Sen. Tom Coburn (R-Okla.), who will be leaving the Senate prematurely next year for health reasons, can't resist taking a couple of underhanded swipes at the Affordable Care Act on his way out.
To begin with, he's co-sponsoring a GOP proposal to "repeal and replace Obamacare" -- though it doesn't repeal all of the act and to the extent it replaces the ACA does so with a manifestly inferior patient-unfriendly measure. We'll get to that in a moment.
Coburn's other swipe was an offhand remark he delivered to Joe Scarborough of MSNBC this week. Speaking of the health insurance plan he purchased through the federal insurance exchange, he said, "my new coverage won't cover my specialist." He was referring to the doctor who's been treating him for cancer.
As with all previous ACA mythmaking, this requires close scrutiny. As you might expect, the truth may well be rather different. We put several questions to Coburn's office to help us get to the bottom of his situation, but so far they haven't responded. (They've also given the cold shoulder to Brian Beutler of Salon.com.)
We asked for the name of Coburn's cancer specialist, to determine whether the oncologist was in the network of any exchange health plan available to Coburn as a federal employee. We asked which exchange plan Coburn joined and what his premium is. We asked whether, as a 65-year-old, he has enrolled in Medicare, and if so, whether the same doctor is available under that program. (And if he has not joined Medicare, we asked, why not?) If we ever get any answers, we'll let you know.
What we do know, however, is that some of the exchange plans for which Coburn is eligible have minimal restrictions on access to out-of-network specialists. A platinum plan available to congressional employees in Washington, for example, allows members to visit out-of-network specialists for a 30% co-pay -- but the co-pay and other out-of-pocket expenses are capped at $6,000 a year. There's also a $1,000 deductible for out-of-network visits.
Such a plan might cost Coburn about $685.93 a month in premiums, net of the employer's share provided by his employer, the federal government. (We're basing that figure on the D.C. exchange's published rate card adjusted for a 65-year-old, minus the government's $426.14 maximum monthly employer's contribution for 2014.) That brings the cost to $8,231 for the year. Pretty good deal for a top-shelf plan -- a mere 4.7% of his $174,000 salary as a senator. Anyway, Coburn, an M.D. with extensive investments, is a millionaire. He's said he'll be paying for his specialist out of his own pocket, though it's unclear whether that just means he'll be springing for the out-of-pocket maximum.
One way or another, Coburn is doing very well under Obamacare. He told Scarborough he expects to get very good cancer treatment, and the ACA-provided health plan is certainly one reason why.
A few more points about Coburn's situation. He's required as a senator to buy coverage from the exchange rather than through the federal employees health plan he had until this year, because of his own party's actions: In an attempt to undermine the ACA when it was being passed, GOP senators insisted that Capitol Hill employees, including themselves, be forced to get their coverage that way starting this year.
As Beutler observes, that makes them unique among Americans with employer-sponsored insurance. The exchanges weren't designed for employees of big enterprises like government, who customarily have employer-sponsored plans that are more generous; the exchanges are for people who would otherwise have ruinously expensive plans, bare-bones plans, or no insurance at all. For most of them, the ACA means a major improvement in their lives.
Second, it's pure sophistry for Coburn to blame his specialist's absence from his network on Obamacare. The narrowing of provider networks has been a trend in health insurance for years, as everyone who has been in the market--individual or employer-based--well knows. There's no certainty that Coburn's doctor would be in his network this year or next year, Obamacare or not.
Coburn and his followers fail to point out that it's only because of the ACA that many patients with his medical condition can find any affordable insurance on the individual market. That's because the ACA forbids insurers from refusing coverage or jacking up its price because of preexisting conditions like, for example, cancer.
That brings us to Coburn's other swipe at the ACA, the alternative proposal he has introduced with fellow GOP Sens. Orrin Hatch of Utah and Richard Burr of North Carolina. It's a formula for medically bankrupting Americans, eviscerating the consumer protections that are the hallmark of the ACA, and driving healthcare costs through the roof.
The GOP plan purports to maintain the prohibition on exclusions for preexisting conditions. But it does so only for customers who have kept their coverage continuously for at least 18 months before switching plans. That can be an insurmountable barrier for many Americans, often because of economics -- some laid-off workers may simply not have the wherewithal to keep up premium payments on a plan on their own, for example. Nothing would keep insurers from shutting them out of the coverage market or offering them coverage only at stratospheric prices because of their health conditions. Nothing but the ACA, that is.
The Coburn et al. proposal would sharply cut back premium subsidies for low-income Americans, who are prime beneficiaries of the ACA. Subsidies would be offered to people earning only up to 300% of the federal poverty line, rather than the 400% ceiling in the ACA, and would be skimpier for everyone.
Finally, the proposal would "modernize Medicaid" by giving states more flexibility to set their benefits and financing structure. The goal, the Republicans say, is to "empower" Medicaid patients. If you live and breathe in the 21st-century United States of America, you know what "empower" means in that context -- it means low-income Americans would be on their own.
Tom Coburn deserves our heartfelt best wishes in his medical battle. But as a member of Congress he has been an obstacle to good, science-based and responsible public policy, and hostile to the needs of the disadvantaged. His approach to healthcare reform is a good example of that. So may he prevail in his personal struggle and enjoy years more of good health. But in the months remaining in his Senate tenure, maybe he should do something concrete to help his fellow Americans have the same advantages he does.