Post Election Update: Changes to Medicare

Established in 1965, Medicare now covers nearly 48 million seniors and an additional 9 Changes to Medicaremillion people with disabilities. For information about Medicare, read our previous blogs or our Quick Guide to Medicare. Congressional leaders have indicated that there are changes to Medicare on the way.

Medicare’s benefits can be accessed in two ways. Through traditional Medicare, services are covered as fee for service.  Meaning that you can get medical care from any provider that accepts Medicare coverage.  Alternatively, Medicare Advantage is a way to get Medicare coverage through a managed care plan (HMO or PPO). These managed care plans are offered by private health insurance companies and have specific networks of providers that are covered by the plan.

Throughout the contentious election season, President-elect Donald Trump, promised to preserve Medicare as is.  However since the election, key Republican leaders have proposed changes to Medicare.

For example, U.S. Congressman Tom Price, a noted conservative who was recently nominated to be the next U.S. Secretary of Health and Human Services (HHS), has proposed, among other changes, moving Medicare to a voucher system. This would mean giving each individual a voucher worth a certain amount of money to go and buy private health insurance coverage.  There are a number of potential challenges with this approach for consumers:

  1. If the ACA is repealed, many of the consumer protections will no longer be available
  2. It is unclear if the amount of the voucher will be enough to actually buy coverage. If it isn’t then individuals will have to pay more for their health insurance than they were paying under Medicare
  3. It is unclear what the individual health insurance market will look like and what plan options will be available
  4. It is unclear if those options will provide equal coverage to Medicare
  5. As seniors and people with disabilities often have higher medical expenses, they may be charged more for their coverage and plans may be too expensive for people to buy

Congressman Price’s nomination to lead HHS, which has control over Medicare, has caused many to question the validity of President-elect Trump’s campaign promise to protect Medicare.

Speaker of the House Paul Ryan has also championed a voucher system, which he calls “premium support.”  In his 2016 proposal entitled “A Better Way,” Ryan makes several recommendations. Under his plan, the Medicare eligibility age would be raised from 65 to 67 by 2020.  Then in 2024, “Medicare beneficiaries would be given a choice of private plans competing alongside the traditional Medicare program on a newly created Medicare Exchange.” Increasing subsidies for Medicare Advantage and allowing private insurers to offer a variety of coverage levels is suggested as well.  Unfortunately, consumers who choose plans with more comprehensive coverage and flexibility may be required to pay the difference.

Some economists say that a privatized Medicare Advantage would be more efficient and enhance benefits to consumers while decreasing the cost to taxpayers.  Other experts say that Medicare would not automatically be more efficient if privatized. They argue that Medicare already efficient and the projected savings privatized Medicare Advantage was supposed to provide have not materialized.

Additionally, both Price’s and Ryan’s proposals leave out important details.  For instance, how much money would be given to individuals to purchase insurance? Would benefits be guaranteed?  How would the quality of coverage be monitored and ensured?  Would subsidies increase in proportion to the rising cost of healthcare?

Exactly what, if any, changes will be implemented is still unclear.  Not every member of Congress who is committed to repealing the Affordable Care Act, also thinks that making changes to Medicare should be their top priority.  Those who do want to make changes to Medicare have different opinions on how to do so.

One thing is certain: these proposed changes have caused considerable anxiety for Medicare recipients and their advocates. Triage Cancer will continue to follow this issue and share information as we receive it. Stay tuned to our blog and newsletter for the latest information.

Post-Election Update: What does the Budget have to do with the ACA?

budget repeal provisions ACAThere have been many stories in the news over the last few weeks about potential changes to our health care system and last night the Senate voted on a budget resolution that started the ball rolling on to repeal provisions of the  Affordable Care Act (ACA).

President-elect Donald Trump, Speaker of the House of Representatives Paul Ryan, and Senate Majority Leader Mitch McConnell have continued to state that they are eager to make changes to our health care system. In December, on 60 Minutes, Speaker Ryan stated that the repeal of the Patient Protection and Affordable Care Act (ACA) was a priority in the House of Representatives.  Senator McConnell has repeatedly confirmed that the ACA repeal will be the first item the Senate votes after the inauguration of President-elect Trump.

