Another Obamacare Horror Story Debunked

[Straight Shooter]

Deborah Cavallaro is a hard-working real estate agent in the Westchester suburb of Los Angeles who has been featured prominently on a round of news shows lately, talking about how badly Obamacare is going to cost her when her existing plan gets canceled and she has to find a replacement.

She says she's angry at President Obama for having promised that people who like their health plans could keep them, when hers is getting canceled for not meeting Obamacare's standards.

"Please explain to me," she told Maria Bartiromo on CNBC Wednesday, "how my plan is a 'substandard' plan when ... I'd be paying more for the exchange plans than I am currently paying by a wide margin."

Bartiromo didn't take her up on her request. So I will.

The bottom line is that Cavallaro's assertion that "there's nothing affordable about the Affordable Care Act," as she put it Tuesday on NBC Channel 4, is the product of her own misunderstandings, abetted by a passel of uninformed and incurious news reporters.

I talked with Cavallaro, 60, after her CNBC appearance. Let's walk through what she told me.

Her current plan, from Anthem Blue Cross, is a catastrophic coverage plan for which she pays $293 a month as an individual policyholder. It requires her to pay a deductible of $5,000 a year and limits her out-of-pocket costs to $8,500 a year. Her plan also limits her to two doctor visits a year, for which she shoulders a copay of $40 each. After that, she pays the whole cost of subsequent visits.

This fits the very definition of a nonconforming plan under Obamacare. The deductible and out-of-pocket maximums are too high, the provisions for doctor visits too skimpy.

As for a replacement plan, she says she was quoted $478 a month by her insurance broker, but that's a lot more than she'll really be paying. Cavallaro told me she hasn't checked the website of Covered California, the state's health plan exchange, herself. I did so while we talked.

Here's what I found. I won't divulge her current income, which is personal, but this year it qualifies her for a hefty federal premium subsidy.

At her age, she's eligible for a good "silver" plan for $333 a month after the subsidy -- $40 a month more than she's paying now. But the plan is much better than her current plan -- the deductible is $2,000, not $5,000. The maximum out-of-pocket expense is $6,350, not $8,500. Her co-pays would be $45 for a primary care visit and $65 for a specialty visit -- but all visits would be covered, not just two.

Is that better than her current plan? Yes, by a mile.

If she wanted to pay less, Cavallaro could opt for lesser coverage in a "bronze" plan. She could buy one from the California exchange for as little as $194 a month. From Anthem, it's $256, or $444 a year less than she's paying now. That buys her a $5,000 deductible (the same as she's paying today) but the out-of-pocket limit is lower, $6,350. Office visits would be $60 for primary care and $70 for specialties, but again with no limit on the number of visits. Factor in the premium savings, and it's hard to deny that she's still ahead.

Cavallaro told me a couple of things that are worth considering. First, what she likes about her current plan is that she can go to any doctor of her choice and any hospital. That's not entirely true, because her current plan with Anthem does favor a network. Plainly, however, it's broad enough to serve her purposes. She's concerned that the new plans will offer smaller networks, which is probably true, though it's not necessarily true that the new networks will exclude her favorite doctors, hospitals or prescription formularies.

She also mentioned that her annual income fluctuates. It can be substantially lower, or substantially higher, than it is this year. What if next year she earns too much to qualify for the subsidy? Also a fair point -- at her current income, the subsidy is worth more than $200 a month to her. But that's not the same as saying that "there's nothing affordable about the Affordable Care Act," because at her current income, the act is vastly more affordable to her than what she's paying now.

When she told Channel 4 that "for the first time in my whole life, I will be without insurance," it's hard to understand what she was talking about. (Channel 4 didn't ask.) Better plans than she has now are available for her to purchase today, some of them for less money.

The sad truth is that Cavallaro has been very poorly served by the health insurance industry and the news media. It seems that Anthem didn't adequately explain her options for 2014 when it disclosed that her current plan is being canceled. If her insurance brokers told her what she says they did, they failed her. And the reporters who interviewed her without getting all the facts produced inexcusably shoddy work -- from Maria Bartiromo on down. They not only did her a disservice, but failed the rest of us too.

http://www.latimes.com/business/hiltzik/la-fi-mh-debunked-20131030,0,6010994.story#axzz2jHHxUwr8

Talk about incompetent journalism. It's the media just following a narrative. The narrative of sticker shock and they find someone who claims they'll pay higher premiums and then that's as far as it goes. Just incompetent journalsim

 

[Jack Davenport]

That was a nice try but debunk fail. She has catastrophic coverage now just as I do. Her at makes it only possible to qualify for a "good" silver plan and I will wager that the plan will not begin to cover what would be covered under her current catastrophic plan. No limit on yearly doctor visits sounds nice but actually 2 a year is enough when most people basically need a yearly physical. Any sudden illness would be covered in the treatment clause of her plan and not as a visit. I know Obamascare proponents are scrambling to salvage this thing but this is one fucked up law. Remember when only 2 weeks ago we were talking about how fucked Republicans were going to be in 2014? That my friend is how quick the political winds can change.

