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Wendell Potter

Wendell Potter is a health insurance industry whistleblower and author of 'Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans'

August 12th, 2013 11:49 AM

Reality check on the Affordable Care Act: Misleading information, sloppy coverage are confusing the public about Obamacare

Not confused enough yet about how much health insurance might cost some of us next year when the consumer protections in Obamacare kick in? Just wait. It’s likely you’ll soon be far more confused — and alarmed — than you already are.

Take, as an example, the CNNMoney story from last week, headlined, “Where Obamacare premiums will soar.” The subhead was equally scary: “Get ready to shell out more money for individual health insurance under Obamacare … in some states, that is.”

The first thing you should keep in mind when you read such stories is that very few Americans will be affected by how much insurers will charge for the individual policies they’ll be selling in the online health insurance marketplaces beginning Oct. 1. The CNN story doesn’t mention, as it should have, that in a country of 315 million people, only 15 million — less than five percent of us — currently buy health insurance on our own through the so-called individual market because it’s not available to us through the workplace.

Although the CNN story focused exclusively on the individual market, nowhere in the story was it explained that, according to the U.S. Census Bureau, the vast majority of Americans — about 55 percent of us — are enrolled in health insurance plans sponsored by our employers. Another 32 percent of us are enrolled in Medicare, Medicaid and other public programs. That means that almost 9 out of 10 of us will not be affected at all by rates insurers will charge next year in the individual market.

The Americans who will be affected most by Obamacare are the millions who are uninsured because they either cannot buy coverage at any price today as a result of pre-existing conditions or they cannot afford what insurers are charging.

Although the CNN story didn’t mention that one of the main reasons for Obamacare was to make it possible for the uninsured to at long last buy affordable coverage, it is the uninsured who will be most directly affected by the reform law, and most likely to benefit. That’s because insurers next year will no longer be able to refuse to sell coverage to people who’ve been sick in the past. And because most people shopping for coverage on the online marketplaces will be eligible for federal subsidies to offset the cost of the premiums.

Not until deep in the CNN story are we informed that “Americans with incomes up to $45,960 for an individual and $94,200 for a family of four will be eligible for federal subsidies.” That’s a huge point to bury, especially considering that the median household income in this country is still just around $50,000. It’s just a small percentage of folks buying coverage through the online insurance marketplaces that will have to pay the full premium price on their own.

Below the headline of the CNN story was a startling graphic showing the states of Ohio and Florida with the numbers 41 percent and 35 percent right below them, leading one to believe that all residents of those states would see their health insurance premiums skyrocket.

As I did my own research of those claims, I found that not only did those numbers apply to just the individual market, but they did not take into account the subsidies that will be available. So not only will very few Ohioans and Floridians see their premiums increase by that much, many if not most will pay less than they do today thanks to the sliding-scale subsidies.  

I also found that officials in those states were being disingenuous in the way they calculated their “Obamacare” figures. Ohio and Florida and many other states permit insurers to sell policies today that are so inadequate they will be outlawed beginning Jan. 1. The reason those kinds of policies are being outlawed is because, even though they are profitable for insurers that sell them, people who buy them often find out when it’s too late — after a serious illness or accident — that their policies are essentially worthless.

As The Miami Herald noted in a story about the projected rates announced recently by Florida’s Office of Insurance Regulation, the source for the CNN graphic, “The OIR compared ‘apples to oranges’ by failing to factor into its projections the fact that statewide averages for pre-Obamacare premiums included a wide variety of low-value plans — including plans with extremely limited benefits, such as no prescription drug coverage; and high-deductible plans, where the insured first must pay hefty out-of-pocket costs before the insurer begins to cover services.”

Considering all the intentionally misleading information we are being subjected to about Obamacare from politicians and special interests with an obvious agenda, it will be vitally important for reporters to be more responsible in their reporting. Sensational media stories with attention-grabbing headlines but inadequate analysis will only add to Americans’ confusion about a law that in reality will help the vast majority of us.

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