More Obamacare fuckups

[Parkbandit]

Everyone now is clamoring about Affordable Care Act winners and losers. I am one of the losers.

My grievance is not political; all my energies are directed to enjoying life and staying alive, and I have no time for politics. For almost seven years I have fought and survived stage-4 gallbladder cancer, with a five-year survival rate of less than 2% after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31.

My choice is to get coverage through the government health exchange and lose access to my cancer doctors, or pay much more for insurance outside the exchange (the quotes average 40% to 50% more) for the privilege of starting over with an unfamiliar insurance company and impaired benefits.

Countless hours searching for non-exchange plans have uncovered nothing that compares well with my existing coverage. But the greatest source of frustration is Covered California, the state's Affordable Care Act health-insurance exchange and, by some reports, one of the best such exchanges in the country. After four weeks of researching plans on the website, talking directly to government exchange counselors, insurance companies and medical providers, my insurance broker and I are as confused as ever. Time is running out and we still don't have a clue how to best proceed.

Two things have been essential in my fight to survive stage-4 cancer. The first are doctors and health teams in California and Texas: at the medical center of the University of California, San Diego, and its Moores Cancer Center; Stanford University's Cancer Institute; and the M.D. Anderson Cancer Center in Houston.

The second element essential to my fight is a United Healthcare PPO (preferred provider organization) health-insurance policy.

Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.

But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market. The company suggested I look to Covered California starting in October.

You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan—a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).

So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.
Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.

What happened to the president's promise, "You can keep your health plan"? Or to the promise that "You can keep your doctor"? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician.
For a cancer patient, medical coverage is a matter of life and death. Take away people's ability to control their medical-coverage choices and they may die. I guess that's a highly effective way to control medical costs. Perhaps that's the point.

http://online.wsj.com/news/articles/...71710423780446

[Androidpk]

I'd like to see a liberal spin on that one.

[Parkbandit]

I'd like to see a liberal spin on that one.

"He's lived a long enough life, the needs of the many outweigh the needs of the one"

[cwolff]

The He is actually a She and of course she is not going to die because of this. She will be treated by different doctors but that's about it.

[Androidpk]

I'd think a former soldier could understand the point of it quite well.

Nope.

[AnticorRifling]

I'd think a former soldier could understand the point of it quite well.

You're basing this on all of that time you spent being a soldier right?

[AnticorRifling]

The He is actually a She and of course she is not going to die because of this. She will be treated by different doctors but that's about it.

Source for your certainty please?

[Jarvan]

Frankly, there will be a number of similar cases, as a number of hospitals and Dr's are refusing to take the insurance plans provided on the exchanges.

The cheapest plan in my state and for my area (because yes, they are broken down THAT far), which arguably will be the most purchased by people, apparently only has access to one hospital out of the 7 that are within 20 miles of my home. This hospital, while not a slum, is certainly not the best, or even what I would consider good. They have a very fast turn over rate for the ER, but that is because their goal is to get you out quickly. I had a friend that went there for back pain, they did an MRI, and found a kidney stone that was 9 mm big. They gave her some prescriptions and told her it should pass in 3-4 weeks.

Now.. when I had my kidney stone, I was told anything over 5 mm usually had to be broken up cause it wouldn't be able to fit thru your tubes.

So.. 6 months later.. she still has the stone. Her family is just about at the point where they plan to kidnap her and take her to a real hospital.

It's funny.. "you get what you pay for" used to mean something. Apparently America thinks it can pay practically nothing, and get the worlds best medical attention.

[Parkbandit]

The He is actually a She and of course she is not going to die because of this. She will be treated by different doctors but that's about it.

Yes.. because if I were facing this cancer, the first thing I would want is a new doctor and new insurance.

What happened to “And if you like your insurance plan, you will keep it. No one will be able to take that away from you. It hasn’t happened yet. It won’t happen in the future.” - Barack Obama

“That means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what.” - Barack Obama

[Parkbandit]

“Bottom line: of the 189 million Americans with private health insurance coverage, I estimate that if Obamacare is fully implemented, at least 129 million (68 percent) will not be able to keep their previous health care plan either because they already have lost or will lose that coverage by the end of 2014,” he said in an email. ”But of these, ‘only’ the 18 to 50 million will literally lose coverage, i.e., have their plans entirely taken away. This includes 9.2-15.4 million in the non-group market and 9-35 million in the employer-based market. The rest will retain their old plans but have to pay higher rates for Obamacare-mandated bells and whistles.” - Christopher Conover. Conover is a research scholar in the Center for Health Policy & Inequalities Research at Duke University and an adjunct scholar at the American Enterprise Institute.

ETA: Yes, I realize the AEI is a conservative leaning think tank. We will see how this unfolds in a year.