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Mary Lou Retton’s Explanation About Having No Health Insurance Makes No Sense

January 15, 2024 | FlaglerLive | 7 Comments

It may take some vaulting over logic and fact to take Mary Lou Retton's explanation at face value about why she has no health insurance. (Wikimedia Commons)
It may take some vaulting over logic and fact to take Mary Lou Retton’s explanation at face value about why she has no health insurance. (Wikimedia Commons)

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 when kicking off the annual open enrollment period in November.




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,” said Sabrina Corlette, co-director of the Center on Health Insurance Reform 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,” said 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 of 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,” said Joseph Antos, a senior fellow at the American Enterprise Institute.

–Julie Appleby, KFF Health News
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Reader Interactions

Comments

  1. Celia Pugliese says

    January 15, 2024 at 10:08 am

    Well all Mary Lou’s fans helped her. Something that most that can’t afford insurance do not have access too: https://www.spotfund.com/story/a2e0582c-e62f-4e5b-a586-18349014f761. Her problem solved.

  2. Shark says

    January 15, 2024 at 10:31 am

    Fortunately I have that wonderful trump care. It’s the greatest insurance that you can have.

  3. JW says

    January 15, 2024 at 10:41 am

    We should have a national referendum on a healthcare system similar to what the Europeans have. But…..
    Unfortunately Americans are not educated enough to understand what that means (as Julie Appelby’s article implies); our politicians are not interested for political reasons because it is the Healthcare Industrial Complex (like the Military Industrial Complex) that governs our country for the profits. Politicians get their share from lobbying contributions (which should be outlawed too). We have built this country with hard work but we have become lazy and some of us extremely rich.
    To put this in context:
    Suggest that FaglerLive readers read the 2021 book by Ray Dalio, Principles for Dealing with The Changing World Order, which also helps to understand the wars the world is currently dealing with and the book’s subtitle: Why Nations Succeed and Fail.

  4. Janet Sullivan says

    January 15, 2024 at 6:38 pm

    Yes. Thanks for the reminder to all about the ACA. I have many family members and friends were without insurance for years but now have affordable policies (thanks to subsidies) through the ACA. It can be a game-changer.

  5. Maria says

    January 15, 2024 at 9:26 pm

    Just tried to get my daughter on the healthcare act. They want 497 per month for a young person that makes 1400 a month. Deductible is 800. Really wonder what you need to make to make it affordable?

  6. DaleL says

    January 18, 2024 at 7:41 am

    Now, now, now. Mr. Trump and his supporters proposed to repeal the ACA and replace it with something infinitely better. He promised a health care system so great, so wonderful that some many called it a dream or vision, or even magical. It was strange though that the details of this great replacement for the ACA never have seen the light of day. It is almost as though Trump’s replacement didn’t actually exist. I’m sure that trump care would have incorporated all of our former president’s charity, honesty, and empathy.

  7. DaleL says

    January 18, 2024 at 7:56 am

    I assume that the $1,400 per month is after taxes, etc. The minimum wage in Florida is $12 per hour. Assuming 40 hours per week and 4 weeks in a month, that is $1,920. That written, it is true that the ACA shifts money from young healthy people to the older less healthy. People in their 60s use, on average, 6 times as much health care, by cost, than people in their 20s. Yet the ACA mandates that premiums for those in their 60s be no more that 3x that of people in their 20s.

    The ACA does allow children up to the age of 26 to remain on their parents health care plans.

    Medicaid expansion would help cover more low income people, but that is being blocked by the GOP.

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