The Affordable Care Act and You

I’m no expert on the Affordable Care Act, or (full name) 2010 Patient Protection and Affordable Care Act but I’ve decided to be a become a more informed consumer and figure out just exactly how the ACA (Obamacare) benefits cancer patients and, inversely, what a repeal of the Affordable Care Act (without a replacement, even temporarily), would mean to cancer patients and their families in the US.

First off, let’s acknowledge that the last thing a cancer patient and his or her family want to think about when cancer is first diagnosed is how much treatments are going to cost and if they can afford them. After all, we’re often talking about life versus death and no one wants to put a price tag on life.

But for most of us 98%ers the question of how we’re going to pay for surgeries and treatments, prescription and over the counter medications, not to mention time off work, possible travel to remote sites, alternative therapies, supplements and organic food and juices, becomes all too real, all too soon. Before you blink, you may find your out of pocket expenses are in the thousands of dollars–and that’s when you are fortunate enough to have health insurance! And if you’re an hourly employee, are self-employeed, or have to take an unpaid leave of absence to fight cancer, your finances will be put to the test with or without insurance.

That said, having insurance can make most cancer treatments within the average family’s reach. They will still be expensive, and you may even need to borrow money to pay for them, but they will be generally doable. Without insurance, however, the exorbitant treatment costs will exceed the average person’s ability to pay the bills, even if spread out over several years.

Take J who was diagnosed with small intestine or small bowel cancer in July of 2015. His first (colorectal) surgery to remove the visible cancer and create clean margins involved removing part of the small intestine and large intestine (or colon) and his ileocecal valve. All went well and he had a surprisingly short stay at the hospital of 2 nights (versus the 4-7 days they had prepared us for). He had no complications, yet his total hospital bill was exorbitant. A few weeks later he had a minor procedure to insert his chemotherapy port, followed by chemo treatments every 2-3 weeks (depending on white blood cell counts) for 8 months, an injectable drug called Neulasta to help keep his white blood cell count in a safe range, scans and bloodwork every 3 months (ongoing), at home nursing visits for inserting and detaching the intravenous chemotherapy treatments (separate from the onsite chemo treatments) and numerous visits to the oncologist. Those are just the direct, purely medical costs, and if I had the courage to add them all up, I’m sure I would faint. However, with health insurance, we have been able to make it work. Our out of pocket costs were a hit to our budget, but not so overwhelming we had to forgo treatments.

But what would happen if my husband had to change jobs in the future? No one has complete job security, and we are all advised to have an emergency savings account in case of unexpected joblessness. But J and I both know that no amount of savings could pay for cancer treatments we might incur if his cancer recurred. We would absolutely need health insurance to fight this awful pre-existing condition.

Before the Affordable Care Act was passed into law in 2010 (and slowly implemented through March 2014), people with pre-existing conditions like cancer (or diabetes or asthma, etc.) were out of luck if they had to change jobs. With the ACA, all of that changed and those same people were no longer forced to stay in deadend of dissatisfying jobs just to keep their health insurance. Millions of Americans have benefited from this health insurance portability. In addition, because of the ACA, patients cannot be charged more for having a specific condition, such as cancer. Furthermore, the ACA bars insurance companies from instating lifetime coverage amounts and from discontinue ongoing treatments. Here’s what the website cancer.net has to say about the ACA. I have bolded in blue and/or underlined the parts that apply most directly to cancer patients.

General information on the Affordable Care Act  (from cancer.net)

  • You cannot be denied insurance because of a condition you had before you applied for insurance. Your insurance company also cannot refuse to pay for a condition you had before you got insurance. Companies call this a “pre-existing” condition. They must pay unless a special rule says they do not have to.
  • Your company cannot charge more because you are female, male, or have a specific health condition.
  • If you join a group insurance plan, you get benefits in 90 days or less. This means the company starts paying within this time. Group plans include many people. For example, health insurance from work is usually a group plan. This rule started on January 1, 2014.
  • Private insurance companies cannot limit how much they pay for care in your lifetime. In the past, they could stop paying after a certain amount. But most cancer care is expensive. Some people had to pay for all their care after the coverage stopped. Now, your insurance company must keep paying for care. This is true even if you need a lot of care, such as for cancer.
  • Your insurance company cannot stop paying its part of your bills. This is true unless you or someone else commits fraud (cheating).
  • A company cannot cancel your insurance if they find a mistake in your application.
  • If the plan covers your children, your children can use it until they turn 26.

In addition, the ACA also affords people free (no deductible) screening and other preventative services, such as screenings for colo-rectal cancer, mammograms, genetic counseling, HPV vaccine, cervical cancer screenings, and smoking cessation programs. Without the ACA, these types of services would no longer be required to be covered by your insurance company.

Take the time to become informed about how your or your loved one’s treatment options could be affected by a repeal or changes to the ACA.

For more information about the ACA and pre-existing conditions (healthcare.gov) click here.

To learn more about the ACA and preventive care (hhs.gov), click here.

You may also find the healthcare.gov blog interesting to read. Click here.

I also found this article by Kimberly Amadeo of the balance helpful for understanding the ACA/Obamacare. Click here.

The Cancer Center Treatments Centers of America website provides an extensive list of resources for calculating projected costs of cancer treatment (General Financial and Co-Pay Assistance) and finding help for expenses (Travel and Lodging Assistance). Click here.

If, after learning more about the ACA, you’d like to speak with your representatives in Congress about it, you may find their contact information using the “Find Your Representative” tool on the House.gov website. Make your voice heard!

20150827_074331
Move over, Gucci! Here is J, sporting his “man purse” or “murse” which costs more than any designer purse you could imagine!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s