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Dec. 17 2009 - 9:09 am | 360 views | 3 recommendations | 30 comments

Would the Senate healthcare bill have helped Obama’s mother?

Right-to-left: Barack Obama and half-sister Ma...

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Back in the day, Candidate Obama told a touching story about his mother’s struggle to pay her medical bills while battling cancer. Obama’s mother, Ann Dunham, died of ovarian cancer at the age of 53, an event Obama said in part inspired him to tackle healthcare reform.

But what kind of coverage would Dunham receive today under the Senate bill as it stands right now?

In this experiment, Dunham is still 50-years-old (her age in 1992 when she received her Ph.D. from the University of Hawaii). She is the single mother of two grown children, so she no longer has dependents. In this model, she has just been diagnosed with ovarian cancer.

She is employed as an anthropologist with USAID, the United States federal government organization responsible for most non-military foreign aid. In 1999, the federal government starting annual salaries for anthropologists were $37,744 for persons with a Ph.D., so for the sake of this experiment, I’m going to assume that she earns an annual salary of $37,744.

(Dunham may have been working with USAID to supplement her income– a common practice for anthropologists– but for the sake of this example, this is her total income. I know this model income will be an area of contention. On the one hand, a Ph.D.-holder earns much more than an average worker. However, Dunham worked as a consultant in non-military foreign aid, hardly a position of great power in a booming market. Nonetheless, I address the possibility that she earned much more than $37k later.)

I’m taking the estimates of her healthcare costs from the CBO’s report on premiums for people at different income levels. A single person like Dunham earning an income of $38,300 ($37,744 isn’t an option on the CBO chart,) would pay $3,900 (healthy years) up to $5,800 (sick years) in premiums, and could expect to pay $1,900 in out-of-pocket expenses. The government would cover 25% of Dunham’s premium.

(Here is a point of disagreement for Progressives: Nate Silver calls these figures “affordable,” while RJ Eskow thinks they’re “harsh.” Most Progressives appear to agree that cost subsidies need to be improved. Personally, I make less than Model Dunham, and consider the base premium, $3,900, a hefty chunk of change.)

If Dunham did manage to land a sweet-ass $50,100+/yr anthropological gig, she would not receive government assistance, she would pay between $5,200 and $7,100 in premiums, and $1,900 in out-of-pocket expenses, according to the same CBO report. (Note: the $26,500-$50,100 income range pay the exact same OPE: $1,900. Just sayin’.)

So for this experiment, Model Dunham is thoroughly middle class and would certainly have to purchase some kind of insurance, since the Senate Democrats dropped plans to expand Medicare, and mandates all Americans purchase private insurance, or pay a punitive fine. Purchasing healthcare on the private market would ordinarily be expensive, but Dunham has the added burden of having ovarian cancer, quite the costly disease.

President Obama has previously talked about how his mother was worried about the mounting medical bills at a time when she was in tremendous pain. She needed her energy to fight cancer, and yet all she could focus on was how she was going to cover her enormous medical expenses. Like millions of Americans, Dunham was PeC’d (Preexisting Condition) by the insurance companies, Obama explained in a town-hall-style session at the AARP’s Washington headquarters:

My mother, when she contracted cancer, the insurance companies started suggesting that, well, maybe this was a preexisting condition. Maybe you could have diagnosed it before you actually purchased your insurance.

Ultimately, they gave in…but she had to spend weeks fighting with insurance companies while she’s in the hospital bed, writing letters back and forth just to get coverage for insurance that she had already paid premiums on. And that happens all across the country. We are going to put a stop to that.

The Dunham in our modern example, covered under the Senate healthcare bill, could not be turned down for a preexisting condition like ovarian cancer, nor could she be dropped if she developed ovarian cancer while already insured.

However, according to the Washington Post’s David S. Hilzenrath, insurers would not be prohibited from using Dunham’s health status against her until 2014. In the meantime, they could continue to deny her coverage or charge her higher premiums. As Ezra Klein points out, there will be some interim help for people who have preexisting conditions, though the bill does not instantly ban discrimination on preexisting conditions.

Meanwhile, the insurance exchanges don’t open open until 2014, and Americans who are denied coverage because of a pre-existing condition will have to participate in a national high-risk pool, a program that is susceptible to its own fiscal limitations. The proposal would permit the HHS secretary to stop accepting applications for the pool once it has exhausted the $5 billion the proposal would appropriate for the program and premiums no longer cover claims. The Congressional Budget Office estimates that this would happen in mid-2011, reports Daniel Esquibel, California Healthline Managing Editor.

