Pre-Existing Conditions Under The AHCA: Cancer Survivor Sees A "Cautionary Tale"
Republican legislation to dismantle the Affordable Care Act is on its way to the Senate. The House of Representatives-passed American Health Care Act (AHCA) would allow insurance companies to once again take pre-existing conditions into account, and health researchers with the Kaiser Family Foundation say the change could leave millions of Americans with pre-existing conditions paying more for insurance if they have a gap in coverage. And that has some people with chronic health problems in the Miami Valley worried about the future.
"Come on, let’s go! Come on!"
Lilly the dachshund's nails click across the linoleum as she follows Karen Gardner through the kitchen and out to the backyard for a little walk.
Afterwards, sitting in the living room, Gardner says dog and human have become inseparable. The tiny brown dog was a steady presence through her recent battle with cancer.
"The last seven years have truly been pure hell," Gardner says. "And she got me through it."
The Moraine 47-year-old’s cancer is finally in remission. But Gardner worries what may happen if it returns after the Affordable Care Act is repealed.
Under the American Health Care Act, states could seek waivers allowing insurance companies to consider a patient's health status. Analysts say some patients could see premiums rise as a result.
This could mean trouble for Gardner. She’s recovering from the cancer, but she continues to live with a chronic arthritis condition she’s had since childhood.
"How can you tell me that I can't get insurance when I was born that way? I didn’t even have a chance, and you're telling me that you're going to penalize me for that?"
She says she's afraid a repeal of the Affordable Care Act would leave her unable to find or afford health coverage. Gardner already knows what that’s like.
When her cancer first took hold, she had no insurance. In fear of medical debt she couldn’t repay, Gardner delayed seeking care for months until concerned family members finally insisted she go to the hospital.
"And they said we have to admit you. And I said I can't afford that. He [the doctor] goes, 'well, you really need to stay,' and I said what, am I going to die? He goes, maybe," she says. "I let them run their test to find out what was wrong. Non-Hodgkin's lymphoma, stage four originally, and then they came back and were able to say it was stage two."
Non-Hodgkin's lymphoma is a cancer that typically begins in the body’s white blood cells. Doctors recommended Gardner seek immediate treatment. But, by that time, she was too sick to work and had no income.
Family members helped her stay afloat financially. But she also burned through the retirement money she saved during her years working in sales.
Gardner credits her family doctor with saving her life. He provided her chemotherapy free of charge until she could secure disability or Medicaid coverage. It took six months. In the meantime, her medical bills added up.
"It had to be over $300-some-thousand just for that doctor and the care," she says.
Soon after her cancer diagnosis, the Affordable Care Act took effect. Gardner remembers what went through her mind when she heard the law would require health insurance companies to accept people with pre-existing conditions.
"It made me sit and cry to think that, for the first time in my life, that I wasn't ever going to have to go without insurance again, that I wasn’t going to have to worry about this."
Numbers show many Americans feel the same way.
In a recent Politico poll, about half of people surveyed opposed allowing states to opt-out of pre-existing condition requirements.
Wendy Patton, who directs the nonprofit research institute Policy Matters Ohio, says allowing states to opt out of such requirements could leave many Ohioans in a difficult spot.
“Government data shows that almost 5 million Ohioans in 2009 had some condition that could be considered a preexisting condition and could make their premiums rise or make them ineligible for coverage,” Patton says.
A recent analysis by the nonpartisan Congressional Budget Office found a previous attempt by Republicans to repeal and replace the Affordable Care Act would reduce federal deficits by $337 billion and leave 24 million Americans without health insurance over the next decade.
Earlier this month, after the House narrowly passed the American Health Care Act, Gov. John Kasich said in a statement the bill doesn’t do enough to maintain health care for the state's most vulnerable residents.
But Republican eighth district Congressman Warren Davidson says it’s just not that simple. Under the American Health Care Act, he says, people with pre-existing conditions whose insurance lapses for at least two months could potentially face higher premiums.
The Kaiser Family Foundation estimates more than six million people -- nearly a quarter of all non-elderly adults -- could fall into this situation.
"So if you wait until you're sick to sign up you are potentially going to pay more," Davidson days, "but only for that first year and then in the second year, you didn't have a gap in coverage so you get back to market-based pricing."
After the first year policyholders would be eligible for premiums not dependent on health status, he says. Davidson, who voted for the American Health Care Act, says he’s confident the Senate will address what he sees as a critical need for more competition in the health-care marketplace. More competition across state lines, he says, will help to bring insurance costs down.
"We have a phenomenal set of health-care institutions in the United States. We're finding it increasingly unaffordable. And I think the answer to that isn't a subsidized system, I think the answer to that is a competitive system."
"There’s nobody out there," Gardner tells the dog Lilly. "Go lay down, it's alright."
Now that she's feeling better, Gardner is thinking about writing a book about her experiences navigating the health care system after a cancer diagnosis. She says it's a cautionary tale, what she fears could happen to more Americans if lawmakers succeed at rolling back the Affordable Care Act’s pre-existing condition requirements.
"Coming from somebody like me, who never thought I would need assistance, it can happen to you. Let me tell you right now, I don't care if you make a million dollars a year. Your bills are going to be more than that," she says. "And you can lose everything that you have because you were sick."
Through Medicaid, