Betrayed by the President & Obamacare? Try SAVED Instead

My KINGDOM for a $373 a month premium and ONLY $1,500 maximum out-of-pocket in order to take care of myself and the Lupus inside of me!!!

That is what fellow Lupus sufferer Emilie Lamb is complaining about as she blasts President Obama over her new health care plan, forced upon her under the Affordable Care Act. She’s the star of a commercial attacking “ObamaCare” and is giving interviews left and right slamming the President.

Tennessee resident Lamb is one of the few who received one of the now infamous letters from her insurance company, CoverTN, telling her she will not longer be able to keep her plan because it does not comply with the landmark legislation.

But let’s break down the coverage she is so upset to lose, because Lamb is ANGRY at the President, even attending the State of the Union as a guest of Congresswoman Marsha Blackburn.

CoverTN was run by the state of Tennessee. Hmmm, right away I’m raising an eyebrow, as usually those against “ObamaCare’” don’t want “government run” health insurance. Yet Lamb clearly doesn’t have that issue. Good. So let’s move on.

What was the great thing about CoverTN? According to Lamb, “The coverage was perfectly suited to my unique medical condition. It offered me low premiums, a low deductible and low co-pays for my regular trips to doctors and specialists. This plan was perfect for someone with my unique medical condition and limited financial means.”

Yes, Lupus is a unique medical condition and can be very, very expensive for those of us that suffer from the disorder. Lupus has you bouncing from test to test, doctor to doctor and ER to ER.

Lamb says she had low premiums, awesome. How low? $57 a month. WOW. That’s AMAZING. How low was Lamb’s deductible? She doesn’t say. How low were the co-pays? She doesn’t say. Low prescription coverage? Lamb doesn’t say. There is no mention of a maximum out-of-pocket from Lamb. Something KEY to us Lupus patients as most of us hit this maximum every year due to the crazy high costs of all the drugs and treatments we need in order to keep our auto-immune disorder in check. To give you an idea, I have hit my maximum out-of-pocket every single year since my Lupus diagnosis in JANUARY of that year, after my FIRST TREATMENT.

January. I’m not kidding.

Mine was $6,000 for an individual and $12,000 $18,000* for the family under our old plan. We’re saving $2,000 in that category on our new ACA plan and I was THRILLED. Yes, that was a SAVINGS. So to have my maximum be $1500 like Lamb’s…WOW, I’d be crying tears of joy and frankly licking the President’s boots for saving us so much money. I’m jealous.

But, like most Americans, we’re all on a tight budget. So I wanted to figure out just how much more Lamb is paying under ACA and why she’s so upset. She claims she’ll be paying at least $6,000 more per year.

$6,000 was my maximum out-of-pocket so again, I’m jealous.

I know we all have different incomes and an extra $300 a month isn’t easy for anyone. So I headed over to CoverTN to try and figure out what her old plan was all about and why she thinks it was the be all and end all of Lupus coverage. I quickly learned CoverTN was, by far, the scariest type of coverage someone with a chronic illness could possibly have. The only saving grace was it was affordable for those who simply couldn’t afford anything else.

You need to understand something about Lupus patients. We are chronically sick. Like…as in, all the damn time. That means we are CONSTANTLY in and out of the hospital, in and out of the ER, at our doctor’s office, undergoing treatment, missing work, having tests done, undergoing X-rays and MRIs and really weird brain tests to make sure we haven’t lost any cognitive skills. We accumulate thousands upon thousands upon hundreds of thousands of dollars in medical expenses per year. That means we NEED an insurance plan that has things like NO annual caps, NO penalties for pre-existing conditions and NO waiting periods as we get SICKER while we wait and NO lifetime limits.

Guess what CoverTN had? You guessed it, all of those things I just listed. In fact, in announcing they are no longer going to offer the program, they lamented their inability to screw over the chronically ill: “…those that administer the Cover Tennessee programs, can no longer implement annual or lifetime limits, institute a waiting period for pre-existing conditions, require a ‘go bare’ period, or deny an individual coverage due to a pre-existing condition. Insurance companies must also cover preventative services without any out-of-pocket costs to the member.”

But it gets worse for a Lupus patient who had CoverTN, “CoverTN is a limited benefit program that has a $25,000 annual limit.”

HOLY SHIT (sorry, but this deserves a curse word) $25,000!!!!!

Just ONE ROUND OF TREATMENT FOR MY LUPUS COSTS ALMOST DOUBLE THAT. $44,000 is what was billed to Aetna for one round of IVIG for me. That’s what I get EVERY 2-3 weeks!!!! That doesn’t even count the Rituxan I receive every four months or the 17 medications I take monthly or the co-pay every time I go see my doctor or the labs every time I go see my doctor. Just ONE of my treatments ALONE wipes out everything CoverTN had to offer me.

I would hit CoverTN’s $25,0000 annual limit the first week of January. 

I would also hit their lifetime limit. Accrue their penalty for having a pre-existing condition. Have to undergo a waiting period with NO HEALTH CARE  just to QUALIFY and have to pay for basic preventative services of which are ESSENTIAL to keep my system healthy to fight Lupus.

Now, maybe I am an extreme case and Lamb is a minor case. She is, after all, working. She says in the article she’s taking on a second job. My Lupus does not allow me to work.

However, according to information given to me by the Lupus Foundation of America the mean annual direct costs of people with lupus ranged from $13,735-$20,926; the costs of those with and without nephritis ranged from $29,034-$62,651 and $12,273-$16,575, respectively. (source)

That means Lamb’s CoverTN health care was essentially a tiny notch above catastrophic coverage- if that. Her new plan actually will help her should she have a Lupus flare. Except Lamb says, “For me, the impact of ObamaCare is a health plan that is both unaffordable and uncaring. For a law named  ‘The Affordable Care Act,’ this is both backward and perverse.”

