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There is one group of health care users who are being buffeted hard, and totally unfairly, by this whole ACA rollout mess.

I am talking about the men and women who are currently in their states' assigned risk pools - most of whom are struggling with illnesses like metastatic cancer, multiple sclerosis, and end-stage heart disease.

Most of these people really do not need pregnancy coverage, or preventive screenings - they've already gotten their bad news - but they are paying for it in so many ways.

Let's look at one friend of mine, S. She is young - in her 30s, her husband runs a small family business, they have two kids.
And two years ago, the cancer had already spread by the time they found it.

So for the last two years, S. has been in the state's assigned risk pool; her family has a separate insurance package that meets their needs.

A couple of weeks ago, she got The Letter. The assigned risk pool coverage will no longer be available, and she has to go onto the exchanges to get insurance. Except, she can't get through the website. She may have finally gotten registered, but nothing is getting any better.

Now, I know that she lives in a state (not mine) where Medicaid is not expanding (not that she is eligible for it), and where there is no state exchange, and the navigators are being blocked. But none of that is her fault.

And this is bad. And she is very angry. And she blames Obamacare.

Ladies and gentlemen, this woman needs a break. She has enough to worry about, without the Dec 15 sword of Damocles hanging over her head.

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Comment Preferences

  •  This reads a lot like a letter from Ronald Reagan. (1+ / 0-)
    Recommended by:
    samddobermann

    My ex is a surgeon at Brigham and Women's. He supports Medicare for All. And, he's a Texan.

  •  Why isn't she blaming her state government? (5+ / 0-)

    Her state is the one who decided not to expand Medicaid.

    Her state is the one who decided not to set up their own exchanges.

    Her state is the one who is blocking the people who will help her find out what is best for her.

    Why is she blaming the ACA for the mess her state caused her?

    "That being said, I do agree I am going to hell. But for other reasons. Mostly boring tax stuff ' Amy Pohler

    by Annie B on Wed Oct 30, 2013 at 08:16:43 AM PDT

  •  Can she call the hotline? (0+ / 0-)

    Supposedly they can help you enroll from beginning to end by phoning the call center.

  •  Go to the main page for ACA, (11+ / 0-)

    click on the PHONE button and select the state and county to find all the local agencies that are prepared to assist a person in making application.
    All the public health clinics, planned parenthood and social security offices are prepared to help. Also, any number hospitals, as well as entities like Children and Family Services.
    The kerfuffle over the web site is a distraction created by people who want the endeavor to fail.

  •  No one is forced to use the exchanges (6+ / 0-)

    She can simply pick up the phone (she's got one of those, right? She knows how to dial it, too, I presume), call an insurance broker in her state, and ask for help selecting a policy.

    Before Obamacare, of course, she couldn't do this because no insurance company would cover her pre-existing condition.

    •  Risk pool coverage (0+ / 0-)
      Before Obamacare, of course, she couldn't do this because no insurance company would cover her pre-existing condition.
      I don't understand risk pool coverage but it seems that may be before Obamacare she didn't need to do this - so isn't it irrelevant?
      •  The assigned risk pools were terrible coverage (3+ / 0-)
        Recommended by:
        catullus, Glen The Plumber, elmo

        very high prices, very low benefits.

        I can appreciate the fear involved - and no one wants to deal with shopping for insurance while sick.

        But really, I think once the friend makes the calls/takes the time to find a new policy, she'll be relieved. And going forward, she'll have the option to change to a new plan if she doesn't like her current insurer or if her insurer drops her doctor - something she couldn't do before.

        Fry, don't be a hero! It's not covered by our health plan!

        by elfling on Wed Oct 30, 2013 at 09:26:33 AM PDT

        [ Parent ]

  •  Your friend (3+ / 0-)
    Recommended by:
    Lilith, elfling, catullus

    will almost certainly do better with an ACA policy.

    She is in an assigned-risk pool because, prior to 1.1.2014, no insurance company would cover her because of her cancer.

    She will instead be rated based on her age and residence.  As a 30 year-old, her premiums will be relatively low.

    "Well, I'm sure I'd feel much worse if I weren't under such heavy sedation..."--David St. Hubbins

    by Old Left Good Left on Wed Oct 30, 2013 at 09:18:19 AM PDT

  •  Your concern is duly noted. (3+ / 0-)
    Recommended by:
    elfling, guyeda, catullus

    Please tell your friend to have a little patience and wait a couple of weeks for the website to get cleared up.  Or if, she doesn't want to wait, then simply have her call the 800 number, or start looking at the individual insurer's websites in her area.  

    The ACA is not a website, the website is merely ONE of the ways of accessing the coverage guaranteed by the ACA.  

    Now, how about being a good friend and help her to use the resources that Kossacks have been advocating for weeks that doesn't include using the healthcare.org website.  

    Instead of pushing to have her returned to the high risk pool of insurance uncertainty.  

    not all those who wander are lost - J.R.R. Tolkien

    by Lilith on Wed Oct 30, 2013 at 09:23:26 AM PDT

  •  "They don't need pregnancy coverage" (7+ / 0-)

    That's one of the cries going around this week, that 50-year-old person does not need pregnancy coverage.

