Okay…where in the world to begin. Yes I guess we can say that Obama lied to the American people when he said if you liked your insurance that you currently had, that you could keep it. In hindsight maybe he should have said “If you want that crappy p.o.s. health policy that’s not worth the paper it’s printed on, yeah you can keep it. But don’t blame me when you use it and find out your policy will cover all of fifty dollars for two visits to your doctor’s office per year. As has been explained ad infinitum, health insurance companies are being forced to cancel those policies because they do not provide the minimum coverage required by the Affordable Care Act. This is not a bad thing people and the fourth estate has done a piss-poor job of covering it or explaining it other than the screaming headlines of Obama lied and a video clip of a distraught man or woman angry because their insurance company cancelled that policy and it’s Obama’s fault!
Let’s take the case of Diane Barrette, a 56 year old Florida woman. You may have seen her on the teevee. Diane is upset because she got one of those cancellation letters from Blue Cross Blue Shield in Florida. Blue Cross informed Diane that her policy was being cancelled and offered to sell her a new policy that is ACA compliant for $591 per month compared to the $54 monthly premium she’s paying for her current policy. Nancy Metcalf, Consumer Reports’s senior project editor for health examined Barrette’s policy and found out what a piece of crap she was getting for her over $600 a year in premiums. Quoting from that piece:
Here are some of the gory details. (You can see the rest for yourself on this complete plan summary from the insurance company.) [NOTE: Check out the plan. It’s obscene that they were allowed to sell this!]
- The plan pays only the first $50 of doctor visits, leaving Ms. Barrette to pay the rest. Specialist visits can cost several hundred dollars.
- Only the first $15 of a prescription is covered. Some prescriptions can cost hundreds or even thousands of dollars a month
- The plan only pays for hospitalization for “complications of pregnancy,” which are unlikely given Ms. Barrette’s age and in any event only the first $50 is covered.
- It pays $50 for a mammogram that can cost several hundred dollars, and only pays $50 apiece for advanced imaging tests such as MRIs and CT scans and then only when used for osteoporosis screening.
As Karen Pollitz of the Kaiser Family Foundation said:
“She’s paying $650 a year to be uninsured,” “I have to assume that she never really had to make much of a claim under this policy. She would have lost the house she’s sitting in if something serious had happened. I don’t know if she knows that.”
As the C.R. article says, well fine but can’t we feel bad for Diane having to pay that $500+/mo plan that BCBS offered her? In a word..NO. Blue Cross has been swindling Diane for years so far be it for them to suggest a policy that might be a little bit cheaper. Diane said her income was around $30k/yr. so Metcalf went to the website for esurance, eHealthinsurance.com, and did a little checking for Diane. Metcalf determined that Diane qualifies for a subsidy of around $320 per month and was able to find a Humana policy, Humana Direct Silver 4600/6300 plan for $165 a month. It’s not the best and it’s certainly not a “Cadillac” plan as some have been described. Still it has some decent coverage, certainly much better than what Diane currently has.
Like all plans sold in the state Health Insurance Marketplaces, it covers essential health benefits such as doctor visits, inpatient and outpatient treatments, diagnostic and screening tests, maternity care, mental health care, prescription drugs, home health care, and rehabilitation services.
It’s not the most generous plan in the world. The deductible is $4,600 and the only things the plan pays for outside the deductible are preventive services, the first $500 of diagnostic lab tests and x-rays in the year, and “diagnostic” office visits, meaning going to the doctor because you’re feeling awful and need to know what’s wrong. Visits for treatment are subject to the deductible. There’s a separate $1,500 deductible for prescription drugs, after which there’s a copay of $10 for generics and $50 for brand-name drugs. Once you’ve run up $6,300 in out-of-pocket expenses, the plan picks up 100 percent of your costs for the rest of the year.
As Metcalf says in closing her article:
To put these two plans in perspective, let’s imagine that Ms. Barrette’s luck runs out and she receives a diagnosis of breast cancer that will cost $120,000 to treat.
