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. [UPDATED.]
“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
I posted yesterday about the odd claims in this ad and about Glenn Kessler’s exchange with her in which she told him exactly WHY she was so happy with her old policy, which, she indicated, had a $25,000 cap on annual benefits, and no limit on out-of-pocket costs, and that it would only cover generic medications. The reason: That her hospital, Vanderbilt Medical Center in Nashville, and her Vanderbilt-affiliated specialists, were forgiving her payments, including for intravenous medications provided multiple times weekly, above $1,000 annually.
Kessler said she told him that in 2007, before she was diagnosed with lupus, she “fell off a horse, requiring seven surgeries at Vanderbilt Medical Center.” And that one surgical bill was for $125,000, but that “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.” She said, “Really after that, I was not worried about something catastrophic”–something that would exceed the $25,000 cap.
Kessler continued:
To put her [lupus] 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.
And then he provided more details from his communication with Lamb:
Once Lamb was required to go on Obamacare, she discovered she qualified for a $15-a-month subsidy, which could be applied to nearly 40 different options. She chose one of the more expensive options—a Platinum plan – because it limited out of pocket expenses to $1,500, as her doctor fees and blood tests would be higher under the Obamacare plans. She also considered a plan with a lower premium, but it would have meant higher out of pocket expenses. “Instead of paying $6,000 a year, I would have been paying $10,000 a year” with the plan with a lower premium, she said.
I titled my original post: 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. But today I reread Kessler’s post after I reread my own, and I realized that her claim is this: that pre-Obamacare, she had been subsidized by her doctors’ and her hospital’s largesse, but that because of Obamacare her doctors and her hospital were now requiring her to pay her full out-of-pocket costs–all her medical costs that are not covered by her new insurance plan.
The chance that this true is zero. Its sheer absurdity is why, upon first reading or hearing her complaint, it doesn’t immediately register that that is its sum and substance. She’s saying that when she had a policy that had no caps on out-of-pocket expenses, and an annual cap of $25,000 (probably well below her annual medical bills each year), her doctors and her hospital were willing to forgive all but $1,000 of those bills each year. But that now that she has a policy that has no annual cap and has a $6,000 out-of-pocket cap-–so that the hospital and doctors will receive much more of the amounts they bill than they were before–they’ve told her that she now has to pay in full that $6,000 a year. And that she chose a platinum plan rather than a lower-cost plan that has a $10,000 cap on out-of-pocket expenses because her suddenly uncooperative hospital and doctors would require her to pay the full $10,000 in annual out-of-pocket expenses rather than just the full $6,000 in full annual out-of-pocket expenses for the platinum plan. Because of Obamacare.
No matter that Obamacare has a maximum annual out-of-pocket cap of about $6,500.
Because of Obamacare, her hospital and doctors said they would require full out-of-pocket payments from her rather than forgive the now-much-smaller amounts above $1,000 a year that her insurance plan will cover. So because of Obamacare she chose a platinum plan rather than a gold or bronze one that was the same cost as her cancelled one. No, she didn’t chose the platinum plan out of fear that her old tin plan would leave her bankrupt or unable to access the care she needs if her hospital and doctors suddenly withdrew their largesse. Uh-uh. Because of Obamacare she suddenly needed a platinum plan. So she bought one. Even though paying for it makes her life almost impossible.
Reader Urban Legend posted this comment to my earlier post:
Besides the fact that her policy was crap, it appears there are numerous bronze or silver plans available in Tennessee to a 40-year-old for between $150 and a little over $200 (in Davidson County, Nashville, presumably the most expensive county in the state) . That is the overwhelming majority of plans, and that is without any tax credit assistance. Plans near $373 for someone that age are gold or platinum plans, some with $0 deductibles and out-of-pocket maxes at $1500 or less.
And presumably her employer is continuing to contribute the same amount as before. She was happy with her old plan, but would not have been happy with one for about the same cost as that old plan and that has better benefits, so that more of her medical bills will be paid by her insurer. Her hospital and her doctors now want her to pay her full medical bills that are not covered by her insurance, and they didn’t before Obamacare.
