Saturday, December 20th, 2014

Advocacy group stirs Michigan senate race with ad featuring leukemia patient

This Americans for Prosperity ad is airing in Michigan and features a leukemia patient whose insurance plan was canceled last year.

A new ad in the Michigan U.S. Senate race featuring a woman with leukemia has received national scrutiny from both fact-checkers and news outlets.

Naturally, we wanted to weigh in as well.

The minute-long spot from Americans for Prosperity is a first-person account of Julie Boonstra, a Michigan woman who has battled leukemia for five years. The ad criticizes President Barack Obama as well as Rep. Gary Peters, the Democrat running for Michigan’s open U.S. Senate seat, who voted for the Affordable Care Act.

"I found this wonderful doctor and this great health care plan. I was doing fairly well fighting the cancer fighting the leukemia," Boonstra said. "And then I received the letter, my insurance was canceled because of Obamacare. Now the out-of-pocket costs are so high, it's unaffordable. If I do not receive my medication, I will die. I believed the president, I believed I could keep my health insurance plan. Congressman Peters, your decision to vote for Obamacare jeopardized my health."

The ad is constructed in a way that it's difficult to fact-check because the particulars of Boonstra's situation are not immediately clear. Boonstra has publicly commented on some, but not all, of the details. Attempts by PolitiFact to reach Boonstra were unsuccessful.

Some outlets, including the Washington Post Fact Checker, have questioned whether the ad is misleading, even if Boonstra’s tale is grounded in truth. One of the key issues is whether her insurance is affordable.

Americans for Prosperity has shot back that the underlying message — that Boonstra lost her coverage during a health crisis, despite Obama’s promise of  "if you like your health care plan, you can keep it" — should remain the focal point. (Obama’s now-famous line was our 2013 Lie of the Year.)

We decided not to put Boonstra’s claims on the Truth-O-Meter since we can’t independently verify her specific health care situation. But we expect readers in Michigan, and nationwide, would want to know more about the ad and if it tells the full story. Like a similar AFP ad featuring a woman with lupus, it’s a complicated bag.

We’ll break down her story piece by piece.

"I found this wonderful doctor and this great health care plan. I was doing fairly well fighting the cancer fighting the leukemia."

Boonstra bought her old policy from Blue Care Network (a.k.a. Blue Cross Blue Shield of Michigan) on the individual market, she told the Detroit News. While the cost of the plan was expensive at $1,100 per month, there were no co-pays or deductibles. Basically, her out-of-pocket expenses were nonexistent, she said. She received care from an oncologist at the University of Michigan.

"And then I received the letter, my insurance was canceled because of Obamacare."

The Affordable Care Act requires every insurance policy sold to meet a certain set of standards of coverage. Policies sold after the law passed in 2010 that do not meet those standards were scheduled to be eliminated.

While the vast majority of policies were unaffected, a small percentage of plans were axed. Boonstra was one of 240,000 Michiganders whose plan was canceled.

It was on this point that Obama overpromised when he said Americans would be able to keep their existing health care plans. After the reality became clear, Obama sought to assuage the fears of those affected by allowing these policies to remain in place for a year.

But in Michigan, Blue Cross Blue Shield chose to proceed as planned, canceling all but one plan. About 140,000 Blue Cross Blue Shield customers initially had their individual policies canceled and were told to find coverage on the federal health insurance marketplace. 

It’s not clear why Boonstra’s plan was canceled. There are many reasons the government may have deemed the plan insufficient. If it capped insurance benefits or did not include services like maternity care, it would not have met the minimum standards required by the law.

"Now the out-of-pocket costs are so high, its unaffordable."

This line is where the debate really begins.

Boonstra said she attempted to first purchase insurance on the federal marketplace, which was supposed to go live Oct. 1. Like nearly everyone who attempted to log on initially, she confronted errors.

She was later told she may qualify for Medicaid, but it was unclear if and when it would kick in and whether she could keep her existing doctors.

Boonstra turned to the Michigan Farm Bureau, she told the Dexter Leader, her local paper. There, she applied for a new policy through Blue Cross Blue Shield.

This plan cost much less — $571 a month, she has reportedly said — which would cut her insurance costs in half. The difference between her previous monthly premium of $1,100 and her new plan is about $529 a month. Over the course of a year, that’s savings of $6,348.

The new plan also requires her to pay 20 percent of all her medical bills, while the insurance company picks up the remaining 80 percent. For someone needing expensive treatment, like chemotherapy, those out-of-pocket costs can add up quickly.

But the Affordable Care Act requires caps on out-of-pocket expenses paid by policyholders. Without seeing the plan, we don’t know what that cap is, however, the law says for an individual it can’t be higher than $6,350. Some of the pricier plans have caps that are even lower.

So at most, Boonstra would pay $2 more over the course of the year under her new policy. And if the annual cap is lower than $6,350, her new plan could actually save her money. It's also possible she is receiving more benefits under the new plan, but the two plans were not provided to compare.

During an interview on Fox News, Boonstra said she preferred the certainty of her expensive premium. It meant at most she would pay $1,100 a month. While her new policy prevents any out-of-pocket expenses after $6,350, if her bills are high enough, that lump sum could hit her all at once.

"To me it’s unaffordable," she said. "When I had a health care plan I could budget for and had a stable amount, it suited me better. I do not care for not knowing what my expenses will be month to month."

Hospitals are often willing to work with customers to pay off the patient portion of the bill over time. It’s possible Boonstra would be able to arrange such a deal so she isn’t paying $6,350 in one month.

Boonstra has not said whether she could reach such an agreement with her doctors at the University of Michigan, said Levi Russell, a spokesman for Americans for Prosperity.

"The private financing options that she may or may not be able to work out is well beyond her point. She hasn’t weighed in on it," Russell said. "If that’s the argument, the promise should have been, ‘You can not keep it, but hopefully you can work out financing options.’"

"If I do not receive my medication, I will die."

Boonstra receives oral chemotherapy to treat her leukemia. It’s unclear what other medication she takes. But she is still receiving the same medication on her new policy, Americans for Prosperity confirmed.

The cost of the medication and and any other prescriptions are undoubtedly more than they were before, since she previously had no out-of-pocket costs aside from the monthly premiums.

But just like medical treatment, prescriptions are included in the annual cap. Meaning once she reaches $6,350 in out-of-pocket expenses for the year, she will no longer have to pay for her medication.

Our conclusion

Being tasked with finding new insurance amid chemotherapy treatment for leukemia certainly doesn’t gel with how Democrats framed the implementation of the health care law. The malfunctions of HealthCare.gov in October undoubtedly did not make it any easier for someone forced to leave their plan and find a new one.

That said, the ad is, at worst, misleading and, at best, lacking critical context. It leads viewers to believe that Boonstra lost her doctor along with her insurance and her life-saving medication. She has kept her current doctor and still receives the treatment she needs.

Further, the ad said the new plan is unaffordable. While the plan does create less cost certainty, annual caps will limit her bills. At most she will end up paying about the same for her health care as before.