ObamaCare - Making Insurance Affordable For Fitness Buffs

The WaPo wants to highlight the good news about ObamaCare, so they lead with the touching story of an aging Young Invincible who gambled with his health insurance and lost:

Beneath health law’s botched rollout is basic benefit for millions of uninsured Americans

Adam Peterson’s life is about to change. For the first time in years, he is planning to do things he could not have imagined. He intends to have surgery to remove his gallbladder, an operation he needs to avoid another trip to the emergency room. And he’s looking forward to running a marathon in mid-January along the California coast without constant anxiety about what might happen if he gets injured.

These plans are possible, says Peterson, who turned 50 this year and co-manages a financial services firm in Champaign, Ill., because of a piece of plastic the size of a credit card that arrived in the mail the other day: a health insurance card.

Peterson is among the millions of uninsured Americans who are benefiting from the Affordable Care Act, the 2010 law that launched far-reaching changes to the U.S. health-care system and is President Obama’s premier domestic achievement.

More on Mr. Peterson's new-found peace of mind:

"I get these messages from acquaintances on Facebook saying, ‘Let me keep my doctor,’ ’’ Peterson said. “Well, what about those of us who didn’t have health insurance before? . . . I have been walking a tightrope and have had some twists and falls off of it. To not have to worry about this anymore is a tremendous relief.”

And what are the circumstances that led to this? Staying with the WaPo to the end of the story:

For Adam Peterson, awaiting gallbladder surgery in Illinois, the dark tunnel without insurance began about six years ago, when he decided to forgo health coverage because he needed the cash to set up his financial services business. The cost of that decision hit home in March, when the emergency surgery to remove a gallstone cost him $27,000.

So he set up his own business. Per Manta (and you know I believe everything I read on the internet), his small firm is doing nicely now, although six years ago and through the crash, who can say?

Camargo Investments

A privately held company in Champaign, IL.

Categorized under Financial Planning Consultants, our records show it was established in 2009 and incorporated in Illinois, current estimates show this company has an annual revenue of $1 to 2.5 million and employs a staff of approximately 1 to 4.

Back to the WaPo:

When he went to HealthCare.gov this fall, the online system at first balked at verifying his identity — an essential step. It took a few calls to a help line before anyone called back. But just before Thanksgiving, he managed to enroll in a top-tier plan with a monthly premium of $475.

“I do not feel that it gives me the freedom to do reckless things,” Peterson said, contemplating his insurance coverage, which begins on New Year’s Day. “More, it just allows me to live a normal life with one less worry.”

$475 per month is about $5,700 per year. Per the Kaiser health cost estimator, a silver plan (one notch down from "top-tier") would cost someone in Champaign, IL (ZIP 61820, one non-smoking 50 year old adult, no kids) would cost $4,592 per year without subsidies. Subsidies would kick in for income above $46,000 per year, and we hope this financial consultant is doing that well (although we have no idea what tax jiggling he might be doing; Mickey Kaus says "tax cheats", I say "income managers"; you say 'potato', I say 'Obama').

So is our financial entrepeneur (U of Chicago MBA 1990, per his Facebook page) actually collecting a Federal subsidy? The WaPo is coy on this. However, Mr. Peterson has a blog devoted mainly to chronicling his marathon training and is active on Facebook. [And via Twitter, Mr. Peterson is kind enough to inform me that no, he is not collecting subsidies.]

Per the blog we learn he has been training for marathons since at least 2009, which seems to predate his gall bladder situation. Per basic Googling, we also learn that his state of Illinois established ("IPXP", under another provision of ObamaCare) a high-risk pool for people with a pre-existing conditions problem back in 2010.

Which leaves us scratching our heads at this rhetorical flourish we found at Mr. Peterson's Facebook site, posted last September:

All this discussion about the government shut down around the Affordable Care Act has me thinking that I would like the conservatives to answer a few questions for me. I don't mean to be a downer, but I am 50 years old and do not have health insurance (I am an independent contractor). If I were to purchase insurance on the open market, I could not because I need to have my gall bladder removed (pre-existing condition). Even then, if it was not an issue, health insurance would cost me over $500 per month (unaffordable today, since I am not part of a larger purchasing group). So my dear de-funding friends, let me ask you why (1) you want to deny me affordable health insurance (the "Obamacare exchanges" in Illinois (without any subsidies) will bring my monthly premium in line to about $175 per month because I am finally going to be part of a large purchasing group), (2) you want to exclude me from the insurance market because I have a pre-existing condition that prevents me from buying insurance at all, let alone on an affordable basis, (3) you want me to go bankrupt by having all of my medical issues handled in the emergency room (the most expensive form of healthcare delivery) since I will not have access to preventive care without insurance and (4) you think that REGULATING THE INSURANCE COMPANIES IS ANYTHING CLOSE TO GOVERNMENT CONTROL OF HEALTHCARE.