Her hospital and doctors must be Republicans. She shouldn’t have told them she voted for Obama, thinking that the ACA would help her. They sure showed her!
And to think she had thought Obamacare would help her–by requiring her hospital and her doctors to provide free lifetime healthcare for her, saving her $1,000 a year.
Lamb, it turns out, was, like Julie Boonstra, a guest of her Tea Party Republican congressional representative at the State of the Union address. And, like Boonstra, she’s a pretty cheap date.
—-
UPDATE: Here’s an exchange between reader EMichael and me this morning, 3/2, in the Comments to this post:
EMichael:
I wonder what the financial effects on the hospital and doctors who are forgiving her debts?
And who pays for that forgiveness?
Another thought, I wonder if Ms Lamb has already been hit by the IRS for this past debt forgiveness, or will be hit now that she has gone public?
ME:
Hi, EMichael. My earlier post on her did make the point that it’s the federal government (in very substantial financial assistance to hospitals for the very purpose of helping them cover the uninsured or the underinsured–an important purpose of the ACA), and her doctors, and people who do have comprehensive insurance, that have been footing her very large medical expenses. In this current follow-up post, I make the point–which I originally missed and which Kessler missed–that she makes, in essence, a key claim to Kessler that surely is false: that her hospital and her doctors have told her they will no longer forgive her uninsured bills that total more than $1,000 a year, and that their reason is Obamacare.
And if THAT is false, and her hospital and her doctors have told her no such thing, then she was flagrantly lying by saying that she was happy with her old plan. If she was happy with her old plan, which had NO cap on out-of-pocket expenses and a total annual cap of $25,000, because she felt she could continue to rely on the generosity of her hospital and doctors to forgive all but $1,000 a year, why would she have been unhappy with a bronze or gold plan that would have paid her hospital and doctors more than her old plan did? Why did she believe that she now would have to pay out-of-pocket expenses of $10,000 annually under a plan that would have cost her and her employer–who presumably is still contributing the same amount as last year–the same as her cancelled plan did last year, and instead chose a platinum plan whose premiums are causing her to take a second job and making her life almost impossible in order to have to pay $6,000 a year rather than $10,000 a year in out-of-pocket expenses? Why is she suddenly no longer comfortable relying on the special $1,000 annual cap that her hospital and doctors were providing her, and why is she claiming that Obamacare is at fault?
I’m going to email Kessler and ask that he inquire further about this. If Lamb refuses to answer, maybe he can ask the Vanderbilt Medical Center whether they’re now refusing to forgive out-of-pocket expenses because of Obamacare, and, if so, what it is in the ACA that has caused them to make that decision. If Kessler won’t do it, I’ll ask PolitiFact or even Greg Sargent to do it.
This is serious stuff. This woman has so little concern for others who have serious chronic illnesses that she’s willing to baldly lie in exchange for a free trip to Washington. Wow. I mean, really. Wow.
I’ll add that I’m pretty sure that the IRS does not consider a hospital’s or doctor’s forgiving of medical costs to a patient who cannot pay those costs taxable income. I certainly hope it doesn’t. It’s basicly a gift of medical services. But Ms. Lamb pretty much personifies the ultimate in chutzpah by claiming falsely that Obamacare has, rather than helped her, instead made her life almost impossible by causing her hospital and doctors to stop forgiving her uninsured medical bills of more than $1,000 a year because under Obamacare those uninsured medical bills will be much lower and because she chose to pay more in order to reduce those uninsured medical bills to $6,000 a year rather than to $10,000 a year–now that, thanks to Obamacare, she has access to private healthcare plans.
Several commentators have noted that the AFP ads curiously stage only middle-aged women who have chronic life-threatening illnesses, and who make “reasonable judgments” that they were harmed, based upon flatly false beliefs or representations.
So here’s what I suggest to the Democrats: Have a middle-aged woman who has a chronic life-threatening illness ask in an ad why the AFP keeps portraying middle-aged women who have chronic life-threatening illnesses as deeply ignorant, seriously math- or logic-challenged, or just plain easily manipulated. In fact, of course, these women are knowingly propagating a fraud about what they, of all people, know is, for many, many others a life-or-death, or bankruptcy matter.
