Olympian Mary Lou Retton made a stunning revelation when asked why she didn’t have health insurance while she was in intensive care fighting for her life. “I couldn’t afford it,” Retton told the Today Show on January 8 when she was faced with a life threating pneumonia recently. Retton’s daughter started a “Go Fund Me” page to help her mother pay for what was likely to be tens of thousands of dollars in hospital bills.
Health Care News managing editor AnneMarie Schieber talked to Kansas State Senator Beverly Gossage as to why Retton may have gone without health insurance. The likely answer is Obamacare, the only option for people without an employer health plan. Gossage discusses what Retton might have paid for an Obamacare plan without subsidies and why there are almost no other options today for middle income people. She also discusses what Congress needs to do about it.
PHOTO: ROBIN MARCHANT/GETTY IMAGES NEWS
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Narrator (00:00):
This is the Heartland Daily Podcast.
AnneMarie Schieber (00:19):
Hello, everyone, and welcome to the
podcast. This is AnneMarieSchieber from Health Care News.
You know, every once in a while,we'll get a blockbuster
illustration of how the publicappreciates or doesn't
appreciate Obamacare. In lateJanuary, we got one. Mary Lou
Retton, America's sweetheartOlympian recovering from a life
(00:43):
threatening pneumonia, told NBCthe reason she didn't have
health insurance was shecouldn't afford it.
Now there is so much to dissectin this, and that's why if I'm
invited senator Beverly, Kansasstate senator Beverly Gossage to
be on the podcast. Like Imentioned, Beverly is a
(01:09):
insurance agency, and she isalso part of the American Care
Choices Health Care Coalition.Thank you for coming on, senator
Gossett. You know health careinside and out.
Beverly Gossage (01:21):
Anne Marie, thank you. It's a pleasure to be
with you, and I'm glad we wereable to find the time. It's this
time when I'm in session, it'svery hard to carve out a few
minutes. So I'm happy to be withyou.
AnneMarie Schieber (01:32):
Great. Well, you know, I have a hard time
believing Mary Lou Rentoncouldn't afford healthcare. Now,
she's had a successful careerwith many endorsements. And I
know she went through a divorce.But, you know, she was married
for many years to a professionalfootball player.
My guess is that Rhett and, likeso many people who do not buy
Obamacare, just didn't thinkthere was any value in it. Am I
(01:56):
wrong?
Beverly Gossage (01:58):
No, I think you're right. Because we, as
consumers, look at valuecompared to cost. So and I think
I sent you an example of when Iwent in to look at her ZIP code
and for her age. And by the way,when you go to healthcare.gov,
that's really all they ask,because they don't even ask your
(02:20):
sex, male or female, does itmake any difference? So they
wanna know what is your ZIPcode, what is your age, and what
is your income?
So quite likely, when she put inher income, if she's at least
middle age, it's going to sayyou get no subsidy, so here you
go. And it's the lowest priceplan that I found for her was
$1200 with a 94 or $98100 out ofpocket. Who would think, wow. Is
(02:47):
is it worth it? Maybe I couldjust pay for some of that myself
instead of paying and that wasthe low on the low end.
I mean, she could have gotten agold plan
AnneMarie Schieber (02:56):
for her.
Beverly Gossage (02:57):
Yeah.
AnneMarie Schieber (02:57):
Yeah.
Beverly Gossage (02:58):
So it's the bronze plan. And she could have
gotten a gold plan, you know,for 4 or $5,000 a month. It gets
extremely expensive. And when Itell people this, it's not
uncommon for folks to go bet.Okay.
Well, what other options do Ihave? I'm afraid when they pass
the ACA, they took away all yourother options. I'll give you an
(03:18):
example. In most states,especially in the Midwest, they
had state laws, state regs. Westill do.
And they said that insurancecompanies may, for example,
underwrite. So that means, justlike with life insurance or with
homeowners insurance, it's basedupon the risk. So if you're
(03:39):
lower risk, well, when she wouldhave signed up for this, maybe
she did it have pneumonia, maybeshe did. The idea is right. We
want people to have insurancebefore they really need it.
That's the whole purpose ofinsurance. And that when we were
a before the ACA, people wereable to buy it very, very low
premiums. I licensed in nearlyhalf the states for 21 years. I
(04:04):
wrote policies every day forchildren for $25 Young people
could get a policy for around50. Females were a little bit
more about 62.
Even if you were a 69 year oldfemale, the most expensive
person to try to insure withprivate insurance, it'd be about
169 a month. What happened?Well, what happened was the ACA
(04:25):
stepped in and said, oh, we wantto be fair to people. We want to
be nice to people. These meaninsurance companies can't ask
them health questions anymore.
They took away all healthydiscount. So on average, in my
state of Kansas and neighborMissouri and others, they saw
rates go up by 400%. So we knewthat was going to happen. And so
(04:50):
it was like, you have to takeeverybody. So when you say you
have to take everybody, youcan't ask them health questions,
people are gonna wait until theyget sick to buy.
Right? Why did I buy now? Youcan't ask me health questions.
I'm gonna wait. So then theysaid, wait a minute.
People are gonna wait. So let'sforce them to buy. Remember
(05:10):
that?
AnneMarie Schieber (05:11):
So you're gonna pay a
Beverly Gossage (05:12):
fine if you don't buy policies. And then it
was like, well, how can peoplehow can we force people to pay a
fine for a policy they can'tafford? Well, now we need to
subsidize this. So let's figureout a way to pay for it. They
had all these pay fors, ofcourse, which were taxes on all
of us.
And so only for the lowestincome folks did they get these
(05:36):
subsidies to reduce theirpremiums somewhat. But you know
what happened? They reduced thepremiums down to kind of what
they were before. And they actthis is the way I look at it.
It's like the federal governmentsays, you know what?
