Donald Trump's administration is reeling from the news that their repeal plan will throw 24 million people off of their health coverage. Republicans are trying to fight that reality with the talking point that high deductibles mean that your insurance card does not enable you to see a doctor. But that's also a lie.
The Republican plan to repeal Obamacare was already poorly received before the Congressional Budget Office (CBO) revealed that the bill would throw 24 million people off of their insurance. The Trump administration and Republicans tried to preempt that conclusion by attempting to discredit the CBO, and also by moving the very goalposts of reform.
Last week, Office of Management and Budget Director Mick Mulvaney actually said that "insurance isn't really the end goal" of insurance reform, asserting that Obamacare was a "great way to get insurance, and a lousy way to actually be able to go to the doctor."
Other Republicans and administration officials have adopted the talking point, including White House counselor Kellyanne Conway, Health and Human Services Secretary Tom Price, House Republican Whip Steve Scalise, and White House Press Secretary Sean Spicer:
CONWAY: There are people who have a health insurance card who literally can't use it, they can't afford the deductions and the premiums. That's something that impacts American lives. Let's talk about real things, not fantasy things.
CONWAY: Some people in this country have an insurance card, and literally can't use it. They can't afford to pay the premiums or the deductibles.
PRICE: If you're an individual out there making 50,000 and 60,000 and your deductible is 8, 10, 12 thousand bucks, you may have that insurance card, but you don't have coverage.
SCALISE: There are millions of Americans that have a health insurance card, but don't have the ability to use it for their family.
SPICER: Having coverage that, when you walk into a doctor's office has a deductible of $15-20,000 a year isn't coverage, that's a card, that doesn't get you the care you need.
The premise is absurd on its face, since even a plan like the ones they describe would be better than no plan at all. But the fact is that they are all lying about what an Obamacare card gets you: Yes, many plans on the individual market have high deductibles, but many of those same plans cover some, or even most, of your medical care without requiring you to meet the deductible first.
Here are the actual facts.
Every Obamacare plan covers an extensive set of 77 different preventive services with no deductible, copay, or any out-of-pocket expense. It also limits out-of-pocket expenses to a maximum of $7,150 per individual, or $14,300 per family, so under Obamacare, there is no such thing as a "deductible of $15-20,000 a year." All copayments, coinsurance, and deductibles contribute to the out-of-pocket maximum, which, once met, requires insurers to cover 100 percent of qualified expenses. This is true of every Obamacare plan, everywhere.
Depending on the plan you choose, however, many more services can be covered without first meeting the deductible, and by paying a small copayment. To illustrate this fact, I have analyzed plans from places where, as Republicans have pointed out, only one or two health insurers remain in the market.
First is South Carolina, where only one insurer remains. However, that provider offers 4 "gold" plans, 14 "silver" plans, and 5 "bronze" plans. According to Healthcare.gov, a family of four making just above the median household income can get a BlueCross BlueShield Of South Carolina "BlueEssentials Silver 14" plan for an estimated monthly premium of $282.18, after subsidies. That plan does have a family deductible of $8,000.00, but in addition to those services mandated by Obamacare, there are many other services that can be accessed without first meeting the deductible. In-network office visits are $20, specialists are $50, prescriptions start at a ten-dollar copay, children's eye exams are $25, glasses are $50. That is all without even touching the deductible, and this plan's out-of-pocket maximum is $11,400 for the family.
In Arizona, where Republicans like to complain about a deceptive and cherry-picked 116 percent premium increase, there are two insurers left in the market. A family of four making $60,000 a year can get a "silver" plan for an estimated monthly premium of $248.38. That plan has a deductible of $5,250 per individual, and $10,500 per family, but again, many services are covered with a small copay and no deductible, and once the deductible is met, the plan covers 100 percent of eligible expenses.
Another benefit of the insurance card that Republicans deride is that, even for services that apply to the deductible, consumers benefit from the lower rates negotiated by the insurance companies. If a participating hospital charges you $1,000.00 for a visit, but your insurance company only allows $553.00 for that visit, that is all you pay.
There is widespread agreement that there are changes that need to be made to our health care system, but most people want Obamacare to remain in place or to be expanded. That support would certainly grow even more if people understood the truth about what they have now, instead of the lies Republicans are telling them to serve their own ends.