Lawmakers OK ‘scarlet letter’ insurance bill

Measure singles out patients with Obamacare on insurance cards

A bill that would add a special label to the health insurance cards of people purchasing plans on the Obamacare exchange is sent to Gov. Abbott for signing.

If you buy insurance through the Obamacare exchange in Texas, your doctors are going to know about it. The question is what they’ll do with the information.

The Texas Senate this week approved a bill that would require insurance identification cards purchased through the health insurance marketplace established under the Affordable Care Act to bear the letters QHP, for qualified health plan. The bill now heads to Gov. Greg Abbott, who is expected to sign it, and would take effect on Sept. 1.

Physicians pushed for the measure to avoid a retroactive denial of payment if a patient stops paying the insurance premium. But consumer advocates and health plan leaders are concerned the label will be used to deny care to patients with marketplace plans.

“The move essentially amounts to placing a scarlet letter on insurance cards that can lead to discrimination at the doctor’s office,” said Jamie Dudensing, CEO of the Texas Association of Health Plans. “The last thing Texas consumers need is a measure that has the potential to create a barrier to access.”

Under the Affordable Care Act, people who receive subsidies to buy exchange plans have a 90-day grace period if they fall behind on paying their premiums. If the premiums are not paid, insurance plans must cover the cost of care provided in the first 30 days, but insurers can ret-

roactively deny payments and request refunds from providers for care provided in the last 60 days. Physicians are then left to collect from the patient.

“There is a completely legitimate concern from providers that they are taking on some risk that they didn’t have before,” said Stacey Pogue, senior policy analyst with the Center for Public Policy Priorities, a liberal Austin think tank.

There are also concerns that patients might not be seeking care from providers in their network, or that they might not fully understand how health insurance works.

“All of those things are problems,” Pogue said, “most of which existed before Obamacare but none of which are really addressed by putting QHP on a card.”

Ken Janda, CEO of Community Health Choice, a nonprofit managed care organization, said physicians’ staff will still have to check with the insurer to determine whether patients have kept up with the premiums and whether they are eligible for a 90-day grace period. The only accurate way to determine a patient’s eligibility, he said, is to call the insurance company.

“An excess of 99 percent of all physician front offices do this for all patients every day,” Janda said. “This is not adding a burden.”

Physicians counter that if they can identify patients in exchange plans, they can counsel them on the importance of paying their premiums on time, especially once they get into the 90day period.

“It’s been confusing for patients and it’s been confusing for some physicians, so we’re just trying to streamline it,” says Dr. Tom Garcia, a Houston cardiologist. “It’s a new world with the ACA.”

Physicians might have a hard time denying care to patients with exchange plans. Many of the plans sold on the exchange are the same plans sold through other means. And when physicians contract with those plans, they agree to take any patient who enrolls.

Still, there is concern that labeling the cards could undermine coverage.

“We’re talking about a very small subset of people who won’t pay premiums, and 1.2 million people who have this label on the card,” Pogue said. “If physicians are going to avoid people who have that label on their cards, that would make it much harder for people to do the right thing and get health insurance as they are obligated to do under the law.”

The bill originally would have required the card to be marked with an S if patients qualified for a subsidy. That would have also identified them as low-income beneficiaries. The provision was removed with an amendment by Rep. Garnet Coleman, D-Houston.

“I think that this is a sad day for the medical profession to use the Legislature to create a class on insurance cards that is not required by the federal government or anyone else but is put in place because of the narrowness and some would say the greed of people in the medical profession,” he said. “It really doesn’t speak well of Texas.”