I hate to have to keep doing this, but Lori Gottlieb is complaining about ObamaCare in the pages of the New York Times. She claims that her health insurance carrier dropped her coverage and that she will have to pay $5,400 more annually than she was paying in order to get a new policy. From the article, I learned that she is 46 years old, a single mom, and a self-employed psychotherapist.
To try to get an idea of how much she will need to pay for insurance, I had to make a few assumptions. I assumed that she lives in Los Angeles County (since she used a Los Angeles byline), although she might not. And I don’t know how many children she has, so I gave her two. Psychotherapists generally make a good living, but Ms. Gottlieb suggested that she narrowly exceeded the cut-off to be eligible for a subsidy. The cut-off for a family of three is $76,360 so I decided to be generous and assume she makes $80,000 a year. Using the Covered California shop and compare tool, the cheapest Bronze plan Ms. Gottlieb is eligible for will cost $426/mo (L.A. Care Covered Bronze 60). That’s an annual cost of $5,112. How does that square with this claim?
THE Anthem Blue Cross representative who answered my call told me that there was a silver lining in the cancellation of my individual P.P.O. policy and the $5,400 annual increase that I would have to pay for the Affordable Care Act-compliant option: now if I have Stage 4 cancer or need a sex-change operation, I’d be covered regardless of pre-existing conditions.
Unless her old plan actually paid her $288 a year rather than charging her anything, it is impossible that she is facing a rate hike of $5,400. She’s either misinformed or the worst kind of liar.
No slight tweak in my assumptions (about her income, number of children, or county of residence) could come close to making her claim true.
A lot of these articles are padding the annual cost with the amount of the deductible to estimate an actual out-of-pocket cost before one gets benefits. Given the nature of insurance, the cost-benefit approach gives you a dishonest argument. It does not factor in actuarial realities. Insurance after all is about covering risk.
I cared greatly for this response comment to Gottlieb’s post in the Times (the author claimed she only got two sympathetic responses from over 1,000 Facebook friends):
MaryD
Chicago
Ms. Gottlieb, Maybe you should take the hint from your facebook (and real life) friends and take a good hard look at yourself.
The pre-ACA insurance landscape created winners and losers in the individual market. The winners were the healthy who could get reasonably affordable premiums and decent coverage. The losers were anyone with a chronic condition, a family history of a serious illness, a past history of a serious illness, inadequate income to afford the premiums, or the bad luck to have a serious accident or illness after getting the individual policy, after which their coverage would be changed or eliminated.
Thanks to the ACA, there are now protections in place for those “losers” who were locked out of individual policies previously. But those “winners” whose low rates were a product of those discriminatory exclusions are now seeing their rates go up.
You seem to be a person who does not care about correcting an injustice done to others if it affects your own bottom line. But you should realize that the ACA serves your own selfish self-interest as well. Because sooner or later, you are going to get sick, and sooner or later it will be serious. Your child could get a serious illness or have an accident. Thanks to the ACA, your private policy won’t be able to drop you if any of those things happen and you will be guaranteed a decent level of coverage– don’t you see that these reforms are a protection for you and your child as well?
Ok now that I have the computer open and can actually check, let’s compare apples with apples (or my best attempt):
Disclosure: I work for the Feds, not sure how you could get greater bargaining power than the largest employer. So this is probably the best you could get through an employer, especially because a lot of large companies have been going the HSA route (I know the Silicon Valley companies and Microsoft/Amazon et al. have), or increasing people’s deductibles. I am also not subscribed to any of these plans, and am still on dad’s insurance.
Work Plan
Kaiser P. HMO
Monthly Premium (pre-employer contribution): $385.86
Monthly Premium (post-employer contribution): $96.46
Deductible: $0
Out-of-pocket max: $3500
Primary in-network: $20 copay
Specialist: $30
Imaging (MRI etc): $100
Generics: $12
Out-patient surgery: $150
ER: $125
Urgent care: $30
Exchange in VA
Kaiser P. HMO
Monthly Premium (pre-subsidy): $279.51
Deductible: $0
Out-of-pocket max: $6350
Primary in-network: $20
Specialist: $40
Imaging: $20
Generics: $10
In-patient surgery (out patient not shown): Free
ER: $250
So yes, she is fucking full of shit.
Wait, out-patient surgery was shown, I just didn’t see it:
Out-patient for the exchange plan: 30% coinsurance
Urgent care: $40
So you’re younger than 26? I would have thought you were much older based on your posts and I mean that as a compliment.
Work plan out of pocket max – $3500
Exchange plan out of pocket max – $6350
There’s a world of difference in those figures that you would appreciate more if you were forty years older.
