Obamacare Sticks It to the Critically Ill: 50 Failed Attempts to Get Coverage

Lily Dane
Activist Post

Can you imagine making more than 50 phone calls during a 3-month period – with no results – to try to buy a product or service that a loved one desperately needs?

That’s what happened to John Gisler when he tried to buy healthcare coverage through HealthCare.gov for his critically ill son.

Gisler’s 45-year-old son has a rare degenerative condition that affects his coordination and speech. He is currently covered by Utah’s high-risk insurance pool, but the clock is ticking – that coverage will end on December 31.

“We’ve had three separate applications that failed to make it through,” Gisler told The Washington Post. “I have a notebook with all the calls I’ve made, maybe 50 or 100. It just goes on and on.”

Gisler finally gave up trying to get coverage for his son through HealthCare.gov and purchased through a local insurance broker – a move that cost him the loss of the $3,000 tax credit his son would have received if he signed up via the exchange.

“We have a son who is critically ill,” Gisler said. “We cannot take any chances. Not having insurance would, in no short order, lead our family to bankruptcy.”

Gisler has filed an appeal with the federal exchange and is hoping to eventually get coverage for his son through the marketplace.

The combination of website issues and cancelled insurance plans is leaving people with coverage gaps – and many will have no coverage at all when January 1 rolls around.

For people with serious health issues, this presents a huge problem:

“As we approach the end of the month, there is set of chronically ill people for whom a coverage gap is a big deal,” says Caroline Pearson, a vice president at research firm Avalere Health. “These are folks who use a lot of drugs and a lot of services and could potentially have. We haven’t left them very much time.”

And what about Americans who receive coverage through state-run high-risk plans, which provide subsidized insurance to residents whom insurance companies have rejected because of preexisting conditions? Around two-thirds of the nearly 300,000 of them will lose coverage at the end of December. These programs tend to cover some of the sickest patients, whose monthly medications can cost more than $60,000 without coverage.

People with specialty medication needs face an additional challenge: being able to determine which Obamacare plans will cover their prescriptions. For example, hemophiliacs can require $100,000 in prescriptions each month. The exchange does not typically provide information on which drugs are covered, and finding that information can be challenging. Imagine signing up for a plan, and later finding that your six-figure-per-month medication won’t be covered.

On Wednesday, Health and Human Services Secretary Kathleen Sebelius told Congress that the cancellation of a private plan should not be considered losing coverage:

“I know people have been told their health plan doesn’t necessarily match the Affordable Care Act requirements,” she said. “Losing coverage and being notified that the plan they have doesn’t exist anymore are two very different things.”

Two very different things? Either you have coverage or you don’t. If a plan doesn’t exist anymore, then how would one be covered under it?

Lily Dane is a staff writer for The Daily Sheeple, where this first appeared. Her goal is to help people to “Wake the Flock Up!”

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