For those who don’t know, I was released from the hospital at the end of last week. Lupus flare.

Our new Affordable Care Act plan info was given to the admitting people as I cried in the emergency room, knowing full well I was going to be stuck in the hospital for days. I waited to hear the usual “That will be $500 for your ER copay, your deductible and other bills will follow…would you like to pay now or should we bill you?”

Instead I heard ‘That will be $150 for your ER copay, you have no deductible. Would you like to pay that now or shall we bill you?”

Uncaring? Backwards? Perverse? I shudder to think what would have happened to Lamb if she found herself being admitted to the hospital for a Lupus flare under her old plan.

Unfortunately Emilie Lamb doesn’t see it this way. She went on to say “When you were on the campaign trail, you promised that ObamaCare would help me with my medical problems. You promised that people like me with pre-existing conditions would be better off. And you promised that if I liked my health-care plan, I could keep it. Mr. President, you’ve now broken all of these promises — and not just to me.”

Except she couldn’t be more wrong. She now will be able to receive the expensive treatments to help with her medical problems. She won’t be discriminated against for her pre-existing condition.

However Lamb is 100% correct in that she did not get to keep the health care plan she liked, and I, for one, am glad.

But what of that extra $300 per month? Believe me, I’m not dismissing the extra cost for Lamb. So I took a look at what was available, with the best estimates I could make from what she has disclosed publicly, and plugged it into HealthCare.gov for an estimate on plans she could have chosen for less per month. Even the minimum plans would be a step up from the CoverTN plan she loved. Some of the bronze and silver plans were as low as $137 a month NOT including the tax credit Lamb would qualify for, easily putting her in the $60 range- the same amount she way paying previously with BETTER coverage.

I also spoke with my rheumatologist’s office and they confirmed there are several programs for Lupus, RA, Fibromyalgia, and other patients with auto-immune disorders to help off-set their costs. There are a handful offered through my doctor who partners with various organizations, so I would highly suggest Lamb check with her rheumatologist for similar.

Emilie Lamb, I am sorry you feel betrayed by President Obama. I just hope in time you will see no one is trying to ruin your life by forcing you to give up your bare-bones health insurance. In fact, it’s exactly the opposite.

Should you happen to read this, I am happy to help in any way I can. Something tells me those in the White House you call uncaring and perverse are willing to help too. Whether you realize it or not, they already have.

 

 *cost of our Aetna plan family maximum revised after double checking the photos I made available of our plans on my original enrollment post & subsequent media coverage 

Comments

  1. As usual, a very well written and well-reasearched post. I’m so tired of these “Obamacare screwed me” ads that feature people who are actually BETTER off under the ACA, but have been convinced that they have been– or the GOP is portraying them as having been — given a worse deal. i’m still going through this with my girlfriend who has had trouble with healthcare.gov, but she will save over 50% on her premiums for a better policy once she gets it taken care of.

    Kudos to you, as always!

  2. David I hear ya… we STILL do not have our new ID cards, and had issues getting prescriptions even after we had our subscriber ID #’s from Blue Shield.

    Clearly they are SWAMPED. But in a way i think that’s good- it means more people are signing up and getting COVERED. I’ll take the bumps in the road with a smile and some patience if it means someone will get care they couldn’t get just a few months ago.

  3. I agree, i am very ill have a PPO my silicone implany burst , i am poisoned from it with lesion and holes all over my body. i am ejected from ers Treated less than human. no dr wants to do the procedure, turned away from about 20 drs. Was in one of the besr hospitals pre authorized, they yelled to kick me out . i am getting sicker, lost my home car, it has infiltrated my entire system eating away my flesh. 7 months and living in a hotel broke and barely disability to live on from paying all the co insurance. the drs hate me ,i m so glad to hear im not alone

  4. I have early onset Parkinson’s disease, which is a chronic disease. My health insurance premium in August 2008 (before Obama was elected) was $976 per month. This woman is trying to tell me, that she had a premium of less than $60 per month, even if it was a minimal policy? In what universe? I would kill for a health insurance premium of less than $400 per month, let alone $57. BTW, I see very few people who actually have Lupus, who are able to work. Supposedly this woman has taken a “second job” to pay for her atrocious health insurance premium? I don’t usually question people, or their illnesses, but I really have to question this entire ad. BTW, I posted this comment on an obviously right wing site. My comment disappears every time I try to post it. Gee, I wonder why?

  5. Holy crap, I want Lamb’s new plan, too! I don’t know what sort of plan we’ll end up with when Tom’s employer-sponsored plan is up for renewal in March – it’s changed every year for the past…at least 4 years. This past year, our premiums were higher than Lamb’s new premiums, and we still had a deductible over $5,000. And this is with the employer contributions. It’s dubbed a “high deductible plan,” but “catastrophic coverage” is the more common buzzword. I’m pretty sure that’s not legal anymore.

    I have to also question the validity of Lamb’s claims. I know that there is varying severity when it comes to chronic illnesses (boy, do I know it!) but if her old annual maximum was not an issue for her finances, and she is able to take a second job to pay for her new premiums, she’s hardly a typical lupus patient, and certainly not disabled.

    As for your own treatments…I know how much it costs every time my dad gets his Rituxan – $11,000 each time he goes in for chemo.

  6. God bless you Erin for saying these things that so need to be said, and heard. My blood boils when I see and hear such ignorance, such intentionally distorted propaganda, that I can’t even begin to find the words to break it down.

    A cheap insurance plan is a great until you actually need it. We learned that one the hard way. I wouldn’t even wish that experience on Lamb.

  7. I wouldn’t dare question her illness. Lupus is different in anyone and can be totally dormant to taking your organs and killing you.

