Request for proof of citizenship offends Nevada Health Link applicant


Just a fraction of the more than 1 million unique visitors who’ve stopped by Nevada Health Link’s website have bought a plan.

A little more than 19,000 consumers statewide had enrolled in plans through the Silver State Health Insurance Exchange’s website as of Feb. 22.

Officials with the state exchange, and its contractor, Xerox, are working to understand why so few people are pulling the trigger. This week, we feature comments from one consumer who was offended by the application process.

Also, we have fresh numbers on how readily Medicare recipients can get an appointment with their doctor.

Let’s get started:

■ Manny Ceballos feels singled out. He copied us on this letter he sent to Nevada Health Link:

“Please accept this letter as a written complaint that I do not agree with your request requiring me to send you proof of citizenship. I have had my Social Security number for 50 years and was born in the United States. I have a feeling that since you saw a Hispanic last name you … have decided to single me out as not being from this country.

“I am NOT going to send you this proof as I do not trust the person who is receiving this information nor do I know who that person is. How do I know that my identity will not be stolen and used to cause me harm? By the way I know of several non-Hispanics who have acquired insurance through Nevada Health Link and they were not required to send proof of citizenship.”

To help you out, Manny, we turned to Andres Ramirez. As president of the Ramirez Group, the state’s largest health-insurance navigator firm, he’s seen just about every enrollment conundrum out there.

So here’s the deal: Everyone who applies for coverage through Nevada Health Link is asked if they’re a U.S. citizen because they’re ineligible to buy through the marketplace if they’re not.

But you’re right, Manny, in that not everyone is asked to actually prove citizenship by uploading a scanned copy of their birth certificate or passport to the site.

What spurs a request for proof? Sometimes, it’s a problem with the application details a consumer entered, Ramirez said. An enrollee might have gotten a digit wrong on his Social Security number or hit the wrong birth date. That mismatch will often generate a demand for proof. Some consumers don’t input a Social Security number at all, because the system doesn’t require it. But if you forgo your number, the site is likelier to ask you to verify citizenship.

The system may also validate the citizenship of people with common names who were born in the same year, Ramirez said.

“I’ve seen as many Smiths and Joneses get prompted (for citizenship proof) as I have Sanchezes and Rodriguezes,” he said.

Ramirez estimated that less than 20 percent of the people he’s helped enroll have been asked to document citizenship.

The bigger enrollment trip-up in Nevada has been incomes, Ramirez said. Thanks to the state’s uneven economic recovery, there are plenty of consumers who continue to see big changes in incomes year to year. It’s not unusual for someone who made $45,000 in one year to take home just $30,000 the next year from job loss or cuts in hours. And that triggers the income-vetting process to ferret out consumers who might lie about earnings to qualify for the federal premium tax credit.

“We deal with income verification much more often than proof of citizenship,” Ramirez said.

Anyone who won’t verify income or citizenship upon request won’t be able to enroll through the exchange.

Manny, you could start by deactivating your Nevada Health Link account and reapplying, in case you made any mistakes when you applied the first time. You may not get a proof-of-citizenship prompt the second time.

As for whether your information is secure, no one can promise you that.

“We do whatever is available and possible to prevent (website) hacks,” Ramirez said. “But even Google has been hacked, and they’re one of the most technologically advanced companies out there. The Las Vegas Sands Corp. has spent multiple millions on their Internet security, and they got hacked.”

■ There was much ado this week about proposed federal cuts to Medicare Advantage plans, private policies that cover what Medicare doesn’t (think dental care).

The Obama administration said it wants to cut 1.9 percent from federal funds for the plans in 2015. The reduction isn’t a sure thing yet; the administration proposed a 2.2 percent cut in 2014, and boosted spending 3.3 percent once lawmakers and insurers weighed in.

But it’s not a bad time to look at how seniors are able to access care.

Medicare sometimes gets a bad rap because some doctors don’t like the low reimbursement rates, so they refuse to see patients who are on the program. But a Feb. 26 report from the Journal of the American Medical Association flies in the face of that reputation.

First, 91 percent of U.S. doctors accepted new Medicare patients in 2012 — exactly the same share that took on new patients with private insurance.

That rate was a little lower in Nevada, although the majority of doctors reported being open to added Medicare business. Eighty percent to 89 percent of doctors in the Silver State said they were seeing new Medicare patients in 2012.

Also, less than 1 percent of doctors nationwide had formally opted out of Medicare, and 42 percent of those docs were psychiatrists, rather than primary-care providers.

In all, just 12 percent of seniors across the country reported being unable to schedule timely appointments with doctors.

■ Next week: Reader questions on federal tax credits and Medicaid sign-up delays.

 

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