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UPDATE #3: Emilie Speaks! (Be sure to read the original diary and first 2 updates to get the full story)

The Tennessean newspaper did a good story about about Emilie with lupus from  Lawrence, TN. We hear a lot about the political implications of the AFP ads starring this unfortunate young lady, and then there is this paragraph:

When Lamb fell from a horse in 2007, CoverTN took care of her seven surgeries over the next 3½ years, she said. Lamb said one surgical bill ran $125,000, but the insurer apparently negotiated a much lower price, allowing her to stay under the $25,000 maximum. Her total cost for the hospitalizations, she said: $100.

So let's unpack this data and see how it squares with what we have learned about Emilie and her insurance.

First, we find that Emilie's major health issues are not lupus-related, as we have been led to believe in the TV ads, but caused by a fall from a horse. My ACA-dar is really alerting here.... remember the original press release quoted her about '...numerous emergency room visits and several major surgeries...'. Are we really to believe that those were lupus-related and the horse fall stuff was in addition? And that her horribly sub-standard 'non-catastrophic' insurance covered everything?

Second, CoverTN - Emilie's previous insurance - had a limit of $10,000 per year for hospital in-patient services (the $25,000 is the annual limit for ALL services). So Emilie is asking us to believe that her $125,000 surgery, which was undoubtedly in-patient, somehow got shoe-horned into a $10,000 annual limit.

Third, we are asked to believe that her 7 surgeries over 3.5 years somehow fit into either the in-patient hospital limit of $10,000/year or the outpatient limit of 2 surgeries per year, and that all of this surgical stuff, PLUS her lupus-related medical care, PLUS any other medical care she needed during this period, fit neatly into all of the limits of CoverTN (like $1,000 per year for prescriptions), so that her TOTAL medical expenses never exceeded $25,000 per year?

Fourth, her TOTAL cost for her hospitalizations was $100! So she had up to 7 hospital admissions, and NONE of them had a cost over $10,000. Has anyone reading this ever had in-patient surgery and come out with a bill less than $10,000?

Now, let's look at the next paragraph:

Lamb said her medical costs were always manageable, despite frequent doctor visits and medication for her lupus. Her out-of-pocket costs, including premiums, were slightly more than $1,000 last year, she said. She expects her out-of-pocket costs will top $6,000 a year under her current BlueCross BlueShield of Tennessee plan.
As we know from the ads, Emilie paid $53 in premiums X 12 = $636/year. That leaves her less than $500 for out-of-pocket expenses. CoverTN charges a $15 copay for doctor visits (limit 12 per year), $10 for 30-day prescription (limit $1,000 per year), and $25 for out-patient surgery (limit of 2 per year).

Another little tidbit:

Today, she’s paying $373 a month, even with a small federal subsidy.
By a little backwards math, we now know that Emilie earns about $29,800/yr and her subsidy is about $16 per month. (Isn't it scary how little clues can be use to ferret out stuff like this?)

And let's not forget that Emilie has a Platinum plan with ZERO deductible and $1,500 OOP max. This is the best insurance in the country that I've seen. Of course, since Emilie appears most concerned with her up-front costs - and totally unfazed by
the possibility of running up disastrous back-end bills - she might have chosen one of the lower-premium Gold or Silver plans, but, of course, she didn't.

So where does all this leave us? Here are the choices I see for what's going on with Emilie:

1. She somehow managed to navigate the serious limitations of her CoverTN plan and, despite multiple major surgeries, minor surgeries, numerous visits to the emergency room, lots and lots of doctor visits, and all those prescriptions, and found a way to stay within those limits each and every year since 2006.

2. Emilie's lupus is the less serious version (DLE). This is a skin disease and, while still a serious, incurable condition, as far as I can tell DLE isn't likely to require nearly as much medical care.

Everything I've written so far is taking Emilie at her word. The other possibility, of course, is that Emilie is lying about some of this. I don't really believe she is, but as each piece of the puzzle comes out, we find out things she didn't tell us about before.

Bottom line: I stand by my original assessment: Emilie is one of the big winners of Obamcare. She has spent years teetering on the edge of financial ruin, and now she has some of the best health insurance available anywhere.

And she's aiding and abetting the people who want to get rid of Obamacare and replace it with...... something?

Cheers.

ORIGINAL DIARY

Emilie, as many of us have seen on the AFP tv ads, is a young woman from Tennessee who suffers from the terrible disease of lupus. I have great sympathy for her, and I feel sad that she's had to suffer both from the disease and from the disruption of her health insurance. My purpose in this diary is to explore the story behind these highly provocative ads and present a fuller picture of whether her claims are true, as well as whether her issues really are caused by Obamacare/ACA.

Emilie was diagnosed in 2002, and my awareness of her health insurance situation begins in 2006, from this press release authored by Rep. Marsha Blackburn R-TN. An excerpt:

Emilie, like so many Americans, works in the backbone of our nation’s economy: small business. It was cost prohibitive for her employer to purchase a companywide plan, so Emilie needed to obtain an individual health care plan. Emilie found a plan that was affordable for both her and her employer. Since 2006, Emilie has called it “stellar and affordable” and it has helped her cope with the high costs of numerous trips to the emergency room and several major surgeries. - See more at: http://energycommerce.house.gov/...
Ok, let's stop right there. Ms. Blackburn implies that Emilie has been on the individual health care market, with what Emilie calls 'stellar and affordable' insurance, since 2006.

ACA-dar alert! In one of her TV ads, Emilie says her premium before her policy was cancelled was $53 per month.

Looking around a bit more, I found a slightly different press release from Ms. Blackburn that reveals the truth of Emilie's health insurance:

Emilie, who suffers from Lupus, is one of millions of Americans who had her health insurance plan cancelled because of Obamacare. Since 2006 Emilie received health insurance through CoverTN, which provided her with the affordable care she required for the numerous Emergency Room visits and surgeries she has had to endure to treat her chronic illness. Left without any other choice, Emilie signed up for Obamacare and as a result her monthly insurance premiums increased by 700 percent. Congressman Blackburn has been fighting to help Emilie find a better solution to ensure she continues to receive the care she needs and deserves. - See more at: http://blackburn.house.gov/...
OK, that's better, why did this wonderful health insurance, provided by the state of Tennessee at a cost of $53 per month, get cancelled? From The Tennessean:
The letter states that as a limited-benefit plan, CoverTN does not cover all the services required by the federal law and will no longer exist as of Jan. 1. CoverTN had a $25,000 annual limit on benefits. The federal health law does not allow yearly expenditure caps.
So Emilie really got all of her treatment, including 'numerous trips to the emergency room and several major surgeries' and all those medications we see in her TV ad, for less than $25,000 per year? Really?

But why did Emilie's policy - and those of the other 16,000 needy Tennesseans - get cancelled? Simply put, because they were junk policies, by any definition of the term.

The state of Tennessee, faced with the requirement to bring the CoverTN program into ACA compliance, just folded the entire plan, completely washing its hands of the needs of all those people.

What could they have done differently? Well, first off, they could have turned these policies into real insurance policies, and stopped making these people either pay out of their own pockets for additional, high-deductible coverage, or just hope their costs were low for the year so they didn't get wiped out financially.

Another option would have been that the state could have taken the money they were spending on the CoverTN - my guess is perhaps as much as $25 million - and turned it into some sort of premium support for these 16,000 people. I don't know if that's allowable under ACA, but it's at least a possibility. Did the state try to help these people, having known since mid-2010 that this requirement would take effect on 1/1/2014? There's no sign of that.

Compounding this problem, although presumably not for Emilie because she's employed, is, of course, Tennessee's refusal to participate in the Medicaid expansion program, that is completely paid for by the federal government for 3 years and at least 90% after that.

People unlucky enough to be caught in what I'm now calling the 'Roberts-hole' - those between the top amount for pre-ACA Medicaid qualification and the ACA maximum income for Medicaid - get no subsidy at all. For Tennessee, that is between $0 and $15,282. Anyone in that hole gets no subsidy. That's right, in Tennessee adults in most cases can't qualify for Medicaid at all, and now the people who need it most can't get an Obamacare subsidy. That's perverse to the point of being evil.

So let's summarize: Emilie had junk insurance paid by the state, PPACA outlawed junk insurance almost 4 years ago effective 1/1/14, her state did nothing all that time, then sent her a letter last September cancelling her policy and doing nothing at all to help her. Who's to blame? I'm going to reserve judgement on that until I see what others are thinking. Have at it, folks.

Now, you might ask, what's Emilie doing now?

Funny you should ask! According to Emilie herself in one of her ads, her insurance premium has gone from $53 to $373 per month.

Now, you might ask, what kind of insurance does that get you in Emilie's county, Lawrence County, TN?

