Relevant and even prescient commentary on news, politics and the economy.

Okay, so why was Julie Boonstra advocating for lower-cost oral chemotherapy treatment in Washington when she was getting that medication for a set, low monthly price under the insurance plan she liked and did not want to part with? Was she concerned about reaching her annual or lifetime coverage cap?

Boonstra is the ex-wife of Mark Boonstra, the former Washtenaw County GOP chairman whom Gov. Rick Snyder appointed to the Michigan Court of Appeals in 2012. Julie Boonstra said she’s never been a political person beyond advocating for lower-cost oral chemotherapy treatment in Washington. [My boldface.]

Dexter cancer patient who called health care ‘unaffordable’ will save more than $1K, Marisa Schultz, Detroit News, Mar. 10

Boonstra famously was quoted in that article as saying when told the details of her new Blue Cross plan that it  “can’t be true” that that plan is cheaper, by a minimum of $1,200 for the year, than her old plan. “I personally do not believe that,” Boonstra told Ms. Schultz.   Schultz continued:

She said she still fears her costs will be unaffordable because she could be hit with large out-of-pocket bills in the early months when she wouldn’t have the money to pay. She also said her out-of-pocket maximum could be higher than advertised because there’s one prescription that was previously covered by her old plan that isn’t and she now buys with a separate prescription discount card.

An interesting comment thread developed here during the last few days in response to my post on Tuesday about the Detroit News article.  I titled that post “Julie Boonstra Tells the Detroit News Why Her New Healthcare Plan Doesn’t Work for Her: It Requires Her to Read the Policy or Ask Blue Cross a Few Basic Questions In Order to Learn What the Plan Actually Covers and What Her Expense Cap Is.”  One subject of the discussion concerned her statement that there’s one prescription that was previously covered by her old plan that isn’t and she now buys with a separate prescription discount card.  I pointed out that she does not say that that prescription is part of her cancer treatments, and that according to a Blue Cross spokesperson Ms. Schultz contacted for the article, it is not; all her cancer drugs are covered.

I also noted that Boonstra has not said that her old plan covered all medications.  She just said it covered all of her current medications.  And since I happen to know, having shopped there many times, that there is a Rite Aid pharmacy on the far west side of Ann Arbor, just east of Dexter, a village that is a small bedroom community mainly for people who work in Ann Arbor, I posted this from Rite Aid’s website:

Rite Aid, 500 generic-brand prescriptions available: $9 for a 30-day prescription; $16 for a 90-day one.

I also said in that comment something that, surprisingly, no one else (to my knowledge) has mentioned:

She also, by the way, has not said–because she doesn’t know, and either does Blue Cross–what her old plan would have cost in monthly premiums and out-of-pocket expenses and co-pays THIS YEAR, had the plan not been discontinued. But it sure as hell would be interesting to know how her old plan differed in costs and coverage last year from the year before, and how much her premiums and out-of-pocket and co-pay costs went up in, say, the last five years on that plan.

But there’s an even more fundamental question about Boonstra’s comments to Ms. Schultz: Why was Boonstra advocating for lower-cost oral chemotherapy treatment in Washington during a period when she was paying set, low monthly out-of-pocket costs and was happy with her plan?

When I first read the article it seemed strange to me that this anti-federal government Republican was advocating in Washington for federal regulation of the cost of a particular medical prescription.  But only after reading through the comments to my post on the article, in which I did not mention that statement of hers, but a commenter to the post did, did it occur to me that there was something more, something fundamental, wrong with this picture.

This clearly is someone who is locked deep inside the Fox News/Rush Limbaugh sphere of reality.  She seems to want a single-payer, Medicare-for-all type of healthcare insurance system, and wants the actual benefits of the ACA, including, apparently–no, undoubtedly–the removal of annual and lifetime caps on coverage. And it’s a safe bet that she personally does not believe that the ACA includes these bars, and that that is why her old plan was cancelled.  It can’t be true, because Fox News and Rush Limbaugh haven’t mentioned it.

This woman is among those who cannot be reached with facts.  But they are in the minority among the electorate. It’s deeply unfortunate that our Democratic president won’t educate the public about the actual specifics of the plan.  He doesn’t do specifics in speaking to the public, and doesn’t do facts and explanations at all. And he certainly doesn’t do refutations of misinformation.

