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by Sheila Salter, a 61-year-old self-employed marketing consultant from Chapel Hill, describing the cancellation (later rescinded) of her NC Blue Cross Blue Shield policy.

...my 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.