Dare I answer his questions with a few of my own? First, for six years he has "saved" roughly $5,000 per year by foregoing insurance - that is $30,000. Now his emergency procedure set him back $27,000. Over the six years, that is roughly breaking even (we lack information on deductibles, co-pays and other medical expenses, mercifully). He self insured at about break-even - this is a problem why? I am confident a Chi-town MBA can run those numbers, and probably has.

As to his somewhat recent pre-existing condition, I would hope a financial consultant understands risk management and financial planning. Why should the rest of us pay for his health procedures while he re-invests in his seemingly successful company?

And on that topic, are we in fact directly subsidizing his health insurance? [We are not, as noted above, but if I let new facts interfere with a rant what kind of blog would this be?] Per Facebook $500 a month was unaffordable; per the WaPo, Mr. Peterson went with a top shelf plan at $475 per month. Is he collecting subsidies, or did the $25 per month difference make it affordable? Of course, without info on deductibles and copays premium comparisons are meaningless. That said, the ChiTrib reported that sticker shock, with higher premiums and deductibles, is the Illinois experience under Obamacare.

Well: let me extract his first question and express my bafflement:

(1) you want to deny me affordable health insurance (the "Obamacare exchanges" in Illinois (without any subsidies) will bring my monthly premium in line to about $175 per month because I am finally going to be part of a large purchasing group).

That was posted before the ObamaCare website debuted, so we may simply be observing the power of positive wishful thinking, but... does Mr. Peterson still think his premium will be knocked down to "$175 per month" because he will be "part of a large purchasing group"? Or would it be fair to say that he experienced a bit of sticker shock?

My psychic guess - over the last few years Mr. Peterson was a fitness buff and aging "Young Invincible" who figured it would be cheaper to take his chances rather than buy insurance priced for the frail and sickly. He had his gall bladder problem in March 2013 which washed out his six years of insurance savings and left him with an impending medical bill for gall bladder surgery. He then decided to ride it out until ObamaCare kicked in in 2014 and he could avoid the (probably pricey) IPXP plan designed for those with a pre-existing problem.

So he is happy and the WaPo is happy. But if he is collecting Federal subsidies, well, maybe I am not so happy.

Pressing on with the questions:

(2) you want to exclude me from the insurance market because I have a pre-existing condition that prevents me from buying insurance at all, let alone on an affordable basis...

Well. Defunding the ObamaCare subsidies and altering the restrictions on pre-existing conditions are separate topics. As to what conservatives want, there are different 'repeal and replace' plans out there, and I daresay they all recognize that pre-existing conditions (and asymmetric information) is a conceptual problem for any market for insurance.

However, even if he is not being subsidized by the Feds, Mr. Peterson now wants the insurance companies, and ultimately their customers, to subsidize his choices which worked out badly even though a few years back he was not interested in buying seemingly expensive insurance. If somewhere out there in 2014 is a young, fit man hoping to invest in his own business, why is Mr. Peterson intent on denying him the same choice he made for himself in 2007?

(3) you want me to go bankrupt by having all of my medical issues handled in the emergency room (the most expensive form of healthcare delivery) since I will not have access to preventive care without insurance...

No one wants to bankrupt anyone - this isn't personal, although it is about personal responsiblity. And don't think of this a bankrupting you - think of it as a chance to see the world! Medical tourists in India or Mexico can have a pesky gall bladder plucked for $4,500 to $6,000. Bankrupt a high roller like you? C'mon...

I can quit anytime but will have to stop soon since this is the last question:

(4) you think that REGULATING THE INSURANCE COMPANIES IS ANYTHING CLOSE TO GOVERNMENT CONTROL OF HEALTHCARE.

That's what we think? ALL OF US? That said, once the government is deeply enmeshed in setting standards and reviewing the pricing and reimbursement rates for all the different procedures in the medical world, well, yes, THAT LOOKS A LOT LIKE CONTROL!!!

