Andy Mangione is not just a random concerned citizen. He is—after years working in the health-care industry, including four at Humana, his current insurance provider—the vice-president of government relations at the Association of Mature American Citizens, an organization that bills itself as, essentially, a conservative alternative to the A.A.R.P. And AMAC opposes the A.C.A. In a post on AMAC’s Web site last month, Mangione himself announced the group’s “unwavering support” for the “Defund ObamaCare Act of 2013.” “Should ObamaCare continue to go unfixed,” he wrote, “economic vitality, consumer choice, and access to quality health care will be significantly impaired.”
Angle does not appear to have ever disclosed Mangione’s work to his viewers or to readers of a companion article on FoxNews.com. Nor was it mentioned in other outlets that picked up the story, like Breitbart.com and the Drudge Report, or on the floor of the Senate, when Senator Marco Rubio, Republican of Florida, read parts of Angle’s article aloud during his time helping his Texan colleague Ted Cruz stage a filibuster of sorts against legislation that would keep the government—and Obamacare—funded. (A spokeswoman for Fox News did not respond to voice mails and an e-mail seeking comment.)
Mangione’s place of employment, though, does not change the fact that premiums for the insurance plan he bought his family could indeed skyrocket under Obamacare. Under their current plan, the Mangiones’ monthly payments over the next year of coverage would be $334. They have the option of keeping this plan through the end of 2014 (something that Angle did not acknowledge in his story), but after that, it goes away for good. If, instead, they choose to switch to the “ACA Compliant Policy,” which was outlined in a letter that they received from Humana telling them about the changes and the potential increase, their premiums would be $965.07 each month.
Despite his personal opposition to Obamacare, Mangione did as much as he could after receiving the letter to educate himself about his options for his family’s coverage, and the potential costs of his choices. And he told Angle about the research he’d done and what it showed. Angle didn’t include it; indeed, he left out a wealth of context about both the A.C.A. as a whole and the Mangiones’ specific situation. That, perhaps even more than his neglecting to disclose Mangione’s occupation, was his journalistic failure. After all, when you look carefully at Mangione’s options, you see that the issues are quite complex—and that Obamacare might actually help Andy and his family.
In his reports, Angle failed to mention two key parts of Obamacare. He left out the exchanges that opened just this week—the new markets in each state through which individuals and small businesses that had previously bought insurance on their own will be able to band together to form the kind of sizable risk pools that help large employers bring down the rates that they get from insurers. And he ignored the subsidies that the federal government will be giving many of the people who get their insurance on the exchanges, in order to help them afford their premiums.
The plan that Humana offered Mangione is worse than what he has now. But what about the best option he could find under the new law? It’s tricky to figure out, in large part because it’s not immediately clear whether the Mangiones would be eligible for the A.C.A. subsidies. Mangione confirmed to me that he and his family would, based on their household income, most likely qualify. But anyone who is offered what the law considers “affordable” insurance through their employer is not eligible for the subsidies, and Mangione’s employer does offer insurance. He chose not to buy it because he personally thought it too expensive—that does not necessarily mean it would be considered unaffordable under the A.C.A., though. (He did not recall the details of the plans he was offered.) For the sake of a thought experiment, though, it’s worth considering what the implications for the Mangiones’ overall health-care costs would be if they do, in fact, qualify.
Although the Web site for Kynect, Kentucky’s exchange, had difficulties on Tuesday—including ones that stopped Mangione—I was able to get it working well enough at times that I could at least look at the various options available to a family like the Mangiones, and the costs for each.
The cheapest plan I was able to find on the exchange for a family like the Mangiones was the Humana Connect Bronze 6300/6300 Plan—so called because, for an individual, the deductible and out-of-pocket limit on the plan are both sixty-three hundred dollars—at $528 a month. That’s a little less than two hundred dollars more than what the Mangiones pay now, but it’s more than four hundred dollars cheaper than the plan Humana offered them, the one Angle discussed in his story. And that’s even before taking the federal subsidy into account.
While there were not exact figures available for the subsidy that a family like the Mangiones could receive, there are good estimates that can be found through the Kaiser Family Foundation’s subsidy calculator, which is the go-to source for such numbers. According to the calculator, a hypothetical family making $84,700 next year—currently the median income for a family in which the primary earner holds a bachelor’s degree or more; Mangione has an M.B.A.—would, based on national averages, be eligible for a subsidy of $208 per month. Subtract that from the cost of the plan that I found on Kynect, and you get an effective monthly premium of $320, a savings of $14 compared to the $334 the Mangiones will pay if they elect to stick with their current plan for a final year. In other words, if the Mangiones switch to the cheapest available plan, and are granted standard subsidies, their premiums wouldn’t triple, as reported by Fox. They’d go down.
