Debunking those Obamacare horror stories

Insurers and the media need to better explain how the new health insurance system works

Share with others:


Print Email Read Later

Deborah Cavallaro is a hard-working real estate agent in the Westchester suburb of Los Angeles who has been featured prominently on a round of news shows lately, talking about how badly Obamacare is going to cost her when her existing plan gets canceled and she has to find a replacement.

She says she's angry at President Barack Obama for having promised that people who like their health plans could keep them, when hers is getting canceled for not meeting Obama-care's standards.

"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."

Ms. Bartiromo didn't take her up on her request. So I will.

The bottom line is that Ms. Cavallaro's assertion that "there's nothing affordable about the Affordable Care Act," as she put it Tuesday on NBC Channel 4, is the product of her own misunderstandings, abetted by a passel of uninformed and incurious news reporters.

I talked with Ms. Cavallaro, 60, after her CNBC appearance. Let's walk through what she told me.

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.

This fits the very definition of a nonconforming plan under Obamacare. The deductible and out-of-pocket maximums are too high, the provisions for doctor visits too skimpy.

As for a replacement plan, she says she was quoted $478 a month by her insurance broker, but that's a lot more than she'd really be paying. Ms. Cavallaro told me she hadn't checked the website of Covered California, the state's health plan exchange, so I did while we talked.

Here's what I found.

I won't divulge her current income, but this year it qualifies her for a hefty federal premium subsidy. 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.

Is that better than her current plan? Yes, by a mile.

If she wanted to pay less, Ms. 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'd still be ahead.

Ms. Cavallaro told me a couple of things worth considering.

First, what she likes about her current plan is that she can go to any doctor of her choice and any hospital. 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.

Ms. Cavallaro also mentioned that her annual income fluctuates. It can be substantially lower, or substantially higher, than it is this year. What if next year she earns too much to qualify for the subsidy? Also a fair point -- at her current income, the subsidy is worth more than $200 a month to her. But that's not the same as saying that "there's nothing affordable about the Affordable Care Act," because at her current income, the act is vastly more affordable to her than what she's paying now.

When she told Channel 4 that "for the first time in my whole life, I will be without insurance," it's hard to understand what she was talking about. (Channel 4 didn't ask.) Better plans than she has now are available for her to purchase today, some of them for less money.

The sad truth is that Ms. Cavallaro has been 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.

Michael Hiltzik is a columnist for the Los Angeles Times.


First Published November 2, 2013 12:00 AM


Advertisement
Advertisement
Advertisement

You have 2 remaining free articles this month

Try unlimited digital access

If you are an existing subscriber,
link your account for free access. Start here

You’ve reached the limit of free articles this month.

To continue unlimited reading

If you are an existing subscriber,
link your account for free access. Start here