The missing context in yet another AFP ad featuring yet another Obamacare victim


— Tennessee resident Emilie Lamb, in another AFP ad

These emotional and gut-wrenching attack ads should be every Democrat’s worst nightmare, combining references to President Obama’s 4-Pinocchio promise that people could keep their plans if they liked them with a raw account of an ill woman (Boonstra has leukemia and Lamb has lupus) who says she suffered because of the Affordable Care Act, a.k.a. Obamacare.

But do the facts match the emotions? Is there context missing?


The Facts

First of all, many viewers might think Boonstra lost her doctor, as she mentions her “wonderful doctor” and then says her plan was canceled. But AFP confirms that she was able to find a plan, via Blue Cross Blue Shield, that had her doctor in its network.

Boonstra, like many Americans, initially had trouble getting a plan because of the botched launch of HealthCare.gov. No doubt that was a difficult experience. She then was invited by her local member of Congress to attend the State of the Union address and participated in a Republican National Committee news conference that highlighted problems with Obamacare’s stumbling launch.

At that news conference, Boonstra said, “I’m paying a higher cost now as far as out of pocket costs and the coverage is just not the same.” But in the ad she says “the out-of-pocket costs are so high, it’s unaffordable.”

The claim that the costs are now “unaffordable” appeared odd because, in her Michigan Blue Cross Blue Shield plan, there is an out-of-pocket maximum of $6,350 for covered expenses, after which the insurance plan pays 100 percent of covered benefits.

Meanwhile, Boonstra’s monthly premiums were cut in half, from $1,100 a month to $571. That’s a savings of $529 a month. Over the course of a year, the premium savings amounts to $6,348 — just $2 shy of the out-of-pocket maximum.

Thus, on the fact of it, the premium savings appear to match whatever out-of-pocket costs she now faces.

In an interview with the Dexter Leader responding to the online version of this column, Boonstra said: “People are asking me for the numbers and I don’t know those answers — that’s the heartbreak of all of this.”

Later, in response to a complaint to television stations from Democrats about the ad, AFP did not shed light on how the new health plan has made out-of-pocket costs for Boonstra “unaffordable.” Instead, it emphasized that these costs may be unpredictable.

As for Lamb, her 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.

Why was the plan so inexpensive? For one thing, it had a $25,000 cap on annual benefits. It also had no limit on out-of-pocket costs, and it would only cover generic medications.

CoverTN was terminated at the end of the 2013 because it did not meet key requirements of the ACA, in particular a ban on such caps on benefits.

For health-care reformers, such annual caps on benefits were a sign of a substandard plan that could put someone in bankruptcy if they had an accident that resulted in unexpected medical costs. But Lamb doesn’t look at it that way because she already had suffered a costly accident that was unrelated to her chronic condition.

In 2007, Lamb fell off a horse, requiring seven surgeries at Vanderbilt Medical Center. She saw one surgical bill for $125,000, but 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.

“Really after that, I was not worried about something catastrophic” that would exceed the $25,000 cap, she said.

(Others might hear this story and decide she was unusually fortunate that the hospital, confronted with a patient who had inadequate coverage for the surgery, decided to eat the difference.)

Meanwhile, lupus can result in very high medical expenses, but that is not the case with Lamb. She said her out-of-pocket costs, for doctor visits and drug costs, amounted to just $1,000 a year.

“I have very good doctors who have helped me manage my condition,” she said. “I was comfortable with the risk of having this limit.”

To put her expenses in context, the American College of Rheumatology says the 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.

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.

Anyone with a chronic condition would have opted for the plan with the lowest out-of-pocket maximum, even with a higher premium, so Lamb’s choice makes sense. But it did mean she faced sticker shock, going from $52 a month to $373 a month, even after her subsidy.

In other words, AFP has managed to highlight a very unique case—someone with a chronic condition who did not face high annual costs.

One Lupus sufferer, Erin Kotecki Vest, blogged that she was amazed at Lamb’s tale of woe after she researched the coverage provided by CoverTN. I would hit CoverTN’s $25,000 annual limit the first week of January,” she wrote.

In contrast to Lamb, this Lupus sufferer is thrilled to be on Obamacare. Kotecki Vest said that her family ditched her husband’s employer-provided plan after they discovered they would save nearly $19,000 a year by switching to a plan offered on healthcare.gov.

For some reason, Kotecki Vest was not asked to appear in an AFP ad. AFP did not respond to a request for comment.


The Pinocchio Test

As we have often noted, there are winners and losers under the Affordable Care Act. The Obama administration erred in suggesting that everyone will be a winner and that nobody would be forced to give up a plan that they liked.

But AFP takes it to the other extreme, using either a unique case (Lamb) or leaving out important information (Boonstra). Both ads earn Two Pinocchios.

To read previous Fact Checker columns, go to washingtonpost.com/
factchecker
.

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The missing context in yet another AFP ad featuring yet another Obamacare victim
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