Funny you should ask! Here it is:

That's with no subsidy, BTW. Emilie's TV ad also mentions that her total health insurance cost had increased to $6,000 per year. That matches with the total cost of this policy: 389 x 12 = $4,668 + $1,500 max OOP = $6,168.

That, folks, is about as good as it gets. I've been researching ACA policies for several months, and that is the best non-subsidized policy I've EVER seen. And keep in mind that this is platinum-level insurance - no annual max, no life-time max, no 'sorry, that's not covered'.

So if Emilie really does have a major operation - which will certainly cost WAY more than her previous $25,000 limit - it will be paid for. And she can't be rescinded or dropped. And she won't be one 'bad state legislative day where they just had to cut a few million from middle-class benefits to pay for tax cuts to millionaires' from not being able to get ANY insurance.

Let me close with just one more example of the astounding ability of Republicans to be hypocrites. Here is a descriptionof one of the main principles of the latest Republican Senate 'Obamacare Alternative':

In essence, the plan attempts to lower health care costs by making people shoulder a greater share of those costs—or "sensitizing" consumers to the actual cost of health care, as Senate aides put it in a meeting with reporters on Monday.
Isn't that exactly what happened to Emilie?

I wonder what Emilie's plan used to be in the event she had exceeded the $25,000 annual coverage limit, especially because she has a serious condition.

Did she pay for a catastrophic policy? It's doubtful she could have gotten one, given her pre-existing condition.

Did she save money for those costs?

Did she pray for good health?

Did she spend every day of the past 8 years scared to death that she would be wiped out financially by a single emergency?

Did she worry every night that her extended family might have to step in to help pay for her medical care, exposing them to financial ruin?

I suspect she did all of those - except for the first one.

And today she does none of them. Emilie has affordable, adequate health care with a solid platinum policy that can't ever be taken away from her.... unless the Republicans she now chooses to support manage to somehow repeal Obamacare..... because every alternative plan I've seen would once again allow insurance companies to decide that Emilie is uninsurable, or impose limits on coverages, etc. etc. etc.

UPDATE #1: About that insurance Emilie had.

I answered a question in the comments about what type of state-sponsored insurance Emilie had, and then went on a bike ride for the first time this week - it's been raining all week. There's no better time to think things through, IMHO! Here's what occurred to me.

We know from above that Emilie had a policy known as CoverTN. Here's the link to the details of that now-discontinued program:
Link to CoverTN

It's a very limited plan. We know about the $25,000 max annual benefit, but there are also co-pays, and other limits, like 2 emergency room visits per year, and a total of $10,000 for hospital expenses. Hunh???

Does this look anything like a policy that someone suffering from a serious debilitating disease like lupus, who by her own admission needed 'numerous emergency room visits and several major surgeries' would choose? Ummm, what about prescriptions? Let's take a look:

My ACA-dar strikes again! If you watched the TV ad, one poignant moment while Emilie prattles on about 'Obama's broken promises' is her standing at the sink facing her collection of prescription medication bottles. Lots of them, as you'd expect for someone with a serious, debilitating disease that requires expensive drugs like corticosteroids, immunosuppressive drugs, anti-malarials, etc., etc., etc.

And this woman thinks, by her own words, that a plan which limits prescription coverage to $250 per quarter, is 'stellar and affordable'?

And, of course, she is so angry and disappointed with President Obama for making a REAL, affordable insurance policy available to her, that she goes on national television to complain about it?

This is outright fraud, perpetrated by the Koch-funded astro-turf group Americans For Prosperity, who created the ad and are paying to broadcast it.

A couple of other factors that I should deal with, anticipating questions to be raised in the comments:

Which type of lupus does Emilie have? We don't know, but as far as I've been able to ascertain (and I'm soliciting better information from those who know it), the skin-only form of lupus (discoid or DLE) isn't as serious as the other form (systemic or SLE). Without taking away from the seriousness of DLE, it doesn't appear to be a likely candidate for causing 'numerous trips to the ER and several major surgeries'.

And here's where Emilie is caught in a trap of her own construction: if she tries to claim that she has DLE, then either she's lying about how serious it is, or if it IS serious enough to require all those major medical expenses, then everything I said above still rings true.

Somebody might wonder if this was the only medical coverage Emilie could possibly have found, given that she was obviously not insurable in the barbaric pre-ACA days.... well, all I'm going to say on that right now is, NO, that is not the case. This is enough of an update for the moment, so I'll just tease you with 'wait for the next installment of....... Emilie isn't quite who you thought'!

Now, a couple of other tidbits:

First, why is Emilie walking around in her back yard in broad daylight with no hat on? I don't profess to know much about lupus - although I've learned a lot about it today - but isn't sunlight supposed to be the biggest trigger for lupus attacks?

And second, if you have watched the video of Emilie, you remember her saying that her previous policy had a monthly premium of $53. So, on her CoverTN policy, what is the only mix of circumstances that could result in a 39-year-old woman having a premium of $53?

I'm not accusing her of anything, this just caught my eye. Anyone who hasn't figured it out should go google 'what to do and not do if you have lupus'.

Finally, if anyone who voted for anything other than 'she should be grateful for it' in the poll in this diary now wants to change their vote, I understand, but I don't think it's possible.

UPDATE #2: Emilie had a choice before Obamacare

In the first update, we saw that Emilie's CoverTN policy was completely unsuited for someone with a serious disease like lupus.

So did she have options?

Glad you asked! The answer is: Yes, she did. Tennessee had a high-risk pool, called AccessTN, available to people with serious diseases/conditions. Here's a partial list of the 55 pre-approved medical conditions that required only a doctor's statement for eligibility:

Coming in at 47.... Systemic Lupus Erythematosus.

And if Emilie actually suffered from the less severe type of lupus, discoid lupus, and had been denied coverage because of it, here's the other way to qualify:

Denial by one unaffiliated insurance carrier for individual coverage due to a health-related condition
So she was eligible for AccessTN, one way or the other. There are 3 levels of coverage, so I'm going to choose the best, which is most equivalent to the Obamacare policy she seems to now have.
So, assuming she doesn't smoke (in spite of the $53 problem), she would pay $477. And what kind of insurance would that get her?
Now, that's not half-bad insurance for an uninsurable person, pre-ACA. I couldn't screen capture far enough down to show the max annual OOP of $5,000, max medical annual $250,000, max pharmacy annual benefit $100,000. The rest is pretty decent, pre-ACA... follow the link if you're interested.

My eyes zeroed in on the generic drug co-pay of $10. Remember, if you will, that her CoverTN policy had an annual limit of $1,000.

So what does this policy cost?

Gee, you keep asking all the right questions! I'll use my new notation:

Premium      $5,724
Deductible    $1,000
Co-pay         $4,000
MAX             $10,724

This is the policy that any rational person suffering from a serious debilitating, un-curable disease would choose, knowing that they would be faced with taking multiple expensive prescriptions, have numerous trips to the emergency room and facing several major surgeries. It isn't cheap, but I reckon that in the end analysis, given all the limitations on the CoverTN policy that Emily had, that it would have been comparable in terms of total out-of-pocket expenses for health care. And if not, remember, then Emilie isn't nearly as sick as she (and the Koch brothers) are leading us to believe.

Let's compare this to the ACA-compliant, Platinum plan it appears she now has:

Premium     $4,668
Deductible   $0
Co-pay        $1,500
MAX            $6,168

It occurs to me that everyone else on the Tennessee high-risk pool insurance  - there were 2,600 of them - was paying something like the first example above, and is now paying something like the second. (Please don't jump on me, there is a very wide range here - 3 levels of pre-ACA Access TN policies with age/location/smoking/weight variations and 4 levels of ACA policies with age/location/smoking variations. And no, I'm not going to post a whole bunch of them for comparison - I'm satisfied that these are reasonably representative)

Is it any wonder that none of THEM is appearing in TV ads excoriating President Obama?

Cheers.

Originally posted to databob on Sat Feb 08, 2014 at 06:48 PM PST.

Also republished by Three Star Kossacks.

Poll

Is Obamacare to blame for Emilie's health insurance woes?

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| 986 votes | Vote | Results

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    Against stupidity the gods themselves contend in vain. Friedrich Schiller

    by databob on Sat Feb 01, 2014 at 07:20:02 AM PST

  •  Wasn't CoverTN their version of a (25+ / 0-)

    "High-Risk Pool" for those with pre-existing conditions?

    Which was a low premium-high deductible policy which didn't cover much, if I can recall what other states' versions of such plans are.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Sat Feb 01, 2014 at 07:41:01 AM PST

  •  i love this work you do. (41+ / 0-)

    i read these whenever you publish them and i try to remember them when i am confronted by rwnjs who blather about the scourge of obamacare.  thank you so much for demolishing the media's attempts to demonize the ACA, in cahoots with republicans.  i talk up health care coverage every chance i get because so many people have such limited information about it due to the media's tilt towards the right wing faction.  your diaries help me make the point better.  again, thank you.

