The questions dealt with disability coverage, which is totally not health insurance, and Ann Dunham's possible misrepresentation

Ann Dunham, the president's mother, in Indonesia.

NY Times

By Kevin Sack

The White House on Wednesday declined to challenge an account in a new book that suggests that President Obama, in his campaign to overhaul American health care, mischaracterized a central anecdote about his mother’s deathbed dispute with her insurance company.

During his presidential campaign and subsequent battle over a health care law, Mr. Obama quieted crowds with the story of his mother’s fight with her insurer over whether her cancer was a pre-existing condition that disqualified her from coverage.

In offering the story as an argument for ending pre-existing condition exclusions by health insurers, the president left the clear impression that his mother’s fight was over health benefits for medical expenses.

But in “A Singular Woman: The Untold Story of Barack Obama’s Mother,” author Janny Scott quotes from correspondence from the president’s mother to assert that the 1995 dispute concerned a Cigna disability insurance policy and that her actual health insurer had apparently reimbursed most of her medical expenses without argument.

Ms. Scott took a leave from her job as a reporter for The New York Times to write the book and has not returned to the staff.

On Wednesday, in response to repeated requests for comment that The Times first made in mid-June, shortly after the book’s release, a White House spokesman chose not to dispute either Ms. Scott’s account or Mr. Obama’s memory, while arguing that Mr. Obama’s broader point remained salient.

“We have not reviewed the letters or other material on which the author bases her account,” said Nicholas Papas, the spokesman. “The president has told this story based on his recollection of events that took place more than 15 years ago.”

In her book, published in May by Riverhead Books, Ms. Scott writes that Mr. Obama’s mother, Ann Dunham, had an employer-provided health insurance policy that paid her hospital bills directly, leaving her “to pay only the deductible and any uncovered expenses, which, she said, came to several hundred dollars a month.”

Mr. Papas suggested that even if Ms. Scott was correct, Mr. Obama had not mischaracterized the facts because his mother needed her disability insurance payments to cover unreimbursed medical costs.

“As Ms. Scott’s account makes clear, the president’s mother incurred several hundred dollars in monthly uncovered medical expenses that she was relying on insurance to pay,” Mr. Papas said. “She first could not get a response from the insurance company, then was refused coverage. This personal history of the president’s speaks powerfully to the impact of pre-existing condition limits on insurance protection from health care costs.”

Disability insurance, which primarily replaces wages lost to illness, was never at issue in the legislative debate over the Affordable Care Act.

Ms. Scott said in an interview that her reporting relied on copies of letters from Ms. Dunham to Cigna that were made available by friends.

The book concludes that although Mr. Obama often suggested that Ms. Dunham “was denied health coverage because of a pre-existing condition, it appears from her correspondence that she was only denied disability coverage.” Ms. Dunham, an anthropologist who worked on development projects in Indonesia, died in 1995, less than a year after her diagnosis.

During the 2008 campaign, Mr. Obama used several rhetorical formulations to relate the anecdote, stressing, in his words, that “this issue is personal for me.”

In his second debate with Senator John McCain of Arizona, in October 2008, he said: “For my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.”

He put it similarly as president in a town-hall-style meeting in Portsmouth, N.H., in August 2009. “I will never forget my own mother, as she fought cancer in her final months, having to worry about whether her insurance would refuse to pay for her treatment,” Mr. Obama said.

The health care act, which Mr. Obama signed in March 2010, outlawed pre-existing condition exclusions for children under 19 starting last September. The ban extends to adults in 2014.

Robert J. Blendon, a professor of health policy and political analysis at Harvard, said that if an alternate narrative about Ms. Dunham’s dispute had been discovered during the 2008 campaign “people would have considered it a significant error.” He added: “I just took for granted that it was a pre-existing condition health insurance issue.”

According to Ms. Scott’s book, Ms. Dunham’s problem with Cigna started after she left Jakarta, Indonesia, where she had recently taken a consulting job with an American firm, and returned to Honolulu for treatment of abdominal pain that had been diagnosed as appendicitis. After being told she had uterine and ovarian cancer, she underwent a hysterectomy in February 1995 and then six months of chemotherapy, according to the book.

The Cigna disability policy, according to Ms. Scott, allowed the company to deny a claim if a patient had seen a doctor about the condition that caused the disability in the three months before employment. During that period, Ms. Dunham visited a New York gynecologist. When Cigna obtained the doctor’s notes, it learned that she had formed a working hypothesis that Ms. Dunham might have uterine cancer, Ms. Scott wrote.

The doctor ordered up a series of tests, and Ms. Dunham submitted to most of them. “None of these tests indicated that I had cancer,” Ms. Dunham wrote to Cigna, according to the book.

After several months, Cigna denied the claim. Ms. Dunham then requested a review, writing to Cigna that she had turned the case over to “my son and attorney, Barack Obama,” Ms. Scott wrote.

Ms. Scott said in the interview that she did not turn up documents to suggest that Ms. Dunham had a similar dispute with her health insurer, which she did not name. She said she could not determine from the documents she viewed whether Mr. Obama, then a lawyer in Chicago, had in fact petitioned Cigna on his mother’s behalf.

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