    However the program she was on, as I think maybe we shouldn’t call it ‘insurance’- was a STATE program for people who couldn’t afford ‘regular’ insurance. So she wasn’t even in the regular insurance pool, therefor it’s hard to say what her premium would have been had she had real insurance.

    So now that she has REAL insurance, I would HOPE she’s feeling much more secure. Apparently not though, due to the cost.

    Too bad her state didn’t take the medicaid expansion it could have. She should be pissed off at Blackburn for not standing up for her so she didn’t have these additional costs the President wanted to give her a break from.

  8. I’ve been seeing these commercials on CNN for the past 2 days & finally got around to Googling her to see what the real story was. It’s amazing to me that anyone could believe she was on a “real” insurance plan for $50/month and that was a plan that would be of any help in the long run. From what I see here, the plan she was on before was a state run plan for low income people that basically didn’t live up to the requirements of care that the ACA requires. Instead of being mad at the president, she should be mad at her Republican governor for refusing to expand medicaid so that she could get the help she needs without that second job. Even at $350/month, a comprehensive plan with no limits for someone with a costly condition like lupus is a deal…b/c under the old law she wouldn’t even be eligible for coverage under most plans b/c of her preexisting condition.

  9. Brendazzle* says:

    Erin, do you have more info about the criteria for the fibro cost offset? I’m about to age off my parents’ plan (bless the ACA for letting me stay as long as I did; I couldn’t afford coverage this good on my own ever) and am preparing for sticker shock.

    As of now, I am capable of working (albeit not full-time) and am worrying about medical bills when more of them fall to me. Any info you have can only help me.

    As for the monthly premiums Lamb is facing, I have more than that as a deductible now on my super-compliant blessing of a plan. I don’t know what the policy I’m on would cost at fair market value as my father gets it through his workplace but I’m sure it costs more than $400 a month when all is said and done.

    I think the issue is a lot of people, you and me included, need more than just “affordable.” People with chronic illnesses really need someone to wave a magic wand and make all their bills go away. But truly socialized medicine scares the Republicans so all we can do is have a heavily modified ‘Affordable’ Care Act.

  10. vernon james says:

    Lam is full of bull TN is full of Republicans who don’t want our president to succeed

  11. I’m confused. I thought we needed the ACA to help protect people from shoddy plans that didn’t cover the things they needed and to protect them against the evil insurance companies that would drop people when they got sick and needed the coverage.

    If that is the case, why is it that the insurance companies didn’t drop Ms. Vest before the ACA? She is spending their money to the tune of well over $1,000,000.00 a year. And that’s just for her lupus treatments!!

    I guess that was just another one of the lies used to try and sell this scam.

  12. Ah Jim… what you don’t know, you just assume?

    We had Aetna before ACA. They did try to drop me. SEVERAL times. ACA began in 2010 and some of the provisions kicked in as I was diagnosed. I am forever grateful for those protections. However for the things that didn’t kick in until 2014, we still fought with Aetna – like when my husband’s company paid our premium EARLY and they considered that a breach of contract and tried to kick me off the policy.

    Or how they fought each and every treatment option after my diagnosis and we had to go through months of testing ‘cheaper’ drugs my doctor KNEW wouldn’t work for my condition in order to ‘satisfy’ the policy and get me to the drugs I actually needed.

    I will repeat this again for those who don’t know or seem to skip over many parts of my story…you may not have ever been to my blog before…but we paid out of pocket for our family insurance, with the only help given to us a ‘before taxes’ amount premium than an after taxes. My husband’s company did not pick up the family tab.

    And now, with our ACA Blue Shield plan, we are getting ZERO dollars in subsidies and pay the full amount.

  13. Dear Erin, First I want to say that I am glad you can get the care you need and that you are happy with the ACA. However, I want to point out that you are looking at this from only one perspective. For everyone like yourself who plays the ACA lottery and wins there are thousands who play and lose. If your care costs approximately $1M per year that means that around 1000 families of 4 have to purchase a platinum plan and have no medical expenses for the insurer to break even. We should all know that basically healthy people who have no medical expenses are not going to purchase a platinum plan. It makes no financial sense. Therefore, it will probably take about 1500 to 2000 families in silver and bronze plans to cover just your expenses. Notice that I did not say individuals, I said families. Of course, that’s assuming that they have no medical costs of their own. In California, less than 30% of the people signed up are from the prime age group. That means that there are not enough of the low cost “invincibles” signed up. So, what happens next year? Premiums will start to rise. For you, that hardly matters as you will still be much better off financially. For the rest of us…screwed!

    What I hope you will understand is that there are winners and losers with the ACA. I know you don’t want to be a “winner” but, you are. There are far more losers than winners of the terrible ACA lottery. Please remember that when you tout the benefits of this horrible legislation. All of the benefits you love about this law could have been accomplished without destroying our medical care system.

    Why do I say destroying? Because any medical cost savings that the supporters of the ACA tout will come at the expense of the very doctors you need to treat you. This will inevitably lead to a shortage of doctors and lack of the medical care availability that those previously mentioned 1500 families are paying for. Doctors, like anyone else need incentive to do their best. Take away the financial incentive and what is left?

    Many people have argued that insurance will be cheaper once everyone is covered. Not so. It has already been shown in a recent study called the Oregon Health Insurance Experiment (Don’t trust me? Check it out for yourself) that Medicaid recipients will still overwhelmingly go to the emergency room instead of a primary care physician for services better handled in a primary care setting. What does this mean? It means that we will not as a society receive any benefit from these people being covered because they will still neglect preventive care and use the more expensive services of ER’s get their care. The study also noted that those people had no better health outcomes by being covered. Hmm, guess that busts that theory!

