Tip:
Highlight text to annotate it
X
Again you're ... you're watching Curbside Consult. I'm having a great conversation with
Michael Hiltzik of the L.A Times. So now let's get to those Obamacare horror stories. So
tell me about some of the stories that you've covered that ... where there was ... where
there's some national attention and then you dug a little deeper and it turned out to be
a little different.
Michael Hiltzik: Right, well I think the one that I probably did the most work on was a
woman named Deborah Cavallaro who was a real estate agent here in Southern California who
I noticed was getting a lot of air play. She was on our local NBC station, she was on NBC
nationally, she showed up on CNBC, she showed up on Fox, she was on Marketplace, the radio
report. I later learned, although I didn't learn this until much later, she'd actually
been quoted in the L.A Times before I was aware of her.
She was telling a story about how the Affordable Care Act was not affordable for her. She said
she had gotten a cancellation notice and had discovered that she couldn't replace her insurance
except by paying 65 percent more in premiums and she also said ... she kept repeating that
she was going to lose access to her doctors and I was interested in this because it just
sounded ... when I would see her speak that she wasn't actually telling a full story.
She wasn't talking about what her benefits were and her own plan, what her benefits might
be under her new plan, where she found the new plan and so on, so I called her and I
reached her actually an hour or two after she appeared on CNBC where she was interviewed
... we could call it an interview but it was really just sort of a speech she gave with
Maria Bartiromo where she told this story.
And I ... when I talked to her, I had Covered California which is our state enrollment website
up and running, and we just walked through her vital statistics and her situation; how
old she was, well she's 60, she's single, she's looking for single coverage ... what
she had ... what her old plan was, how much she was paying, what the benefits were and
what she was looking at moving ahead and what I discovered very quickly was first of all
she had not been on Covered California.
Up to that point, she had gotten a cancellation notice, she called an insurance broker who
told her, "Well here's a plan you might be able to buy." She had a ... I believe she'd
been steered into a plan by her old insurer, which was ... we've seen this over and over
again ... overpriced, under-benefited ... it was basically just the way to keep her with
the same insurer.
Then when we actually plugged in all these numbers and looked at the benefits, we discovered
that she was eligible for a much better plan. Even a Bronze plan in California would be
better than what she had and she was eligible for premium subsidies which of course she
hadn't talked about up to that point. Then in fact she was going to do much better. She
wasn't facing a 65% premium increase, she was facing a cut. She was going to have ... her
old plan covered part of her doctor visits twice a year at most. After that she was going
to be on her own. Hospital benefits were virtually non-existent. All the things that we've seen
are flaws and these stories that ... a lot of these stories we're being told.
Harold Pollack: Now what's happened to her story once you got to the bottom of it? I
mean she'd been all over the media. How did the media organizations and how did she herself
respond when you dug deeper and determined with her that she actually was eligible for
better insurance at a lower premium under the Affordable Care Act?
Michael Hiltzik: Well I think she's sort of fallen off the media radar now that might
have been because she had been apparently fully exposed. I mean she had been pretty
much everywhere. Already she hasn't really expressed a lot of gratitude for my introducing
her to Covered California. She went on a right wing radio program a day or two later in which,
she now she complained that she hadn't gone to Covered California because she was afraid
that it could be hacked ... that she was afraid of her personal information security and of
course that's not an issue that's really been raised with a California website and whether
it's a genuine problem with the federal website I think we're not quite sure.
And she kept insisting that the problem she had was that she was not going to be able
to keep her doctors and her hospital.
I think I acknowledged in the original piece I wrote that that's a fair issue and a lot
of insureds are discovering that they're going to end up in narrower networks but the fact
of the matter is that she actually had not checked. She didn't know what her new network
might be under her new plan because she hadn't looked into it. So she was spinning a yarn
that was at best incomplete and at worst very misleading.
Harold Pollack: Did the news organizations that had interviewed her do any kind of correction
or follow up?
Michael Hiltzik: Not that I'm aware of. In fact, um, CJR or the Atlantic or somebody
went back and revisited her story and the coverage that she had gotten and I know I
asked Marketplace, “How do you respond to the fact that you just put this woman on the
air without actually doing reporting, and they were quite defensive about it. They said,
"Well, she was somebody who was expressing anger and we put her on the air as a representative
of the category of American who’s expressing anger," and I don't think that's good enough
frankly. I mean if you're going to do that you really have to do the reporting to determine
whether they have a right to be angry and whether their indignation has any factual
basis and if not you should say that.
Harold Pollack: The ... I think many people's anger ... I mean there's a lot going on in
these stories and there are some ... and some people are definitely ... will be facing less
favorable insurance in a variety of ways. There are both winners and losers. We think
the winners will outnumber the losers but we'll see on that. The ... it does seem to
me that there's two things there. One is change is very ... makes people angry and uncertain
and there's a lot of change here for people in her situation and that's what's generating
a lot of the anger ...
