I have read so many horror stories about the Affordable Care Act (ACA) that when I read the story of how a skeptical Ohio family found plenty to like in the ACA, I had to assume that TIME Magazine was lying, that Steven Brill -- the author -- was lying, that health-insurance agent Barry Cohen was lying and, especially, that Sean and Stephanie Recchi -- the couple who now loves Obamacare -- was lying.
I say, "especially" the Recchis, because how can a couple that heard and believed so many bad things about Obamacare -- that "it doesn't cover pre-existing conditions, it's too expensive, etc." -- a couple that finally, out of desperation, repeatedly visited HealthCare.gov only to see it freeze or crash every time, how in heavens can such a couple now say that they love Obamacare.
But first some background, all quoted or paraphrased from TIME Magazine's Jan. 27 "How a skeptical Ohio family found plenty to like in health care reform."
In 2012, Sean Recchi, then 42, was diagnosed with cancer. At the time, the Recchis were making together about $3,500 a month from their small business in Lancaster, Ohio, and the couple "had to borrow from [Stephanie's] mother and max out their credit cards to try to save him."
MD Anderson Cancer Center in Houston had told Stephanie that their insurance (for which they paid $469 a month) was virtually worthless. So the hospital demanded $83,900, in advance, just to develop a treatment plan for Sean and cover his first $13,702 transfusion, along with simple items like gauze pads at $77 per box and routine lab tests for which he was billed tens of thousands of dollars.
As I reported, Stephanie recalled that her husband was "sweating and shaking with chills and pains. He had a large mass in his chest that was... growing. He was panicked." Nonetheless, Sean was held in a reception area and kept from seeing a doctor for about 90 minutes until the hospital confirmed that the Recchis' check had cleared.
As late as October of 2013, the Recchis told Brill that they did not think Obamacare would help them.
Finally, at the urging of Brill, Stephanie consulted an insurance broker.
Health insurance agent Barry Cohen recalls, "When they came to my office, Stephanie told me right up front, 'I don't want any part of Obamacare.' These were clearly people who don't like the President. So I kind of let that slide and just asked them for basic information and told them we would go on the Ohio exchange" -- which is actually the Ohio section of the federal Obamacare exchange -- "and show them what's available."
Even though by that time their income was set to grow to about $90,000 in 2014, Stephanie's family of four would qualify for a subsidy under Obamacare.
The Recchis and their agent soon zeroed in on a plan with a $793 monthly premium that provided full coverage, though with a deductible of $12,000 for the entire family, meaning the Recchis would pay the first $12,000 in expenses. After the deductible was reached, there would be no co-payments for anything, including all drugs. However, the Obamacare subsidy, assuming a $90,000 income, brought their cost down to $566 a month. If their income was the same $40,000 Stephanie had estimated for 2013, the subsidy would increase and their premium would be just $17 a month.(emphasis mine)
The agent, Cohen, says, "They had budgeted insurance at $1,200 for each of them for their new business. That's $2,400 for the two of them, compared to $566, so they were thrilled... They had seen all those stories on television, and because of their views about Obama, they believed what they wanted to believe -- until they saw these policies and these numbers."
And Stephanie says, "Here I get full protection for $566, compared to no protection for almost $500," referring to her old plan that had cost $469 monthly and that MD Anderson had scoffed at. "This is wonderful."
But, Brill says:
It ended up even better than that. Because Cohen could enter only the Recchis' actual reported 2013 income onto the website, not their anticipated income when and if the investment deal is completed, and because that reportable income turned out to be significantly less than the $40,000 Stephanie had estimated, the website moved them automatically into Medicaid -- meaning their coverage, for now, is free. That's because Ohio Governor John Kasich decided to buck a majority of his fellow Republican governors and accept Obamacare's subsidies so he could expand Medicaid coverage.
Brill then explains three ways in which politicians and other factors can "throw cold water on such "fairy tale endings."
First, the fact that Kasich did not follow "the lead of Obamacare resisters like Texas Governor Rick Perry" which "left the poor in states such as Texas or Florida that did not expand Medicaid faced with having to pay more than those who are not poor. Unlike the middle class, they could buy only health insurance without subsidies, because they were supposed to have been sent into Medicaid."
Second, the complexity of buying health insurance at the exchanges: "Buying health insurance is exponentially more complicated than buying a plane ticket," says Brill.
Understanding the limits of what consumers are buying puts another damper on the Recchis' story: their insurance -- whether Medicaid for now or the plan they are likely to transition to later this year -- is not going to cover them at MD Anderson in Houston. No Ohio plan will. In fact, only two of 79 plans offered in Texas on its federally run Obamacare exchange include coverage at MD Anderson.
On the latter, Stephanie Recchi says, "No, we don't get MD Anderson, but we do get the Cleveland Clinic and lots of other good care... We understand that."
And Brill concludes, "Amid the likely attacks from his opponents that he's taking away patients' favorite doctors and hospitals, Obama has to hope that others come to share her attitude."
Reading this "fairy tale ending" again, I really do not think that TIME, nor Brill, nor Cohen nor the Recchis are lying.
I just think that we have been fed so many half-truths, inaccuracies, so-called "horror stories" about Obamacare that when we read or hear an ACA success story our antennas immediately go up.
As more and more "fairy tale endings" become known, this phenomenon should disappear.
Read the entire fascinating and uplifting Obamacare success story here.
Thank you, TIME.