Former Olympic gymnast Mary Lou Retton spoke last week on the NBC Today show about what she said was a rare pneumonia that nearly killed her and led to an expensive month-long hospital stay.
It was a shocking discovery. One major comment jumped out from those following the health policy: Retton said she was uninsured, blaming the lack of coverage on 30 orthopedic surgeries deemed “pre-existing conditions,” a divorce and her poor finances.
“I couldn’t afford it,” Retton told host Hoda Kotb, who did not challenge the assertion.
Retton, who after winning the gold medal in 1984 became a well-known figure — “America’s Sweetheart,” appearing on Wheaties boxes and receiving a variety of other endorsements — did not provide details about her income, illness, and the hospital she was in. Her treatment or what type of insurance she was looking for, so it’s hard to pinpoint the details.
However, its status can be useful because the reasons you mentioned for not purchasing coverage — pre-existing conditions and cost — are among the things the Affordable Care Act directly addresses.
Under the law, which has offered coverage through the state and federal markets since 2014, insurers are prohibited from turning away people with pre-existing conditions and cannot charge them higher premiums either. This is considered one of the most popular provisions of the law, according to opinion polls.
The Affordable Care Act also includes subsidies that offset all or part of premium costs for the majority of low- to moderate-income people who seek to purchase their own insurance. An estimated “four out of five people can find a plan for $10 or less per month after support on HealthCare.gov,” Health and Human Services Secretary Xavier Becerra said in a written statement. Open enrollment continues on HealthCare.gov through January 16.
Benefits are set on a sliding scale based on family income, with a large portion going to those making less than twice the federal poverty level, which this year is $29,160 for an individual or $60,000 for a family of four. Premium costs for consumers are set at 8.5% of household income.
However, “we know from surveys and other data that even 10 years later, many people don’t realize there are premium subsidies available through the ACA marketplaces,” says Sabrina Corlett, co-director of the Center on Health Insurance Reforms at Georgetown University. .
This support is one of the reasons behind record enrollment in 2024 plans, with more than 20 million people having registered so far.
To be sure, there are also many Americans whose share of the cost of premiums remains overstated, especially those who may be higher on the sliding scale of support. Looking at KFF’s subsidy calculator, for example, a 60-year-old with an income of $100,000 would receive a monthly subsidy of $300, but would still have to pay $708 per month for insurance premiums, on average, nationally . Without support, the monthly cost would be $1,013.
Even with insurance, many U.S. residents struggle to afford the deductibles, copayments, or out-of-network fees included in some ACA or job-based insurance plans. The ACA provides subsidies to offset deductible costs to people at the lower end of the income scale. For those with very low income, the law expanded eligibility for Medicaid, a federal program, to the state level. However, 10 states, including Texas, where Retton lives, have chosen not to expand coverage, meaning some people in that category can’t get Medicaid or ACA support.
“If her income had been below poverty, she could have fallen into the coverage gap,” says Larry Levitt, executive vice president for health policy at KFF.
Attempts to reach a Retton representative were not immediately successful.
One final point — enrollment in the ACA generally must occur during annual open enrollment, which for 2024 opens on November 1 and runs through January 16 in most states. But Retton did not provide any details about what type of health insurance she shopped for or when. There are types of plans and coverage, for example, that fall outside the ACA rules.
These include short-term plans, which provide temporary cover for people between jobs, for example. There are also coverage efforts called “health care sharing ministries,” where people pool money and pay each other’s medical bills. Neither is comprehensive insurance because they generally offer limited benefits, and both can exclude people with pre-existing conditions.
If she is considering insurance during a time of year that is not during the open enrollment period, Retton may still be able to enroll in an ACA plan if she meets the “special enrollment” requirements. Eligible reasons include relocation, loss of other coverage, marriage, divorce, and other specified situations.
Retton excelled at pulling off difficult moves as a gymnast, but she may have missed the bar when it came to purchasing insurance coverage.
“You can be a very successful person in another life and not understand American health care and get into a situation that you might have prevented,” says Joseph Antos, a senior fellow at the American Enterprise Institute.
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