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:

What’s going on in the courts with health care reform? Part One

What’s going on in the courts with health care reform? Part Two

 

Do you have questions about things you’ve heard or read? Share in the comments!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
1. Closing the Coverage Gap: Medicare Prescription Drugs Are Becoming More Affordable 2. The Affordable Care Act & Mental Health: An Update. 3. Essential Health Benefits. href=”http://www.healthcare.gov/glossary/e/essential.html 4. Living with Migraine & Depression

Comments

View Comments (9)
  • Nicole Veenhuis Helget
    7 years ago

    My husband had to get a second job just so we could have health insurance. We own our own business and health insurance for us would be over $1200 a month just because of my migraines. He now works 7am to 1am Monday through Friday and 8am to 1pm on Saturdays.

  • Kathy Lowery
    7 years ago

    I wonder if it is still cheaper to pay the fine if you are healthy than to pay for the health insurance.

  • Felicia Murphy
    7 years ago

    The mandate is unconstitutional! I know of great doctors (neurologists) who are going to get out of the medical field if Obamacare stands!

  • Bonna Mullaly
    7 years ago

    Does Migraine.com support Obamacare?

  • Migraine.com
    7 years ago

    Hi Bonna Mullaly – All of our contributors are welcome to share their opinions in their blog pieces, just as community members are welcome to share their thoughts in comments. We never expect that every community member will agree with each and every article we post, but we do encourage discussion on issues that impact people with migraine.

  • Bonna Mullaly
    7 years ago

    Hi Migraine.com , the article begged the question. It sounds very pro-HCRA to me. One thing to consider is that it has already significantly driven up the cost of health care to those of us who already have it. Wait times are longer to get into to see a doctor. Why? Too many docs want no part of this and throwing up their hands and giving up – or they are giving in and taking on too many patients and then aren’t able to schedule them in a timely manner and once we get there, they dont’ have time to take care of us adequately. The HCRA is a lose-lose for everybody.

  • Migraine.com
    7 years ago

    Hi Bonna – While we aren’t taking a political stance on reform, we always like to hear from our bloggers/contributors and community members on trending topics that affect migraine care!

  • Catherine Charrett-Dykes
    7 years ago

    are they going to give everyone the money to get this mandated insurance? don’t they think people would have it already if they could afford it?

  • Bonna Mullaly
    7 years ago

    Already making employee sponsored health insurance much more expensive. Already changing the attitude of many doctors – just b/c you have an emergency doesn’t mean you will get seen. Where I live, perhaps it is because I now have had to give in and see neuros – they seem to be among the worst. I don’t think it is a good thing at all. I agree that we all need health care, but this mandate is the most ill thought out and made to destroy more jobs and drive health care up. Canadians already have it and drive here to pay out of pocket for procedures they’d wait forever on in Canada and pay out of pocket. Where will we run to? Also seems at least where I live – migraine is just ‘pain’ and pain isn’t urgent anymore. Doesn’t do much good to tell me you can see me next Thursday when I have an excruiating migraine today. Don’t look for ER’s to be less used, look for more use. Oh and thanks to the HCRA, my ER copay is $200 – up from $50 just a couple years ago. The thought of paying that co-pay is enough to give me a migraine. FORCING parents to keep children up to age 26 on their healthcare isn’t a good thing either. I’m okay with making it an option, but the mandate says if they are uninsured, mom and dad have to keep them on their plan. That takes away the motivation for many to get off their duffs and take care of themselves. If they refuse to do that, then mom and dad are stuck.

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