As I explained on a previous thread, my wife is a psychotherapist that works at one of Florida's largest substance abuse treatment centers. She works mostly Utilization Review as the primary clinician that interfaces with insurance companies. Last night, we discussed this article that describes all the potential abuse of the ACA and mental health coverage: New Mental Health Mandate Will Make Obamacare More Expensive, Increase Fraud And Canceled Policies This lead us to discuss what her company is doing to take advantage of all the new coverage that will be suddenly available starting January 1st. First, they trained all their interventionist to assist families on signing up addicts for policies that will allow them to get treatment right away. Since these policies cannot discriminate based on pre-existing conditions, the addict's family only needs to sign them up and they will immediately qualify for a 28-day inpatient substance abuse treatment. The cost of that treatment is just under $20,000. Here's the kicker... To qualify for treatment, the addict's family (on behalf of the addict) signs them up for a Platinum plan (about $350 a month if the addict is in their 20s). Of course, the addict can just cancel the policy as soon as they finish with treatment. Once insured, the addict can immediately be admitted for the $20k treatment. The addict is supposed to pay for the 10% copay, but the treatment center puts them on long-term payment plan knowing they may have to write it off some day. In other words, for a one-time payment of about $350, the addict can immediately get $20k in treatment. And, the interventionist from the treatment center are all now thoroughly trained to both market to the affect families and assist with getting the addict qualified. Well, that works great between now and March 31st when the open enrollment ends. But, of course, there's a loophole. Normally, the addict cannot sign up for a policy outside of the open enrollment period. However, after the open enrollment, they can still sign up as long as they experience a "Qualifying Life Event." There are two main Qualifying Life Events that can be exploited: (1) Loss of a job -- the addict just needs to quit his job and will immediately qualify to sign up for the Platinum Plan and get $20k of treatment for $350, or (2) Moving to a new state -- my wife's company has treatment centers in other states. So, the addict just needs to move to the new state where the new center is located and sign up for a Platinum Plan there. Now, this situation will not be exploited just in the substance abuse industry. I imagine we'll see the same exploitation in the rest of the mental health field and virtually all long-term, chronic illness areas (i.e., Dialysis, Diabetes management, cancer, etc.). The patient can just remain uninsured, have a "Qualifying Life Event" and then immediately get tens of thousands worth of treatment for next to nothing. More than anything, this type of exploitation will cause the death spiral. There just aren't enough healthy people to support people immediately getting $20k+ worth of treatment only paying in $350.