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February 21, 2014 12:40 PM UTC

Today In BS: The "$10,000 Obamacare Deductible"

  • 26 Comments
  • by: Colorado Pols

UPDATE: The Denver Post appears to be making corrections to this story from the version you see below, which is the version that appeared in the print edition today. But as of now they appear to have only made it more confusing. According to the story as it reads now, the insurance buyer cited below was looking at both "single plans and family plans because he is engaged." But the story still claims that the "plan with the lowest monthly premium had a deductible of $10,000," and if he was looking at single plans, that's not accurate. The previous version of the story plainly says he opted to take the "penalty for a single person," but the new version actually removed that clarification. Also, neither version of the story mentions the premium subsidies this buyer would have almost certainly qualified for–especially if he couldn't afford a $175 monthly premium–to get a plan with a much more reasonable deductible.

We appreciate the Post's stated willingness to correct these glaring factual inconsistencies, but for whatever reason, they're not actually succeeding. We invite them to keep trying.

—–

Stop Whining About Overreaching

Freelance reporter Arthur Kane has another negative story about the Affordable Care Act, a.k.a. "Obamacare" on the front page of the Denver Post today that is generating a lot of fact-based criticism. It starts like this:

Matt Leising spends about $3,600 a year on medication to treat asthma and sinus problems, so he was supportive when Washington politicians were debating the Affordable Care Act.

After the law passed and then began rolling out last fall, Leising went to Colorado's health care exchange website to look for coverage, but the 29-year-old Littleton resident quickly realized he couldn't afford any of the plans.

The lowest monthly premium was $175, but the deductible was $10,000, [Pols emphasis] meaning he would still have to pay for his medication and other expenses. He decided to just pay for his medication out of pocket and take the $95 tax penalty for a single person. [Pols emphasis]

Quite the horror story, isn't it? Except, as Healthcare.gov explains, the "$10,000 deductible" for an single policyholder cited in this story is fictional.

The most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit must include deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits.

The maximum out-of-pocket cost limit for any individual Marketplace plan for 2014 can be no more than $6,350 for an individual plan and $12,700 for a family plan. [Pols emphasis]

This isn't subject to debate: the maximum deductible for an individual policyholder is thousands less than this story asserts in the lede. We don't dispute that high deductibles for health insurance plans today are a problem, though they are offset in many cases by the guaranteed benefits provided by the ACA. But the figure quoted in this story is simply not factual. And once you see that, you start questioning other things. The premise of the story was that young people aren't signing up for insurance plans in the numbers hoped. While nobody can disagree right now, over the last few months the percentage of younger people signing up has grown. Kane quotes 3% in this story, but according to Connect for Health Colorado's signup data, the percentage of young people signing up was 17% for the initial period of October 1st through November 30th. Currently, the rate of 18-34 signups is at 23%–admittedly not where proponents want it, but that's a 6% higher rate, not the 3% this story claims.

The Los Angeles Times has a story up today that explains this situation, and so many other "Obamacare horror stories" that fall apart under casual scrutiny:

What a lot of these stories have in common are, first of all, a subject largely unaware of his or her options under the ACA or unwilling to determine them; and, second, shockingly uninformed and incurious news reporters, including some big names in the business, who don't bother to look into the facts of the cases they're offering for public consumption.

And that appears to be what happened here, folks.

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26 thoughts on “Today In BS: The “$10,000 Obamacare Deductible””

  1. Back in the 60s, 70s and 80s none of these horror stories would have been reported without rigorous fact checking through which the reporter would clearly point out the inaccuracies. Journalism has gone to the dogs. It seems like reporters today think their job is just to record and present whatever is said and, if the error riddled text at the Post is any indication, edit with spell check. Most of them could be replaced by hiring the unemployed to head out the door with simple smart phones. 

  2. Of course most of these false stories are being put forward – either directly or indirectly through the media – by the Koch brothers' PAC Americans For Prosperity. Fortunately, the media seem to be catching on to the scam and are beginning to aggressively fact-check.

    Remember, too, that the $6,350 out of pocket expense is a "skin in the game" incentive promoted by Republicans. Anyone complaining about the fact that all of the ACA plans have this deductable should complain about their Republican Congressmen. (It does no good complaining TO them, because they'll just blame it on Democrats and deny any and all involvement – they didn't vote for it, after all. Nevermind that the ACA has a large number of Republican proposed amendments.)

  3. The Denver Post's story is nonsense. I have a son who is over 26 years of age with a pre-existing chronic condition and he has purchased health insurance on the Connect for Health Colorado website. His policy is a Silver policy for $175 per month with an annual deductible of $600.