I know the WaPo will be all over this. Let's close with a photo of our fretful patient; this is from Sept 8 and the caption is reproduced below:

Well, it all started like fun and games morning until the gun went off. 3 hours and 27 minutes, 3,500 calories and 31 miles later, it felt exhausting but was a great accomplishment.

A marathoner turned tri-athlete. Let's all praise ObamaCare for relieving his worries.

OVERLOOKED BY THE WAPO: Don Surber passes along the story of Stephen Eimers, an independent contractor with seven kids. His old plan was disqualified by ObamaCare and despite more than 100 hours of effort Mr. Eimers can't weave through the new website all the way to an insurance card. A snippet:

Since October 1 I have spent over 50 hours navigating that terrible website and over 40 hours on the phone. I was able to complete the application and it was trying to force my children onto Medicaid. I had to make a change in the application that required the Advanced Resolution Center's help. After my initial request I was promised a call back within "48 hours." I'm on day 44 and 6 escalations later!

...

I finally got to the end of the application and noticed the website had changed my answer on filing a tax return from a joint return to not filing a return. I hit the edit button which deleted all my answers. The website then prompted me to answer questions about my dependents but a glitch would not let me do this so after another extended call to the 1-800# I was forced to delete my 2nd completed application. Stupid me decided to try again and I did the whole process and got to the end and the thing glitched again and said we were not filing a return AGAIN. An hour long call to the 1800# and guess what: completed application #3 was DELETED!

I am a true sucker so I tried again this morning. I made it through the application in about 75 minutes and got my eligibility. My wife and I along with our 2 year old son could purchase a policy but our 8,9, 11, 12,14 and 14 year old children would not be able to purchase insurance. Application #4 got deleted. I am done trying!

But we've made the country better for well-off triathletes who've been deferring their medical challenges. Win some, lose some.

OTHER WINNERS!: In the comments AliceH summarizes the other ObamaCare winners storied by the WaPo:

Dan Munstock: 62yo, he's fine. Just wants a checkup. Instead of, you know, going in for a checkup (Ranges $5-$200 depending on where he goes/what is included), he's happily paying $87.57 (after subsidies) for Health Insurance.

Nancy Beigel: 55yo. Now on Medicaid

Amy Torregrossa: 27yo. Used to be covered under her boyfriend's employer insurance (I didn't even know that was possible!), but he changed jobs in July. Neither seem to have attempted to go on COBRA or shop indiv. market. She has pre-existing condition, but apparently found it worth letting coverage slide until October. Now she's on a silver plan for $310/mo.

Emily Wright 28yo. Student w/ parttime job. She has many worrisome symptoms plus a pre-existing/diagnosed condition needing surgery. She's getting subsidies on a "top tier" plan for $125/mo.

 

 

Comments

[Danube on iPad]

Thanks Rich. Hope to be walking Friday. It's been 49 days....

[MarkO]

A good start. Badda Bing. You'll be here all ze week.

[MarkO]

I suppose now you are going to tell me that none of you chokes his prostitute.

[Gmax]

A good start?

I will be here all week, and don't forget to tip your waitress!

[Beasts of England]

@davdickian: Abortion is not on my radar screen, so I guess you can assume I'm an outlier.

@JiB: I assumed it was Dana. Only schools is can think of that are close to that are the service academies, where USMA is usually called West Point or even Army in sports.

[Danube on iPad]

"Depends on how consistent you wish to be about your concerns wrt innocent children."

Absolute, undiluted gibberish.

[narciso]

smaller gang plank, for small fry;

http://legalinsurrection.com/2013/12/cms-official-who-oversaw-obamacare-rollout-is-retiring/

[consistent gibberish]

"Absolute, undiluted gibberish."

Things you say when speechless, or terminally confused.

[JIB]

New thread.

[Beasts of England]

@MarkO: That usually costs extra...

[MarkO]

BoE,

She'll pay it.

[dublindave]

It's never a popular solution but raising taxes on the top one per cent and rolling corporate loopholes should pick up the slack in the ACA. If Obamacare still struggles under it's own weight then we'll simply switch to a single payer system,something in my heart of hearts I kind of believe the Obama administration is working toward anyway. The only way you could have had this many problems bringing the ACA online is you intentionally wanted this many problems to weigh down and finally break the entire system.

[peter]

marko @ 5:42

funny.

