Dear Ms. Boonstra: It’s too bad that you don’t live in Kentucky. Or Rhode Island. Or New York State. Or California. Or Arkansas. Or that Michigan’s state government now has a Republican governor, a Republican-controlled House, and Republican-controlled Senate. And, yes, that healthcare.com didn’t work until December. [UPDATED]
Congratulations, Republicans. You’ve finally found a case in which the failure of the federal ACA website amounted to the failure of Obamacare itself. At least for what turned out to be a very difficult two months for one particular woman, Julie Boonstra, a resident of Michigan Republican Rep. Tim Walberg’s district.
Which, contrary to your (and the news media’s) incessant conflations, does not mean that the website is the ACA. No, the website is still a website, not an insurance program. And its failure last fall created havoc, for those two months, for people like Boonstra. And also gave the 36 state Blue Cross/Blue Shield companies–all the cancelled-plan horror stories I’ve heard of involve a Blue Cross/Blue Shield company–in Republican-controlled states that did not create their own online healthcare exchange the opportunity to cruelly try to manipulate people Boonstra into buying its costliest plan, by implying that that was the sole alternative.
Boonstra has Chronic Myelogenous Leukemia (CML). She was diagnosed with her cancer five years ago. Necessary oral chemotherapy treatments cost $4,100 a month, out-of-pocket, and she will need those treatments for the rest of her life.
When, for weeks, she could not get the necessary information from healthcare.com, and then could not get through by phone to an ACA navigator for Michigan’s federally established exchange until mid-December, and then was told there was a waiting period of two weeks, extending beyond her old policy’s expiration date of Jan. 1, she contacted her congressional Representative asking for assistance in learning of them. He told her instead that she could be his guest at the State of the Union address. She accepted. Then, in desperation to learn her options for insurance, she contacted the Michigan Farm Bureau, which assisted her in finding a new policy, not through the exchange but apparently through Blue Care, her old insurance company. The Farm Bureau even looked into the possibility of Medicaid for her, through the ACA’s Medicaid expansion, which Michigan has joined.
At least as of the date of the State of the Union address, she still did not know what her options were through the exchange. Nor whether she even qualifies for Medicaid under the expansion; she was unable to get a determinatio of that. Nor whether she would qualify for a federal subsidy, had she purchased her policy through an ACA exchange established by Michigan or through healthcare.com.
Well, hopefully, next year.
By which time she may well be quickly approaching her old policy’s lifetime coverage limit. Or by which time Blue Care might simply have decided that she was too expensive to continue to cover, and unceremoniously dropped her as a policyholder. And, unable then to obtain coverage through another company because of her preexisting condition, she might have contacted her congressional representative, Tim Walberg, and asked him for assistance.
She apparently does work, full-time, but not for an employer that provides healthcare insurance.
I know about Ms. Boonstra because, well, she’s now cut an ad, funded by the Koch brothers’ super PAC, Americans for Prosperity, attacking Democratic Congressman Gary Peters, who is running for the Senate seat that will be vacated by Carl Levin, for–surprise!–voting for Obamacare. And I also know this, from Glenn Kessler’s “The Fact Checker” in the Washington Post today:
First of all, many viewers [of the Americans for Prosperity ad] might think Boonstra lost her doctor, as she mentions her “wonderful doctor” and then says her plan was canceled. But AFP confirms that she was able to find a plan, via Blue Cross Blue Shield, that had her doctor in its network.
Local news reports recount that Boonstra, like many Americans, initially had trouble getting a plan because of the botched launch of healthcare.gov. No doubt that was a difficult experience. She then was invited by her local member of Congress to attend the State of the Union address and participated in a Republican National Committee news conference that highlighted problems with Obamacare’s stumbling launch.
At that news conference, Boonstra said, “I’m paying a higher cost now as far as out of pocket costs and the coverage is just not the same.” But in the new ad she says “the out-of-pocket costs are so high, it’s unaffordable.”
The claim that the costs are now “unaffordable” appeared odd because, under Obamacare, there is an out-of-pocket maximum of $6,350 for an individual plan, after which the insurance plan pays 100 percent of covered benefits. The Blue Cross Blue Shield plans in Michigan that appear to match Boonstra’s plan, as described in local news reports, all have that limit.
Meanwhile, Boonstra told the Detroit News that her monthly premiums were cut in half, from $1,100 a month to $571. That’s a savings of $529 a month. Over the course of a year, the premium savings amounts to $6,348—just two dollars shy of the out-of-pocket maximum.
We were unable to reach Boonstra, but on the fact of it, the premium savings appear to match whatever out-of-pocket costs she now faces.
And next year, she might be able to get a policy through healthcare.com that is better than her current one and better than her former one. And maybe a substantial subsidy to help pay for it. In any event, she’ll continue to have healthcare insurance. Until, of course, the Republicans win the White House and control of both houses of Congress. With the help of her vote.
If only she lived in Kentucky. Or Rhode Island. Or even Ann Arbor, which borders on her town of Dexter and is represented in the House by a Democrat who, had she contacted his office, might have assisted her in getting the information she so desperately needed last December. But who wouldn’t have invited her to be his guest at the State of the Union address.
UPDATED: run75441, a.k.a. Bill H, of AB, a Michigan resident, posted the following comment to my post, detailing what actually happened in Michigan regarding the insurance exchange for the state and the state’s Medicaid expansion:
The fact of the matter is; the Republican controlled Senate and House waited until the last minute to pass the Medicaid Expansion and other aspects of the PPACA. They also waited to the last minute to decide not to establish healthcare exchanges thereby causing the Federal Government to step in to establish them. Gov. Synder recognizing a good deal, supported the Medicaid Expansion.
Insidious amongst the legislature is it failed to cause the PPACA Medicaid Expansionto be implemented January 1, 2014 through vote and instead GOP Senate Majority Leader Randy Richardville opted to delay the vote causing the PPACA Medicaid Expansion to be implemented April 1, 2014 instead of January 1st. It is costing Michigan ~$7 million/day as a result. The funding provided and if used in the manner it was previously used is enough to fund the “Expansion” until 2028 making it a good deal for the state.
Even if eligible for Medicaid under the PPACA, Ms. Boonstra would not have had access to the expanded Medicaid in Michigan until April 1, 2014.
Sooo … yes, Virginia, er, Ms. Boonstra, there is, almost certainly, a financial advantage to you from Obamacare. Or at least there almost certainly will be, soon.
Here’s a suggestion: Call Rep. Peters’s local office and ask for assistance in, possibly, swapping out the plan you bought, for a plan through the ACA exchange, in order to receive the subsidy you’re almost certainly entitled to. The ph. # is: 313-964-9960.
And, who knows? Maybe soon you’ll be able to resume your pre-illness plans to be a stay-at-home mom. Although Rep. Walberg, who thinks job lock in order to have healthcare insurance is great national policy, would disapprove of your choice.