December 19th, 2014
Another Obamacare ‘Horror Story’ Debunked; And, No, the President Didn’t Lie About the Law
As the week began, another “Obamacare” horror story hit the press, instigating a fleet of outrage-pornographers and concern trolls across the political spectrum to continue self-flagellating and screeching about the disastrous Affordable Care Act — selectively forgetting about actual healthcare horror stories that existed before the law was implemented. It was a story focusing on yet another vague, anecdotal tale about a hapless ACA victim whose insurance policy was canceled, thus vindicating the accusation that the president lied about “keeping your existing insurance policy if you like it.”
Before we dive into the lie accusation, let’s take a closer look at an op/ed for the Wall Street Journal written by a stage-4 gallbladder cancer survivor, Edie Littlefield Sundby.
Sundby wrote that she received a letter from UnitedHealthcare announcing the cancellation of her insurance policy. She was advised to seek a different plan from the ACA exchange in California, known as Cover California. However, she claimed that there aren’t any insurance plans in the exchange that are accepted by both her primary care doctors at University of California San Diego, and her oncologists at and Stanford, thus forcing her to choose one or the other.
But here’s the thing: Sundby wasn’t shoved into this predicament because the ACA law forced her insurance provider out of the ballgame. UnitedHealthcare, one of the most notorious insurance providers before the ACA was passed, responsible for canceling policies and penalizing customers, decided to voluntarily bail out of the individual insurance game as a matter of corporate strategy. In doing so, it could avoid taking on less healthy customers early in the exchange sign-up process, forcing other insurers to absorb the risk. Clever. And sinister.
UnitedHealthcare Chief Executive Officer Stephen Helmsley said, “The company’s plans reflect its concern that the first wave of newly insured customers under the law may be the costliest.” He continued, “UnitedHealth will watch and see how the exchanges evolve and expects the first enrollees will have ‘a pent-up appetite’ for medical care. We are approaching them with some degree of caution because of that.” A pent-up appetite — you know, to not go broke while attempting to not die.
As you probably recall from the days before the ACA was passed, scores of customers were stripped of their insurance policies, many while suffering from life-threatening illnesses. The difference back then was once they’d lose their insurance, they were unable to qualify for a new policy due to rules against pre-existing conditions. That’s thankfully not the case with Sundby — not after the passage of the ACA, not any more. While she might be forced to switch emergency care facilities or to a new team of oncologists, she will absolutely be able to sign up for a new policy with better benefits thanks to the ACA. Conversely, four years ago, when UnitedHealthcare and others were pulling these exact same kinds of profit-making stunts, she would’ve faced bankruptcy or death or both, unable to sign up for a replacement policy.
These are details not mentioned in context of the “Obama lied” story.
Indeed, going back to 2009, the president continuously reassured individual policy holders that if they liked their current insurance, they could keep it. On Monday’s edition of Morning Joe, they aired a series of clips of the president saying in various forms, “If you like your plan you can keep it.” This promise hasn’t actually panned out exactly as originally conceived, forcing Mika Brzezinski to literally smack herself in the face with a stack of paper. Brzezinski continued by shouting at panelist Chris Matthews, “Why would you let your president go out and say that?!” During the ensuing melee, Scarborough held up Sundby’s WSJ op/ed, “There’s this story in the Wall Street Journal about a lady with stage-4 cancer that’s been kicked off her plan!”
Once again, no. The ACA didn’t force Sundby off her plan. UnitedHealthcare’s profit margin was the culprit here. But regarding this alleged lie, the president was actually correct given the language of the law.
The Affordable Care Act, as signed by the president in 2010, states quite clearly that if your individual health insurance plan was in effect prior to March 23, 2010, your plan would be grandfathered as-is, despite new rules that expand mandatory benefits and ban practices such as lifetime limits. In other words, if you signed up for an insurance policy before March of 2010, and if you like that policy, you could ostensibly keep it. It’s in the law.
However, an implementation rule was added later by Health & Human Services which narrowed the grandfathering parameters. If the benefits of a policy were altered after that date, those policies would lose grandfathered status. Meanwhile, HHS determined that up to 67 percent of customers would lose their plans, but only as a reflection of normal trends in the system — not as the result of a sudden drop off due to the ACA.
So when the president said, “If you like your insurance you can keep it,” he meant that the law itself wouldn’t force you to call up your insurance provider and cancel your policy if you liked it. Nor was he suggesting that an insurance company would be compelled by the law to keep you as a customer for life, irrespective of circumstances. While the law in fact prohibits the cancellation of a plan if you’re suddenly sick or injured, or if you make a mistake on your application — two common occurrences before the ACA — you can still lose your plan if you fail to pay your premium or if you lie on your paperwork.
Here’s the kicker. The law absolutely prohibits arbitrary cancellations — except for grandfathered plans like Sundby’s UnitedHealthcare plan. Frankly, switching to a Cover California plan might be the best thing for Sundby because her grandfathered plan likely included lifetime and annual limits on coverage (bad news for cancer patients); it wasn’t required to comply with government audits to prevent excessive premium hikes; and it could’ve randomly forced her to change doctors anyway.
Now let’s be honest: did the president and especially HHS secretary Kathleen Sebelius do a terrible job explaining the law? Absolutely. The roll-out of the website has been a disaster and Sebelius completely botched the implementation of the law then bungled a crucial appearance on The Daily Show.
Granted, it’s no easy task to fully explain a sweeping new program like the ACA, especially given the complexities of the health insurance system. But when I read blog commenters who are doing a better job at detailing the law than the administration has, I can’t help but to think the Obama team is inadvertently sabotaging one of its biggest accomplishments by derping its way through the process. Meanwhile, the press and the GOP has been nefariously seizing upon the confusion and amplifying it into a melodramatic hellscape, which, in reality, is far from being an accurate illustration of reality. In spite of its flaws, the ACA is an historic achievement and if these issues can be ironed out soon, and if the administration can get back in the ballgame, the ACA will surely live up to its potential.
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