Kathleen Sebelius understates Obamacare health-dental costs, also not mentioning Texan's federal subsidy

Urging Texans without health insurance to hop to shopping before a looming enrollment deadline, Kathleen Sebelius enthused about a Texan she described as landing a good deal via the HealthCare.gov website.

Sebelius, the U.S. secretary of Health and Human Services, said in an opinion column published in the March 18, 2014, Austin American-Statesman: "On a recent visit to the Lone Star State, I met Mark Sullivan, a 31-year-old software developer. Though he was eager to start his own business, the thought of fending for himself without his employer-based health coverage made him hesitate.

"But then Mark researched his options on HealthCare.gov. You can imagine his excitement when he found a good plan that includes dental, for less than $80 a month." That column touting Sullivan’s experience also appeared in the Dallas Morning News, San Antonio Express-News, El Paso Times and McAllen Monitor.

We were curious about Sullivan’s experience on the Obamacare website, which often didn’t function at its launch. Did Sullivan, co-founder of an Austin-based company, snag an early health/dental bargain anyway?

An account re-told

Sullivan’s sign-up success has been a centerpiece for advocates at least since an Oct. 4, 2013, web post by Enroll America, a Washington, D.C.-based nonprofit focused on maximizing the number of Americans enrolled in and retaining health coverage.

Enroll America’s post said Sullivan overcame glitches on HealthCare.gov shortly after the site’s debut to line up affordable coverage for himself, effective in 2014. After comparing plans, Enroll America said, Sullivan "settled on a bronze option and added dental insurance. He will receive an $82 per month subsidy, which will halve the monthly premium he will pay down to $78."

Sebelius’ oped column, distributed about five months later, made no mention of Sullivan’s subsidy.

Enroll America’s write-up further noted that Sullivan’s subsidy might decrease: "While his new startup will require a lot of personal expense early on, if profits grow faster than he projects, his subsidy may end up being a bit lower by the end of the year. That’s no concern for Mark, since even without the tax credit, his total premium is still much more affordable than the private plans he had been able to find on the individual market."

On Oct. 25, 2013, Sullivan joined an Austin press conference where Sebelius talked up the importance of residents complying with the mandate that Americans obtain coverage, as noted in news stories by outlets including the American-Statesman. (The next enrollment deadline is March 31, 2014.)

Agency spokesman: Dental plan an added cost

We asked a Washington, D.C.-based HHS spokesman, Fabien Levy, for backup related to Sebelius’ description of Sullivan’s shopping success. Levy largely deferred to Sullivan, though by email Levy said the described dental coverage has been costing Sullivan $15 a month in addition to the less than $80 for health and dental coverage celebrated by Sebelius. Hence, Levy said, the original column was being revised. A fresh version sent by the agency to the Statesman lacked any mention of Sullivan’s dental plan.

Sullivan offers details

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Fortuitously, Sullivan elaborated on his experience on HealthCare.gov. By phone, Sullivan told us he pays $77.67 a month to Blue Cross and Blue Shield of Texas to be in its Blue Advantage Bronze HMO plan.

On a Blue Cross and Blue Shield web page, the plan is described as having an individual annual deductible of $6,000 along with maximum annual out-of-pocket costs to the purchaser. Notably, though, the purchaser must pay all medical costs up to that ceiling. Also, according to information on the web page, the plan covers 100 percent of prescription costs once the deductible is paid.

By phone, Sullivan told us that in addition to the costs of his health policy, he chose to pay about $15 a month for a Starmount Life Insurance Co. dental plan.

By email, Sullivan shared a computer screen shot of a Blue Cross Blue Shield web page showing that his health coverage, effective Jan. 1, 2014, would cost $159.67 without his $82 monthly subsidy; which was awarded based on his income, Sullivan said. The image shows that thanks to the subsidy, he’s been paying $77.67 a month.  

Sullivan said he appreciated the plan’s low monthly cost to him, its provision for a free annual check-up and its cap on out-of-pocket expenses. Notably, too, he said a medication he purchased in February that would have cost him more than $340 if he had no coverage ended up costing only $30 out of pocket.

Looking back, Sullivan wrote that he had trouble logging on to HealthCare.gov the first three days of October, but by Oct. 4, he was browsing 76 available plans and, to his memory, signed up for his plan a day later.

"Overall, the shopping experience was a good one," Sullivan wrote. In his view, he wrote,"the only thing slightly off" in Sebelius’ published statement "is that the dental coverage was separate from health insurance, which was an additional $15/month that I probably wouldn't have chosen without the subsidy."

Our ruling

On HealthCare.Gov, Sebelius wrote, Texan Mark Sullivan "found a good" health insurance "plan that includes dental, for less than $80 a month."

No doubt, Sullivan liked how things worked out for him.

But Sebelius’ recap struck us as incomplete and misleading. The secretary incorrectly described what Sullivan pays as covering both medical and dental coverage; the latter costs him about $15 more a month. The article also didn’t acknowledge that Sullivan’s monthly charge was fueled by an $82-a-month subsidy. Also, there was no concession that purchasers including Sullivan must pay $6,000 a year for medical procedures before the plan pitches in on such.

We rate this statement as Mostly False.

MOSTLY FALSE – The statement contains an element of truth but ignores critical facts that would give a different impression.

Click here for more on the six PolitiFact ratings and how we select facts to check.

CLARIFICATION, 4 p.m., March 24, 2014: We removed an incorrect reference to "hidden" cost in our section explaining our ruling above and clarified that the oped column celebrating the low out-of-pocket cost of Texan Mark Sullivan's combined medical-dental plans didn't including the substantive detail that the Austin purchaser would still face a $6,000 annual deductible for his medical coverage. This revision did not change our rating.