  •  What's the discrepancy between her saying (4+ / 0-)
    Recommended by:
    Lujane, FiredUpInCA, aitchdee, worldlotus

    #373/month and the $389 for the Platinum policy?

    Thanks for these diaries - they're great.

  •  If she was diagnosed with Lupus in 2002, she's (21+ / 0-)

    lucky she could find ANY insurance between 2006 and 2014.

    •  depends on how it was written up (1+ / 0-)
      Recommended by:
      OhioNatureMom

      Having spent the past few years dealing with various government agencies and insurance carriers and providers over dementia-related Dx, I can attest that a sympathetic provider might have been persuaded to have written up the Dx in a manner which may have allowed her to find coverage.

      For example, with AD, there are too different ICD-9 codes, one which reflects it as a psychiatric dx and the other as a physical dx.  In the same manner, hospital DRGs vary wildly in reimbursement as to whether bronchitis is diagnosed as viral or bacterial  

  •  The way states can still subsidize premiums (13+ / 0-)

    is by expanding Medicaid -- including the states that have done it through a waiver, by actually paying premiums for a private policy. (I'm not a fan of that approach, but it's way better than leaving people in the "Roberts hole.")

  •  All you have to do here in TN to lead is be stupid (11+ / 0-)

    and look great in a business suit. Even the possibility of having a bunch of hospitals close in rural, already medically underserved counties will not (1) sway state GOP acceptance of Medicaid expansion to receive federal funds, or (2) sway rural voters to give the jerk-offs less than 70% of their votes next time around.  And the state Dems appear to be no brighter.  Progressive Dem campaign ads are being written almost daily by the GOP, such as:  "Here is the truth of Rep. Blackburn's story about Emilie.  The State of TN, not the federal government, made the choice to close her previous state-subsidized plan.   Emilie could also have obtained an even cheaper, yet still superior, OBAMACARE plan for less than the OBAMACARE PLATINUM PLAN @ $389/mo. she chose.  Why did she not do this? This is a question we have to ask?"    

  •  More Great Work databob. Any idea what the sliver (6+ / 0-)

    and bronze plans cost?

    •  Cheapest bronze = $164/mo $4,000 ded (10+ / 0-)

      $6,350 max OOP Primary doctor 50% copay after ded.... generic prescription 50% copay

      I don't like the % co-pays, would probably go for a higher premium fixed copay.

      Cheapest Silver = $214/mo $2,000 ded, $4,000 OOP same co-pays (somewhat odd, I thought they were supposed to be different for different levels)

      So the Bronze breaks out as:

      Premium: $1,968 + $4,000 = $5,968 out of pocket before co-pay kicks in, then another $2,350 = total max $8,318

      So let's see if I can express it this way:

      Premium = $1,968
      Deductible  $4,000
      Co-pay       $2,350
      MAX           $8,318

      I've been trying to come up with a utilitarian way of evaluating different policies, and this might work.

      The Silver:

      Premium   = $2,892
      Deductible -  $2,000    
      Copay          $2,000
      MAX             $6,892

      Looking back at the Platinum:

      Premium  = $4,668
      Deductible     0
      Co-pay        $1,500
      MAX            $6,168

      Yeah, I like this notation!

      So if I'm Emilie, and I know I've got lots of medications, and those numerous visits to the emergency room, etc. I'm jumping right on the Platinum plan, because I know I'm going to blow through the Premium and co-pay and into the 'free' stuff for sure, so I might as well make the bottom line as cheap as possible.

      But if I'm healthy and don't think I'm going to fall off my bike (I did that a month ago, ouch!) I'll for the lower up-front but higher max of the Bronze.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sat Feb 01, 2014 at 12:38:40 PM PST

      [ Parent ]

  •  from memory, other reports are her "cat" policy (9+ / 0-)

    had a $10K deductible and a $25K cap, as noted and allowed 4 doctor visits per year, along with no lab or drug coverage.  I can find no mention of any limitation on the providers or if she were free to choose her own physician (I suspect not). I also have to wonder about how pre-existing conditions are treated under her old policy.
    Finally, one of these debunked horror stories was about a lady who saw her premium go up many thousands of dollars but further investigation reveals she priced a "gold" plan to replace her "cat" plan, which is comparing MacIntoshes to golden apples and that she also refuses to use the .gov site, but instead went on her private carrier's site for all of her pricing information.  Is this the same lady?

    At least she was working; many workers with lupus or related diseases are not able to work a full time job.  Many find themselves in that twilight zone between being too healthy for disability and too sick to work enough to earn a living.  (I was in that country from 2000 to 2007; it is not a good place to be).  Pricing the local high risk, state subsidized pool in my state informed me that my monthly premiums would be a tick or so above $2500/month.  

    I was amused to find some of the same carriers and brokers who spent the last 6 years fighting HCR reform to now be billing themselves as "re-insurance specialists" and setting up their own websites to compete with the .gov site.  I am also finding that more and more tax prep places ($35 to fill out a 1040 EZ with one poor soul revealing in an ad that in 2012 it took him 7 hours to fill out this form) are now "ACA specialists" to "assist with the intricacies and complexities of completing the 1040 correctly now the ACA is in force.

    •  No deductible for her CoverTN plan... (8+ / 0-)

      but a limit of 2 emergency room visits per year, 25,000 total expenses, and even $10,000 total for inpatient hospital expenses. There are also co-pays for some services, and is administered by BCBS. Here's a link to some of the info:

      http://www.covertn.gov/...

      If you go to #22, there are links to the benefit sheets for the 2 versions of this plan.

      It's perhaps not a bad plan for someone who is young and healthy, but is nothing short of stupid for someone with a serious condition like lupus, who by her own admission has had 'numerous emergency room visits and several major surgeries'.

      I'm going to cover this and more in the major update I'm just getting started writing. It will be worth reading, I promise you!

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sat Feb 01, 2014 at 12:11:03 PM PST

      [ Parent ]

      •  it appears there are several ACA horror stories (9+ / 0-)

        out there with several women claiming to have their lives ruined because before they had Cadillac policies for a few pennies and now Obamacare costs them a pound of flesh and their first born child.  Or at least so the GOP would have us believe but so far, each one has been debunked and most of the people had crap cat policies which are now outlawed, which is how most people are "losing" their insurance.  (the Galtians are complaining loudly that they are being forced to pay less for much better policies now against their wills)

        •  This doesn't even qualify as a 'cat' policy... (5+ / 0-)
          Recommended by:
          JVolvo, entlord, worldlotus, caul, skohayes

          given that it quits providing benefits just about where a cat policy begins.

          In fact, in the Tennessean newspaper story linked at the beginning of the diary, that's exactly what one woman did: paid her ~$50 for CoverTN, and then some unknown amount for a cat policy with a $15,000 deductible.

          It's hard to know what she paid, but I suspect she ought to be happy with her replacement ACA policy, because with all of the exclusions and limitations on the CoverTN policy and how bad we know the average cat policy was, she must have been bleeding money badly.

          Cheers.

          Against stupidity the gods themselves contend in vain. Friedrich Schiller

          by databob on Sat Feb 01, 2014 at 02:02:47 PM PST

          [ Parent ]

    •  "Won't look at Obamacare Lady" (1+ / 0-)
      Recommended by:
      marykk

      is "Bette from Spokane," not "Emilie from TN."

  •  One other point about ACA plans (and this is where (21+ / 0-)

    people like Bette and Emilie can save a lot on out of pocket expenses) is that many come with prescription medication coverage, plus contraception is covered 100%.  For a patient like Emilie, having effective contraception is very important since pregnancy with lupus can be life threatening.  Also she is likely on immune suppressing drugs that can cost thousands of dollars per dose.  

    Now for a patient like our erstwhile Bette (who seems determined to cut her nose off to spite her face) if her husband is sick enough to be "disabled" he too is probably on a variety of meds and  possibly needs physical or specialized therapy and equipment.  I can guarantee that their catastrophic policy did not cover prescription medications.  One of the benefits of an ACA plan would have been more comprehensive medication coverage, leading to a savings of possibly hundreds of dollars a month.  So despite an increase in monthly premiums with an ACA exchange plan, they could actually have had fewer out of pocket expenses than before.

    Something similar happened for me:  To switch into a silver ACA plan from my individual policy, and keep the premium roughly the same, I went with a higher yearly deductible, up to $1500 more if all three of us maxed out.  But I am saving ~$200/month on my prescription medications so I am ahead even if we all do get sick or are injured.

