Obamacare insurance options dwindle for neediest U.S. patients

Obamacare insurance options dwindle for neediest U.S. patients
From Reuters - December 6, 2017

WASHINGTON (Reuters) - Josh Brookhart has four health insurers to choose from in Seattles King County for 2018, more than many Americans like him who buy coverage on the Obamacare individual market.

Yet none of the plans cover all the complex medical care needed for his seven-year-old son, Gabriel.

Born with an extreme form of Chiari malformation, Gabriel required surgery to reinsert a part of his brain into his skull. He lives with hydrocephalus, or extra fluid in his brain, and spina bifida, which causes abnormal development of the spinal cord.

The Brookharts insurer, Regence BlueShield of Washington, said in June it would exit the Obamacare markets in 2018, citing unsettled marketplaces across the country, a move common to many insurers uncertain about the programs future under President Donald Trump.

All of Gabriels specialists, who span multiple medical centers and practices and have been coordinating his care for five years, were covered under Regence.

Based on the limited options for 2018 enrollment, the Brookharts plan to pick an insurer that will cover some of Gabriels care and expect to pay tens of thousands of dollars for the rest of his needs.

I would pay a high price for a good policy. Its just mind-boggling to me that it doesnt exist no matter how much I would want to pay, Brookhart said.

Gabriels case shows how difficult it can still be to find adequate healthcare for very complex conditions four years after Obamacare took full effect. In many cases, an insurer will cover medical care but not certain prescription drugs. In other cases, an insurer may cover one specialist doctor but not others, or cut expensive academic medical centers out of their networks to lower costs.

Patients with complex medical cases often take high-cost prescription drugs, rely on specialists who sometimes coordinate their care and may require sophisticated surgeries, among other needs.

The challenge of finding adequate healthcare on the Obamacare market is expected to intensify as the Trump administration strips away aspects of the law, healthcare experts say.

Instability is just a very stressful thing for people dependent on a stable connection to the healthcare system, said Daniel Polsky, professor at the University of Pennsylvania and executive director of the Leonard Davis Institute of Health Economics. Even just a change of doctors could result in some difficult health consequences.


U.S. consumers have often complained that subsidized health insurance under former President Barack Obamas Affordable Care Act restricted their choice of doctors, or forced them to change providers. In some cases, that may mean switching primary care providers. But for patients with serious medical needs it can prevent them from seeing their specialists.

The Obama administration attempted a fix, directing more federal oversight of the plans, requiring transparency from insurers on what they did, and did not, cover and setting guidelines for insurers to cover enough healthcare providers.

Trump has promised to repeal Obamacare and is using executive powers to undermine it, including a rule finalized in April that allows individual states to determine whether insurers provide enough access to doctors.


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