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:

MIKE MEYER:

What if Lamb is telling the TRUTH?

MARK:

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….

ME:

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.

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