US Thyroid patients have been abuzz behind the scenes for months about what the Patient Protection and Affordable Care Act ((PPACA), aka Obamacare, will mean for them, positively or negatively.
And more discussion has been sparked by the disastrous enrollment launch since October 1st, followed by many of us going through the shock of our private insurance being cancelled, or facing much higher premiums. So questions and concerns abound.
Of course, the stated intent of this healthcare reform, says Obama Care Facts, is to “give more Americans access to affordable, quality health insurance and to reduce the growth in health care spending in the U.S.” In other words, it’s supposed to give affordable healthcare to those who have been uninsured or improve the terms of the health insurance you already have.
But is the latter so for thyroid patients? Will we as thyroid patients be better off? Let’s look at the Affordable Care Act in general first.
Obamacare’s stated benefits and facts are:
- It will mostly benefit a large body of the uninsured, as well as those who don’t have employer-based or government-based health insurance.
- Premiums will vary depending on the state you live in, your age, health, income, and which of four plans you decide upon.
- You can choose between four types of medical plans with Obamacare–better plans mean higher premiums but lower out-of-pocket costs.
- You can still have private insurance plans instead.
- There will be a Medicaid expansion to cover more people in approx. 26 states
- Medicare recipients will have an easier time getting prescription drugs.
- Certain preventative medicine will be covered 100%, including health, dental and vision.
- You can buy Obamacare health coverage until March 31, 2014. If you don’t buy any health coverage, you may pay a tax penalty of $95 or 1% of your taxable income in 2014
- Larger businesses will be required to provide insurance for their employees.
- Your won’t be charged extra if you have to go out of your area for emergency room visits.
- You’ll be covered for goods and services to help you maintain a standard of living if you have a chronic disease like Multiple Sclerosis
- All preventative care lab tests will be covered before you are diagnosed.
Obamacare effects private insurance companies this way:
- All participating health insurance companies are required to cover services in ten Essential Health Benefits categories, from emergency room and hospital care to mental health and approved prescription benefits.
- You cannot be dropped because you have an illness or because of pre-existing conditions or charged more.
- Your yearly out-of-pocket costs are limite
- There will be no annual or lifetime limits to your insurance.
- You cannot be discriminated against because of your gender.
- Young adults can stay on their parents plan until they are 26 years old, and low budget plans until they are 30.
- You have the right to rapid appeal of insurance company decisions
- Whatever prescription meds that you pay out-of-pocket will count towards your deductible.
- There will be free yearly check-ups, immunizations, counseling, and screenings for all non-grandfathered plans at no out-of-pocket costs
- You will still have several different insurance plans in the Marketplace to choose from.
And the negatives as outlined by critics:
- Not all preventative tests you might want or need will be covered.
- It’s going to be a one-size, fits all policy created by your federal government, as if all people fall under one umbrella of needs, lifestyles and goals.
- Treatment goals by hospitals may end up being related to whether they are financially rewarded by the government for that treatment or not.
- Like an HMO, your network of doctors to choose from will be narrower if you go with Obamacare, which means you may not be able to use your current doctor.
- Up to 30 million still won’t be insured.
- A survey completed by The Doctors Company found that 60% of physicians feel their patients will get less quality of care due to the Obamacare pressure to decrease costs and improve their patient load. It will also cause 43% of doctors to go into early retirement.
- Private insurance premiums will probably go up for most.
- The higher premiums in exchange for stated better coverage will only be a good trade for those who have hefty medical expenses in any given year.
So how might thyroid patients see all this??
1. Obamacare says that all preventive care lab tests will be covered. This could continue to mean that the most favored test to diagnose thyroid disease will be the TSH, similar to what veterans in the VA system get, and which thyroid patients know has been an abject failure for diagnoses since its inception in the 1970s. So the thyroid madness with the TSH might sadly continue.
2. Obamacare says that you’ll be covered for goods and services to help you maintain a standard of living if you have a chronic disease. Thyroid patient skeptics have expressed doubts that we will be covered for the chronic and debilitating low cortisol issues we tend to have–the latter usually due to undiagnosed or undertreated hypothyroidism from the use of the TSH lab test or T4-only treatment. Then think of the disability from Lyme and compromised immune function and you have a continuation of the problems we encounter today, on top of how adrenal issues keep us from working.
