Everything Changes - The Guide to Young Adult Cancer

Lots of us want to know how the new Healthcare Reform Bill will impact cancer patients. This is the longest post I’ve ever put up on my blog because there’s a lot of info to cover. Still, these are just the highlights – there is so much more to cover and I will be sure to provide updates.

I’m not a policy expert, but was hell bent on learning what I could. I have culled the below information from the Kaiser Family Foundation (KFF), a non-profit, non-partisan healthcare organization; The American Cancer Society’s Cancer Action Network; and from the bill itself.

I will also be talking about health insurance reform and cancer care today on SIRIUS Doctor Radio’s Oncology Show,  1pm EST. Don’t have satellite radio? Neither do I.  But you can still listen to it. Sign up here to listen for free .

A Few Items That Go into Effect The First- Year:

1. New help for some uninsured
People with a medical condition that has left them uninsurable (yep – such as the big C) may be able to enroll in a new federally subsidized insurance program. It will be established within 90 days. It’s not clear exactly how much you the patient would pay as your share, but there are maximum limits so you would not pay more than $5,950 per year for individual (that’s $495/month) or $11,900 per year for a family. Wow, anyone who thought this bill is dishing out free insurance to everyone is clearly wrong!

Some of you may live in states that have High Risk Pool Insurance. This federal program sounds very similar. It is private insurance offered to people with pre-existing conditions. The government pays part and you pay part. I was on a very similar plan in Illinois. The insurance was actually extremely good, Blue Cross PPO and had no limits on the docs I could see.

2. Discounts and free care in Medicare
This is not for us young adult patients, but applies to and is very important for seniors. KFF says: “The approximately 4 million Medicare beneficiaries who hit the so-called ‘doughnut hole’ in the program’s drug plan will get a $250 rebate this year. Next year, their cost of drugs in the coverage gap will go down by 50 percent. Preventive care, such as some types of cancer screening, will be free of co-payments or deductibles starting this year.” This is a very big deal for people like my grandma and Aunts and Uncles who have been hit so hard from being in the doughnut hole. It will also help a lot of seniors to catch their cancer at earlier more treatable stages, which helps reduce the burden on the entire cancer care system.

3. Coverage of kids and young adults
KFF says, “Parents will be allowed to keep their children on their health insurance plan until age 26, unless the child is eligible for coverage through a job. Insurance plans cannot exclude pre-existing medical conditions from coverage for children under age 19, although insurers could still reject those children outright for coverage in the individual market until 2014.” But what if a young adult between 19 - 26 has a pre-existing condition and is currently not covered under their parent’s insurance, will the bill enable them to get on to their parent’s insurance? If so, when does this kick in? I’m still not clear on this one and am waiting to speak to policy analysts about it. I’ll update this post with the clarification as soon as I understand more.

4. Tax credits for businesses
KFF says: “Businesses with fewer than 25 employees and average wages of less than $50,000 could qualify for a tax credit of up to 35 percent of the cost of their premiums.” Young adults are often work entry-level jobs that don’t offer health insurance. This provision should help increase the number of jobs available to us that come with benefits.

5. Changes to lifetime and annual insurance limits
KFF says, “All existing insurance plans will be barred from imposing lifetime caps on coverage.” What’s this mean? Let’s say that currently your insurance states that over the course of your entire life they will cover no more than $500,000. Cancer patients can rack up a bill that size in six months and then are left with no coverage at all. This bill would make it so insurance companies cannot limit the dollar amount of care that you can receive over a life time.

Restrictions will also be placed on annual limits on coverage. Similar to life time limits, under the bill, insurance companies also cannot place a restriction on how much money they will pay for your coverage in a given year.

6. Insurers can no longer cancel insurance retroactively
What does this mean? Let’s look at this scenario: You get diagnosed with cancer and have health insurance. Great you’re covered. Well in the past, insurance companies could say, “You know what, you went to your doctor’s two years ago because you stubbed your toe and thought it was broken. We’ve suddenly decided that your stubbed toe is a pre-existing condition, so we are going to retroactively cancel your insurance because of this ailment and we won’t cover your cancer care or any other care for that matter.” This bill will make it illegal for insurance companies to do that. And believe me, this happens A LOT to cancer patients.

7. Insurance companies have to spend more money on our care
KFF says, “Insurers must report how much they spend on medical care versus administrative costs.” It used to be that 90% of what you paid to insurance companies for your health insurance was actually used to cover your care. This number has now dropped to 80% because instead of spending more on your cancer care, insurance companies are spending more on advertising, slick brochures, golf outings, and CEO bonuses. The bill makes it such that if your insurance spends more than 15% of your premium on non-medical costs, they will have to give you a rebate.  Sorry insurance guys, no more box seats to theYankees.

8. Other Goodies for Cancer Patients
Here are just a few other goodies I noticed in the bill that will impact cancer patients, though these do not all kick in immediately:

* Health insurance companies cannot deny cancer care costs if you are on a clinical trial. I need more clarification on the details and effective dates of this one. (Did you even know cancer patients were being caught in this double bind? It’s terrible not just for patients whose bills were not being covered, but it screwed all of us because it discouraged patients from participating in clinical trials that greatly contribute to new scientific discoveries to a cure cancer and improve quality of life for survivors.)

* Funding for oral cancer awareness campaign. Oral cancer is spiking in young adults.

* The EARLY act is included in the bill! This is the act that provides awareness and education about young adult breast cancer.

* Funding for “qualifying therapeutic discovery programs” within 60-days of the bill passing. Cancer is listed in this section meaning more specific, directed funding for cancer research.

* Grants and other initiatives to improve med students’ and doctors’ understanding of pain assessment and management. It also supports a pain care research and reporting.

* Insurance companies must explain their benefits and packages in a streamlined chart that will allow you to shop for insurance by making apples-to-apples comparisons.

Stay tuned for upcoming posts where cancer patient Rebecca MacKenzie explains healthcare exchanges, we look at medicare and young adults, and delve into other topics of the bill and how they impact your cancer care.

Let me know if this post was helpful and if you have any additional insights on how this bill will help cancer patients.

For more information on financial assistance for cancer patients, read Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s.