 

[Jack Davenport]

I couldn't edit the post to include that at her age of 60 she only qualifies for the silver plan which is NOT what she has now.

 

[georges]

That was a nice try but debunk fail. She has catastrophic coverage now just as I do. Her at makes it only possible to qualify for a "good" silver plan and I will wager that the plan will not begin to cover what would be covered under her current catastrophic plan. No limit on yearly doctor visits sounds nice but actually 2 a year is enough when most people basically need a yearly physical. Any sudden illness would be covered in the treatment clause of her plan and not as a visit. I know Obamascare proponents are scrambling to salvage this thing but this is one fucked up law. Remember when only 2 weeks ago we were talking about how fucked Republicans were going to be in 2014? That my friend is how quick the political winds can change.

Indeed Indeed :yesyes:

 

[larss]

That was a nice try but debunk fail. She has catastrophic coverage now just as I do. Her at makes it only possible to qualify for a "good" silver plan and I will wager that the plan will not begin to cover what would be covered under her current catastrophic plan. No limit on yearly doctor visits sounds nice but actually 2 a year is enough when most people basically need a yearly physical. Any sudden illness would be covered in the treatment clause of her plan and not as a visit. I know Obamascare proponents are scrambling to salvage this thing but this is one fucked up law. Remember when only 2 weeks ago we were talking about how fucked Republicans were going to be in 2014? That my friend is how quick the political winds can change.

So you are saying that the author of the above article is guilty of shoddy journalism and has not got all the facts?
Sorry, councillor, but it seems to me that he has done a great deal more than the original journalist and has at least found some alternatives instead of producing a totally biased and uninformed view.

 

[Jack Davenport]

So you are saying that the author of the above article is guilty of shoddy journalism and has not got all the facts?
Sorry, councillor, but it seems to me that he has done a great deal more than the original journalist and has at least found some alternatives instead of producing a totally biased and uninformed view.

Larss I am saying that through that California exchange the woman is getting a "good" silver plan but it is more expensive than the "great" plan that she had that included catastrophic coverage. I am saying that this journalist , eager to prove a point, may have missed a very important one in the process.

 

[Mariahxxx]

BC you and your brethren would hate this law if it was a single payer where everything was included. you would find fault in it no matter what because it's too much government for you. but funny how another war wouldnt be too much government for you. or another Haliburton no bid contract. Or another fleet of airplanes that come off the assembly line at $74 million each and go directly into the scrap heap.

poor sick people medicine = bad!

military subsidies and war = good!

 

[larss]

Larss I am saying that through that California exchange the woman is getting a "good" silver plan but it is more expensive than the "great" plan that she had that included catastrophic coverage. I am saying that this journalist , eager to prove a point, may have missed a very important one in the process.

To quote the above.
This fits the very definition of a nonconforming plan under Obamacare. The deductible and out-of-pocket maximums are too high, the provisions for doctor visits too skimpy.

I would say the "catastrophic" health plans are better for younger people - they tend to be cheaper as the main focus is on hospitalisation. As one gets older, doctor visits become more frequent and this "silver" plan would suit this persons needs better.

Deborah Cavallaro was not given all the options by her current health care provider and the media coverage has not helped get her the coverage that she needs or even shown her the choice of options. I thought that this was the whole point of the ACA. To get the right coverage to the right people at the right cost. The biggest problem appears to be the technical one of the government's IT provision to be totally inadequate to handle the traffic.

 

[mongo18]

BC you and your brethren would hate this law if it was a single payer where everything was included. you would find fault in it no matter what because it's too much government for you.

Ha, it's because of them that it's NOT a better, single payer system. The only influence the republicans have had on the law has made it far worse than it could have been.

And they only hate government if it's doing what Americans want, they're fine with government working for them, check out anti-abortion laws, anti-gay marriage laws and voter suppression laws, just to name a few.

 

[mongo18]

So far, only six people have signed up for ObamaCare.

Hahaha, some teatards manage to create the illusion that they can function on a basic level, then you have guys like this....

 

[mongo18]

Larss I am saying that through that California exchange the woman is getting a "good" silver plan but it is more expensive than the "great" plan that she had that included catastrophic coverage. I am saying that this journalist , eager to prove a point, may have missed a very important one in the process.

OK idiot, "catastrophic coverage" is not a good thing, catastrophic coverage is the absolute bare minimum of insurance, because catastrophes rarely happen. It's saying if you have a heart attack we'll cover your hospitalization up to $39.95 after you pay the first $5000, and then we'll dump your ass.

Her new plan will cover both catastrophic claims and preventive care (why would a 60 year old woman want that?), that's why it's more expensive. I hope you know more about law than you do about insurance.

 

[Mariahxxx]

only 6 people signed up the first day. way to take shit out of context.