    BTW;  I'm loving your "series" of diaries databob.  What a fabulous public service you are providing!  Any news on the PA company people who were screwed and used by an unscrupulous Insurance broker?  I hope they sue the shit out of him for malfeasance!

    •  Thanks, I'm having a great time doing this! (12+ / 0-)

      And glad I'm happily retired... I don't know how Brainwrap can do his admirable work on ACA signups while working full-time!

      If you check down at the end of the comments on the PA story, you'll find a quote from the broker that surfaced this morning, along with my response to it.

      I agree with everything in your post. I always try to show that the cost of health insurance is more than just the premium, and that evaluating it requires looking at all the components: premium, deductible, co-pay and OOP max. I think I'm working up to a diary on that topic.

      That's one of the things that was really scummy about the way that the broker broke the news to the employees in PA. He should have sat down with them and had a frank discussion about WHY their premiums were going up - when you start looking at all the things that are covered in and ACA-compliant policy but were commonly missing before..... mental health coverage, preventative, etc, etc, etc.... overall costs, as you pointed out so well, look much better.

      For instance, what if Judy's kid needs mental health counseling... or Judy or her husband, for that matter. The new policy might be the difference between being able to afford - or even GET - that kind of service. A mammogram costs several hundred dollars, if I recall, and that is covered completely, etc, etc, etc.

      And a good broker will know these kinds of things, and will consider them (at least in the past, when it mattered) in order to tailor the insurance policies to the specific group. But this guy obviously set up the policies to benefit his ideology, and dumped them on the employees in front of the cameras in the most painful and shocking way possible, all for his own twisted purposes.

      Arrrrghhhhh!!! I'll never tire of exposing this type of evil.

      cheers

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sat Feb 01, 2014 at 12:20:34 PM PST

      [ Parent ]

  •  How? (2+ / 0-)
    Recommended by:
    Involuntary Exile, Tortmaster

    "That's with no subsidy, BTW."

    Because she's in the Medicaid gap?

    "Emilie's TV ad also mentions that her total health insurance cost had increased to $6,000 per year."

    Which means an individual income "between $0 and $15,282".

    So how's that going to work?

    But if she's not in the gap, of course, she's paying much less for health insurance. At least is she chose a silver plan.

    •  My assumption is that her income is too high... (8+ / 0-)

      (weird, why was that bold?)

      for her to get a subsidy. Here's my reasoning:

      She has an accounting degree, and has been employed - presumably at the same firm - since 2006.

      In Lawrence county, TN, it looks like the subsidy drops off completely for a single person somewhere around $30,000.

      The subsidy calculator on healthcare.gov is doing some weird things - the first page says subsidy available, but the policy summary page says no, for some income levels.

      And at $30,000 it shows a subsidy of $12/mo.... I've never seen one that low, they usually cut off pretty abruptly from a level well over $100. I think this behavior is caused by the fact that this area is WAY under average for health insurance costs. That Platinum policy Emilie has, as I said in the diary, is the sweetest I've ever seen.

      And she's bitching loudly all over our TV sets about it!

      That galls me! We need to get this on Rachel!

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sat Feb 01, 2014 at 02:11:14 PM PST

      [ Parent ]

  •  And what the heck does this mean? (6+ / 0-)

    "Emilie found a plan that was affordable for both her and her employer."

    Since her employer was paying $0, it sure was affordable for them.

    •  No, the employer paid the same amount: $53 (3+ / 0-)
      Recommended by:
      JVolvo, Bluefin, caul

      I neglected to post this link:

      http://www.covertn.gov/...

      That's the info on the plan she was covered on. Of particular interest is the benefit sheets linked to in item #22.

      Also, when you look at the rate table, see if you can figure out the major significance of the rate of $53, particularly for a person with lupus. That's the subject of the major update I'm working on.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sat Feb 01, 2014 at 12:22:54 PM PST

      [ Parent ]

      •  So the employer didn't offer (2+ / 0-)
        Recommended by:
        JVolvo, caul

        employees health coverage but paid a share of the CoverTN plan. Got it.

        •  But I still don't see (1+ / 0-)
          Recommended by:
          caul

          how she can afford anything if she's in the Medicaid gap.

          •  Sorry, I didn't write that very well.. (3+ / 0-)
            Recommended by:
            Bluefin, worldlotus, caul

            let me explain. Here's what I wrote:

            Compounding this problem,

            although presumably not for Emilie because she's employed,

            (here's where I excluded Emily from what followed, which is just my stock screed about states refusing to expand Medicaid)

            is, of course, Tennessee's refusal to participate in the Medicaid expansion program, that is completely paid for by the federal government for 3 years and at least 90% after that.

            People unlucky enough to be caught in what I'm now calling the 'Roberts-hole' - those between the top amount for pre-ACA Medicaid qualification and the ACA maximum income for Medicaid - get no subsidy at all. For Tennessee, that is between $0 and $15,282. Anyone in that hole gets no subsidy. That's right, in Tennessee adults in most cases can't qualify for Medicaid at all, and now the people who need it most can't get an Obamacare subsidy. That's perverse to the point of being evil.

            Hopefully it makes sense now.

            Cheers.

            Against stupidity the gods themselves contend in vain. Friedrich Schiller

            by databob on Sat Feb 01, 2014 at 02:14:26 PM PST

            [ Parent ]

            •  OK, so she's employed. (0+ / 0-)

              But does her income put her above the Medicaid gap?

              If so, she could be paying a lot less than the $6,000 a year.  That's for a platinum plan and still a good deal if she can afford it. And if she can afford $500 a month for health insurance, I'll stop worrying about her.

              But if she's not in the Medicaid gap, she could be getting substantial subsidies and pay a lot less if she chose a silver plan.

              Or is she working but still in the gap?

  •  TN used to help people, because of the Kenyan (12+ / 0-)

    Muslim, they decided to stop helping at all.

    nice
    TN is this woman's problem.

    "The poor can never be made to suffer enough." Jimmy Breslin

    by merrywidow on Sat Feb 01, 2014 at 10:50:18 AM PST

  •  Let's be blunt (22+ / 0-)

    Republicans are not being hypocrites about this.  They are being outright liars.

    There are huge problems with Obamacare.  But those problems argue for further reforms, like eliminating co-pays, deductibles, and tiered pricing, which in turn lead to reduced profits for both insurers and providers.  Or they lead to a single payer system or a regulated non-profit system like the Swiss system.

    50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

    by TarheelDem on Sat Feb 01, 2014 at 11:31:29 AM PST

    •  And the problem with all GOP lies is that (0+ / 0-)

      When there is a genuine case that could be fixed with improvements they might be believed. As the gop has cried wolf too many times

    •  Did you hear all their concern (1+ / 0-)
      Recommended by:
      Nance

      about the people who would have to pay higher premiums before the ACA rolled out? Of course not, because they're not interested in fixing the problem.
      Abortion and gay marriage are the real problems facing this country today, according to my representative.
      Screw all those people who didn't have insurance before.

      Your beliefs don't make you a better person. Your behavior does.

      by skohayes on Sun Feb 02, 2014 at 02:59:22 AM PST

      [ Parent ]

  •  Junk Insurance (5+ / 0-)

    Why do the GOP want people to have such bad insurance. A lot of people who file for bankruptcy had insurance, that is the problem.

    •  Wellll, how about this? (7+ / 0-)

      When your junk insurance causes you to declare bankruptcy because of medical bills, that means you have given ALL of your money, past, present and future (for the most part, because they will never cease hounding you) to the rich people.

      Bankruptcy is the ultimate victory of the rich people!

      Of course, in some ways it's like a virus that kills, which isn't as successful as a virus that just gets you sick, but that's another discussion.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sat Feb 01, 2014 at 12:25:31 PM PST

      [ Parent ]

    •  Because it proves that government can do (10+ / 0-)

      something valuable, which undercuts their argument for getting rid of all taxes, regulations, and social programs, while keeping subsidies, tax breaks, and government-mandated monopolies, so that the rich can get ever richer. Because those moochers, especially in finance, don't know how to run a business that can compete on making an actual product.

      Ceterem censeo, gerrymandra delenda est

      by Mokurai on Sat Feb 01, 2014 at 12:56:37 PM PST

      [ Parent ]

  •  What, exactly, is this supposed to mean? (3+ / 0-)
    It was cost prohibitive for her employer to purchase a companywide plan, so Emilie needed to obtain an individual health care plan. Emilie found a plan that was affordable for both her and her employer.
    (emphasis mine).

    Are they saying that while this employer couldn't or wouldn't provide a group plan (which would certainly have been much cheaper per participant than any individual policy), they were providing, or underwriting, or somehow sharing the cost of health insurance for this woman with a serious chronic illness? I wonder what the rest of the staff thought about that.

