FOLLOW-UP TO: “What Glenn Kessler–and I–Missed Earlier In Emilie Lamb’s Claim: That She SAYS Obamacare Caused Her Hospital and Doctors to Stop Gratuitously Forgiving Her Medical Expenses Above $1,000. That’s Palpably False.”
On Saturday I posted a lengthy post with an almost-as-lengthy title:
What Glenn Kessler–and I–Missed Earlier In Emilie Lamb’s Claim: That She SAYS Obamacare Caused Her Hospital and Doctors to Stop Gratuitously Forgiving Her Medical Expenses Above $1,000. That’s Palpably False.
Following are two comments to it from readers Mike Myer and Mark, respectively, and my (lengthy) response to it in the Comments thread:
What if Lamb is telling the TRUTH?
Ms. Mann, check one more aspect of this story which might explain some of the discrepancies. I have psoriatic arthritis which requires some of the same medications as lupus. I take an infusion every five weeks and the negotiated cost is about $6000 of which I pay 20%.
My out of pocket max is $5000, so after 4 treatments I’m good for the year. However the drug company has a rebate program which pays all but $50 of my out of pocket expenses, most of which are the medication. There are several different rebate and subsidy programs. I suspect that in this case the doctors and hospital aren’t forgiving anything, the woman is in one of these programs and either doesn’t realize it or doesn’t understand how it works….
Mike and Mark, here’s the problem: This woman claims (1) that she was happy with her now-cancelled plan, even though that plan had NO out-of-pocket cap and had an annual total-coverage cap of $25,000; (2) that she was happy with that plan because–and ONLY because–her hospital and her doctors had agreed, year after year going back to 2007, to forgive all her uninsured costs totalling more than $1,000 annually; (3) that because of Obamacare she had only these options: a Bronze or Gold plan for about the same monthly premium cost to her but that has a $10,000 annual out-of-pocket cap and no annual coverage cap and that, unlike when she had her old plan, she would be forced to actually PAY that amount, and a more expensive Platinum plan with a $6,000 annual out-of-pocket cap and no annual coverage cap, and that unlike unlike when she had her old plan, she would be forced to actually PAY that amount.
What matters here isn’t WHO–her hospital and doctors or instead the pharmaceutical companies–had been picking up her uninsured costs, but instead whether WHOEVER IT WAS THAT WAS DOING THAT will continue to do it or instead has told her that it will not continue to do–because of Obamacare. And, remember: She had seven surgeries in 2007 because of injuries from falling off a horse, and one of her surgical bills was $125,000, all but $1,000 of which was forgiven–by her surgeons.
Setting aside that, as we all learned from the Julie Boonstra controversy, the Bronze or Gold $10,000 annual out-of-pocket maximum is actually an approximately $6,500 annual out-of-pocket maximum–something she may well not have known in December or January–and also setting aside that (presumably) her employer continues to be contributing the same amount to her monthly premiums, she has to take on a second job, making her life almost impossible, so that she can pay the additional cost of the premiums–the difference between the premiums for her old plan/a current Bronze or Gold plan and the Platinum plan she chose because–she says– the cheaper plan would have FORCED HER TO PAY $10,000 annually in out-of-pocket costs and the more expensive plan would have FORCED HER TO PAY $6,000 annually in out-of-pocket costs.
She says she’s angry because she wanted to keep her old plan. Why? Her old plan had nothing to do with the reason she says she felt comfortable with it, and everything to do with her doctor’s and her hospital’s generosity in voluntarily limiting her annual costs to $1,000.
Unless there’s something in the only new plans available to her, or something in the ACA, that prevents her doctors and her hospital from continuing to do that, than she’s baldly lying when she says she liked her old plan because she felt comfortable relying on the continued generosity of her doctors and hospital. The very moment this woman had the option of buying a plan that has a $6,000 rather than a $10,000 out-of-pocket yearly cap (along with no annual cap), she opted for the more expensive one that she must take on a second job to pay for.
