If CA is poster child for Obamacare rollout, watch out

If CA is poster child for Obamacare rollout, watch out

aca.lied.diedThanks to incessantly upbeat and frequently dishonest press releases from Covered California, the Golden State is often depicted as the poster child for the rollout of Obamacare. Don’t tell that to Edie Littlefield Sundby, a San Diego woman with a deadly form of cancer who wrote about her personal nightmare in The Wall Street Journal.

“Everyone now is clamoring about Affordable Care Act winners and losers. I am one of the losers.

“My grievance is not political; all my energies are directed to enjoying life and staying alive, and I have no time for politics. For almost seven years I have fought and survived stage-4 gallbladder cancer, with a five-year survival rate of less than 2% after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31.

“My choice is to get coverage through the government health exchange and lose access to my cancer doctors, or pay much more for insurance outside the exchange (the quotes average 40% to 50% more) for the privilege of starting over with an unfamiliar insurance company and impaired benefits.

“Countless hours searching for non-exchange plans have uncovered nothing that compares well with my existing coverage. But the greatest source of frustration is Covered California, the state’s Affordable Care Act health-insurance exchange and, by some reports, one of the best such exchanges in the country. After four weeks of researching plans on the website, talking directly to government exchange counselors, insurance companies and medical providers, my insurance broker and I are as confused as ever. Time is running out and we still don’t have a clue how to best proceed.”

Obamacare happy talk vs. grim reality

cov calBut what about all those sunny press releases? What about all the happy talk from health bureaucrats and Gov. Jerry Brown and Insurance Commissioner Dave Jones? Was it all made up?

In Sundby’s case it was.

“Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.

“But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market. The company suggested I look to Covered California starting in October.

“You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan—a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).

“So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.

“Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.”

It’s insurer’s fault Obama changed rules. Huh?

That’s from the Wall Street Journal. Now here’s where things get even more obnoxious. Think Progress, defender of all things Obama, implicitly criticizes Sundby for not criticizing her insurer.

“Sundby is losing her coverage and her doctors because of a business decision her insurer made within the competitive dynamics of California’s health care market.”

But Sundby lost her coverage because Obamacare changed those dynamics — even as the president said over and over and over again, “If you like your plan, you can keep it.”

The president should tell that to Edie Littlefield Sundby.

Or he can wait a year or two and tell it to her surviving relatives.

7 comments

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  1. LetItCollapse
    LetItCollapse 5 November, 2013, 08:24

    There should be a criminal penalty for politicians who sell programs financed by taxdollars based on lies. Essentially, it is a form of fraud. And the “If you like your health care plan you can keep it” line wasn’t the only lie. There were several more too. A law approved based on a pack of lies told to the public should be immediately rescinded or put into limbo requiring another congressional vote. If a businessman promised you a certain good or service, collected your payment and then failed to deliver what he promised there would be serious consequences. However, if there were no consequences consumers would be getting routinely swindled and conned by business establishments everywhere. No one could trust the business community and the economy would suffer greatly. But in politics we are routinely lied to and there are no immediate consequences for those who commit acts of fraud or perpetuate lies on the taxpayers. This is precisely the reason why poll approval ratings are in the teens. And when trust in the political system is repeatedly damaged by lying politicians holding the highest offices it causes immense and irreparable damage to the fabric of our nation. But this concept seems to escape the notice of the liberal mainstream media which makes excuses for or tries to cover up the lies. And by doing so it is complicit in perpetuating irreparable harm on our nation.

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  2. RT
    RT 5 November, 2013, 08:38

    Here are but a few of the problems with California’s Version of Obamacare “Covered California”:
    1. Many of the largest Health Insurance Companies in California are leery of California’s ever changing Health Insurance regulations and the interpretation/misinterpretation of those regulations by enforcement bureaus at the state level.

    2. Just as has happened with “Medi-Cal,” Covered California will soon begin to lose health care providers such as doctors and hospitals due to low payment rates.

    3. In most counties, Covered California customers are being encouraged to contact their local Department of Health and Human Services (The Welfare Dept.) for help. Not only are County Department of Health and Human Services known for their poor customer service, many have gone to “call center” formats which means a customer may get conflicting answers depending on what staff they contact.

    4. As, Covered California customers begin to see the monthly cost and the extremely high deductibles, there will be sticker shock.

    5. Once the federal subsidies tied to Obamacare end the entire Covered California system will crash causing yet another budget crisis for California.

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  3. MikeH
    MikeH 5 November, 2013, 11:49

    RT you are so correct ! I had not thought about #2, #3, or #5. I called our counties’ welfare department and they turned me over to one of their Covered California staff. Let me tell you customer service is not a skill that this person possessed. Boy they were rude. They told me that I may qualify for Medi Cal due to the new rules. When I said I did not want to go on a government program they said that all the policies were government programs and I needed to apply for Medi Cal.
    I just wounder if Covered California will crash before the fed subsidies end or soon after. What a mess.

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  4. LetItCollapse
    LetItCollapse 5 November, 2013, 14:40

    Of course it will crash. Just give it a little time. I foresaw what would happen back in 2010 when ACA was approved. It’s so simple it’s stupid. The healthy people would opt out of purchasing a policy and pay the lesser penalty instead. This would leave only a majority of chronically sick people who need routine care in the risk pool. Where are young (20-30) healthy people going to come up with an extra $3000 a year to pay for health care insurance? Most who don’t have rich mommies and daddies can’t even afford to pay the rent. And they are expected the subsidize the baby boomers? How do you think that’s going to work out? Oh, and if you get sick and you don’t have insurance you can opt in at any time and not get denied! lol. That would be like being able to buy fire insurance after your home burns down or comprehensive auto insurance after you rolled your car on the freeway! lol. Nice business model, huh? ACA was not about providing new and improved medical care. It’s about the government imposing more control over your lives. It punishes society’s producers and rewards the parasites. How do you think that’s going to work out in regards to stimulating GDP? If you haven’t already figured this out I can’t help you.

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  5. Ulysses Uhaul
    Ulysses Uhaul 6 November, 2013, 01:01

    Many low margin employers will dump employees into these grisly exchanges and use as many part timers as possible…..

    -the nightmare will go on and on!

    Reply this comment
  6. RT
    RT 6 November, 2013, 07:28

    LetitCollapse, you make some great points. I am not sure why we would think California can run a program like “Covered California”. Of all the various social and regulatory departments(not to mention the prison system) the state runs, how many run well? Why do we expect “Covered California” to be any different?

    Reply this comment
  7. Queeg
    Queeg 7 November, 2013, 00:25

    California government is pretty good at giving free goodies!

    RT. Relax. Covered California will nail it….you betcha!

    Reply this comment

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