February 4, 2014

When I saw this ad last week I knew immediately it was bogus, because I've been friends with Erin Kotecki Vest for years now, and she suffers from the very same disease as Marsha Blackburn's SOTU guest, Emilie Lamb -- Lupus.

Erin was diagnosed with Lupus while the battle to pass the Affordable Care Act was underway after suffering from all sorts of mysterious ailments that required expensive treatment and scary tests. There is no one I know who can testify to how critical health care access is than Erin.

This is Erin's response to the Koch Brothers' latest salvo, via Emilie:

CoverTN was run by the state of Tennessee. Hmmm, right away I’m raising an eyebrow, as usually those against “ObamaCare’” don’t want “government run” health insurance. Yet Lamb clearly doesn’t have that issue. Good. So let’s move on.

What was the great thing about CoverTN? According to Lamb, “The coverage was perfectly suited to my unique medical condition. It offered me low premiums, a low deductible and low co-pays for my regular trips to doctors and specialists. This plan was perfect for someone with my unique medical condition and limited financial means.”


Lamb says she had low premiums, awesome. How low? $57 a month. WOW. That’s AMAZING. How low was Lamb’s deductible? She doesn’t say. How low were the co-pays? She doesn’t say. Low prescription coverage? Lamb doesn’t say. There is no mention of a maximum out-of-pocket from Lamb. Something KEY to us Lupus patients as most of us hit this maximum every year due to the crazy high costs of all the drugs and treatments we need in order to keep our auto-immune disorder in check. To give you an idea, I have hit my maximum out-of-pocket every single year since my Lupus diagnosis in JANUARY of that year, after my FIRST TREATMENT.


Guess what CoverTN had? You guessed it, all of those things I just listed. In fact, in announcing they are no longer going to offer the program, they lamented their inability to screw over the chronically ill: “…those that administer the Cover Tennessee programs, can no longer implement annual or lifetime limits, institute a waiting period for pre-existing conditions, require a ‘go bare’ period, or deny an individual coverage due to a pre-existing condition. Insurance companies must also cover preventative services without any out-of-pocket costs to the member.”

But it gets worse for a Lupus patient who had CoverTN, “CoverTN is a limited benefit program that has a $25,000 annual limit.

Something isn't right about Emilie's claim about how CoverTN was so perfect for her. On the one hand, she liked that low premium, but was paying for a junk plan that didn't actually cover anywhere near the care a Lupus sufferer needs.

Erin gave Emilie the benefit of the doubt and assumed perhaps her Lupus was in remission at the time she had her coverage via CoverTN. But even in that case, the Lupus Society confirmed to her that the mean costs for maintenance treatments fell into five figures.

Either Emilie is not getting the treatment she needs, or she is lucky enough to be in a remission. But as all Lupus patients should know, flares can happen at any time and when they do, a $25,000 lifetime cap on benefits isn't going to touch the costs to treat it.

According to Emilie, she chose a Platinum plan on the exchange and is paying $373 per month for it, after the federal subsidy. As Erin will testify, while that's a lot of money, it's nothing when compared to what the costs would be if her Lupus flared and required medications and hospital stays to bring it under control.

Here's what happened to Erin last week when she was admitted to the hospital under her new ACA policy for a new flare:

Our new Affordable Care Act plan info was given to the admitting people as I cried in the emergency room, knowing full well I was going to be stuck in the hospital for days. I waited to hear the usual “That will be $500 for your ER copay, your deductible and other bills will follow…would you like to pay now or should we bill you?”

Instead I heard ‘That will be $150 for your ER copay, you have no deductible. Would you like to pay that now or shall we bill you?”

This is what Emilie calls a 'tragedy.' Like Erin, I call it a blessing.

I wish Emilie health and happiness. I hope her Lupus doesn't flare, but if it does, she might regret her decision to side with those who would have no compassion for her situation.

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