3. Obamacare will have standardized kinds of treatment. Say thyroid patient Andy: “That can certainly be a disappointment if they favor T4-only for hypothyroidism, just as government-run VA care does for my Dad”, and which leaves him with worse problems than he had when diagnosed. And a large body of thyroid patients know what an abject failure T4-only treatment has been. i.e. the failure of T4-only like Synthroid, whether from the beginning or the longer one stays on it, is not isolated.
4. Obamacare states that because of the required Essential Health Benefits categories your insurance has to cover (preventative medicine), it will allow more people to find and treat chronic diseases before you have to go into the emergency room. If the government believes the fantasy that the TSH is the best way to diagnose, or T4 is the best treatment, or the low cortisol problem doesn’t exist except for Addisons patients, or the only test for cortisol levels is blood testing instead of saliva (the latter which we know gives far better information)…some thyroid patients aren’t going to avoid the emergency room.
5. Obamacare has always said you can keep your doctor. But with recent news revealing millions of people are experiencing cancellation of their insurance policies, that may not be so, which can be crushing if you finally found a doctor who isn’t obsessed with the TSH and T4-only medications, or who understand the low cortisol problem. If you aren’t able to keep your current health plan, and have to purchase another coverage, the latter may not cover your current doctor. You’ll need shop for a plan that does.
In other words, whether one is for or against Obamacare, it may continue the backwards diagnosis and treatment of hypothyroidism, plus new issues and direction that everyone will have to deal with on top of it, both positives and negatives.
Read more:
http://obamacarefacts.com/obamacare-facts.php
http://obamacarefacts.com/insurance-exchange/health-insurance-plans.php
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/09/30/%3Fp%3D63297/
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15 Responses to “The Affordable Care Act, aka Obamacare, and Thyroid Patients: How will it be for us?”
Paul R
Armour thyroid comes from the part of the pig which is raised through tax payer dollars for “food” for the animal.Armour is named after the company that processes meat animals for human consumption.
Lynn
Just found out today that my Armour prescription of 90mg/day is going to cost me out of pocket $240 every three months. Last year it was $56. The government will not let insurance cover Armour. Something is wrong here. My insurer said it is dangerous to “seniors.” I’m not a senior and insurance has never covered Armour–even when I was 30. I was just hoping that it would be covered now with “better health care” — not.
Carla Golden
You are getting ripped off by your pharmacist, Lynn. I get my prescription for about $30 a month at Costco and my husband paid $34 a month for 90 mg at CVS. Shop around.
rachel
We have to change the way medicine addresses thyroid disease, autoimmune in general really! !
Alan
I already got hosed when my awesome healthcare started aligning its policies with the Affordable Healthcare Act. I was covered for preventive screenings and follow up tests at 100%. Now its only 100% preventive for females. I am male and appealing the ruling by my insurance company. This has to be fixed. Cancer covers every race and gender! I’m part of the 3% of men that get papillary cellular carcinoma and get booted to the 80/20 insurance plan.
JMR
I pay out of pocket for doctor and meds even though I have employer offered insurance. The meds (T3) my doctor prescribes aren’t on my plan’s approved list so it isn’t covered and my doctor doesn’t take insurance although he does effectively treat my health. Insurance will pay for the doctors who won’t help me. I don’t see that changing under Obamacare except for the fact that my insurance plan is now a lot more expensive with even fewer choices. My sister had her insurance cancelled…one of Arleen’s 5%, but those people don’t matter I suppose.
KellyB
It will be a good thing for me and my daughter. My employer does not offer health insurance and due to my daughter’s hypothyroid and back pain issues, private health insurance was quoted to us as $1200 a month with a $7500 deductible. I couldn’t even afford half of that. With the Affordable Care Act, insurance will cost us $400 a month. I will finally be able to get insurance again.