    "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

    by sidnora on Sat Feb 01, 2014 at 12:19:10 PM PST

    •  That's the subject of the update I'm working on.. (8+ / 0-)

      so I'm going to tease you by saying that I dropped a few hints in the responses I just wrote, but I really need to write the update while it's fresh. I hope it won't take a long time, and I promise it will be worth waiting for.

      Emilie, on the other hand, isn't going to like it, not one little bit.

      Cheers.
       

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sat Feb 01, 2014 at 12:42:42 PM PST

      [ Parent ]

      •  Can I just say, one more time, (13+ / 0-)

        that you are knocking it out of the park on a daily basis here? Thanks!

        "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

        by sidnora on Sat Feb 01, 2014 at 12:48:14 PM PST

        [ Parent ]

        •  Thank you very much! (8+ / 0-)

          My wife just told me 'you're way too involved in this', but hey, I'm retired and I enjoy it and I think I still manage to do the things I need to and keep her happy (not in that order) so why not? She's sitting in the next recliner playing a mindless computer game that has a level she can't beat, but am I complaining?

          BTW, in answer to your original question: yes, her company was paying their $53/mo share.

          I think that the CoverTN program was a company-wide plan offered to small businesses as an alternative to providing real health insurance, so the rest of the employees likely got the same 1/3 premium contribution to really, really crappy 'insurance'.

          But Emilie had another option, which I intended to make the subject of the update #1, but when I found out about the prescription benefit garbage, I decided to save it for update #2

          Stay tuned!

          Cheers.

          Against stupidity the gods themselves contend in vain. Friedrich Schiller

          by databob on Sat Feb 01, 2014 at 02:25:38 PM PST

          [ Parent ]

          •  Hey, some people discovered (2+ / 0-)
            Recommended by:
            worldlotus, skohayes

            that they had a second calling here. Maybe you're one of them.

            And on a personal level, ROFL. The LH thinks I'm "way too involved" in this stuff too, and I only organize meetups! In the meantime, what's he (also retired) doing? Oh, Angry Birds, or Candy Crush...

            "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

            by sidnora on Sat Feb 01, 2014 at 07:54:50 PM PST

            [ Parent ]

          •  Read the update, (2+ / 0-)
            Recommended by:
            worldlotus, skohayes

            and you did not disappoint.

            "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

            by sidnora on Sat Feb 01, 2014 at 08:01:54 PM PST

            [ Parent ]

  •  Will you marry me! BOOM! (6+ / 0-)

    Another clown busted.  These lies need to be stomped out every single time. Where is the MSM???  Wait.  Don't answer.

    Fantastic work.  Is it wrong that I'm smiling?  :-)

    End the wars! Single payer now!

    by HCKAD on Sat Feb 01, 2014 at 03:08:33 PM PST

  •  How does the saying go? "You can lead (2+ / 0-)
    Recommended by:
    joynow, skohayes

    a horse to water, but you can't make him grateful."

    "The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"

    by Lily O Lady on Sat Feb 01, 2014 at 03:16:09 PM PST

  •  Every single time... (14+ / 0-)

    ...I have fact-checked a supposed Obamacare horror story, it turned out to be: (1) bunk; or, (2) due the fact that the person's state rejected the Medicaid expansion.

    http://imageshack.com/a/img809/3384/zm0s.jpg

  •  We Need to Be Able to Recommend Multi-Times (6+ / 0-)

    Once for the original, then for a major update.

    This just blows the whole ad out of the water.

    Blackburn, McMorris Rogers -- peas in a pod.

  •  So this cRetin Emillie is a g'damned smoker too, (0+ / 0-)

    eh?
    What a complete, addicted ass she is. Addicted to tobacco, and a toxic political ideology, both of which can destroy you.
    How in the hell are there still so many of these dumbshits around?

    So, on her CoverTN policy, what is the only mix of circumstances that could result in a 39-year-old woman having a premium of $53?...
    'what to do and not do if you have lupus'.

    "The church of life is not in a building, it is the open sky, the surrounding ocean, the beautiful soil"...George Helm, 1/1977

    by Bluefin on Sat Feb 01, 2014 at 04:14:48 PM PST

    •  I'm not totally convinced she smokes... (4+ / 0-)
      Recommended by:
      Slightly Wobbly, sidnora, badlands, catwho

      which is why I'm not pushing that assertion.

      The evidence, however, is pretty good..... better than what they used to convict Amanda Knox, that's for sure.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sat Feb 01, 2014 at 04:22:33 PM PST

      [ Parent ]

      •  Well, you posed the question, I just made a (3+ / 0-)
        Recommended by:
        skohayes, tb mare, VPofKarma

        SWAG conclusion based on data presented.
        BTW, Thanks for all these fact-based diaries, a most excellent series so far.

        I have a RWNJ bro who is one of those who rants about 'OMGbamacareOMG' like the rest of these cretins.

        And yet he is exactly the type of person O'care is targeted to help (barely self-employed/bizman, previously paid for expensive individual policy, now with health problems and cannot 'afford' a policy, as if there were any available (even before ACA really kicked in), so has NO health insurance (but is prepared to wait years for 'his' Medicare).
        But will not even touch the healthcare.gov webpage and look up what he might be able to get. He's become an utter fool politically by marinating in the RW propaganda, sad.

        "The church of life is not in a building, it is the open sky, the surrounding ocean, the beautiful soil"...George Helm, 1/1977

        by Bluefin on Sat Feb 01, 2014 at 05:50:02 PM PST

        [ Parent ]

        •  I've got a brother-in-law like that... (1+ / 0-)
          Recommended by:
          skohayes

          I only see him a couple times a year, and I've learned to not confront him, just ask him about 'do you think this is fair?' kind of stuff, try to sneak up on him.

          I'm getting pretty good at it, and the look on his face when he realizes I've backed him into a corner defending a liberal point-of-view.... priceless!

          No problem on the smoking thing... I realized later that I did ask, and you're the first direct response.

          I sure hope Rachel runs with this - I sent her the link with an urgent plea, highlighting the Koch brothers connection, knowing that's a big one for her - and if she could find a picture of Emilie smoking.... well, that would be HOT!

          Cheers.

          Against stupidity the gods themselves contend in vain. Friedrich Schiller

          by databob on Sat Feb 01, 2014 at 06:05:22 PM PST

          [ Parent ]

  •  There are lies and then there are Republican (3+ / 0-)
    Recommended by:
    zbob, KayCeSF, Turn Left

    lies and no one can lie like a Republican not even a rug!

    Dogs and Philosophers do the greatest good and get the fewest rewards (Diogenes)

    by Out There on Sat Feb 01, 2014 at 04:25:56 PM PST

  •  Ding! Ding! Ding! (0+ / 0-)

    "This is outright fraud."

  •  tweet a link to this diary (2+ / 0-)
    Recommended by:
    politik, 4Freedom

    to every media outlet and every chamber of commerce in Tennessee

    •  I don't do twitter, but anyone else is encouraged (3+ / 0-)
      Recommended by:
      raincrow, skohayes, 4Freedom

      to do that.

      I did e-mail the link to Rachel's blog, and to TPM as well. TPM showed some interest, haven't heard from Rachel.

      If everyone would send the link to Rachel, that would probably help.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sat Feb 01, 2014 at 06:07:07 PM PST

      [ Parent ]

  •  T&R'd, bookmarked for community edu. (4+ / 0-)
    Recommended by:
    Black Max, sidnora, 4Freedom, VPofKarma

    Great diary! I wonder if "Emi-Lie" is actually REAL...  I couldn't quite tell by your diary. But she could be one of those mere "tropes" another diarist wrote about yesterday.

    Poverty is not an accident. Like slavery and apartheid, it is man-made and can be removed by the actions of human beings. —Nelson Mandela

    by kaliope on Sat Feb 01, 2014 at 07:05:33 PM PST

  •  Math and Reality were never a strength for R's (1+ / 0-)
    Recommended by:
    Nance

    Seriously, they use some other kind of Math, like the new, new, old math or something. Personally I think they pull their facts and figures off a Quija board.

    What would really be great is if we could just say, fine.... you want your old crappy insurance back? do it. But don't come whining to us when you realize what a absolute piece of junk it is.

    I say the same thing for stuff like Social Security, Unemployment insurance, etc. Unfortunately managing such a thing would be a nightmare and these systems are set up so that every pays and everyone benefits.

    So lets take Unemployment Insurance. Employers would still have to pay into it. If you don't believe in Unemployment insurance then you can opt out. But the catch is....you can NEVER collect on it. Same with Social Security.

    How many of those Tea Party nuts actually live off of disability or Social Security? They don't seem to realize that the check they cash every month in order to live is the same Social Security that is being debated. It is as if they think it is different somehow.

    I am saddened by how our country is collectively losing the ability to think critically.