I suppose it’s possible that her hospital and doctors told her last fall that she needed to purchase a Platinum plan or they would stop forgiving her expenses above $1,000. But that would be true even if her old plan had been grandfathered in under the ACA. Her claim that her doctors and her hospital would have happily continued to forgive annual expenses well above $6,000 or $10,000 but will not forgive annual expenses of $6,000, $6,500 or $10,000 is certainly false. And she certainly knows this.
May we call her a super-moocher? When she relies on individuals’ charity instead of by gum pulling herself up by her bootstraps and showing personal responsibility and accountability and paying all those bills herself out of pocket without expecting anyone to be generous to her?
Damn, she has been lucky. And she has no clue.
I think she absolutely has a clue, Carolannie. I also think she’s gievn the Dems a huge gift, if they just recognize it and use it–which, considering how timid the Dems’ political consultants and ad folks are, is doubtful.
The Dems sooooo need new consultants and ad people. Soooo, soooo, soooo need that.
Btw, I didn’t email Kessler until just a few minutes ago. Here’s what I wrote to him:
“I write for a blog called Angry Bear, and on Saturday I posted a lengthy post titled “What Glenn Kessler–and I–Missed Earlier In Emilie Lamb’s Claim: That She SAYS Obamacare Caused Her Hospital and Doctors to Stop Gratuitously Forgiving Her Medical Expenses Above $1,000. That’s Palpably False.” Today, in response to two comments to my post , I posted a follow-up to the original, at http://angrybearblog.strategydemo.com/2014/03/follow-up-to-what-glenn-kessler-and-i-missed-earlier-in-emilie-lambs-claim-that-she-says-obamacare-caused-her-hospital-and-doctors-to-stop-gratuitously-forgiving-her-medical-expe.html, which briefly summarizes the original and adds a couple of points in light of the two comments.
“The essence is that although it’s easy to miss–I did, at first–statements she made to you that you related in your Friday post necessarily contradict claims she made in the AFP ad and claims she made to you and to other news media folks. Specifically, unless her hospital and her doctors have told her that they no longer will forgive her uninsured expenses above $1,000 annually and have told her that they are doing so because Obamacare requires it, she had no reason to buy a Platinum plan rather than a Bronze or Gold plan–other than that, contrary to her statements to you, she was in fact afraid continue to rely upon the generosity of her hospital and doctors to keep her uninsured expenses affordable for her. Afraid enough that at her earliest opportunity, she opted for a plan that would limit her annual expenses to $6,000 a year rather than what she thought would be $10,000 a year–even though that meant she had to take on a second job, making her life almost impossible.
“Her claim is absurd that she was comfortable with an annual coverage limit of $25,000 and no out-of-pocket cap at all, but unhappy with an affordable option similar to the cost of her cancelled policy because that policy had (she thought) a $10,000 out-of-pocket cap and no annual coverage cap.
“She said she thought Obamacare would help her? What, pray tell, did she think it would do to help her that it hasn’t done?
Ms. Mann: Should I need it I have the VA, my disclaimer.
Most times I have my own doctor that I see, that I have associated with and done business because she is my Cousin. I don’t even get a bill, nada, nothing. She and her brother own controlling interest in a hospital so they don’t send me a bill either. Fortunately I’ll always been relatively healthy and active my whole life. Should I have to start paying $6,ooo a year I would be “unhappy” also.
STILL , no proof that the situation Ms. Lamb claims has been shown, only speculation.
I CONTEND that its WAY too early to start making decisions on whether ACA is helping or hurting.
I DO BELIEVE Obama is not always forthcoming with the TRUTH (Hey, how’s about that GITMO)
Ms. Lamb may well have been quite happy with her old plan or not, I can’t read her mind. I she says she is more dissatisfied now then I’ll not call it a lie, Teabag association or not.