They’re con artists, pure and simple.
I wonder what the financial effects on the hospital and doctors who are forgiving her debts?
And who pays for that forgiveness?
Another thought, I wonder if Ms Lamb has already been hit by the IRS for this past debt forgiveness, or will be hit now that she has gone public?
Hi, EMichael. My earlier post on her did make the point that it’s the federal government (in very substantial financial assistance to hospitals for the very purpose of helping them cover the uninsured or the underinsured–an important purpose of the ACA), and her doctors, and people who do have comprehensive insurance, that have been footing her very large medical expenses. In this current follow-up post, I make the point–which I originally missed and which Kessler missed–that she makes, in essence, a key claim to Kessler that surely is false: that her hospital and her doctors have told her they will no longer forgive her uninsured bills that total more than $1,000 a year, and that their reason is Obamacare.
And if THAT is false, and her hospital and her doctors have told her no such thing, then she was flagrantly lying by saying that she was happy with her old plan. If she was happy with her old plan, which had NO cap on out-of-pocket expenses and a total annual cap of $25,000, because she felt she could continue to rely on the generosity of her hospital and doctors to forgive all but $1,000 a year, why would she have been unhappy with a bronze or gold plan that would have paid her hospital and doctors more than her old plan did? Why did she believe that she now would have to pay out-of-pocket expenses of $10,000 annually under a plan that would have cost her and her employer–who presumably is still contributing the same amount as last year–the same as her cancelled plan did last year, and instead chose a platinum plan whose premiums are causing her to take a second job and making her life almost impossible in order to have to pay $6,000 a year rather than $10,000 a year in out-of-pocket expenses? Why is she suddenly no longer comfortable relying on the special $1,000 annual cap that her hospital and doctors were providing her, and why is she claiming that Obamacare is at fault?
I’m going to email Kessler and ask that he inquire further about this. If Lamb refuses to answer, maybe he can ask the Vanderbilt Medical Center whether they’re now refusing to forgive out-of-pocket expenses because of Obamacare, and, if so, what it is in the ACA that has caused them to make that decision. If Kessler won’t do it, I’ll ask PolitiFact or even Greg Sargent to do it.
This is serious stuff. This woman has so little concern for others who have serious chronic illnesses that she’s willing to baldly lie in exchange for a free trip to Washington. Wow. I mean, really. Wow.
Oh, I agree. The idea is absurd(as you say).
And I feel this woman should pay a price for her actions. Hopefully, the IRS will notice the assistance she has claimed and takes action. Curiously, her new policy will limit her tax liability. Course, then the ATP will claim another IRS scandal.
Just goes to show; there’s always something.
EMichael, I just updated my post to add your comment, my response, and some additional comments of my own.
PS: My additional comments do include that I’m pretty sure that the forgiving of medical costs that the patient can’t afford to pay is not considered taxable income, though. Nor, in my opinion, should it be. But this woman needs to be exposed as the con artist she is.
“In general, if you owe money and it’s eventually written off, as far as Uncle Sam is concerned, the destroyed debt is taxed like income. Using Mike’s example, since he’s no longer on the hook for $23,000 of his $30,000 medical bill, he’ll be getting a 1099-C at the end of the year for $23,000.
This might not seem fair. After all, it’s not like Mike got a check for $23,000. The forgiven debt is more like a gift, and gifts aren’t taxable. So why would the IRS treat this forgiven debt as income?
The logic lies in the way income and losses are treated for tax purposes. Basically, it’s yin and yang: One man’s deduction is the other man’s income.
When it comes to business, most transactions involving money are deductible to the one paying it and income to the one receiving it.
For example, if a bank pays interest on your savings account, they get to deduct that money as an expense on their taxes – and you count it as income on yours. And if the bank lends money you don’t pay back, the bank deducts the bad debt as an expense – and you have to include it in your income.
In short, the term “debt forgiveness” makes it seem like a gift, but it’s more like “debt deduction.” When one party is writing something off, the opposing party is typically reporting it as income.