But the second thing is that you said that reporters need to become experts to cover
... this is not really a situation where you need to be such an expert. What you really
need to do is you need to have the person's old insurance policy and you need to go on
to Covered California and see what she's eligible for. That's ...
Michael Hiltzik: Right, and I should say I have been in situations where reporting has
really been hard. I've been in situations where people have been actively trying to
keep me from learning what I wanted to learn and I've been shot at for example. I don't
brag about it but that's the fact.
Harold Pollack: No ... HealthCare.gov is a dangerous site. I can see how that could happen.
Michael Hiltzik: That's right.
This is not a case where the reporting necessarily is difficult or particularly challenging.
You need to know the fundamentals of the law and you need to know what questions to ask
and they are ... if you're doing this professionally, they're pretty obvious.
You want to know how old the subject is, the income or at least whether he or she will
be eligible for premium subsidies and co-pay and co-sharing subsidies. You need to know
the basics of the old benefits and the new benefits and what do they have for hospitalization,
prescription coverage, doctor visits, how much do they pay, were there limitations on
the number of visits or conditions under which they pay mental health coverage; all these
things ... preventive care. And then compare it to what is available for the plan that
they are looking at or that they are eligible for under the Affordable Care Act. I think
you also have to be aware too, which is something that never gets ... a couple of things that
never get discussed that drive me crazy:
One is that in all of these cases where we're talking to people who’ve gotten cancellation
notices, we're always comparing their 2013 premiums and costs to their 2014 premiums
and costs that they're funding under Obamacare. One other thing you need to ask is what's
been your premium history thus far? How often have your costs been raised by your old insurer?
And we know that on ... maybe it's on average but in the individual insurance market, costs
have been going up by 10, 20 percent a year sometimes ... certainly at least 4 or 5 percent
a year ... so you have to factor that out when you're talking about well what are they
facing in 2014 because they were going to almost certainly face higher costs going forward.
The other thing that never gets mentioned is the real fundamental issue here in the
individual market that the Affordable Care Act brings to the table is that many of these
people, whether they're being cancelled because they had non-complying coverage or because
their insurer wanted to get out of the individual market, which happens a lot and has happened
to a lot of these people, without Obamacare many of them would be uninsurable.
They would have come under the exclusions for preexisting conditions, they would be
medically underwritten in every way possible and as we know that's not allowed any more.
So right there, we know that a lot of these people who are ... who THINK they're victims
are really ... they're really beneficiaries and that goes to one of the other cases I
looked:
This is another exemplary case. Edie Sundby is a businesswoman in San Diego who's actually
a figure that really deserves our respect and admiration. She's been a seven year survivor
of stage 4 gall bladder cancer and she survived in large measure ... she attributes her survival
to ... the work of her doctors at Stanford and at the Anderson Cancer Center in Houston
and at UC San Diego which of course has a very fine cancer treatment program, but it's
clear that she's also survived because she's taken her care in hand. She's made sure that
physically and mentally she's kept fit. She has the support of her husband, so she’s
really done very well by herself, but she had a piece in the Wall Street Journal, an
oped that she wrote in which she said because of Obamacare I'm going to lose access to my
doctors and I might die as a result of this.
Because I've been cancelled by my insurer and I've got to go find new insurers and the
only choices for me in San Diego are a network that will keep me having access to UC San
Diego but wouldn't allow me free access to Stanford or Anderson. Now I tried to reach
her and never was able to get her to respond, but I did look at much more closely at the
situation and what was happening there was that she had an insurer; an individual insurance
policy. The insurer informed her last January that it was pulling out entirely of the California
individual insurance market. Now this was an insurer that was pulling out of the California
market, not really because of Obamacare but because it couldn't compete in the individual
market and it had 8,000 customers in all of California, so it wanted out in any way it
could find.
Under California law, if you pull out of the market entirely, you are not bound to continue
offering your customers continuing coverage. So she was going to be ... as of really December
... she was going to be cut loose. The point that I thought was important that she didn't
make but that needed to be made is that absent the Affordable Care Act, here's a seven-year
survivor of stage-four gall bladder cancer, she's uninsurable. There isn't an insurance
company in the land that would offer her a policy that ev en an upper class, middle class
patient could possible afford.
Michael Hiltzik: We need to keep all this in perspective, that there are ... these are
features of the Affordable Care Act that we keep forgetting about and that when we're
reporting on it we need to remember.
Harold Pollack: A couple of points on that by the way. One is you're right that without
the Affordable Care Act she would have been uninsurable. Under some of the alternative
proposals to ACA, there would be high risk pools to take care or catastrophic coverage
to take care of people with her set of challenges. Those also have questions about what is the
network of providers? What do you have to do to get into those? Do you need a period
of uninsurance or a medical debt to get into those high risk pools? How do they work?
There is ... the Affordable Care Act works much worse than my preferred hypothetical
alternative that I haven't specified and there's no doubt about that. There is ... so in these
stories there is that in the background of “Compared to what?”