'Victims' of Obamacare

Obamacare’s ‘victims’

Who are the people willing to identify themselves as casualties of the Affordable Care Act — and did they really 'shop' in the exchanges?

By
January 2, 2014

In November, Fort Worth’s Star-Telegram ran a story with a compelling lead:

Whitney Johnson, an Arlington 26-year-old with multiple sclerosis, can’t afford to go without health insurance. Her life depends on it.

She gave birth to her first child Sept. 2 after undergoing a series of rigorous steroid treatments, surgeries and a plasma exchange that saved her life. She pays $325 a month for an individual insurance plan – a drop in the bucket compared with the cost of her plasma protein replacement therapy, which runs $40,000 a pop. She undergoes treatment every five weeks.

But now, with the Affordable Care Act in full swing, Johnson’s insurance is under threat.

Recently, the story explains, Johnson’s insurer sent her a letter saying that because her policy “does not comply with Obamacare” it will be cancelled Jan. 1, 2014.

In a video talking about her experience, Johnson claims that when she started “trying to shop around, the rates went from $1,000 to $1,800 a month for not even close to the coverage that my previous insurance had offered me.”

Johnson also told the reporter that her husband’s employer covered him as well as her son, but that if she tried to join his plan, his $325 premium would triple.

Familiar ‘horror story’

Johnson’s charge that Obamacare has ruined her perfectly good health coverage and stands to drive her premiums through the roof is far from unique. These are the complaints that have shown up, again and again, in recent media reports about the impact of the ACA.

But when “victims” step forward, reporters need to investigate these claims. If newspaper editors and television producers are willing to put them in the media spotlight – in front of a huge local or even national audience – they also have a duty to give their readers and viewers the facts they need so that they can judge the validity of the allegations.

Have the people profiled in these stories actually checked prices in the exchanges? Do they know whether they would qualify for government subsidies that could help cover their premiums? How many didn’t even try to find out because they just don’t like the ACA? Who are these people who are willing to identify themselves as casualties of the “trainwreck” called Obamacare?

Finally, and perhaps most importantly, are reporters fact checking these stories? How many are just writing down whatever their sources tell them?

With those questions in mind, I decided to do a little fact checking myself.

Over $1,000/month to insure 26-year-old

According to the Star-Telegram, Johnson “had been unable to access the federal health exchange website, which has been hampered by technical problems.” Fair enough; in October many people ran into glitches on HealthCare.gov. But this also told me that, in fact, she had no idea how much an exchange policy would cost.

Meanwhile, she insisted that when she “tried researching and comparing rates with other insurance companies” outside the exchanges she discovered that a plan comparable to the cancelled policy would cost “over $1,000″ and “that was just a quote. I was told I should expect that cost to go up.”

That was when I realized that there was something very wrong with her story. The facts just didn’t add up.

Anyone who knows anything about Obamacare would realize that under the ACA, no 26-year-old would be asked to pay $12,000 a year – even if she had MS. Obamacare does not let insurers charge more because a customer suffers from a pre-existing condition. This rule applies to all new policies, whether they are sold inside or outside the exchanges.

And Johnson is just 26. In the exchanges, 20-somethings pay far less than older Americans. I was certain that that she could get a much better deal. It didn’t take me long to find one.

Using HealthCare.gov, I plugged in Johnson’s age, and the county where she lives. Since she suffers from MS, I realized that she would want a Gold plan rather than a less expensive Bronze or Silver plan. Within ten minutes, I found ten Gold plans with premiums ranging from $260 to $379 a month – including a Blue Choice Gold PPO for $332.

That was just $7 more than Johnson had been paying for the plan that has been cancelled. The deductible is low ($1,500) and limits her annual total out-of-pocket spending to $3,500.

Her co-pay when visiting a specialist would be $60. Co-pays for medications would range from $35 to $150 for a “specialty prescription.” (These co-pays are not “after the deductible. She would owe just $60 when seeing a specialist, even though she had not yet paid down the deductible.)

No fact checking

I was puzzled: Why had no one at the Star-Telegram checked HealthCare.gov? When the November 26 article was published, the website was working smoothly. (As of November 30, over 17,000 Texans had enrolled in the marketplace, more than in any other state except California, New York, Florida and Washington.)

Without fact checking, the paper published the article, and Johnson’s tale went viral, turning up everywhere from Sean Hannity’s show, to House speaker John Boehner’s website. Boehner also tweeted the story. Anyone who read the story would be led to believe that under Obamacare, a 20-Something might have to fork over $1,000 a month for coverage.

If you wanted to discourage young Americans from enrolling, this story would do the trick.