Mary
The ACA is probably not perfect and it will probably work better in some states then others due to the politics involved… That being said, I don’t see that it will affect the treatment of thyroid disease any better or worse than the old insurance system did. If doctors don’t know any better then they will still promote the BS from big pharma. Change will have to come from the grass roots efforts of patients and sites like STTM.
JP
NDT is readily available in Canada, if your doctor is willing to prescribe it. Government healthcare, which actually does not cover meds for most people here, does not seem to have affected that. I have not yet seen an insurance ccompany here that did not cover it. Also, in Ontario anyway, thyroid testing is all covered. I wonder if the US system might not just need some pressure to add these things?
Arleen Lindstedt
Affordable Care is a blessing for me! I’ve talked with my doctors — including a Naturopath — and for the first time in 7 years, I WILL be covered!! I have Hashimoto’s, Diabetes, and vision issues: No insurance carrier would cover me. I spend over $1200 a month “out of pocket” without insurance. Now, my monthly premium will be $169 a month — and I opted for the highest level available to me……I read through this article, and some info has not been verified. For those who have had insurance “cancellations”, it was because policies were not inclusive. This impacts just 5% of the population…..I recommend going directly to the source: http://obamacarefacts.com/obamacare-facts.php
We should be about health; not politics.
Ms. Rants
I think that the ACA’s requirement that insurance companies cover those with preexisting conditions, and not at hugely increased premiums, will be hugely beneficial to our community! So many of us who were denied insurance coverage due to preexisting conditions will no longer face that hurdle. In addition, health insurance will be much for affordable for many. Also, many people who have had their insurance cancelled are eligible for more inclusive plans. Is this setup perfect? No. But I do think we will be better off because of it in the long term.
Eileen
Your comment, “We should be about health; not politics,” that’s exactly why the government shouldn’t be involved in health care!
Diane Fama
I was laid off in August the day after they introduced our new healthcare. Funny because every person that had family coverage were laid off. I had alot of armour but I am running out, and my doc did prescribe t3 but it is a $104 out of pocket expense. all my hard work of losing weight and feeling better is scaring me now with what is going on…
Anne
I am in agreement with the potential effects of the affordable care act as you stated here. Especially as I have been made aware that in the European Union countries it is almost impossible to get access to Natural Dessiccated Thyroid. In France it was outlawed in 2003 for example. This tells me that the governments are making deals with the pharmaceutical companies to lower their healthcare costs and part of the deal is that only synthetic (patented) can be used and doctors are brainwashed into believing that the reason is that the natural version is not reliable. I am worried that this will also happen here. I was for the affordable care act because of its original intent, as in my state health insurance costs are impossible to afford, if you get sick how do you earn to pay for this high amount so how can you even use it? and the insurance companies were getting the reputation of dropping people when they needed them. So the intent is good. But in states where the governors (as here in NJ) are not playing along, the rates are still way out of reach, so we are still uninsured. But I have also thought about all that you mentioned and would not use insurance that didn’t let me see my open-minded doctor or help me pay for my dessiccated thyroid or for the expensive tests Free T3 and Free T4.
Is this an opportunity for us to go out there and be heard? or is this going to be another troublesome turn on the road to survival?
Michelle Devon (Michy)
I just got Medicare this month (after two years of being disabled to qualify for it), today, in fact, and looked up the meds on the website that goes with Medicare. My Armour Thyroid is not listed in the covered meds, so if I’m going to keep taking it, I’ll have to continue to pay the cash pay price for it.
Considering Medicare is similar to the VA care, and VA care doesn’t cover Armour either, then it’s unlikely any insurance exchanges are going to recommend Armour or NDT as the main course of treatment. I do think they still have to cover it as they would any prescription though, as long as folks can get it without having to go through a compounding pharmacy. I was very disappointed to see Medicare doesn’t pay/cover it at all. Very discouraging.
Fortunately, it’s not super expensive in the scheme of things for the benefits. I will never go back to T4 only (or T3 only, which I tried on a doc’s advice a while back too). Never, ever again. Armour all the way for me.
But maybe this puts us as advocates in a better position to petition the insurance companies and the government to look at the research and see that NDT is the way to go for almost everyone… I’m trying so hard to see the possible positive things that might come out of all of this. Maybe, maybe.