Sunday, July 1, 2012

Affordable Care Act and Cancer

On Thursday, the Supreme Court upheld the Affordable Care Act (ACA) by a 5-4 vote.  Surprisingly, John Roberts sided with the four liberal justices to make the majority.  Everyone was expecting that if it passed, Anthony Kennedy would have been the swing vote.  In today’s New York Times, Tom Friedman states about John Roberts “It’s the feeling that it has been so long since a national leader ‘surprised’ us...I think it was inspired by a simple noble leadership impulse at a critical juncture in our history – to preserve the legitimacy and integrity of the Supreme Court as being above politics” This post is not meant to be political – it is about the healthcare system and how it works when you have cancer or any other pre-existing condition.

Brian McFadden - The New York Times

Currently, my health insurance is mostly paid for by my employer. I contribute a portion to the cost through payroll deductions, insurance company deductibles and out of pocket expenses.  Since I am asymptomatic, I have told no one in my department that I have cancer and don’t intend to unless I need to take time off for sick leave.  My company’s benefits department must know that I have cancer since it shows up in the company’s insurance costs.  If my company downsizes and I am terminated, I could receive COBRA for 18 months. But due to the cancer diagnosis - a pre-existing condition, I am virtually uninsurable.  I am ineligible for Medicare for another 12 years (age 65) and I am not poor enough for Medicaid.  The Affordable Care Act (ACA) will allow me to get medical coverage should I be jobless and not out on disability.  This is a huge benefit and relief to me as a cancer survivor.  My cancer costs have been running about $70,000 annually and I am only taking monthly shots of Sandostatin and getting semi-annual scans – no surgery, chemotherapy or other treatments for the disease at this point.  I have no idea how much it will cost for me to get into one of the pre-existing condition insurance pools but I have to believe it will be substantially less than the $70,000 per year my insurance company is currently paying for my treatment.

There is another issue that is a concern to me as an employed cancer survivor and unrelated to the ACA: What might I need to do if I wanted to change jobs?  Suppose I interview for a new job and they want to do a pre-employment physical?  I know the new company will not hire me if they know I have cancer. Is it appropriate to handle it with something similar to “don’t ask, don’t tell”?  Should I not mention the cancer drugs I am taking if asked? This worries me as I am not sure if the new employer would know I have cancer before I got hired. But not disclosing my situation and then signing up for their health insurance could get me fired.  If I am in one of the pre-existing condition insurance pools that are part of the ACA, do I still have to worry about this?  These are things I think about as Wall Street continues to downsize and consolidate or if a better job prospect comes up.  Having a pre-existing condition is a big problem from an insurance and employment perspective. I am hoping the ACA will help me if I ever need insurance if I am unemployed or retired before age 65.