On the other hand, the Humana Connect Bronze 6300/6300 Plan, like all the other plans Humana offers a family like the Mangiones through the exchanges, is an H.M.O. That means that it won’t cover care from a non-network provider, and that the Mangiones would have to get a referral before they saw a specialist. Andy doesn’t want that. The cheapest non-H.M.O. option, at $562 a month, was the Kentucky Health Cooperative Bronze, but that plan had quite a few drawbacks. The second-cheapest non-H.M.O. plan was the Anthem Bronze DirectAccess with Health Savings Account. That would cost $687 a month, or $479 after the subsidy, $146 more than what the Mangiones would pay with their current plan.
But the premium is not the only part of the Mangiones’ health plan that will change. For one thing, under the A.C.A., all insurance must at the very least cover ten “essential” benefits, such as emergency-room visits, inpatient treatment, mental health, prescription drugs, lab tests, and dental and vision care for children. “There are going to be people with skimpy coverage today that simply won’t meet the minimum standards under Obamacare,” said Larry Levitt, senior vice-president at the Kaiser Family Foundation. “It’s kind of like safety standards for cars. You could certainly produce cheaper cars without air bags and seat belts, but we set minimum standards for cars and we now set minimum standards for health insurance, which has never been the case before.”
And even if they never benefit from that aspect of the A.C.A., the Mangiones’ health-care costs will not go up as much as their premium increase might suggest. The deductible on the plan changes as well, going from $15,000 on their current plan down to $12,600 with the Anthem Bronze DirectAccess Plan. So does the out-of-pocket annual limit, the amount of money they can spend after their deductible before the insurance would just pay all the costs for anything covered under the plan, which would actually increase from $10,000 to $12,700. The co-insurance percentage that the Mangiones must pay after they’ve hit their deductible, but before they’ve reached their out-of-pocket limit, would also change: it’d go from thirty per cent with their current plan to zero with Anthem, which instead asks for co-pays for certain situations like emergency-room services, urgent care, and hospital stays. (All of these figures are for in-network coverage, since the letter that Mangione received from Humana did not list costs and coverage for out-of-network providers.) In fact, due to those other changes, there are circumstances in which—even accounting for the premium hike—the Mangiones could, by going with the Anthem option through the exchange, actually see their overall health-care costs decreased thanks to Obamacare.
The Mangiones’ current insurance is a high-deductible plan. It’s something of a gamble, but it’s a calculated one. Andy and his wife are healthy, and so are their kids, so they’ve opted to pay lower premiums in exchange for a deductible of fifteen thousand dollars. If, in any given year, they just go to the doctor for a few regular check-ups, and maybe a couple cases of strep throat, then the gamble pays off. But kids—even healthy ones; especially healthy ones, actually—play sports. They climb trees. They may need their tonsils out, or an appendix. The Mangiones know that if those things happen to their children, they will have to pay a great deal of money out of their own pockets. It’s happened to them before; two years ago, Andy Mangione said, his son, who was then six, “almost singlehandedly” caused the family’s medical bills to reach their insurance’s out-of-pocket limit by doing the kinds of things that six-year-old boys do.
Say, for the sake of argument, that the Mangiones’ current plan covers exactly the same conditions and services that the Anthem Bronze DirectAccess plan would. And imagine that, God forbid, one year something bad happens and the family needs to use a lot of insurance. Let’s call it $30,000. (Because there’s no information about out-of-network coverage in that letter from Humana to Mangione, let’s say that they do all this while never going out of their network.) In a scenario like that, a simplistic calculation of their expenses shows that the Mangiones’ total health-care expenditure for the year—including their premiums—would be $23,504 under their current plan. With the Anthem plan, if everyone could manage to stay out of the E.R. and avoid hospital stays, it would be $18,351—five thousand dollars less. Even if we imagine that, in the course of racking up these bills, the Mangiones visited an emergency room ten times and required five hospital stays—which seems very unlikely—and incurred the Anthem plan’s co-pays for doing so, their total bill would still only come to $22,851, or six hundred and fifty dollars less than their current plan.
Such a scenario is, fortunately, unlikely. But as the Mangiones’ own experience shows, it can happen. Discussing bills of thirty thousand dollars in a year, Levitt said, “You’d be unlikely to run up bills like that for a few prescriptions and a few visits to the doctor, but if someone in the family ends up in the hospital, they could very easily run up bills of that amount. It would likely be some kind of surgical procedure, but could even be outpatient. One of the kids tears their A.C.L. playing soccer and needs to have it repaired, you could start to run up bills of that amount.”
There’s a trade-off here, and it’s not one without complications. Families like the Mangiones, families on a budget, are being asked to pay more money up front in exchange for potential savings down the line. That’s not an easy thing, and it’s not something that Mangione wants to do. He chose to pay lower premiums, and accept a higher amount of risk down the line. “I’m hoping that I have a good outcome here,” Mangione said. “I just still have to make decisions for my family along the way…. This is an expense we never saw coming.” But it is a trade-off, not just a premium increase, and there are very good reasons why Obamacare was passed and why people like the Mangiones are facing issues like these. Jim Angle never bothered to mention any of them, but they’re real, and for some people like the Mangiones, they mean that life might actually be better under Obamacare.
Original Article
Source: newyorker.com
Author: Alex Koppelman
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