For people with pre-existing conditions and terminal illnesses, the Affordable Care Act, aka Obamacare, has been viewed as a positive. With a firm stand against long standing discrimination in the health insurance industry, Obamacare strived to bring in equality for all, irrespective of their medical condition. However if Obamacare left any gap to make health insurance equal for all, it is the access and cost of drugs needed to cure chronic medical problems. Currently, these ‘specialty’ drugs are adding financial burden on people with chronic illnesses.
According to available data, these specialty drugs cost somewhere around $8,000 a month, and people who have purchased health insurance off the health insurance marketplaces could be responsible for up to 50 percent of those costs. Insurers cite increasing drug prices for this sharing of costs, stating that these drugs can cost roughly $100,000 per year, per patient, and thus require some support from patients. Although this replacement trend of fixed dollar co-payments with co-insurance cost sharing model stands since before the implementation of PPACA, it has gathered more force in the last few months, particularly because of the increasing drug prices.
For people with preexisting conditions, the ACA is hit or miss as well. Take the case of Robert Ruffino, a blood cancer patient. Robert used to shoulder the financial liability of $13,000 to $19,000 a month for premiums, co-payments, and coinsurance charges. With the launch of Obamacare, he was able to get covered under the employer sponsored family health plan through her wife’s employer that offered a significantly cheaper option. An example of the miss would be Emilie Lamb, a 40 year old woman with lupus. With four of six prescribed drugs being covered by Obamacare, Emilie is still facing an additional liability of $4,400. With a monthly premium of $373, no deductible and $1,500 limit on out of pocket expenses, she feels Obamacare has made health insurance costly for her. Her plan, before the ACA, was unbelievably inexpensive with $53/month premium and modest co-pays that added up to around $1,000/year. The problem is the most rampant in Bronze Level plans, the option on the exchanges. For instance, in Texas and Florida, there is no coinsurance cost or co-pays for specialty drugs, but the deductibles are in the range of $6,350, somewhere around the maximum out of pocket costs. More than 60 percent of Bronze plans have coinsurance rates above 30 percent, bordering roughly around 50 percent of costs. For Silver and Platinum plans, only 55 percent and 38 percent plans, respectively, had coinsurance rates.
Expensive Drugs, the Core Problem
Naturally, the bigger problem is prescription drug costs. Earlier, the coinsurance rates were limited to a nominal 10 percent, with 20 percent being the highest coinsurance rate. Now, 30, 40, and even 50 percent rates seem to have become the norm. These models have patients bearing the majority of the cost. Furthermore, patients are expected to hit their out-of-pocket maximums before health insurance plans step in.
While some ACA opponents are quick to the point their finger at the act, it is widely accepted that the onus is not just on the ACA.