Migraine Patients & Health Care Reform: How Are You Affected?
The United States Supreme Court recently held oral arguments on the legality of the 2010 Patient Accountability and Affordable Care Act (ACA), also referred to as health care reform or Obamacare.
While lawyers on both sides appeared in front of the justices to plead their arguments, regular citizens, some cheering and some jeering the law, gathered outside the Court in support of their beliefs. Feelings about this law are intense, which can make it hard to make heads or tails of how you could be affected. Keep reading for some information about the law and what might change for you as a migraineur if it is overturned.
Parts of the ACA Likely to Affect Migraine.com Readers:
- Pre-Existing Conditions Coverage: The ACA mandates all children be offered insurance coverage regardless of any pre-existing condition now. After 2014 the same requirement is mandated for adults.
- Costs: Insurance companies are not allowed to charge more to people who have pre-existing conditions, such as migraine disease. This combined with the previous item about mandating coverage of anyone regardless of health history is huge for people like us. Especially for those who do not have employer-provided health care benefits and must attempt to buy insurance on the individual market.
- Insurance Mandate: Every American is required to have insurance coverage or pay a fine. If you don't already get it through an employer, you will need to buy an individual or family policy. Although it should be more affordable for people like us considering the first two points on this list, this is a controversial requirement. Some argue it is unconstitutional to require citizens to buy a health insurance policy. Although the government requires you to have insurance if you choose to drive a car, opponents would argue you can opt out of driving or owning a car. They say there is no way to opt out of this requirement and wonder how far the government could take the reasoning being used to justify this law. In oral arguments the justices asked whether similar reasoning could justify a federal law requiring all citizens to buy flood insurance, food or burial insurance.
- End to Limits: The law forbids insurance companies from imposing yearly or lifetime spending limits on patients with expensive conditions. Like chronic migraine.
- Cancellation Limits: Insurance companies can no longer cancel your insurance coverage because you make a mistake on your application. Even if you get sick and become very expensive to your insurance company. This applies to all policies enacted after September 23, 2010. Unfortunately, this practice was somewhat common before the ACA made it illegal.
- Mental Health Coverage: After 2014, coverage for mental health issues and addiction will be included as part of the "essential health benefits" required for Medicaid and for any plan certified and included in the health care exchanges. This is extremely important for the thousands of migraineurs with co-morbid mental health issues, such as depression. According to a 2010 National Headache Foundation survey, as many as 80% of migraineurs have symptoms of depression.
- Medicare Donut Hole Closure: The Medicare donut hole is closing under the ACA. In 2012 Medicare patients pay 50% of their medication copays on name brand meds in the donut hole. (Medicare pays 14% of the cost of generic meds in the donut hole in 2012.) Within the next few years the donut hole will be completely eliminated, saving both elderly and disabled people thousands of dollars a year they can apply toward other living expenses.
- Appeal Rights: The ACA provides patients with the right to appeal decisions of their insurance companies to outside third parties with no conflicts of interest. Patients now finally have the right to a full and fair review of their appeals. Learn more about how to handle that process here: Navigating Insurance Appeals Under the Patient Protection Act.
- Maternity Coverage: Insurance companies will be required to provide pregnancy-related benefits after 2014. Only 62% of individual plans cover it right now. Considering that three times more women than men live with migraine disease, our population is highly likely to be affected by this provision.
- Extended Insurance Coverage for Young Adults: The ACA requires insurance companies to cover people up to 26 years of age. For anyone who either sought an advanced degree after undergrad (like me) or took longer than the traditional four years to finish undergrad, this is a huge improvement for both students and the parents helping them make ends meet. It's also huge for young people who are still trying to figure out what they want to do in life.
Learn more about the ACA-related legal issues being considered by the Supreme Court here:
Do you have questions about things you've heard or read? Share in the comments!
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