Emilie Lamb was subsidized by her doctor’s largesse and by federal taxpayers and full-coverage-insurance policyholders. She still will be. She should acknowledge that, publicly.

“I was diagnosed with lupus when I was 27. Lupus is an autoimmune disorder. It’s dramatically affected my life. I voted for Barack Obama for president. I thought that Obamacare was going to be a good thing. Instead of helping me, Obamacare has made my life almost impossible. Barack Obama told us we could keep our health insurance if we liked it. And we can’t. I got a letter in the mail saying that my health insurance was over, that it was gone.  It was canceled because of Obamacare. My premiums went from $52 a month to $373 a month. I’m having to work a second job to pay for Obamacare. For somebody with lupus, that’s not an easy thing. If I can’t afford to continue to pay for Obamacare, I don’t get my medicine; I don’t get to see my doctors. I am very disappointed in Barack Obama as a president. He made promises he didn’t keep. And that’s disheartening.”

–Tennessee resident Emilie Lamb, 40, in an ad sponsored by Americans for Prosperity

The Facts

Lamb’s old plan was provided through a public-private program aimed at lower-income workers called CoverTN, which split the premium costs between an employee, the employer and the state. That’s a big reason why Lamb’s premium was only $52 a month, but in an interview she said she would have gladly paid and could have afforded the full $156 a month.

Why was the plan so inexpensive? For one thing, it had a $25,000 cap on annual benefits. It also had no limit on out-of-pocket costs, and it would only cover generic medications.

CoverTN was terminated at the end of the 2013 because it did not meet key requirements of the ACA, in particular a ban on such caps on benefits. The Obama administration denied the state’s request for a waiver, and so the plan was shut down.

For health-care reformers, such annual caps on benefits were a sign of a substandard plan that could put someone in bankruptcy if they had an accident that resulted in unexpected medical costs. But Lamb doesn’t look at it that way because she already had suffered a major and costly accident that was unrelated to her chronic condition.

— Glenn Kessler, The Fact Checker, Washington Post, today

This woman is someone who has managed to avoid financial catastrophe, or death for lack of access to medical care, by dint of a state healthcare insurance plan and–and–what is in essence charity by her medical providers: her hospital and her physician.  The hospital and physician undoubtedly will continue on as before, and she makes no claim to the contrary; her sole complaint is that her monthly premiums have risen from $52 a month to $373 a month.  Kessler continues:

For health-care reformers, such annual caps on benefits were a sign of a substandard plan that could put someone in bankruptcy if they had an accident that resulted in unexpected medical costs. But Lamb doesn’t look at it that way because she already had suffered a major and costly accident that was unrelated to her chronic condition.

In 2007, Lamb fell off a horse, requiring seven surgeries at Vanderbilt Medical Center. She saw one surgical bill for $125,000, but after negotiations with CoverTN, the hospital agreed to reduce the charges to below $25,000. In the end she barely paid anything in hospital costs after her accident.

“Really after that, I was not worried about something catastrophic” that would exceed the $25,000 cap, she said.

(Others might look at this story and decide she was unusually fortunate that the hospital, confronted with a patient who had inadequate coverage for the surgery, decided to eat the difference.)

Really, once she was accorded a dramatic reduction in hospital bills, Ms. Lamb presumed that she would always be accorded a dramatic reduction in hospital bills, and so she stopped worrying about enormous medical expenses. No questions asked–by her, anyway–about who ended up footing that bill or further bills for something else catastrophic. Ergo, she’s really angry that she now has to pay more for her monthly premiums, so that her further medical expenses, unexpected catastrophic ones or expected ones for very expensive treatment for her serious chronic illness, will be paid by her insurance carrier rather than by, say, the federal government in subsidies to her hospital, and by her doctor, and by other policyholders. Kessler continues further:

Meanwhile, lupus can result in very high medical expenses, but that is not the case with Lamb. She said her out-of-pocket costs, for doctor visits and drug costs, amounted to just $1,000 a year.

“I have very good doctors who have helped me manage my condition,” she said. “I was comfortable with the risk of having this limit.”

To put her expenses in context, the American College of Rheumatology says that average cost per patient with lupus is between $14,000 and $28,000, though patients with one form of lupus have significantly higher costs – ranging from $29,000 to $63,000.

Yes, she was comfortable with the risk of having a $25,000 annual cap on her expenses, because her hospital and doctors were willing to eat the additional cost and she expects to live out her life in Nashville, Tenn., using that hospital and those doctors–only that hospital and only those doctors.

The moral of this story is that the AFP is no longer even taking care to make their stories sound credible at least at first blush.  No one–I mean, really, no one–is going to see this particular ad and not recognize that an insurance policy that cost $156* per month was not going to pay most of the expenses for treatment of lupus.

Keep this up, AFP.  Please.

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*This post originally used the $52/mo. figure, but since that was the amount she paid after contributions from her awesome work-from-home employer and from the state, I switched the amount to $156, the full amount of the monthly premium. 3/1.

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