Pulitzer Prize Winning Investigative Journalist
The Dignity of Medical Coverage
For mesothelioma and other asbestos-related disease victims, the Supreme Court’s landmark decision upholding the Affordable Care Act (ACA) should mean lifesaving medical coverage, according to Linda Reinstein, a mesothelioma widow and the co-founder and president of the Asbestos Disease Awareness Organization.
"As a mesothelioma widow, I think the Affordable Care Act will save lives and dollars for Americans who may have been exposed to asbestos” said Reinstein in an interview. “The continuation of primary care is essential for those exposed to asbestos and diagnosed with asbestos-caused diseases. Now they can be treated promptly and appropriately."
Reinstein, whose late husband Alan was diagnosed with mesothelioma in 2003, said that the recent decision would benefit victims and their families through two key provisions: the elimination of insurance company discrimination based on pre-existing conditions, and the abolishment of annual and lifetime caps.
"Eliminating the annual and lifetime insurance caps are significant to ensure expert medical care and maintain the patient's quality of life," Reinstein said, explaining that medical coverage for asbestos-related victims is often continuing and costly.
Millions of Americans Affected
Overall, the Supreme Court’s milestone decision upholding the ACA should translate into significantly enhanced medical coverage for tens of millions of Americans. As Reinstein stated, the key provisions will put an end to existing lifetime/annual expenditure caps and policy discrimination against people with pre-existing conditions. Both are specifically relevant for patients diagnosed with asbestos-related or other forms of cancer.
According to the Department of Health and Human Services, between 50 million to 129 million Americans under the age of 65 have pre-existing conditions, with cancer patients comprising a significant percentage of the group.
According to Dick Woodruff, vice president of federal affairs for the American Cancer Society's Cancer Action Network, many uninsured adults who die prematurely are cancer patients. "Without good insurance coverage, surviving cancer is very expensive or very difficult," Woodruff said in an interview with the Sarasota Herald Tribune. "There are currently 12 million cancer survivors in this country, all of whom have a pre-existing condition.”
Without the Supreme Court’s ruling, added Woodruff, “it's doubtful that those people, aside from the wealthy, would be able to afford treatment."
While it is tempting to look at the court’s decision simply in terms of the massive number of Americans that will benefit, its significance becomes truly evident when looked at through the prism of individual cases, where the effect on people’s lives is extraordinary.
In the wake of last week’s decision, cancer patients from across the country have come forward to tell their stories and talk about the positive impact the law will have on their mental and physical health going forward.
“The Dignity of Being Covered”
One is the story of Bev Veals, a 48-year-old North Carolina housewife with two children. She is a breast cancer survivor who was forced to go without medical insurance for an extended period, but who obtained coverage in 2011 under a key interim provision in the Affordable Care Act.
Over an extremely-trying 10-year span, the cost of Veals’ breast cancer treatments led to bankruptcy and foreclosure on her family’s home. Finally, four years ago, the out-of-pocket costs were so debilitating that Veals had to drop off the family insurance policy so their monthly payments could drop from an exorbitant $1,700 to an affordable $400.
Veals went the next two-plus years without health insurance, until 2011, when she became eligible for the stopgap policy offered by the Affordable Care Act that temporarily covers individuals previously denied coverage for pre-existing conditions. (This provision runs until 2014, when the pre-existing-conditions ban officially kicks-in.) She now pays $377 per month for her insurance.
Being covered again also produced a pronounced boost of Veals’ self-respect. "It has only been a little over a year for me, but I can't tell you the dignity being covered brings," Veals told the Associated Press.
"My biggest fear was I would have to beg for help to cover medical bills; Panhandling to pay a doctor's bill -- not my idea of the American Dream."
Veals’ experience has also had an impact on her political views. "As a conservative, I believed if you can't make your way, you don't get your way. Now I've cost more medically than I will ever be able to make. I've changed my political stance because of this," she said. "It doesn't do our economy any good when we have so many people having to file for medical bankruptcy."
Not Just for the Uninsured
The positive ramifications of the Supreme Court’s ruling can also have life-saving implications for cancer patients who have always had comprehensive medical coverage. One example is Robert, a 58-year old PhD from Brooklyn, who is a Shakespearean scholar and former Professor of English at Queens College.
