As president of the National Blood Clot Alliance, I get many inquiries about the world of blood clots and clotting disorders. Among the most common relate to problems people are having with health insurance. They are not able to afford it or they can’t get coverage because their clotting disorder is considered a preexisting condition and they are denied. Even if they have insurance, there may still be limits that affect which drugs are covered.
These are always difficult questions to address. Sometimes I know of a volunteer program that will ensure that the person gets medical care. In some cases, a pharmaceutical firm has a subsidy program to provide medication to people who can’t afford to purchase it. Usually, however, there is no adequate answer to the questioner’s need. It is frustrating to head a patient advocacy organization and not be able to solve insurance coverage issues.
Those days of frustration may be limited, however, with the enactment of the new health reform law. Although it continues to be a contentious issue in Washington, DC, and many other parts of the country, it may offer great hope to people whose clotting history or life circumstances have forced them outside of the standard health insurance system. Only time will tell if everything works as planned, but a new direction has been set that I hope benefits those who need help, and does not disrupt insurance coverage for people who already have it.
The world of health insurance will not change overnight as many of the most important provisions won’t go into effect until 2014. But there are interim actions that could help many of the people who ask the National Blood Clot Alliance for help and guidance on insurance matters.
Although the law is complex, the framework is straightforward.
- First, everyone in the country will have to be insured, beginning in 2014, or pay a penalty.
- Second, employers will have to offer health insurance to employees, or pay a penalty. There are some exceptions to these two mandates, but other mechanisms will be available to help people get insurance coverage in cases where exceptions apply.
- Third, for those people who can’t get insurance through their employer, there will be new exchanges, or insurance markets established to allow people to purchase insurance that today is not available to them.
- Fourth, there will be income-based subsidies to make sure that people can actually afford the insurance they need.
- Fifth, no one will be denied insurance because of their health status. For example, a history of blood clots will not be a reason for an insurance company to deny coverage to an individual.
- Finally, public programs like Medicaid will be expanded to cover more people.
Experts estimate that as many as 32 million Americans who currently don’t have insurance will be able to get coverage once all of these steps are in place.
While we are waiting for federal, state and local officials to write the rules that will be the framework beginning in 2014, some actions are already being taken that may help many of the people who contact the National Blood Clot Alliance about health insurance problems.
By the end of June 2010, a temporary national high risk pool will provide coverage to adults with preexisting conditions. At the same time, a temporary reinsurance program will assist employers in providing coverage to retirees over age 55 that aren’t yet eligible for Medicare. By the end of September, covered dependents must be allowed to stay on their parents’ health policies until age 26. These efforts should expand health insurance coverage to many.
The law also imposes some immediate restrictions on health insurance companies. By the end of this coming September, health plans will be barred from placing lifetime limits on coverage; from rescinding coverage, unless fraud was involved; and from excluding coverage for children who have preexisting conditions.
These changes are important, although not everyone can benefit immediately. Already the media have carried stories about people falling through the cracks because certain provisions of the law don’t go into effect for a few more months. Nonetheless, these are major strides to a better situation for many people and their families who are afflicted by blood clots and clotting disorders. It is certainly my hope that the number of people turning to the National Blood Clot Alliance for help with their health insurance will quickly decline and eventually drop to zero.
Increasing health insurance coverage, while tremendously important, still does not solve the medical issues surrounding blood clots and clotting disorders. People still don’t know about the risk of clots or can identify the warning signs. Delayed diagnosis and even misdiagnosis remain all too common in hospitals and doctors’ offices. While our knowledge about clots is not perfect, much is known about prevention, proper diagnosis and effective treatment. Our challenge is to make sure that the medical establishment uses the tools available to consistently and effectively diagnose and educate patients about blood clots, that the public knows about risk factors and symptoms and that scientists continue to increase our understanding about why blood clots occur and how to deal with them. Health reform answers one important set of questions. The National Blood Clot Alliance, in collaboration with its partners, hopes to find answers to the others.
If you want more information on the health reform legislation, try the federal government website www.healthreform.gov, visit the Henry J. Kaiser Family Foundation website http://www.kff.org or this recent article from the Washington Post
Randy Fenninger, President
National Blood Clot Alliance