We're gonna make things betterby crippling everybody. Not not
to worry, though. We're going togive some people a crutch. So by
(05:56):
crippling everybody, they madethese rates astronomically high.
And then the lower incomepeople, the crutch was, we're
going to pay we're going to givethe insurance company some money
on your behalf.
And, oh, if you're lower, lowerincome below that 250% of
poverty level. If you choose asilver plan, we're gonna also
(06:17):
lower your out of pocket. Inother words, we're gonna lower
your co pays, we're gonna loweryour total out of pocket. We'll
do double, so you get thatdouble tax credit. But what did
that do to the middle incomepeople, even higher income?
Mhmm. Like, let's say, Mary LouRetton. Those rates are still
astronomically high. And theyalso did this. Insurance
(06:40):
companies were like, well, ifwe're forced to take everybody,
we have no clue who's going toapply.
We have to the rates are goingto be really, really high. And
they said the only way we can dothis is squeeze our provider
networks by saying, hey, suchand such insurance or hospital
(07:01):
association, you're gonna be theonly hospital we're gonna send
our people to. You're gonna bethe only one in network, so give
us a good deal. So Yeah. Reducethe rates a little bit.
So they have lower sorry. Theyhave lower network or fewer
hospitals to go to at very, veryhigh rates.
AnneMarie Schieber (07:21):
Yeah. Well, you know, this interview on NBC
didn't go into too much depth,but, you know, Rhetton did say
she had preexisting conditions.
Beverly Gossage (07:29):
Right.
AnneMarie Schieber (07:29):
And, you know, which is surprising
because Obamacare will not denycoverage for that. You just said
that. Now what do you take fromthis? I guess, you know, the
alternative to Obamacare areshort term plans. I have one of
these and, you know, I gotta geta new one every 6 months.
And we're you know, the Bidenadministration is about to
(07:50):
change the rules on these again.Is that possibly an option for
her? Because they don't coverpreexisting conditions. You have
to be they're very easy to applyfor. But, you know, if you
deceive them, they will go andfind out that you lied and they
won't cover you.
So you got to be really carefulwith the plans. What do you
(08:11):
think that that do you think shepossibly meant might have
considered a short term plan?Would that have been a fix for
her in her situation?
Beverly Gossage (08:18):
Sadly, because of the ACA, no. They the short
term medical plans are at closeto what we had prior to the ACA,
which is they're going to lookat your health risk. But here's
the point. I'm sure that veryhealthy Mary Lou Retton could
have had a health insurance planprior to this. Right?
(08:39):
And it would have been extremelyaffordable for her because she
was very low risk. She couldhave kept that year after year.
It just would roll over. Itmight go up a little bit, but it
was a very competitive freemarketplace. So you could go
like you buy auto insurance,they're gonna ask your risk,
but, hey, they can't drop you.
Right? And rates don't go upvery much. However, with short
(09:04):
term medical plans, also calledshort term limited duration
plans, I write those too. But ithelps those people who are
healthy, not able to get anykind of a healthy discount at
all. They are middle income, andthey're like, okay.
No. I have very, I don't reallyhave any preexisting conditions
(09:24):
or I do have a very minorpreexisting condition. And so
and and I take a medication, butthat's okay. I will cover that.
I will cover that medication.
I just want you to covereverything else that I may,
encounter or I might have a newprocedure or may develop a new
condition, I want that to becovered, and that's how short
(09:46):
term plans work. Now in somestates like yours, perhaps, you
have to apply every 6 months. Inmine, it's every 2 years. So you
apply you apply, it's short termmeaning less than one full year.
So it's, like, 364 days, and youapply for that plan.
It can start as early astomorrow, the next day. You have
(10:09):
it for a year, then you reapply.But the you at that time, let's
say that you reapply, it's up tothe carrier to decide you were
going to re underwrite youmeaning we're going to ask again
do you have any conditions?Well, anything that you
developed in that 1st 12 monthsis now considered and so they
(10:31):
could decline you that nextyear. Under the Trump
administration, they made it 3years.
So insurance companies may notunderwrite you. So you sign up
in advance, hey, I want to goahead and sign up for 3 years so
that you don't re underwrite meand I've got a guaranteed 3
years no matter what I develop.It's going to be covered for the
(10:54):
next 3 years. And they will tellyou upfront, your 1st year is
going to cost you this, 2nd yearis going to be a little bit
more, 3rd year is going to be alittle bit more. When you apply,
you don't have to actuallyreapply.
But if you do reapply and youuse the same policy, you're not
(11:14):
going to have to bereunderwritten. In other words,
we're not going to ask you newhealth questions. Anything that
was preexisting is now going tobe covered. That was under the
Trump administration. Why didthey do that?
Because if somebody developscancer in that 1st year and this
is the only policy they canafford, it is going to be
covered and it will continue tobe covered probably long enough
(11:37):
for you to get your chemo, allof the things that you need
covered. And they are a fullmajor medical plan. A perfect
example is I had one of myclients, this was 2 years ago,
bought a short term medical planin January. In February, he had
to go in for an emergencygallbladder surgery. Yes.
They dug into his past to see ifhe was lying. Did he have or
(11:59):
have any trouble with hisgallbladder before? He had not.
So they did the research found,no. He had not.
A $95,000 hospital bill wasfully covered with his $25100
deductible. This is actually howinsurance used to work in most
days
AnneMarie Schieber (12:16):
Right. Yeah.
Beverly Gossage (12:17):
Through the ACA. Yes. But here's another
thing people don't know. We asinsurance agents were called
health underwriters back inthose days because we were all
given underwriting guides. So Ihad, in my state, 17 carriers to
pick from.
Other states were 23 carriers topick from. And if somebody
starts, this is how they wouldsay, I'd like to buy an
(12:38):
insurance policy. I don't drinkalcohol. I'm not I don't use
tobacco. I've not really hadanything.
