As a patient living with MS, maintaining affordable health care insurance is important to me and my family.  Having proper access to care can mean the difference between my disease progressing and maintaining a normal quality of life. With the Patient Protection and Affordable Care Act being upheld by the Supreme Court, there are going to be positive changes for people living with all chronic illness (not just MS). This blog hopes to educate readers to some of the key benefits for people living with chronic illness.

To this author, the most important benefits revolve around access to health care services. Prior to the PPACA, insurances had the right to deny a person coverage based upon pre-existing conditions.  Currently, for an insurance company to accept a person with a preexisting condition, that person would be subject to higher premiums.  This makes it cost prohibitive for a person with a chronic illness to get sufficient coverage unless that person is covered by group health insurance benefits.  The PPACA (2010) aims to reform these restrictions granting more affordable health care access to people with preexisting conditions.

The PPACA section 1201 (PPACA, 2010, p. 5) states, “no group health plan or insurer offering group or individual coverage may impose any pre-existing condition exclusion or discriminate against those who have been sick in the past.”  As a person living with Multiple Sclerosis, this author understands the importance of being covered with health care insurance.  The cost of the medicine to manage the Multiple Sclerosis is $8,000 per month.  When this author was employed by Banner Health and covered by large group benefits, the out-of-pocket expense was $30 per month. However, when this author switched to a smaller company with less inclusive benefit structure, the out-of-pocket costs have jumped to $2,500 a year for me and $2,500 for my family.  This created a huge financial burden because my entire deductible comes due on renewal due to the cost of the medicine.  It is June and we are still paying December’s medical bills.

Insurance decisions also made me sacrifice quality. In order to reduce the infusion cost of the drug, this author switched from being infused in the hospital to a standalone infusion clinic with less extensive resources.  In addition to having a higher out-of-pocket expense, the quality of service has been reduced by switching from a large company with big group benefits to a small company with more expensive benefits.  Even with the higher expense, this author must maintain a job to get the medicine that sustains his quality of life.  If this author was to lose his job, he would be a preexisting condition that would not be able to afford insurance and his condition could progress to the point where he would become indigent and a burden to the state.

The PPACA aims to change that.  Now, a complicated MS patient can obtain health care insurance without being judged for having a preexisting condition.  According to the lecture notes (PPACA, 2010, p. 2), “any individual, even those with preexisting conditions, can gain access to health care coverage with a maximum of $2,000 out-of-pocket for the individual and $4,000 for the family.”  In some cases, as in the case of this author, persons with preexisting conditions could become self-employed and still gain access to health care coverage which would have been too cost prohibitive without the PPACA.

There are both strengths and weakness to the reform instituted with the PPACA.  One of the key improvements is that people with preexisting conditions will not be excluded from insurance coverage.  Another benefit is that insurance will be capped at affordable prices. The key liability, however, of this is that everyone will now have access to health care appointments creating more demand for services.  This can lead to longer wait times.  Another liability is that the government is forcing everyone to carry health care insurance and penalizing people who do not participate.  To meet the increased demand, Accountable Care Organizations will be created with the doctor serving as the point person, but routine medical appointments may now be deferred to nurse practitioners and physician assistants.  This reform is still in its infancy and more measures are going to come into effect in 2014.  Time will tell whether or not the reform of the PPACA is an improvement or liability, but for those with preexisting conditions, like this author, and those who can’t afford health care premiums this is a welcome change.

Reference

PPACA. (2010, December 10). The patient protection and affordable care act. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/LegislativeUpdate/downloads/PPACA.pdf