We know by now that hell will freeze over before he refutes Boonstra, Emilie Lamb and the others in the AFP ads, and I guess that’s okay, because everyone’s tuned him out anyway.  But why has it taken so very, very long for the Dems to begin to take over this slack?  Their failure to do do this because Obama is unpopular is a key reason why Obama is so unpopular. Or at least a key reason why Obamacare is unpopular.  Which, apparently more than anything else, is what matters this election cycle.

As for Boonstra, reader Alex Bollinger posted this comment this morning to my earlier post:

Yes, we should feel compassion for this woman. And our blame should be mostly on the political consultants who are taking advantage of her loyalty to movement conservatism (I don’t think she’s stupid at all because I’ve seen very intelligent people really, really want to believe something is true so much that they believe their rightthink).

But her comments are intended to rescind the ACA, which has already insured over 12 million people. I’m sure there are people who either have or will get cancer among those 12 million. Just because they don’t have TV ads doesn’t mean that their lives aren’t important as well, and Boonstra has the ability to temper her ideological fervor with, you know, having a basic understanding of her plan before going on national TV to talk about it.

Exactly.

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Julie Boonstra Tells the Detroit News Why Her New Healthcare Plan Doesn’t Work for Her: It Requires Her to Read the Policy or Ask Blue Cross a Few Basic Questions In Order to Learn What the Plan Actually Covers and What Her Expense Cap Is.

Oh, dear. I won’t summarize this for you; you really have to read it in full.  (Or maybe just read Glenn Kessler’s article about it posted today.)

And to think I had thought Julie Boonstra’s only comprehension problem was with basic math.  Turns out she also has a problem with reading comprehension and with understanding explicit short answers to oral questions posed to, say, a Blue Cross representative. Or maybe just with recognizing that she could learn the specifics of her plan simply by doing one or the other of those things.

Hey, she could have done both!  But first she’d have to have figured out that reading her plan or asking a Blue Cross representative might provide that information.

Yep.  The Republican Party really is the party of stupid. Then again, maybe she knew all along, but thought everyone else is stupid. Okay, I’ll give in and quote this, from Kessler’s post:

Boonstra’s response to this report was that it “can’t be true” because she was worried about high expenses early in the year and because she thought one of her prescription drugs was not covered. A spokesman for Blue Cross told the News that all of her prescriptions are covered and her co-pays on the drugs would help with meeting her out-of-pocket maximum.

It can’t be true, because the truth exists not in reality but instead in her mind. Hopefully, this woman doesn’t fear a nuclear attack by Martians.  Or by the Koch brothers, although that might be prescient, if the attack is to be on, say, Nancy Pelosi’s congressional district.

Seriously, folks.  Does anyone really think this woman had no idea what her plan provided, if not when she purchased it, then sometime shortly afterward?  This new information brings into question the truth of her back-story about being unable for nearly three months to access the Michigan link at healthcare.com and gain information about available plans.  (It also raises questions about whether she is in fact receiving subsidies for her new in-any-event-lower monthly premiums, although of course there is no way to learn that.)

Let’s hear it for Detroit News reporter Marisa Schultz.  And, for those of you who are unfamiliar with the Detroit newspaper market: Detroit has two longtime mainstream newspapers, the Free Press, which leans Democratic, and the News, which leans Republican, but both papers’ reporting staffs are journalists in the old-fashioned sense. They’re real journalists, not propagandists.

Yes, folks. The Detroit News leans Republican.

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Julie Boonstra Continues to Play (Ridiculously) Dumb, as Americans for Prosperity Now Concedes She’s Looking a Gift Horse in the Mouth

In post-initial-ad interviews with fact checkers and with her hometown newspaper, [Boonstra] claimed that the problem was the uncertainty now of not knowing month-to-month what her out-of-pocket expenses will be, whereas she had always reached the low monthly out-of-pocket expenses, and budgeted for that amount monthly.

In other words, her entire complaint is that she might spend the additional $550 a month as soon as she gets it, on something unrelated to her medical care, and then her out-of-pocket expenses totaling an annual maximum of her yearly savings of about $500 on her monthly premiums will become unaffordable.