About 4 years ago, why did theytell me all this stuff? Because
it mattered. And so I would say,you have asthma. Let me go to
the underwriting guides onasthma. Asthma.
These 5 these 5 companies willstill take you depending on how
(13:01):
severe is your asthma. I'm gonnaask you some questions. Were you
hospitalized in the last 2 yearswith asthma? And if so, how
often? What do you use for yourasthma?
And how often do you need to useit? Is it something These three
companies probably are gonna beyour best bet. This is These
(13:21):
three companies probably aregonna be your best bet. This one
will ride her at meeting. We'renot gonna cover the asthma for a
couple of years.
Then we're gonna see how thatgoes. And then we could see if
we would consider adding asthmaback in for coverage. This one
says, we're gonna cover yourasthma, but we're gonna raise
your rate by 10%. Which do youwant? Yeah.
(13:43):
You had all those options, andthey when Right. Right. We were
lied to about Obamacare, AnneMarie, that they don't cover
anything. They don't even coverdo you remember this statement?
They don't even cover if youhave acne.
I thought, what?
AnneMarie Schieber (13:58):
What are you talking about? That.
Beverly Gossage (14:00):
And I well, I did because, you know, I wrote
those plans, and I went back andthought, oh, wait a minute.
There was a medication calledAccutane that was very
dangerous. Oh, yes. Right. Sideeffects.
So if you said you had acne, thequestion they were gonna ask you
was, are you taking Accutane?And if you said yes, they would
deny coverage, but not becauseyou had acne.
Narrator (14:26):
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(14:46):
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Oh, yeah. We're also on Rumble.See you there.
AnneMarie Schieber (15:45):
Yeah. Now, you know, I'll tell you,
Obamacare is in effect reallyentering its 10th year. When did
it affect What? 2014? Right.
Many people are now covered byit because Obamacare has also
expanded Medicaid. Right? Wehave a ton of people now in
Medicaid.
Beverly Gossage (16:02):
Right.
AnneMarie Schieber (16:03):
Not in Kansas. Right. Anyway, president
Biden Biden touted a few weeksago on how Obamacare enrollment
went up 30% this year. What doyou think about that? Are people
starting to like it?
Beverly Gossage (16:16):
No. I'm happy to address that. What they did
was, when we had the COVIDoutbreak, they said, if you keep
people on, even though they nolonger are eligible for
Medicaid, if you keep them onduring this pandemic, we will
give you an additional FMAP.And, of course, an FMAP is the
(16:38):
percentage that the federalgovernment pays towards
Medicaid. Right now in thosestates, my state, it's right
around 60% that they pay.
The state pays 40%. Well, I'venever seen a health department
that didn't wanna get moremoney. So they said, sure. We'll
keep them on. Give us that extra6 point 9%, whatever it was for
(16:59):
the FMAT.
Some states, 5.7. So they keptthat. So for 3 years, people who
were no longer eligible forMedicaid were kept on Medicaid
and not kicked off. So when theydid the, quote, unwinding, they
were saying sending out anevaluate your updated income. So
(17:22):
all these people were taken off.
Well, these people automaticallythen applied on health care dot
gov for a very, very lowpremium, low subsidy lots of
subsidies because they were justright at that poverty level or
more. And so, yeah, so, ofcourse, they had been on
Medicaid. Now they're on healthcare dot gov. Big surprise.
AnneMarie Schieber (17:43):
Yeah. Yeah. Now, you know, one of the things
I use with my short term plan isdirect primary care, which is
amazing. I pay $90 a month. Iget in to see my doctor, and I
never see my doctor for lessthan an hour.
Beverly Gossage (17:58):
I I
AnneMarie Schieber (17:58):
don't how he does it. Mhmm. But it's just
incredible care. They give mediscounted drugs sometimes,
imaging labs.
Beverly Gossage (18:05):
Yep.
AnneMarie Schieber (18:06):
They now have a flat fee surgical center.
You know, they've been around, Ithink, probably for about 10
years now, but they're notreally no I mean, DPC has been
around for about 15 years. Yeah.But around the country, a lot of
people do not know about them.And they don't even know, you
know, direct primary care.
(18:27):
Do a Google search in your city.I I know people that live in big
cities. They have no idea whatthis is. Why do you suppose
that's the case?
Beverly Gossage (18:33):
Well, I remember when they were calling
cash doctors way back in theday, and there was a link where
you can go and look up a cashdoctor. And then they went from
there to DPCs. They're terrific.I really support them. I've
spoken at their conferences.
Think it's great, and we havemore of them going to that all
of the time. But, again, if I goback to, pre Obamacare, when you
(18:56):
could pick a policy that said,we don't cover primary care
physicians. Let's think aboutit. What is health insurance
supposed to cover? The bigcatastrophic stuff, right, that
you can't pay for or negotiateyourself.
So why in the world did weinclude a primary care physician
visit or generic drugs for thatmatter? So you could have chosen
the policy with a much smallerpremium that says, we don't
(19:18):
cover primary care. Go whereveryou want and negotiate that rate
with your doctor. We don't covergeneric drugs. Those are $3.5.
So those are not catastrophicthings. You negotiate that
yourself. Under the ACA, theysaid, all insurance plans must
cover, and that's one of thethings, was primary care. So
when people are going to adirect primary care doctor and
(19:41):
they're paying that monthly fee,whatever it may be, they're kind
of paying twice because theyhave to pay to be able to get a
discount to see a primary carephysician, plus go to the direct
primary care. That stinks.
You know? But you cannot take itoff of your, you know, your
traditional policy. Now withshort term medical, they also
(20:02):
they allow, for your primarycare visit to apply to their
deductible, but not to a directprimary care doctor. But in the
long run, you win, especially ifyou have if you have several
doctor's visits, you takeseveral medications because most
short term medical plans don'tpay toward don't allow your
(20:23):
medications to apply to thedeductible. They don't cover
them.
