The Difference Between Insurance Companies and "Obamacare" is Important

Republican Congresswoman Cynthia Lummis suffered a horrible loss in late October, when her husband died of a massive heart-attack in his sleep. Her husband, former Democratic Wyoming State House member Alvin Wiederspahn, was apparently also having issues with his health insurance enrollment on the Affordable Care Act exchanges in Washington, D.C. Rep. Lummis decided to take this issue up in a Congressional hearing this past week though, and completely seems to have confused the issue:

Alvin Wiederspahn, a former Democratic member of the Wyoming state House, died in October of a heart attack in his sleep. He was 65. Lummis recounted the experience to Centers for Medicare and Medicaid Administrator Marilyn B. Tavenner, who was called to testify before the House Oversight Committee on transparency issues regarding the Affordable Care Act. 

The Wyoming Republican said that even though her husband was enrolled for insurance in the D.C. health insurance exchange, "when we filed claims, we were told we were not enrolled in Obamacare." The couple filed claims once more, Lummis said, and once again they were told they were not enrolled.

"My husband was having chest pains at the time that he was told we were not enrolled in Obamacare, and come to find out, he didn't have all of the tests that he was advised by his physician to have," said Lummis. "So on October 24, a week before the election, my husband went to sleep and never woke up."

Lummis said that her husband had chosen to forgo a test prescribed by his doctor -- a decision, she said, that was partly due to the confusion over his enrollment status.

"I'm not telling you that my husband died because of Obamacare," she said. "He died because he had a massive heart attack in his sleep. But I am telling you that during the course of time that he was having tests by a physician and was told we were not covered by Obamacare, that he then decided not to have the last test the doctor asked him to have."

First off, it's a really sad story. Second off though, bad health outcomes have been a part of our system for a long time, so this is not a new thing to "Obamacare." Third though, and maybe most crucial here, there is no product called "Obamacare," you are buying a private-market product from a health insurance company.

I'll take a bit of a leap of faith and presume that Wiederspahn and Lummis went on the exchanges, picked a plan out, and paid their premiums each month, because they probably did. At that point, they became enrolled in a plan offered by a private company. At that point, basically the reforms of the Affordable Care Act were no longer relevant. At that point, it was old fashion health insurance bureaucracy, where you are subject to their "glitches" in administration. It sounds like the company they picked did a tragically bad job tracking who their paying customers are. That is awful, and you have to feel for this family to have to suffer through this. It is something that happened before "Obamacare," and will happen after, as long as companies administer health care how they do.

It's important though that we don't accept this as a substantive attack on the Affordable Care Act. The Department of Health and Human Services does not administer the insurance of people buying plans on the exchanges, the companies selling insurance on the exchange do. HHS is not the responsible party for the insurer (quite literally they are not, if you were to sue over an event like this). This has a lot less to do with "Obamacare," and a lot to do with poor client services.