Yesterday, President Trump stated that he would offer his own plan to repeal and replace the ACA simultaneously, as soon as his nominee for Secretary of Health and Human Services, Tom Price, is confirmed by the Senate.

But repealing an entire law, as if it never existed, is a complicated thing.  Especially a law that has been in effect for six years and touches so many people and involves so many federal and state agencies.  And the steps that they are taking to repeal the law are also complicated.

Road to Repeal

Normally, when a bill is proposed in the Senate or House of Representatives, it is reviewed by one or more committees and then if suggested by a committee, all of the members have the opportunity to vote on the bill. Most bills require a majority vote.  In the Senate that means 51 votes are required to pass.  However, if some members don’t want there to be a vote on a bill, they can filibuster it. A filibuster is procedure where debate over a bill is extended to delay or prevent a final vote. Sixty votes are required to break a filibuster. To avoid the filibuster, Senator McConnell has lead an effort to pass changes to the ACA through the budget reconciliation process, which cannot be filibustered and only requires 51 votes, which the Republicans have.

Senate Action Yesterday

Yesterday, the Senate took the first steps to repeal the ACA. Members of the Senate voted 51-48 to pass a budget blueprint, which directs the House and the Senate to come up with repeal legislation by January 27. The House of Representatives could vote on the budget blueprint by Friday.

What Does a “Replacement” Look Like?

Even though Congress is moving forward with plans to repeal the ACA, exactly what they would replace the ACA with is still unclear, and when changes will go into effect is also unknown.

Repealing the ACA will have a significant impact on the cancer community.  In previous blogs we have explained some of the consumer protections in the ACA, as well as the danger in only keeping protections for people with pre-existing conditions, without also keeping those consumer protections.

In this blog, we wanted to start to share with you one of the proposals that these leaders have advocated for, as they might be part of a “replacement.”

President-elect Trump has suggested that he would replace the ACA, with High Risk Pools. A high risk pool is a health insurance coverage option available for people with pre-existing conditions that is subsidized by the government.

History of High Risk Pools

High risk pools are not a new idea. In fact, more than 35 states had high risk pools to try to help people with pre-existing conditions access health insurance coverage, before the ACA became law.  While those high risk pools offered a lifeline for many people to get access to coverage when they couldn’t get it another way, they were not a solution to the problem. For example, in California, the state’s high risk pool only offered coverage up to $75,000 a year.  Cancer care is often much more expensive than that, which left people to pay for their care out-of-pocket. Many of those state high risk pools had 6-month waiting periods for coverage if you had a pre-existing condition, wait lists due to state budget constraints, and very high deductibles and out-of-pocket costs.

Kaiser Health News released a video in October, describing why high risk pools may sound like a good idea, but have some challenges in reality.

For a more detailed explanation of high risk pools and our past experience with using high risk pools to try to meet the needs of people with pre-existing conditions, visit: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few days, weeks, and months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.
  1. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-storyor at canceradvocacy.org/blog/share-your-aca-story.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, our recently released toolkit, Finances 101, may be useful.

Stay Tuned

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available in the coming weeks and months.

Getting Back to Work: Ticket to Work Program

triage-cancer-blog-return-to-workIf you are receiving disability benefits because of a cancer diagnosis, you may be considering going back to work. You may even be eager to get back to the normalcy of working.  As Americans, we get a great sense of worth and identity from our jobs.  Work is also a great social outlet for a lot of people.  After a cancer diagnosis, working can mean more than financial independence.  It can also mean moving beyond your diagnosis.

Well, when you’re ready to return to work, the Social Security Administration is ready to help.  They have a robust program designed to assist you to find work after a disability: the Ticket to Work Program.

