Gayle Ayala says that while she was “once a poster child for Obamacare,” she’s finding herself increasingly frustrated. At 62 years old, she has high blood pressure, high cholesterol, and is at high risk for developing breast cancer, but it has been a struggle to confirm coverage or find an acceptable doctor.
She is one of many Nevadans who have found themselves in limbo after they failed to receive their insurance cards, and who have discovered that the doctors they were promised had been dropped from their insurance plans.
“I’m a huge supporter of the president,” Ayala says. However, she has learned first hand that “the whole thing kind of got messed up for many reasons. . . . It makes you wonder. It’s embarrassing for the president and the whole administration.”
Last fall, Ayala signed up for insurance coverage from the Nevada Health CO-OP (“consumer owned and operated health plan”), a state-level start-up insurer created under the Affordable Care Act. The recipient of $66 million in taxpayer-backed loans, the CO-OP was supposed to compete with larger insurers. It is run in part by Culinary Local 226, a union that made national news last fall when some of its members, picketing outside a Las Vegas casino, harassed tourists, calling them “fat” and “ugly.” And today, the CO-OP’s Facebook page is filled with consumer complaints, including Ayala’s.
The website of Nevada Health Link, the state’s insurance exchange, had reported that the CO-OP held contracts with several doctors in Ely, the rural town in eastern Nevada where Ayala lives. But after choosing her plan, she discovered there were actually no longer any CO-OP doctors in Ely. (Only recently did the exchange update its information on CO-OP physician contracts.)
Under the CO-OP’s coverage, Ayala would have to travel three hours each way to Elko to see a physician. Furthermore, though she needed to see a gynecologist, there was only one CO-OP option within driving distance — and he had a history that made her nervous.
The doctor had paid a $325,000 settlement in 2005 after the Medical Board of Nevada filed a formal complaint; in treating a 29-year-old pregnant woman, he misread her baby’s heart-tracing test and delayed performing a C-section, and the baby died, according to records form the Nevada State Board of Medical Examiners. He had later, in both Michigan and Wisconsin, been fined by state authorities.
Moreover, Ayala wasn’t confident she even had coverage, despite enrolling on the insurance-exchange website.
As the weeks passed since she had signed up, Ayala says, she realized she had not received an insurance card or any acknowledgment from the CO-OP. When she called, CO-OP staffers told her she was in the system — but the insurance card still never turned up in her mailbox.
Finally, she consulted her insurance broker, Kristi Hughes of Jewels Benefits, Inc., in Carson City, who had helped her enroll online in the fall.
Hughes says when she called the CO-OP, representatives twice promised that Ayala would receive a temporary insurance card within days. It never arrived. When Hughes followed up again, she was told that Ayala was missing from the system.
Hughes then logged on to Nevada Health Link. “I see her name,” she tells me. “I see that it says, ‘in force.’ But when I click on her name, there’s nothing but an unresolvable issue.” Hughes says she phoned the exchange, and a representative told her the records said Ayala had never submitted an application.
Finally, Ayala decided to cancel her CO-OP insurance and enroll instead with Anthem Blue Cross. But Hughes says both Nevada Health Link and the CO-OP were responsible for Ayala’s problems, and “every carrier is having their issues.”
“We have clients that are still showing ‘pending,’” Hughes says. “They have no coverage, and the carrier doesn’t even know the people. Yeah, it’s a mess. That was my breaking point. I actually cried. I didn’t know what to do! By the end of the week, I was on the phone for 15 hours with Nevada Health Link. I’d have to say that just about every single person has had some type of issue with Nevada Health Link.”
— Jillian Kay Melchior writes for National Review as a Thomas L. Rhodes Fellow for the Franklin Center.