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Special Needs
CrazeyJaneyR
member
What are the pros and cons of "Obamacare" re: people with special needs?
CrazeyJaneyR
member
I am interested in your opinions 
Thanks!
Thanks!
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Re: What are the pros and cons of "Obamacare" re: people with special needs?
I honestly don't know much, but I'm grateful for the fact that children and adults will no longer be denied insurance coverage based on pre-existing conditions -- which practically any SN are, I'm sure.
There are many, many kids with SN and health issues who aren't covered by medicaid (including my own). At least, thank God, DD1 and other kids can no longer be outright denied insurance coverage. Even though it may be insanely expensive and/or not offer coverage for therapies depending on the state laws, at least it's there.
DD1, 1/5/2008 ~~~ DD2, 3/17/2010
I think right now it's just the children who the no denial based on PECondition extends too. We were trying to find an alternative to cobra and I was told it only applies to children so far. But they can still charge higher rates from what the few companies (anthem, etc) I called told me as well. That's why we ended up just doing cobra because the individual plan was $1500 vs $1200 for cobra.
I do know that it took the cap off of insurance which lets face it 1mil can be eaten up quickly depending on your childs needs. I'm very grateful for that.
I am fully in favor of it, due largely to the preexisting conditions part.
To the PP who mentioned universal healthcare eventually moving towards restrictions on meds/procedures/etc which may effect the elderly and SN more, you are probably right. But personally (even having a SN child) I am strongly in favor of that. It is the only way health expenses will go down. Our family had a crappy HSA last year (which we paid 1300 a month for with COBRA) and our total OOP medical expenses for 2011 were 17K. SEVENTEEN THOUSAND DOLLARS. That is insane. That does not include anything groundbreaking- DH had a minor same-day surgery, the rest was insurance premiums, and DS and DD's regular appts (which include specialists, but no procedures or therapists).
IMO the only way to significantly bring down the cost to ration care.
I get where you're coming from, but I can't personally make the jump. Lauren had open heart surgery, which totalled over $250,000 (insurance paid the vast majority). Who's to say when it's a "community pot" so to speak that the people in charge will decide that someone with Down syndrome isn't worth the cost? What about kids with hypoplastic left heart syndrome? The minimum number of open heart surgeries is 4. Who's to say "they" won't decide the cost vs survival rate isn't worth it? And I just think it's a terrible way to work on advancing medical tecnhnology in the sense that risky procedures/drugs/surgeries will be deemed not worth the cost.
And what about therapies? When the government is paying for it I bet they get a say in how much is allowed. What if we, as parents and advocates, don't think it's enough? Will we even have the option to pay out of pocket for more? Will there be enough therapists, available appointments and time for this? How can we truly advocate for our children if we don't get a say? Right now a person can choose to have private therapies for their child, especially if they hold private health insurance, on top of EI. Will that right be taken away? I worry a lot about the autonomy of care.
And where will the money come from? Will there be wait lists for every type of procedure, even urgent ones?
If you really think about it, the issue of people being deemed "worthy" of expensive care is already happening now. The rich are able to find the best doctors and cutting edge procedures, while the middle-class and poor are stuck with what's available and what their insurance (if they have it) will cover.
I would rather have a system where everybody has a minimum expectation of care, and people can go above and beyond via their own expenditures and/or charity.
We live in capitalist country. I can't imagine there not being a way to "buy the best" even with universal health care.
Well, what was passed here isn't even close to true universal healthcare. I think a lot of assumptions were made about the decrease in costs if a larger portion of the population had health insurance and we will have to see how that pans out. There is also the supreme court case right now to decide if they can even force people to have health insurance.
My general thoughts are that I like the preexisting condition thing but I'm pretty ticked off about the decreasing on the limits for flex spending. We pay for a LOT of stuff out of pocket (because my state doesn't have a law forcing insurance companies to cover autism treatments but that's another post) even with just the co-pays at $40 per therapy session with 2. My state education system is underfunded and the amount of services they offer my 2 is virtually non-existent. The major user of the larger flex spending accounts are people who have ongoing $$$ medical issues that we are paying for out of pocket.
I lived in 2 countries that had UHC (Australia and the UK) and in both of them most middle class or above people had private coverage as well. In Australia you actually had to have it once you made X$ or there was a tax penalty. That was actually better than what they are proposing here because there was a public option (note - you could always use the private if you paid for it). It might mean longer waits, less posh hospitals, and non-private rooms but the option was there. I know multiple people that used the public system and had good healthcare although it definitely was different in terms of comfort to what we are used to. At least they did have access to a basic level of care at all levels. The private hospital I went to in Australia to have my DS medically was the same as the standard of care I experienced here.
I love the concept of mandated minimal healthcare coverage. No child/adult should go without medical coverage just because they can't afford it or their job doesn't offer it.
However, right now it doesn't seem we're going in the right direction. Health insurance is becoming more and more minimal while becoming more and more expensive.
All I can add is this. In Massachusetts we have mandated health insurance, those who can't afford it have access to Common Wealth Care.
One of the state mandates for health insurance offered in the state is the coverage of medical food.
Doesn't seem like a big deal. But it is. There are 40 kids in the country right now with the same tri diagnosis as Asher. There used to be 42, but 2 have passed away. Out of the 40 left, Asher has the worst form of the condition, but he is the healthiest. He is the only one not on a feeding tube. Only one that doesn't have failure to thrive.
Why? Because he is being taken care of. My family doesn't have to pay $2800 a month just for medical food, never mind all our other health related costs.
A good friend of mine is from the midwest, her little girl just had to get a G tube placed. Her insurance refused to pay for anything up until this point. It took this little girl slipping beneath the 1% for weight and being classified "severe failure to thrive" to cover any medical food.
All because her state can't mandate the coverage because all the insurance is private.
That is horrifying and represents what I think is a much bigger problem with our healthcare - getting insurance companies to cover all medical expenses not just the ones they want to cover. In my state private insurance policies aren't required to cover therapy for autism or developmental delays. They are currently trying to pass a law here for this, but that doesn't help all of the other things like the medical food. This is exactly why I believe in some sort of public option for everyone even if you have to pay for it.
The bigger issue is the providers/hospitals charging outlandish costs. If you ever truly look at the amounts billed prior to insurance you would see where the real problem lies with our healthcare system.
If the law is not completely overturned but the mandate is, I see a lot of insurance companies going out of business. Which will leave the government to step in. Reason being is that people will be allowed to wait until they are sick/dying ect and then get insurance because they cannot be rejected and the claims will increase but the insurance company would not be getting premiums from those people when they are healthy to cover those claims.