Stephen J. Blackwood is utterly, unalterably convinced that his mother has lost access to her cancer medicine because of
That's the theme of his passionate op-ed in today's
Since we recently expressed perplexity about how easy it is to debunk most (if not all) Obamacare horror stories being retailed by Republicans and other critics of the Affordable Care Act, it's only fair to take a look at this one. It's not quite like many of the others, which present as victims people who actually are clear beneficiaries of the act. By contrast, Blackwood's mother appears to have been genuinely abused by the health insurance system.
But the story is a lot more complicated than the version laid out in the Wall Street Journal. In fact, the problem with the article is that it points the finger in the wrong direction. Blackwood curses Obamacare as "Sisyphean," "abysmal," "deeply and incontestably perverse" and a "brutal, Procrustean disaster." (Sisyphus is a figure in Greek mythology who was condemned for eternity to rolling a boulder up a mountain and watching it roll back down again; Procrustes a mythological figure who fit his guests to their bed by either stretching them on the rack if they were too short or cutting off their legs if too tall.) Yet most of his complaints can't be documented to be the result of the Affordable Care Act at all.
Blackwood's mother, Catherine, was diagnosed with carcinoid cancer, which attacks the neuroendocrine system, in 2005 at the age of 49. Fighting cancer takes great stores of physical and mental courage, as well as the help of a supporting family, and it's plain from Blackwood's essay that Catherine has had all of that. She's the mother of 10, has managed her husband's medical office in Virginia Beach, Va., for decades, and even writes a blog on parenting.
Her treatment has involved several surgeries and bouts of painful symptoms. To a great extent it relies on twice-monthly shots of Sandostatin, a drug which Blackwood reports "slows tumor growth and reduces (but does not eliminate) the symptoms of fatigue, nausea and gastrointestinal dysfunction." It also can cost thousands of dollars per dose.
But Humana's agents couldn't verify that Sandostatin was in its formulary--that is, covered by her plan--until she signed up. She did, and in mid-February belatedly was informed that it's not covered. Humana refuses to cover the bill, which year-to-date is $14,000. The family says the disapproval is under appeal.
Dr. Blackwood acknowledges that health insurance pre-ACA "wasn't a perfect system." He told me that when the ACA was enacted, "my concern was about how it was going to affect my practice. But this other side of the coin"--how it affects his family--"is probably a bigger challenge."
But let's try to figure out what's going on here. First, we don't know why Blue Cross/Blue Shield canceled the old plan. We can say almost certainly that the sole reason isn't that the plan failed to provide benefits required under the ACA, because even adding those couldn't conceivably justify raising the premium to $132,000 a year for a family of four.
As for Humana, its most expensive plan in Virginia for a four-person household appears to be a silver-level plan costing about $1,500 a month, with a maximum family out-of-pocket of $12,500 (for in-network care). It isn't clear if this is what the Blackwoods signed up for, though Dr. Blackwood told me he believes they bought a silver plan from Humana.
Stephen Blackwood's essay doesn't say so, but it implies that the Humana plan covered her doctors and continued other aspects of her care--at least, he doesn't say she's lost access to her doctors or other treatments.
So other than the cancellation of the old plan, which may or may not have anything to do with the ACA, the Blackwoods' problems fall into two categories: the difficulty of navigating the enrollment process, and Humana's refusal to cover Sandostatin.
The first is certainly due in part to the federal health enrollment site's birth pains, which have been well-documented. But they didn't have to affect Virginia residents. In choosing to let the feds do a job that the state should have taken on, Virginia kissed off more than $100 million in federal funds that would have been available to help its 844,000 uninsured residents find the insurance they need.
Neighboring Maryland had $165 million to do the job; Virginia spent $6 million. Virginia had 16 consumer helpers in the entire state, according to the Washington Post; Maryland, with about the same number of potential customers, had 325. It's not surprising that Catherine Blackwood faced "repeated and prolonged phone waits" to get insurance information; the fault wasn't Washington's, but Richmond's.
The misdirection over her medication is a different story, but it appears to be an issue between the Blackwoods and Humana. The ACA doesn't dictate which medications are or are not offered by insurers, and the law certainly doesn't demand that information on formularies be withheld from customers. It sounds as if Mrs. Blackwood was sorely misled by Humana's customer reps, and it seems likely that its refusal to cover her crucial medication is unjustified.
That does point to a problem with Obamacare, just not the one Stephen Blackwood and the Wall Street Journal think it does. The problem is that the Affordable Care Act not only left commercial insurers at the center of our healthcare system, but strengthened their grip on coverage. Many of the problems that have cropped up with the ACA are reflections of the private industry's role, including its lousy customer service.
There's no question that confusion and complexity still govern America's healthcare system. But for millions of Americans, there's less of that, and more fairness, than there was before the ACA. Judging from her son's op-ed, Catherine Blackwood is still getting her cancer treatment, with the exception of a decision about medication that Humana should be ashamed about.
Blackwood wrote that "it is precisely because health care for 300 million people is so complicated that it cannot be centrally managed." But the ACA is the exact opposite of "centrally managed" healthcare. In fact, as advocates of a single-payer system argue, if it were centrally managed, it might work better.