  •  Tea Party Health Plan: Don't Think about being Ill (1+ / 0-)
    Recommended by:
    Nance

    I don't understand it.  But I don't live in a fantasy world.

  •  Your work is great, important even, and also (4+ / 0-)
    Recommended by:
    worldlotus, Nance, catwho, Cardinal Fang

    We need to empathize with some of these people first. Not just that we are sad someone young is sick with Lupus and has health care woes.

    But try to imagine that it is possible that they DO feel duped, dissapointed...even furious. I think it IS possible that for many of these stories, the person had cobbled together, after perhaps so effort, care that they could get along with (perhaps telling themselves it was good enough), but it was a rocky boat for them. They heard the the ACA wouldn't change their insurance. THEN IT CHANGES. It rocks their boat. And they find that as a betrayal and threatening.

    Not that they are right that they had good enough insurance. Not that they are right that the ACA is screwing them. Not that they are right that the ACA option is worse for them than what they had.

    But still, initially SOME if not most of these people, in their ignorance perhaps, feel betrayed.

    I have seen us get impatient and annoyed by these people. I think we need to look at how the ACA comes across to them. I think the feeling of being BETRAYED after hearing they wouldn't loose their insurance from the President and then it Seems to them, they do...is what runs many of them. They thought they had it cobbled together and had it all set and then their world was rocked. THis is going to be especially scary for people who have chronic health problems.

    I really appreciate the diarists efforts here. I wouldn't personally have the fortitude to wade through this stuff. But Many people don't have what it takes.

    I think we need to acknowledge that even if it was the best choice in the moment for Obama given the circumstances, telling people flat out they could keep their insurance mislead some people and that they now, humanly, feel betrayed. Their trust, already perhaps precarious, was broken around this.

    Sure some are wingers and surely the RW is using and abusing the situation and these people to their own nefarious ends.

    But we need to acknowledge that some of these people, especially those who NEED insurance for their own well being, feel betrayed and threatened when TOLD it has to  change. We need to have compassion for them first.

    The only way I've been personally able to reach people who are angry at the ACA because it is screwing up their insurance (members of my own extended family and people I know on FB, mostly) is to acknowledge the legitimacy of their feelings and label it as  the betrayal of trust that they seem to be feeling. When I do they can move on to, given that, what is the actual situation.

    •  It's the move to using (2+ / 0-)
      Recommended by:
      databob, FishOutofWater

      these people as public examples of reasons to hate the ACA that is the problem.

      Privately, you are upset that change is happening. A normal reaction. Especially if you thought you had things all figured out and wouldn't have to change.

      Heck, I wasn't happy when the accountant gave me back my paperwork and made me do it a different way this year. Having to rethink and redo sucks.

      But then, privately, you find out what the new deal is. You move on. You have better coverage. At an overall lower cost.

      But then your initial upset at change is used to illustrate a political point.

      Your private dealings can continue to a good outcome -- better understanding and better coverage. But once one of these stories becomes a political tool, the poor person in the story -- if they even exist -- has to go along with the political BS or be strong enough to speak out and denounce their fellow travelers. A heavy lift.

    •  I agree with you.. (0+ / 0-)

      and I do have sympathy for the people who really are being disadvantaged by Obamacare - there are legitimate horror stories out there.

      My motivation in this series is to debunk the cases that have been publicized by the RW media and political operations like AFP.

      I think we all share the frustration that the flaws of Obamacare - and yes, there are many of them - are, for the most part, fixable, but it won't happen soon because of the Republican obsession with destroying what, for all intents and purposes, is THEIR healthcare reform idea.

      That's galling, to say the least.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sun Feb 02, 2014 at 07:19:21 AM PST

      [ Parent ]

    •  But the betrayal is by the insurance (0+ / 0-)

      companies who CHOOSE not to grandfather in the old policies.  They are the ones to be pissed with — and I would tell them that.

      The President should have said  "you can keep your same {policy, doctor, etc} if your insurer is willing. The ACA does not force the insurers to change nor does it forbid them from changing."

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sun Feb 02, 2014 at 10:54:54 PM PST

      [ Parent ]

  •  Had a friend over tonight bemoaning the fate (8+ / 0-)

    of his tenant.  He's a recent college graduate with no job.  Apparently, his insurance was just canceled.  My friend was saying how terrible Obamacare was because of this.  I said, "It was probably a jink policy."  He said, "I don't know about the coverage or deductibles."  I said, "He's under 26, right?  Can't his parents put him on their policy?"  My friend said, "For some reason, they didn't want to."  I said, "He has no income?" My friend said, "He doesn't have a job."  I said, "He must be eligible for Medicaid."  My friend said, "I don't think he's checked."

    OMG!  I just can't deal with the willful, proud ignorance any more!!!  If you don't want to be helped that's your choice.  But, then, don't blame the President because you refused or couldn't be bothered to lift even a finger to obtain that help.  How can Obama be blamed for turning all those rugged, bootstrap Republicans into helpless ninnies?

    •  He was probably required (2+ / 0-)
      Recommended by:
      anon004, VPofKarma

      to have insurance while he was in college and was able to get affordable coverage through the college's group plan. Which is terrific.

      You would think, though, that somewhere along the way someone would have pointed out to him that he would graduate at some point and need to start acting like the adult he is. Sigh. . .

  •  Another potential ACA-dar Sheila Salter (2+ / 0-)
    Recommended by:
    Sherri in TX, Skyye

    Sheila Salter, a "small business owner" appears daily on TV in Raleigh trashing Kay Hagan for supporting Obamacare and complaining about how she lost her insurance and is now paying much more. I see her ads here on DKOS as well. (Yes I need to pay my subscription!) Here is a link where she describes her "preferred plan" that was cancelled.
    http://freebeacon.com/...

    •  Another Republican (1+ / 0-)
      Recommended by:
      science geek

      who suddenly does not understand how insurance works.

    •  This one looked tough, but I think I found her lie (4+ / 0-)

      Sheila Salter is founder, president and only employee of early2surg, a consulting firm.

      Her complaint is that before ACA she had a plan with a premium of $202, $3,500 deductible and $25 co-pay.

      Now she's forced into a Bronze plan with $584 premium, $5,000 deductible and $45 co-pay.

      Why, that's horrible! How can this be?

      I verified her ACA policy. She lives in Chapel Hill, NC which happens to be one of the really expensive areas in the country. Her Bronze plan costs a LOT more than Emilie's Platinum plan.

      So at first glance it looks like Sheila is right.... but then my ACA-dar started beeping....

      Why did her premium jump so high so fast? Her chart from her Senate testimony shows that she already had most of the '10 essential services', all except for pediatric (which is just another doctor, OK) and some mental health services and, of course, maternity (sorry, Sheila, 61-year-old women HAVE gotten pregnant!). It just doesn't make sense for her premium to skyrocket - that is something that typically happens when one moves from a truly junk policy (that's missing something essential like ER services, or prescription drugs or even hospitalization.

      If something looks too good to be true, it probably is.

      Then I looked at her business's web site and all became clear. Take a look:

      http://early2surg.com/...

      It looks pretty barren, no client list, nothing substantial... looks like she just went into business and threw up a website.... so I looked around for about 30 seconds and found

      On Wednesday, March 20, 2013,  a U.S. federal trademark registration was filed for EARLY2SURG by Sheila A. Salter,

      OK, she just started up her business.

      I also found that she worked for over 20 years for a major company called Covidian, and more recently for a couple of other similar firms.

      So there it is: Sheila got her 'premium' insurance through her previous employer, heavily subsidized of course. That's the only way I can see her actually having that premium policy - you just couldn't possibly have gotten a policy like that on the individual market in that area.

      My guess is that she left her most recent employer with some sort of run-off insurance - subsidized COBRA, layoff, etc. and was on that when last year ended.

      So Sheila's lie was one of omission, which makes it no less a lie. She tried to convince the world that an apple was the same as a pear.

      Shame on Sheila.

      Of course, she could easily prove me wrong by providing details of the premium individual market policy she was getting for $202 last year.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sun Feb 02, 2014 at 05:30:31 AM PST

      [ Parent ]

      •  Great investigating, Databob! (1+ / 0-)
        Recommended by:
        wa ma

        Also noticed from her website that at her previous job she was selling medical equipment.

        Sheila spent over 20 years with Covidien Surgical Devices (formerly Tyco Healthcare and US Surgical Corp.) where she commercialized more products than anyone in the history of the Company.  More recently, Sheila was employed in Marketing roles by TransEnterix and Teleflex Medical.
        So she has some "skin in the game" so to speak. I am sick of hearing this woman every time I open a website. I wonder who is sponsoring her ads?
        •  I'm going to send this to Kay Hagan's campaign... (1+ / 0-)
          Recommended by:
          science geek

          they might be able to use it to counter the ad that I've heard is running in NC starring Sheila.

