In selling his plan to repeal the Affordable Care Act, co-sponsored with Sen. Lindsey O. Graham (R-S.C.), Sen. Bill Cassidy repeatedly has mentioned the case of a Louisiana resident who faces $40,000 in insurance premiums.

There are actually two such cases, one of which Cassidy touted on Facebook in 2016, though the details are a bit fuzzy. He displayed an insurance sheet that shows a couple being quoted $3,300 a month in premiums for a plan with a $6,200 deductible and $13,000 cap on total expenses. Cassidy has not identified this person.

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Obamacare's rising premiums aren't just a national statistic. Unaffordable insurance costs are a real burden for real individuals and families. It is time we recognize Obamacare has failed and replace it with a plan that works. The #WorldsGreatestHealthCarePlan will fix our broken system. Posted by Bill Cassidy on Thursday, November 17, 2016

The second case involves a conservative talk-radio host named Moon Griffon. Cassidy invoked Griffon when he introduced the bill on Sept. 14 and explained why he was making one more try at repealing Obamacare.

“Folks ask why. The simple answer I can give is, there is a fellow back home by the name of Moon Griffon. He is a conservative talk show host who speaks with passion about the Affordable Care Act. Why does he speak with passion? Moon Griffon is very open. He has a special needs child, and he has to buy insurance. His premium per year is over $40,000–$40,000, with a $5,000 deductible and an additional deductible for his pharmaceutical costs. He has to pay $50,000 a year for insurance, deductible, and pharmaceutical deductible….Now, there are many Moon Griffons across our nation.”

The Fact Checker sought out Griffon to learn more about his situation.

The Facts

Griffon used to get group insurance through an employer but then he moved and had to buy insurance on the individual market. He said he and his wife, a nurse, have a six-figure income, though “it’s not high but middle class.” They have two children: a 15-year-old son and a 20-year-old daughter who has seizures and needs to take four kinds of medicine.

The medicine started out this year at $2,800 a month, he said, but they were able to switch one, Keppra, to a generic brand, Levetiracetam, which significantly cut the costs this year – to $1,100 a month. “We have used generics before but sometimes they don’t work,” he said. “But this seems to work.”

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This year, he said, his premium for a Blue Cross Blue Shield Blue Max plan is $2,654 a month, for a yearly total of $31,848. His deductible is $3,300. Under the law, the out-of-pocket maximum for 2017 is $14,300 for a family plan, so the family would easily hit that with the cost of medicine. So, that’s a total of almost $46,150.

The year before, he said, they had a $1,770 monthly premium with a $1,100 deductible. For 2018, he says he’s been quoted a $3,582 a month premium — almost $43,000 a year — with a $5,000 deductible. For 2018, the government has announced out-of-pocket maximum will be $14,700. Still, that would bring his health care costs to $58,000 a year.

“This will be two and half times my house note,” he said. “There’s a 90 percent chance that I will sell my home. That’s my next move.”

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Neither Griffon nor his wife is a smoker, but both are in their mid-50s. Under Obamacare, the only health condition that raises premiums is being a smoker, but older Americans can be charged as much as three times as young Americans.

Under Obamacare, the tax subsidies for a family of four are cut off at 400 percent of the federal poverty level — $98,400 in 2017. So with a six-figure income, Griffon and his family make too much to qualify.

According to the Department of Health and Human Services, more than 110,000 people in Louisiana — 90 percent of those on the Obamacare exchanges — receive tax subsidies averaging $433.11 a month that help defray the cost of premiums. Almost 60 percent receive cost-sharing reductions that help bring down the cost of deductibles and out-of-pocket expenses. Louisiana recently expanded Medicaid, so an additional 427,000 people receive health care through it.

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The percentage of people without insurance in the state has dropped from 16.6 percent in 2013 to 10.3 percent in 2016, according to the Census Bureau.

Nevertheless, statistics indicate that about 76,000 people in Louisiana’s individual market receive no tax subsidies and must pay full freight for their plans, as Griffon does. Unfortunately for Griffon, he seems to be one of the losers under Obamacare. But there are many winners.

“What gets me mad was everyone focuses on the poor,” he said. “They do not focus on the people who pay taxes and who help pull the wagon.”

As for whether Cassidy’s plan — which appears dead in the Senate — would have improved the situation for Griffon, he says he didn’t know. “I have talked to Bill personally, and I don’t know,” he said.

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Griffon in May had been upset with Cassidy when he appeared on “Jimmy Kimmel Live” and spoke about ensuring that health-care repeal met “the Jimmy Kimmel test.”

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On his radio show, Griffon warned, “A lot of people upset about the comment he made [about the Kimmel test]…. The only thing I would tell Senator Bill Cassidy is he needs to be very, very careful about the way he votes. He’s got to be very careful some real conservative doesn’t come along because people are not liking his voting record.” Griffon also was wary about the fact that Cassidy was working at the time with moderate Sen. Susan Collins (R-Maine) on a potential bill.

The Cassidy-Graham bill is certainly more conservative than the Collins-Cassidy plan. But it might have not worked out well for Griffon and his family, even though it essentially left it up to the states to create health-insurance markets. His daughter has a preexisting condition, and Louisiana could have decided to increase rates for people with certain condition. The state waivers envisioned in the plan also might have impacted prescription drug coverage and caps on out-of-pocket expenses, both of which could have been dropped or changed by a state.

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Griffon said he wanted to be able to buy health insurance across state lines like car insurance. But as we have noted before, car and life insurance currently is sold exactly the same way as health insurance — regulated by state insurance regulators, with policies tailored to the rules and laws set by the state. He also said he wanted to be able to buy insurance as part of “pool,” but that’s a central concept of Obamacare. The law already creates a single-risk pool for the individual market, but premiums have risen in part because fewer younger people than expected have purchased health insurance.

The Bottom Line

Regular readers know that we often warn about making policy by anecdote. Griffon’s insurance costs are through the roof and we understand his frustration. Cassidy portrayed Griffon as a “striver” who was being wronged by Obamacare, but in doing so the senator ignores the tens of thousands of state residents who receive subsidies and other help to pay for health insurance — help that has significantly increased the percentage of people with health insurance in the state.

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Moreover, it’s unclear whether Griffon would find himself much better off under a repeal plan, especially because he has a child with a pre-existing condition who could find herself priced entirely out of the market. In fact, he might have found himself worse off, with even higher premiums, depending on how the market was restructured.

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