Hypocrites With Government Coverage Do Not Care
Calling Health Care Reform "Obamacare" is offensive, misleading, and annoying.
President Obama: "I don't want to tell students that we're booting
them off their parents' coverage. I don't want to tell seniors that
their medicine is out of reach again. I don't want to tell any mother
that her child can't get the care that he or she needs after all.
That's not who we are, and that's not what we stand for."
Health Law's Uncertainty Leads to Worries on Care Limits
By REED ABELSON
With a court decision on Monday declaring the health care law
unconstitutional and Republicans intent on repealing at least parts of
it, thousands of Americans with major illnesses are facing the renewed
prospect of losing their health insurance coverage.
Federal Judge Rules That Health Law Violates Constitution (February 1,
2011) The legislation put an end to lifetime limits on coverage for
the first time, erasing the financial burdens, including personal
bankruptcy, that had affected many ailing Americans.
For example, Hillary St. Pierre, a 28-year-old former registered nurse
who has Hodgkin's lymphoma, had expected to reach her insurance plan's
$2 million limit this year. Under the new law, the cap was eliminated
when the policy she gets through her husband's employer was renewed
this year.
Ms. St. Pierre, who has already come close once before to losing her
coverage because she had reached the plan's maximum, says she does not
know what she will do if the cap is reinstated. "I will be forced to
stop treatment or to alter my treatment," Ms. St. Pierre, who lives in
Charlestown, N.H., with her husband and son, said in an e-mail. "I
will find a way to continue and survive, but who is going to pay?"
As judges and lawmakers debate the fate of the new health care law,
patients like Ms. St. Pierre or Alex Ell, a 22-year-old with
hemophilia who lives in Portland, Ore., fear losing one of the law's
key protections. Like Ms. St. Pierre, Mr. Ell expected to reach the
limits of his coverage this year if the law had not passed. In 2010,
the bill for the clotting factor medicine he needs was $800,000, and
his policy has a $1.5 million cap. "It is a close call," he said.
Exactly what will happen to the law's specific provisions that prevent
insurers from imposing lifetime limits and require them to phase out
the annual limits now in place is unclear. While even Republicans
concede that a full repeal is unlikely, Congress could strip certain
elements of the legislation, like this one. As challenges to the law
move through the courts, patients who have felt an immediate impact
now confront added uncertainty.
"We've got to protect people from catastrophic health problems," said
Ron Pollack, the executive director of Families USA, a consumer
advocacy group that favored the law's passage. "We don't want people
bankrupted."
Protecting people from facing these extremes is one of the main goals
of the law, according to its proponents.
Asked about the effect of the law on those who had encountered an
insurance ceiling, Kathleen Sebelius, the health secretary, said in a
statement: "The Affordable Care Act is freeing Americans from worrying
about having their insurance benefits run out when they need them the
most."
Before the law was passed, an estimated 20,000 insured Americans
reached the lifetime limits of their coverage each year. Decades old,
these restrictions were put in place when both medical care and health
insurance were much less expensive than they are today, said Tom
Wildsmith, an official with the American Academy of Actuaries.
In recent years, many employers, if they still had caps, set them
fairly high, so that it was rare for someone to exceed the benefits
unless they were seriously ill and required expensive care.
"This is the kind of thing that grabs a cancer survivor who has had
several operations," said Gary Claxton, an executive with the Kaiser
Family Foundation, which studies employer coverage. Only the very sick
were affected. "People don't voluntarily use this level of services,"
he said.
Ms. St. Pierre nearly lost her insurance in 2008. After her first bone
marrow transplant failed, she realized the coverage from her husband's
employer would run out before she could receive another transplant.
She remembers reviewing her options and looking into treatments that
would be less expensive. She enrolled in a clinical trial to test an
unproved form of chemotherapy, for example, because it was free. She
considered divorcing her husband, a move that could qualify her for
Medicaid, or moving to Massachusetts, where she thought she might be
able to afford and qualify for a policy. She has written about her
experiences on her blog, called BaldiesBlog.
But she was spared from making those decisions when her husband's
company was acquired, and she was able to enroll in a new health plan.
"Luckily, the cap started over," she said.
Ms. St. Pierre also now qualifies for Medicare, the federal health
insurance program, because she is disabled, but her husband's plan
remains her primary source of insurance. Medicare would still leave
her with significant medical bills if she lost her husband's coverage
because she has no supplemental insurance.
Without the lifetime cap, Ms. St. Pierre says she can now focus on
what treatment makes the most sense rather than gamble that the most
aggressive care will cure her and allow her to escape the maximum
limits on coverage. "It opens up all sorts of options," she said,
including viewing her cancer as a chronic condition that she can
afford to treat for many years.
Cancer patients like Ms. St. Pierre who are concerned about running
out of coverage often try to tailor their treatments to see if they
can avoid hitting their lifetime caps, said Stephen Finan, senior
director of policy at the American Cancer Society. "People have to
think about what's their strategy," he said.
And while Ms. St. Pierre, who has worked with the cancer society, says
she knows she is likely to be able to continue to receive some
treatment without insurance, she also knows that it is not likely to
be the optimal care. The same is true for any patient who runs out of
coverage, Mr. Finan said. "You may well continue to get care, but the
quality of care is markedly lower," he said.
Multimedia Interactive Feature
The Growing Legal and Political OppositionDocument: Judge Vinson's Ruling
Related
Federal Judge Rules That Health Law Violates Constitution (February 1,
2011) The last time Mr. Ell neared the maximum on his parents'
policies, he had only $77,000 in remaining coverage — about a month's
worth of his clotting medicine. He had been able to switch plans
offered by his parents' employers. He works part time and is not
eligible for insurance from his employer.
Among employers, the feelings are mixed about whether the limits
should be eliminated, said Andrew Webber, who is the president of the
National Business Coalition on Health. One of the coalition's members,
the Midwest Business Group on Health, recently conducted a survey of
opinions by employers. About a quarter of those surveyed wanted to
repeal the new law's ban on lifetime and annual limits to coverage.
While about half wanted to keep the provisions, some employers object
on the grounds that they do not want the government to dictate what
benefits they offer their workers. "Employers, for so many years, have
had so much flexibility to design and change their policies from year
to year," Mr. Webber said, and the new law changes that.
The expense of doing away with lifetime limits is fairly modest, said
Mr. Wildsmith, the actuary. If a plan currently has a $1 million
limit, eliminating it would add only 1 percent to the cost of the
premium, he said. Many employers have much higher caps, making it even
less expensive to eliminate them.
While proponents of the law favor the elimination of the caps, some
Republicans also think health coverage should no longer be subject to
caps on a yearly or annual basis. The plan being proposed by the House
Republicans "banned annual and lifetime limits and lowered premiums
for millions of people," said a spokeswoman for the House Ways and
Means Committee.
Ms. St. Pierre says she knows she will want to continue her treatment,
regardless of whether she has private coverage, but she also knows
that someone will have to pay the bill. "Where the problem lies is who
is going to pay for that," she said. "Will they take my house or car?"
More:
http://www.nytimes.com/2011/02/02/business/02insure.html?_r=1&pagewanted=2&src=busln
--
Together, we can change the world, one mind at a time.
Have a great day,
Tommy
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