The Affordable Care Act and Cancer

Politics aside, one of the emotional volleyballs that was tossed back and forth at the presidential debates is the Patient Protection and Affordable Care Act (ACA; “Obamacare"). Indeed, the reactions to ACA were so explosive it might be more accurate to compare it to a volleyball game using hand grenades.

When the plan passed in 2010, it phased in a number insurance options that were supposed to provide affordable health insurance for all Americans. Well, we all know there were major problems with that, and today a number of the insurance companies that offered ACA have now pulled out or raised the cost to the point that instead of being the Affordable Care Act, it should be called the “Affordable Care Act for those who can afford it.”

But aside from that part of the program, cancer patients and survivors need to look at two parts of the plan that have made our lives much easier.

Under ACA, insurance companies can no longer deny coverage because of preexisting conditions. Before ACA, insurance companies could turn down anyone who might cost them money in the future. This meant cancer families were often forced into job lock or marriage lock, unable to leave a job that provided no upward mobility or satisfaction to move on unless they already knew that their next job would be one with insurance that had no problem with preexisting conditions. This usually meant very large companies that could absorb the cost of employees that might actually use their health insurance.

Not very many people talk about marriage lock, but for women in marriages that needed to end, insurance for herself and her children has been a major issue. This could be because she had a preexisting condition or one of her children did. If the health care coverage is held by the man in the family, there is often little choice but for the woman to stay married. Now she has other options. Allowing children to stay on their parents’ insurance plan until 26 is another benefit that shouldn't be ignored for those who have experienced major illness or cancer.

Another implication has been coined by economists as "entrepreneurship-lock." Similar to the issue of job lock, workers are less likely to leave their position because of employee benefits. However, in this case they are not leaving for a separate job, but rather self-employment. As a result, workers stayed at jobs that didn't fully make use of their skills or give them opportunities for advancement or that, for whatever reason, made them unhappy. The need for insurance also prevented workers from trying to start their own business or taking a part-time job to spend more time with their family.

This is what happened to me. Before I was diagnosed with cancer, I had stopped teaching to care for my newborn daughter. My husband had become a consultant, and we had COBRA from his last job. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) added health care continuation requirements that applied to group health plans. In other words, you could pay to continue your insurance after you left a job -- at a considerable increase of premiums.

At that time, insurance was insurance to me. Sure, we were paying a huge price for COBRA, but I thought that was the way it was. I had never even filled out an insurance claim until then. When my daughter came six weeks early, I learned how to read that policy and all the things it didn't cover or paid only a certain amount and then we were responsible for the rest. You know those equations they give you that read something like this. This problem is covered 80 percent up to this amount and not to exceed regular and usual costs. And it turned out that the policy covered well-baby needs but not premature baby needs.

So, we charged her on a credit card to get her out of the hospital and I started looking for a good policy. It took a while but I found one that covered 80 percent up to a max of $1,000 and then 100 percent.

And then I was diagnosed with breast cancer.

So we had great coverage — and then six months later, the policy came up for renewal and the cost almost tripled. Ouch.

Luckily, I was getting ready to go back to work at a wonderful university that had a large enough insurance pool that I could find a plan that worked for all of us.

Another aspect of ACA I would like to see us keep for cancer families is the prohibition on lifetime or annual limits, the cap on the benefits you may get from your insurance company. The old insurance policies put a cap on what they paid out, and it stayed the same while the costs of having cancer grew. Even what is considered a good policy when 80 percent is covered, no longer has much appeal when you consider it is not unusual for treatment to cost upwards of $200,000. This means that your part is $40,000, and I don't know about you but I don't have that in my savings account.

According to one study, families with cancer are 2.5 times more likely to declare bankruptcy than those families without cancer.

Yes, there is no doubt the Affordable Care Act needs tweaking. But let's not lose these critical pieces.