Fox News is now so desperate they're recycling their victims, while ignoring the fact that their problems are not the fault of the ACA.
March 3, 2014

Is anyone as tired as I am of seeing these people paraded across our TV screens on a near-daily basis to help Republicans get elected in November? It really takes chutzpah to exploit people's personal health problems for political means. Next they'll start criticizing President Obama during an international crisis. Oh, wait.

Stephen Blackwood's mother has a problem, but it's not the problem Huckabee thinks it is. Michael Hiltzik at the LA Times actually did some digging into what is going on with his mother's cancer medications, and the story is definitely complicated, frustrating, and totally not the fault of the ACA.

But the story is a lot more complicated than the version laid out in the Wall Street Journal. In fact, the problem with the article is that it points the finger in the wrong direction. Blackwood curses Obamacare as "Sisyphean," "abysmal," "deeply and incontestably perverse" and a "brutal, Procrustean disaster." (Sisyphus is a figure in Greek mythology who was condemned for eternity to rolling a boulder up a mountain and watching it roll back down again; Procrustes a mythological figure who fit his guests to their bed by either stretching them on the rack if they were too short or cutting off their legs if too tall.) Yet most of his complaints can't be documented to be the result of the Affordable Care Act at all.

Blackwood's mother, Catherine, was diagnosed with carcinoid cancer, which attacks the neuroendocrine system, in 2005 at the age of 49. Fighting cancer takes great stores of physical and mental courage, as well as the help of a supporting family, and it's plain from Blackwood's essay that Catherine has had all of that. She's the mother of 10, has managed her husband's medical office in Virginia Beach, Va., for decades, and even writes a blog on parenting.


Blackwood didn't respond to my request for more details, but I did reach his father, Robert, a family physician. He wasn't sure of the reason for the cancellation either, but did say that the old plan cost $5,000 a month in premiums to cover four family members. When it was canceled, BC/BS offered a substitute plan with a monthly premium of $11,000, which Dr. Blackwood quite properly concluded was out of line.

Instead, the family sought a new plan on the Virginia health exchange. Stephen Blackwood reports that the Virginia enrollment website wasn't working, so his mother spent hours reaching out to individual insurance companies. The truth, actually, is that Virginia doesn't have an enrollment website--he's referring to the federal website, which Catherine had to use because Virginia's Republican leadership, in their wisdom, refused to set up their own.
She finally made a deal with Humana, after receiving assurances that all her treatments and medicines would be covered 100%, after the deductible.

But Humana's agents couldn't verify that Sandostatin was in its formulary--that is, covered by her plan--until she signed up. She did, and in mid-February belatedly was informed that it's not covered. Humana refuses to cover the bill, which year-to-date is $14,000. The family says the disapproval is under appeal.

Go read the rest. Among the other twists and turns? Mrs. Blackwood's husband is a family doctor.

Once again, what we have here is a situation -- a very unusual situation, I might add -- where the insurers and the state have made a decision to make things as complicated and expensive as possible.

I am having difficulty understanding how it's possible for any plan that is ACA-compliant to cost $11,000 per month, for starters. Given that she has 10 children, it's possible that there are still some covered under their plan, but that still seems excessive for even a top-of-the-line platinum plan. The formulary is a more difficult problem, and one insurers have been dragging their feet on for months now. I had similar issues with the formulary and the provider network under our exchange plans here.

The Blackwoods' problem shines a light on areas where the ACA needs to be strengthened, for sure. There should be an avenue for patients like Mrs. Blackwood, where treatments are working and outcomes proven. That was the whole point of the outcomes-based approach written into the ACA. It also highlights the insanely expensive world of pharmaceuticals, and a need for aggressive negotiation to bring those costs down.

In Mrs. Blackwood's case, the problem isn't what the ACA is doing. The problem is what it isn't doing, and that's because far too much discretion is granted to insurers and pharmaceutical companies. Before the ACA, BC/BS could simply have removed Sandostatin from its formulary on January 1st and that would have been that. Post-ACA, there should be some recourse for existing treatments to remain covered. That should change, but we have a Congress who wants to bash it and repeal it instead.

I hope the Blackwoods succeed with Humana and get her medication covered. But it's worth being honest about where the fault lies, and looking for solutions rather than telling the rest of us we should die and die quickly.

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