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Donna Smith

Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation

October 13th, 2013 2:18 PM

Cancer Chronicles and the ACA/Rombamacare

ACA exchanges, single-payer, Medicare for all for life, cancer care, SiCKO, Michael Moore

Because I have never seen the situation Larry and I face as unique within the dysfunctional, profit-driven US health care system, I think what is happening to us is happening to many more people. My cancer chronicles will follow not only what is happening with my disease but also how I am able to wind my way through the whole insurance mess right now.

I am a cancer survivor and once again a cancer patient. My cancer markers for my carcinoid syndrome are elevated again, so I will likely begin the diagnostic process once again for finding the source of the neuroendocrine issues. And we will also need to make sure I have the health coverage needed to get those diagnostic tests and any recommended treatment.

We also have to make it through the Affordable Care Act/Rombamacare exchange to see if we can secure health coverage at some cost that is remotely affordable for us. Rombamacare, by the way, is simply a more accurate way to describe the health insurance reform model upon which the ACA was patterned. Mitt Romney was the governor of Massachusetts when their insurance-mandate-anchored plan was fashioned and passed, and President Obama used much of that Massachusetts model as the basis for the ACA. Hence, Rombamacare is the law of the land.

Right now, I am covered through my Aetna/COBRA coverage. It was an ugly fight to get the policy reinstated after it was cancelled due to the confusion over the billing statement and payment. I am deeply appreciative of those who helped me make it through that appeal and pay the premiums which to date in 2013 have totaled $7,522.08. The monthly premiums were $803.64 for the first five months, and then jumped to $875.97/month retroactively to July 1. Add to that the previous delays and denials I have had with Aetna coverage during cancer care and treatment as well as fights about claims reimbursements, and it would be an understatement to say I would be fine with some other coverage that had more manageable premiums, a lower deductible, and smaller co-pays.

Actually, I'd be more fine with an improved and expanded Medicare for all for life system that didn't require me to make financial calculations about when to get care and when to say I'm done with all this based on money instead of health and any things I have left to do in life that I still want the time to do.

Those Aetna delays and denials in the past caused me to feel sicker and weaker longer and also did irreparable damage to my career and future. The decisions I felt compelled to make were made more compelling because I was seen as weaker and sicker than I needed to be to continue working as effectively in a career that often required extended periods of travel and 18-hour work days. I simply couldn't do that and do carcinoid at the same time. I deeply fear that impact again though I changed jobs so that being a cancer patient would not be such a detriment to my work.

And I do not know yet if I can get any relief on the exchange. In Colorado, I had to apply for Medicaid coverage before finding out if I can get a subsidy/tax credit. How much simpler it would have been if the Connect for Health Colorado marketplace (ACA/Rombamacare exchange) would have asked me some simple pre-screening questions first -- the same way the IRS long forms do about whether or not medical deductions will exceed 7 percent of income before having you go through the whole process. I already know we will not qualify for Medicaid but I also know we will likely qualify for a subsidy to purchase my coverage. Now I have to wait up to 45 days for the Colorado Medicaid denial before trying again to make my way through the exchange to "shop" for insurance. (And, sadly, some of the larger states have cheaper premium rates for better coverage than some of the small states -- it's simply a matter of the size of the risk pool. That really stinks when we already have to decide if we're bronze, silver, gold or platinum people.)

All this is so damned unnecessary and so maddening. It was enough last week to hear the news on my medical tests much less now begin the macabre calculations many cancer patients do about when the costs for insurance and keeping me alive will exceed my value to society or even to myself. If we had improved and expanded Medicare for all for life, I could be focusing on other things like a bucket list that did not include spending half my time dealing with insurance issues and medical bills. I'd rather be sitting on a mountainside or beach somewhere counting my blessings than sitting on hold waiting for an exchange navigator or an insurance company representative. Is that so selfish?

October 13, 2013 -- Today's count of the health care dead and broke for profit in the U.S.:

The 2013, to date, U.S. medical-financial-
industrial -complex system dead: 35,565
The 2013, to date, U.S. health care system bankrupt: 560,820

** These figures are calculated based on the Harvard University studies on excess deaths in the U.S. due to lack of insurance coverage or the ability to pay for needed health care, and the Harvard University study that calculated the high percentage of personal bankruptcies attributable to medical crisis and debt in the U.S. 123 people die daily due to lack of coverage or cash to pay for care; 1,978 go bankrupt every day due to medical crisis and debt though the majority had insurance at the time their illness or injury occurred. This statistic is also based on the 1.2 million bankruptcies in the U.S. in 2012, according to the U.S. Bankruptcy Court, and calculating those medically-related bankruptcies from that number.

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