Obamacare isn’t going away any time soon. And neither is the fight over Obamacare.
by digby
How many people are going to see this ad?
… and how many people are going to see the Fact Check on that ad?
Lamb’s old plan was provided through a public-private program aimed at lower-income workers called CoverTN, which split the premium costs between an employee, the employer and the state. That’s a big reason why Lamb’s premium was only $52 a month, but in an interview she said she would have gladly paid and could have afforded the full $156 a month.
Why was the plan so inexpensive? For one thing, it had a $25,000 cap on annual benefits. It also had no limit on out-of-pocket costs, and it would only cover generic medications.
CoverTN was terminated at the end of the 2013 because it did not meet key requirements of the ACA, in particular a ban on such caps on benefits. The Obama administration denied the state’s request for a waiver, and so the plan was shut down.
For health-care reformers, such annual caps on benefits were a sign of a substandard plan that could put someone in bankruptcy if they had an accident that resulted in unexpected medical costs. But Lamb doesn’t look at it that way because she already had suffered a major and costly accident that was unrelated to her chronic condition.
In 2007, Lamb fell off a horse, requiring seven surgeries at Vanderbilt Medical Center. She saw one surgical bill for $125,000, but after negotiations with CoverTN, the hospital agreed to reduce the charges to below $25,000. In the end she barely paid anything in hospital costs after her accident.
“Really after that, I was not worried about something catastrophic” that would exceed the $25,000 cap, she said.
(Others might look at this story and decide she was unusually fortunate that the hospital, confronted with a patient who had inadequate coverage for the surgery, decided to eat the difference.)
Meanwhile, lupus can result in very high medical expenses, but that is not the case with Lamb. She said her out-of-pocket costs, for doctor visits and drug costs, amounted to just $1,000 a year.
“I have very good doctors who have helped me manage my condition,” she said. “I was comfortable with the risk of having this limit.”
To put her expenses in context, the American College of Rheumatology says that average cost per patient with lupus is between $14,000 and $28,000, though patients with one form of lupus have significantly higher costs – ranging from $29,000 to $63,000.
Once Lamb was required to go on Obamacare, she discovered she qualified for a $15-a-month subsidy, which could be applied to nearly 40 different options. She chose one of the more expensive options—a Platinum plan – because it limited out of pocket expenses to $1,500, as her doctor fees and blood tests would be higher under the Obamacare plans. She also considered a plan with a lower premium, but it would have meant higher out of pocket expenses. “Instead of paying $6,000 a year, I would have been paying $10,000 a year” with the plan with a lower premium, she said.
Anyone with a chronic condition would have opted for the plan with the lowest out of pocket maximum, even with a higher premium, so Lamb’s choice makes sense. But it did mean she faced sticker shock, going from $52 a month to $373 a month, even after her subsidy.
In other words, AFP has managed to highlight a very unique case—someone with a chronic condition who did not face high annual costs.
One Lupus sufferer, Erin Kotecki Vest, blogged that she was amazed at Lamb’s tale of woe after she researched the coverage provided by CoverTN. “Just ONE of my treatments ALONE wipes out everything CoverTN had to offer me,” she wrote. “I would hit CoverTN’s $25,000 annual limit the first week of January.”
In contrast to Lamb, this Lupus sufferer is thrilled to be on Obamacare. Kotecki Vest gleefully wrote in November that her family ditched her husband’s employer-provided plan after they discovered they would save nearly $19,000 a year by switching to a plan offered on healthcare.gov.
For some reason, Kotecki Vest was not asked to appear in an AFP ad. AFP did not respond to a request for comment.
I have hope that this will all sort itself out to the point at which a majority of Americans fully understand and accept that the health insurance system has been improved overall by the reforms. But I think we have to face the fact that everything that’s wrong with the American health care system writ large will now be attributed to Obamacare by a large number of Americans. And there will be no convincing them that they were not better off before. The fight is not going to magically go away once the Republicans fail to repeal or lose some more elections.
Maybe in a generation or two this will change. But I wouldn’t get my hopes up. After all, we’re still fighting off those who want to get rid of Social Security and that’s been in place since 1938. Government welfare state programs are ground zero for the ideological battle in American politics.
And anyway, even the Fact Check is so vague and equivocal in can’t help but make people throw up their hands and believe what they want to believe:
We can’t quibble with the ad’s words–we certainly would not call it a “lie”–but the lack of context is going to earn it Pinocchios. We wavered between One and Two, but ultimately settled on Two because this is really an exception that proves the rule.
Whatever …
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