Conservative groups are highlighting the case of an Arizona man with leukemia whose insurance plan was canceled because it didn’t comply with the Affordable Care Act. A news report quoted the man as saying he would need to pay $ 26,000 to keep the same doctor. It turns out, he was able to get a new plan, which has his doctor in its network, for a lower premium and a lower out-of-pocket maximum than his old plan.
Michael Cerpok, from Fountain Hills, Ariz., was featured in a local TV news segment on Oct. 3. The ABC15 report said that Cerpok, who was diagnosed with leukemia in 2006 and requires ongoing treatment, had received a letter from his insurer, Celtic Insurance Company, saying that his policy wasn’t “fully compliant” with the Affordable Care Act and would be canceled. Cerpok, a self-employed businessman, was paying $ 855 per month for the policy for himself.
The report said his out-of-pocket costs in 2012 were only $ 4,500, even though his treatment for leukemia totaled more than $ 350,000. Cerpok wanted to keep the same doctor he had at the Mayo Clinic. He told ABC15: “Now it doesn’t mean I can’t go see my current doctor, but my $ 4,500 out-of-pocket, is going to turn into a minimum of $ 26,000 out-of-pocket to see the doctor that I’ve been seeing the last seven years.”
That local Phoenix news segment has gone viral. Cerpok’s plight now has been highlighted by the Heritage Foundation, a conservative think tank; cited in an ad from Americans for Prosperity, as the announcer says “Arizonans are losing the health care plans they love, the doctors they know”; and featured on many other conservative websites. Heritage Foundation President Jim DeMint wrote a letter in early October to President Obama that said: “We are fighting for people like Michael Cerpok, a leukemia patient in Arizona, who recently learned he will lose his current health insurance due to this misguided law. He notes that ‘my $ 4,500 out-of-pocket [expense] is going to turn into a minimum of $ 26,000 out-of-pocket to see the doctor that I’ve been seeing the last seven years,’ and he worries that he and his wife might need to take second jobs to stay afloat.”
But this story has a happy ending. We spoke with Cerpok a month after the TV report aired, and things have changed. Cerpok told us he was able to sign up for a new plan that has his current oncologist and hospital in its network. He said the policy was less expensive, but didn’t have some of the same benefits — such as a specialty prescription drug benefit for cancer drugs. “I will say that my premiums went down, as did my yearly total out of pocket maximum, commensurate with the benefits I lost,” he said in an email to FactCheck.org. “My policy contains MANY things that I will never use.” He didn’t want to reveal how much money he was saving with the new policy or other details on the coverage, saying that he had received a lot of criticism after the ABC15 report aired.
That report, however, is what led him to a new plan. Cerpok had a career as a martial artist, and one of his former student’s parent, who owns an insurance agency, contacted him after seeing the news report, Cerpok said, and helped him find comparable insurance. “He did a lot of research,” Cerpok said, and “found a plan for me which I have now signed up for.”
It’s an individual market plan, but it is not through the federal exchange. “I didn’t want my new plan to be a part of a subsidized government-mandated health care,” he told us. He said he had no problem with Americans getting subsidies to help them buy insurance, but he was opposed to the individual mandate, requiring everyone to buy coverage. “This is about freedom to choose,” Cerpok said.
He said he did not look at health plans on the federal exchange, HealthCare.gov. Estimates available on the exchange website show significantly lower rates than the $ 855 Cerpok had been paying. Coverage for a single person over 50 — Cerpok is 52 — starts at $ 237.04 per month for a bronze plan. The highest-priced plan was an estimated $ 576.62 in Maricopa County, Ariz.
His old insurer, Celtic, did not offer him a new plan and is no longer selling individual market plans in Arizona, according to its website. We contacted Celtic’s parent company, Centene, but haven’t received a response to our questions. The $ 26,000 figure Cerpok cited in the news report comes from him looking into joining his wife’s employer-based plan, which is through Blue Cross Blue Shield and doesn’t include Cerpok’s doctor and the Mayo Clinic in its network. He said Blue Cross Blue Shield told his wife he could continue to see his doctor on that plan, but the out-of-network costs would total $ 26,000 for the year.
The $ 855 Cerpok is paying for the soon-to-be-canceled Celtic policy is a high price, but he said he was happy it covered the bulk of his leukemia treatment. Individual market premiums vary — and as his premium shows, can vary greatly. The average price for Arizona, as calculated by the conservative Manhattan Institute, adjusting for preexisting conditions, was $ 127 per month for a 40-year-old and $ 386 for a 64-year-old male before the Affordable Care Act. The Kaiser Family Foundation found an average individual market premium of $ 241 per person per month in 2010 in Arizona, noting that was an average for all adults and children.
The cost estimates aren’t what’s important to Cerpok, however. It’s about the right to choose to buy whatever you want. “The health insurance industry certainly needed to be put in check, and we certainly needed to provide affordable care for low income earners,” he told us in an email. “But, I should not have had a product that I was willing to pay for, and that I had been very happy with, taken away from me by a government mandate and then taxed…er, I mean fined…if I chose not to replace it with a product I don’t like.”
The cost of insurance has been the focus of political claims, and it was the focus of the local Arizona news report, which said the insurance switch could cost Cerpok “tens of thousands of dollars.”
In the end, Cerpok isn’t facing such an increase, and instead lowered his monthly payments. He wasn’t able to keep his plan, but he was able to keep his doctor.
– Lori Robertson
- Insurance
- Affordable Care Act