Pre-existing conditions? ‘No such thing’

Obamacare changed everything for those with chronic conditions, improving access to coverage, treatment, information and outcomes

Patrick Carr went an awfully long time without health insurance. For someone living with two chronic health conditions — asthma and high blood pressure — doing without health insurance for more than 12 years was downright dangerous. Carr says his health suffered as a result, but he didn’t have a choice.

That’s because those chronic conditions put the cost of buying health insurance out of reach for Carr. Before the Affordable Care Act (ACA), also known as Obamacare, insurance companies could charge exorbitant prices to people with chronic conditions, if they didn’t deny them coverage altogether. They could also drop someone if they were diagnosed with anything from allergies to cancer after buying coverage.

“Before the ACA, people with chronic conditions that ran the gamut from diabetes to more serious conditions like multiple sclerosis were shut out of our private health insurance system,” says Lydia Mitts, senior policy analyst at Families USA, a national nonprofit health reform organization. “That’s no longer how health insurance works in this country. People are able to get health insurance that covers the treatments they need to manage that chronic condition.”

What’s more, consumers can’t be charged more because they have a chronic condition. In fact, the application on HealthCare.gov doesn’t even ask about health status, because insurance companies aren’t allowed to discriminate based on any health condition people may have, now or in the future.

Then: ‘Don’t even bother …’

It’s vastly different from the system Carr was forced to deal with when the company he was working for stopped providing insurance to employees after it suffered huge losses following the attacks on September 11, 2001. In fact, his doctor told him not to even bother trying to get health insurance, because his asthma and high blood pressure made him uninsurable.

Carr still looked into it, and was quoted premium rates of $2,000 a month. So he had no choice but to go without coverage. While he was uninsured, he was forced to stop taking his blood pressure medication because it was too expensive — even though uncontrolled high blood pressure can lead to serious complications including a heart attack. Carr also couldn’t afford the best asthma inhaler for his needs, so he switched to a less expensive one that caused him a lot of side effects.

“My health really suffered,” Carr says. “My doctor helped me out as much as he could, but I skipped visits and tests I should have had because I just couldn’t afford it.”

Now: Affordable insurance, improved treatment

That’s all changed thanks to the ACA. Carr was able to find affordable health insurance, which includes prescription coverage that makes his medication — including his preferred inhaler — much less expensive, he says.

“My health is the best it has ever been, because I can see all the doctors I need to see and get all the tests I need, so I know what I need to do to take care of myself,” says Carr, who lives in California.

“There’s also the psychological aspect of it — I had a lot of stress being uninsured,” he adds. “I don’t know why anyone would be against Obamacare unless they’re pro-illness.”

According to Mitts, one of the primary goals of the ACA was to make sure everyone had access to affordable coverage, regardless of income or health status. The ACA also requires that all plans cover a number of preventive services at no additional cost — preventive services everyone needs to stay healthy, whether or not they have a chronic condition, such as annual check-ups and cancer screenings.

“It opened the door for more people to get preventive screenings to catch something early or prevent chronic conditions from ever happening,” she says.

Pre-existing condition? ‘No such thing’

It’s also opened the door for massive shifts in the way healthcare is provided, which health policy experts call system transformation.

A notable aspect of that transformation, says Families USA, is the fact that there’s really no such thing as a pre-existing condition anymore. Removing barriers to insurance access has turned them into chronic conditions that can be managed with appropriate, affordable healthcare. That means the healthcare system can shift more emphasis to providing quality care.

“Because we aren’t worried about coverage for people with chronic conditions, the ACA allows a lot of system transformation that improves other areas that support chronic condition management,” says Caitlin Morris, program director for Health System Transformation at Families USA.

For example, people with chronic conditions often see a number of different doctors and healthcare providers. This can be confusing for patients and providers, leading to duplicate tests and even duplicate treatments, which can be expensive and potentially dangerous in some cases.

Less fragmented care

The ACA is helping bridge the gaps that can lead to fragmented care, with provisions such as the implementation of electronic health records (EHR), which make it easier for providers to share information about a patient.

What’s more, the ACA is driving changes in the way providers are paid, to prioritize quality of care over quantity of care.

“Through the ACA, the Center for Medicare & Medicaid Innovation is testing ways to improve chronic disease management by paying for quality in outcomes,” Morris says, as one example. “The ACA puts an emphasis on high-value, coordinated care for patients.”

This system transformation will take some time, but it’s headed in the right direction. In the meantime, people living with chronic conditions who haven’t shopped for insurance under the ACA yet will find a vastly changed insurance marketplace.

Time to enroll

With open enrollment beginning again on November 1, 2015, Mitts encourages everyone to look at their plan options, especially people with chronic conditions.

“Think about the types of healthcare services you need to manage your condition and which plan is best for you,” she says. “It might be the plan with the least expensive premium, or it might be an option with a slightly higher premium but more up-front coverage you need to manage your condition, like doctor visits and prescriptions.”

Many plans now also include coverage of services to manage chronic conditions at low or no cost, something else to consider. Especially with the availability of financial assistance to help qualified consumers pay for coverage, the ACA is a real game-changer for many, Mitts says.

“Everyone should see what’s available,” she says. “Not only does it provide peace of mind for the unpredictable, it’s access to preventive care to ensure that you always stay healthy.”

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