    Actuaries already know this and have already priced your plan considering that it's very unlikely you will become pregnant at age 50+. However, sadly, it is rather more likely you will need treatment for heart disease or diabetes than it was when you were younger.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Wed Oct 30, 2013 at 09:29:33 AM PDT

    •  ^^^This! (2+ / 0-)
      Recommended by:
      grover, Glen The Plumber

      I had a RW friend complaining that he should be able to pay less for his insurance because he and his wife didn't have any plans to have any more children. (Neither of them had any surgical intervention to prevent pregnancy)  This is after they had already had 5 children!  I pointed out the fact that they had already taken advantage of a lot of insurance monies for the previous 5 pregnancies and that well to be frank, it could happen again!  He was unmoved and remained adamant that he was getting ripped off.  /facepalm

      I'm so glad for you and your daughter, Elfling, hopefully you'll be able to find a good policy!

      not all those who wander are lost - J.R.R. Tolkien

      by Lilith on Wed Oct 30, 2013 at 09:58:09 AM PDT

      [ Parent ]

    •  Stupidest meme ever. (2+ / 0-)
      Recommended by:
      elfling, Glen The Plumber

      My husband isn't paying for pregnancy coverage. I'm not paying for prostate cancer coverage.  We don't pay for pediatric coverage since we have no kids.. If we try to put in claims for any of these, coverage would be denied (and we'd probably be investigated for fraud as a bonus).

      We buy coverage for disease/injuries we may incur. That's it.

      If I buy the identical policy from Allstate as my neighbor who drives a Ferrari, that doesn't mean Allstate will give me a Ferrari if I total my car.

      We are rated and insured as individuals (or families).

      People who repeat this meme are either incredibly ignorant or incredibly partisan. Or both.

      Given that most of them do buy some insurance at some point, though, I'm going with the latter. Or maybe they really hope to have Bill Gates' mansion/complex rebuilt for them if their homes burn down.

      /eyeroll

      © grover


      So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

      by grover on Wed Oct 30, 2013 at 01:20:59 PM PDT

      [ Parent ]

      •  I think they just don't understand how insurance (3+ / 0-)

        is priced and developed.

        If you're 50 years old, your insurance won't cost less if it doesn't have maternity or if you got a carve-out to exclude yourself from coverage for pediatric diseases. That is already built in to their calculations. They figure out what is likely to happen to you, have a cost factor for each of those things, and figure out what it costs to add someone with your allowably considered characteristics to the pool.

        Adding birth control didn't add to the costs, either, because birth control actually lowers the cost to the group in aggregate, if you are covering maternity.

        (Some huge percentage of births have ended up being covered by medicaid, which is its own whole other story. Births are absurdly expensive in the US, not really a cost that a twentysomething couple can just absorb any longer.)

        One of the most hideous carve outs is for durable medical equipment, which includes prosthetics. They know people didn't think to shop for that stuff. My friend the childhood cancer survivor had charities pay for her leg prosthesis when she was under 18, but after she was an adult, she had to pony up the $10k cost out of pocket every 5-10 years... out of her $15/hr salary.

        The large group plans don't have carve outs in the same way, usually. So they look the same on paper but in actual usage they're dramatically more valuable.

        Fry, don't be a hero! It's not covered by our health plan!

        by elfling on Wed Oct 30, 2013 at 02:07:06 PM PDT

        [ Parent ]

        •  Actually, even group policies (2+ / 0-)
          Recommended by:
          elfling, samddobermann

          Tend to only pay a portion of durable medical coverage. Usually it's 70-50%.

          It doesn't seem that bad, but if you're replacing prosthetics or even just CPAP equipment (some of that stuff is supposed to be replaced every few months), it gets costly really fast.

          Youre right. Folks have no clue.

          © grover


          So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

          by grover on Wed Oct 30, 2013 at 02:31:16 PM PDT

          [ Parent ]

  •  My daughter and I were uninsurable (4+ / 0-)

    even though our "conditions" were trivial.

    My insurance agent felt the high risk pools were so terrible that we were better off going without insurance than trying to apply for one... between the 18 month waiting period to enroll, the ridiculously low coverage limits, and the absurdly high premiums.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Wed Oct 30, 2013 at 09:31:47 AM PDT

  •  She will probably (2+ / 0-)
    Recommended by:
    Glen The Plumber, samddobermann

    get a better deal on the exchange. Has she called to find out?

    I almost went into the California assigned risk plan once. It wasn't a great deal at all - very expensive and there was an annual cap of $75k. It was better than nothing, but when something else came along I took it even though it was even more expensive. One major illness or accident can go through $75k in a heartbeat.

  •   I call bullshit on this diary. (0+ / 0-)

    This "friend" still has insurance until Jan. 1 and if she is still in treatment her doctor or clinic can help her get signed up.

    Or as pointed out by the commenters above there are lots of options to get coverage.

    Diarist seems to feel that having cancer excuses you from life but he gives no details. Is she in remission? Or is she on the verge of expiring? Apparently this "friend" has a husband; surely he could take care of this.

    I think this was for show by a troll. (at least for this purpose.)

    I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

    by samddobermann on Thu Oct 31, 2013 at 03:39:23 AM PDT

    •  Yep, troll. Next time, please ignore n/t (0+ / 0-)

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Thu Oct 31, 2013 at 03:43:45 AM PDT

      [ Parent ]

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