Help me (a cancer survivor) figure out worst case healthcare scenario
October 16, 2020 10:44 PM   Subscribe

(If if if) ACB gets confirmed, SCOTUS destroys ACA, Biden loses or Dems fail to get a Senate majority, and I have a pre-existing condition at age 35. What now? Especially looking for comments from health policy-savvy MA residents.

I survived advanced cancer (just barely!) in 2016. Because I knew that Trump would pose a threat to the ACA, I moved to the state with the supposedly best healthcare/insurance protections in the U.S., Massachusetts, thinking that I could fall back on 2006 Romneycare here.

Unfortunately, there seems to be contradictory information on what our state's healthcare system would look like under a worst case scenario (which I realize is not the *only* possible outcome, depending on what happens with the election - but I want to be prepared!).

These sources suggest that several key protections of the ACA would remain in place in MA because the state codified pieces of the federal law (useful for anyone here who wants to check on their own state, too): 1, 2.

But these articles paint a much bleaker and frankly terrifying picture, which amounts to the fact that it's impossible for Romneycare to come back, and MA is just as screwed as anywhere else in the country: 1, 2.

I hope someone can help me make sense of all this, knowing that I don't expect you to predict the future. I'm confused as to what my options would be. For reference, I am unmarried and work as a freelancer, so I do not qualify for employee or spouse plans. My income is about 200 percent of the poverty level so I do qualify for subsidies now (but not for Medicaid/MassHealth) which would...I guess...vanish? Or else be reduced? The articles weren't clear on this. I am not able to move out of the country or to work full-time anywhere.

It seems like my options would be to try to save up/crowdfund to pay for private insurance at least for several months while the state inevitably designs a new system. But that's assuming I'm eligible/won't be denied a plan (again - not clear in these articles)? Is there anything else you would do in my situation? I'm trying to be proactive without feeling deep despair about this.

*Please refrain from commenting "this is why you need to vote" - I already am, as well as donating, sent letters, postcards, text-banking, etc!
posted by CancerSucks to Law & Government (6 answers total) 8 users marked this as a favorite
Trump has said that he would protect those with pre-existing conditions. I am counting on it.

posted by AugustWest at 11:53 PM on October 16, 2020

Medicaid isn't a part of the ACA, in that it existed long before and has no pre existing condition modifiers . There were also something called high risk access pools that disappeared after the ACA that might come back. The ACA created a third party way for companies to administer medicaid programs, so it would likely consolidate back to the one state plan(s), but ultimately medicaid before and after the ACA pretty much covers the exact same stuff.

Ultimately , if your sick enough to lose any employment income, your next step would be the disability process and once you are determined to be disabled you'll end up on medicaid once you burn through your assets. There is a special application process for people who have cancer to expedite the process. If you've been paying medicare taxes, you might end up on medicare as well. Medicaid does pay for care, but likely not the doctors or facilities you would prefer or the treatments that you would like (especially if they are new or experimental).

You may be able to get insurance that doesn't cover your pre exisiting conditions for the regular stuff and fall back on medicaid if worst case senario happens.

It is a scary place to be, and worst case scenarios are real. Medical debt is a very real thing. I hope that this doesn't come to pass.
posted by AlexiaSky at 4:05 AM on October 17, 2020

Even the articles that paint a bleaker picture suggest that Mass state government would have a bipartisan approach to protecting healthcare in the state. It would also take time to undo the ACA, and the moves to do so would be in plain sight. This should give your state legislature time to come up with a replacement and may help to reduce any gap. Given that Mass is likely to vote Dem for President regardless, you might find it helpful to remind your state-level representatives how important healthcare is.

I think that in any realistic worst case your healthcare costs will increase substantially. It may be helpful to build up your savings if possible. Certainly in the worse possible case if you are denied coverage and have to pay out of pocket then no amount of savings is likely to be enough, you'll burn through it all either way. But on the other hand in the slightly less bad but still not good cases, if it will pay for increased insurance premiums, or deductibles, or care that is free/cheaper under ACA, then it may be helpful. You might want to also see if there are any provisions in your insurance you can take advantage of in the near future (after Nov 3 and before any changes) - things like getting prescriptions filled, moving up any appointments, and so on.
posted by plonkee at 6:37 AM on October 17, 2020 [2 favorites]

I'm not sure how answerable this is right now. First, it's a scary situation, so of course you're worrying. Do whatever you can to address the all-too-real stress.

Monday, call your state's Insurance Division. They can tell you what state regulations are, and they should have some understanding of how the SCOTUS case will affect you, either way. They will have expertise.

I'm so sorry you have to go through this.
posted by theora55 at 8:11 AM on October 17, 2020 [1 favorite]

I’ve been an unmarried freelancer since before the ACA and understand your worry. I’m worried too. Frankly, there’s no way to know what will shake out of this. Back then, insurance applications for folks like us were more than 10 pages of medical history. Once I was denied in my 20s, every other insurance company auto-denied me. States did used to have high risk access pools —- I was told that was the only way to get insurance but there was a multi-year waiting list for my state. In the end, I went without insurance and paid cash for all my doctors for 7 years until the ACA passed.

This time I think there’s much more awareness of the issue and more political pressure. There is also a lot more independent workers in the “gig economy” now than pre-ACA. There’s lots of ways this can go. Even if the result “protects” pre-existing conditions, if it doesn’t have a cap or limit to charge people different amounts then it’s almost worthless. Insurance companies could just raise rates to so high for those folks that they couldn’t pay it. Sometimes they used to offer insurance but exclude your pre-existing condition (in the broadest sense). There may be an option offered that’s more of a catastrophic plan. If you’re in a more progressive state legislature then there’s hope that they will take measures to look out for the people affected by any changes made.

My advice to myself and you is to try not to stress about something like this that you have literally no control over. Sure, you can save your money, that’s always a good idea. Take care of your health in the meantime and get anything you know you need done this year. Take solace that there are millions of Americans in similar situations and we are a larger and more recognized group than pre-ACA days.
posted by Bunglegirl at 4:43 PM on October 17, 2020 [3 favorites]

YMMV here, but I have a friend with serious medical issues who was having lots of struggles pre-Obamacare. She moved to Portugal and is very happy with her care.
posted by amoeba at 9:56 PM on October 18, 2020

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