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A guide to reading and watching Obamacare coverage

By now you’ve probably seen a bunch of news reports about people who have received cancellation notices from their insurers, and are finding that new policies will cost much more than their old plans. What you may not know, since the follow-up stories have received much less attention, is that many of these reports have turned out to be wrong. Under closer examination, most of the people we’ve seen profiled will actually benefit from the Affordable Care Act, with cheaper, better coverage.

It’s not just conservative media like Fox News that’s getting it wrong–mainstream news organizations like NBC and CBS have filed incomplete and inaccurate reports as well. The coverage has been so bad that MSNBC host Chris Hayes put together a guide with three questions viewers can ask to figure out if a story might be misleading. They’re definitely helpful, but we’ve found some bogus stories can still sneak through, so we’re adding a couple guidelines of our own.  

1. Does the person qualify for subsidies?

If a report doesn’t mention whether a person qualifies for subsidies, you’re not getting the whole story. As an example, Hayes points to a California woman, Deborah Cavallaro, who NBC News reported was told by her insurer that her current plan, which costs $293 a month, was being canceled. The plan her insurer offered as a replacement cost almost $200 more per month. What NBC News missed, according to the Los Angeles Times, is that not only can she get a better plan on the exchanges for less than she’s paying now, but based on her income she’s also eligible for a hefty subsidy of $200 per month. Between the slightly cheaper plan and the subsidy, Obamacare could actually save her up to $3,000 a year.

2. What kind of policy is this?

To illustrate this point, Hayes gives the example of Dianne Barrette of Florida, who told CBS News she was shocked to learn that her current $54 a month policy was being canceled, and a new policy would cost ten times that. However, when other people took a closer look at her current plan they discovered that it’s what Consumer Reports calls “junk insurance”- it only pays the first $50 of the services it covers, and doesn’t cover hospitalizations at all.

The New Republic’s Jonathan Cohn talked to Barrette and found that she also qualifies for a subsidy of $331 per month, meaning that she can get real insurance– a Bronze plan– on the exchange for about $100 per month. Or she could go for an even better silver plan for $150. After learning about her new options, Barrette told Cohn that she’s no longer against losing her current plan, saying, “Maybe it’s a blessing in disguise.”

3. Is the reporter taking the insurance company at face value?

Both Dianne and Deborah were eligible for much more affordable coverage than what their insurers offered, yet CBS and NBC news only reported the rates in the letters– missing a big part of the story. Talking Points Memo reports:

“Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies’ own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces — which could lead to people like Donna spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked.”

Luckily regulators in some states have caught on. In Kentucky, the insurer Humana was fined over $65,000 for sending misleading letters to customers, and the 2,200 people who were tricked into signing up for more expensive coverage were released from these contracts. In Washington state, regulators issued a consumer alert about these scams. Unfortunately, consumers in states with less vigilant regulators might be out of luck if they fall prey.

Ok, so those are Hayes’ rules. They should help you sort through most bogus Obamacare victim stories, but we’ve seen a few that pass his test that are still inaccurate or incomplete, so we’ve added two rules of our own.

4. Does the person claiming to be harmed have an expensive medical condition? If so, be skeptical.

One of the ways insurers are trying to keep premiums low under Obamacare is by restricting provider networks, which means that for some people their preferred doctor or hospital won’t be covered. Edie Sundby, a stage-4 gallbladder cancer patient, is one of those people. She wrote in a Wall Street journal op-ed that her current plan is being canceled and none of the plans on the exchange cover all of her doctors:

“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.”

Later in the op-ed, she writes that taking away people’s ability to control their medical coverage choices may kill people like her, adding ominously, “Perhaps that’s the point.”

Mediaite’s Tommy Christopher looked into her claims, and found (perhaps unsurprisingly for a Wall Street Journal op-ed) that she has it totally wrong:

Obamacare will not only not kill her, she will probably end up spending much less for the same care. Since she didn’t reveal what her old premium was, it’s impossible to say for sure [one estimate put it at over $2,000 per month], but for about $664 a month, Edie Sundby can get a plan with better benefits than the one she had, even if none of her doctors participate. As it happens, though, the hospital where her primary oncologist practices, Stanford Medical Center, does participate with Blue Shield of California’s Gold 80 PPO plan. UCSD, where Sundby says she’s gotten emergency treatment, does not, but the plan covers her out-of-network. Even better, though, the Affordable Care Act forbids insurance companies from penalizing members for receiving out-of-network emergency services, and California forbids emergency providers from balance-billing patients for emergency care.

The Affordable Care Act was designed specifically to help people with serious medical illnesses, by limiting out-of-pocket costs, preventing insurance companies from dropping coverage or raising their rates when they get sick, and making sure plans cover “essential benefits.” So if someone with a serious condition says they’ll be worse off under Obamacare, it’s worth taking a closer look.

5. Can a person whose coverage is getting more expensive afford it?

At the end of the day, there are still some people whose policies are being canceled who (1) don’t qualify for subsidies, (2) have decent insurance now, (3) find that coverage on the exchange is still more expensive than what they pay now, and (4) don’t have expensive illnesses that might be helped by Obamacare’s new limits on out-of-pocket costs.

But we’ve always known that premiums for some people who lucked out under the old system– particularly young, healthy men— would increase under Obamacare, now that their plans can no longer discriminate against the old and sick. The real question isn’t how much premiums go up or down, but are the new premiums– once you factor in subsidies– affordable?

For example, Matthew Fleischer, a 34-year-old with “taxable income hovering right around the Obamacare subsidy level,” complains in a Los Angeles Times op-ed that he’ll have to pay 43% more for slightly worse coverage than he has now. Sounds like a lot, but when we took a closer look at the info in his op-ed, we find that he’s making about $45,000 a year and will be paying only $214 per month in premiums– just over 5% of his income. Of course, Fleischer is “not pleased”– no one likes to pay more for something they got at a bargain before– but it’s not like he’ll be forced to choose between buying groceries or paying premiums. What he’s describing is a nuisance that he can easily afford– not an actual hardship.

All right, that’s it for our guide to Obamacare coverage. Apply these rules to cancelation stories you’re hearing, and you’ll probably find– like we did– that almost none of them check out.

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