Yes I am 25. Thanks. I’ll be jumping off of it this open-season, methinks. I went to urgent care recently and it was ~$80 out of pocket and $10 per generic. He’s with Microsoft and has a PPO/HSA.
Oh I know that’s a world of difference; it’s probably the main sticking point that I am seeing with plans on the exchange vs. with work. The out-of-pocket maxes are higher (on average) with the exchange, but the premiums (pre-subsidy) are lower. Could be a wash.
However, the family out of pocket maxes are still too high. For example, out-of-pocket max for family with work is $7000. With the Exchange it’s around $12,700.
Yes, it would absorb the whole year’s income and then some for a McDonald’s or Walmart employee. Hell, it would take 40% of my take home pay for a year and my income is above average. That would be a financial disaster.
A McDonald’s employee or Wal Mart would probably be eligible for the Medicaid expansion, especially if they were single with children.
Also remember that out of pocket stuff is on a sliding scale with income. So even if the sticker Silver plan is a high(er) out of pocket max, someone who is at ~250% FPL will be paying significantly less than what the plan says they will.
See here:
Cost sharing subsidies and the near poor
For instance, a family on a Silver Plan with a $3000 listed deductible would only be responsible for $600 of the deductible. I think the family is still on the hook for the $600 instead of transforming the deductible into a sliding scale co-insurance. A family making just under 250% of federal poverty line would get a 10% discount on their out of pocket expenses. These subsidies transform a Silver plan for a family making under 150% of FPL into a Platinum plus plan, and for families making between 150% to 200% FPL, their Silver plans get transformed into very good Gold plans to weak Platinums.
They’re eligible for the Medicaid expansion in states where it was expanded. A number of states have refused to expand it. They tend to be the ones with the worst poverty rates, as well as the ones with Republican governors and legislatures. Gee, I wonder what the causality is there?
Hospitals are going to be hurting in states that didn’t get it. Expect a major lobbying push soon.
So I didn’t know you were actually like “employed” by Sawant. I hear it’s down to the wire ;). Good luck.
These plans aren’t supposed to be 100% comparable to work plan, we should be comparing to what’s on the market now for individuals. Group plans will always be a little better given group buying power.
My point of the comparison is that the exchange plans are coming out with numbers that are comparable to that of work plans, including those of large companies with a lot of bargaining power. IMO it puts the exchanges in a positive light.
I think I replied to the wrong person, I meant to reply to Wilderness’s post but yes you’re right.
The exchanges were meant to function as a group plan that pooled the risks of all individual within a state.
The penultimate group plan, remember, is Medicare-for-All. And the ultimate group plan is Medicare-for-All operated by the World Health Organization–a single global pool.
The two best comments/rebuttals on the article, which came in back-to-back:
and
wow! that is a great comment
Also just tweeted this at NYT public editor Margaret Sullivan:
“Why don’t all NYT pieces about the ACA, pro or con, include figures that can be fact-checked?”
I’m not expecting an answer.
https://twitter.com/AntonSirius/status/399949127414734848
Exactly – it almost sounds as if this woman was being lied to by her health insurer – they are doing it like crazy right now – who is trying to steer here into the wrong plan.
It’s one thing that the individuals quoted these stories are either deluded or have been lied to. It’s quite another that reporters or editors never bother to do even the minimal online check Boo is doing, that casts all their assertions into doubt.
If these outlets were accustomed to practicing journalism, rather than stenography, you wouldn’t see these sorts of stories at all. Then again, if unicorns could fart glittery rainbows the world would be a lovelier place, too.
Does the NY Times have Lara Logan envy?
Stunning that they can’t even bother spending five minutes to check on the plausibility of Gottlieb’s claim.
You know, this is some important stuff going on here. Newspapers have a duty to determine if the claims citizens are making about their personal encounters with the ACA are true. To allow false and damaging information to enter the public discussion in this way will cause Americans to avoid pursuing real information about their options. The Times is doing the work of Fox News here, unless they run a response Op-Ed from someone (Martin, perhaps?) who directly and specifically refutes what Lisa Gottlieb claims here.
You are comparing to a Bronze plan. What is the comparison to a Gold plan which is more like the plan Fortune 500 companies offer their employees?
See my post.
I just saw it. Thanks. See my reply to it.
All I have to say is that I think there is a reason she isn’t providing the numbers. The numbers don’t support her level of poutrage. Insurance policy comparisons are complex and there is much to compare in the context of one’s own probable needs.
What all of these whiners manage to leave out every time is that if someone in their family develops a serious chronic condition, they will never get dropped and they will never be refused due to pre-existing conditions. Also there is no lifetime cap so if there are extended hospital stays, it won’t bankrupt the family like many previous policies do. There is a lot of risk prevention that the Obamacare compliant policies are providing.
