I don’t support Americans for Prosperity, but that is not the topic here. The topic here is the AFP’s recent “Julie” commercial that has liberals objecting to its “truthfulness.” While not a fan, I encourage you to watch the video, and then to consider my support of the video. (Go to the Americans For Prosperity website and you’ll find the ad.)
In the ad, “Julie” worries about her son who has seizures and her smaller paycheck and a limit on the doctors she can choose. In the commercial, the line that has democrats choking is Julie’s line that says, “I have some questions about Obamacare. If we can’t pick our own doctor, how do I know my family is going to get the care they need?” That’s the line that’s got democrats running and arguing that there is nothing in the PPACA that limits physician choice…half-truth at best, or truth by a technicality.
I like the ad because:
1) Unlike any amount of pleading, prodding or requesting that has come before, FINALLY a specific is being addressed with the Julie scenario. (The democratic answer to the ad claims it’s untrue because the PPACA does not limit physician choice.)
2) The ad does not provide enough details about Julie’s situation for it to be considered either true or false, which underscores the complexity of Obamacare that supports better reading and understanding of what COULD negatively impact physician choice.
3) The ad does not advocate REPEAL, but confines itself to a specific issue which paves the way for the opportunity to address that issue, how to tweak Obamacare to address its potential for limiting physician choice.
So, why do I support the ad?
1) So is Julie’s physician choice limited? The Democratic response is truth by a technicality, the PPACA does not specifically limit physician choice. But does it make physician choice MORE limited than before? In many instances, YES, and in Julie’s case, there is no reason to believe that she still has the right to choose her physician under Obamacare.
In regard to specificity: Without a doubt, the PREMISE of Obamacare was that by providing for health insurance coverage, individuals would have access to medical care because the COST of medical CARE is reduced by having health insurance coverage. But Julie’s complaining about her physician CHOICE options.
As Americans, we’ve always been able to choose our physicians, that’s how insurance companies got around accusations that they were illegally practicing medicine, they didn’t choose for the patients, they just chose what they would pay for.
Just another hypothetical: What democrats really don’t like is that the Julie ad is not their hypothetical. Certainly the President has paraded out people cheering Obamacare’s features that he wanted to highlight, no lifetime limits, essential health benefits, and the legal prohibition to discriminate based on preexisting conditions. What they should be doing is addressing the issues raised by the ad with more than a knee-jerk, truth by a technicality one-liner essentially claiming, “They’re liars, Julie and you are fine.”
Julie’s situation highlights other aspects of the law including increased demands put on physicians in terms of bureaucratic modernization, predictions of increased copays and coinsurance in response to mandatory coverage of essential health benefits, increased premium amounts OK’d by Obamacare for the young, including Julie’s son, healthcare coverages that could actually increase medical bankruptcies for individuals trying to comply with the law by choosing Bronze plans that cover merely 60 percent of covered costs, which for Julie would not be realistic, she’d have to go to a higher coverage plan.
2) Are Julie’s physician choices limited? The answer could be YES, which indicates that underscoring the importance of your situation and the options available to you, in other words the details, is the only way to determine whether Obamacare limits your physician choices. Could “Julie” be telling the truth? Yes.
A) If Julie has her child on her insurance plan, the provisions of Obamacare that limit premiums that insurance companies can charge to employees under employer plans FAIL to limit premiums that can be charged to dependents. This is not hypothetical. As reported here in February of this year, an insurance “glitch” can mean that Julie’s child is no longer insurable under her plan because she can’t afford the premiums. That would certainly limit physician choice, poor “Julie.”
B) As this blog reported in December 2012 under the heading, “Affordable Care May Worsen Rich/Poor Divide,” there are physicians who argue they will no longer accept any insurance in order to avoid Obamacare requirements. These physicians will be inaccessible to those Americans who rely on insurance coverage in order to pay for medical care, which effectively reduces physician choice. Poor Julie.
C) Third, “Julie” addresses the cost-shifting of Obamacare. While essential health benefits are covered without copays and coinsurance, those payments will likely rise for consumers for every other service. In the instance of “Julie,” she may be priced out of the market for her physician of choice. Even if she somehow figures out how to pay for those costs, the costs of medication for her child will likely increase, as discussed in the July 11, 2013 article reported on CNBC.com under the heading, “Trade-Off: More People Get Drug Coverage But at Higher Costs.”
D) Many physicians have argued that they won’t take any insurance as a result of Obamacare and its extensive increases in bureaucratic demands. You can read about this in a NY Times article entitled “When Doctors Stop Taking Insurance” by Roni Caryn Rabin(10/2012). Fewer doctors accepting insurance = fewer choices among doctors, poor Julie.
E) In combination with the increased costs that Julie is likely to pay in order to get health insurance coverage sufficient to help her avoid bankruptcy, there is another consideration and that is the fact that the medical deduction, formerly allowable for amounts paid by individuals over 7.5 percent of their income is now at 10 percent, meaning Julie will not be able to deduct her medical expenses as much as she could before, Poor Julie.
F) Perhaps Julie will choose to shop for insurance on the health care exchange in California (CA is where the commercial appeared). California has a health care exchange, BUT, in a May 23, 2013 article entitled “Covered California Announces A Few Individual Rates,” under the subheading, “Limited Plan Types,” the limited choice of PPO plan choices, which would allow Julie to choose her provider, is noted along with the exchange choices of more EPO and HMO choices, neither of which allows for physician choice beyond what the network provides. Poor “Julie.”
G) Perhaps Julie could qualify under California’s expanded Medicaid program, because California did choose to expand Medicaid. But there is good indication that physician choice will be limited in this instance too, as reported by Emily Bazar, on March 3, 2013, in an article entitled, “Obamacare to Pressure Californians’ Access to Medi-Cal Doctors,” physician choice is likely to be extremely limited as well. As the article explains, “The primary reason doctors don’t participate is financial, doctors themselves say.” Poor Julie.
3) The final positive aspect of the ad is that it does not advocate repeal. It advocates asking questions beyond the simplistic to better understand what changes Obamacare might require to effectively help situations like Julie’s, or yours.