[dublindave]

sorry...rolling back...

[rich@gmu]

I'd cut-and-paste, but then again...bad idea.

[Danube on iPad]

Lisa Myers of NBC reports on a few winners and lots of losers at a 41-employee Michigan auto dealership:

http://investigations.nbcnews.com/_news/2013/12/29/21893911-workers-at-auto-dealership-come-face-to-face-with-obamacare-trade-offs

[MarkO]

Tebow to ESPN.

[Another Bob]

JIB | December 30, 2013 at 04:47 PM:

Missouri / Mizzou?

[MarkO]

Peter,

marko @ 5:42

funny.

Posted by: peter | December 30, 2013 at 05:00 PM

Prescient.

[peter]

Peter,

marko @ 5:42

funny.

Posted by: peter | December 30, 2013 at 05:00 PM

Prescient.

Yeah? it ain't so easy being funny when the pressure is on. Ask every failed comedian.

[NK(withnewsoftware)]

DD@5:00 takes a sober pill. Yes we know all that; in unguarded moments Obummer and Harry 'Alleged Pederast' reid have said just that. The problem for those of you in the Prog echo chamber is that the Dems lied to all of the important voters about that, and they will lose control of the Senate. One thing we can all agree to though, when Obummer loses the Senate, he will engage in tyrannical power grabs, because the constitutional checks and balances thing won't work for him. I welcome that show down.

[MarkO]

LOL

[peter]

Really wonder why Spitzer's ex-wife, Silda, who is a Harvard Law grad, stuck with him as long as she did. I know they had a 13 year old at the time the scandal broke, but still....she had to know what a creep he was by that point.

[maryrose]

Nk:
I agree with your statements. especially the comment about this doofus who has been a free rider. .I don't mind helping children but this guy reeks of bad choices he wants us to pay for while he enjoys the money made from his own business. There is no free lunch. Here's hoping his premiums skyrocket in the second year.

[NK(withnewsoftware)]

Unfortunately-- Adam Peterson is getting a $20,000+ free lunch THIS YEAR alone. And I bet his ExchangeCare rates won't skyrocket, the Illinois --ILLINOIS!!-- state insurance commission will fix it to keep ExchangeCare rates as low as possible, and stick it to everyone else.

[Ballsy, but peanut sized.]

"they will lose control of the Senate."

Hmm. Considering the negative influences of your paramours, perhaps you'd like to make a friendly wager on what seems to be premature ejaculation.

[AliceH]

Being uninsured is correlation, not causation, to the lower percentage of childrens' immunizations, primary care visits, etc.

[peter]

Well, Marko, you missed your cue. Choked, as it were.

[deductive reduction]

"Being uninsured is correlation, not causation"

But, you do understand the abortive alternative.

[NK(withnewsoftware)]

ObummerCare in 2014? here are the policy and political facts- terrible for the country, DOOM for Dems: http://www.newsmax.com/newswidget/worst-of-obamacare-yet/2013/12/30/id/544415?promo_code=EB8D-1&utm_source=National_Review&utm_medium=nmwidget&utm_campaign=widgetphase1

[dublindave]

"The problem for those of you in the Prog echo chamber is that the Dems lied to all of the important voters about that, and they will lose control of the Senate"

What are you going to do once you control the Senate? You have no policy ideas,no agenda,no vision. Unless of course the goal is for a Republican controlled Senate to compete with the Republican controlled House for the most incompetent and non-productive legislative body in American history(combined with George W.Bush's worst American President in history that should create a permanent Republican majority).

Come on,NK, what really going on with you? You can confide in your old buddy,Dave? You don't really want to govern,you hate Government. Government stands for everything that's wrong with this country,right? So why would you want to do something that you inherently despise and to be quite frank, totally f'fing suck at?

Republicans should forget about politics and elections and all that crap because it's having a really negative effect on their collective aura. Go smell the flowers,set up corporations in underdeveloped countries and employ really horrendous workplace practices.Go dump toxic waste in nature preserves, poison water supplys, con people out of their life savings and try to invent ways to hide your money from Uncle Sam....just reconnect with the things that made being a Republican so much fun and try to feel happy and free and alive again.......forget about all this politics malarky.

[blah, blah]

http://www.nytimes.com/reuters/2013/12/30/world/asia/30reuters-china-environment-farmland.html?pagewanted=all&_r=0

""In the past there have been news reports about cadmium-contaminated rice - these kinds of problems have already been strictly prohibited," he said.

