McCain also proposes letting carriers sell across state lines, in the hope that more competition would lower premiums. Experts doubt that will happen, since states tend to be dominated by single carriers; in Arkansas, that carrier is Blue Cross Blue Shield. Culp is a savvy shopper and already has begun searching the Internet for other options. They chose their current policy because it would pay $8 million in lifetime benefits, instead of the $1 million paid by their previous insurer. To the extent that any of McCain’s proposals will foster more price transparency and consumer information, the Culps might benefit.

How the Culps would do under Barack Obama’s plan

The aspect of Obama’s proposals most relevant to families like the Culps is his promise to cut the average family’s premiums by $2,500. However, as The New York Times pointed out in July, such a promise may be nothing more than pie-in-the-sky campaign propaganda. The Times reported that Obama is “offering a precise ‘chicken in every pot’ guarantee, based on numbers that are largely unknowable.” Obama’s plan might help the Culps change insurance carriers for a better plan—if, as president, he can persuade insurance companies to insure people who have health conditions. He has promised to regulate insurance more strictly, but it’s unclear if he can do that once the legislative process gets going and the lobbyists move in.

It’s also unclear whether the Culps will be able to join Obama’s so-called public plan option and obtain better, more comprehensive coverage. They already have insurance, and might not be eligible for the public plan, depending on how the legislation gets written. Lobbyists for the insurance industry will probably voice the “crowd out” argument; that is, they will argue that people should buy insurance from private carriers instead of taking a government plan that is likely to be cheaper, but will siphon business from Aetna, Blue Cross, and company. The bottom line: Because there are so many “ifs” that Obama and his surrogates have not yet answered, the Culps might not benefit much from his proposals.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.