The Widdershins


Posted on: November 4, 2013

simpsons angry mob

He said we could keep our insurance!

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,, 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.


24 Responses to "BARACK OBAMA LIED TO US!!!"

Auto insurance policies used to be run this badly, until states got a grip on them, and insisted that they clean up their act. Prior to that, the standard joke was that your fire and theft policy only covered your vehicle being stolen while it was on fire,

Well, to be fair, some of the policies being cancelled are the paying-to-be-uninsured kind, but some of them are merely that expensive kind. Dromaius at Corrente has been doing posts on that. Her latest, with an example of a bladder cancer survivor being conveniently dropped from good insurance.

When somewhere over 50% of individual policies are being cancelled (number for CA, but I believe it’s comparable nationwide), you know it’s not all useless catastrophic policies. The insurance companies are jumping on the chance to improve their bottom lines, which is hardly a surprise.

What has people so riled is that Obama said clearly people could keep their insurance. When they took him at face value, now he’s saying, “Well, duh, except for super-bad policies and those where the insurance companies lose money. You shoulda known that. I told you on page 37 of a speech delivered at 10 pm March 27, 2011.”

There was nothing to stop him supplying those caveats at the time.

You are correct It may be that his super stars were unaware of what life in the slow lanes is like.

quixote: Well then why hasn’t the media mentioned those scenarios instead of just harping on the ones like the examples I had from those sites? You see I blame the media for pulling up examples of folks who have not even tried to go onto the exchanges to look for coverage, that is, where the exchange is up and running, as in Cali.

Perhaps that’s why Mary Landrieu and some others have proposed legislation that would allow people to keep a plan they liked if they were satisfied with it. Although, for the life of me, I cannot understand why the two ladies I cited would want to keep what they have.

Ah Corrente…I used to go there frequently but I felt like a mental midget in a sea of mental giants when it came to commenting there, completely overwhelmed.

From Dromaius’ post at Corrente:

Obamacare architect Dr. Ezekiel Emanuel:”The insurance companies don’t like — the insurance companies don’t like the individual market as it’s constructed. They see the future. That individual market is going away. They don’t want to invest in it. “

Well what is going to replace it?

From the piece linked above:

>blockquote>”People are sharing stories with me,” Scalise said. “Shawn from Covington said: ‘My current plan through United Health is no longer being offered in 2014 due to Obamacare.'”

“Madam Secretary,” Scalise said, “what would you tell Shawn who liked his plan and now has lost it? He was promised by you and the president he would be able to keep that plan.”Sebelius said she would tell “Shawn to shop the (Affordable Care Act) marketplace.” She also said United Health didn’t have to cancel the plan if the policyholder had a plan issued before the law’s 2010 enactment, or one that met the minimum criteria for health insurance.

In view of that statement by Sebelius, I’m surprised the person in the Corrente link was able to keep her plan. I haven’t read the linked WSJ article but was that individual on an individual plan Quixote or was it a group plan?

The media? Honestly, it’s hard to tell who’s worse: them or Our Gubmint. I agree 100% that some real reporting on this issue would help. That would involve fact-checking though, and that seems to be too weird for them.

quixote said: That would involve fact-checking though, and that seems to be too weird for them.

Agree totally. Unless they can cram something into a 15 second segment or something similar, they aren’t interested it seems.

Fredster, thanks for writing this. This is really important for everyone to understand. I’ve been wanting a source compilation of all the good stuff and viola, it appears from your excellent work.

If I were to summarize three truisms they would be:

1. If you are healthy, you don’t know squat about insurance. If you are chronically unhealthy, you know your insurance.

2. There is a market for anything that people will buy. Insurance companies are not the first ones to figure this out and they certainly won’t be the last to give up. These “term, sucky policies” are the wild, wild west of insurance. They are almost pure profit for insurance companies because they can be “insured over” through reinsurance. The churn in this market is unbelievable, but it is so easy to sell since it is agents who do the dirty work — you won’t find high profile branding of a national company on these policies. This is the stuff of climbing high on the shelves of a locked closet to pull these policies out.

3. The yapping about these people by certain media companies (read Faux) is the height of hypocrisy. It is people who “pay to be potential bankrupt paupers” through these policies who are one car accident away from a comfy seat with the dreaded 47%. The logic behind championing these policies is laughable — when things go terribly wrong for people these p.o.s. policies are the welcoming mats for cost shifting to everyone’s rise in insurance premiums and increasing health care costs overall. So much for individual responsibility — welcome to the invisible hand of economics.

Prolix, I cannot for the life of me understand why someone would have been happy or satisfied with the types of policies these two ladies have. All it would have taken was for one of them to have developed a condition where they needed a recurring medication and they would have seen how much a p.o.s. those policies are.