Robert, who asked that his last name not be disclosed to protect his privacy, was diagnosed with lymphoma 8 years ago. He beat that, but was then diagnosed with mesothelioma four years ago. He currently receives chemotherapy treatments every three weeks for the disease.
Until now, Robert’s insurance coverage has never been a problem. He initially got his medical insurance through his employer over 20 years ago, well before he was diagnosed with the cancers. As there was a cancer history in his family, he wisely purchased a catastrophic supplemental plan at the same time, and this policy has proved to be enormously beneficial.
Robert is well aware that, in terms of medical coverage, he has been more fortunate than many of his fellow patients. “If I had tried to buy that Insurance Plan after being diagnosed with cancer, I would have been turned down. Now with Obamacare, a pre-existing condition would not disqualify me,” he said in a recent interview with this reporter.
But even for longtime survivors like Robert the Court’s ruling could be a lifesaver. “That Catastrophe/Supplemental Insurance plan, which luckily I held on to, has a cap or ceiling, which could be reached if my condition eventually requires expensive surgical procedures, like bone marrow transplants. Now with Obamacare, there is no cap or ceiling on benefits,” he said.
“The Result is Awesome”
Mailet Lopez, a 38-year old, Cuban-born Long Island woman diagnosed with breast cancer five years ago, said that for cancer survivors, the Supreme Court decision is tremendously beneficial for both their physical and mental health.
"The result is awesome" said Lopez in an interview with the Guardian (UK). "There is a buzz on Facebook and Twitter right now among my community. Because they all had cancer, they have been affected by the pre-existing condition provisions, and they don't need to worry about that anymore."
When Lopez was first diagnosed with breast cancer at the age of 33, she called the chemotherapy process "pretty terrifying". Lopez subsequently wanted to try alternative therapy, and her health insurance company allowed her to go out of network. Though she had to go out-of-pocket up front, she was eventually reimbursed for the treatment, which cost $20,000. She has been cancer-free for four years.
While Lopez had few problems with her insurance company, she was disqualified for a supplementary policy she wanted that her company offered. "There are so many loopholes for insurance companies who won't cover people with cancer,” said Lopez. "Even if you do have insurance, if you lose your job, you lose your healthcare and it is really, really difficult to get healthcare again.
Lopez feels that overhauling the current way most people get their medical insurance is crucial. “People have to stay with the same employer for the rest of their lives because they are afraid of losing their insurance. There aren't a lot of options," she said.
“I Don’t Know What I’d Do.”
Another example of the ACA’s extraordinary benefits is the story of Brian Rose, a 34-year old Wichita man and coach of a local minor-league baseball team. Three years ago, Brian was diagnosed with Stage 4 melanoma, a deadly skin cancer. The cancer has extended to his brain, bones and liver.
While Rose did initially qualify for emergency Medicaid coverage for his illness, the policy only lasted six months. Now, under the ACA, his monthly premium is $200, which is literally lifesaving, as his medical bills for the prior year exceeded $250,000.
Without that coverage; "I don't know what I'd do," said Rose in an interview with USA Today. Insurers had denied his earlier applications for coverage by designating his cancer as a pre-existing condition.
Having medical coverage has changed his outlook for the future and given him peace of mind. "I can't fathom the concept of not having any kind of health care," he says.
“But Is It Feasible?”
While the general reaction among cancer patients and their doctors has been overwhelmingly positive, some health care professionals have tempered their enthusiasm with caution.
One is Dr. Caroline Hastings, a pediatric oncologist at Oakland’s Children’s Hospital who has seen "hundreds" of cancer-stricken children denied adequate treatment because their parents’ insurance companies consider cancer a pre-existing condition and were subsequently denied coverage.
Though Hastings was elated with the Supreme Court decision, she was skeptical of how it would actually play out.
"It’s great,” she said in an interview with KNTV-TV in San Jose. “But how is it feasible? What insurance product will be available that is comprehensive and affordable? Or, I worry that the insurance that will be affordable will be like not having insurance at all."