This year, inspectors found dangerous levels of cadmium in rice sold in the southern city of Guangzhou. The rice was grown in Henan, a major heavy metal-producing region.

China's determination to squeeze as much food and resources as possible from its land has put thousands of farms close to chemical plants, mines and other heavy industries, raising the risks of contamination.

With food security still the most pressing concern, China is determined to ensure that at least 120 million hectares (295 million acres) of land is reserved for agriculture, a policy known as the "red line". The rehabilitation of polluted land is part of that policy.

A government land survey revealed traces of toxic metals dating back at least a century as well as pesticides banned in the 1980s, and state researchers have said that as much as 70 percent of China's soil could have problems."

fitness buffs in China understand the Freeeeeee Market has to be unfettered for the greatest economic growth. The well-being of the population takes a back-seat and rightly so.

The Economy trumps everything.

[NK(withnewsoftware)]

YAWNnnnn......

[blah, blah]

"Come on,NK, what really going on with you? "

Closet Anarchy.

[Jeff Dobbs]

the Republican controlled House for the most incompetent and non-productive legislative body in American history

The house will be ours in 2014 and with all three branches of government under our control we could ...

Posted by: DublinDave | October 13, 2013 at 05:01 AM

Shocking, someone who couldn't answer "Quick, name the three branches of government" reveals himself to also be suspect when it comes to passing an elementary quiz on Scholastic Rock's "I'm Just a Bill".

[Gimme a Seven !]

Well, that was 2 1/2 months ago. It's more difficult than predicting birthdays.

Who will be the victorious Republican candidate for the WH in 2016?

It seems fair to hold you to it.

[boricuafudd]

DublinDave

If your "vision" is so great, I am sure that winning that retaining the Senate and gaining the House will be not problem.

All you Progs have to do is wow everyone with your "visions and ideas" and voila, fait accompli.

[MarkO]

peter,

Being a musician, I know something about transposition, which you did with your 5 and 4.

I was honored to have amused you. Twice?

Now, I'm all choked up.

[clarice]

TM, IMO this is one of your very finest posts. Well-done and needed.

[H. S. Normal]

$27k for gallbladder removal is more than twice the US national average price. http://clearhealthcosts.com/blog/2012/05/how-much-does-a-gall-bladder-removal-cost/

[John F.]

Self-absorbed narcissistic POS. More government please. Because fairness.

Bet he loves fiat currency and gun control.

[ebonystone]

Mr. Peterson claims to be a financial planner, and yet he got himself into such a predicament? Pretty poor planning, I'd say. He'd better hope that none of his clients see this story; they'd drop him like a hot potato.

[ebonystone]

Mr. Peterson claims to be a financial planner? He did precious little planning on his own behalf. He'd better hope that none of his clients see this article; they'd drop him like a hot potato.

[21_cathy_f_in_tripep@d_prison_98]

I'll say it again: it is a sad but unavoidable fact that any sane insurance system must provide less satisfactory outcomes for those with pre-existing conditions.

It's a sad but unavoidable fact that if you go to the track and bet the rent and grocery money on a horse, and it comes in last, then you will have a less than satisfactory outcome...

[AliceH]

--Mr. Peterson claims to be a financial planner? He did precious little planning on his own behalf.--

Oh, he did quite well - the amount he saved by not paying premiums on insurance exceeds the amount he paid out of pocket. That is simply the self-pay-patient model.

What's objectionable is his pretense that his years without insurance was in any way based on 'necessity' rather than his rational choice based on his personal priorities.

In fact, if it weren't for the mandate plus the 'just ignore my pre-existing condition' risk pooling, I suspect he'd still choose to be uninsured/self-pay.

I wonder if he's got his business picking up some/all the costs of his premiums.

[Sioned L]

Did Mr Invincible actually pay the $27,000 or did he negotiate a reduced price. I negotiated a 30% discount on the deductible portion of an emergency room and 6 day hospital stay. The balance of > $ $100,000 was covered by a "substandard" "doesn't cover enough" "bad apple" insurance policy. Two days after this accident, and still in the hospital, a diagnosis of cancer was in the works. Followed on by a second surgery needed for the accident, biopsy and surgery for the cancer. Add in > $ 900/day rehab facility for 11 days. Suddenly, $895 /mo health ins prem for 2 healthy adults seemed cheap.

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