Is this how you see Obamacare?

Here is a story (another story) defining the success of Obamacare. What’s wrong with this picture and why does it portend the fiscal difficulties facing Obamacare (pay attention Mr Krugman)?

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Here is a man who despite running a small business did not have health insurance; he instead decided to take the risk of no coverage. Based on this story, before last year he had no medical conditions to prevent him from obtaining coverage. He had no pre-existing condition before the end of last year.

However, after contracting a serious illness he rightly sees the light to obtain coverage. His premium is now highly subsidized by taxpayers and the cost of his treatment is covered not by his insurance company, but by all others covered by the same company. While millions of other Americans have paid their premiums for years and collected no benefits (and happily so) thereby subsidizing the risks and health care of others less fortunate, Americans less responsible like this man are held up as success stories for Obamacare.

And consider this. For the insurance company to simply break even, approximately twenty-seven other insured people with the same coverage must pay their premiums for an entire year and not use one penny of health care. (assumes a total premium of $600 per month). This is what guaranteed acceptance and adverse selection means Except for the part paid by taxpayers. SEE NOTE BELOW

And once again the HHS story is questionable. Scanning the marketplace plans in Florida I could not find a platinum plan with anything near a $2,000 deductible.

What an upside down world we have created.

I’m Covered Stories: A Just-in-Time Convert to Health Insurance
Posted July 15, 2014
By Judy Sarasohn, Public Affairs, Department of Health and Human Services

Before Robert Mandler Jr. would tell his amazing story of recovery, he insisted on fessing up: “I was not in favor of Obamacare. Last year I was not going to get health insurance. I was going to pay the penalty.”

“But I have to come clean,” he told me the other day from Florida’s Gulf Coast. “I was wrong. I’m very grateful to be where I am now.”

You see, after living a healthy life and not having much to do with doctors, Robert, 47, realized late last year that he had a growth on his tonsils. He got covered through the Health Insurance Marketplace and made his first doctor’s appointment for January 2. It turned out he had a late stage cancer.

His radiation and chemo treatments ended in April, and Robert says he’s cancer free now. He has to have a corneal transplant, because of a complication of the disease. But he says he’s lucky: He hasn’t lost parts of his jaw. Other people haven’t been so fortunate, he said, recalling a man he knew who died of tonsil cancer.

Robert chose a platinum plan that with the financial assistance available through the Marketplace costs him $118 a month. His treatment expenses are running about $200,000, but thanks to his insurance, he only had to pay a $2,000 deductible and about $1,500 in co-pays. He says without insurance, he would have gone bankrupt or died. Robert also points out that because of the Affordable Care Act, an insurer couldn’t deny him coverage because of his pre-existing condition.

Noting his Argentine roots, Robert says it’s important for all Americans, including Latinos, to know they have the right to check out their options for affordable, quality coverage through the Marketplace.

“Health insurance saved my life and is giving me a new life. Until you experience something like this …” Robert said, overcome by emotion and unable to continue for a few moments.

After a rough winter and spring, things are looking up. In May, he was well enough to expand his bread distributor business. He’s working on regaining his full strength and energy. He’s even joined a gym and walks on a treadmill.

“Part of my experience is great access to care. I would not have had access to any of this if not for the health care law,” Robert said. “I must be one of the luckiest people in the world. I’m going to live and work and be productive.”

You may be able to enroll now in a Marketplace plan before open enrollment starts again in November because of special circumstances, such as aging off a parent’s plan at 26, having a child, or a change in immigration status.

Why wait to get covered? See if you qualify today.

Content last reviewed on July 15, 2014

NOTE: The Affordable Care Act establishes three premium stabilization programs—risk adjustment, reinsurance, and risk corridors—to protect against adverse selection. The Affordable Care Act directs that a permanent risk adjustment program be established in each State to mitigate the impacts of possible adverse selection and stabilize premiums in the individual and small group markets as and after insurance market reforms are implemented.