Who is Whitney Johnson?

When a reporter isn’t familiar with a source, he normally does a background check to make sure the source doesn’t have an axe to grind.

When I Googled Whitney Johnson, a letter that she had written to a pro-life organization called Concerned Women for America – asking for help – popped up. The letter immediately explained why she might be willing, even eager, to believe that Obamacare would triple her premiums:

“I am one of many who have been lied to over and over again by our president,” Johnson wrote. “I am one of many other fellow countrymen who have preexisting conditions …”

“Before you tune me out and accuse me of being a radical conservative, understand that I’m neither a democrat nor republican; I’m an American. An American that wants to see our country restored to its original intent. A country for the people, by the people. A country that once again can stand up and say, ‘In God we trust!’ …”

“We as a nation need to stand with the likes of Senator Ted Cruz and Senator Mike Lee who are committed to stopping ObamaCare.”

The letter continues in this vein for some eight paragraphs. She ends by quoting Norman Thomas:

“The American people will never knowingly adopt socialism. But, under the name of ‘liberalism’ they will adopt every fragment of the socialist program, until one day America will be a socialist nation, without knowing how it happened.”

Whitney Johnson may not be a Republican or a Democrat, but her letter makes it clear that she is far from apolitical. She was channeling Ronald Reagan. With a little more Googling, I found her Facebook page, which revealed that she is a member of the Parker County Tea Party Facebook Group and that she has attended its meetings. (Her mother, Dawn King, was one of two founding members when the Parker County Tea Party was formed in 2009.)

At that point, I wondered: Who are the other three people profiled in the article?

Determined to boycott Obamacare

I began with Shari Lusk. The 57-year-old retired school teacher from Lubbock, Texas, was candid in her Star-Telegram interview, confiding that she was “enraged” when she found out that her premiums would rise under a new policy that complies with the Affordable Care Act. She didn’t attempt to find coverage through the exchange because she didn’t want to have anything to do with Obamacare:

“I don’t want any kind of subsidy,” she said. “I don’t want the government giving me money that takes away from a fellow citizen when I can pay for it. And I don’t want my personal information out there for anybody to have ahold of.”

So Lusk looked outside the exchange and bought a $420 policy – $60 more than she had been paying – with a deductible that is $1,000 higher.

When I Googled Lusk, I discovered that she is no stranger to publicity. A year ago, she was interviewed on television, describing how she drove 16 hours, alone, to Nashville in order to attend a Tea Party convention. When asked by a reporter why she made the pilgrimage, she replied, “Because I think it’s time for the people who love this country and are conservative to step up to the plate, to speak up and to change some things that are going on in Washington.”

Obamacare is not the reason Lusk is paying more for insurance. Her own politics determined her decision to boycott the exchange. That is her right. Still, I couldn’t help but wonder: Could she have gotten a better deal on the exchange?

HealthCare.gov reveals that a 57-year-old living in Lubbock could pick up a Bronze policy for $320 – $100 less than the plan Lusk bought. Alternatively, since she is 57, she might be better off with a Gold plan that comes with a zero deductible. The premium is $583, but co-pays are low ($30 when seeing a primary care doc; $60 when visiting a specialist).

Finally, since Lusk is a 57-year-old single retiree, very likely she earns less than $45,000, and would qualify for a government subsidy, slashing the premium.

The Star-Telegram describes Lusk as one of Obamacare’s “losers.” In fact, Lusk could have been one of Obamacare’s “winners.” She just didn’t want to benefit from the ACA. This is her choice. But it doesn’t make her a “victim” of reform.

Resistance to ‘central planning’

The paper’s third source, Robert Kesceg, told the Star-Telegram that under Obamacare, his deductible had doubled – from $10,000 to $20,000. But, like Johnson and Lusk, he had never actually checked exchange prices. So I did it for him.

In his exchange, the deductible for a family ranges from $0 to $12,700 – the maximum allowed under the law. Under the ACA, a family’s out-of-pocket spending, including co-pays and deductibles, is capped at $12,700 ($6,350 for individuals) – both inside and outside the exchange. This is true nationwide. There are no policies with $20,000 deductibles.

A highly successful money-manager who Money Magazine named to its 1988 list of All-Pro Stocker Brokers,” the 61-year-old Kesceg should have had no problem finding a better deal on the exchange – if he wanted to. But it turns out Kesceg is an active member of the Lone Star Tea Party.

In a telephone conversation, Kesceg told me that he views Obamacare as “central planning” by the government. “I am going to make my own decisions,” he declared, “and choose what insurance I want. No one is going to tell me what to do.”