Under her current junk plan, she would probably receive no more than a few hundred dollars of benefits for doctor visits and drugs. It wouldn’t cover her surgery, her chemotherapy, her many expensive medications, or the repeated diagnostic tests she’d likely require. She would end up with probably $119,000 of unpaid medical bills. With the Humana plan, those bills top out at $6,300 a year, no matter what.
Then there’s the case of Deborah Cavallaro a real estate agent from Westchester, a suburb of L.A. She’s mad because her plan is being cancelled because it is “substandard” according to the guidelines of the A.C.A. and said “Please explain to me,” she told Maria Bartiromo on CNBC Wednesday, “how my plan is a ‘substandard’ plan when … I’d be paying more for the exchange plans than I am currently paying by a wide margin.” Well Maria of CNBC didn’t try to help Deborah, but Michael Hiltzik decided he would do that for her since Maria wouldn’t.
Hiltzik talked with Deborah, aged 60 (that’s important btw) after her appearance and here’s what he found out:
Her current plan, from Anthem Blue Cross, is a catastrophic coverage plan for which she pays $293 a month as an individual policyholder. It requires her to pay a deductible of $5,000 a year and limits her out-of-pocket costs to $8,500 a year. Her plan also limits her to two doctor visits a year, for which she shoulders a copay of $40 each. After that, she pays the whole cost of subsequent visits.
Cavallaro says she was quoted a premium of $478/mo by her insurance broker. 😯 Well okay then. But she could have done a little work on her own and gone to the Covered California website (it’s working) but she hasn’t so Michael Hiltzik did and found this:
At her age, she’s eligible for a good “silver” plan for $333 a month after the subsidy — $40 a month more than she’s paying now. But the plan is much better than her current plan — the deductible is $2,000, not $5,000. The maximum out-of-pocket expense is $6,350, not $8,500. Her co-pays would be $45 for a primary care visit and $65 for a specialty visit — but all visits would be covered, not just two.
If she wanted to pay less, there was even a bronze plan that was better than what she currently has:
If she wanted to pay less, Cavallaro could opt for lesser coverage in a “bronze” plan. She could buy one from the California exchange for as little as $194 a month. From Anthem, it’s $256, or $444 a year less than she’s paying now. That buys her a $5,000 deductible (the same as she’s paying today) but the out-of-pocket limit is lower, $6,350. Office visits would be $60 for primary care and $70 for specialties, but again with no limit on the number of visits. Factor in the premium savings, and it’s hard to deny that she’s still ahead.
Now Cavallaro said what she likes about her plan is that she can go to *any* doctor or *any* hospital she wishes to go to. Hilzik says, nope, not true. “That’s not entirely true, because her current plan with Anthem does favor a network. Plainly, however, it’s broad enough to serve her purposes. She’s concerned that the new plans will offer smaller networks, which is probably true, though it’s not necessarily true that the new networks will exclude her favorite doctors, hospitals or prescription formularies.” As for me, if I were in that situation, I would be looking at the networks and then asking my doctor or his rep “why aren’t you in this network and which one(s) are you in? ” As far as drug formularies, I have been able to find the formulary for BCBS-AL and BCBS-LA to see if my medications and those I think I might need are indeed on their lists and whether they are tier 1 generic or tier2 Preferred brand or what have you. In these cases all you have to do is to do a little legwork or keyboard work to get some answers. In Deborah’s case, I don’t know why Maria Bartiromo couldn’t have had her staff do some checking or for that matter, even someone at the local L.A. channel, channel 4. As Michael Hiltzik said in closing:
The sad truth is that Cavallaro has been very poorly served by the health insurance industry and the news media. It seems that Anthem didn’t adequately explain her options for 2014 when it disclosed that her current plan is being canceled. If her insurance brokers told her what she says they did, they failed her. And the reporters who interviewed her without getting all the facts produced inexcusably shoddy work — from Maria Bartiromo on down. They not only did her a disservice, but failed the rest of us too.
To read some more about these “Obama lies” stories, you can go here, to Mother Jones for one, by the excellent Kevin Drum, and there’s one here at The American Prospect which is quite good, and another excellent one at Raw Story by the always interesting Amanda Marcotte. Amanda has cute graphics for that.
This is an open thread.
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