Does anyone know how next year's new health care will affect us, and what we can do?

[loayachil]

Yes, everyone one of is in the US have been hearing in the news since forever the new health care laws that will be starting in 2013, and realistically, noone has read it or really knows what's in it.

From a CFS/Lyme patient, I am curious in how this in the short run will affect us? Will treatments/doctors that we used to pay for become subsidized (that will be nice), or will some treatments/doctors that insurance might have paid for now be considered "not necessary"?

I used to have Carefirst which more or less reemberesed for most of everything, and curently have Aetna which more or less reimberses for nothing. I am currently paying around $500 for specialist visits and around $1500 monthly for supps and drugs out of pocket.

And between those of us who either have insurance or run the gambit of having garbagy to excellent insurance, the new laws will affect us enormously.

My gut tells me that since the CDC and the NIH are not major fans of either CFS (beyond cbt) nor Chronic Lyme (beyond a two week treatment of antibiotics), I think that we will be in for a less smooth ride in the coming year.

Therefore, I am posing to the group, does anyone know details about the new health care laws in a way that we can maxmize its usage or at least prepare us for it. Are there doctors/protocols/whatevers, that we can somehow register with or sign up to or do something (yeah you can tell I have no idea) before 2014 comes so we can be prepared and not be caught behind the proverbial 8 ball?

Thanks,
Lo

 

[camas]

You might find this timeline of the Affordable Care Act helpful.

I would think the only concern would be making sure you have a good primary care doctor in place. As more people have access to health insurance come 2014, PCPs may be harder to come by. I hope you'll be able to find better and more affordable insurance under the new health insurance exchanges. Here's where you can learn more about the exchange in New York.

 

[Junto]

Since CDs/me/fibromyalgia is not "life threatening", I believe our care will be de-prioritized. We have to be informed and take our health into our own hands. If you frequent this site, your likely already doing this. With so many motivated and smart people here, I think well eventually come to a "cure" without the help of the FDA or allopathic medicine.

 

[WillowJ]

I think it will be hard to tell until it happens. There is a board which will have some power to decide what will be covered under insurance, and my understanding is that insurance coverage will become more standardized.

Conjecture: Unfortunately I think this will look more like Atena than like the good insurances, because the mandate will be to save money. There will probably be some conditions with a good lobby who may be able to get treatments better covered, but that is not us.

http://www.forbes.com/sites/scottat...nt-obamas-nice-way-to-ration-care-to-seniors/
IPAB: decision-power for coverage in Medicare and all other insurance. Specific direction: reduce health spending, though this is defined as "not rationing". whatever.

Administrator of Medicare and Medicaid, Donald Berwick, officially appointed within a few months of the bill’s signing. Berwick proclaimed to the NHS in 2008 that individual choice is not appropriate in structuring health care – “that is for leaders to do”

Beginning January 15, 2014 and every year thereafter, the law requires the board to submit specific recommendations to the President and Congress to “slow the growth” in national health expenditures. However, decisions by the panel are not simply recommendations to Congress; if the Senate, the House, and the president do not concur on an alternative proposal, or if Congress does not act at all, the HHS Secretary is required to implement the board’s recommendations. The Secretary’s actions are immune from any administrative modification, presidential veto, or judicial review.

http://www.nejm.org/doi/full/10.1056/NEJMp1006344

In addition, the rate-regulation section of the ACA may have further implications affecting medical practice and patient care. Insurance premiums are directly related to the cost of medical care, and the increasing cost of care is a major factor in premium hikes. As government entities begin to monitor and limit plans that seek “unreasonable” premium increases, insurance companies will have new incentives to try to eliminate unnecessary costs. This effort, in turn, will create concerns for physicians regarding decreased practice revenues and more administrative hassles in obtaining treatments for their patients.

(I don't know what profits they are talking about earlier in the article. 250% sounds like a lot of increase, but it depends what 250% is a percent of. Standard profit across industries in USA is 10%. Insurance companies typically make 2-3% profit [I suppose even the nonprofits lodge 2-3% excess; they have to or else they would be going out of business - having a deficit is bad, and they can't predict everything so it's better to be a little over than to end up owing money one doesn't have], and perhaps as much as 7% (this is what some CA companies asked for a few years back)...

the bigger the company, the bigger the percent will look in dollars, but also the bigger the overall outlays they will have in terms of payroll, supplier costs, etc., and there does need to be some buffer in case of stuff going wrong... the executive compensation could be another story, though; there is a lot of room for debate there!)

http://www.chcf.org/~/media/MEDIA LIBRARY Files/PDF/R/PDF ReadyReformHealthInsRegulationACA.pdf

Requires non-grandfathered issuers that offer coverage in the individual or small group market to cover essential health benefits. “Essential health benefits package” means coverage that offers specified benefits, limits cost-sharing, and provides coverage at the bronze, silver, gold, or platinum level (based on actuarial value)

I think those are the same as the plans on the Exchanges. So basically all plans will be the same.

again:

• Cover all essential health benefits as defined by DHHS.
• Fairly and affirmatively offer at least one product in each of the five actuarial levels (bronze, silver, gold, platinum, and catastrophic-only) developed by DHHS (state requirement added by the California ACA).
• California Exchange may standardize products and/or require participating carriers to offer additional products in each of the five coverage levels outlined in federal law (added by California law)

so, yeah, looks like DHHS will define what is covered.

Other than that we will no longer have a problem with pre-existing conditions, it doesn't look too promising to me.

Also the costs have gone up markedly since AHA has begun. All the insurance companies have said no, this is not from the Act, but I think they are saying this under duress (personal opinion). You add a bunch of requirements about what additional things must be covered, and a bunch more paperwork and stuff to fill out, and clearly the cost will go up. Even if you are adding people (yes, some were young and healthy [and some of these even had plenty of money] and just didn't bother getting health insurance, but some couldn't because of illness or finances [and low income is a risk for illness]). Of course, until the government runs out of money, it will be subsidised for low and middle-income people.

However there is another bright spot: cost of clinical trials for cancer drugs must be covered. In a few states, they have added other conditions and we might qualify.

 

[August59]

Not sure where I read this and I don't know what state was affected. I think some of it depends on whether your state has decided to take the Medicaid supplement??). There was 1 or 2 states that drop coverage of a highly accurate cancer test due to funding. I'll try to find more about it. The thing that really pisses me off about the whole thing was what we had was broke, but they didn't even take the time to try to really fix it. Slapped a bunch of crap on paper from what a bunch of people in congress thought they knew the way it worked because there friendly lobbyist told them that was the way it worked.