Obamacare Tragedy Watch: Scotts Bluff edition

Protester on the right looks a little like Pam (don't think it's her, though). Photo by Jonathan Ernst/Reuters, March 2013.

Haven't had one of these in a while!

Pamela Weldin, a San Diego dental hygienist who was diagnosed with carpal tunnel syndrome in 2000, subsequently moved to Minatare, Nebraska, in the Scotts Bluff region, where she acquired a catastrophic insurance policy from Humana and a "directorship" with The Pampered Chef, a multilevel marketing cookware company selling frying pans at a 200% markup over normal retail value to unwary ladies at Tupperwarish parties where wine is served, with three employees and an annual sales volume of $558,000.

Why she would have had the catastrophic coverage is pretty clear: she couldn't get a reasonable policy in those days, because she had a preexisting condition and no insurer would touch her with a normal policy, for which they'd essentially be paying out more every month than they were taking in in premiums. She must have been thrilled by Obamacare, right?

Sadly, no. To start with, it seems, she got a note from Humana saying they were pulling out of the state altogether by December 2013, and then when she tried to sign up for something else that November the website didn't work, and she was (understandably) somewhat freaked out. She took a photo of the note Humana sent her announcing that they were pulling out of the state (so it could be reproduced in the Signal a year later, I guess), and contacted her congressman, Representative Adrian Smith about it, too, which he discussed in the House:

Pam Weldin, a self-employed small business woman from Minatare, Nebraska, has a preexisting condition. She has had affordable health insurance coverage which meets her needs, but she just received this letter which explains her current plan will no longer be offered. Pam told me she had great coverage before, which obviously included coverage of her preexisting condition. She has since tried to see what is available through healthcare.gov and the 800 number as well, but has been unsuccessful. As of January 1, she will lose the coverage that she likes.

Which is pretty odd, because if it was a catastrophic plan, as she told the Heritage Foundation, it might be said to cover your preexisting condition, but only after you've paid out the $7,500 deductible (that was the deductible on Humana's catastrophic Monogram plan in 2010), so it met her needs only to the extent that she didn't mind paying full price for all her medical care up to that point. That's what a catastrophic plan is, something that takes care of you only in a dire emergency, when you need more than $7,500 worth. It's OK for a young person who's healthy all the time and well-off enough to be able to afford an emergency that costs less than $7,500, but it's a terrible option for a 58-year-old with a chronic medical situation like carpal tunnel who needs to make regular visits to a practitioner seven hours away in Colorado (quite a bit further than Denver, which is only about four hours from Minatare), as Weldin allegedly did.

Thus either it was a truly terrible plan that she just didn't realize at the time was terrible, and Rep. Smith just assumed out of order that it was taking care of her when it wasn't, or she isn't telling the truth to the Heritage people, and it was some kind of group plan that she wasn't entitled to, like a union plan for a union she wasn't a member of (we were in one of those for a while before I went back to a job-with-benefits 14 years ago, a beauticians' plan if I recall). I imagine it's the former, because I can't see why anybody would have introduced the word "catastrophic" if it wasn't true. Or she and Smith cooked up a bit of a lie together to make the whole thing—"I liked it but I couldn't keep it"—sound more plausible and tragic.

In the end, no thanks to Rep. Smith, she got the healthcare.gov website to work, and got a terrific-sounding Platinum plan from CoOportunity, costing her $307 a month (presumably after the subsidy), although there's something funky about that in the Heritage report too, since she claims she had a $2,500 deductible and it wouldn't cover her trips to Colorado, while the CoOportunity Platinum had (in 2014) a $500 individual deductible in-network and $1000 out-of-network (plus $1000 OOP limit in-network, $2000 out-of-network), which should have allowed her to go wherever she wanted. That's what Platinum plans are like. ($2,500 deductible or OOP limit doesn't apply to any of last year's CoOportunity plans, so I can't even imagine what she's talking about.)

But then that plan got canceled and she had to negotiate a new one last December, encountering new problems with the website and ending up with a Silver plan, at a monthly payment of $165 (deductible $4000/$8000, which would definitely dampen the Colorado visits). And then CoOportunity died in Nebraska just after Christmas—with 120,000 enrollees instead of the expected 12,000, because the website was too successful (and enrolled too many sick people, like Ms. Weldin)—giving Heritage a headline:

How One Nebraska Woman Lost Her Health Insurance Three Times Under Obamacare

In fact the story has a perfectly happy ending. When CoOportunity folded, the state stepped in quickly to make sure nobody's coverage lapsed. Weldin's got a Blue Cross plan that will pay for her Colorado habit for $235 a month, something that was unthinkable two years ago whatever she says, and on February 12 Rep. Smith introduced an entirely useless and chanceless bill to express, apparently, his feelings about the whole thing:

Congressman Adrian Smith (R-NE) introduced legislation today to exempt consumers who purchased coverage under a terminated qualified health plan funded through the Consumer Operated and Oriented Plan (CO–OP) program, such as CoOportunity Health, from paying Obamacare’s individual mandate penalties. 

But Weldin still thinks she's entitled to be pissed off, because why should she be covered for pregnancy at her age, and besides, she's just suffered so fucking much:

“I’ve been pulled into the middle of all this through no fault of my own,” she said, “and there’s nothing fair about it. It is what it is, and you move forward.... We have a president who said, If you like your plan, you can keep it. If you like your doctor, you can keep it. You will have choices,’” Weldin said. “All three things were an outright lie.”

While you enjoy the fruits of your pyramid scheme and the passionate attentions of the Heritage Foundation. You're a bad person. On the other hand, if this is the worst story Heritage can come up with nowadays, I think the ACA has won.