Ticket to Work
If you are receiving SSI or SSDI, and are between the ages of 18 and 64, you qualify for a program called Ticket to Work.  This is a free and voluntary service that can help you go to work, get a good job that may lead to a career, and become financially independent.  Essentially, this program matches you with career planners and vocational rehabilitation services that will help you make a plan for getting back to work, and then help you execute that plan.  They will review your resume, set up interviews, conduct job training, and much more.  They will also provide information about your disability benefits and what they will look like when you go back to work.  Here are some things you should understand about the Ticket to Work program:

  • Opening a Ticket to Work does not mean you will automatically lose your SSDI or SSI benefit. If you open a Ticket to Work and make timely progress with either an employment network or a state vocational rehabilitation counselor, your medical condition will not be reviewed and you will continue to receive you normal benefit until you start actually working.
  • Opening a Ticket to Work will not cancel your Medicare benefit. Even if you go back to work and make enough to stop your SSDI benefit, you are still eligible to keep Medicare Part A (hospital insurance) for up to 93 months.
  • Opening a Ticket to Work will not necessarily cancel your Medicaid benefit. If you make enough to stop your SSI benefit, but are still under the earnings threshold set by your state, you could still be eligible for Medicaid.  Even if you make more than your state earnings threshold, you could be eligible for a Medicaid buy-in program.  You need to speak with your state Medicaid office to find out what that threshold is in your state. Click here to find your state Medicaid agency.

Another concern you may have about returning to work too early is sacrificing the SSDI or SSI benefit that took you so long to get in the first place.  Social Security has a work incentive program called Expedited Reinstatement.  Basically this means that if your benefits ended within the last 5 years due to an increase in your earnings, and you still have your original medical condition, you do not have to reapply for benefits.  Instead, you will receive 6 months of temporary benefits while your case goes under medical review.  If you are found not to be eligible for benefits after that review, you don’t have to pay back the temporary benefits you received.

Don’t be afraid to get back out into the workforce if you are able.  Cancer can be very isolating and working can be just the thing you need to feel better and move on from your diagnosis.

Survivorship, Activism, and Cross-Cultural Relationships

By Ruth Ebenstein

I was nursing my baby when I got the bomb-drop.Survivorship, Activism, and Cross-Cultural Relationships

“That lump is cancer. If the pathology report comes back negative, I’m going to think it’s a mistake.”

Breast cancer? Mixed in with mother’s milk? In addition to my baby, I had two others sons under five and two young adult stepdaughters. In an instant, my life plans crashed. Forget a fourth child. Would I even get to rear the ones that I had? I was still mourning a friend I’d lost to breast cancer a few weeks earlier; she was in her 40s, around my age. I despaired, unable to access any hope. Was a good outcome even possible?

Three weeks later, I had a lumpectomy and an axillary dissection, to remove lymph nodes from my armpit. While the doctors tried to decide if I needed chemotherapy, I looked for a support group. I’d heard that women survived better/longer/stronger if they’d had support, and I was keen on that. But most of all, I was looking for a friend.

I’d always been a connector. As a girl, I had embraced babysitters as friends. I connected with everyone: long chats with the bus driver to school, discussions with the librarian over sandwiches at my house (yes, she agreed to come over!), and even my mother’s friends. Friendships were one of my great joys. And now was no different. I wanted women in my life who understood what I was going through. Of course, I did not want my old friends to get breast cancer! But I did hunger to find true companions in breastcancerland. Women with whom I could laugh, complain about hot flashes, share my fears, gather strategies for coping.

And then this email turned up in my inbox. “Would you like to join an Israeli-Palestinian breast cancer support group?” I wondered if perhaps something good could come out of something bad.

At the first support group meeting, a mother-earth woman with warm brown eyes came over to introduce herself. Although Ibtisam Erekat was a devout Palestinian Muslim woman hailing from the West Bank and I was an American-Israeli Orthodox Jewish woman hailing from Jerusalem, we discovered that we had very similar life narratives. We were both religiously observant and we had both married in our thirties, late in our respective traditional communities. Each of our husbands was a divorcé who was several years our senior and had brought children into the marriage. We both had birthed three children in three years. And we were both diagnosed with breast cancer while nursing our babies, which was rather uncommon.  I had never met anyone who shared so many critical elements of my life story. “Same here,” said Ibtisam at our first meeting, in impressive English she had gleaned off the television. I soon discovered that we were both fearless, outgoing, daring. The conversation flowed and we cracked each other up.

