Monday, April 28, 2014

The ACA saved his life. Its subsidies saved his finances. Its enemies almost killed him

The Philadelphia Inquirer's Robert Calandra has a great story about a death's-door ACA conversion experience for a certain Dean Angstadt:
"I don't read what the Democrats have to say about it because I think they're full of it," he told his friend Bob Leinhauser, who suggested he sign up.
That refrain changed this year when a faulty aortic valve almost felled Angstadt. Suddenly, he was facing a choice: Buy a health plan, through a law he despised, that would pay the lion's share of the cost of the life-saving surgery - or die. He chose the former.

Read more at http://www.philly.com/philly/health/healthcare-exchange/20140427_Hs1obamacare27xxxxxxxxx.html#E8pxpMvPEBLcEwee.99
"I don't read what the Democrats have to say about it because I think they're full of it," he told his friend Bob Leinhauser, who suggested he sign up.
That refrain changed this year when a faulty aortic valve almost felled Angstadt. Suddenly, he was facing a choice: Buy a health plan, through a law he despised, that would pay the lion's share of the cost of the life-saving surgery - or die. He chose the former.

Read more at http://www.philly.com/philly/health/healthcare-exchange/20140427_Hs1obamacare27xxxxxxxxx.html#E8pxpMvPEBLcEwee.99
 He's a self-employed, self-sufficient logger who has cleared his own path for most of his 57 years, never expecting help from anyone. And even though he'd been uninsured since 2009, he especially wanted nothing to do with the Affordable Care Act.

"I don't read what the Democrats have to say about it because I think they're full of it," he told his friend Bob Leinhauser, who suggested he sign up.

That refrain changed this year when a faulty aortic valve almost felled Angstadt. Suddenly, he was facing a choice: Buy a health plan, through a law he despised, that would pay the lion's share of the cost of the life-saving surgery - or die. He chose the former.
Angstadt's conversion was complete almost immediately following his online signup for a private plan in late January. ", "All of a sudden, I'm getting notification from Highmark, and I got my card, and it was actually all legitimate," he said. "I could have done backflips if I was in better shape."

At that point in the story I did wonder whether this jubilation would be tempered when the gentleman had a full accounting of his share of out-of-pocket costs. ACA plans tend toward high deductibles -- an average of almost $3,000 for silver plans, which is the level he chose -- and out-of-pocket maximums that often hit the allowable per-person limit of $6,350.

But then I considered his monthly premium -- $22.11 -- and worked backward via ValuePenguin, which is still posting prices with a subsidy calculation for the just-finished 2014 open enrollment season. That premium for Angstadt's plan in his home county of Berks County, PA bespeaks an annual income in the neighborhood of $16,000. At that income level, he qualifies for the ACA's highest level of cost sharing reduction (CSR), calculated to give the plan an actuarial value of 94%, comparable to the best employer-sponsored plans. For this particular plan, the Highmark Blue Cross Silver PPO, that translates to a deductible of $100 and an out-of-pocket maximum of $500, as ValuePenguin shows and a Highmark rep verified for me.

The OOP max would be approached via $5 copays for primary care office visits, $10 for specialist visits, $5 for diagnostic tests, $25 for imaging (CT scans and MRIs), $8 for generic drugs and $45 for brand name drugs. That is a great deal in anyone's book, and fully appropriate for someone earning under $17,285, the break point for the next-highest level of CSR, which would reduce the actuarial value to a still-stellar 87%.

Small wonder, then, that Angstadt has concluded, " "From my own experience, the ACA is everything it's supposed to be and, in fact, better than it's made out to be."

That's only after the ideological blinders came off, though, by the grace of a loyal friend who urged him repeatedly to get covered and sat with him through the signup process.  Which raises the question: how many Dean Angstadts are dead because morally bankrupt and intellectually corrupt public officials relentlessly demonized the law, abstained from helping their constituents understand the benefits the law entitled them to, and even actively obstructed the process by which navigators could get certified?  How many heeded billionaires' active urgings to "burn your Obamacare draft card"? And who will ever be held responsible -- or liable -- for inducing the gullible and the ignorant to forgo coverage?

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