Death by Obamacare: Reform Reams Cancer Patients
by Robert Goldberg - The New York Post
November 12, 2013
Bev Veals, undergoing chemo at Duke Cancer Center, was in the hospital when she learned
that the president's "reform" was forcing her into a higher-cost health plan.
ObamaCare is supposed to be a huge boon for anyone with a pre-existing condition. Count that another promise broken: It’s actually denying care because of pre-existing conditions.
Millions of Americans with cancer and other chronic illnesses will wind up paying more for lifesaving care, if they can get it all.
To keep costs down, the White House designed ObamaCare plans as cut-rate HMOs. The low profit margins have forced insurers to downsize the number of doctors and hospitals in their networks — and to slash what they cover for out-of-network treatment.
So most ObamaCare plans don’t include the vast majority of the best cancer doctors and cancer centers. That’s a huge problem for these patients. As Dr. Scott Gottlieb, a former Medicare official, writes: “Cancer patients often need the help of specialized doctors and cancer institutions that won’t make it into many of these cheapened networks.”
All across the country, leading cancer centers — including New York’s Memorial Sloan Kettering — are excluded by the largest plans. In Washington state, the largest exchange plans exclude world-class cancer care for kids such as the Seattle Cancer Care Alliance. California’s state-of-the-art Cedars-Sinai cancer center isn’t in any ObamaCare plan. Only a few plans include the Mayo Clinic.
And if you want a doctor outside such networks, you’ll generally have to pay the full cost of care.
Many people will get better coverage at a lower cost under ObamaCare (after all, the feds are spending hundreds of billions on it). But most cancer patients will wind up paying more for less.
Take Michael Cerpok, a leukemia survivor in Fountain Hills, Ariz. Right now, his monthly premium is about half his monthly take-home pay. But the ObamaCare law forced his insurer to kill that plan for one that fits the law’s rules.
Now he’ll have to pay more for drugs, and his Mayo Clinic doctor is no longer in his network.
Last year, his treatment bill was more than $350,000, but thanks to insurance his out-of-pocket was only $4,500. Now, to keep his doctor, the one who has kept him alive for seven years, Cerpok will have to pay $26,000 out-of-pocket.
ObamaCare also stints on drug coverage, severely limiting the medicines plans cover. Many pre-Obama plans just charged a co-pay of about $50-70 a month for cancer drugs. Under ObamaCare, thousands of cancer patients will have to pay more than $2,500 a month for medicines.
Horribly, ObamaCare is limiting access to new medicines just as a revolution is delivering far better treatments. More than 40 new treatments target the genetic source of tumors, as opposed to older therapies that kill cancer cells after they spread. On average, ObamaCare plans cover only 10 targeted therapies, and insurers don’t have to add new breakthroughs until 2016.
A study by Avalere Health found that up to 90 percent of ObamaCare plans will force cancer patients to cover half the cost of new drugs until they hit the out-of-pocket maximum. By comparison, only 29 percent of non-ObamaCare employer-based plans do so.
Many patients will just give up. Another Avalere study found that people are four times more likely to stop using innovative therapies if they have to pay $500 or more.
South Carolinan Bill Elliott, 50, and a late-stage lung-cancer survivor, is looking at doing just that. He reports that premiums for his family will jump from $150 to $1,500 a month. His doctor isn’t in the ObamaCare network and neither are his medicines, so he’s thinking about stopping altogether, “pay the $95 or whatever fine and I’m just going to let nature take its course,” because he doesn’t want to burden his family.
Forget the Web site and other disasters: The ugliest part of ObamaCare is how it denies life-saving coverage to cancer patients. That isn’t a “glitch”; it’s a cruel and key feature of the law.
[NOTE: Robert Goldberg is vice president of the Center for Medicine in the Public Interest and publisher of valueofinnovation.org.]
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