In 2012, we traveled together to Bosnia as part of an Israeli-Palestinian delegation of breast cancer survivors. The mission: to meet and learn from other breast cancer survivors who also cross religious, ethnic and cultural lines to support each other. On that trip, many incredible things happened. I felt a tremendous connection with the Bosnian women, women who remain my friends today, despite the challenges of a language barrier. I also developed beautiful friendships with the Palestinian breast cancer survivors, facilitated by the intimacy of togetherness and being miles away from the bloody headlines and turmoil of our region. In particular, my friendship with Ibtisam blossomed. Over the next months and years, we grew to be kin; our children, spouses, and extended families grew close, too.

I realized that this inspiring friendship story ought to be shared. So I did. I crafted a piece about our trip to Bosnia for Tablet, which won an award. I wrote another essay about our friendship for the Atlantic. Penning a memoir was a natural next step.  I’m working on that manuscript right now, with literary agents waiting to read my book proposal.

In 2014 I started to do public speaking across the US to share the positive things that emerged from my breast cancer experience. The cross-cultural friendships, the growth, the peace and health activism—and the hope. Most remarkably, the incredible sisterhood with Ibtisam Erekat.

Through my public speaking, writing and activism, I’ve made friends with breast cancer survivors who hail from Mexico City to Mostar, Herzegovina, from Abu Dis in the West Bank to an ultra-Orthodox community in Israel. Breast cancer has taught me how to connect in ways that I did not even know were possible. My hope is to spread this message to others: our real enemy is illness, not man-made conflict. And the greatest lesson of all? “Other” is actually just like me.

Medical Marijuana: A Post-Election Update

medical marijuanaOn Election Day, voters across the country showed they were in favor of legalizing medical marijuana, and in some states, recreational marijuana as well. California, Maine, Massachusetts, and Nevada voted to legalize the recreational use marijuana, while Arkansas, Florida, and North Dakota passed ballot initiatives legalizing medical marijuana.

Marijuana, whether used recreationally or for medical reasons is still illegal under federal law. However, over the last few years, the federal government has opted to let states pass laws in this area and not to prosecute people who are following those state laws.

We have posted previously about the laws related to medical marijuana, which you can read more about here.

President-elect Donald Trump has nominated Senator Jefferson Sessions for Attorney General of the United States. If confirmed, it is likely that Senator Sessions will take a different approach towards state laws on medical and recreational marijuana.

To learn more about Senator Sessions’ views on marijuana, read this informative article: http://www.politico.com/magazine/story/2016/12/jeff-sessions-coming-war-on-legal-marijuana-214501.

Difficult Conversations: Estate Planning

Estate planning and talking about end of life issues is one of the most difficult triage cancer blog difficult conversations estate planningconversations to have with a loved one.  Nobody likes to think about their own mortality, much less make a plan for it.  Nevertheless, end of life conversations are vitally important for everyone to have.  The overwhelming number of people don’t have these conversations until a terminal illness is diagnosed, but sadly, anyone of us could find ourselves on emergency life support tomorrow.  Talk to your loved ones and make sure they are aware of your final wishes.

The term “end of life issues” does not just mean funeral arrangements.  In fact, the greater issues that need to be discussed are what the patient wants in terms of live saving measures.  Does the patient want to receive CPR?  Does the patient want artificial hydration or nutrition?  Not only should you talk about this, but the patient should complete an advance directive and make sure their families and their healthcare team have a copy.  There are other estate planning documents that should also be considered and completed. Check out our Quick Guide to Estate Planning for more information. You can also read previous blogs on estate planning topics.

Another important thing to discuss is where the patient would like to spend his or her last days.  Not just which bucket list activity they want to complete, but do they want to stay at home, in a hospital or maybe a hospice facility?

For a terminal cancer patient, there is another question that needs to be posed.  At what point does the patient want transition from treatment that attempts to cure the cancer, to treatments that attempt to mitigate symptoms and provide quality of life? This can provided through hospice care.  Hospice care can be given in home, in a hospital, or in assisted living – wherever the patient is.  Hospice care is about making the most out of whatever days are left, while remaining comfortable.  Hospice care can even include art or music therapy.

