Nov. 3, 2013 6:37 p.m. ET
Everyone now is clamoring about Affordable Care Act winners and losers. I am one of the losers.
My
grievance is not political; all my energies are directed to enjoying
life and staying alive, and I have no time for politics. For almost
seven years I have fought and survived stage-4 gallbladder cancer, with a
five-year survival rate of less than 2% after diagnosis. I am a
determined fighter and extremely lucky. But this luck may have just run
out: My affordable, lifesaving medical insurance policy has been
canceled effective Dec. 31.
My choice is
to get coverage through the government health exchange and lose access
to my cancer doctors, or pay much more for insurance outside the
exchange (the quotes average 40% to 50% more) for the privilege of
starting over with an unfamiliar insurance company and impaired
benefits.
Bloomberg News
Countless hours searching for
non-exchange plans have uncovered nothing that compares well with my
existing coverage. But the greatest source of frustration is Covered
California, the state's Affordable Care Act
health-insurance exchange and, by some reports, one of the best such
exchanges in the country. After four weeks of researching plans on the
website, talking directly to government exchange counselors, insurance
companies and medical providers, my insurance broker and I are as
confused as ever. Time is running out and we still don't have a clue how
to best proceed.
Dan Henninger is joined by Edie Sundby, a Stage-4
gallbladder cancer patient who is about to lose her 6-year-old medical
insurance policy under the Affordable Care Act. Also, Paul Gigot on the
Virginia gubernatorial race.
Two things have been essential in my
fight to survive stage-4 cancer. The first are doctors and health teams
in California and Texas: at the medical center of the University of
California, San Diego, and its Moores Cancer Center; Stanford
University's Cancer Institute; and the M.D. Anderson Cancer Center in
Houston.
The second element essential to my fight is a United Healthcare PPO (preferred provider organization) health-insurance policy.
Since
March 2007 United Healthcare has paid $1.2 million to help keep me
alive, and it has never once questioned any treatment or procedure
recommended by my medical team. The company pays a fair price to the
doctors and hospitals, on time, and is responsive to the emergency
treatment requirements of late-stage cancer. Its caring people in the
claims office have been readily available to talk to me and my
providers.
But in January, United
Healthcare sent me a letter announcing that they were pulling out of the
individual California market. The company suggested I look to Covered
California starting in October.
You
would think it would be simple to find a health-exchange plan that
allows me, living in San Diego, to continue to see my primary oncologist
at Stanford University and my primary care doctors at the University of
California, San Diego. Not so. UCSD has agreed to accept only one
Covered California plan—a very restrictive Anthem EPO Plan. EPO stands
for exclusive provider organization, which means the plan has a small
network of doctors and facilities and no out-of-network coverage (as in a
preferred-provider organization plan) except for emergencies. Stanford
accepts an Anthem PPO plan but it is not available for purchase in San
Diego (only Anthem HMO and EPO plans are available in San Diego).
So
if I go with a health-exchange plan, I must choose between Stanford and
UCSD. Stanford has kept me alive—but UCSD has provided emergency and
local treatment support during wretched periods of this disease, and it
is where my primary-care doctors are.
Before
the Affordable Care Act, health-insurance policies could not be sold
across state lines; now policies sold on the Affordable Care Act
exchanges may not be offered across county lines.
What
happened to the president's promise, "You can keep your health plan"?
Or to the promise that "You can keep your doctor"? Thanks to the law, I
have been forced to give up a world-class health plan. The exchange
would force me to give up a world-class physician.
For
a cancer patient, medical coverage is a matter of life and death. Take
away people's ability to control their medical-coverage choices and they
may die. I guess that's a highly effective way to control medical
costs. Perhaps that's the point.
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