Kill health reform? Not on their lives. (pt. 1)

Cancer survivors await pre-existing condition provisions

Cancer patients can look forward to health reform provisions that include a ban on carrier denial of coverage based on pre-existing health conditions. (iStockphoto illustration)

EDITOR’S NOTE: This is the first of a three-part series from journalist Arlene Karidis, whose career as a health reporter spans two decades. A breast cancer survivor, Karidis says the Affordable Care Act is already helping many of the people who need it most, but that for many more Americans, the best of the reform law is yet to come.

There’s been a lot of controversy over whether the health reform law was worth the struggle and whether it should ultimately be repealed, but it’s plainly evident from my personal experience that some folks have benefitted from it already – and why some can’t wait for provisions to kick in three years from now.

In my personal situation, I never would have expected to consider the words “I have cancer” and “I am one lucky person” to go hand in hand – at least not until I got diagnosed last year, and started hearing horror stories from other survivors still waiting for relief.

I call myself “lucky” because I’m on my husband’s employer-sponsored health plan, and it has pulled through for us. If – as  freelance writer – I had to purchase my own insurance on the private market, every insurer out there could deny my cancer treatment on the pre-existing condition clause. It’s still on the books if you’re over age 19 – at least until 2014.

beyond pre-existing conditions

Deep-sixing the pre-existing clause is one of many changes health reform is slated to deliver that sick people, especially, are holding out for. The provision not only will ban carrier refusal to cover pre-existing conditions or renew policies because of such conditions, but also prohibits insurers from charging more due to health status or gender.

People with ongoing health problems are seeing some immediate relief through new provisions already in place, like no lifetime dollar limits on hospitalization and other essential benefits.

When more provisions kick in, life should be better on countless fronts – from no worries about hitting an annual dollar limit for individuals’ plans, to knowing you can tap into Medicaid if you’re at less than 133 percent of the poverty level (earning less than approximately $15,000).

My new survivor friend Susan, is among those unable to make ends meet and who’s holding out for relief – the people most critically in need. A single parent with heart and liver problems on top of cancer, she never smiles. I got on her for that and she told me, “I just can’t. All my teeth have broken off from the chemo.”

She has no dental insurance, so, at 38, she goes toothless and worries about abscesses common in her situation. Susan is on disability and doesn’t have the reserves to pay into the high-risk pools, one of nearly a dozen health reform provisions already in effect. For now she depends on state aid to help with basic care.

“I am hoping that the long-term care insurance program with cash benefit to adults who became disabled (CLASS) will offer me more assistance. But that won’t happen until late 2012. Also, if the bill’s Medicaid guideline (for 2014) would be put into effect immediately, I could benefit.”

As for now, Susan continues to be denied.

“The waiting is frustrating, because I was recently diagnosed with a late stage of a breast cancer with a very high chance for recurrence in the first three years. I am in the most crucial period, now.”

Read more about Affordable Care Act benefits to cancer patients.

Part Two: Mental health advocates see health reform law as victory

Part Three: Reform law’s preventive benefits, expanded coverage succeed in bringing patients back to the care they need

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