    The ACA has also done nothing to promote competition among insurers. That is why my premiums double and my out of pocket doubled. I have been relatively healthy so, I do not have any doctors to lose. I just hope that if I ever get sick, I can still get a decent physician after this debacle of a law takes full effect.

  14. Well Chris, I guess for every study and stat, there is another out there looking to disprove and debunk.

    While I realize many are put off by rising premiums, I’d point out that since well before I got sick and well into our insurance coverage…our premiums have gone up yearly since – well since about every year I can remember. Turns out this is true for most, however premiums are now finally slowing down, and are rising at a much slower rate than they have in a decade. That’s good, right?

    Let’s also take a look at your assumption that what I pay is somehow different than what I was paying before and it somehow falls on the healthy and young to make up for the sick and old. Keep in mind I signed up 3 very healthy individuals with our plan and myself.

    Via the WH: One study co-authored by a leading health economist found that reductions in health care cost growth due to health care reform could increase job growth by 250,000 to 400,000 per year by the second half of this decade.

    Economic research shows that, over time, an increasingly large fraction of the premium savings are passed on to workers in the form of higher wages. If only one-third of the recent slowdown in health care cost growth persists, the savings after a decade will amount to $1,200 per person, much of which will show up in worker’s paychecks as higher wages.

    Oh but wait… there is more:

    By expanding coverage, the ACA will expand access to needed medical care. Greater access to care as a result of being insured has been shown to reduce mortality, improve mental health, and improve self-reported health status. For Americans who had coverage before the ACA, the ACA guarantees access to preventive services recommended by the United States Preventive Services Task Force without cost-sharing, services that have been proven to improve health and save lives. Since 2010, more than 71 million Americans have received at least one preventive service without cost-sharing.

    In addition, the ACA is helping to improve the quality and efficiency of care for all Americans, contributing to better health outcomes while reducing costs. One striking example comes from an ACA initiative that gives hospitals incentives to reduce the number of patients returning to the hospital after discharge, such as by ensuring higher-quality care during the initial hospital stay or making appropriate arrangements for where patients will receive care after discharge. Medicare has also funded community-based organizations that help patients move more smoothly from a hospital stay to care at home. Hospitals have responded to these programs, and, over the last three years, Medicare 30-day hospital readmission rates have turned sharply lower, and are now more than a percentage point below their average level from 2007 to 2011. Through August 2013, this decline corresponded to 130,000 avoided hospital readmissions.

    People who live longer, healthier lives will miss fewer days of work, are less likely to become disabled, will tend to spend more years in the workforce, and will be more productive while on the job. – WhiteHouse blog http://www.whitehouse.gov/blog/2014/02/06/six-economic-benefits-affordable-care-act

    All of that is sourced on the link above. Each study and each stat.

    And I’d like to think that having access to better care (as opposed to zero care) and preventative care, without pre-existing conditions, etc etc etc will help you. Because you are healthy you seem to think this doesn’t affect you except in the pocket book. But a fundamental change in how health care is perceived – as a non profit business and one that is available to all- won’t come without people upset over the change. And it won’t come easy for those who seem to like the status quo.

    Too many are hurt by the status quo to justify your complaints (which can be manipulated just as easily to look like great thing for your future) and turn back.

  15. Erin, I know that premiums have been rising yearly. I have experienced that painful fact also. However, I stand by my original point that you can only do so much from the cost side. That is the lowering of rates paid to physicians. That is majority of all that has happened so far because of the ACA. The insurance companies have reduced payments to physicians and hospitals in an effort to control costs as dictated by the government.

    I am sorry but, I am having a hard time trying to reconcile that premiums are going down when mine just doubled. We have had a paradigm shift that is driving up premiums very quickly. Even before any provisions of the ACA took effect, we had double digit increases that the insurance companies attributed to it. I would expect some leveling after that. It will be some time before that equates to higher wages. But, don’t mind me, what do I know? As for the study from the WH, is this the same WH that hires DNC campaign donors to investigate itself?

    I am curious as to how you come up with information that says that increased access to care has produced different outcomes when what I have seen contradicts that. Access to care is not the same as quality of care. We have a screwed up system in this country where care is not results driven but, fee for service driven. This does not equate to quality care, only to volume. The ACA addresses nothing about adding more physicians to provide care for the newly insured. On the contrary, it insures that we will have fewer as there will be less people willing to take the risk of student loans for a return that will leave them paying student loans until they retire.

    Please do not insult me by saying that I like the status quo. You do not understand my motivations or my thought process even if you think you do. I am just to lazy to type you a book about all I see wrong with this legislation. I very much already gave you information that it is more than the effect on my pocketbook. You seem to think that healthcare being a non-profit business will improve it. I have news for you. From the orderlies to the nurses to the doctors to the administrators, there is a profit motive for everyone who has a job in this industry as well as others. May I remind you that most hospitals are not for profit. But, that does not mean that there can’t be some kind of return. Trust me, I have tried to survive in business while breaking even. You will not survive.

    Once again, I have to vehemently disagree with you that the ACA helps to “improve the quality and efficiency of care for all Americans”. It is not designed to do that. It is only designed to ensure that there is coverage for care. Please do not equate lack of coverage for lack of care. Of course, there are people who have been jerked around by the insurance companies. I readily acknowledge that there was a need to address those concerns. However, a great many of the people who are not covered are not covered by choice. Those people made a financial decision. They have been making a gamble. Some get burned. But, paying for insurance or having it provided for you through taxes on others still does not guarantee a quality result. Just because you swallow water and sunshine does not mean you will toot rainbows!