 

[Jack Davenport]

OK idiot, "catastrophic coverage" is not a good thing, catastrophic coverage is the absolute bare minimum of insurance, because catastrophes rarely happen. It's saying if you have a heart attack we'll cover your hospitalization up to $39.95 after you pay the first $5000, and then we'll dump your ass.

Her new plan will cover both catastrophic claims and preventive care (why would a 60 year old woman want that?), that's why it's more expensive. I hope you know more about law than you do about insurance.

My patience is about to run out with this fool. HDHP's have a lower premium because the deductible is high. And is another reason that the Silver plan offered to this woman included more physician visits per year because like me she pays for the majority of her visits OOP. The woman had more peace of mind even though she has to pay for routine visits out of pocket because in the event of a catastrophic illness she knows that she is covered. She gets the lower premium not because her coverage is worse, she gets it because the meat of her coverage is for catastrophic care and the deductible reflects that. Something that this journalist skimmed over trying to cover for this clusterfuck.

 

[Mariahxxx]

Just finished with some delicious Lamb Tikka Masala with saffron rice and a little bowl of vanilla bean gelato with fresh mint. Now going to open a nice bottle of Mariah Milano Vineyards Pinot Noir and watch Bill Maher. that nearly rhymes!
I hope everyone has a great night and a wonderful weekend! Even you BC. This is me being warm and fuzzy now!

here's to those who have issue with poor people getting health care:


you can kiss it!

 

[mongo18]

What you keep skipping over is that her new plan also covers catastrophic claims, they all do. The old plan is called catastrophic because that's literally all it covers. The new one covers catastrophic claims and preventive care, with both a lower deductible and a lower out of pocket. Fucking mouth breather. Please don't lose your patience with me, I can't imagine what you'll do, get even more wrong???

 

[Jack Davenport]

Dilligaf?

 

[Mariahxxx]

you should watch Bill Maher tonight Ann Coulter is on and Bill i shitting on Obama and calling him a liar. never see anyone on the right doing that in their own party.

 

[Jack Davenport]

What you keep skipping over is that her new plan also covers catastrophic claims, they all do. The old plan is called catastrophic because that's literally all it covers. The new one covers catastrophic claims and preventive care, with both a lower deductible and a lower out of pocket. Fucking mouth breather. Please don't lose your patience with me, I can't imagine what you'll do, get even more wrong???

You stupid sack of shit! Under ACA guidelines people 30 and under qualify for catastrophic coverage. It is only offered under individual plans and not for families. The only exceptions for people over 30 is if they can present a case for hardship. The woman in the article makes too much to qualify as a hardship but if her income flvctuated to a certain amount she still may qualify for a subsidy. She is 60, she had catastrophic coverage and wanted to keep it but the absolute best she could muster is the Silver plan. The Silver plan does not offer her catastrophic covrage because of her age. I make a good living and I am 47. Before this fucking law kicked in I had catastrophic coverage no questions asked but I have a 10000 dollar deductible. I pay all of my routine visits out of pocket. What this law does for me is allow me because of my age and income to play along with coverage I do not want just to feed the system but if I needed treatment for a serious illness, all of that comes out of my pocket and more than likely this woman too. So present plans that give me and the lady from California the exact same coverage in the event of catastrophic illness that we pay a higher deductible for and are happy with, or shut the fuck up.

 

[Mariahxxx]

under ACA the loophole for medication pricing is closed, so seniors can get all of their medications instead of just picking the ones they can afford. Seniors also get an annual wellness exam that has no cost or copay. women get free mammograms every year and a colonoscopy. There are many good things that are written into the law. People who couldn't afford it will have it now, and no more putting the burden of emergency room health care on tax payers. In a year this will have been fixed and mended to be better.

 

[mongo18]

The Silver plan does not offer her catastrophic covrage because of her age..... I have a 10000 dollar deductible. I pay all of my routine visits out of pocket. .... if I needed treatment for a serious illness, all of that comes out of my pocket and more than likely this woman too.

This is the problem. The people making the most fucking noise are the ones who know the least because they're not interested in learning anything, they just want America to fail.

One last time and then I'm out, because you're unimaginably dense - she will still have catastrophic coverage on the silver plan, she'll just have a whole lot more as well, with a lower deductible and lower out of pocket expense.

This catastrophic plan bullshit that you keep going on about is the silver plan with the following stuff stripped out:

Ambulatory patient services
Emergency services
Maternity and newborn care
Hospitalization
Prescription drugs
Mental health and substance use disorder services, including behavioral health treatment
Laboratory services
Rehabilitative and habilitative services and devices
Pediatric services, including oral and vision care
Preventive and wellness services and chronic disease management

Sure, there's a couple of things in there that a 60 year old might not want, but plenty that she clearly should have. And her maximum out of pocket is still more than $2000 less. You should go and look at porn and let the grown ups talk.