    The Post's story is very very bad journalism. All the reporter need do is access the website or call one of the insurance brokers listed on the Connect for Health Colorado website to find out how ridiculous Mr.Leising's assertions are. 

    1. Um – deductible of $600, but additional co-pays I'm assuming? Generally plans still have a $6350 individual annual out of pocket expense.

      And I missed something earlier that might be a poor assumption on my part. This person is under 30, so he's eligible for catastrophic-only plans. That could be where the $10k deductable is coming from.

      Regardless, as you note, there are other plans on the exchange that are better for his situation.

      1. I don't think so, the out of pocket limit is the limit isn't it?

        Either way, where are the subsidies in this example? If he can't afford $175 a month, he shouldn't have to pay that much at all. There's just so much about this story that doesn't pass the smell check.

        1. What you missed is that it was reported as a 10K deductible, meaning it would cover nothing before the young man had paid out 10K.  That's wildly off base. Paying a copay, even after a $600 deductible, is not at all the same thing as having to pay everything up to 10K.

      2. Yes, PR, you're correct. He has co-pays. I don't remember the exact amount but the co-pays are reasonable.

        My point is Mr. Leising can certainly find a policy at a reasonable price where the deductible is no where near $10,000.00.

  4. I was a bit incredulous about that story as well. I am 29 and am back in school to get my teaching licence. I still work part time and do some freelance work as well. When I signed up for ACA, I found a very reasonable plan with Kaiser that was only $25 a month (with subsidies) that had a $4,000 deductable but many guarunteed health benefits including of course the free physical and $50 co-pays for doctor visits and $75 co-pays for specialist visits. I don't have any major health problems but if I had something like asthma, I could've paid slightly more ($75 a month) for a "silver plan" that would've had a $1,000 deducatable and even more benefits (including presciption benefits). The unsubsized cost for the plan was only $200 a month…so it would be pretty silly to be someone like Matt Leising to pay out-of-pocket costs for medicine and a tax penalty when he could have insurance that would drastically reduce the cost of his medicine and health-care even if he didn't get subsidies at all.

    I am much more similar to Marty Pool mentioned in the article in that I am in school and I was surprised that he would be paying $200 a month for his health-care plan…like I said, I got significant subsidies…the type of plan he is talking about would have only cost me about $75 a month…the $200 would be without subsidies at all.

    And the article is also misleading when it says "Only 7 percent of Coloradans signing up are between 18 and 24," when many in that age group either have health insurance with their parents (something the law allows until age 25) or with their colleges.

    My experience with the health care exchanged has been overwhemlingly positive. $25 a month for a very basic coverage is more than affordable and if I had health problems, I could bump up my coverage to something more comprehensive for only $75 a month.

     

    1. Thanks. It's great to have access to solid info from a real person who really went through the process. Now shall we all hold our breath for a correction from the Post? Probably not unless we have coverage for what's going to happen when we pass out and injure ourselves falling down.

      I urge you to write a letter to the editor about your experience. It has to be edited down to 150 words to have the best chance of being accepted and not being edited too much by them in ways you don't like. You can e-mail it in today.  Just that you don't know what the young man in the article is talking about because you got yours (tick off the particulars) for $75. A nice concise letter on this topic is pretty much a sure thing for publication. I get  letters published pretty regularly so I kind of know what I'm talking about. 

      Republican36, this goes for you too. If they get a bunch of letters disputing the article they'll print more than one. If they get more disputing than supporting they'll print more disputing. Short, don't stray from the one point, stick to facts, few adjectives, shortish sentences and severe self editing is the key.

  5. Thank you.  And may I say: ITLDUSO. 

    I pointed this out earlier in the Friday Open Thread.  I also wrote a letter to the Denver Post editor (Open Forum) questioning the story and the use of an author on a front page story with zero attribution about who he is.  I also tied it to our previous discussions re: the loss of real journalists at the Denver Post. 

    Here is the text of the letter I wrote.  I doubt it will be published:

    Editor,

    Who is Arthur Kane, the author of the front page article, "Young adults not buying in to coverage at a healthy rate", February 21, 2014?  The only attribution provided is "Special to the Denver Post." 

     

    Perhaps more important is why did he write an article that contains blatant inconsistencies?  For example, he first describes a 29 year old Littleton male whose lowest monthly premium was $175 coupled with a $10,000 deductible.  Yet, later in the article he cites another 27 year old male from Denver who obtained a policy costing about $200 a month with a $2,200 deductible.  Did the author find this peculiar?  Did the Denver Post editorial staff?

     

    I guess this is the result of the Denver Post's elimination of actual journalists.  In their stead we now get articles not written by actual journalists and apparently, not vetted by actual editors.