Kesceg also made it clear that he is strongly opposed to both Social Security and Medicare. He confided that when his own father was on Medicare, he was distressed to see him “wasting taxpayer dollars as he went from doctor to doctor.”

Unfinished search

Unlike the first three, the newspaper’s fourth source, Wayne Hoelscher, actually tried to shop in his exchange and in doing so, he learned that he was eligible for a premium tax credit.

In his interview with the Star-Telegram, Hoelscher – who is in his early 60s – explained that he went to the federal HealthCare.gov site to try to establish an account, but ran into the infamous glitches. Ultimately, he called an 800 number for the exchange, and “after he provided personal information about himself and his wife, he was told that a packet would arrive in the mail in up to 14 days.” So far, so good.

But, “more than two weeks later, he still hadn’t received anything in the mail,” the Star-Telegram reports. “Concerned that his family would be without insurance” on November 20, “he submitted an application for a policy outside the federal exchange.”

Without further comment, the reporter adds, “He would have qualified for a $900 subsidy on the exchange.”

I was dumbfounded. Why would he walk away from $900? He had another four weeks to enroll. Why not call the 800 number again?

Googling Hoelscher’s name, I found no evidence that he belongs to the Tea Party, or is opposed to Obamacare as a matter of principle. (His phone was disconnected, so I couldn’t reach him.)

My best guess is that he was discouraged by everything he had read or heard in stories like the one that ran in the Fort Worth paper.

What happened?

How did so many TeaParty sources wind up in the Star-Telegram piece? Why didn’t anyone at this major daily newspaper check the facts? Why didn’t the reporter check her sources’ claims against numbers on HealthCare.gov? Why didn’t her editor flag unbelievable claims: that under the ACA, a 26-year-old might have to pay $1,000 a month – or that a couple’s deductible could rise to $20,000?

After many calls, I reached the reporter who wrote the story, spoke with two editors at the daily and interviewed Johnson. Read on to find out what they told me.


Tags: health insurance exchange, health insurance marketplace, Star-Telegram, subsidies, Tea Party, John Boehner, Maggie Mahar, Sean Hannity

About Maggie Mahar

Maggie Mahar

Maggie Mahar is an author and financial journalist who has written extensively about the American health care system. Her book, Money-Driven Medicine: The Real Reason Health Care Costs So Much, was the inspiration for the documentary, Money Driven Medicine (which Mahar also co-wrote). She is…

All authors

Visit the authors page and find out who is behind all of the great content at healthinsurance.org™.

Latest Obamacare news & opinion

Health Wonk Review June 5 2014

Health Wonk Review for June 5, 2014

If you haven’t gotten your health policy fix, head over to Health Wonk Review –…

fix-obamacare

Looking beyond the botched ACA rollout

"People have given up on the repeal. There are very few people who want Congress to…

price responsive consumers

Figuring out how to put ‘skin in the game’

The studies indicate that people are very responsive to healthcare prices when they see…

Curbside Consult David Cutler

Can we ‘do the right thing’ profitably?

David Cutler was the author of a prescient and scathing 2010 analysis warning of the need…

obamacare-john-kline

Dem ad slays Obamacare-hating Republican

Of the nearly half a billion dollars that has been spent on political ads mentioning the…

health-wonk-review-may-22-2014

Health Wonk Review for May 22, 2014

Summer's here (at least it is where I am) and with it comes a summer-y edition of Health…

Sabrina Corlette health reform

Obamacare: Just what the doctor ordered?

In Part 2 of my conversation with Sabrina Corlette, we talk about whether the Affordable…

Health Wonk Review May - 2014

Health Wonk Review for May 8, 2014

Just a reminder that if you're still looking for some compelling health policy reading…

youth-enrolled-obamacare

‘Bros’ on board – and other promising signs

With 8 million Americans enrolled in Obamacare's exchanges – 28 percent of them young…

all posts

See all 379 blog posts.

Browse by date

Search within posts

Related terms

health insurance exchange

A health insurance exchange – also known as a health insurance marketplace – is a key provision of the Affordable Care…

health insurance marketplace

A health insurance marketplace – or health insurance exchange – is a key provision of the Affordable Care Act, established to…

subsidies

Individual subsidies were included in the health reform law to help ensure the goals of the legislation's individual mandate. Legislation provides…

Recent tweets @EyeOnInsurance

Wed Jul 23 17:51 2014 • reply • retweet • favorite

Wed Jul 23 17:48 2014 • reply • retweet • favorite

Wed Jul 23 17:45 2014 • reply • retweet • favorite