Millions of Blue Cross Blue Shield customers will be able to opt in to credit monitoring.
Millions of Blue Cross Blue Shield customers will be able to opt in to credit monitoring. - 

One of the primary goals of Obamacare is to make sure sick people get the health insurance they need.

But proposed rules issued by the federal government this week could mean for the sickest of the sick, getting coverage will still be difficult. 

Wanna impress your Thanksgiving guests with a bit of health care trivia?

 “The sickest 10 percent of the population accounts for half of total health care spending in this country,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

Right now insurance companies can restrict really sick people’s access to coverage. But under Obamacare, the most egregious forms of so-called "cherry-picking" -- denying people for pre-existing conditions, for example -- are outlawed.

These proposed rules still permit the cherry-picking, just in less overt ways.

“It’ll become kind of like a game of whack-a-mole,” says Pollitz.

Pollitz wants Washington to force insurers to offer all but identical plans and beef up oversight.

“I think this is really stretching it,” says Robert Laszewski with Health Policy and Strategy Associates. “We’ve written a 2,800 page law here. Hundreds of pages having to do with insurance reform. It’s all written by the Obama Administration.”

The insurance business likes the flexibility in the proposed rules. An industry spokesperson warns the more plans look alike, the more expensive they’ll be.

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Follow Dan Gorenstein at @dmgorenstein