Julie Boonstra’s Follow-Up Ill-Woman-Who-Cries-Wolf AFP Ad Is Here!, me, yesterday

Weirdly, in an article by Cameron Joseph on The Hill blog yesterday and updated today, AFP President Tim Phillips concedes that Boonstra’s real problem is that she can’t do simple math and therefore can’t budget from one month to the next.  Joseph reports:

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Julie Boonstra’s Follow-Up Ill-Woman-Who-Cries-Wolf AFP Ad Is Here!

Hmm.  Leukemia patient Julie Boonstra and Americans for Prosperity are up with a new ad in Michigan, Boonstra’s home state.  This time, she thinks people are too stupid to wonder why a healthcare plan that costs her less annually than her cancelled plan for identical care “doesn’t work for [her].”  And too stupid to wonder why she originally claimed that that plan is “unaffordable” even though her earlier plan for slightly more money annually was affordable.

“My plan doesn’t work for me,” she says, dramatically.  She just doesn’t say why.  Which is understandable, since we all know by now that her plan works just fine for her.

That’s right; her plan works just fine for her.  She just doesn’t want people whose plan doesn’t work fine for them, or who have no access to a plan at all, to have one that works for them.

She says early in the new ad that it was painful to her that Rep. Gary Peters, the Dem Senate candidate in November, challenged her credibility after her last AFP ad, in which she claimed that her new ACA-compliant plan was unaffordable because of higher out-of-pocket expenses than her own plan, and implied that she would be unable to continue to see the specialist she’d been seeing.

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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.

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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.

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Michigan Republican Senate Candidate Terri Lynn Land Comes Out For Single-Payer Healthcare Insurance! Seriously!*

As far as Julie Boonstra being taken advantage of, I don’t think it’s just AFP that’s involved. She owns a home in Dexter with the former chair of the Washtenaw County Republican Party Mark Boonstra.

Eclectablog, this morning

Hmm.  Okay, so it’s not just Ms. Boonstra who can’t perform simple math, it’s also former Washtenaw County Republican Party chair Mark Boonstra who can’t, at least if he communicates regularly with the person with whom he owns a home in Dexter, Mich.  Or maybe he can, but just didn’t.

In any event, the Americans for Prosperity ad featuring Ms. Boonstra has been targeting Rep. Gary Peters, the Dem candidate to replace retiring Sen. Carl Levin. Peters’ opponent is Terri Lynn Land, a former Michigan secretary of state, who earlier came out for full repeal of Obamacare.  Michigan is one of the few states with Republican governors to adopt the ACA’s Medicare expansion, which will begin this spring and, as Greg Sargent points out, will provide healthcare coverage to about 400,000 Michigan residents.

Given Land’s repeal-Obamacare stance, Sargent asked her campaign whether she wants the Medicaid expansion repealed along with the rest of the law.  Sargent published the campaign’s response to him yesterday:

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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.

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Julie Boonstra, Americans for Prosperity, and the Triangle Shirtwaist Factory Fire Trial

The Tea Party group Americans for Prosperity has now released its factual documentation for its misleading ad featuring Julie Boonstra, a Michigan woman stricken with Leukemia who suggests Obamacare forced her to take on a new plan that is now “unaffordable.” The ad has been widely pilloried ever since Glenn Kessler discovered that her premiums had come down, likely making her overall costs a wash or even cheaper. Gary Peters, the Dem candidate for Senate in Michigan, had written to TV stations insisting on documentation.

The documentation provided by AFP, which was passed along from TV stations by the Peters campaign, doesn’t actually back up the ad’s key claim. But it tells us something interesting about how the AFP campaign — and by extension, the broader GOP strategy against Obamacare — really work.

To buttress the ad’s charge that Boonstra’s “out of pocket charges are so high, it’s unaffordable,” AFP cites a single Politico article reporting that “consumers may have to dig a little deeper into their wallets to pay for health care in the Obamacare insurance exchanges,” because the law could mean additional out of pocket expenses. Needless to say, that doesn’t shed light on Boonstra’s individual situation. And on that front, AFP’s documentation offers this (emphasis mine):

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