Additionally, opponents like Howard Dean claim the legislation “allows insurance companies to charge older Americans up to three times as much as younger Americans, pricing them out of coverage.”

The House-passed bill allows age-rating at a 2-to-1 ratio, which means an elderly person could be charged twice what a 20-year-old normally pays. The bill in the Senate would set the ratio at 3 to 1. Insurers may agree to cover everyone, but they could also charge a lot of money to cover older people, who are more likely to get sick. Model Dunham may have to pay much more for coverage simply because of her age.

Donna Smith, legislative advocate for the California Nurses Association, says age-rating will “leave a lot of people exposed by buying only those policies they can afford…So they can still be driven to foreclosure and bankruptcy.”

There is also some concern that so-called consumer protections like the “no annual or lifetime caps on coverage” are just pretty, empty rhetoric. The AP reports that the Senate bill calls for annual limits on the dollar value of medical care as long as those limits are not “unreasonable.” Whatever that means. Maybe they’ll pay to fix the right ovary, but not the left one? (The White House has since claimed they will help close the loophole in the Senate bill if you are inclined to take their word on that.)

Harry Reid’s chief spokesman, Jim Manley, claims that there was concern banning all annual limits could lead to higher premiums, an explanation that seriously underwhelms veteran healthcare and consumer issues journalist, Trudy Lieberman:

Sounds to me like the bill reflects the handiwork of the insurance industry on this point. It would be interesting to know what the White House has to say. After all, it was the president who took to the airwaves last summer to promote his consumer protections. What does the president think now? Does he side with insurers or with consumers?

If the loophole remains, the Dunham in our example had better pray the costs of her ovarian cancer treatment don’t exceed her annual limits (some chemotherapy drugs like Folotyn cost $30,000 a month, which would almost eat up Dunham’s entire salary).

Insurance limits are especially devastating for cancer patients, who quickly amass huge medical bills due to expensive treatments. Take this example from a 2009 Kaiser Family Foundation report:

Doctors diagnosed Jamie Drzewicki with breast cancer in November 2006 . Jamie, 58, had a partial mastectomy followed by radiation and chemotherapy treatments . She experiences side effects from her cancer treatment, including swelling, pain in her arm, intestinal distress, and a damaged larynx from the radiation . She continues taking medication .

In April 2007 Jamie’s insurer informed her that she had reached the $100,000 annual limit on her policy, an employer-sponsored plan through her job as a director of activities at a nursing and rehabilitation center . As a result, she amassed about $75,000 in medical debt from her treatment. Collection agencies have been calling her regularly, sometimes as many as two to three times per night . Her hospital eventually forgave $40,000 of Jamie’s debt, but about $30,000 in debt remains.

$30,000 of debt is almost Model Dunham’s entire annual salary, a sum she could only hope to begin to pay if she could work full-time straight out of chemotherapy and rehabilitation, and even then, full repayment could take a decade. Even imagining an ideal world, where Dunham-like anthropologist consultants, who write their dissertations on peasant blacksmiths, earn $100,000/yr, these kinds of medical bills would still bankrupt a single woman who cannot work to keep a steady income, and has no spouse to rely upon. All she could hope for is that – ya’ know – her son becomes the President of the United States and pays for her medical bills.

It is not cancer victims like Model Dunham, but rather the insurance and pharmaceutical industries, that are the clear winners of healthcare reform. Dunham would not be permitted to buy cheap cancer treatment drugs from Canada or Europe, reform that would have cost Big Pharma billions in lost revenue. Now, 30 million Americans will get health insurance subsidies from the government to purchase private insurance and expensive drugs. It’s a bonanza for all the right private industries.

Were she alive today and newly diagnosed with cancer, Dunham would be able to get some coverage under the proposed Senate bill as it stands right now. However, she would have to wait five years for the guarantee that she would not be discriminated against for committing the “crime” of getting cancer (promises that could easily be terminated in 2010 or 2012).

The government would cover a quarter of Dunham’s premium, though she would pay $3,900 – $5,800 in premiums, and $1,900 in out-of-pocket expenses. However, if these annual caps remain, she could quickly hit her annual limit and find herself in the uninsured wilderness yet again.