I have a friend who is now experiencing first hand how to look for a policy on the exchange and what he needs to look for. He had gone to a doc in the box last week because he was feeling quite ill, running a fever and such. He had an infection and his blood sugar was sky-high. Well, he’s now been diagnosed as having type-2 diabetes. The guy is in excellent health otherwise, he runs a lot plus other workouts. However now, he is going to need a good primary care doctor. I suggested to him that he look for a plan that covers doctor office visits with a co-pay and hopefully one that will not charge a great deal more for a visit with a specialist. (I’m guessing he may need to see an endocrinologist at some point or another…correct chat?) Also told him to check out the plans’ drug formularies.

Previously I think he was considering a bronze plan but now I think he’s looking toward the silvers or possibly a gold if he can swing it with the subsidies.

Well, well, well. Just got in from my first post-Medicare age doctor’s visit. I already knew my PCP had opted out years ago, but my supplemental policy has a $500.00 deductible, so what the heck, might as well pay the doc.

Now mind you, we’ve been together since 1986. And she had to READ me the medicare opt-out agreement. She knows I’m a lawyer. Her father was a lawyer. I couldn’t make it through the damn thing with a straight face. There was one clause so convoluted neither of us could understand it, and it took me several read throughs to figure it out. If I’d drafted that form, my legal writing professor would have put a big “D” on it, and handed it back to me to rewrite in plain English. These corporate lawyer types sure love their double negatives and heretofores.

I considered signing it with my name, followed by Esq., but decided to be a good girl and just sign my name. Actually I considered editing it and sending it back to them!

And so the fun begins!

@12: Too bad that you didn ‘t have a red pen with you.

@Mary Luke: so your doc doesn’t participate in Medicare? If that’s the case will your payments to him even apply toward your $500 deductible on your supplemental? Is the supplemental a medigap policy?

Ouuuuuuu!! Rachel Maddow just dumped a big ole can of whup ass on Rand Paul. 😆

@14 No Fredster, they won’t and that was the most confusing part of the form. It was like a Seinfeld episode, or a Bill Maher monologue, with the doc having to explain the medicare policies to me, a lawyer. Of course, she’d been over the form a couple hundred times, and I was seeing it for the first time. She’ll probably retire in a year, and then I’ll have to find a primary who takes medicare when I cut down work.

The real problem is she provides a lot of specialized, not medicare-covered services, and medicare prohibits her from billing for just the services that are covered. Docs cannot combine covered and non-covered services. I did not have that problem with MA Blue Cross. So she had to opt out to practice the way she believed was right. She’s very well qualified, a Northwestern grad M.D., so I will try to hang in as long as I’m working. Here in MA, which is crawling with high priced specialists, no one is going into primary care and you are likely to end up with a P.A., or if you’re lucky, a nurse practitioner. I like NP’s better than PA’s. If you want an actual M.D. for a primary here, it’s an impossible wait, if you can get one at all.

Mary Luke@16: Wow, so those visits are completely out of pocket!

she provides a lot of specialized, not medicare-covered services, and medicare prohibits her from billing for just the services that are covered

That is such a crock! I was looking at some docs down in the parish I’ll return to and the pickings were slim. Not all of them came back after Katrina, including the ones my mom and I saw. After looking at the ones on the BCBS list I found one that looks promising. He also has an office across Lake Ponchartrain so he’s probably only in St. Bernard one or two days a week. He’s younger than me so I hope I won’t have to worry about him retiring anytime soon and I’ll just hope he stays around. I checked him on healthgrades and he seems pretty good. I can only hope!

Mary Luke said: Go Rachel!

Oh it was great! I’ll have to wait a few days and see if I can find it on youtube so I can embed it.

Oooh, I want to see it, Rachel that is. I will look on their site.

Great article Fredster. Appreciate all your hard work!

Thanks Annie. Yes, I’m sure the Rachel/Rand duel thing will be on the msnbc site, but unfortunately you can’t paste those into comments here on wordpress.

When a Democrat lies, nobody dies.

@18 Fredster when my doc was on BCBS/Mass they would let me submit the bill and then they would reimburse me for what they considered “primary care” so I got about two-thirds to three-quarters of the money back. But medicare won’t. I’ve talked to friends who go to their PCP’s now and the young docs are sitting there with a computer and a check-list, typing as the patient is talking.

@3, 13 “superstars unaware of life in the slow lane” and @14 “red pen”

LOL, Chat you sure are on a roll with the one-liners.

Note to self: Take red pen to all doctor visits so I can mark up the “bureaucratise” and edit it into English.

That editing would be good job for Prolix.

Mary Luke@23: I guess medicare lives and dies by the ICD 9 codes:

That editing would be good job for Prolix.

Let’s get really crazy and get the both of you in on the editing thing! LOL!

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