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The Senate’s version of the health care bill is best summed up as a return of skinny plans. The Affordable Care Act (ACA) required certain essential services be covered, but before the ACA plans could basically pick and choose what they covered. Often this was very obvious as in we-don’t-cover-prescription-drugs, but sometimes what wasn’t covered was buried and somewhat obscure and so the average person wouldn’t know this was a big deal until they needed it. It was like buying car insurance and trusting that the insurance covered car repairs, but then having a crash, going to the body shop and finding out your plan doesn’t cover engine work! Good times.

Over the years I have had plans that didn’t cover a variety of things or covered them very superficially, basically the kind of plans that could come back. I want to share some experiences to highlight exactly how bad this can be.


No home intravenous therapy

Sometimes people have really bad infections that require prolonged intravenous therapy. This can be up to 6 weeks or even longer for osteomyelitis (bad bone infection) or an infection around an implant. The thing is after a few days many people aren’t really sick enough to be in the hospital so a plan is made to go home and administer the antibiotics at home. This seems like a win-win for everyone. The health plan saves money because hospital beds and nursing care is expensive, the patient reduces their exposure to hospital bacteria and they get to be more comfortable. If they have to pay a percentage of their hospitalization there are also clear cost savings.

When I was 29 years old I got an infection in my face, a cellulitis. It involved my nose and forehead and I have no idea how it happened. I probably had a small pimple that I scratched, but I don’t remember. I went to sleep fine and woke up in the middle of the night with raging pain. This is a bad place for an infection as bacteria can travel from by the facial veins to a part of the skull called the cavernous sinus causing a very severe infection. The treatment was intravenous antibiotics. Seven days! After 24 hours I was bored and my blood work was improving and so I begged until they let me go home with home intravenous therapy. I didn’t need a nurse to administer it, so the home infusion service dropped off some supplies and antibiotics (generic). Awesome I thought, until 2 weeks later when I received a bill for $1100. Turns out home intravenous therapy wasn’t a covered benefit. That was $1100 over 20 years ago for six days of the cheapest antibiotic.

No ambulance transfers between hospitals

My son, Oliver, was 783 g at birth and in the neonatal intensive care unit. He also had a severe heart defect and needed surgery. The equipment for a baby of his size was at another hospital, fortunately in network. He was transferred by ambulance and had the procedure. The next day he was transferred back to the ICU. Four weeks later I got a $1200 bill for the transfer, $600 each way. Ambulance transfers, not a covered benefit.

Limited oxygen benefits

Both my sons came home on oxygen and honestly I never, ever thought to check on this as a covered benefit. I mean it’s oxygen! Turns out the HMO we had covered $100 a calendar year for home oxygen. As my boys were discharged in the fall and were initially on such small amounts due to their small size we made it through 2003 with no bill. April 2004 the home oxygen therapy company started billing us over $100 a month. Apparently in 2006 the average cost of home oxygen therapy was just over $200/month.

Low reimbursements for mental health

Sure we cover mental health services, my plan said. This was at the University of Colorado and over 10 years ago. Only problem the reimbursement for mental health services was so poor that the psychiatrists at the University wouldn’t even accept their own health plan! A plan is not much good if no doctor will accept it.


Many of these “skinny” benefits would only be found on reading fine print, but what does $100 of home oxygen therapy or home antibiotics mean to the average non medical person? I’m a doctor and it didn’t even register with me, possibly in part because I was a healthy person when I selected each plan. Some skinny plans might not cover vaccinations, others mammograms, and another one might not cover cancer screening of any kind.

Skinny plans offer the illusion of care. People pay money thinking they will get help when they need it, but really they are paying to roll the dice. When people are angry about their insurance the GOP can just say it’s the insurer’s fault conveniently neglecting the fact that they wrote the legislation.

Mitch McConnell and the other men who crafted this bill should be ashamed of themselves and if they think skinny plans are so great then someone needs to change their insurance so they get to experience them first hand.

If this new bill becomes law even healthy, young men are just one pimple away from thousands of dollars of uncovered, but essential care. The choice will be between bankruptcy and death.



Join the Conversation


  1. I was just reading a memoir of Leslie Howard. A woman he was having an affair with, Violette Cunnington, died at 29 of a facial cellulitis infection much like the one you describe having (turned into cerebral meningitis).

  2. Viewed from afar it is hard for me to understand how the American health system works (or doesn’t). I know that if I travel to the US my health insurance goes through the roof because of the sky high cost of American health care. It’s hard to believe that the government in the US (certainly one of the world’s largest economies), can’t take care of its own people. I really do not understand why your president wants to scrap the affordable health care system. It seems to me like the most spiteful and hurtful thing he could possibly do to his own people. It is my fervent wish that we manage to hang on to the creaking National Health System in the UK. I can’t help thinking that if you are poor in the US, you’re doomed to die painfully.

    1. Unfortunately, you are correct. Our new president doesn’t care about his citizens; what he cares about is the Almighty Dollar, and “revenge” of some sort, so that he can make it seem that he has “saved” us from “Obamacare”. Pathetic.

    2. Logic has no more place in US healthcare than compassion for the suffering of others!

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