That’s the rule and the logic behind it. But as with many rules, especially those relating to income taxes, there are many exceptions. Let’s look at a few.”
Read more at http://www.moneytalksnews.com/2012/05/29/ask-stacy-if-i-settle-a-debt-do-i-have-to-pay-taxes/#zsBmmr8zHbc2iZU0.99
Course, there are ways to not have this be a liability and maybe this woman qualifies. But somehow I like the idea of her getting a phone call from the IRS.
Interesting thoughts relevant to this topic. And an interesting group not relevant to this topic.
“Miller, Kunstler, and Hrbek told Tax Analysts that forgiveness of the debt does not result in income to the debtor if that forgiveness comes from a detached and disinterested generosity. Lion said these debtors seem to have a good case that they’re receiving an exempt gift rather than a taxable gain.Mayer agreed, saying the debt forgiveness counts as a gift under section 102. He said that when Rolling Jubilee buys the debt, it doesn’t know who the beneficiaries are but discharges the debt purely out of a desire to benefit those who incurred it.
“It seems to be that’s about as detached and disinterested as you can get,” Mayer said. “The one weird thing is usually you don’t think of entities being detached and disinterested givers — you just think of individuals.”
Robert Willens of Robert Willens LLC said he believes the IRS would resist the characterization of these cancellations of debt as gifts but that they’ll “get lost” in the reporting process anyway.
“Since there’s no way for the IRS to verify all this, there won’t be much enforcement on their part,” Willens said. “That’s not the way we like to do tax planning, but I guess it could work.”
Mayer said he doesn’t expect immediate IRS movement regarding any aspect of the Rolling Jubilee program. Unless the dollar volume grows higher or there’s an indication of someone with Rolling Jubilee personally profiting, it won’t be a high priority for the IRS, he said.
Mayer said he doesn’t think the IRS would act “until at least an initial [Form] 990 is filed,” adding, “Even then, of course, the IRS has three years at minimum to audit the 990, and they may or may not bother to do so depending on their other priorities.”
http://strikedebt.org/taxanalysts/
“In fact, of course, these women are knowingly propagating a fraud about what they, of all people, know is, for many, many others a life-or-death, or bankruptcy matter.”
If not the women certainly the producers of the ads are perpetrating a false claim. I wonder how the FTC rules regarding false advertising, specifically concerning advertisement endorsements, comes into play in response to such ads.
“The FTC’s Endorsement Guides: Being Up-Front With Consumers”
“Endorsements are an important tool for advertisers and they can be persuasive to consumers. But the law says they also have to be truthful and not misleading. The FTC’s Guides Concerning the Use of Endorsements and Testimonials in Advertising are guidelines designed to help advertisers of all stripes – TV, print, radio, blogs, word-of-mouth marketing – make sure that they meet this standard. For example, advertisers are advised that using unrepresentative testimonials may be misleading if they are not accompanied by information describing what consumers can generally expect from use of the product or service. In addition, the Endorsement Guides let endorsers know that they shouldn’t talk about their experience with a product if they haven’t tried it, or make claims about a product that would require proof they don’t have. The Endorsement Guides also state that if there is a connection between the endorser and the marketer of a product that would affect how people evaluate the endorsement, it should be disclosed. The Guides are not regulations, and so there are no civil penalties associated with them. But if advertisers don’t follow the guides, the FTC may decide to investigate whether the practices are unfair or deceptive under the FTC Act.”
http://www.ftc.gov/news-events/media-resources/truth-advertising/advertisement-endorsements
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.
Feel free to e-mail me if you want more details.
Mike, Beverly and EMichael have made a good case that Lamb CAN’T be telling the truth, but in any case, Beverly is asking Kessler at the Post to follow up on their understanding of it. Did you not read either part of that? And if you did, what else do you expect Beverly should do about it? Kessler can follow up on it pretty easily, if he wants to. Unfortunately, I don’t think he has the best reputation for doing so.
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.
The only way ANY of this makes sense is if she is enrolled in an NIH or pharma sponsored study, probably phase II or III. In which case she is still enrolled, and they may be looking to recover additional costs based on the ACA.
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