Health Care Reform: What Does It Mean To You?

PJ Hamel Health Guide
  • Health care reform.

    These three simple words have polarized America for the better part of the past 2 years. Under the banner of health care reform, Congress and President Obama painfully forged a series of laws designed to fix a dysfunctional health care system, one that’s inexorably driving Americans and their workplaces towards fiscal insolvency.

    The Affordable Health Care for America Act (passed by the House November 7, 2009) morphed into the Patient Protection and Affordable Care Act (passed by the Senate December 24, 2009 – Merry Christmas!).

    That in turn was translated into the Health Care and Education Reconciliation Act of 2010 – which became the law of the land on March 30, 2010.

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    Some of the act’s provisions went into effect immediately. But most are being phased in gradually. One key provision – a first step toward eliminating discrimination against people with pre-existing conditions – begin June 21. Still more laws take effect in September, and full legislation will be enacted by January 1, 2018.  

    I’m betting none of you have read this far-reaching legislation – very few Americans have waded through the 906 complicated pages that make up this act.

    In fact, most of us are probably thinking, “Yeah, great, but what’s in it for me?”

    What’s in it for you, the cancer survivor? Some really good things – life-changing stuff – and some changes that aren’t so good.

    The following are the major points I feel will most impact us as survivors.

    •Affordable health insurance will be available for everyone. What it’ll look like and how much it’ll cost are still being hammered out. But never again will a woman have to choose between paying rent, buying food, or having a mammogram.

    “I’m out of work and don’t have insurance but I’m worried about this lump in my breast – do you think it can wait till I find a job?” Thankfully, that question should be a thing of the past. As of January 1, 2014.

    •Pre-existing conditions: Beginning this month, the common practice of preventing cancer patients from purchasing health insurance, due to cancer being a high-risk, pre-existing condition, is ending. All adult cancer patients without health insurance are now eligible to join a temporary “high risk pool,” which will be replaced by a “health care exchange” offering coverage in 2014.

    For children under 19, elimination of the pre-existing condition penalty begins in September.

    In addition, as of 2014, insurance companies will be prohibited from charging higher rates for policyholders based on pre-existing medical conditions. “Oh, you’ve been diagnosed with breast cancer? We’ll triple your premium.” No more.

    Along the same lines, insurance companies are prevented from dropping current policyholders if they get cancer (going into effect September 23, 2010). Yes, some insurance companies were previously able to do that – and did.

    •For existing health insurance plans (e.g., the health insurance you currently get through your employer), co-payments for preventive care and screening, and annual checkups, will be eliminated. Translation: free mammograms. But not till January 1, 2018. Mark your calendar!

  • However, starting in September of this year, any new private insurance plans will be prohibited from charging co-pays for preventive care and screening services.

    •Dependent children can remain on their parents’ health care plans until their 26th birthday. This may not affect you; but if you’re the parent of a young adult with cancer, it’s huge.

    In the past, college students who got cancer and were forced to drop out of school also lost their parents’ health coverage. Imagine being a parent whose child has cancer, and who has no health insurance. Many American families have lost everything – savings, home, everything – to save a child’s life.

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    That’s not right. Now, at least, young adults have a chance to go to college, graduate, and get a job without worrying about gaps in their health insurance.

    •Annual spending caps instituted by insurance companies will start to be phased out now, and will be completely eliminated by 2014. Lifetime caps will be banned next year. This is good news for patients with metastatic cancer, those kept alive by VERY expensive regular chemo treatments and drugs.

    •The CLASS Act (Community Living Assistance Services and Supports Act), a little-known part of the bill, offers long-term home-care insurance at an affordable cost for home-care services if you become disabled – for example, by metastatic cancer, or the results of cancer treatment. Estimated premiums would range from $60-$100/month; the benefit would pay $50-$75/day for a home health provider to help you with your daily activities. You can thank the late Ted Kennedy for this one.

    •The yearly deductible for insured individuals will be capped at $2,000 for single individuals, and $4,000 for families. There’s a bit of wiggle room on this one (“special exceptions may apply”), but it’s a good start for those of us who’ve been paying HUGE deductibles along with big premiums. The co-pays for a surgeon (try three lumpectomies in 6 weeks, or regularly scheduled expander fills); as well as those many visits to the “specialist” (read: oncologist) do add up.

    •Here’s a good one: effective in September, those who use indoor tanning services will pay a 10% tax each time they tan. It only makes sense – if you choose to significantly raise your risk of skin cancer, you should help pay in advance for the possible future consequences of that choice.

    •The Medicare “donut hole” – as of next year, 50% of that hole will disappear, leaving seniors who struggle to pay annual drug costs in excess of $2,700 (but below $6,155) with a bit more money in their pockets.

    •Participation in clinical trials: By 2014, the law will prohibit new insurance plans from refusing to cover an individual’s expense for participating in a clinical trial for cancer or another life-threatening illness. Insurors will also be prevented from denying normal health-care coverage to individuals who choose to participate in those clinical trials.

    And now, for the parts of this new health care bill you may not like, as a cancer survivor:

  • •Biologic drugs: Drug manufacturers are insured 12 years of exclusive use of their biologic drug patents before generics can be spun off. What does this mean to you? Avastin and Herceptin are examples of breast cancer biologic drugs currently in wide use. Both are expensive, with Avastin costing a patient upwards of $20,000/year after insurance, in co-pays.

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    The Avastin patent expires in 2017; Herceptin, in 2019. Which means the cost of both of these life-saving drugs will remain high for years to come. As will the cost of any of the new cutting-edge biologic cancer drugs currently in the development pipeline.

    •Flexible Spending Accounts (“Flex” plans, or FSAs): Unfortunately, the new law caps the medical portion of these at $2,500, far below what most of us would spend in a year on out-of-pocket medical expenses (drug co-pays, lymphedema sleeves, etc.) This limit goes into effect next year (2011); check with your employer if you currently have an FSA.

    •Bad news for those of us with high co-pays and expensive prescriptions: the income tax deductions bar has just been raised. If you itemize deductions on your yearly tax return, the qualifying medical expenses deduction will increase from the current 7.5% of earned income to 10%, as of  2014. 

    So, that’s the way I see it. All in all, the Health Care and Education Reconciliation Act of 2010 will be beneficial for cancer survivors. No more pre-existing condition penalty? Free mammograms? Insurance for ALL?

    Sounds like a (good) plan.

    Note: I’ve deliberately chosen not to examine the financial ramifications of health-care reform. Whether or how much all of this raises taxes is yet to be seen. For purposes of this post, I’m interested only in the Act’s provisions, not its financing.

Published On: June 20, 2010