The size of The ACA Bill(more than 1000 pages, I’m lead to understand) puts into immediate question on what controls are applied to her doctors. They may not be ALLOWED to forgive her any more
Hell, I may not be allowed to use my Cousin anymore, even though I love her and ABSOLUTELY TRUST her. Still, as I have said above, for what its worth, I have The VA.
As far as The Dems needing better PR I TOTALLY AGREE. IMHO the best way to get that said good PR would to start being truthful, lose the corruption, stop stabbing their constituency in the back.
Ms. Mann: Ms. Lamb said she could pay $156 per month, willingly. She now pays $373, I believe and its a strain as she is a lower income person. That’s around $2,500 a year more than the gold/bronze plan yet SAVES $3,500 a year in out-of-pocket.. She has a chronic illness, so its not unreasonable to expect her to pay the whole out-of-pocket every year. She most certainly would have a greater strain with the extra $1,000 per year out-of-pocket which may come in large chunks as opposed to a double up in monthly payments.
NONE-THE-LESS until actual bookwork on what has been paid and/or forgiven is produced, a spreadsheet, then its just speculation.
Bagger association does not necessarily make one guilty of falsehoods.
I am in 100% agreement with what you’re saying here Ms. Mann. I offered my comment only as an illustration of an aspect that doesn’t get factored in when analyzing all these “Obamacare doesn’t work” horror stories that the media keeps trotting out.
Drug company rebate and support programs and medical debt forgiveness plans come in many shapes and sizes and change frequently and that has nothing to do with any impacts from the ACA. I suspect and I have encountered several of these so called horror stories where the person claimed harm from ACA but was not disclosing one of these alternative support programs.
Ms. Lamb’s story seemed false on face but had an element that looked like it could be related to one of these types of programs which she either didn’t understand or didn’t disclose. My experience is that doctors and hospitals don’t regularly forgive debt outside of some established program that either offers a tax credit or some sort of rebate, for example in my state the state reimburses a percentage of uncollected medical debt to hospital systems.
I have a number of acquaintances who have been positively affected by ACA. They took the time to analyze their new options and made choices that benefited them. The media is focusing on people who have either made bad or even sometimes false choices because of either a lack of awareness or ideological predisposition that causes them to cut their nose off to spite their face. In some states political opposition to ACA has led to a dearth of good information on ACA choices and opportunities, an element of the story that has gone under reported as well.
Thanks for what you’re doing to highlight this stuff. My example was offered not as explanation or potential excuse but as an element that could get overlooked and may actually be a mitigating factor in proving some of these anti- ACA stories false.
“I DO BELIEVE Obama is not always forthcoming with the TRUTH (Hey, how’s about that GITMO)” = Mike Meyer-
Your slip is showing.
Exactly where have you see Obama not being forthcoming about the truth regarding Ms. Lamb? Why in the world is this comment in this topic?
There is only one reason, and strangely enough, that reason has been made clear in a previous topic in here regarding another bs anecdote from ATP:
“Julie Boonstra Says That Because Obama Lied to Her, She’s Entitled to Lie to Others.”
Mike, for whatever reason, you seem not to realize that, contrary to her representation in the ad, this woman had MANY CHEAPER OPTIONS, including (according to a commenter to my original post about her on Friday) SEVERAL that cost about the same OR SLIGHTLY LESS THAN the canceled plan she claims in the ad to have been happy with and claimed to Kessler that she was comfortable with.
The essence of her representation in the ad wasn’t simply that she was happy with her old plan–although, since she rejected options for about the same cost and unequivocally more comprehensive coverage for her current illness and for any other medical needs going forward, she appears to have lied even that she was happy with her old plan. The essence of ehr representation in the ad is that her CHEAPEST OPTION under an ACA-approved plan was one costing her substantially more in monthly premiums and therefore requiring her to take on a second job to pay for the premiums.
That was an unequivocal lie–and I’m not sure why Kessler thought it was worthy only of half the maximum in his lie-assessment score. Her key representation in that ad was outright false. Period.