On top of that the no-cost preventive care piece adds some immediate help to the pocketbook. I’m looking forward to the writer’s first colonoscopy and her write-up of that.
Still the annual cap of $12,700 (figure from seabe’s post on this page) each and every year would destroy families employed by McDonald’s, Walmart and many other giant corporations.
The figures from seabe’s post had Lisa Gottlieb’s out-of-pocket annual cap at a little over $6,000, not $12, 700. The annual caps under the ACA are pro-rated at a percentage of income, so the low-wage workers you mention in your post will have annual caps which are much lower than $6K. My understanding is these new, lower personal caps on expenses exist whether people gain their insurance on the individual marketplace or through their employer.
And indeed, as seabe mentions above, low-wage workers who do not get insurance through their employer will likely have income levels that qualify them under the expansion of Medicaid eligibility, and if they are in one of the horrible states which are refusing to accept the full funding of Medicaid’s expansion, that’s the fault of their sociopathic Governors and Legislatures, and they should turn out and vote their State officials out of office.
There are a lot “gotchas” in those subsidies. For example, if you live with family members (because you can’t afford rent), you are part of their household and all income in the household counts toward eligibility. Likewise, non-wage income. I know one man whose physically and mentally handicapped daughter has an annual income of $13,000 from a trust fund that her grandfather set up in his will. That is her sole income, but it makes her ineligible for Medicaid according to the Illinois department of Public Aid and she wouldn’t qualify anyway because she lives with her father whose income in $59,205 (same as mine, we’re at the same paygrade and step). Also, her free rent is counted as “income” of $600 a month.
No matter how you slice it, it looks like the expanded Medicaid is aimed at the generationally poor, not middle class people who have fallen on hard times. I’m not saying the expansion isn’t good, far from it. I’m saying it isn’t Christ come back to earth for the Millennium as Democrats make it out to be.
Illinois is not expanding Medicaid eligibility to cover citizens with $13,000 in income? That’s terrible. Many States are providing Medicaid at that level; others are not, and of course some Super Stupid States are not taking any Federal money for eligibility expansion at all.
This does identify a problem with modern government programs: the Republicans want to reduce the middle class to poverty incomes and assets in order to qualify for ANY program. That’s a big part of their $40 billion in cuts to the SNAP program. You may have been able to purchase property, a car, investments or other assets through your life, but the crash has interrupted your income? Screw you, buddy- liquidate your 401K and sell your home, or lose it to foreclosure.
That seems like unsound policy and profoundly immoral to boot, doesn’t it?
yes. their idea is an oligarchy with a pool of destitute, uneducated workers
These oligarchic clowns even want to keep educated and skilled workers in destitution. How a capitalist economy can be sustained when People Got No Money escapes me.
IL fully implemented the Medicaid portion, so yes someone making $13,000 would get Medicaid
Not if they are living with a parent and the income is from a trust fund. Application denied.
Your friend might want to look into Medicaid for his daughter again. While her $13,000 trust fund income makes her ineligible for SSI which is means tested and jointly paid for by the fed and state, she’s still disabled. From SSA.gov
Depends on the plan, and whether family or single.
The max-out-of-pocket you’ll see for a single person is around $6k. Family it’s around $12.5k.
Some have lower, but I’ve yet to really see many $0 deductible plans (in my state, anyway) that have as low out of pocket as my employer plan.
Plus again, the pro-rated sliding scale, as you mentioned, in addition to the subsidies.
Than you. Poor people do have families. Everyone at McDonald’s isn’t a teenager or young single adult.
Not only have lifetime coverage caps been eliminated by the ACA, but policyholders now have yearly caps on the total amount of money (premiums, co-pays and all other fees) they can be made to pay for their health care. It’s almost certain that the woman writing this opinion piece will never have to spend more than $6000 a year for health care IF she purchases her insurance on the exchanges; in fact, she’ll likely cap out at a much lower cost to her.
All the horror stories told by people whose individual plans are being canceled and are claiming that their rates are going up by astronomical amounts say this because the letters from their insurers or, in the case of Lisa Gottlieb, her Anthem salesperson, are telling them so.
But the letters and this Anthem salesperson are desperately trying to PREVENT their policy holders from pricing out their options and discovering the networks of physicians and hospitals on the individual insurance exchanges. Read her story carefully: Lisa never talks about going on the exchange, and she only mentions Anthem. If she is in Southern California, she will likely have six insurance companies competing for her business, and will likely find that her options will be an improvement on her status quo. If her premiums are higher even under the various Bronze plans, her other fees will almost certainly be lower than the plan she currently has, and she is likely to find her doctor and hospital under one of the insurers’ networks.
