by Chris Angelini
Recently, on FOX News Sunday with Chris Wallace, regular panelist Juan Williams was extolling the benefits of ObamaCare that Americans are discovering: “Although last year’s health care conversation revolved around death panels, socialism and how ObamaCare is going to end the world … now as we’ve closed the doughnut hole, said your kids can stay on your insurance until they’re 26, and guaranteed [that] insurance companies can’t eliminate people with pre-existing conditions, the American people are coming to say this is a good idea and the Republicans have nothing.” Unfortunately, all three of these triumphant claims are flawed.
1) Pre-existing-condition coverage is old news
From the very start of President Obama’s perpetual ObamaCare promotion tour, Republicans were hoodwinked into perpetuating the notion that ObamaCare mandates a new benefit: pre-existing-condition coverage. On numerous occasions, asleep-at-the-wheel Republicans have regurgitated the Democrats’ talking point that extending coverage to those with pre-existing conditions is one of the few good parts of the bill. But the facts and the congressional record show that this claim is specious.
It was President Clinton who signed into law the Health Insurance Portability and Accountability Act of 1996, which forbids health insurance companies from denying coverage to people with pre-existing conditions. Despite its 2,400 pages and 425,000 words, the ObamaCare act offers no substantive changes to existing law and simply preserves the status quo.
2) Coverage to age 26: Delaying adulthood
ObamaCare uses the full force and weight of our government to encourage young adults who have been fed, clothed and educated for 20 years by their parents to remain dependent on those parents and renounce responsibility for another six years — well past college. While not compulsory, ObamaCare pressures parents to remain liable for their adult children’s health care costs. The government thereby insinuates itself into the relationship between parents and children.
To many, the coverage age extension will come as an unwelcome obligation, because it is standard practice for companies to enroll newly hired employees into their group health care plans. Allowing adult children to remain on their parents’ health insurance for years after graduation will decrease the total number of participants in corporate group plans. This membership decrease will inevitably lead to higher costs and fewer benefits for remaining plan participants. Guilt-ridden parents on fixed incomes will be forced to pay the premiums of their irresponsible adult children who fail to contribute.
3) The doughnut hole is NOT closed
The most misleading ObamaCare claim is that it eliminates the infamous Medicare prescription “doughnut hole.” Everyone following the ObamaCare debate has heard the president and his minions shamelessly extol this “fix” as the single greatest gift to seniors since the inception of Medicare. Unfortunately the facts paint an entirely different picture.
The doughnut hole refers to the gap where Medicare does not reimburse the cost of a member’s prescription drugs. It begins at the point when the total amount paid for drugs by the insurance carrier, combined with the co-payments of the Medicare Part-D participant, reaches $2,840 dollars in a calendar year. While in the doughnut hole, the participant is responsible for 100 percent of all drug costs. The doughnut hole ends once the participant has spent $4,550 out-of-pocket.
The closing of the doughnut hole was deliberately scheduled to take effect immediately in January 2011 in the hope that it would increase support for ObamaCare among seniors. Yet, as my personal experience shows, Medicare providers are clueless about this new benefit, which is hardly as good as it’s cracked up to be.
Early this year, I was called by a pharmacy and told that my uncle, whose insurance matters I handle, had fallen into the Medicare doughnut hole. The pharmacist explained that instead of my uncle’s normal co-payment, the price for one of his prescriptions would now be $1,095 per month. I immediately called my uncle’s insurance company, AARP Medicare Complete/SecuredHorizons, Oxford Health Plans. An hour or so into the phone call — after speaking to a representative, getting transferred to a supervisor, being disconnected, calling back, and finally transferred again — a manager told me that the $1,095 price actually represented a $300 dollar savings due to ObamaCare. It was clear that no one had the vaguest idea of what the fix fixed. The hole appeared to still be wide open.
A week later, I called again. As before, the customer service representative and supervisor were oblivious to the doughnut-hole fix. This time, though, I was transferred to a Medicare-Part D prescription drug specialist/manager, who explained the bewildering new guidelines to me.
Here’s the skinny: The last drug my uncle purchased in January 2011 put him $795 dollars over the $2,840 coverage limit, and into the doughnut hole. According to the prescription manager, my uncle had to pay the full price for the drug, minus 50 percent of the total money spent in the doughnut hole. In other words, because of ObamaCare, instead of spending $1,095 that month for one drug, my uncle had to spend $1,095 – ($795 x 50%), or $697.50 for it. This is an improvement to, but NOT the elimination of, the doughnut hole. Close but no cigar.
This so-called fix is complex, unwieldy and torturous. Pharmacies are not privy to the total amount individual Medicare patients have spent and patients are not furnished with the amounts expended by their insurance carrier until at least a month after each transaction. Furthermore, many of the elderly who fall into the doughnut hole are in poor health and don’t have someone like me, willing to spend hours on the phone with their Medicare providers. In most cases, seniors will have to pay the full price and then be obligated to go through the hassles of getting their insurance carriers to reimburse them — which few have the time or energy to do.
Juan Williams needs to do his homework on ObamaCare. His claims, the same as those parroted by the Democrats, are wrong-headed (coverage to 26), exaggerated (doughnut hole closed) or false (pre-existing-condition coverage). It is nauseating to hear the Democrats’ talking points endlessly spewed, especially when they’re spewed by a FOX News pundit with a lucrative new contract.
Chris Angelini is a Constitutional Conservative dedicated to self reliance and individual liberty.