But their your direct primarycare doctor can give you a lower
price. Usually, it's a passthrough price to you from the
care from directly through thepharmacy. And, yeah, I think
it's fabulous. But why do mostpeople not know about them? For
the very reason you mentioned,they say, oh, does that oh,
(20:46):
they're not in my network.
Oh, it doesn't apply to mydeductible. That's why.
AnneMarie Schieber (20:51):
Yeah.
Beverly Gossage (20:52):
They're just you. And we've
AnneMarie Schieber (20:53):
really, yeah, we've really warped
people's thinking about whatinsurances. We've turned health
insurance into payment plans.Yes. Prepayment. Plans and
discount programs.
And, really, we've lost the truemeaning of insurance, which,
like you said earlier, is tocover stuff you don't anticipate
that would really be devastatingto you financially.
Beverly Gossage (21:13):
You're exactly right.
AnneMarie Schieber (21:14):
Crazy crazy.
Beverly Gossage (21:15):
You know, Anne
AnneMarie Schieber (21:16):
Marie You know, the other
Beverly Gossage (21:17):
Oh, I was just gonna say, if the I've actually
had people call me. I need toget an insurance policy because
I need to go to the doctor.Well, you do know that you could
just call and make anappointment and go to a doctor.
You can? Oh, I thought I had tohave insurance.
It reminds me of years ago,there was a commercial of people
(21:39):
standing on an escalator thathad stopped, and nobody moved.
Yeah. And, like, you know, youOh, yeah. Walk up the stairs or
walk down the stairs. You don'thave to wait for the escalator
to move.
It's the same we have soindoctrinated people in that.
You don't even go to a doctor oryou don't go get a prescription
unless you get insurance. That'ssilly.
AnneMarie Schieber (22:00):
Yeah. I I I think of my DPC doctor as
keeping me away fromspecialists. And in the rare
event, they need to see aspecialist. I call and I
negotiate the price you stayaway from a hospital operated,
(22:21):
physicians because the pricesthey charge are astronomical.
Wonderful.
You know, the other op the otheroption Rhett and could have had
was a health share ministry.
Beverly Gossage (22:31):
Now You might.
AnneMarie Schieber (22:32):
The costs are a bit higher and they're not
really they're not insurance.And, you know, the cost can be
pretty high because, again, theythey're gonna ask you all about
your lifestyle and your yourpremium's gonna be dependent on
that. They may not even acceptyou if you have a, you know, a
high risk lifestyle. What canyou say about those
arrangements?
Beverly Gossage (22:51):
Okay. 2 things. 1, we know they're not actually
insurance. So you could not gofile a complaint with your
insurance department if theydon't pay or you don't feel like
the contract is made. It wouldhave to be a lawsuit situation
that they didn't fulfill acontract.
It is large group of folks thatare faith based primarily, and
they have all said, let's shareeach other's medical expenses.
(23:14):
Initially, when this kind offirst started and they
approached me about this yearsago, my concern was there were
not enough people in the pool tobe able to share the risk. In
other words, let's have somebodywho has a $300,000, premature
twins. How is that going to becovered when everybody's paying
this small amount into thispool? Now, of course, thanks to
(23:36):
Obamacare, that was theexception of, paying the fine.
If you didn't go into Obamacare,you could go to a health sharing
ministry, and you were notsubject to the fine. Of course,
under the Trump administration,they dropped that down that fine
down to 0. So, you know, peoplecan do that without paying a
fine or get a short term medicalplan, without paying a fine. But
(23:57):
to answer the question, 22things. And by the way, I help
people sign up for those typesof plans.
You have to understand why theythey're not more expensive than
the ACA, but they're they'reabout not quite half, but they
could be about 80%. Or I'msorry. You would pay about 80%
(24:18):
of what it would be for the ACAdepending on which of the plans
that you went to. Was itSamaritan or was it CMS, which,
can be the the, ChristianSharing Minister, CSM's
Christian Sharing Ministry.There are several of them, that
they all have varying rates.
No. They're not as low as theshort term medical plans that
(24:40):
can save you 75%. You're onlypaying 30%, you know, of what
you would have paid. Then here'swhy. They they you don't have to
reapply.
They continue. They don't dropyou unless you drop them. Unlike
the short term medical plans,it's only 1 year at a time. It's
only 6 months at a time, andthen you reevaluate it. So
(25:01):
because it continues, they'regoing to be a little bit more.
They don't cover preexistingconditions either. They do and,
like, short term medical plansdon't cover normal maternity. So
So let's say you're a youngcouple, you're not gonna have a
baby right away, but you wouldlike to sometime in the next 5
years, let's say. Then they dohave some maternity built in,
(25:24):
but you have to be with themfor, say, 12 months or 24 months
depending on the plan. So that'swhy they're a little bit more,
but it depends on the type ofcoverage that you want and what
you want it to cover.
But the one the one concern is,of course, it is not insurance.
You have to rely upon the factthat it will be covered. Some of
(25:45):
them have an actual network.They usually, work with the PCM
network or one of the othernational networks. Some don't
have a network at all.
You negotiate your own prices.So, yeah, there are folks in
that plan and it ballooned afterthe ACA. Some of those plans
have 250,000 people in them.
AnneMarie Schieber (26:09):
Well, we have run out of time. Thank you
for coming on the podcast.
Beverly Gossage (26:12):
My pleasure, Anne Marie. And sometime maybe
we could talk about when Itestified before the Republican
study committee and what Irecommended.
AnneMarie Schieber (26:20):
That would be great. Alright. Thank you.
Beverly Gossage is a statesenator from Kansas who is
knowledgeable about Obamacarebecause she happens to be in the
health insurance business. Andthank you listeners for tuning
in.
We appreciate, your giving usyour time. And, we would also
appreciate if you could shareour link, rate us, and become a
(26:42):
regular subscriber to theHeartland Daily podcast. This is
AnneMarie Schieber.
