Good News! Obamacare Will Not Kill Cancer Patient Who Wrote The Wall Street Journal Op-Ed
If The Wall Street Journal and Fox News have anything to say about it, everyone in America will soon know the name of Edie Sundby, the California woman who has been fighting bladder cancer for nearly seven years, and whose Wall Street Journal op-ed is the latest Obamacare horror story to gain traction. On Wednesday night’s The Kelly File, host Megyn Kelly interviewed Sundby, and tried to paint White House senior adviser Dan Pfeiffer as a villain for challenging the facts in Sundby’s editorial.
Pfeiffer’s crime was challenging a specific, factual claim in Sundby’s powerful op-ed, that “Thanks to the (Affordable Care Act) law, I have been forced to give up a world-class health plan.” He did so by citing a ThinkProgress piece which points out that her insurance company, United Healthcare, chose to pull out of the individual market in California. They were not forced to, and in a statement announcing their decision, cited small market share and difficulty “administer(ing) these plans in a cost-effective way,” not the Affordable Care Act. The company had already decided, months earlier, not to participate in California’s health care exchange, Covered California.
While Kelly dinged Pfeiffer for a lack of empathy, she didn’t offer much of a challenge to his facts, conceding that “I know United pulled out of the market for various reasons,” but added that “the CEO was explicit that Obamacare tipped the scales.”
There’s a philosophical argument to be had over whether United Healthcare is the villain here, but to a woman fighting for her life, abstractions understandably mean little. On the other hand, to an administration whom Sundby explicitly charged with her potential murder, they mean a lot. As ThinkProgress pointed out, the reason United Healthcare gave for opting out of California’s exchange amounts to a desire to avoid insuring patients exactly like Edie Sundby, only who weren’t lucky enough to have health insurance until now.
There were many other claims in Edie Sundby’s op-ed that were difficult to measure, and factual holes that made it impossible to make meaningful judgments about it. For example, her overarching claim, repeated to Kelly, was that the new health insurance marketplace would cause her to “lose access to my cancer doctors,” and would force her to “choose between Stanford and UCSD. Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.”
The facts she offered, though, only seemed to prove that whatever plan she ends up with won’t be exactly the same as her old plan. That’s sort of a given. She doesn’t reveal how much the old plan cost her, or even claim that a new, off-market plan would cost more than her old plan, only that it would cost more than the exchange plans. She calls her old plan “affordable,” but as IBT points out, it’s unclear that this word means the same to Sundby as it does to the average American. Her husband, Dale Sundby, is an IBM executive-turned “entrepreneur” who has made hundred-million-dollar deals, and Edie herself plans to launch a skin care line. As the debate over Obamacare has made clear, however, a medical catastrophe can bankrupt even the relatively well-off.
Sundby reveals that United Healthcare “has paid $1.2 million to help keep me alive” since March 2007, but doesn’t reveal how much she has had to pay (although a 2012 AARP interview with Sunby says “the 20 percent out-of-pocket copayments amounted to tens of thousands of dollars). These factual holes aren’t necessarily the result of dishonesty; they’re the perceptions of a woman fighting for her life, so naturally, other details stand out more to her than these.
Fortunately, some of her interview with Megyn Kelly helps to fill in the gaps, and there’s good news for Edie Sundby. Obamacare will not only not kill her, she will probably end up spending much less for the same care. Since she didn’t reveal what her old premium was, it’s impossible to say for sure, but for about $664 a month, Edie Sundby can get a plan with better benefits than the one she had, even if none of her doctors participate. As it happens, though, the hospital where her primary oncologist practices, Stanford Medical Center, does participate with Blue Shield of California’s Gold 80 PPO plan. UCSD, where Sundby says she’s gotten emergency treatment, does not, but the plan covers her out-of-network. Even better, though, the Affordable Care Act forbids insurance companies from penalizing members for receiving out-of-network emergency services, and California forbids emergency providers from balance-billing patients for emergency care.
But even if all of Edie Sundby’s care is out-of-network, the Blue Shield plan has an out-of-pocket maximum of $6,350 for in-network services, and $9,350 out-of-network. Pacificare PPO, the plan she told Kelly she had, had a $10,000 OOP max for in-network services, and $15,000 for out-of network, which did not include her $5,000 deductible. It also did not include an extra $1,000 deductible she had to pay every time she was hospitalized, in or out of network, emergency or not. Blue Shield of California’s Gold 80 PPO plan has no such hospitalization deductible, nor any deductible at all.
Yes, it will be a different plan, but Edie Sundby will not lose access to the doctors that have kept her alive, and she stands to pay less for their care.
The good news doesn’t end there, though. In a 2011 New York Times column, Sundby expressed gratitude for her insurance, writing that when the cancer struck, “fortunately for me and my family, I was enrolled in a health plan that gave me the freedom to choose my doctors.”
It was fortunate, because had she not been insured at the time, she would not have been covered for those treatments by that Pacificare policy. Sundby credits United Healthcare for paying claims and continuing to insure her through her illness, but that’s because the law says they have to. The only way they could have cancelled her plan was if they found an error on her application (which Obamacare makes illegal) or by pulling out of the market altogether, which is what they eventually did. But thanks to the Affordable Care Act, millions of other Americans can be as lucky as Edie Sundby was to be covered for such a serious illness. If Edie Sundby’s story continues to gain traction, the true story, continues to gain traction, it could become a perfect symbol of Obamacare’s promise to give millions of Americans the same health security that most Americans take for granted.
(h/t Johnny Dollar)
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