Progressives should tell President Obama to remember the struggle of his late mother and pressure Democrats not to allow arbitrary “annual limits” to remain in the final Senate bill. No cancer victim should ever be told his or her suffering costs too much.


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  1. collapse expand

    Although the question is good, I think the example isn’t. I feel a better expample would have been to see if Ann Dunham would have fared while she was pregnant with the future President.

    I beleive that was the time she was on food stamps and as Obama declared that was a difficult time on his mother.

    His father was pretty much absent. What would this healthcare reform do for a young preganant woman carrying the future President?

    What will it do for the young, poor woman today, who is also pregnant and who just may be carrying a future President?

    Obama has turned his back on his own mother. Thanks for listening.

  2. collapse expand

    It seems like you are comparing 1999 apples (income) with 2009 oranges (insurance costs). But I see your point.

    Still, this is only a starting point and will help a lot of people, even if this version of the legislation misses the newly minted 50 year old PhDs taking their first professional job.

  3. collapse expand

    A very interesting analysis.
    I have to agree that it would still be as effective but more on point if you converted her 1999 salary into it’s2009 equivalent since you are using the health insurance premium rates and subsidies as of 2009. I think your point would still hold up.
    Also, to be fair, it is unlikely she would be maxed out on an annual insurance cap for the illness she had. This does not excuse the language that was submitted into the Senate Bill regarding “reasonable” annual caps when one of the keystones of reform was to be the end of annual and/or lifetime insurance caps.

    • collapse expand

      Rick, she is talking about the senate health will…which to this point no one has read…not even most democrat senators, let alone republicans…..no one can make an analysis based on a bill that hasn’t been completed and is being held in secret….just like obama’s birth certificate is being held in secret….these people have a lot of secrets…….because if the truth came out….they would be run out of OUR congress

      In response to another comment. See in context »
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        All due respect, are you out of your mind? Just to help you out, the whole birther thing is not true. In fact, it’s about as true as the birther movement for John Mccain–even though he was born in Panama as opposed to Hawaii. You just need to do your own research on this matter, instead of referring to one network for all your “facts”.

        The senate bill is in the CBO to score the cost of the Medicare Buy-in. That’s why they are keeping it hidden in case it comes out with a shitty score, just like what happened to the Republican bill. And even though the media, pundits and anxious politicans are talking about the bill as if it’s dead, once it’s scored, there will be a complete shift in public opinion. Guaranteed!

        I wonder if your opinion of the bill would change if the democrats came out at the start with the exact same bill the Republican are pushing now. I’m sure you would be against it because your party would have shift it’s own position to be against whatever the Dems were doing. It would be wild seeing the carnage of Reps tearing apart their current bill and throwing it in the face of the Dems. It doesn’t even reduce the deficit or cover more people! I think it actually covers less.

        I always liked the saying, “you can’t handle the truth”.

        In response to another comment. See in context »
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          With all due respect…Harry Reid has hid the bill from the public…after Obama promised to debate health care on C-span

          Nobody has read the health bill…it is being written in secret by lobbyists, Harry reid is bribing senators to sign on…hopefully they will force a reading of this entire anti-american
          bill….which is a direct assualt upon the Constitution by the drug addicts in the senate….our tax money being these crackheads drug of choice…

          Call it what you want….Obama’s birth certificate is locked up in the governors desk in hawaii…but not for long….Obama is taking a family vacation to hawaii this christmas….where he will destroy the original birth certificate which no one has layed eyes on in over 40 years….except two hawaii civil servants…..who had no authority to look at it…but claim its legit…

          McCain was born while his father was serving the country in the Navy

          In response to another comment. See in context »
          • collapse expand

            The circumstances surrounding President Obama’s birth are clear to anyone who cares to weigh the evidence. And there lies the problem. No amount of evidence will ever satisfy a determined conspiracy theorist. Facts make you more angry.

            While I agree that John McCain should be Constitutionally eligible to serve as president, the facts surrounding his birth are more problematical because of the Constitutional language. It is time to amend the Constitution and make it clear that any American citizen who wants to be president is eligible to serve.

