“Lies” are what Senate Majority Leader Harry Reid calls the television ads complaining about Obamacare. But the people in those ads are not liars. They have pre-existing conditions and can’t see the specialists or get the medications they need. They’re the people President Barack Obama claimed he would help, but instead they’re getting hurt.
They had insurance, but their plans got canceled because of the Affordable Care Act, forcing them into Obamacare. Now they’re discovering that Obamacare plans are not for sick people. They offer “free” mammograms, “free” colonoscopies and “free” contraceptives, meaning there is no copay. But if you have cancer, multiple sclerosis or Parkinson’s disease, you’re in trouble. Most plans skimp on specialists and life-saving medications.
Dr. Jeffrey English, a Georgia neurologist who treats patients with advanced MS, worries that patients who switched to exchange plans will deteriorate rapidly. Some plans refuse to cover six out of the 10 drugs that can treat MS, including drugs most effective at staving off irreversible paralysis.
“Obamacare is a throwback to the old HMO model of the 1990s, which promised a broad package of coverage for primary-care benefits like vaccines and routine doctor visits. But to pay for these benefits, the Obamacare plans skimp on other things, principally the number of doctors you’ll have access to and also the number of costlier-branded drugs,” explains Dr. Scott Gottlieb, a practicing physician and fellow at the American Enterprise Institute.
Bells and whistles, but inadequate access to care. Like a car with leather seats and Bose speakers, but a lousy engine.
Most exchange plans exclude the academic medical centers cancer patients look to when their local hospital runs out of answers. Dr. Katherine Albrecht, who lives in Nashua, N. H., developed stage 3c breast cancer that spread to her lymph nodes in 2011. Her local hospital told her to get her affairs in order. But her Anthem PPO health insurance allowed her to go to Dana-Farber Cancer Center in Boston, where she was successfully treated, and afterward, to Weill Cornell Breast Center.
Late in 2013, Albrecht’s insurance was canceled because it didn’t include Obamacare mandates, such as maternity coverage. But Obamacare-compliant policies in New Hampshire won’t cover care at 10 of the 26 hospitals in the state, and none outside the state. Albrecht says, “Under Obamacare, I’d be dead.”
Recently, the president urged Organizing for Action volunteers to enroll as many people as possible in Obamacare before the March 31deadline. He called it “God’s work.” Really? Maybe helping the uninsured is God’s work. But not convincing people with health problems to move into plans that won’t provide the care they need to stay alive. In the private sector, this would be fraud. It takes politics to a new low.
In February 2013, the Obama administration whacked people with pre-existing conditions even more by suspending the cap on out-of-pocket expenses, originally set at $6,350, for an individual beginning on Jan. 1, 2014. Theodore M. Thompson, vice president of the National Multiple Sclerosis Society, said, “The promise of out-of-pocket limits was one of the main reasons we supported health care reform.”
Without the cap, an MS patient on Copaxone, which costs $6,000 a month, will have to spend about $1,500 to $2,000 every month for the copay on that one drug alone. Unaffordable for many.
Before the Affordable Care Act, nine out of every 10 patients with pre-existing conditions had coverage. They got it through an employer-provided plan, Medicare or Medicaid without discrimination. Only the individual insurance market allowed insurers to charge sick people more or turn them away, and even in that market, most got covered. Nationwide, only 2 million to 4 million people with health problems needed help getting insurance. That’s about 1 percent of the population — a small, fixable problem.
Obamacare will make it bigger. As millions lose on-the-job coverage this year or next and get pushed into Obamacare, those with pre-existing illnesses will have the same difficulty getting care as the patients in the television ads. It’s no lie.
Betsy McCaughey is a former lieutenant governor of New York and the author of “Beating Obamacare.”
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