RUSH: Here’s Stacy from somewhere in Georgia. She is our semi-regular caller keeping us up to speed on health care and health insurance. She’s our insurance analyst. Stacy, as always, welcome back. Great to have you here.
CALLER: Hey, Rush. Great to talk to you.
RUSH: Thank you.
CALLER: And for the NAGs out there, the problem is you.
CALLER: I solved that real quick and they didn’t even have to rent a conference room. But, listen, I have found some truly delicious information.
CALLER: On these preexisting condition insurance plans that just came into effect last month.
RUSH: By the way, before you get into this, have you heard that the Democrats have been given new marching orders? They are to stop talking about how Obamacare is going to save money.
CALLER: And I can tell you why that is.
RUSH: Well, yeah, because it’s not going to save anybody any money.
CALLER: Well, these poor suckers with these preexisting conditions who thought they were gonna get all this care, the very minimum — I calculated it — the very minimum these people are gonna pay if you’re under 35 is $12,340 a year.
RUSH: Wait. No, no, no, no, no, no. Wait, wait just a moment. You’re talking about preexisting conditions are not going to be covered because people were told by the Democrats and Obama that at some point after the bill was signed that preexisting conditions and your kids and so forth would be covered, no longer could you be denied.
CALLER: Well, that’s true, but, remember, they set up a two-year transition plan, quote, unquote.
RUSH: Yes, but you’re telling me that the minimum cost for the free service is $12,000?
RUSH: Wait, per person?
CALLER: Per person.
RUSH: So the free coverage of preexisting conditions is $12,000 per year per person?
CALLER: Yes. And I can explain it to you. And another delicious factoid about this, all of these plans — well, okay, back up. Twenty-two of the states told the Department of Health and Human Services that they didn’t want to run this crap. They kicked it back to Washington and said, ‘You handle it.’
RUSH: Wait, wait. Did not want to run the preexisting condition form of the insurance?
CALLER: So they kicked it back to HHS. HHS contracted out to a private insurance company called the Government Employees Health Association.
RUSH: The Government Employees — the GEHA, GEHA.
RUSH: Writing this down.
CALLER: So they’re administrating this plan on their website. And I’m going to quote it to you. This plan is an HSA qualified high deductible health plan. The plan gives you greater control over how you use your health care benefits, and they want you to open an HSA account.
RUSH: Wait. A health savings account?
RUSH: They want you to open one of those?
CALLER: Yes. Now, here’s the really, really fun part about it. There are no benefits payable for anything other than preventive diagnoses until you pay out of pocket $2500.
RUSH: Wait. No benefits payable, meaning the insurance company is not going to pay for your free health care other than preventive diagnoses until you pay $2500 out of pocket?
RUSH: How does this relate to the 12,000?
CALLER: Well, the very minimum in Georgia, the minimum premium is $323 a month. Okay? That works out to $3,840 a year.
RUSH: For free preexisting coverage?
CALLER: Okay. So you’re just gonna pay that, then you’ve also gotta add $2500 as your deductible before any benefits are payable, minus your preventive diagnoses. Then, it’s an 80-20 for in network, 40-60 out of network until you have paid out of your pocket, not including the $2500, $6,000.
RUSH: Okay, so that’s how we got to the 12. What is in network, out of network, what does that mean?
CALLER: Well, this insurance company has gone out and gotten providers to sign contracts for services. That’s an ‘in network.’
RUSH: Provider is a hospital, a doctor, or a nurse?
CALLER: Exact. All of the above.
CALLER: Now, mind you, that $2500 that you have meet before they’re going to pay a dime —
RUSH: The deductible.
CALLER: — that includes prescription drugs; that includes hospital stays; that includes durable medical equipment; that includes everything.
RUSH: ‘Gerbil’ medical equipment?
CALLER: Yeah. Okay, let me give you an example to kind of clear it up for you. Say you’re a diabetic.
RUSH: Wait a minute, ‘gerbil’ medical equipment?
CALLER: Let’s say you’re an insulin-dependent diabetic, and you’ve been —
RUSH: Wait a minute, I’m just now getting my composure back. We are an insulin-dependent diabetic. Okay.
CALLER: Okay. So you have to buy your syringes, you have to buy your insulin, okay, the syringes are considered medical equipment.
RUSH: No, wait. You gotta buy it yourself, gotta go to the drugstore, gotta buy it yourself?
RUSH: This is not part of your free health care.
CALLER: Exactly, until you have paid $2500. Now, you have to go to your physician every couple of months and have blood tests run to see what your blood levels are. That’s not covered.
RUSH: Why can’t you just get one of those finger prick things that you get in the drugstore to test your blood sugar, why go to the doctor?
CALLER: They do that, but you do go to the doctor because they run more expensive laboratory tests.
CALLER: There’s different levels of sugars in your blood and they have to see your three-month average and all of that.
RUSH: Right. I’m writing all this down, so far I feel like I’m in a maze.
CALLER: It is a little crazy.
RUSH: I’m an insulin-dependent diabetic, and all I’ve learned here is I gotta somehow come up with $2,500 bucks to go out and buy all this equipment, and then it’s going to cost me $300 a month if it’s pre-existing, I’m still trying to figure out where the $6,000 per year comes into this.
CALLER: I’ll help you. We’ll get there. When you go to your doctor to have your blood run, that’s not a preventive, so you have to pay the doctor’s office.
RUSH: Wait a minute. When does your insurance kick in?
CALLER: After you have $2500 at the insurance company of claims that they’ve run up but they’re not paying.
RUSH: All right. So you have to have the equivalent of $2500 of medical services by your provider —
RUSH: — and that’s your deductible. You gotta pay that before any insurance kicks?