It is easy to say that these are crucial decisions that need to be discussed with loved ones, but it is much harder to start the discussions.  There are many resources for you to find inspiration on how to begin this difficult conversation.  Being around friends and family during the holiday season might provide some opportunities to have some of these conversations. Get these decisions and discussions out of the way, so you can move on to enjoying your time together.

Important News Regarding Changes to Medicare

medicaredotgovThe new year will bring changes to Medicare.  Click here to see what Medicare will cost in 2017.

Also, if you recently became eligible for Medicare, but thought it would be less expensive to keep your Marketplace coverage because you get financial assistance to pay for your Marketplace coverage, then the rest of this message is for you. 

When you became eligible for Medicare Part A (the hospital portion of Medicare that is usually premium-free), you also became ineligible for Marketplace financial assistance. So that means you will be on the hook for the full price of the Marketplace plan. This also means that you probably missed the open enrollment period for Medicare Part B (the other part of Medicare coverage that has a premium). And, it means that if you do try to get Medicare Part B now, you will pay a late enrollment penalty for the rest of your life.  But . . .

For a limited time, you can apply for “equitable relief” that will give you a Special Enrollment Period to enroll in Part B. It also means that they won’t apply a late enrollment penalty, but you must apply by MARCH 31, 2017!

Some of you in this situation may have been notified of this program by mail. But it you weren’t notified, or lost the notice, or even feel you received misinformation about qualifying for financial assistance, you should contact the Social Security Administration (800-772-1213) to apply for the “equitable relief.”

Your application should include:

  • Any information or documentation you have on how you learned that the financial assistance would not apply and/or why you thought you could continue financial assistance.
  • Any letters (including the notice mentioned above), emails, notes from conversations
  • Or any other relevant information

And more good news – you don’t need to show that your confusion was caused by any particular source to qualify for this relief. You can just be confused.  We know health insurance is confusing!

To learn more about Making Sense of the Medicare Mazewatch our recorded webinar.

The Future of Clinical Trials is Now

triage-cancer-blog-future-of-clinical-trialsTriage Cancer believes that everyone should have access to quality cancer care. Sometimes, that care comes in the form of a clinical trial. We have a number of resources on clinical trials, but wanted to share with you a newer resource from one of our partners, that might be helpful for you.

***

One of the earliest clinical trials can be dated as far back as the famous 1747 scurvy study conducted by James Lind. Almost 200 years later, in 1946, the first randomized controlled trial occurred on streptomycin, an antibiotic we continue to use today. Over time, technology has advanced but many aspects of running a clinical trial have remained the same, until now.

Science 37 has introduced a new model and approach to running clinical trials by combining technology with telemedicine. Participants in a Science 37 clinical trial can join, receive study medications, and participate from the comfort of their home, no matter where the study is being conducted. The goal is to allow participants to join clinical research from home, and reduce the pain of travel or the inability to participate due a patient’s geographic location. For current cancer research opportunities that are being conducted in this way, please visit https://www.science37.com/participants.

Here are some potential scenarios to illustrate the differences between a Science 37 clinical trial and a traditional clinical trial:

Science 37 Clinical Trial                                             Traditional Clinical Trial

1. Initial Search & Signing Up

Jane is newly diagnosed and searches the internet to learn more about her condition. She lands on a virtual trial site.

 

Jane is newly diagnosed and searches the internet to learn more about her condition. She lands on an academic site’s research study page. The trial site is a 72 mile round trip from Jane’s home.

2. Being Contacted

Jane signs up online to receive more information. A study coordinator reaches out to her the following day.

 

Jane calls the site & is scheduled for a screening clinic visit.

3. Getting Screened

Jane is screened by phone to determine eligibility.  She answers questions about her condition.

 

Jane drives to the clinic site, checks in and waits to see the study staff who screen her to determine eligibility.  She answers questions about her condition.

