How To Navigate Health Care Reform and Cancer Survivorship

Even with all of the attention that has been paid to health care reform in the news outlets, there is still confusion about what is actually in the law. Read on to learn about what healthcare reform means for you.

The Patient Protection and Affordable Care Act of 2010 (ACA), also known as health care reform or Obamacare, was a landmark law designed to improve the affordability and quality of health care in this country. Although it was passed in 2010, there are still many parts that won't be in effect until 2014 - 2020. However, many of the provisions that were designed to protect consumers are already in effect.

What has happened so far & why does it matter to those with cancer?

1. Lifetime limits on insurance plans prohibited.

Many insurance plans had limits on the amount of benefits someone could use during each year, or over their entire lifetime. These benefit limits were very easy to reach, especially when you were being treated for a serious medical condition, such as cancer. Once a limit was reached it left that person virtually uninsured and with limited options. As of September 23, 2010, insurance companies are no longer allowed to impose lifetime limits on payments for essential health benefits. Although we are still waiting on states to define the details of essential health benefits, they generally include items associated with cancer treatment, such as emergency care, hospitalization, prescriptions, and ambulatory care.


2. Annual limits on insurance plans restricted.

Until 2014, insurance companies may still impose some annual limits on your benefits. However, annual limits on essential health benefits cannot be less than $1.25 million this year and $2 million until 2014.


3. Rescission of health insurance plans are prohibited.

In the past, insurance companies often cancelled individuals' policies, if they got sick. The ACA prohibits insurers from canceling someone's plan unless that individual failed to pay the premiums, committed fraud, or made an intentional misrepresentation of a material fact (i.e., lied about something very important) about their medical history on their initial application for coverage. The bottom line is that people no longer have to worry about losing their insurance after a cancer diagnosis, if they were honest on their application.


4. Adolescents and young adults will be able to stay insured under their parents' plan until they are 26 years old.

Young adults who are transitioning from school to the working world are often left without affordable health insurance options. Under the ACA, as of September 23, 2010, all adolescents and young adults can be covered under their parent's health plan until they are 26 years old, unless they are eligible for their own employer-sponsored health insurance. Starting in 2014, even if they are eligible for employer-sponsored insurance; they will still be able to stay on their parent's plan.


5. Children under the age of 19 cannot be denied health insurance because of a pre-existing condition.

Prior to the ACA, health insurance companies were able to charge higher premiums or even outright deny selling coverage to someone with a pre-existing condition. Now, children under the age of 19 cannot be denied health insurance coverage because of a pre-existing condition and the same will be true for adults, starting in 2014. Also, in 2014 insurance companies will be limited in what they can consider to establish premiums. Specifically, insurance companies will only be able to look at the type of plan you are purchasing (i.e., individual or family plan), your age, your tobacco use, and your rating area (zip code) to determine how much you will be charged for insurance coverage.


6. Most insurance companies must cover preventative services without charging co-pays or making policy holders meet their deductible.

The hope is that this rule will make cancer screenings, and other preventative services, more accessible to people with insurance.

What's Next?

As we quickly approach 2014, there is still quite a bit that needs to happen in order to fully implement the ACA. For example, states need to establish health insurance exchanges. These exchanges are meant to be a place for individuals and small businesses (less than 50 employees) to be able to shop for and purchase health insurance. Not only will these exchanges offer plans that are presented in a clear and standardized manner, but consumers will be able to have peace of mind that they are buying insurance from legitimate companies. Additionally, the ACA gave states the option to expand Medicaid coverage to individuals who are at or below 133% of the federal poverty level ($14,856/year in 2012). So, states have to decide if, and how, they are going to expand Medicaid coverage. The federal government also has to come up with a plan to enforce the individual mandate, the requirement that most Americans have health insurance, or pay a penalty.

All of this, however, is somewhat in flux. In its decision last month, the Supreme Court of the United States upheld the most controversial provisions, the individual mandate and the Medicaid expansion, as constitutional. But there is still quite a bit of disagreement about the law. One presidential candidate and many congressional candidates have declared that if they win their elections in November they will work to repeal the ACA. If the law is repealed, it is unclear what would happen to the rights and benefits that have already been put in place.



(Photo courtesy of I Had Cancer)