Oh, absolutely, Mark, the information you’ve provided is REALLY important. I was unaware of it. I’d love to see Kessler or some other journalist contact Vanderbilt Medical Center and ask what their policy actually is for forgiving an uninsured’s or underinsured’s costs, and who it works. The pharmaceutical company may well be dramatically discounting her access to the drugs she needs, but I’d also like to know about other large expenses such as her surgical bills in 2007.
EMichael: Because ACA is Obama’s signature achievement. He’s staked his reputation on it. Closing GITMO was the FIRST thing he staked his reputation on.
Beverly Mann: Considering out-of-pocket she may well be right. Still, until some hard numbers are shown, a spreadsheet where WE can count pennies, then to call her out for falsehoods is wrong. Her choice may well be “cheapest” for her.
Gitmo has absolutely nothing whatsoever to do with the fact that this woman lied.
Thinking it does is beyond silly.
You want to criticize Obama for something? Find a topic that is relevant.
Btw, Mike, your comment to Beverly is beyond silly.
Think of the options open to the providers under Lamb’s old policy. Now, think of the options open to the providers under the new policy.
Do the math.
The only way any of this makes sense is if Ms. Lamb is enrolled in a clinical trial, in which case the costs would be borne by the trial. If the trial has ended then Vanderbilt would try and move her onto a health care plan. Indeed Vanderbilt does appear to have lupus medication trials underway and in the near past
EMichael: The whole concept of those ad are whether ACA IS as advertised by .gov. Therefore credibility IS THE ISSUE.
Well, I just suppose I don’t know those “options” of those policies, as NO DISPLAY OF THOSE POLICIES has been shown, THEREFORE no math doing is possible.
FACTS— where are they?
Got a copy of the ACTUAL policies, before and after???
“You can lead a horse to water, but a pencil must be lead.”
i think i am wasting my time with this, but just in case
i have no doubt that Obama, like all politicians, lies. And some of his lies have made me dislike him very much. But the other commenters here are right in insisting that you actually show that he is lying in THIS case, absent any other reason to suspect so. On the other hand, the lies that Ms Lamb is telling are fairly clear.
I believe, perhaps wrongly, that the insurance/medical complex is perfectly happy with Obamacare. But that will not prevent the Republicans from using the dislike the people have for Obamacare as a tool to create more permanent enemies for the Democrats. That’s pretty much the way politics works.
In your case, your previous record of not seeming to understand what you are talking about makes it easy for me to not try too hard to untangle what you are saying here. It’s a question of credibility, see?
Good grace, Mark. What in heaven’s name makes you think that Kessler, other fact checkers and journalists, and I are making the statements we’re making about the SPECIFICS of her old policy and her new one without HAVING the SPECIFICS of these policies. I’ve linked several times now to Kessler’s detailed article two or three weeks ago STATING THE SPECIFICS OF THE TWO POLICIES. I’ve made it extremely clear that I’m basing my comments on the specifics of the two policies as detailed by Kessler.
You say you don’t have the specifics of the two policies. I’ve stated, and re-stated, and re-stated, and linked again and again to Kessler’s blog stating, the specifics of the two policies.
I mean, like, WOW, Mike. This isn’t hard.
Spot-on, EMichael, with that lead-a-horse-to-water thing. You beat me to it.
Oooops. Make that, “Mike,” not “Mark.” Sorry, Mark
Beverly Mann: As I have said up thread CREDIBILITY, facts create credibility. If Kessler has those policies and pay schedules then why not cut and paste them here and END the questions?
Coberly: Geez Coberly, just because I don’t think SS is broken and therefore won’t “echo” YOUR TAX increase, doesn’t mean I don’t “understand” when I’m NOT being presented the facts on a subject. Perhaps the “problem” is I understand too much?
“Never argue with stupid people, they will drag you down to their level and then beat you with experience.”
― Mark Twain