Healthcare Changes : Restarting the discussion with a few more ground rules.

The new healthcare laws that are being rolled out now, and over the next several years, will affect the members of this forum in a number of profound ways, for better or for worse. Its a subject we ought to be able to discuss. I recently locked a thread intended to generate such discussion because, while everyone was trying their best to keep it out of the political weeds, I could see which way it was heading and it was only a matter of time.

But it is an important topic. So, let's take another stab at it, this time with some ground rules. Here they are:

• All discussion must be actionable advice for members of this forum (as members of this forum).
• Theoretical discussion must serve the purpose of explaining benefits to members of this forum and must include specific actions to be taken in order to take advantage of such benefits.
• If you think the new laws are good (or bad) for America take your opinion somewhere else. Your mods will delete it.
• If you think the new laws are good (or bad) for the medical community, or for the voting public, or big pharma, etc., etc., ditto.
• Try to give as much helpful advice, with as little spin, as possible.
• I'm hoping John T will let me hijack his Healtcare Locked? thread for discussuion of these guidelines. Don't complain about them here
• The original locked thread is here. Feel free to read it, a number of interesting ideas were expressed.

Thanks.

www.cancer.org/myacs/eastern/areahighlights/affordable-care-act-six-ways

The Society has a staff of trained experts available to answer questions, free of charge. Our toll-free, cancer information hotline is available 24 hours a day at 800.227.2345


American Cancer Society celebrates six-month anniversary of law; offers free answers and support for people with questions

It's been six months since the Affordable Care Act was signed into law and the measure will meaningfully improve the health care system for people touched by cancer. To mark the six-month anniversary, the American Cancer Society has prepared a list of the top six cancer-fighting provisions in this law.

1) More cancer survivors can now get care - High-risk pools have been established in every state to provide coverage for the uninsured. The program launched on July 1st and is providing immediate access to coverage for people in every state who have been uninsured for six months or more and have cancer or another pre-existing condition.

2) No more “doughnut holes” - The Affordable Care Act is finally closing the Medicare Part D “doughnut hole”. Immediately after enactment, the law provided a $250 rebate to seniors who hit the coverage gap in Medicare’s prescription drug program. In addition, Medicare beneficiaries will receive discounts on brand-name drugs next year, and the coverage gap will be closed completely by 2020.

3) “The kids are all right” – Mantra from the old song by The Who can be applied here. Health plans will be prohibited from denying coverage to children up to age 19 with pre-existing conditions such as cancer. So if you have a child who is a survivor you will no long have to worry about their insurance if you change jobs.

4) The well won't run dry - Health plans will be banned from setting lifetime dollar limits on coverage, ensuring that people with cancer have access to needed care throughout their lifetimes. Annual dollar limits on coverage will be tightly restricted for most plans and will be eliminated altogether in 2014. Patients will no longer have to put off treatments waiting for the new plan year to start.

5) In sickness and in health – Just like marriage, your health plan now takes a vow to you when they take your business. As of this week, health insurers will be barred from dropping people from coverage when they get sick. In other words, you can’t lose your insurance for developing cancer.

6) Prevention, prevention prevention – Also new this week, coverage will be guaranteed and out-of-pocket costs will be eliminated in new insurance plans for proven preventive services, giving people access to lifesaving screenings for breast, cervical, and colorectal cancer.

While major reforms to health care can seem confusing and even overwhelming, you’re not alone. Your American Cancer Society, the official sponsor of more birthdays, is here to help. The Society has a staff of trained experts available to answer questions, free of charge. Our toll-free, cancer information hotline is available 24 hours a day at 800.227.2345. We’ve taken the politics out of the debate and boiled down the facts cancer patients need to know.

The debate on reforming health care is far from over, but these six real-world benefits alone will have a positive impact on the lives of people battling cancer, bringing us all one big step closer to guaranteeing access to affordable, adequate health care for all Americans.