RUSH: Even though you’re paying a premium, minimum $300 some odd a month?
RUSH: Under free Obamacare. Okay.
CALLER: Once you hit that $2500, then you get into some copay so your doctor would be a $25 copay. Out of pocket, and they’re not really clear on what contributes to their out-of-pocket, but the —
RUSH: Whose out-of-pocket?
CALLER: The patient’s. So once you get to $2500 they’re gonna pay 80-20. They’ll pay 80%, you’ll pay 20%.
RUSH: So after you pay the $2500 plus the $300 a month, you’re still paying?
RUSH: Where did you find it? I know you’re in the insurance business.
CALLER: It’s right here on the Web. It’s www dot P as in Paul, C as in cat, I as in India, P as in Paul, L as in Lima, alpha, N as in Nancy, dot.com.
RUSH: And that is what?
CALLER: That is the GEHA’s website for this preexisting coverage. Now, Rush, I gotta give you one more before you gotta go.
RUSH: Wait. GEHA, that’s the general —
CALLER: It’s the Government Employees Health Association.
RUSH: Government Employees Health Association.
CALLER: That’s the insurance company.
RUSH: That’s the insurance company. Okay, so it’s the insurance company website.
CALLER: Exactly. Now, one of the 22 states that kicked it back to HHS and said we don’t want to do this is Arizona. And guess what you have to provide GEHA in order to be approved for their plan? Proof of citizenship.
RUSH: (laughing) No!
CALLER: (laughing) Is this not delicious? I mean, I’m not normally one for schadenfreude, but when I found this last night I was falling all over the floor. Do you wanna know the states that are doing this?
RUSH: This panacea, this utopian free preexisting condition care health care plan is going to cost you $12,000 a year is only accessible if you can prove citizenship?
CALLER: Exactly. In my view, that $12,000 a year is the absolute minimum. It can go up to $27,000.
RUSH: But you said Arizona kicked it back ’cause they don’t want to participate in it.
RUSH: So illegals will now not be mandated to give their proof of citizenship.
CALLER: Well, if they’re in Arizona and they want the preexisting condition insurance, then they’ll have to send proof of citizenship.
RUSH: No, you said Arizona kicked it back and they’re not gonna play.
CALLER: No, no, you can’t do that. All states have to play, but 22 states said we are not going to deal with finding a contractor. They just said, ‘We’re gonna let you do it, HHS. You handle it.’
RUSH: Oh, as the secretary shall determine.
RUSH: That would be Kathleen Sebelius.
CALLER: Yes. So for Arizona, if an illegal alien has a preexisting condition and he wants to get on this plan, he’s going to have to forge him up some documents to send in because you have to provide proof of citizenship.
RUSH: This is too rich.
CALLER: Isn’t it wonderful?
RUSH: This is just too rich.
CALLER: The schadenfreude is through the ceiling. It’s insane.
RUSH: I happen to know that proof of citizenship was one of the things the Republicans were able to force into this. That’s one of the few things the Republicans were able to ram through in this, was proof of citizenship into the health care reform bill.
CALLER: I would love to know if they also ran the HSA piece into it. And the reason that this private insurance company has done this as an HSA and high deductible plan is because they know they’re not going to be able to cover the money that is gonna go out on this.
RUSH: Well, hell, 90% of the patients are not going to be able to afford this.
CALLER: I know. And, you know, you also have to be not covered by any insurance plan whatsoever for six months —
RUSH: Before you qualify for this?
CALLER: In order to qualify for this, and —
RUSH: You mean you gotta have no insurance for six months before you can qualify for this boondoggle?
RUSH: I can’t believe — well, I can believe it, actually, it sounds unbelievable but I — well, you would know. Are you still in the insurance business?
CALLER: I am.
CALLER: Because it’s a tough job market, but I’m working on it.
RUSH: I was going to say.
CALLER: But I’m hopeful. I really am hopeful. God, please let conservatives take the House at least and starve this beast. If they don’t do that, I’m going to be so frustrated I don’t know what to do.
RUSH: Well, that’s a two-pronged problem, taking the House and then getting the Republicans to starve the beast.
CALLER: I know.
RUSH: That’s a separate issue.
CALLER: But, yeah, there is so much irony in this little piece. In my view this is only good for two years. Supposedly in 2014 all of this ends and then you go on to the exchanges.
RUSH: Right. That’s essentially single payer and that’s where they hope to get this.
CALLER: Exactly. Another one, Rush. You remember how they said they weren’t going to put any benefit limits on people?
CALLER: For this plan right here, they have all kinds of benefit limits. One of the big ones that I saw was if you need hospice care, they have a $15,000 benefit maximum that they will pay and you can wipe out 15 grand in hospice in a heartbeat, and that’s including inpatient and outpatient —
RUSH: I know. And there aren’t many heartbeats left in hospice —
RUSH: — to begin with. There’s going to be a revolt when this happens to people.
CALLER: Well, they’re starting to find out. Like I said, enrollment started last month.
RUSH: Yeah, because everybody thinks it’s going to be free.
CALLER: Well, you know, that’s a sucker for you.
RUSH: Stacy, thanks for the call. It’s always a pleasure.
CALLER: Have a great one, dear.
RUSH: And. The ‘gerbil’ procedures, I’m still caught on that.
RUSH: No, I wasn’t making it up. From the Democrat talking points slideshow, ‘The presentation’s final page of ‘Don’ts’ counsels against claiming ‘the law will reduce costs and [the] deficit.” They are not to talk about that now. As they go out into the campaign season (they’re back home for the August recess) they are not to talk about the cost savings and deficit reduction. They’re supposed to talk about the ‘improvements’ in health care that will result, because everybody knows it’s not going to reduce costs.