This is the Heartland Daily Podcast.
AnneMarie Schieber (00:19):
Hello, everyone, and welcome to the
podcast. This is AnneMarieSchieber from Health Care News.
You know, every once in a while,we'll get a blockbuster
illustration of how the publicappreciates or doesn't
appreciate Obamacare. In lateJanuary, we got one. Mary Lou
Retton, America's sweetheartOlympian recovering from a life
(00:43):
threatening pneumonia, told NBCthe reason she didn't have
health insurance was shecouldn't afford it.
Now there is so much to dissectin this, and that's why if I'm
invited senator Beverly, Kansasstate senator Beverly Gossage to
be on the podcast. Like Imentioned, Beverly is a
(01:09):
insurance agency, and she isalso part of the American Care
Choices Health Care Coalition.Thank you for coming on, senator
Gossett. You know health careinside and out.
Beverly Gossage (01:21):
Anne Marie, thank you. It's a pleasure to be
with you, and I'm glad we wereable to find the time. It's this
time when I'm in session, it'svery hard to carve out a few
minutes. So I'm happy to be withyou.
AnneMarie Schieber (01:32):
Great. Well, you know, I have a hard time
believing Mary Lou Rentoncouldn't afford healthcare. Now,
she's had a successful careerwith many endorsements. And I
know she went through a divorce.But, you know, she was married
for many years to a professionalfootball player.
My guess is that Rhett and, likeso many people who do not buy
Obamacare, just didn't thinkthere was any value in it. Am I
(01:56):
wrong?
Beverly Gossage (01:58):
No, I think you're right. Because we, as
consumers, look at valuecompared to cost. So and I think
I sent you an example of when Iwent in to look at her ZIP code
and for her age. And by the way,when you go to healthcare.gov,
that's really all they ask,because they don't even ask your
(02:20):
sex, male or female, does itmake any difference? So they
wanna know what is your ZIPcode, what is your age, and what
is your income?
So quite likely, when she put inher income, if she's at least
middle age, it's going to sayyou get no subsidy, so here you
go. And it's the lowest priceplan that I found for her was
$1200 with a 94 or $98100 out ofpocket. Who would think, wow. Is
(02:47):
is it worth it? Maybe I couldjust pay for some of that myself
instead of paying and that wasthe low on the low end.
I mean, she could have gotten agold plan
AnneMarie Schieber (02:56):
for her.
Beverly Gossage (02:57):
Yeah.
AnneMarie Schieber (02:57):
Yeah.
Beverly Gossage (02:58):
So it's the bronze plan. And she could have
gotten a gold plan, you know,for 4 or $5,000 a month. It gets
extremely expensive. And when Itell people this, it's not
uncommon for folks to go bet.Okay.
Well, what other options do Ihave? I'm afraid when they pass
the ACA, they took away all yourother options. I'll give you an
(03:18):
example. In most states,especially in the Midwest, they
had state laws, state regs. Westill do.
And they said that insurancecompanies may, for example,
underwrite. So that means, justlike with life insurance or with
homeowners insurance, it's basedupon the risk. So if you're
(03:39):
lower risk, well, when she wouldhave signed up for this, maybe
she did it have pneumonia, maybeshe did. The idea is right. We
want people to have insurancebefore they really need it.
That's the whole purpose ofinsurance. And that when we were
a before the ACA, people wereable to buy it very, very low
premiums. I licensed in nearlyhalf the states for 21 years. I
(04:04):
wrote policies every day forchildren for $25 Young people
could get a policy for around50. Females were a little bit
more about 62.
Even if you were a 69 year oldfemale, the most expensive
person to try to insure withprivate insurance, it'd be about
169 a month. What happened?Well, what happened was the ACA
(04:25):
stepped in and said, oh, we wantto be fair to people. We want to
be nice to people. These meaninsurance companies can't ask
them health questions anymore.
They took away all healthydiscount. So on average, in my
state of Kansas and neighborMissouri and others, they saw
rates go up by 400%. So we knewthat was going to happen. And so
(04:50):
it was like, you have to takeeverybody. So when you say you
have to take everybody, youcan't ask them health questions,
people are gonna wait until theyget sick to buy.
Right? Why did I buy now? Youcan't ask me health questions.
I'm gonna wait. So then theysaid, wait a minute.
People are gonna wait. So let'sforce them to buy. Remember
(05:10):
that?
AnneMarie Schieber (05:11):
So you're gonna pay a
Beverly Gossage (05:12):
fine if you don't buy policies. And then it
was like, well, how can peoplehow can we force people to pay a
fine for a policy they can'tafford? Well, now we need to
subsidize this. So let's figureout a way to pay for it. They
had all these pay fors, ofcourse, which were taxes on all
of us.
And so only for the lowestincome folks did they get these
(05:36):
subsidies to reduce theirpremiums somewhat. But you know
what happened? They reduced thepremiums down to kind of what
they were before. And they actthis is the way I look at it.
It's like the federal governmentsays, you know what?
We're gonna make things betterby crippling everybody. Not not
to worry, though. We're going togive some people a crutch. So by
(05:56):
crippling everybody, they madethese rates astronomically high.
And then the lower incomepeople, the crutch was, we're
going to pay we're going to givethe insurance company some money
on your behalf.
And, oh, if you're lower, lowerincome below that 250% of
poverty level. If you choose asilver plan, we're gonna also
(06:17):
lower your out of pocket. Inother words, we're gonna lower
your co pays, we're gonna loweryour total out of pocket. We'll
do double, so you get thatdouble tax credit. But what did
that do to the middle incomepeople, even higher income?
Mhmm. Like, let's say, Mary LouRetton. Those rates are still
astronomically high. And theyalso did this. Insurance
(06:40):
companies were like, well, ifwe're forced to take everybody,
we have no clue who's going toapply.
