Sunday, February 23, 2014

What Sheila Salter isn't telling you

Today's News & Record includes an op-ed by Sheila Salter, a 61-year-old self-employed marketing consultant from Chapel Hill, describing the cancellation (later rescinded) of her NC Blue Cross Blue Shield policy. provider (Blue Cross Blue Shield) suggested a new policy that would roughly replace my canceled one. They recommended a "bronze" plan--the cheapest plan I could buy. It cost a whopping $584 per month. My current plan, by comparison, cost me only $202 per month.

I could hardly contain my shock. My new Obamacare-compliant plan would cost me 189 percent more. It also increased my deductible from $3,500 to $5,000 and increased my co-pays from $25 to $45.
Ms. Salter made similar claims in testimony to the House of Representatives in November and in ads produced by the Koch-funded American's for Prosperity.

The (eventual) cancellation of Ms. Salter's insurance may be costly. However, Ms. Salter misrepresents some parts of her story and omits some others. The cancellation, regrettable as it is, is not nearly as costly as she makes it out to be.

The most important misrepresentation is that a $584 per month "bronze" plan is the cheapest she could buy. In fact, the $584 plan is the most expensive "bronze" plan she could buy. There are seven other "bronze" plans in Chapel Hill; the least expensive costs $150 less per month.

Ms. Salter also fails to mention some differences between her old (2013) plan, and the one that Blue Cross Blue Shield tried to sell her.
  • Under her 2013 plan, Ms. Salter's maximum annual out-of-pocket expenses were $7,500; plus she was responsible for prescription expenses. Under the ACA plan, her maximum out-of-pocket expenses would be $6,350, including costs of medication.
  • Under her 2013 plan, Ms. Salter's co-insurance for in-network medical expenses beyond her deductible was 40 percent. Under the ACA plan, she would only be responsible for 20 percent.
  • Under her 2013 plan, Ms. Salter's medication expenses don't count towards her annual deductible. Under the ACA plan, they do.
  • Under her 2013 plan, Ms. Salter has to pay the full cost of non-generic medications. Under the ACA plan, her copay for preferred brand medications is $75 after the deductible is met; her copay for non-preferred brand medications is $100 after the deductible; and she is only responsible for 25 percent of the cost of specialty prescriptions after the deductible.
  • Under her 2013 plan, Ms. Salter's $25 co-pays for primary physician visits only applied to her first four visits.
Without knowing Ms. Salter's medical expenses, no one can say for sure whether her old plan or the ACA plan is a better deal. Under most circumstances, it looks like her original plan was less expensive. However, her original plan would be more expensive if her pre-insurance physician/hospital expenses were $12,250 or more (about the average for a single hospitalization) and her medication expenses were $3,450 or more--expenses that aren't beyond the realm of possibility for a 61-year-old.

Another advantage of the ACA is that Ms. Salter can obtain more generous insurance this year or in the future if her circumstances change. Under the old system, applications for more generous insurance could be turned down.


Hartzman said...

Is Obamacare revenue neutral?

How much more or less will it cost?

How do you propose to pay for the increased costs, as they seem to be clearly more than anticipated?

why did the President use the doc fix in the accounting, which was never fixed?

Greensboro Teach-In said...

Kudos, Dave. You just did the N&R's job for them and illustrated their lack of fact checking. And a few disclaimers they should have made.

Greensboro Teach-In said...

Google didn't sign me out of that account when I specifically told it to (that's a 2005 identity I deleted yesterday). (It's Sue Polinsky, whether Google things so or not).

Dave Ribar said...


The CBO estimates that the ACA will reduce the federal deficit by just over $100 billion over the next 10 years.

The insurance costs are actually less than originally projected. And the latest CBO estimate revised the costs downward again.

In the current, interim projections, CBO and JCT estimate that the ACA’s coverage provisions will result in a net cost to the federal government of $41 billion in 2014 and $1,487 billion over the 2015–2024 period. Compared with last year’s projections, which spanned the 2014–2023 period, the new estimate represents a down-ward revision of $9 billion in the net costs of those provisions over that 10-year period.

Roch Smith, Jr said...

My evidence is no less anecdotal than these ads, but I have a feeling the Republicans are not going to get the traction they are hoping for from trotting out people with these circumstances. For one thing, much of what they claim, as you point out, will not stand up to scrutiny when campaigns heat up and they are challenged.

More importantly though, most people get health insurance through their employers and are not experiencing negative impacts from the ACA. In fact, they may well be aware of the befits, such as being able to keep their children on parent's plans through age 26, no denials for per-existing conditions, etc.

For those people who do not get health insurance through their employers (and this is where my evidence is a anecdotal as the Republican ads), plenty of people are finding they can afford insurance for the first time or that their insurance costs are actually declining -- and with better coverage.

I just don't think a whole lot of people are going to identify with the Sheila Salters.