Obamacare’s Underwhelming Multistate Options

No matter how worthy the goal nor how well written the law, neither can pre-empt the realities of the human workplace.


The Affordable Care Act requires that every insurer who offers coverage through healthcare exchanges offer one or more multi-state plans that will have network providers in 30 states.  One of my home states, South Dakota (a non-participant at the state level), falls way short.  There are three companies offering 2014 ACA plans in SD, but only one offers anything outside of the state other than “emergency, or outside of network care”.   That one insurer limits its in-network coverage to hospitals and clinics they manage in the frozen north.  Maybe that limbo rocks just within the letter of the law, but it’s a long way from the spirit of offering routine access to quality healthcare in lots of places.  I can only assume that having some insurance participants in each state justifies letting them skate on the multi-state thing in 2014.


Rome wasn’t built in a day, nor was Social Security, or Medicare, or Medicare Part D.  They all rolled out with glitches, they’re all still around, and which one would you eliminate?   Obamacare will improve quickly, and (write this in your book!) you will love it.


Nonetheless, don’t drop everything to retire now with plans to travel the country.  Convenient access to insured medical services in 2014 is not a given if you will spend several months on the road.  I read online today that there’s a fair chance that only Blue Cross has enough contracts with hospitals and clinics to be able to meet the ACA’s 30 state minimum for multi-state plans.  That’s informed speculation.  But with the Supreme Court case decided mostly in favor of Obamacare just five months ago, you know a lot of health insurers bet earlier, and lost, on Business As Usual.  Those guys are nowhere near ready.  Besides, only the biggest companies do business in enough states to Xerox them all into one big multi-state plan.  The others will get there when the market materializes, but given all the negotiations with providers that must come first, they probably cannot offer useful multi-state coverage until another year or three passes.


Meanwhile, what can we do?  I think full-time RV’ers have to take advantage of our legitimate claims to citizenship in more than one state.  Check out the plans in the states where you get W-2’s, where you have your rig licensed, where they send your jury duty notices, and where you spend the most time.  The best way to investigate PLANS is to contact the Obamacare sales agents of each insurer in each state where you can claim your principal residence.


Do your homework, and plan to invest twenty to thirty hours in the hunt.  It will not be fun, but it will be worth your while.

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