It will be interesting to see how the ACS updates the links. These are five years old, general, and a lot has changed in that timeframe. I would depend more reliably on state operated sites and the federal websites, understanding that the latter is still a work in progress. I know the hype, but third party websites are unreliable from my personal experiences with them on the topic. Soon we will have better information such as costs, coverages, formularies and providers from the carriers and that too will be very important to each individual case. It's at the rubber meets the road level that all of us will better understand the legislation. To date, I know of no personal experiences.

Tony

Peter,
For the sake of keeping idealogical arguments out of the discussion I think the rules are acceptable. I'm confused as to which thread to post to using the new rules. Please clarify or start a new thread.
thanks,
JT

Whoops.
I forgot one more ACA question from the call to the ACS.

> Is there any more information available on the ACS website on ACA? You can go to our website and use the search box and enter "Affordable Care Act" and get information there.

Here were those results:

www.cancer.org/search/index?QueryText=affordable+care+act

Tony

I have Medicare (No Part D) and federal retiree Blue Cross . From what my retiree organization states, ACA will not affect me directly. I keep the same insurance and don't have to obtain anything new.

From the Medicare site itself:
www.medicare.gov/about-us/affordable-care-act/affordable-care-act.html

I just called the same 800 number. I explained that I just had to let go of an employee who has a pre-exisitng cancer condition and that she cannot afford Cobra. That she was Hispanic and that I was looking to get her help in navigating her cancer situation vis-a-vis available health options come January with the ACA.

I the next five minutes he said:

I can give you some general information but you would do best to talk directly to our "Health Insurance Team" who can help her navigate through her options under the ACA in her specific State. They are open 7am to 6pm central time M-F. The service is also available in Spanish if she wants to call directly.

He then said that the ACS might also be able to help with private pools which "of course were the only option for cancer patients without coverage before the ACA came along". I asked him what exactly he meant and he reiterated that before the the ACA came along cancer patients without coverage had "very limited options".

He then suggested I go to the ACA Website for further info until Monday but warned that some complain about the efficiency of the Website. I told him that I was actually able to get a tentative quote on the site in about 3 min through the Kaiser link and he chuckled and said "yeah, there is a lot of bad information out there about this whole thing".

Perhaps is a matter of asking the right questions.

Just Saying...

Post Edited (davidg) : 10/26/2013 3:16:00 PM (GMT-6)

I am just waiting for the shoe to drop when my company starts scaling back on my benefits to get below the dollar amount so they don't have to pay the excise tax. It's not a matter of if, it's a matter of when. For years we gave up raises to have better health care, this is real, this will hurt my pocket. I am someone as I'm sure there are others on HW that will be adversely affected by the ACA.

No one really knows what the unintended consequences of the ACA will be. We have already seen some with the individual mandate and will certainly see much more when the employer mandate becomes effective next year.
Those who will benefit will be those without insurance that are at or below the poverty level. So far we have seen about 85% of those that have actually enrolled are enrolled in the Medicaid program and not in the private insurance program. This will be problematic if this ratio continues as private insurance companies will abandon the exchanges or raise rates significantly. For the program to work 7.5 million young healthy individuals must enroll in the private insurance programs.
For most above the poverty level who have private plans their insurance premiums will increase significantly as their plans change to cover the mandated coverages by law. Some of the mandated coverages are birth control, maternity care, mental health, no caps and screening. We do not yet know what changes there will be in employer provided health plans, but it is certain that some employers will discontinue coverage and move employees to the exchanges.
When all is said and done there will still be an estimated 15 million people without insurance, so this is not universal coverage by any means. There will be about 15 to 20 million people that didn't have insurance that will now be covered, mostly through expanded Medicaid.
The ACH was projected to cost $900 million, current projections are in the $1.6 billion range, but no one really knows the real cost. To pay for this, $750 million was transferred from Medicare and this will affect the seniors on this board. The remainder will be paid by taxes on medical devices and taxes on gold level insurance policies that are supplied by many employers and unions. It is unsure how the over run in cost will be paid; most likely it will be rolled into the deficit.
It is stated that many employers will convert full time employees to part time, but there is no evidence that this is occurring at this time. There is some evidence that many small business have made the decision to stop hiring at 49 employees, how this will affect the economy is unknown.
It is reasonable to expect that wait times for doctor's visits will increase and that some doctors will not accept some of the new insurance plans. There is a lot of evidence that this is happening.
Emergency room visits will be unaffected by the ACA. Most emergency room visits are by patients who have chronic conditions and are already under a doctor's care, but fail to take meds or follow their doctor' instructions.
So how will this affect us with PC? Those at the poverty level and under 65 will have coverage through expanded Medicaid. Those on Medicare will see some reduced services and doctors not taking Medicare because of the transfer of funds from Medicare to the ACA. Many on private plans will see their premiums increase and budgets will have to be revised. A few will have to find new doctors. Many will see their taxes increase. Until the employer mandate is in effect we simply won't know what the other effects will be. The vast majority of Americans have insurance through their employers and it would be prudent to expect some changes.