  16. There is so much you are missing here. First and foremost…all of those people you have who are now covered were STILL COSTING YOU MONEY- each and every time they went to the ER. Each and every time they were admitted to the hospital (check THOSE stats) because they put off being treated until it was so bad they ended up costing the system more. THAT is how you find the cost savings for the average taxpayer. With coverage these people now get preventative care. They receive vaccines and check ups and mammograms and more. How on EARTH, with all our premiums having risen since before ACA was even on the table, can we ignore cases like this?

    http://thinkprogress.org/health/2014/02/12/3242731/video-texas-medicaid-expansion/

    I’ve talked with each of my doctors. Not a SINGLE ONE is being paid LESS since ACA kicked in. THeir businesses are BOOMING because they are seeing more patients than before and are opening larger practices and additional practices in nearby cities. While they are bemoaning the paperwork and complaining about lawsuits – they are certainly NOT complaining about the influx of patients. I should point out I see specialists that take only PPOs, doctors that take Medicare, a general doc that takes low income plans and HMOs, you name it…and I’ve been smart enough to speak with each of them about the effects because it would determine the type of coverage our family chose.

    I would love to know why you have not dropped your current insurance and shopped the market if it’s so expensive. That’s what we did. You are aware you can do that unless your employer pays for your insurance…right? Are you in one of the many states (like Texas in the example above) that is literally screwing it’s people?

  17. *This response will be in two separate posts because it will make more sense that way.*

    Erin, just like any good liberal you totally ignored my answer because it did not agree with your preconceptions. The report I mentioned to you stated that by and large the access to preventive care was not being utilized by new Medicaid users chosen by lottery. Those people that were given access to Medicaid still failed to use preventive services and went to the ER. It does not matter if they were uninsured and stiffed the hospital for the bill and thus made insurance rates go up or they had the state pay for it via Medicaid and caused increased taxes. We still have to pay more (either in insurance rates or now higher taxes) because those people will opt not spend the money for a copay and will go to the ER when the situation cannot be ignored any longer. This report was produced by MIT and is based on actual results as opposed to feel good projections. And once again, you entirely missed my point that yes insurance rates were going up but the ACA caused a paradigm shift. I will explain it in a way you can understand. If we are in a 100 yard race and I give you a 50 yard head start, you can run much slower and still beat me. Medical costs were not going up purely because of the poor not having access and going to the ER there are so many reasons. That is really disingenuous argument on your part.

    You highlighted one reason that the ACA will increase costs for physicians and then glossed over it. The increase of paperwork. The physician must either hire someone to fill out increased paperwork of the ACA or take time away from patients to fill it out themselves or option 3 work more hours thus decreasing their quality of life and eventually quality of care. There are way too many reasons for the costs of healthcare going up for me to enumerate here but, suffice it to say that I find your arguments to be weak and have too much reliance on data presented by the WH. Can you say fox guarding the hen house?

    Please note the following quote from an article by a physician named William H Frist. I am taking this somewhat out of context but, it is a telling statement and I gave you the name of the author so that you can look it up yourself. “However, the bulk of health care spending is attributable to patients who rapidly blow through their deductible, after which they have no incentive to shop for value. Those 5 percent of people — who spend a whopping 50 percent of the nation’s health care dollars — have little incentive to consider price. With the cost of multiple medications, frequent doctors visits, use of specialists and one or more hospitalizations a year, these 5 percent will exceed even the highest deductible in the first few months of each year.” I believe that the ACA will exacerbate this because it specifically neglects the underlying causes of this phenomena as further discussed in the article. As a matter of fact, I believe that given time, wasteful spending by this 5% will become much more lopsided than 50% of total expenditures.

    Not one of your doctors is being paid less overall or less per transaction? Those are two different things. Their business is booming but, are their margins shrinking? If the margins are shrinking, then even if the doctor is making more, care is being diminished because the doctor is forced to see more patients to get the same kind of return. I find it really hard to believe that their remuneration rates are the same or higher than before the ACA.

    I am my employer and I pay for my own insurance. I only have one choice in my county and most of my state under the ACA. Because, as I have stated before, the ACA did nothing to address competition. I did not purchase on the exchange because either way, the same plan is the only option available and I am not eligible for subsidies and would eschew them anyway. I have not approached an independent broker yet. That will happen later this year.

  18. We have perverted health insurance in this country. Insurance should be for catastrophic care and people should be responsible enough to pay for preventive services. That would be much more financially responsible. Remember that you can negotiate the cost of services with a provider in advance for preventive services. You do not have to just pay some ridiculous billing amount that is caused by the misuse of health insurance. It is much cheaper for the physicians office to get direct payment from the consumer than to bill an insurance company. My doctor’s office has more administrators and support staff than providers mostly due to acceptance of insurance.

    You put too much faith in preventive services. The latest findings are that mammograms only find the most aggressive forms of cancer earlier and there is no overall change in survival rates whether you get them or not.

    I am not against vaccinations but, why should you have to pay insurance premiums in order to then have someone turn around and pay for vaccinations. It would be much more cost effective to pay for those services a la carte than to pay a company or in the case of single payer, pay increased taxes to the government just to have them turn around and pay the healthcare provider. This increases the layers of bureaucracy that increases costs.

    This same reasoning is why people in lower income brackets are more likely to purchase cheaper processed foods than fresh vegetables. They purchase the lower priced food and then later have greatly increased medical costs due to health complications of their decisions. That will not change with increased insurance coverage.

    I have insurance because, I have too much to lose if I have a medical bill that I cannot pay out of pocket so I have insurance. I do not believe that most preventive services should be reimbursed via insurance because of the reasons I have already given. I do so only because those costs are now embedded in my premiums.

    Those people who could not afford insurance or who made the decision not to get preventive services make a financial decision when they chose not to get preventive services. Now through the ACA we are subsidizing the premiums for around 80% of those on the exchanges. They will get preventive services but at what cost? The bill will come due soon!

