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Obamacare and defining substandard policies

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Over the past few weeks, the administration and their shills on Capitol Hill have tried making the argument that the policies that've gotten cancelled are "substandard policies." In that time, we've heard about people who are alive today because their insurance policies paid for cutting edge medical treatment at some of this nation's leading research hospitals. Here's a portion of Edie Littlefield-Sundby's story:

My grievance is not political; all my energies are directed to enjoying life and staying alive, and I have no time for politics. For almost seven years I have fought and survived stage-4 gallbladder cancer, with a five-year survival rate of less than 2% after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31.


Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.

Only the government would be foolish enough to argue that Edie Littlefield-Sundby's health insurance policy is substandard. Coincidentally, the government, through its minimum required benefits provision, thinks that Edie Littlefield-Sundby's health insurance policy is substandard because it doesn't include coverages that the government, not Edie's doctors, think are important.

Edie isn't alone in this situation. Jim Hoft, who runs the GatewayPundit blog out of St. Louis, MO, finds himself in a difficult situation. Here's Jim's situation in Jim's own words:

In August 2013 I became very sick with what I thought was a cold. After a few days I lost vision in my left eye and I checked into the hospital. I soon found out that what I thought was a summer cold was actually Strep bacteria poisoning my blood stream. The bacteria blinded my left eye, ate a hole through my heart, caused five strokes on both sides of my brain and forced the removal of my prosthetic left knee.

Dr. Lee was the surgeon assigned to perform open heart surgery. What was originally scheduled to last four hours ended up lasting twelve. My heart was severely damaged. Dr. Lee later told me the surgery was one of the most difficult of his career. He also said I only had a few days to live without the surgery.

Thanks to the excellent insurance I carried, I was able to receive life-saving medical treatment at St. Louis University.

This week I found out I am going to lose my insurance. The company that carried me is leaving the Missouri market. I will have to find something else.

It boggles the mind to think that health insurance that literally provides life-saving medical treatment is substandard. Only in a government-knows-best bureaucrat's mind would we find such silliness.

Under the Affordable Care Act, aka Obamacare, insurance policies must have these "essential health benefits":

The essential health benefits include at least the following items and services:

  • Preventive and wellness services and chronic disease management
  • Laboratory services
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Prescription drugs
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Maternity and newborn care (care before and after your baby is born)
  • Hospitalization (such as surgery)
  • Emergency services
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Pediatric services

If a health insurance policy has those coverages, it can't be offered on the health insurance exchanges. If the policy doesn't have those coverages, it's considered "substandard" by pompous politicians and unaccountable bureaucrats.

Shouldn't people like Jim Hoft and Edie Littlefield-Sundby determine what health insurance policies they need? Why does anyone think that a pompous politician will make better choices for Jim or Edie?



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