11/14/13 Obamacare Woes

 

 

There’s lots in the news about Obamacare. Not much of it is very good, though there have been some successes. There have been some enrollment figures released by HHS. It seems that 100,000 plus people have enrolled nationwide, which includes figures from the state exchanges, and about 27,000 have enrolled on the federal exchange. It has not been reported how many have actually paid their premiums yet, which is the ultimate indication of enrollees, anything short just being academic.

 

 

After several failed starts, I managed to navigate the www.healthcare.gov website. I was not comforted by what I found there.

 

 

First, the website was able to determine that I did not qualify for any subsidies, so I would have to bear all the expense of my health insurance straight up. That was no surprise. The surprise came later on when I was able to determine what the exchange plan premiums would be and exactly the nature of what they covered. What little comfort I had just vanished.

 

 

Mississippi is one of the several states that chose not to participate in the Medicare expansion. The Supreme Court ruling that struck down the Federal government’s threat to withhold existing Medicaid coverage hostage to Medicaid expansion was a blow to the administration. They did not anticipate this. The Supreme Court held that threats to withhold existing Medicaid coverage, all the while demanding that Medicaid be offered in conformance with Federal guidelines, was coercive. Thus, 25 states have elected not to expand Medicaid. This means that 25 states do not have their own exchanges, but must rely on the exchange run by the Federal government. DHS has said that this limits options for those who want insurance in those non-participating states, but that is more rhetoric than fact, best taken with more than grain of salt.

 

 

Once I had successfully gotten to the point where I could actually look at the plans available to me and the prices, here is what I was able to determine.

 

 

If for any reason I was forced on to the exchanges, which appears unlikely at this point but is not certain, here’s what would happen to me as a Mississippian who is also a cancer patient.

 

  1. The Federal Exchange only offers coverage in my area of Mississippi through one single insurer, Magnolia Health Plan (a division of Centene Corporation). There is no competition. The plan they offer meets all the requirements of Obamacare.

  2. My monthly premiums for a bronze type plan would be a bit more than twice what I am paying now.

  3. The coverage I would receive on the bronze plan would only be half what I have now. In my way of thinking, paying twice more and only receiving half as much is the equivalent of paying four times more. I’m not sure of how you might figure this, but it will be hard to persuade me otherwise. Coverage under the bronze plan for me and my wife will cost about $1,450 per month. Add that to the maximum out of pocket of $12,170, and my yearly costs amount to $29,570. Prescription drug costs, non-covered drug costs, and any out of network costs are not counted towards any deductibles or maximum out of pocket expense…only those items stipulated in and covered by the plan.

  4. I could not keep my oncologist/hematologist. In fact, no oncologist/hematologist in the Meridian area would be available to me. There is only one solitary hematologist/oncologist, who practices in Columbus, Mississippi, that is in network. Non-network physicians are absolutely not covered.

  5. I could not keep my hospital nor any of my other physicians who have all worked together as a team throughout my cancer experience. I would lose them all.

  6. None of the chemotherapy agents which were effective during my past chemotherapy would be covered under my exchange insurance any longer. I would have to use a demonstrably less effective, outdated chemotherapy unless I could pay for the chemotherapy 100% out of pocket. In fact, I would nearly be guaranteed a failure of chemotherapy upon any relapse because the older chemotherapy agents are somewhat incompatible with the newer ones I’ve already taken.

  7. I could no longer access MDAnderson Cancer Center in Houston, who has been a partner with my local oncologist/hematologist throughout the course of my cancer. Anything out of network must be paid for 100% by the insured. Nor are any insurance benefits provided for anything outside the stated geographical area of coverage. If visiting in another state and I had an accident or sudden illness, emergency care is supposed to be covered since emergency care must be covered under Obamacare, but the extent of this coverage is not indicated on the website.

  8. If it were determined that chemotherapy was no longer effective and I needed a bone marrow transplant, which is not an unlikely possibility at some point, this procedure would only be available if I paid for it 100% out of pocket, since none of the medical facilities in my area do bone marrow transplants.

  9. While every cancer patient faces the possibility of no treatment being effective, or formerly effective treatments becoming ineffective, #6, #7, and #8 above would be the equivalent of an earlier death due to limitations of health insurance and the inaccessibility of health care even though one is insured.

 


I hope I will be able to keep the insurance I have, though it has its own limitations, which I have learned to somewhat manage with the help of my health care providers. I have plenty of skin in the game with my own health insurance as it is, and plenty of out of pocket expense. Sadly, I can name five cancer patients who have been unable to keep what they have and are not facing any hypothetical, but the reality of the things cited above. I have been to and successfully navigated the Obamacare website. I have seen for myself what is available to me and others in Mississippi. It may be different in other areas. I am not addressing anything but what is available to me and others here in Mississippi. Navigate the Obamacare website yourself to find out what is available to you in your area.

 

 

One of the ways that Magnolia Health Plan and its similar insurers are keeping costs down is by keeping the in-network care facilities to a minimum and confined to your geographic area. Having one single insurer and only one hematologist doesn’t allow me any choices other than choosing what is available. Having severely restricted chemotherapy drugs doesn’t allow me any choices other than choosing what is available. In the event of the failure of a response to chemotherapy, I am only able to choose further treatment from what is available. What is available appears to be nothing under the plan, yet there is far more available top choose from, but access to is is denied. This is healthcare by rationing.

 

 

Oversimplification? I think not. I have examined it and the efforts to decrease the cost to the insurer have effectively resulted in rationing since the insurance company has already determined what I am eligible for and what I am not. Choices are no longer relevant between my and my existing health care providers, as the choices have been curtailed. Do I lay this blame at the insurance company? I cannot, since insurance companies must keep their costs within their actuarial guidelines, which are an unknown to them at this time. Insurers have an actuarial history of their costs in Mississippi, but not an actuarial history of insuring those who are the sickest among us, which they did not have to cover before. No history means preparation for the worst case scenario, so every case is presumed to be worst.

 

 

If you like your plan, you can keep your plan …. false.

 

 

If you like your doctor, you can keep your doctor …. false.

 

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