John T, your last post was spot on - kudos to you. There is much that still needs to be learned about where our healthcare is going, including how much this will cost the average American who is not eligible for subsidies.

We (my husband and I) considered ourselves pretty healthy and are finding that under our current health insurance plan - which is called a consumer driven (high deductible) plan through United Healthcare - many of the medical expenses we have are not covered until the deductible is satisfied: John's annual PSA test is one of them, as is his annual visit with the urologist. My annual endocrinologist visit with sonogram (I've been diagnosed with Hashimoto's disease, a form of hypoactive thyroid) and the usual thyroid blood tests are also not covered until the deductible has been met. I have a minor eye emergency that required me to see the eye doctor right away, and a cyst was found on the inside of my eyelid and needed to be lanced (or whatever the doctor did)...that visit is out-of-pocket for me as were the very expensive eye drops and ointment that were prescribed.

My annual ob/gyn visit is coming up, along with the accompanying mammogram, pap test and a bone density test. I called the insurance company to see exactly what would be covered. The insurance rep asked if the mammo, pap test and bone density were for screening purposes - yes they are. If they're screening tests, they're covered 100%. If I need a follow-up mammo for diagnostic purposes, that won't be covered and comes out of my deductible. That just doesn't make sense to me: you pay to find out if I have a lump in my breast but you won't pay to investigate that lump. I imagine that the same would be true for prostate cancer: the biopsy and "diagnositic" PSA and other tests fall under the deductible.

142, Sorry to hear about your insurance battles.  That's a tough situation and I congratulate you for being able to handle it as you do.

As for this thread, I'm not saying anything, except this:  it seems to me that folks are at liberty to say anything about the ACA, so long as it's positive.  If they say anything that sounds like a criticism or if it's in any way negative, that's "political" and threads start getting locked.

So, I'll just take a wait and see position.  So far, all has been good for me.

142,
So far I don't see political overtone except by the data posted by perceptions. I do see why this is a tough subject. The press, depending on which press you read, is divided, the patients here are divided, and also the information posted is divided. I think where one reads what they read will get drastically differing data and that the truth lies in between the expression of these sides. These comments may help us find the truths.

So far I posted what I have seen, complaints from Nevada about the Medicaid enrollment, and my own experience of the most drastic changes in my policy, to the very needed help to those that lack insurance and assistance that I see frequently as a support group leader.

In this thread it should be limited to how it pertains to prostate cancer. In the forum I proposed to Peter Waite I offer to give those who wish to contribute the opportunity to voice themselves.

An opinion that can be made that could be construed as political should not be automatically done so by our members. Instead, this topic, which is very important, as important as our care, should be viewed as positive feedback.

We can discuss a topic like this as long as we can remove ourselves from our political alliances. Otherwise this discussion will deteriorate quickly.

Tony

Tony - I think you hit it squarely. Many of us, me included, will make our comments base don our perceptions and our beliefs, and yes, our sources. I am European, from NYC, and I read The Guardian, you can imagine where I fit in... Not everyone seems to be capable of being as unbiased as say John T and Allen.

I think if we take the above as truth, and we factor in that it is quite possible that the ratio on this forum (as with all forums) politically is quite possibly 75% to 25%, then you run the risk of the shared perceptions, or "psychic unity" will turn it into a bash fest against the minority that is being represented.

That's just a genuine thought, nothing meant by it.