We have to the rates are goingto be really, really high. And
they said the only way we can dothis is squeeze our provider
networks by saying, hey, suchand such insurance or hospital
(07:01):
association, you're gonna be theonly hospital we're gonna send
our people to. You're gonna bethe only one in network, so give
us a good deal. So Yeah. Reducethe rates a little bit.
So they have lower sorry. Theyhave lower network or fewer
hospitals to go to at very, veryhigh rates.
AnneMarie Schieber (07:21):
Yeah. Well, you know, this interview on NBC
didn't go into too much depth,but, you know, Rhetton did say
she had preexisting conditions.
Beverly Gossage (07:29):
Right.
AnneMarie Schieber (07:29):
And, you know, which is surprising
because Obamacare will not denycoverage for that. You just said
that. Now what do you take fromthis? I guess, you know, the
alternative to Obamacare areshort term plans. I have one of
these and, you know, I gotta geta new one every 6 months.
And we're you know, the Bidenadministration is about to
(07:50):
change the rules on these again.Is that possibly an option for
her? Because they don't coverpreexisting conditions. You have
to be they're very easy to applyfor. But, you know, if you
deceive them, they will go andfind out that you lied and they
won't cover you.
So you got to be really carefulwith the plans. What do you
(08:11):
think that that do you think shepossibly meant might have
considered a short term plan?Would that have been a fix for
her in her situation?
Beverly Gossage (08:18):
Sadly, because of the ACA, no. They the short
term medical plans are at closeto what we had prior to the ACA,
which is they're going to lookat your health risk. But here's
the point. I'm sure that veryhealthy Mary Lou Retton could
have had a health insurance planprior to this. Right?
(08:39):
And it would have been extremelyaffordable for her because she
was very low risk. She couldhave kept that year after year.
It just would roll over. Itmight go up a little bit, but it
was a very competitive freemarketplace. So you could go
like you buy auto insurance,they're gonna ask your risk,
but, hey, they can't drop you.
Right? And rates don't go upvery much. However, with short
(09:04):
term medical plans, also calledshort term limited duration
plans, I write those too. But ithelps those people who are
healthy, not able to get anykind of a healthy discount at
all. They are middle income, andthey're like, okay.
No. I have very, I don't reallyhave any preexisting conditions
(09:24):
or I do have a very minorpreexisting condition. And so
and and I take a medication, butthat's okay. I will cover that.
I will cover that medication.
I just want you to covereverything else that I may,
encounter or I might have a newprocedure or may develop a new
condition, I want that to becovered, and that's how short
(09:46):
term plans work. Now in somestates like yours, perhaps, you
have to apply every 6 months. Inmine, it's every 2 years. So you
apply you apply, it's short termmeaning less than one full year.
So it's, like, 364 days, and youapply for that plan.
It can start as early astomorrow, the next day. You have
(10:09):
it for a year, then you reapply.But the you at that time, let's
say that you reapply, it's up tothe carrier to decide you were
going to re underwrite youmeaning we're going to ask again
do you have any conditions?Well, anything that you
developed in that 1st 12 monthsis now considered and so they
(10:31):
could decline you that nextyear. Under the Trump
administration, they made it 3years.
So insurance companies may notunderwrite you. So you sign up
in advance, hey, I want to goahead and sign up for 3 years so
that you don't re underwrite meand I've got a guaranteed 3
years no matter what I develop.It's going to be covered for the
(10:54):
next 3 years. And they will tellyou upfront, your 1st year is
going to cost you this, 2nd yearis going to be a little bit
more, 3rd year is going to be alittle bit more. When you apply,
you don't have to actuallyreapply.
But if you do reapply and youuse the same policy, you're not
(11:14):
going to have to bereunderwritten. In other words,
we're not going to ask you newhealth questions. Anything that
was preexisting is now going tobe covered. That was under the
Trump administration. Why didthey do that?
Because if somebody developscancer in that 1st year and this
is the only policy they canafford, it is going to be
covered and it will continue tobe covered probably long enough
(11:37):
for you to get your chemo, allof the things that you need
covered. And they are a fullmajor medical plan. A perfect
example is I had one of myclients, this was 2 years ago,
bought a short term medical planin January. In February, he had
to go in for an emergencygallbladder surgery. Yes.
They dug into his past to see ifhe was lying. Did he have or
(11:59):
have any trouble with hisgallbladder before? He had not.
So they did the research found,no. He had not.
A $95,000 hospital bill wasfully covered with his $25100
deductible. This is actually howinsurance used to work in most
days
AnneMarie Schieber (12:16):
Right. Yeah.
Beverly Gossage (12:17):
Through the ACA. Yes. But here's another
thing people don't know. We asinsurance agents were called
health underwriters back inthose days because we were all
given underwriting guides. So Ihad, in my state, 17 carriers to
pick from.
Other states were 23 carriers topick from. And if somebody
starts, this is how they wouldsay, I'd like to buy an
(12:38):
insurance policy. I don't drinkalcohol. I'm not I don't use
tobacco. I've not really hadanything.
About 4 years ago, why did theytell me all this stuff? Because
it mattered. And so I would say,you have asthma. Let me go to
the underwriting guides onasthma. Asthma.
These 5 these 5 companies willstill take you depending on how
(13:01):
severe is your asthma. I'm gonnaask you some questions. Were you
hospitalized in the last 2 yearswith asthma? And if so, how
often? What do you use for yourasthma?
And how often do you need to useit? Is it something These three
companies probably are gonna beyour best bet. This is These
(13:21):
three companies probably aregonna be your best bet. This one
will ride her at meeting. We'renot gonna cover the asthma for a
couple of years.
Then we're gonna see how thatgoes. And then we could see if
we would consider adding asthmaback in for coverage. This one
says, we're gonna cover yourasthma, but we're gonna raise
your rate by 10%. Which do youwant? Yeah.
