Patients brace for post- Obamacare costs
Pre- existing condition discrimination out, but high- risk pools likely in
A lack of clarity into what the Trump administration will do about the Affordable Care Act and drug prices is unnervingmany patients with cancer and other chronic diseases who worry the alternative to high premiums and deductibles could lead to worse solutions than high out- of- pocket costs they have now.
Assurances that people with pre- existing health conditions will still be able to get insurance through any ACA replacement plan offers only partial solace to many cancer and heart patients. They know the details of any plan will determine whether they are better or worse off financially.
“There are a lot of important protections in the ACA that people do like,” says Kim Thiboldeaux, CEO of the patient advocacy group Cancer Support Community. “Suddenly you could get coverage. Even if the cost sharing was on the high side, it really felt like a relief.”
Annual and lifetime caps on what insurers will pay for care are among aspects of the law that need to be maintained if not strengthened, says Clifford Hudis, CEO of the American Society of Clinical Oncology.
The law didn’t resolve all of the challenges, Hudis says, but the impending change causes anxiety.
Concerns extend beyond cancer patients. James Harrison, 57, couldn’t get insurance before the ACA because he’d had a cardiac bypass, a pre- existing condition.
He and his wife didn’t buy an ACA plan the first year they were eligible because they thought premiums were too high, Harrison says.
Instead, he bought an indemnity plan that paid only up to 50% of certain claims. It didn’t cover the cardiac catheterization he soon needed. He was billed more than $ 110,000, which the hospital is suing to collect.
“I am deeply concerned, because of my pre- existing condition, that President Trump will throw me to the sharks in a high- risk pool later this year,” says Harrison, who owns a landscaping business in Summerfield, Fla.
High- risk insurance pools, one of the only options for patients with pre- existing conditions before the law, are one of the most likely ways Republicans in Congress and the White House will address soaring premiums for those on the ACA exchanges. These pools were included in legislation introduced by Rep. Tom Price, R- Ga., Trump’s nominee to head the Department of Health and Human Services.
Health care economist John Goodman, who helped draft an ACA replacement measure co- sponsored by Sen. Bill Cassidy, R- La., is among those who believe the pools are needed to lower premiums for healthy people buying on the exchanges without financial subsidies.
Physician Adams Dudley, who heads the University of California- San Francisco’s Center for Healthcare Value, says the pools won’t lower the overall costs of care, however.
“There’s never been a risk pool funded well enough for it to be a stable solution,” Dudley says. “You could put enough in risk pools and they’d be fine, but there isn’t a solution that’s cheaper than the ACA.”