this practice and encourages issuers to reject such third party payments. HHS intends to monitor this practice and to take appropriate action, if necessary.
November 4, 2013
As a result of the November FAQ, insurers started turning down Ryan White money. The CMS stepped up with the advisory linked to in the original diary:
To ensure that individuals reliant on programs similar to the Ryan White HIV/AIDS Program are not being adversely affected by QHPs' and SADPs' refusal to accept third party premium and cost-sharing payments, we are including within the new requirement that QHPs and SADPs must accept third party premium and cost-sharing payments from the following other entities in addition to the Ryan White HIV/AIDS Program: Indian tribes, tribal organizations, and urban Indian organizations; and state and federal government programs. This standard applies to all individual market QHPs and SADPs, regardless of whether they are offered through an FFE, an SBE, or outside of the Exchanges.

Our new standard does not prevent QHPs and SADPs from having contractual prohibitions on accepting payments of premium and cost sharing from third party payers other than those specified in this interim final regulation. In particular, as stated in our November FAQ, we remain concerned that third party payments of premium and cost sharing provided by hospitals, other healthcare providers, and other commercial entities could skew the insurance risk pool and create an unlevel competitive field in the insurance market. We continue to discourage such third party payments of premiums and cost sharing, and we encourage QHPs and SADPs to reject these payments.

Patient Protection and Affordable Care Act; Third Party Payment of Qualified Health Plan PremiumsA Rule by the Health and Human Services Department on 03/19/2014

There is not one word in any of the linked articles that support the diarist's claim that
Now that the hospital can pay $50 to $150 a month to get comprehensive coverage for patients whose monthly medical bills may be in the thousands of dollars, this is deal that is too good to pass up---
Because it is untrue. There is no evidence that Parkland or any other Texas hospital can or would pay the premiums of their uninsured patients, thus improving their bottom lines while distorting the risk pool and forcing insurers to leave the state of Texas.
And if Parkland pays the premiums, the patients will never lose their ACA insurance, no matter how long they stay in the ICU in a coma---with all their bills going straight to Blue-Cross.
It is only a matter of time before all the other urban areas in the 24 states that did not expand Medicaid follow suit. Harris County (Houston-Ben Taub) estimated last fall that 75,000 of its patients qualified.

Let me repeat: Parkland does not pay ACA premiums for those who cannot get expanded Medicaid.

You know, it is tedious to have to continually knock down the Fox News half-truths, distortions and flat out lies on Obamacare that my misguided friends and family members constantly refer to me. But to have to do that here? At Daily Kos, home of reality?

Shame on the diarist for presenting half truths and speculation as if it were reality. But a greater shame is reserved for those readers who put this diary on the Recommended Diary list. Links are included in a diary for a reason. It is up to each of us to follow the links before accepting a claim that, on its face appears ridiculous. This is the same diarist who, less than a few week ago, suggested that we were intolerant of the mere suggestion that the ACA is not perfect, in spite of the many diaries that have appeared questioning multiple issues with Obamacare.

So, if you want to go back to circling the wagons around the ACA, insisting that everything is just fine, go right ahead. You can even accuse me of not being a Family Physician and of not working with the chronically ill and uninsured.  But if you try to accuse me of being a Bad Democrat, of not supporting the President,  because I won’t keep my mouth shut, I

April 13, 2014

There are a lot of problems with the Affordable Care Act that really need to be addressed and corrected without inventing more. Let's focus on the real problems, get them solved and then worry about something that is at best speculative.
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