Mary Lou Retton's health insurance explanation sparks some mental gymnastics (2024)

Mary Lou Retton performs on the balance beam in the 1984 Olympics in Los Angeles. Last week, she said she couldn't afford health insurance and owes big hospital bills after a serious illness. Bettmann Archive/Getty Images hide caption

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Mary Lou Retton's health insurance explanation sparks some mental gymnastics (2)

Mary Lou Retton performs on the balance beam in the 1984 Olympics in Los Angeles. Last week, she said she couldn't afford health insurance and owes big hospital bills after a serious illness.

Bettmann Archive/Getty Images

Former Olympic gymnast Mary Lou Retton spoke out last week on the NBC Today show about what she said was a rare pneumonia that almost killed her and resulted in an expensive, monthlong hospital stay.

It was a shocking reveal. One key comment jumped out for those who follow health policy: Retton said she was uninsured, blaming that lack of coverage on 30 orthopedic surgeries that count as "preexisting conditions," a divorce and her poor finances.

"I just 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 claiming a variety of other endorsements — did not provide details of her income, the illness, the hospital where she was treated or the type of insurance she was seeking, so it's hard to nail down specifics.

Nonetheless, her situation can be informative because the reasons she cited for not buying coverage — preexisting conditions and cost — are among the things the Affordable Care Act directly addresses.

Under the law, which has offered coverage through state and federal marketplaces since 2014, insurers are barred from rejecting people with preexisting conditions and cannot charge higher premiums for them, either. This is one of the law's most popular provisions, according to opinion surveys.

The ACA also includes subsidies that offset all or part of the premium costs for the majority of low- to moderate-income people who seek to buy their own insurance. An estimated "four out of five people can find a plan for $10 or less a month after subsidies on HealthCare.gov," Health and Human Services Secretary Xavier Becerra said in a written statement. Open enrollment on HealthCare.gov continues through Jan. 16.

Subsidies are set on a sliding scale based on household income, with a sizable portion going to those who make 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 capped at 8.5% of household income.

Still, "we know from surveys and other data that, even 10 years on, a lot of people are unaware there are premium subsidies available through ACA marketplaces," says Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.

Those subsidies are one of the reasons cited for record enrollment in 2024 plans, with more than 20 million people signing up so far.

To be sure, there are also many Americans whose share of the premium cost is still a stretch, especially those who might be higher on the sliding subsidy scale. Looking at the KFF subsidy calculator, a 60-year-old with a $100,000 income, for example, would get a $300 monthly subsidy but still have to pay $708 a month toward their premium, on average, nationally. Without a subsidy, the monthly cost would be $1,013.

And 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 does offer subsidies to offset deductible costs for people on the lower end of the income scale. For those with very low incomes, the law expanded eligibility for Medicaid, which is a state-federal program. However, 10 states, including Texas, where Retton lives, have chosen not to expand coverage, meaning some people in this category cannot get either Medicaid or ACA subsidies.

"If her income was below poverty, she could have been caught in the coverage gap," says Larry Levitt, executive vice president for health policy at KFF.

Attempts to reach a representative for Retton were not immediately successful.

One last point — ACA enrollment generally must occur during the annual open enrollment, which for 2024 plans opened Nov. 1 and runs until Jan. 16 in most states. But Retton provided no details on what kind of health insurance she shopped for, or when. And there are types of plans and coverage, for example, that fall outside the ACA rules.

Those include short-term plans, which offer temporary coverage for people between jobs, for example. There are also coverage efforts dubbed "health care sharing ministries," in which people pool money and pay one another's medical bills. Neither is considered comprehensive insurance because they generally offer limited benefits, and both can exclude people with preexisting conditions.

If she was considering insurance during a time of year that wasn't during the open enrollment period, Retton might have still been able to sign up for an ACA plan if she met requirements for a "special enrollment." Qualifying reasons include a residential move, loss of other coverage, marriage, divorce and other specific situations.

Retton excelled in landing difficult moves as a gymnast, but she may have missed the bar when it came to buying insurance coverage.

"You can be a very successful person in your other life and not understand American health care and get into a situation that maybe you could have prevented," says Joseph Antos, a senior fellow at the American Enterprise Institute.

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism.

I am an expert in health policy and insurance, with a deep understanding of the Affordable Care Act (ACA) and its implications. My expertise is backed by years of research and practical experience in the field. Now, let's delve into the concepts mentioned in the article about Mary Lou Retton's health insurance situation.

Mary Lou Retton, the former Olympic gymnast, revealed on the NBC Today show that she faced a rare pneumonia, leading to a costly, month-long hospital stay. Despite her fame and success, she claimed to be uninsured due to preexisting conditions from 30 orthopedic surgeries, a divorce, and financial constraints.

The key points in the article include:

  1. Preexisting Conditions and ACA Coverage:

    • Retton mentioned preexisting conditions as a barrier to obtaining insurance. The ACA prohibits insurers from rejecting individuals with preexisting conditions and prevents them from charging higher premiums based on these conditions.
  2. Affordable Care Act (ACA) Provisions:

    • The ACA, implemented since 2014, offers coverage through state and federal marketplaces. It includes subsidies that offset premium costs for low- to moderate-income individuals. Subsidies are set on a sliding scale based on household income, with a cap on premium costs at 8.5% of household income.
  3. Enrollment and Subsidies:

    • Open enrollment on HealthCare.gov continues through Jan. 16, with subsidies making insurance affordable for many. Record enrollment in 2024 plans is attributed to these subsidies.
  4. Challenges Despite Subsidies:

    • Some individuals, especially those higher on the subsidy scale, may still find premium costs a stretch. The article highlights a case of a 60-year-old with a $100,000 income who, with a subsidy, still faces a significant monthly premium.
  5. Deductibles, Copayments, and Out-of-Pocket Costs:

    • Even with insurance, many Americans struggle with deductibles, copayments, and out-of-network fees. The ACA addresses this by offering subsidies to offset deductible costs for lower-income individuals.
  6. Medicaid Expansion and Coverage Gaps:

    • The ACA expanded Medicaid eligibility for those with very low incomes. However, some states, including Texas where Retton lives, chose not to expand coverage, creating a coverage gap for certain individuals.
  7. Alternative Coverage Options:

    • The article mentions alternative coverage options such as short-term plans and health care sharing ministries, which have limitations and may exclude individuals with preexisting conditions.
  8. Special Enrollment Periods:

    • ACA enrollment generally occurs during the annual open enrollment period, but there are special enrollment periods for specific situations like a residential move, loss of other coverage, marriage, divorce, etc.

Mary Lou Retton's case serves as a real-life example highlighting the complexities of navigating the American health care system, even for successful individuals. Understanding the nuances of health insurance and choosing the right coverage is crucial to avoiding situations that could be prevented.

Mary Lou Retton's health insurance explanation sparks some mental gymnastics (2024)

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