FACT CHECK

Flaws in Obama's health care anecdotes

[September 29, 2009]  WASHINGTON (AP) -- One of President Barack Obama's health care "horror stories" is about a woman who, he says, lost her health insurance on the verge of breast cancer surgery because she didn't disclose a case of acne to the insurer. That's not what happened.

Robin Lynn Beaton, 59, of Waxahachie, Texas, indeed had her insurance suspended and then terminated when she needed it the most. Hers is a cautionary tale about how an insurance company can act in a seemingly arbitrary manner to revoke coverage for lifesaving treatment.

But not for the reasons Obama cites.

She "was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne," he said in one telling.

Beaton did not lose her insurance because she failed to own up to a skin problem in her past. She lost it because, when enrolling in the plan, she had not reported a previous heart condition and did not list her weight accurately.

Obama tells stories of real-life hardships repeatedly, in his speech to a joint session of Congress, in interviews and at his citizen meetings across the country in support of his campaign to rework medical insurance. Beaton's case is just one cited by Obama that mixes fact with fiction.

In reflexively blaming insurance companies, Obama is playing into fears that have become a frightening reality for many Americans. Health insurance under the current system is not always the rock-solid guarantee you think you're paying for.

Especially, it turns out, when you don't fill everything out just right.

In Beaton's case, the insurance company opened an investigation after her visit to a dermatologist and just before her scheduled breast cancer surgery, forcing postponement of her operation almost on the eve of it. The earlier problems on her enrollment form were discovered and her coverage was canceled.

To some lawmakers, that's outrageous enough -- never mind the acne story.

Rep. Joe Barton, Beaton's Republican congressman in Texas, fought the insurer until it restored her coverage, enabling her to get the surgery 10 weeks after it was postponed. She told The Associated Press she owes Barton and his aides her life.

But somewhere along the way, Beaton's case became a White House tale of an insurer canceling coverage because she forgot to report acne.

It's become a political imperative to find real-life examples of people helped or hurt by the issue of the day. People relate more easily to a story than to abstract policy.

But such stories often suffer in the retelling. Corners are cut, complicated situations made sound-bite simple.

It has long been so. Ronald Reagan's "welfare queen" was a politically expedient exaggeration of a real case of welfare fraud. In last year's presidential campaign, scrutiny revealed that Joe the Plumber was likely to benefit from Obama's tax plans, not be hurt by them as Republicans alleged.

Even in his painstakingly prepared speech to Congress, Obama got some material facts wrong.

He said an Illinois man died because his insurance company found an undisclosed case of gallstones in his past, canceled his insurance and delayed a stem-cell transplant for his cancer. The man did lose his insurance, but got it back retroactively and had treatment that his family says extended his life for nearly four years.

Beaton opened an antique shop after retiring as a nurse, and in December 2007 signed up for individual insurance from Blue Cross and Blue Shield of Texas.

She says she thought nothing of a fast-heartbeat episode that had prompted an earlier doctor's visit, and the resulting heart medication she stopped taking two years ago, and did not report that on the enrollment form.

The form asks applicants to list heart conditions and a wide variety of other conditions experienced in the past 10 years, any physician consultations in the last five years, any medication taken in the last year, and more.

Also, Beaton said in an interview, "I wrote down like five pounds less than I weighed," joking that's the sort of mild rounding down that many women do. She is not obese.

In the spring of 2008, Beaton visited a dermatologist. "My face began to break out," she said. "All it was, truly, honestly, was pimples."

The doctor diagnosed mild rosacea, sometimes called adult acne, and seborrheic keratosis, a benign and common skin growth.

Beaton says the visit nevertheless raised a red flag because a notation in her records was misconstrued as meaning precancerous.

Beaton says she's convinced "the acne is what started everything," meaning the insurance company scrutiny. Because she'd had her insurance for months, the acne was not a pre-existing condition that could have imperiled her policy.

Whatever the case, her breast cancer diagnosis that quickly followed surely would have prompted a similar review of her files.

On the Friday before her cancer surgery, she was told her insurance company was opening the investigation and would not pay for her operation before that was concluded, she said. That suspended the surgery.

"They searched high and low for a reason to cancel me," she said.

The insurer retrieved records from a cardiologist pointing to her unreported heart condition. Then, in an Aug. 22, 2008, letter, the company listed four questions it said she answered inaccurately on her form and a fifth that was insufficiently addressed.

As a result, wrote the insurer, "your coverage is rescinded as of 12/04/07, the original effective date of your policy."

Barton's aides in Texas and Washington had been trying to get Beaton's insurance restored since its suspension in July, without success. But five days after it was finally canceled, Barton called the company president directly, said the lawmaker's spokesman, Sean Brown.

Among the points raised: The possibility of a news conference drawing attention to the case. Barton also said he might name a bill after Robin Beaton.

Four hours later, Barton said, he got a call saying her insurance would be reinstated.

The lawmaker acknowledges Beaton misreported her weight and did not disclose a prior heart problem. But it was wrong, he said, for her coverage to be canceled when she desperately needed treatment for a disease unrelated to those matters.

"To be denied coverage right before potentially lifesaving surgery quite frankly is something that no human being should have to undergo," he said.

Barton is a conservative who is no fan of Obama's health care plans. Still, he's pushing legislation to preserve insurance for people like Beaton when they need treatment for a serious illness that's not related to undisclosed conditions on their sign-up form.

Beaton had her surgery in October 2008, by which time, she said, her tumor had tripled in size.

Clinging to her restored insurance, she is undergoing regular chemotherapy and says she needs back surgery, hip replacement and another round of breast reconstruction.

[Associated Press; By CALVIN WOODWARD]

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