  19. I apologize but, I have more for you in the form of several questions. This is what happens when you give me a snow day in the age of climate change!
    1) If the ACA is so great why is the WH using that pen to allow the individual mandate to get delayed for 3 more years? Could it be that they are worried about next year’s elections? If you do something and it sucks…fall on the sword or at least stick by your convictions. To do otherwise is simply cowardly.
    2) Why would they need to do that if all is so great in nirvana?
    I believe that you are ignoring the obvious because it would endanger your preconceived notions and therefore must be discarded. Marx did the same thing with data that did not support his thesis.
    3) Are you going to shop around once your deductible is covered to make sure your care does not drive up insurance costs?
    I ask this because you have a gold or platinum plan. You will have no incentive to try to keep costs down as you are one of the 5% mentioned in the previous post who will be done with any deductible before the end of the first month of each year.

  20. Post #4. Sorry to keep doing this but, I found this article that raises doubt (slaughters) about your assertions that the ACA is the cause for healthcare costs leveling off since 2009.

    http://thehealthcareblog.com/blog/2014/01/29/why-didnt-the-president-mention-the-latest-good-news-on-health-costs/

    Once again, it did not fit your thesis so, it does not fall into your discussion. The drop in the acceleration of costs has nothing to do with preventive care according to those actuaries you mentioned earlier!

    in a damning rebuke to your assertions, the decrease in costs according to these actuaries comes not from decreases in physicians or hospital costs due to the ACA but, from decreases in administrative fees and drug costs because consumers are using HSA accounts and shopping for healthcare. Where were these decreases derived? Not from the current resident of the WH! Funny how you read the actuarial data different than the actuaries who created it do.

    Not only that but, the increased costs to states for the expansion of medicaid are a staggering 15%. That is unsustainable!

    Please Erin, be responsible and stop blogging about this until you can make sense of the data. You are doing the sheeple a serious disservice.

    I am done for now.

  21. Oy vey.

    Alright let me break this down for you since you can’t seem to possibly understand (even when I made it very, very simple) -

    Let’s start with your Medicaid assertion and study which, as must did in January, I ignored. OF COURSE if you ADD people to ANYTHING MORE PEOPLE = MORE SERVICES USED. Not to mention the lack of educational outreach of information on how to properly use services. Over a short period of time, which the study readily discusses and admits, people kept with old habits. HOWEVER, when people learned of the services, how it worked, and were informed on proper usage a LONG TERM STUDY shows exactly what I’ve been saying http://www-personal.umich.edu/~mille/MA%20Outpatient%20ER%20Usage%20-%20Miller.pdf and unlike you I’m happy to link to the findings above.

    Moving on.

    The paperwork effect of ACA is new as of JANUARY and thus there is zero reason or studies or projection on what doctor’s will do with the influx of time spent. Will they hire someone else (hello job added to the economy… win) will they need to hire two people? Will they add to someone else’s workload? As the addition of patients means more money the offices are capable of adding jobs THUS JOB GAINS. And as I mentioned, please don’t just read the WH report on the issue, CLICK ON THE LINKS to the studies they cite or the CBO estimates.

    Moving on again.

    Let’s talk about that 5% you believe are making such horrible decisions. Cough… That would be me. We’re not getting subsidies and we’ve paid more in medical expenses with the BEST of insurance to pay for college for both kids. Why do you assume this sick population will just chuck their responsibly and be so … stupid? Is it because we’re sick? Because we’ve paid and paid and paid and paid more than any healthy person, and you just can’t see why we’d pay anymore? Because if so, it’s clear you’ve never been sick and desperate and will give up your pride, your home, your entire life to hand over whatever the insurance co. wants so you can get well. Do not insult the chronically ill. Do not insult those of us in that 5% who have worked our entire lives so only watch it all be sucked away by ONE illness. Nice to know you think the 5% will engage in ‘wasteful’ spending’ because clearly what we spend to stay alive is ‘wasteful’ to you.

    Let me keep going. Since you did as well. You say your doctors have already added people. Wow. In February huh? In the 2nd month when most are still sorting out even BUYING the insurance? I call bullshit. Show me some stats please. As my doctor may be dealing with some additional paperwork, it’s only gone on for 6 weeks and that hasn’t given him any amount of time to make any decisions on employees.

    Again, show me the studies on preventative services. It’s CLEAR they work and that is why they are embedded in ACA. Keeping people healthy makes for a healthier populate in the long run. It’s really very simple. You may to want them, or would rather choose to pay for them ala carte…but including this in all plans means the entire population gets HEALTHIER as time goes on.

    You say the ACA did nothing about competition. I call bullshit again as someone in California – our marketplace gave me SO MANY OPTIONS it took me several weeks to weed through them all and see if we wanted any, and which one was right for our family. Or if we should keep my husband’s company offered insurance. The competition between the variety of insurance companies was just fine in California. Again I ask, are you in a state that decided not to participate fully?

    As for your disbelief the WH would use their powers to delay some portions of ACA. Have you missed what the President has said since the beginning of all of this and all the way through? This legislation is admittedly not perfect, and when they find something that isn’t working as well as it should be, or is putting a burden on small businesses or any individuals needlessly they will work to fix that portion of the law. The delay came at the request of those saying they wanted more time. So what did they do? Even though they didn’t need to and even though research showed only a small percentage affected… they gave them MORE TIME. Amazing, an administration that actually gives a shit.