(13:43):
You had all those options, andthey when Right. Right. We were
lied to about Obamacare, AnneMarie, that they don't cover
anything. They don't even coverdo you remember this statement?
They don't even cover if youhave acne.
I thought, what?
AnneMarie Schieber (13:58):
What are you talking about? That.
Beverly Gossage (14:00):
And I well, I did because, you know, I wrote
those plans, and I went back andthought, oh, wait a minute.
There was a medication calledAccutane that was very
dangerous. Oh, yes. Right. Sideeffects.
So if you said you had acne, thequestion they were gonna ask you
was, are you taking Accutane?And if you said yes, they would
deny coverage, but not becauseyou had acne.
Narrator (14:26):
Before we get to the rest of this podcast, I wanted
to let you know about 2fantastic live podcasts
Heartland produces every week.We'd love for you to join us
every Thursday at 1 PM EST, noonCST live for our flagship in the
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(14:46):
chat with other fans and alsoask questions that we'll address
on the air and put up on thescreen. And every Friday, also
at 1 PM EST and noon CST, youcan go to Heartland's main
YouTube channel. Just search forthe Heartland Institute on
YouTube for climate changeroundtable.
Heartland's climate team ofAnthony Watts, Sterling Burnett,
and Linnea Lukin cover the crazyclimate news of the week, debunk
(15:07):
mainstream media myths about theso called climate crisis, dig
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There is no show like itanywhere. So become regular live
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Oh, yeah. We're also on Rumble.See you there.
AnneMarie Schieber (15:45):
Yeah. Now, you know, I'll tell you,
Obamacare is in effect reallyentering its 10th year. When did
it affect What? 2014? Right.
Many people are now covered byit because Obamacare has also
expanded Medicaid. Right? Wehave a ton of people now in
Medicaid.
Beverly Gossage (16:02):
Right.
AnneMarie Schieber (16:03):
Not in Kansas. Right. Anyway, president
Biden Biden touted a few weeksago on how Obamacare enrollment
went up 30% this year. What doyou think about that? Are people
starting to like it?
Beverly Gossage (16:16):
No. I'm happy to address that. What they did
was, when we had the COVIDoutbreak, they said, if you keep
people on, even though they nolonger are eligible for
Medicaid, if you keep them onduring this pandemic, we will
give you an additional FMAP.And, of course, an FMAP is the
(16:38):
percentage that the federalgovernment pays towards
Medicaid. Right now in thosestates, my state, it's right
around 60% that they pay.
The state pays 40%. Well, I'venever seen a health department
that didn't wanna get moremoney. So they said, sure. We'll
keep them on. Give us that extra6 point 9%, whatever it was for
(16:59):
the FMAT.
Some states, 5.7. So they keptthat. So for 3 years, people who
were no longer eligible forMedicaid were kept on Medicaid
and not kicked off. So when theydid the, quote, unwinding, they
were saying sending out anevaluate your updated income. So
(17:22):
all these people were taken off.
Well, these people automaticallythen applied on health care dot
gov for a very, very lowpremium, low subsidy lots of
subsidies because they were justright at that poverty level or
more. And so, yeah, so, ofcourse, they had been on
Medicaid. Now they're on healthcare dot gov. Big surprise.
AnneMarie Schieber (17:43):
Yeah. Yeah. Now, you know, one of the things
I use with my short term plan isdirect primary care, which is
amazing. I pay $90 a month. Iget in to see my doctor, and I
never see my doctor for lessthan an hour.
Beverly Gossage (17:58):
I I
AnneMarie Schieber (17:58):
don't how he does it. Mhmm. But it's just
incredible care. They give mediscounted drugs sometimes,
imaging labs.
Beverly Gossage (18:05):
Yep.
AnneMarie Schieber (18:06):
They now have a flat fee surgical center.
You know, they've been around, Ithink, probably for about 10
years now, but they're notreally no I mean, DPC has been
around for about 15 years. Yeah.But around the country, a lot of
people do not know about them.And they don't even know, you
know, direct primary care.
(18:27):
Do a Google search in your city.I I know people that live in big
cities. They have no idea whatthis is. Why do you suppose
that's the case?
Beverly Gossage (18:33):
Well, I remember when they were calling
cash doctors way back in theday, and there was a link where
you can go and look up a cashdoctor. And then they went from
there to DPCs. They're terrific.I really support them. I've
spoken at their conferences.
Think it's great, and we havemore of them going to that all
of the time. But, again, if I goback to, pre Obamacare, when you
(18:56):
could pick a policy that said,we don't cover primary care
physicians. Let's think aboutit. What is health insurance
supposed to cover? The bigcatastrophic stuff, right, that
you can't pay for or negotiateyourself.
So why in the world did weinclude a primary care physician
visit or generic drugs for thatmatter? So you could have chosen
the policy with a much smallerpremium that says, we don't
(19:18):
cover primary care. Go whereveryou want and negotiate that rate
with your doctor. We don't covergeneric drugs. Those are $3.5.
So those are not catastrophicthings. You negotiate that
yourself. Under the ACA, theysaid, all insurance plans must
cover, and that's one of thethings, was primary care. So
when people are going to adirect primary care doctor and
(19:41):
they're paying that monthly fee,whatever it may be, they're kind
of paying twice because theyhave to pay to be able to get a
discount to see a primary carephysician, plus go to the direct
primary care. That stinks.
You know? But you cannot take itoff of your, you know, your
traditional policy. Now withshort term medical, they also
(20:02):
they allow, for your primarycare visit to apply to their
deductible, but not to a directprimary care doctor. But in the
long run, you win, especially ifyou have if you have several
doctor's visits, you takeseveral medications because most
short term medical plans don'tpay toward don't allow your
(20:23):
medications to apply to thedeductible. They don't cover
them.