          If I have time, I'll turn it into a diary - if not, I'll just send what I found.

          I think that an intrepid researcher in a Senatorial campaign ought to be able to ferret out some of the missing details of Sheila's work history, and at least come up with enough to hit the maker of the ad with some hard questions.

          I don't doubt that the companies she worked for had company-sponsored healthcare. As you pointed out, they are some of the biggest winners in the health-care game, and a publicly traded company like Covidien is going to have good benefits.

          I have a brother-in-law who used to work for St Jude, another med equipment maker - something about heart stints, if I recall - and he was in marketing too.... sucked up big bucks until he quit in a dispute over relocating from Michele Bachman's district in Minnesota to Los Angeles.

          Now he sells Christian-crazy home-school materials, fwiw.

          Cheers.

          Against stupidity the gods themselves contend in vain. Friedrich Schiller

          by databob on Sun Feb 02, 2014 at 10:21:49 AM PST

          [ Parent ]

  •  Anyone wishing to question Blackburn (0+ / 0-)

    more closely on the veracity of her fact-challenged, boilerplate GOP prattle will find her at her usual location, on the stool at the end of her favorite bar, touching up her makeup in her compact mirror and winking at the truck drivers and Bible salesman along the rail.

    •  Do you know this? (0+ / 0-)

      or did you write it because anyone who's listened to her more than a few words would get the impression that you wrote?

      I put Blackman in the finals of Bill Maher's 'worst congressperson' competition, along with King, Steve, Bachman and Gohmert, and of course Stockman.... and the list could go on and on.

      But I think if I had to vote for one, it would be Gohmert.... I just cannot fathom how that guy got through law school!

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sun Feb 02, 2014 at 10:25:27 AM PST

      [ Parent ]

      •  Mea culpa! (0+ / 0-)

        I just made a completely reckless, unforgivable assumption after seeing and hearing her prattle more than once. They say first impressions are usually accurate.

        Maybe, we'll find out she volunteers at nursing homes, tutors disabled children and rescues kittens.

        

        

        

        Nahhhh.

        As for Gohmert, as with Cruz, it drives home the point that law schools — even the really good ones — don't screen for personality disorders.

        •  LOL... I think her pucker is so tight she must ... (0+ / 0-)

          poop via proxy!

          I take her for a Christian crazy, but maybe just crazy.

          She has the uncanny ability to act clueless no matter the topic, and isn't even as cunning as Caribou Barbie who can at least string word salad good enough to stoke the base.

          Cheers.

          Against stupidity the gods themselves contend in vain. Friedrich Schiller

          by databob on Sun Feb 02, 2014 at 02:23:30 PM PST

          [ Parent ]

  •  The GOP should be called to account (3+ / 0-)
    Recommended by:
    Skyye, Sherri in TX, tb mare

    Every Republican member of Congress should be caught on tape showing how they either helped or hindered people needing help with healthcare issues.

    There should be at least 1 person in each state or district that has a genuine problem that should ask for help and we need to document the responses.

    I think this is an issue that could lose the house for Republicans. If  we can document they do not care about helping those in need.

    Don't run thru the screen door, Granny, you'll STRAIN yourself!

    by Tuba Les on Sat Feb 01, 2014 at 11:46:12 PM PST

    •  They are available (0+ / 0-)

      on your tube many of them.

      Perhaps we need a citizens shcool of how to take clips and post and edit to make citizen ads and take them all viral?

      All we would need to know how to do is take their own recordings of what they have already said, then what they did (like the vote they may have taken) then the maplight.org or sunlight data on the contributions they got from the industries, or groups.

      If I could learn this I could I think put a citizen ad together of simple facts and video in timeline. I know alot of the brighter more organized diarists here certainly could do this extremely well.

      The concept that it is lawful for a politician to be either reckless and not look for facts, or be leading with half truths without factual information, or outright lie to the citizens of this country has taken us down a snake hole.

      I think we put together, when I say we, I mean citizens, true ads and let them speak for them selves and show their opposite actions, these would gain the attention of those like rachael, chris, ed, joy, lawrence and the likes, as well as those on maybe even CNN.

      Ultimately we could start a truth brigade to help those uninformed whose emotions are high with anger and hate, and show them they have been lied to, mislead, all without even telling them. Complete with links to videos, contribution dates and amounts, links to how they voted.

      Coffee now. Let's see what thoughts are out there and what I missed

    •  just ads saying my congressman voted against (1+ / 0-)
      Recommended by:
      Nance

      Medicaid expansion in my state, and I can't qualify for subsidized health insurance like people in Kentucky and California, and the other 25 states that have expanded Medicaid get. With the subsidy I could have good insurance that would cover my pre-existing condition for less than $100 month. I could maintain my health and not go bankrupt or have to put off medical help because I can't afford it.

      Vote for x, who will expand Medicaid and improve healthcare in our state.

      Today's problems are yesterday's solutions. Don Beck

      by Sherri in TX on Sun Feb 02, 2014 at 05:07:56 AM PST

      [ Parent ]

      •  except that congressmen don't vote (0+ / 0-)

        on or determine whether a state takes up Medicaid expansion.

        So your thing can only be used in state races; not congress.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Mon Feb 03, 2014 at 01:02:40 AM PST

        [ Parent ]

  •  damn. I want Emilie's plan. (0+ / 0-)

    Righteousness is a wide path. Self-righteousness is a bullhorn and a blindfold.

    by Murphoney on Sun Feb 02, 2014 at 01:31:07 AM PST

  •  Higher charges for smokers (1+ / 0-)
    Recommended by:
    Skyye

    seems unfair to me. We don't charge more for other destructive health habits that are only habits, not addictions, and smoking is an addiction. Just saying. It is good that smoking cessation programs are provided for under ACA.

    •  Especially true (1+ / 0-)
      Recommended by:
      marina

      when as far as I know (correction appreciated) these same smokers through their taxes, pay for the loopholes for the producers.

      I believe you could even be a true alcoholic and it would not be a big fine.

  •  I'm in a union (0+ / 0-)

    and I can't get insurance for $389/month.  I say "count your blessings!"

    "The light which puts out our sight is darkness to us." Thoreau

    by NancyWH on Sun Feb 02, 2014 at 05:16:37 AM PST

  •  Remember when it used to be illegal to make false (0+ / 0-)

    claims in television ads? Did I phrase that correctly? Anyway, back in the 70's, I remember TV commercials were different. Different in the sense that they couldn't say anything UNprovable about their competitors. One commercial in particular, for C & C Cola, had a clown horn beeping out "Coke" and "Pepsi". And then we had our own clown President, AKA the star of Bedtime for Bonzo." And so it went...

    Maybe someone in advertising, an expert in commercial speech, or the history of television advertising, or whatever could explain the regulations that appear to have been done away with, but my assertion is that these kind of Koch sucker ads would have been illegal back in the day. Then again, all that Koch sucker cash would have been too and the liberal SCOTUS would never have supported the fraud that is Citizen's United.

  •  Republicans lied? (0+ / 0-)

    Say it ain't so...

    "A lie is not the other side of a story; it's just a lie."

    by happy camper on Sun Feb 02, 2014 at 06:06:20 AM PST

  •  a bigger point being missed (2+ / 0-)
    Recommended by:
    kimoconnor, greengemini

    Covertn was STATE SUBSIDIZED insurance

    so this person wanted government out of her government subsidized insurance

    "Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservative." - John Stuart Mill

    by smartone on Sun Feb 02, 2014 at 06:18:29 AM PST

    •  The state does kick in 1/3 of the premiums... (1+ / 0-)
      Recommended by:
      greengemini

      so that does count as state subsidized. Good point. I didn't emphasize that because, unlike Betty the Roofer, Emilie doesn't appear to be a RWNJ, and she even claims to have voted for President Obama. So I didn't see any ideological angle there.

      I didn't find any evidence of support beyond that.

      I think the AccessTN high-risk pool is heavily subsidized.

      It's pretty reprehensible that the state just cancelled 26,000 insurance policies in their state-supported special needs insurance program, put all that money in their (read rich people's) pockets and THEN refused to allow the Medicaid expansion which would have helped many of these people (although presumably not Emilie) even though it is 100% paid by the federal government.

      The lengths these red states are going to screw their residents - and profit from this - is amazing.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sun Feb 02, 2014 at 06:44:12 AM PST

      [ Parent ]

  •  This line from the Blackburn press release puzzles (0+ / 0-)

    me.

    Emilie found a plan that was affordable for both her and her employer.
    Was her employer helping pay for her pre-ACA insurance?  Was the $56 a month only her share?

