Imagine what a nightmare healthcare scenario might look like.
You are diagnosed with a debilitating chronic disease while young. At first, you can’t even work because of it, and you are dependent on a family member’s insurance to help pay your medical expenses.
Eventually, your disease goes into remission, and you find a job with health insurance. You go off your family member’s plan. But your employer goes bankrupt, and you’re left with no job and no insurance.
Then you get another chronic disease.
You try the individual health insurance market, but the only insurance available to you comes from a high risk pool in which everyone else also has at least one chronic disease. The price is outrageous, but you pay the bill as long as you can.
Eventually, you can’t afford it, and you become uninsured for a few months.
You apply to your state’s Medicaid program for help. You are denied because your state has already spent all the Medicaid dollars the federal government has given it for the year.
You keep searching for work. When you finally land a new job, you are informed by your employer that it only offers a high-deductible, catastrophic-only insurance plan. You have to cover your basic health care needs, including annual physicals, prescription drugs, and counseling, out-of-pocket.
At least, you think, the plan will help with recurrences of your chronic conditions.
But then you learn that as a result of your earlier lapse in coverage, the company’s insurer refuses to cover you because of your pre-existing condition.
You’re out of luck.
You might call this nightmare far-fetched.
Or you could call it Mitt’s Plan.
Mitt Romney now has a plan to repeal the Affordable Care Act if he is elected President.
These are some of the mandates with which he would replace it:
- High risk pools for the chronically ill. These high-cost, unsubsidized private insurance plans for the sickest among us have been around for years, but have never enrolled many people because of their prohibitive costs.
- A law to prevent insurance discrimination against people with pre-existing conditions only if they maintain continuous coverage. If they ever have a lapse in insurance for any reason, insurers could use that lapse to deny insurance to them forever. Eventually, this could affect nearly everyone, because over one-quarter of the population has a lapse in coverage every year.
- A return of states to “their proper place of regulating local insurance markets” – but this would be accompanied by a new federal mandate that would gut state regulatory authority. The federal government would mandate that out-of-state insurers could sell policies in a state that don’t meet the minimum standards set by that state.
- A Medicaid block grant to the states. This will cap federal Medicaid spending each year. States will be forced either to pay a larger share of long-term and indigent care costs or to cap both Medicaid payments and enrollment.
- More managed care and fewer “fee-for-service” plans. Private insurers will be given even more power over patients and doctors to decide who is worthy of care and who isn’t – and no level of government will have the authority to put an end to this rationing of care in the interest of the consumer.
The resulting nightmare isn’t far-fetched. Candace Brown is already living most of it every day.
Candace Brown is a nurse. She was diagnosed with Crohn’s Disease when she was 30. She wasn’t able to work for three years, but was covered on her father’s insurance. Her disease finally went into remission, and she found a job with health insurance. However, she lost both the job and her insurance when the company went out of business.
Then she was diagnosed with depression, and struggled to find insurance afterwards because of her two pre-existing conditions. She finally found a plan that would accept her, but it now costs $1,200 a month.
She describes herself as “financially drained.”
I imagine she sometimes feels physically drained as well.
At least she hasn’t yet had to deal with being uninsured, but even that hasn’t come without stress. She’s afraid to let her coverage lapse to qualify for the Pre-existing Condition Insurance Program (PCIP) - which Romney also would repeal.
The only nightmares Candace has avoided so far – because they won’t be legal unless Mitt’s Plan becomes law – is a non-entitlement Medicaid long term care program someday and being dumped by her current insurer.
But Candace is a realist, and that’s why she is counting the days until ACA takes full effect.
Note: Candace Brown's story was published and made available by Florida CHAIN at the link provided in the column. More information about the work of Florida CHAIN can be found using the link. If you have questions about this column or wish to receive an email notifying you when new Our Health Policy Matters columns are published, please email firstname.lastname@example.org.