END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Dear Senator Sasse: Context Matters.

Ben Sasse is a Republican U.S. Senator from Nebraska. As you might imagine, he's not a fan of the ACA.

About an hour ago, he tweeted the following:

Just heard from small-biz owner--whose plan was cancelled by ObamaCare--that he's been forced into this:
$13k/yr deductible
$15k/yr premium

— Ben Sasse (@BenSasse) April 28, 2017

...which I thought would be the first tweet in a brief thread including some additional details, such as:

  • Is it an individual market or sm. group market plan?
    (he says it's a "small biz owner" but that doesn't mean the plan is...I'm a "small biz owner" as well but my policy is on the individual market)
  • How many people the policy covers (Just himself? His spouse? How many kids?)
  • How old is each person covered by the policy?
  • Do any of them smoke?
  • What metal level is the policy (Bronze - Platinum)?
    Does it include dental and/or optical coverage? Is it a multi-state plan?
  • Did he enroll on or off the ACA exchange?
  • Was he eligible for APTC tax credits?
  • If so, did he blow them off (buying off-exchange)?

Unfortunately...nope, that was it. Zero additional details.

Also, he provides zero details about the old plan either. How much did that cost (premiums/deductibles)? What sort of coverage did it include? Was it cancelled due to the carrier going out of business, pulling out of the state or just dropping noncompliant policies?

Let me get one thing clear here: I'm not accusing him of lying. There are plenty of genuine examples of people who are currently paying absurdly high premiums/deductibles for their policies, and some of them do have worse coverage. Plenty of people here have given such examples in the comments.

All I'm saying is that context matters. If & when Sen. Sasse provides some of the above details on this small-biz owner's situation, I can evaluate that tweet, but without anything other than "I know a guy who's paying $X for coverage", there's no way of taking it seriously.

For instance: Let's assume this person is 21 years old, doesn't smoke, is single, has no kids, with an annual income of just $13,000, living in Omaha.

In that case, they qualify for $266 in APTC as well as qualifying for CSR assistance, and there's a Bronze Aetna Leap Basic CHI Health Omaha plan available (after APTC) for $0/month with a $7,050 deductible, or a Silver plan for just $22/month ($264/year) with a $775 deductible.

At the opposite extreme: What if they're 64 years old, a smoker, married to another 64 year old, with 4 kids age 25 (you got married late), an annual income of $300,000, living in the tiny town of Callaway (pop. 526)? And just for the hell of it, let's say that all 6 of you smoke.

Well, in that case you wouldn't qualify for either APTC or CSR, and a Bronze Aetna Leap Basic POS plan would run a whopping $4,153/month ($49,836/year!) with a $14,100 family deductible. You could also get a Silver Aetna Leap Healthy Minds POS plan for $5,488/month ($65,856/year!) with an $11,200 family deductible.

Obviously those are each pretty extreme/absurd examples (especially the latter one), but you get my point.

The ACA got rid of many of the premium pricing variables which used to exist, but not all of them. The exact same policy can still cost more or less based on:

  • Age (up to 3x as much for older folks)
  • Location (different rating areas in most states)
  • Smoking Status (smokers can be charged up to 50% more)

...in addition to the network size (PPO, HMO, EPO), the actuarial value (Metal Level...bronze/silver/gold/premium) and so on. 

I presume this small business owner falls somewhere in between the low-income 21 year old single non-smoker and the high-income 64-year old smoker with the huge family...but without at least a few of the above details known, just saying "I KNOW A GUY PAYING THIS MUCH!!..." is meaningless. It's like saying "I know a guy who paid $200,000 for a car!" without knowing whether the car is an old Hyundai, a Toyota Tercel, a Cadillac or a Lamborghini.

UPDATE: It's astonishing to me how many people on Twitter seem to be under the impression that I'm trying to "debunk" Sen. Sasse simply because I asked for a few critical details about the situation he tweeted out.