The 2010 Health Reform Law was instated in March 2010, officially titled the Patient Protections and Affordable Care Act. It was specifically designed to change the laws concerning America’s health care insurance coverage. Those with cancer are affected as it pertains to both cost and access to care.
America and Health Care
Both acceptance and resentment has been felt around the country concerning our government’s decision to instate health care reform. But what does this reform mean to cancer patients, specifically those with mesothelioma and other asbestos-related conditions and diseases?
Portions of the health care reform directly affect mesothelioma patients especially those interested in undergoing clinical trials, as well as those patients who are unable to obtain health insurance. The following is an overview of the portion of this reform that mesothelioma patients should take note of. This information was provided by both the American Society of Clinical Oncology, as well as the Kaiser Family Foundation. While the list is not exhaustive it does highlight those issues directly related to patients with cancer:
Private health plans are not allowed to place a lifetime limit (called a cap) on the dollar value of a person’s coverage. Subject to certain restrictions, insurers are permitted to place an annual limit on the dollar value of coverage until January 1, 2014, but will not be permitted to enforce annual limits after that date.
Insurers cannot take away coverage except in cases of fraud. Prior to this reform, insurance companies could revoke coverage for an error or technical mistake in a patient’s insurance application, which is now illegal.
How Will Health Reform Assist You in the Future?
Adults cannot be denied coverage for pre-existing conditions. (Effective January 1, 2014.)
Waiting periods for coverage greater than 90 days will be eliminated by January 1, 2014.
Those who do not have Health Insurance
Uninsured individuals with pre-existing medical conditions now have access to a temporary national high-risk insurance pool program. U.S. citizens and legal immigrants who have been uninsured for at least six months are able to enroll for coverage through this high-risk pool and receive subsidized premiums. (Effective until January 1, 2014.)
States must establish a website to help residents identify coverage options in a standardized format. This includes the federal government’s HealthCare.gov website, which provides information on the new law and insurance options for consumers.
Cancer prevention and risk-reduction strategies can lower the physical, emotional, and financial burden of cancer and improve the overall health of cancer survivors, including reducing the risk of the cancer coming back or the chance of a second cancer.
Most U.S. citizens and legal residents will be required to have health insurance beginning in 2014. Exemptions can be granted for financial hardship, religious objections, American Indians, those without coverage for less than three months, undocumented immigrants, people in jail, people for whom the lowest cost plan option exceeds 8% of an individual’s income, and those with incomes below the tax filing threshold. (In 2009, the threshold for taxpayers under age 65 was $9,350 for singles and $18,700 for couples.) Penalties for not having health insurance will be phased in beginning in 2014.
Medicaid coverage will be expanded to individuals with incomes up to 133% of the federal poverty level who are under 65 and who are not otherwise eligible for Medicare. (The poverty level was $18,310 for a family of three in 2009.) (Effective January 1, 2014.)
State-based health insurance exchanges will be established to help people and small businesses with the purchase of coverage. Premium and cost-sharing credits will be available to individuals and families earning up to 400% of the federal poverty level. The Office of Personnel Management, a federal government agency, will begin contracts with health insurance providers to offer at least two multi-state plans in each exchange. (Effective January 1, 2014.)
For Individuals Participating in Clinical Trials
As of January 1, 2014, insurers will not be allowed to limit or drop coverage to an individual choosing to participate in a clinical trial, and insurers will be required to cover the routine patient costs associated with participation in clinical trials. This applies to clinical trials to treat cancer, in addition to other life-threatening diseases. This is especially good news for patients diagnosed with mesothelioma as this particular cancer often investigates new treatments and drugs through the application of clinical trials. Clinical Studies remain a ray of hope not only for those currently afflicted with the disease, but for the treatment and possible cure of the cancer as a whole.