Lisa Gottlieb doesn’t understand her rights under the law, and her story documents Anthem’s attempt to swindle her. The New York Times needs to determine the facts and correct them. Otherwise they are actively participating, intentionally or not, in a disinformation campaign.
Lying liars lie like fucking rugs.
Very much unlike those chaste rugs we’ve all heard about.
The end.
So if we’re talking her freedom here let’s also talk about the denial of freedom a larger portion of the Independent crowd who HATED their plans but had no way to replace them. Now it’s If You Hate Your Plan You Can Shop and Get a Better One!
So far it’s proven victims zero. That’s actually stunning.
She’s either misinformed or the worst kind of liar.
I’ll give the benefit of the doubt and say misinformed. She was, after all, reporting what her current insurance provider told her. It is to their benefit to misinform her.
On another obamacare topic, one thing that has bothered me is the unquestioning acceptance that the people who truly are being “hurt” – the Sacramento Obama supporters that have been widely quoted are one example (they had a great plan for thousands less than what they will now pay) – really were better off.
Some of these people, such as the Sacramento couple, were in special risk pools for people who basically never get sick.
What would have happened pre-ACA if those people DID eventually get sick? Do they really think they’d still be in that special risk pool?
Even when there is a fully fact-checked example of someone being hurt by Obamacare, the long term view doesn’t add up.
I’m not at all sure she is wrong. I’ve had a similar experience. I live in Philadelphia. My wife and I are self employed, both in our late 50s, no significant health issues. We make a bit more than the cut-off for subsidies. We have had insurance with $2500 individual/$5000 family deductible, and dental. When I first went on the HealthCare.gov website, I was encouraged because it said there were several plans that would probably be available to us at lower cost, albeit without dental coverage. However, when I actually applied and filled in all our information, the only plans actually available to us were significantly more expensive, with much higher deductibles and no dental coverage. We have been paying about $625/mo. The ‘bronze level’ plans would cost from about $400 per month more to about twice as much per month. Coverage more comparable to what we have been getting would be more expensive still.
I don’t know why the original information from the web site was so wrong. Maybe it was one of the “glitches”. But I do know from experience that what one actually pays may be very different, because of address, specific individual situations or other reasons, than what is shown if you just type in a zip code and a little information. Based on my experience, I’d bet Ms. Gottlieb is correct.
By the way, in spite of the extra cost to me and my wife, I am a supporter of Obamacare, although I would much prefer single payer insurance similar to what France or Canada have.
They question – which I alluded to above – is whether you would still be able to get the insurance you have now at such good rates if you became seriously ill. The next year after a horrible accident, for example, or a cancer diagnosis, would your carrier renew you at the same rate? Or at all, if you’re in a state that doesn’t have auto renewal?
If not, then the additional cost you may have to pay now is actually you paying for insurance you would be able to keep throughout a long illness and recovery, rather than paying a lower rate for insurance that would only remain affordable until something happened.
Given the purpose of insurance that might create a shocking situation at exactly the wrong time.
Lori Gottlieb (not Lisa) has, I believe, one child.
And she’s a therapist, bestselling author, media consultant, and executive coach, as well as a paid lecturer and Aspen Ideas Festival speaker. So she may make a hair more than $80K a year.
In that case, let’s say she makes $250,000/yr and has only one kid.
I can get her a bronze plan for $3,936 annually, and $328/mo.
Yes. Just a hair more. And the fact that she apparently considers the difference between $75k and, say, $300k a year insignificant, but she’s bitching about her insurance premiums, is a fairly stout helping of cognitive dissonance. Either that, or she’s shelling out the purest kind of bullshit. Or both.
I wonder if the Medicaid expansion will bolster a push for an increased minimum wage, as that would “graduate” more people out of the subsidy zone. Could be a win-win for everyone but the Walton family.
Some more comments about the author:
“Never mind her numbers don’t add up they never do. What I found amusing was her bio which they didn’t fully let their readers know about. She is a best selling author who dropped out of medical school because she decided she didn’t like being around sick people. OK but then I came across this: In 2010, Gottlieb wrote about her experience dating a 300-pound lawyer for the anthology Scoot Over, Skinny, which was criticized by her ex-boyfriend as exaggerated and fabricated.
You can’t make this up. She is given a platform and she was already known as a liar. Go figure”
H/T Djchefron who posted this at TPV.
Is he NY Times going to correct this and apologize to the readers?
this is some important stuff going on here. Newspapers have a duty to determine if the claims citizens are making about their personal encounters with the ACA are true.
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A Cartogram Of the Vote Numbers
It’s more that college cities in the Valley of Virginia that went for McAuliffe. In general, cities went for McAuliffe. (Or against Cuccinelli, depending on how you want to read the result.)
Stunning that they can’t even bother spending five minutes to check on the plausibility of Gottlieb’s claim.
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