Jan. 22--Republican presidential hopeful Ted Cruz revealed at a campaign stop that he now lacks health coverage because, he proclaimed, an insurance provider governed by the Obamacare law announced it was ditching the Texas market.
According to a video snippet of Cruz's remarks, Cruz followed up general criticisms of the 2010 Affordable Care Act requiring most Americans to have health coverage by saying: "I'll tell you, you know who one of those millions of Americans is who has lost their health care because of Obamacare? That would be me.
"I don't have health care right now," Cruz said. "I had purchased an individual policy, and Blue Cross Blue Shield canceled all their individual policies in the state of Texas, effective Dec. 31. So our health care got canceled. We got a notice in the mail, Blue Cross Blue Shield was leaving the market. And so we're in the process of finding another" policy.
A Politico news story on Cruz's remarks said that in 2015, Cruz and his wife, Heidi, on temporary leave from her job with Goldman Sachs, had purchased an individual plan after previously receiving coverage through the Wall Street firm.
So, as of 2016, did Blue Cross Blue Shield stop selling health coverage in Texas, leaving the market?
Not so, we found, and the "notice" Cruz mentioned in New Hampshire might have been sent his way a couple of months before the year ended, leaving time to consider options.
We didn't hear back from Cruz when we asked about the basis of his statement.
The insurer in summer 2015 did announce changes to its Texas offerings. According to an American-Statesman news story last July, Blue Cross and Blue Shield of Texas said it would offer fewer health insurance plans when open enrollment began in the fall on the online marketplace mandated under the Obamacare law, which Cruz has vowed to repeal and replace.
At the time, the insurer's chief medical officer, Dan McCoy, said preferred provider organization, or PPO, plans wouldn't be affordable in 2016, and the company wouldn't continue to make them available. McCoy also said the company would continue to offer health maintenance organization, or HMO, plans.
An HMO requires enrolled patients to pick a primary care physician through which the patient and family members obtain all but emergency services, sometimes by referral. Visits to health care professionals outside of the HMO network typically aren't covered. PPO plans give more flexibility; you don't need a primary physician and can go to any health care professional without a referral inside or outside its network, though it costs less to stay in the network.
Blue Cross and Blue Shield of Texas' announcement said it had been "the only insurer to offer an individual PPO insurance plan across the state to individuals in 2014 and 2015. Since the Affordable Care Act began, the market has changed."
The company further said it couldn't simply offer the PPO option at higher rates, saying: "The law requires that we set our individual plan rates based on all of our individual members' claims history. This means that if the costs of one plan are high, it will raise the rates of all other plans, not just the high-cost plan. If we kept the Blue Choice PPO, this would have raised the rates so much for all our other plans that most people wouldn't be able to afford them."
The company's announcement suggested it was timed to give customers time to prepare before open enrollment began anew on Nov. 1: "If you enrolled in the individual Blue Choice PPO plan last year, you won't be able to keep your PPO plan in 2016. We're sharing this information well in advance of the required notification date so that you have plenty of time to research the plan options that best suit your needs," the company said.
We asked a company spokeswoman if Cruz was right that the company bowed out of the Texas health insurance market. She replied that the company offers health plans in every Texas county and it's the only company offering coverage to individuals in 58 of the state's 254 counties.
Our ruling:
Cruz said: "Blue Cross Blue Shield canceled all their individual (health care) policies in the state of Texas, effective Dec. 31."
Actually, the company continues to sell coverage all over Texas, according to Blue Cross and Blue Shield of Texas. The company also says individual customers like Cruz were notified months before 2016 changes -- including an end to individual PPO plans -- kicked in.
So, Cruz was both incorrect about Blue Cross' offerings in Texas and evidently mischaracterized how his own coverage came to lapse. That adds up to Pants on Fire!
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Ted Cruz
Statement: "Blue Cross Blue Shield canceled all their individual (health care) policies in the state of Texas, effective Dec. 31."
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