WASHINGTON (AP) – Coping with advanced cancer, Bev Veals was in the hospital for chemo this summer when she got a call that her health plan was shutting down. Then, the substitute insurance she was offered wanted her to pay up to $3,125, on top of premiums.
It sounds like one of those insurance horror stories President Barack Obama told to sell his health overhaul to Congress, but Veals wasn’t in the clutches of a profit-driven company. Instead, she’s covered by Obama’s law – one of about 100,000 people with serious medical issues in a financially troubled government program.
Raw political divisions over health care have clouded chances of a fix for the Pre-Existing Condition Insurance Plan, leaving families like Veals and her husband Scott to juggle the consequences. That’s not a good omen for solving other problems that could surface with “Obamacare.”
“You don’t advertise one thing and then give the customer another thing,” said Veals, 49, who lives near Wilmington, N.C. “I finally felt for the first time going through this cancer that I had something dependable, and somebody pulled the plug.”
In a statement, the federal Health and Human Services department said the program “continues to provide excellent coverage.” But the department said it was unable to provide current enrollment numbers, which might reflect the impact of belt-tightening this summer that led North Carolina and 16 other states to turn their programs over to federal officials.
Known as PCIP, the program was intended as a temporary lifeline for people denied insurance because of medical problems. It’s supposed to provide coverage at premiums that healthy people would typically pay. PCIP will end Jan. 1, when Veals and other enrollees will be able to transition to new insurance marketplaces where they may be able to find lower-cost plans.
Jan. 1 is also when Obama’s law will forbid insurers from turning away people in poor health. At the same time, virtually all Americans will be required to have coverage.
Part of the problem with PCIP stems from a decision by the president and Congress more than 3 years ago to cap funding at $5 billion. Some experts warned that might not be enough to last through 2013.
Veals is a breast cancer survivor now battling colorectal cancer. She had been uninsured for 27 months before she was able to get on the North Carolina PCIP plan early in 2011. She considers herself a strong supporter of Obama’s law.
But even with insurance, deductibles and copays for cancer care strain the budgets of most families. And that doesn’t count lost wages and expenses not covered by insurance.
The more than $3,000 extra the Veals will have to pay this year “is not discretionary money,” she explained. “This is heat-the-house-in-the-winter money.”
When her home health nurse called her at Duke Cancer Center about the health plan changes, Veals was on a chemotherapy pump. Her husband Scott called the North Carolina PCIP plan and learned it was being turned back over to the federal government on July 1 because of financing problems. After more digging, he found out their premiums would go down somewhat in the federal plan, to $420 a month.
But there was a catch: They had already met their deductible in the North Carolina plan, and also reached their annual out-of-pocket maximum of $6,250.
With the federal plan, they would have another deductible of $1,000 for the rest of 2013, and a total of $3,125 in out-of-pocket costs before reaching that plan’s catastrophic limit. Deductibles and copayments shift some financial responsibility to patients.
Veals and her husband say they are looking forward to implementation of the health care law next year. But getting through the next few months will be a struggle.