    And then you realize I’m one of the 5% who has, since 2010, paid the maximum out of pocket by January of every year. Which I discuss in many posts on this blog. I am not getting subsidies and have bought a platinum plan. I had no intention of changing a thing however the social security judge ruled in my favor and I am now eligible for Medicare. This means I will be shopping for a supplement and my husband and children will continue on the new ACA plan and I will use Medicare and probably another Blue Cross plan to make sure all of my treatments are included. I do not do this lightly, as we’ve spent the past 3 years paying not only the maximum out of pocket but hundreds of thousands MORE after. Maximum out of pocket does not mean what you think it means. Those of us in that 5% don’t just get off scott free after we hit our maximums. Bills keep coming for things that were magically not covered in the contract. And usually at the 60/40 rate.

    And finally as for that homework you claim I don’t do. As it turns out others have picked up on my homework with this blog post and amazingly agree.

    http://www.politifact.com/truth-o-meter/article/2014/feb/13/does-americans-prosperity-ad-about-woman-lupus-tel/

    and

    http://www.tennessean.com/article/20140208/NEWS07/302080028/

    shed the same light I did on the Lamb situation. As for the others you mentioned:

    http://www.washingtonpost.com/blogs/plum-line/wp/2014/02/05/cbo-director-obamacare-will-reduce-unemployment/

    http://www.cbo.gov/publication/45010

    http://content.healthaffairs.org/content/32/10/1820 (hits those things you specifically discussed with an actual study..NOT SPIN from an antiACA website)

    http://qje.oxfordjournals.org/content/124/2/597.abstract (on keeping people health)

    http://www.nejm.org/doi/full/10.1056/NEJMsa1202099 (on reducing mortality)

    On mental health http://www.nejm.org/doi/full/10.1056/NEJMsa1212321

    On helping reduce HOSPITAL READMISSIONS – since just 2013 without full implementation. When coupled with the LONG TERM STUDY I gave you above it paints an entire picture
    http://blog.cms.gov/2013/12/06/new-data-shows-affordable-care-act-reforms-are-leading-to-lower-hospital-readmission-rates-for-medicare-beneficiaries/

    I could go on and on and on with my ‘no homework’ if you like. But frankly I’ve given you enough time out of my life.

    Don’t come at me with snark and condescension that I don’t know what I’m speaking of when I’ve done nothing but LIVE THIS since before it came to be.

    You admit the insurance industry is in need of change yet offer no solution (at least not a legislative plan for one) but condemn ACA. Again I ask…is YOUR state full participating or are you feeling the effects of NOT getting the full benefits because of how your state has voted? You claim you buy your own insurance … did you check the exchange and did you find a plan for you and yours that was better than what you currently have? Or are you just refusing to participate?

  22. Ok, I knew among your first arguments was going to be job gains. You are using the playbook to perfection. You cannot spend your way to prosperity by doing make work. This will not help the economy. You are just adding layers of useless bureaucracy. I left that open to see if you would stumble upon it. You fell flat on your face!

    Second, you totally misunderstand me. You think that because I don’t like the ACA that I am against you and sick people like you. My point was that there is no incentive to do the right thing. Most people would not even realize what is the right thing and thus without the impetus to do so, would be capable of making an informed decision. Once again, I hold you no ill will because you are sick. However, just because you have paid a lot out means nothing. You are using services and thus your costs should be higher. I really doubt you have paid in premiums an amount equal to your costs. Since you do not make over $1m per year, this is just not possible. So, as painful as your journey has been, you have been receiving more benefit than cost to you!

    You must have read my post through angry eyes because you missed that when I said that about doctors adding patients I was responding to you and your assertion that your doctors practices are booming. Are you calling BS on yourself???? See that is the problem with liberals. You present them with facts and they get angry because they only want to deal with feelings and emotions.

    Let me be clear about this. California had all of those companies before because of the large concentration of population. I have looked at the CA website and there are 4 different companies that I saw offering the platinum and gold plans. In my state and many others there is only one BCBS. Just because one company offers a lot of crappy plans to choose from and you choose to weed through those does not equal competition.

    This administration only gives a sh*t about themselves. They are doing this unilaterally in a vacuum. They do not understand the consequences of anything they have done because none of them has any real world business experience.

    You say that i have no plan to offer, yet you have not asked me for a solution. You have only spent all of your time telling me how right the ACA is. You would not like my plan because it is market based and would require personal responsibility and choice. No, my state does not participate in the Medicaid debacle part of the ACA. I have checked inside and outside of the exchanges and the answer is the same because BCBS is the only provider offering a plan right now that conforms to the ridiculous mandates for what must be included.

    This administration could have done something to put an option out there for people who wanted it and then if it was successful, everyone could have chosen to join in. Instead they chose to grapple with something they had no comprehension on and lie about it the whole time. The website I sent to for that article is definitely not anti ACA. The articles I mentioned for you do not come from Fox news and they were not written in an inflammatory manner. You choose to see things through the rose colored glasses of liberalism that cloud your judgement.

    Like you, I am done. But, not because I am angry. Because it is pointless to try with you. The ACA will fail in a year, maybe a little more. You will simply blame the republicans and never really understand the truth.

  23. I’m going to take this piece by piece.

    1) Actually, that’s how you get out of a bad economy. See: history. I recommend the Great Depression.

    2) I obviously misunderstand you. This is why I buy insurance. If I were not doing the right thing, I would NOT buy insurance, I would take advantage of the system, I would use the ER as my doctor…and so on and so forth. People buy insurance for exactly this reason. But again, we have a very fundamental disagreement on health care being a privilege and health care being a right. I firmly think a civilized society…the so-called greatest nation ever, should -at the very LEAST- care for it’s citizens. Yes, this means the basics. I think if you take the money making, for profit portion OUT of all of this, you will find that providing the simple bsic right of health care would go a very long way in strengthening our country. Healthy people = happy more productive people. I feel the same way about education, higher education, vocational and otherwise. And before you start labeling me, I also think this can be done in a truly American way (much like the path we have begun with ACA…) where it’s not socialism and it’s not entirely capitalism.