    So I see only tatters of clearness through a pervading obscurity - Annie Dillard -6.88, -5.33

    by illinifan17 on Sun Feb 02, 2014 at 06:26:32 AM PST

    •  The 2 press releases are different... (1+ / 0-)
      Recommended by:
      4Freedom

      You're quoting from the one that insinuates Emilie found a plan on the individual market, the other one specifies it as state-subsidized CoverTN.

      CoverTN premiums were shared equally between the state, employer and employee. So each paid $53 per month for the junk coverage provided.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sun Feb 02, 2014 at 06:49:08 AM PST

      [ Parent ]

  •  in which we discover republicans are (1+ / 0-)
    Recommended by:
    greengemini

    lying motherfuckers pretty much every time they open their mouths

  •  One more thing (2+ / 0-)
    Recommended by:
    paradise50, greengemini

    I'm surprised no one has mentioned this but in Western PA, UPMC and Highmark are in a battle royale over heath care coverage.  UPMC hospitals will only take Highmark customers as out of network patients.  If people at this company have pre-existing conditions and they are seeing UPMC doctors, their coverage choices are limited.  Many people believe UPMC provides the best doctors/hospitals and don't want to switch.  I e-mailed Wendy Bell twice but have received no response either.

    •  ...the website was a problem originally... (1+ / 0-)
      Recommended by:
      greengemini

      ...in states that didn't make their own site. In California we had a superb site Covered California. It has a few minor glitches early on but then smooth sailing.

      The REAL problem is turning out to be the health insurance companies themselves. Many are playing games (big surprise). For instance I've always had to buy my own health insurance due to being self-employed. I had my policy cancelled by AnthemBlueCross because it didn't comply by the minimum standards of ObamaCare. I was paying over $1000 per month (husband and wife) for their shitty policy.

      I got a new policy...the Silver70 one...through Covered California's exchange. My policy is from AnthemBlueCross. We only have them and BlueShield that offer individual plans in our area of the state.

      Well, I lost my doctor because my doctor won't accept my insurance now. WOW! This sounds terrible doesn't it? The problem is AnthemBlueCross is attempting to game the system. They STILL have not told doctors what they will pay them. So doctors understandably will not sign contracts with AnthemBlueCross until they know what they'll get paid.

      I truly believe AnthemBlueCross is hoping a bunch of doctors will simply sign a contract and then screw them. Doctors aren't that stupid. So, I lost my doctor NOT because of ObamaCare, but rather AnthemBlueCross.

      The problem with HeathGov.com was not the intake part of it but rather the back end that hooked up sign-ups with insurance companies. That company (CGI out of Canada) was fired because they turned out to be totally inept. They still made a cool $300,000,000 and their stock went up 45% (I'm sure they "laughed all the way to the bank"). That problem no longer exists. The site works just fine now.

      The problem NOW exists in the for-profit-health-insurance companies NOT being able to handle things on their end...PLUS they are still trying to game the system...same old, same old...

      Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.

      Ignorance is bliss only for the ignorant. The rest of us must suffer the consequences. -7.38; -3.44

      by paradise50 on Sun Feb 02, 2014 at 10:56:21 AM PST

      [ Parent ]

  •  That ad (0+ / 0-)

    It does't even look honest and true.  Its not done well enough to have a lasting impact.

  •  Here's The Ad (1+ / 0-)
    Recommended by:
    greengemini

    Couldn't find it in the diary

    http://www.youtube.com/...

    "I think that gay marriage is something that should be between a man and a woman.” - Arnold Schwarzenegger 2003

    by kerplunk on Sun Feb 02, 2014 at 08:53:02 AM PST

  •  Do NOT go up against the well-researched stats (2+ / 0-)
    Recommended by:
    tb mare, greengemini

    of databob!

    Excellent piece.

    Journalism is printing what someone else does not want printed. Everything else is public relations. ~ George Orwell

    by 4Freedom on Sun Feb 02, 2014 at 10:16:07 AM PST

  •  We cannot chase down the lies in..... (0+ / 0-)

    ...every one of these stories AND we need to be prepared for the fact that ACA does have some holes in it that people can fall through. That is just a fact.

    All we can do is PUT OUT OUR OWN SUCCESS STORIES. We cannot fact check every lie on their part, although I admire your efforts very much.

    If you hate government, don't run for office in that government.

    by Bensdad on Sun Feb 02, 2014 at 10:57:13 AM PST

    •  I think we can do both, Bensdad... (3+ / 0-)
      Recommended by:
      Bensdad, greengemini, pat bunny

      and I think both are important.

      With Bette the Roofer in Spokane, we put a dent in CMR, which I think will get some attention in her own district. Bette is exactly the kind of person we want to 'attach at the hip' to Republicans like CMR..... think Joe the Plumber - I think he ended up being a pretty big negative for McCain once the truth started coming out.

      In PA, we exposed a shady RWNJ who is preying on the emotions of his clients for ideological purposes, and very possibly may have fiddled their policies and rates to increase the effect of his sick theatrics.

      Emilie is important to debunk, because AFP (KOCH Brothers) has obviously sunk a lot of money into that ad campaign. It occurs to me that the reason I'm being deluged with Emilie on my TV right now is that I'm currently in St. Petersburg FL, in the middle of Bill '2 families' Young's district, where they're having a special election to fill his seat.

      The Emily ad is hard-hitting, and if taken at face value will sway some voters. If this ad isn't debunked, we can count on it running nation-wide this fall.

      At the very least, if we can get this ad taken down, it will force AFP to spend more money on another ad. We know they don't have any REAL Obamacare horror stories to put in front of us, because if they did, we'd be seeing them.

      Come to think of it, Emilie is actually BOTH - a deceptive ad from the Republicans, AND a HUGE Obamacare success story.... I covered the reasons in the diary.

      So she could actually be used by our side positively as well.

      I'm perfectly willing to trumpet Obamacare successes in what's turning into a 'series' of diaries under the heading of ACA-dar, but right now I keep getting debunking ideas.... I'm working on Sheila from NC and Garry the not-so-small-business owner from Cookesville, TN in my queue.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sun Feb 02, 2014 at 11:13:09 AM PST

      [ Parent ]

  •  I think the CoverTN policy couldn't be (0+ / 0-)

    cancelled on the basis of the yearly-limit, because grandfathered policies still retain the ability to limit yearly spending, however catastrophic policies are only available to people 30 years-old or younger, and that is a far more likely reason for her policy to be cancelled than the yearly-limit.  https://www.healthcare.gov/...

    •  I'm not sure why they didn't get 'grandfathered'.. (0+ / 0-)

      I do know that they applied 3 times for some sort of waiver - for at least the CoverTN and perhaps the AccessTN high-risk as well, but were denied each time.

      The waiver wouldn't have been to get approval to be grandfathered - I don't know if state-supported plans fall into the same rules you posted for that - but to be able to run these plans permanently with a waiver to not meet the requirements of ACA.

      A suspect the government felt they had to hold the line, because as soon as they granted one waiver, every state and carrier would jump all over it... and the entire ACA would start crumbling.

      Keep in mind that CoverTN is the exact opposite of a catastrophic plan - it's benefits are so limited that they actually cut OFF just about as soon as something significant happens to you.

      BTW, I found that page on grandfathering to be extremely confusing - it left me totally unsure of much of anything!

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Sun Feb 02, 2014 at 02:21:34 PM PST

      [ Parent ]

  •  Databob does it again... (0+ / 0-)

    Great Job Bob !!!

    As for the previous question about grandfathering the CoverTN plan. Even grandfathered plans were subject to some of the ACA requirements, such as allowing children to stay on a parents policy until age 26, and no lifetime or annual limits for an individual plan.
    So it was the annual 25K limit that was unacceptable.

    Here's the link to the Federal Register about grandfathering:

    https://webapps.dol.gov/...

    Thanks again Bob!!

  •  There's a third possibility here (0+ / 0-)

    namely that "Emilie" does not exist, and someone just threw together a composite that sounded plausible but isn't actually a real person.

    When facts don't add up, or don't make sense, or contradict one another, my rule of thumb is that probably most of them are fiction.

    Question: Why is it that all of the examples the GOP is pulling out to prove how awful Obamacare is, seem to be women? I smell a strategy to try to get that elusive female vote -- and to convince women, who may be the drivers on family health care, to resist Obamacare, to make it fail.

  •  and it proves Congresswoman Blackburn is a lying, (0+ / 0-)

    partisan hack for her ignorant Republican party who doesn't care about people.

    Republicans only care about themselves, their money, & their power.

    by jdmorg on Sun Feb 09, 2014 at 06:14:30 AM PST

  •  So she is an accountant? But can't save money (0+ / 0-)

    with Obamacare?  Any accountant would advise their clients like her to get onto Obamacare.

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