            In response to another comment. See in context »
  4. collapse expand

    Every lawyer knows what a Moot court is. It is that arena where lawyers and judges play lawyer and judge without using real cases. Scientists of all kinds, researchers, computer engineers know how to develop and use models — mathematical and otherwise — without using live subjects. The law forbids experimentation on live human beings. Media outlets will usually have the subject sign a waiver before their personal and private data is made public. Yet, inspite of Ms. Kilkenny’s extensive education and enlightenment, she couldn’t or wouln’t find it within her intellect to develop a model and create data to make the necessary analysis without saying to the president “Your mom died of cancer at 53, haha… Look at the little you could have done for her.” Ms. Kilkenny, What were you thinking? Where is your soul? Talk about the quality of our discourse today. May God have mercy on you! You probably will not allow this comment to be published yet you feel totally unfethered to use the Anne Dunham example. Shameful! You could have found very easily a Jane doe, somewhere with similar data on whom to write your expose.

    • collapse expand

      By no means did I mean for this to be a mocking article. I actually take the suffering of cancer patients very seriously, since I have witnessed close family members battle the disease. I’m deeply concerned that cancer patients will not receive the care they need under the Senate health bill, which is why I approached the article in this way.

      In response to another comment. See in context »
  5. collapse expand

    With compromise after compromise on the health care bill public support for it continues to erode. One thing that has kept it from falling even further is the fact that everything is in such flux (different bills that keep changing) that it is tough for people to get a handle on the numbers and see how it will affect them. If and when the final watered down version of health care passes, however, the bill will “stand still” so to speak, and will see a lot more “numbers analysis” like what you put in your article. When that happens, given the madatory purchase requirement, the public is going to like it a lot less and the Democrats are going to pay a severe price for it at the polls. This just when it looked like there was no way for the Republicans to get back in the game. What needs to be done until then is for writers to do what you did in your article. Pick a situation that is likely to occur in the real world, make sure your numbers are reasonably in the ballpark, and offer some analysis.

    • collapse expand

      When that happens, given the madatory purchase requirement, the public is going to like it a lot less and the Democrats are going to pay a severe price for it at the polls.

      You could very well be right.

      In response to another comment. See in context »
      • collapse expand

        So the public employees from the local ctiies around here who get their health paid for by the taxpayers will continue to get their free health care….like teachers, cops, fire, city employees….but the taxpayers who give free health care to the public employees…will themselves be going to jail for not buying their own obamacre because they had no money left over for health care after paying their taxes….

        Let’s go thru this again…and see how this works…

        In response to another comment. See in context »
  6. collapse expand

    Wow, this was a really eye-opening article for me. My annual income is $50K, which is the example used in the article. According to the author who cites a CBO report, under the Senate bill my minimum policy costs would break down to $100 a week. I CAN”T AFFORD THAT! THAT’S WHY I DON’T ALREADY HAVE A HEALTH INSURANCE POLICY! D’uh!
    On top of that, the first $1900 of my annual medical bills would have to come out of my pocket. I can’t afford that NOW, and I sure as heck won’t if I’m paying an extra $100 a month.
    So basically I would still not be able to afford to go to the doctor for anything that wasn’t truly catastrophic.
    Dean is right, this bill stinks and is just a huge gift to the insurance industry. It would be especially hard on us in in the middle class who are uninsured.

    • collapse expand

      To be honest that’s not a huge amount to spent to know you won’t go bankrupt and can get medical care. Also, people pay that and more today. It’s just a matter of if you want coverage or not. Because there is no magic bullet that will make it worth exactly what you want to pay. We live in a capitalist society after all.

      In response to another comment. See in context »
      • collapse expand

        Are you serious? 10% is a substantial chunk of my income. Considering that I would have to pay my first $1900 of annual medical expenses, such a policy would be of no use to me unless I got cancer or something.
        The thing is, I’m really struggling to pay my bills NOW. I drive an 18 year old car, never go on vacation, don’t have cable, and have a frugal lifestyle. An extra $100 a week expense would eat up every penny and more of my ‘disposable income’. This senate bill doesn’t offer me any better a deal on insurance than what is already available.

        In response to another comment. See in context »
  7. collapse expand

    Correction to my previous post:
    “I can’t afford that NOW, and I sure as heck won’t if I’m paying an extra $100 a week….”
    (I meant week, not month)

  8. collapse expand


    Lets say that he was not president receiving so called Intel from all his advisers; and he took time to think for himself what this health care will do to the ordinary man. He would, and i reiterate, would petition against his own reform policy. Barack Obama has more to learn before his Nobel can be truly his, his playing on thin ice. writtenviews is a twitter name for world views, look for more on it.

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    I co-host Citizen Radio, the alternative political radio show. I am a contributing reporter to Huffington Post, Alternet.org, and The Nation.

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