    As for my $$, I’ve made public- with photos of bills and screen shots, etc what I have paid and how it has all worked in our family. Entirely transparent.

    3) You asserted doctors were unhappy and what not with ACA, I gave you what my doctors have said. My doctors are doing very well, because they have more patients thus they are expanding. This has been my consistent line throughout. I said their complaints thus far had mostly to do with paperwork, with which you said they were having to add employees. I found this to be a)interesting considering they seem to be making these decisions to add employees rather fast considering it’s only February and b) if true a good thing because – hey, MORE JOBS. You seem to think these jobs are BS because …. well l’m not entirely sure why you think these jobs are bad. You hate the idea of giving people work through a piece of legislation because OMG it’s all that SHITTY BIG GOVERNMENT. I call a big ‘meh’ on that one. You bitch the a dmi isn’t creating jobs and they do and you decide the jobs suck and are horrible because they are part of something you think is crappy. Again, ‘meh.’

    4) California is doing VERY well with our competition under ACA. There are even other insurance companies being added because they want in on the boom. Aetna, for one…who waited it out to see what would happen. As for your state…what can I say? Your elected leaders want this to fail, they aren’t allowing Medicaid expansion and the poor saps voting against their own interests in said said are getting screwed. Look at Kentucky- if it NOT the legislation’s fault YOUR state opted out. Had they done what they SHOULD have done to HELP THE PEOPLE, you’d see more competition and better selections and OMG the free market at work. Imagine that. And about the whole ‘crappy plans’ thing… um, we chose to buy into an ACA plan because it BLEW AWAY the one we had, which was also very good. I’ve also blogged this, and included the particulars of the plan we had and the plan we chose and compared them all side by side (also with screen shots) so that people could see the savings for us are going to be ASTRONOMICAL. For a family with 3 healthy people and 1 chronically ill wife and mother this is the difference between losing our home or getting quality care and medication. Life and death. This is not small stuff.

    5) As for the administration … you are hitting a very sore spot with me because I actually know and work with this administration. They are not nameless faceless government cronies and the President is not just some leader you think of in abstract. For our family he is a man of his word, a man of integrity and his staff have become people I will absolutely and without hesitation go to the mats for. I’ve been a guest at the WH four times during this administration and the last time my entire family was invited so that we could sit down with SENIOR staff and discuss what it’s like to be a family dealing with a chronic illness and how we can help them make ACA better. I am not saying this to name drop or act like I am more important than anyone else…in fact in my previous life (before I was sick and disabled) it was part of my job to make sure women bloggers were directly connected to those making the political decisions in their district, state, and yes…even the white house. And that meant both sides of the aisle. I have brought republican women into the white house with their very staunch republican husbands to sit down with people like Valerie Jarrett to incorporate THEIR real life ideas into real life legislation. I am proud of this. I am proud of the White House. And I know first hand that they actually DO give a shit and understand far more than you think. When you speak of these people, you speak not on first hand knowledge, but on your media knowledge. I speak of first hand knowledge and am VERY honest about who I find to be trustworthy and who I do not. There are some very, very good people working very hard for you. You may not believe it, but I have seen it. I’ve even helped.

    6) your plan .. go for it. Lay it on me. No, I’m probably not going to agree due to the fundamental difference…however on many other issues I’m all for personal responsibility (who isn’t? the idea that somehow liberals are just all willy nilly throwing money out to everyone for no good reason is really kind of tired) for those who are capable. What I’m NOT for is personal responsibility in situations where people seem to only allow for health care to those who can pay for it and too bad for those who can’t.

    I will remind you the mandate was a conservative idea that was put on the table NOT because the admin wanted it, but because it was a COMPROMISE to get the right to agree. And we’ll have to disagree on the articles sent.

    As for your ‘truth’ … I gave you link after link after link of study after study after study … and not a peep.

    But if you say you are done, I take you at your word and I have enjoyed the lively debate. As I do with all civil debates, I will mull over all that you have written. I can only hope you’d do the same for me.

  24. Sue Johnson says:

    You stated to Chris, “don’t come at me with snark and condescension……” Isn’t that what you did to Emilie with your entire blog piece? Her story isn’t your story. You each had different experiences. So what? And when you are citing the politifact check piece as a reference, please note that they don’t “amazingly agree” entirely with your point. Read their conclusion paragraph instead of cherry-picking what you want to use to make your point. Each of your references, like your judgement of Emilie’s experience, has its own spin, and some are blatantly obvious.
    I’m trying to learn more about the ACA, but the politics are difficult to stomach. Your article’s tone and and down right nastiness didn’t help.

  25. Sue – I would recommend you continue to research as Emilie’s story has now been debunked, or maybe a better word is …. expanded? Each of the issues I brought up have now been taken on by main stream media in her home state of Tennessee and nationally.

    No, her story is not my story. Your story is not my story. However the reason for this blog post was because with her story something was wrong…it didn’t add up as I looked at it through the lens of someone dealing with ACA and Lupus. And as I have been very transparent with my bills, my costs, and my care…there were holes in Emilie’s story. Ones that did not paint a complete picture. Now we know why.

  26. On June 3, 2014 we leared our beloved Kapri has a mass on her brain. She suffered a seizure and was taken to the emergency room.
    They determined she needed to be transferred to UCSF.
    As we speak, she is under going surgery to remove the mass.
    The surgery will last 6-8 hours.
    As you all know know she is a sassy, spunky, loving, on the go little lady.
    She is as good as it gets.
    We are asking that you can donate whatever you can to contribute to her medical costs and the long
    recovery she has ahead of her.
    We thank you from the bottom of our hearts and we will keep you
    posted on her surgery and recovery ahead……

  27. Even when things go sour, remember that things will change again as they always
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