But their your direct primarycare doctor can give you a lower
price. Usually, it's a passthrough price to you from the
care from directly through thepharmacy. And, yeah, I think
it's fabulous. But why do mostpeople not know about them? For
the very reason you mentioned,they say, oh, does that oh,
(20:46):
they're not in my network.
Oh, it doesn't apply to mydeductible. That's why.
AnneMarie Schieber (20:51):
Yeah.
Beverly Gossage (20:52):
They're just you. And we've
AnneMarie Schieber (20:53):
really, yeah, we've really warped
people's thinking about whatinsurances. We've turned health
insurance into payment plans.Yes. Prepayment. Plans and
discount programs.
And, really, we've lost the truemeaning of insurance, which,
like you said earlier, is tocover stuff you don't anticipate
that would really be devastatingto you financially.
Beverly Gossage (21:13):
You're exactly right.
AnneMarie Schieber (21:14):
Crazy crazy.
Beverly Gossage (21:15):
You know, Anne
AnneMarie Schieber (21:16):
Marie You know, the other
Beverly Gossage (21:17):
Oh, I was just gonna say, if the I've actually
had people call me. I need toget an insurance policy because
I need to go to the doctor.Well, you do know that you could
just call and make anappointment and go to a doctor.
You can? Oh, I thought I had tohave insurance.
It reminds me of years ago,there was a commercial of people
(21:39):
standing on an escalator thathad stopped, and nobody moved.
Yeah. And, like, you know, youOh, yeah. Walk up the stairs or
walk down the stairs. You don'thave to wait for the escalator
to move.
It's the same we have soindoctrinated people in that.
You don't even go to a doctor oryou don't go get a prescription
unless you get insurance. That'ssilly.
AnneMarie Schieber (22:00):
Yeah. I I I think of my DPC doctor as
keeping me away fromspecialists. And in the rare
event, they need to see aspecialist. I call and I
negotiate the price you stayaway from a hospital operated,
(22:21):
physicians because the pricesthey charge are astronomical.
Wonderful.
You know, the other op the otheroption Rhett and could have had
was a health share ministry.
Beverly Gossage (22:31):
Now You might.
AnneMarie Schieber (22:32):
The costs are a bit higher and they're not
really they're not insurance.And, you know, the cost can be
pretty high because, again, theythey're gonna ask you all about
your lifestyle and your yourpremium's gonna be dependent on
that. They may not even acceptyou if you have a, you know, a
high risk lifestyle. What canyou say about those
arrangements?
Beverly Gossage (22:51):
Okay. 2 things. 1, we know they're not actually
insurance. So you could not gofile a complaint with your
insurance department if theydon't pay or you don't feel like
the contract is made. It wouldhave to be a lawsuit situation
that they didn't fulfill acontract.
It is large group of folks thatare faith based primarily, and
they have all said, let's shareeach other's medical expenses.
(23:14):
Initially, when this kind offirst started and they
approached me about this yearsago, my concern was there were
not enough people in the pool tobe able to share the risk. In
other words, let's have somebodywho has a $300,000, premature
twins. How is that going to becovered when everybody's paying
this small amount into thispool? Now, of course, thanks to
(23:36):
Obamacare, that was theexception of, paying the fine.
If you didn't go into Obamacare,you could go to a health sharing
ministry, and you were notsubject to the fine. Of course,
under the Trump administration,they dropped that down that fine
down to 0. So, you know, peoplecan do that without paying a
fine or get a short term medicalplan, without paying a fine. But
(23:57):
to answer the question, 22things. And by the way, I help
people sign up for those typesof plans.
You have to understand why theythey're not more expensive than
the ACA, but they're they'reabout not quite half, but they
could be about 80%. Or I'msorry. You would pay about 80%
(24:18):
of what it would be for the ACAdepending on which of the plans
that you went to. Was itSamaritan or was it CMS, which,
can be the the, ChristianSharing Minister, CSM's
Christian Sharing Ministry.There are several of them, that
they all have varying rates.
No. They're not as low as theshort term medical plans that
(24:40):
can save you 75%. You're onlypaying 30%, you know, of what
you would have paid. Then here'swhy. They they you don't have to
reapply.
They continue. They don't dropyou unless you drop them. Unlike
the short term medical plans,it's only 1 year at a time. It's
only 6 months at a time, andthen you reevaluate it. So
(25:01):
because it continues, they'regoing to be a little bit more.
They don't cover preexistingconditions either. They do and,
like, short term medical plansdon't cover normal maternity. So
So let's say you're a youngcouple, you're not gonna have a
baby right away, but you wouldlike to sometime in the next 5
years, let's say. Then they dohave some maternity built in,
(25:24):
but you have to be with themfor, say, 12 months or 24 months
depending on the plan. So that'swhy they're a little bit more,
but it depends on the type ofcoverage that you want and what
you want it to cover.
But the one the one concern is,of course, it is not insurance.
You have to rely upon the factthat it will be covered. Some of
(25:45):
them have an actual network.They usually, work with the PCM
network or one of the othernational networks. Some don't
have a network at all.
You negotiate your own prices.So, yeah, there are folks in
that plan and it ballooned afterthe ACA. Some of those plans
have 250,000 people in them.
AnneMarie Schieber (26:09):
Well, we have run out of time. Thank you
for coming on the podcast.
Beverly Gossage (26:12):
My pleasure, Anne Marie. And sometime maybe
we could talk about when Itestified before the Republican
study committee and what Irecommended.
AnneMarie Schieber (26:20):
That would be great. Alright. Thank you.
Beverly Gossage is a statesenator from Kansas who is
knowledgeable about Obamacarebecause she happens to be in the
health insurance business. Andthank you listeners for tuning
in.
We appreciate, your giving usyour time. And, we would also
appreciate if you could shareour link, rate us, and become a
(26:42):
regular subscriber to theHeartland Daily podcast. This is
AnneMarie Schieber.
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