     

     

  9. ColoradoPols is wrong again, but it is not your fault.

    If you go to the healthcare.gov site it says just what you wrote.

    Before the Obama administration and Obamacare you used to be able to rely on the truth as to what the government said was the law.  No more.

    What healthcare.gov says is a lie.

    Here are the facts:

    This is from Forbes:

    According to the law, the limits on out-of-pocket costs for 2014 were $6,350 for individual policies and $12,700 for family ones. But in February, the Department of Labor published a little-noticed rule delaying the cap until 2015. The delay was described yesterday by Robert Pear in the New York Times.

    Notes Pear, “Under the [one-year delay], many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.”

    http://www.forbes.com/sites/theapothecary/2013/08/13/yet-another-white-house-obamacare-delay-out-of-pocket-caps-waived-until-2015/

     

    – See more at: http://coloradopols.com/diary/54630/weekend-open-thread-54#sthash.NNe8qZXz.dpuf

    It turns out the deductible can be up to $12K.

     

        1. "According to the law, the limits on out-of-pocket costs for 2014 were $6,350 for individual policies and $12,700 for family ones."

          "Notes Pear, “Under the [one-year delay], many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014"

          The Forbes article you referenced compares apples to pears.

           

  10. I want to chime in here because Mr. Leising and myself both have a common friend and have been discussing this on Facebook. Mr. Leising claims that in December, he was given a "hook" offer of $91.41/mo. An offer that he claims isn't real, like the offers you get at a car dealership. He then claims that the offer he gave to the "journalist" is the "real" quote he was given on January 30. Then he admits that his deductible would be $6500 and says it's "still not affordable". He lives on a $33,000 yearly income. I have a similar deductible and earn maybe half that a year, and it's affordable for me. Finally, he claims that he pays $309 every two months for those prescriptions mentioned in the article, and also claims that $309 bi-monthly plus the $95 fee is cheaper than $175 a month. Both Mr. and Leising and our mutual friend pay (or in Mr. Leising's case, would pay) $170 a month. Both earn around $35,000 a year. They whine about how it's not fair that I get a subsidy and they don't. I made $13,000 last year.

    1. There are many "silver" plans available for around $200 (some even a bit less) a month without a subsidy that have deducatbles in the $2000 range. If I had a chronic health condition, it would most definitely be worth the monthly premium. Because even if $309 bi-monthly + $95 a year is cheaper…you are spending that $95 for absoultely nothing.  We're talking about $163 a month versus $175 ($12 difference! or if it is actually $200 a month a $37 difference)  a month for actual insurance that would a) help pay for the prescription costs Mr. Leising knows he is going to incur and b) help pay for other medical expenses that come up. I'm the only one in my family who doesn't have asthma. My sister has it under control generally, but she has on occasion had an asthma attack that has forced her into the hospital as has my mother. Hospitals are expensive without insurance.

      What I don't understand is why anyone is willing to pay a fee ($95) in Mr. Leising's case, but even more in future years, for absoultely nothing. Especially when just a slightly higher monthly cost would give you actual health insurance which may in turn into cost savings over the long run, given that you have a chronic medical condition.

  11. TK,  I have no problem with you getting a subsidy and you have my sympathy living on $13K last year.  Hopefully, things will turn around.

    My quibble is with people not identifying what is the cost of providing the insurance and what is the amount of the subsidy which others are paying when they say it only cost ___.  Society has make a choice to help those when in need.  We all may find ourselves in your situation.  I just think some honesty is in order as to real numbers.

    Good luck.

  13. anyone have any recipes they'd like to share? I just made a dynamite omelette. Seems like eggs cost more than in '08. Must be the result of 6 years of President Obama  

  15. No point in trying to explain what ACA really does and doesn't do to trolls. They don't want to know. They don't care what's true. They just want to spread scare stories.  Here in Colorado the bottom line is they can call it Udallcare all day long and find this or that person to say whatever it is they want to hear but Udall is still going to win in November. 

    Of course the various solid explanations with accurate info we've been seeing here are helpful to the rest of us, especially to younger people who need to sign up. I've passed along a couple of the most relevant comments to my kid who plans to sign up before the drop dead date but hasn't gotten around to it yet. Thanks to everyone who has contributed good info.

  16. "The family plan with the lowest monthly premium had a deductible of $10,000, meaning he would still have to pay for his medication and other expenses, he said. He decided to just pay for his medication out of pocket and take the tax penalty."

     

    That at is a true statement, there are both embedded and aggregate deductibles being sold on the exchanges.  If it is an embedded plan, the plan pays after an individual hits the single deductible.  If it is an aggregate plan the individual must meet the family deductible, if family coverage was purchased

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