4. Giving Consent

Upon confirming eligibility, Jane is given access to a secure website portal where she can review electronic informed consent documents. She takes time to review them while at home and discusses them with her family. She later contacts the research coordinator to complete the virtual informed consent process via phone & video teleconference. The study coordinator and investigator ensure that she understands the study & is willing to volunteer. Jane was able to schedule her virtual consent process around her busy work schedule.

 

Upon confirming eligibility, Jane is given the informed consent documents to review.  She decides to take them home so that she has more time to read them and discuss them with her family. She later makes a follow-up visit to return to the clinic where she undergoes the informed consent process. A study coordinator and investigator ensure that she understands the study & is willing to volunteer. Jane had to take time off from work to return to the clinic to complete the informed consent process.

 

5. Participation and Follow-Up Visits

Jane completes the study baseline procedures at home. These include getting vitals signs and blood work by a mobile nurse. Study medications are shipped to her home and her study questionnaires are completed through the NORA app on the study iPhone.

Jane receives a new shipment of study medications every month to her home and completes monthly study questionnaires on NORA.

 

Jane returns to the research clinic to complete the study baseline procedures. These include getting vitals signs and blood work by the clinic staff. She completes a paper questionnaire and is given her one month supply of study medication to take home. She is scheduled to return to the clinic every month to get a refill of study medications and to complete the study questionnaires. She has to check with her work to make sure she will be able to take time off for the next study visits.

6. Reporting Side Effects

Jane wants to report noticing a new rash so she calls her study coordinator using NORA on her study iPhone. She is advised to take a photo of the rash through NORA. The study investigator is notified and within a few hours, Jane is given instructions on how to manage the rash.

 

 

 

Jane wants to report noticing a new rash so she calls her study coordinator in the clinic. She describes the rash over the phone to the study coordinator who states that they will need to contact the investigator and call Jane back. After speaking to the investigator, the study coordinator calls Jane and instructs her to return to the research clinic the next day for evaluation. Jane is concerned and must ask her boss to take more time off from work to go to the clinic.

6. Study End

Jane is contacted by the study coordinator to give her instructions about completing the study. She completes some questionnaires on NORA, and ships back the remaining study medications and study iPhone. Jane joins a community of others who share her condition so that she can receive updates on the study and learn about future trials.

 

Jane takes a day off from work so that she can return to the research clinic for her last visit. She is accustomed to the routine of driving to the clinic, checking in at reception, and waiting to be evaluated by the research staff. During the visit, she complete some questionnaires and returns the remaining study medications to the staff.

Gift Ideas for a Cancer Patient

triage-cancer-blog-gift-ideasWhen someone close to you is sick, the instinct is to shower that person with love in the form of chocolate, flowers, and balloons. This is a very kind instinct, but when someone is going through cancer treatment or in the hospital, you may need to rethink these gifts.

Chocolate and flowers each may present a possible problem for a cancer patient.  Depending on the type of cancer they have, they may have dietary restrictions, and sugar can be a forbidden ingredient.  Many hospitals are now banning flowers because of the germs and bugs they may carry. And you may want to stay away from mylar balloons, which pose a risk to power lines and there is a worldwide helium shortage.

So, what should you bring to a cancer patient? Really, anything that will bring comfort to the patient and is allowed in a hospital environment.  Here are a couple of ideas:

  • A cozy set of button-up pajamas, robe or slippers
  • Warm, fuzzy socks
  • A soft blanket
  • A basket of unscented lotions and lip balms
  • A good, funny book
  • A nice journal and pen
  • Magazines
  • Music or relaxation/meditation exercises
  • Movies, a Netflix/Amazon subscription, or an iTunes/Amazon gift card to download their own

 

You can also give the gift of your time. Besides visiting someone, you could offer to help with daily activities. For example, you could babysit young children. If their parent is in the hospital, you could take them for a walk or out to get something to eat. Pick up their mail, feed a pet, or water plants. You could even offer to help them sort their medical bills and other paperwork.

 

Use these ideas, or use them to spark your own ideas.  What every cancer patient needs more than anything is love and support, and any gift will be appreciated, because it is the thought that counts!

Why Pre-Existing Condition Protections Are Not Enough

Over the last week, we have continued to hear about proposed changes to our health triage cancer blog pre-existing conditioncare system from the President-elect and members of Congress.  Some of those changes would have a significant impact on the cancer community. Next week, we will start to break down how those changes might impact the cancer community. However, this week, we wanted to talk about pre-existing conditions.

What is a Pre-Existing Condition?

“Pre-existing condition” used to be a term that only health insurance companies and health law attorneys used. The Patient Protection and Affordable Care Act (ACA) made that term more common, because the ACA prohibited health insurance companies from denying coverage to anyone with a pre-existing condition. A pre-existing condition is any medical condition that exists before the health insurance policy begins; the condition “pre-exists” the policy. A pre-existing condition is often thought of as a serious medical condition, such as a cancer diagnosis.  But prior to the ACA, insurance companies would routinely deny coverage to anyone with conditions such as arthritis, allergies, asthma, or even acne. Really, any medical condition was a reason for denial. And this had a huge impact on the cancer community. Over the close to two decades that we have worked in the cancer community before the passage of the ACA, we  would often have to to tell people that they didn’t have any option to access health insurance coverage because of their pre-existing condition.  The ACA changed that.

This change to our health care system was so significant that most people don’t want to see that portion of the ACA repealed. The President-elect and the Speaker of the House have both said that they would want to continue to provide protections for people with pre-existing conditions.  However, they have not provided details on whether they would do that by keeping the ACA rule, or create some other option.

Last week, we highlighted a few of the consumer protections in the ACA, some of which apply to plans offered by employers, plans offered through the State Health Insurance Marketplaces, and individual and family plans that you can buy directly from an insurance company.  Those consumer protections would be lost if the ACA were to be repealed.

Assuming that they keep the rule that ensures people with pre-existing conditions can purchase insurance, that rule by itself, isn’t enough to protect consumers, and here’s why:

  1. Coverage: the ACA ensures that plans have a minimum level of essential health benefits.
    1. Without this protection, people with pre-existing conditions might still be able to buy a plan, but the coverage might be minimal (like not covering mental health care or prescription drugs).
  2. Caps on benefits: the ACA does not allow insurance companies to place annual or lifetime caps on essential health benefits.
    1. Without this protection, people with pre-existing conditions might still be able to buy a plan, but the plan might cap benefits at $100,000 for the year, or $1 million for a lifetime, or even lower, leaving people to pay for medical expenses out of pocket.
  3. Rescissions: the ACA forbids health insurance companies from canceling your policy, unless your commit fraud on your application or leave off important information.
    1. Without this protection, people with pre-existing medical conditions might find their policies cancelled after submitting an expensive claim that the health insurance company doesn’t want to pay.
  4. Prevention: the ACA requires most health plans to provide free preventive care.
    1. Without this protection, we will go back to having to pay co-pays, co-insurance amounts, and deductibles when receiving preventive services, and many people will be forced to forgo that care.
  5. Out-of-pocket maximums: for plans sold in the Marketplaces, the ACA placed a cap on how high the out-of-pocket maximums could be, which greatly reduced out-of-pocket costs for people with pre-existing conditions.
    1. Without this protection, people will likely see even higher out-of-pocket medical costs.

And finally . . .

  1. Price: the ACA requires US Citizens, and those lawfully present in the US, to have health insurance coverage (with some exceptions).
    1. Without this requirement, many who are not currently in need of medical care, will not buy health insurance coverage, leaving only people with pre-existing conditions buying coverage. If we do not have a balanced risk pool, which includes people who are healthy as well as people with more serious medical conditions, then health plans will likely increase monthly premiums for everyone. In addition, if those people who are healthy wait until they get sick to buy coverage, that will further skew the risk pool and increase premiums even more. If the plans are too expensive to buy, then it won’t matter that people with pre-existing conditions are “allowed” to buy health insurance coverage.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.
  1. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-story or at canceradvocacy.org/blog/share-your-aca-story.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017. If you want your policy to begin on January 1, 2017, you need to have picked a plan by December 15, 2016.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, our recently released toolkit, Finances 101, may be useful.

Stay Tuned

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available in the coming weeks and months.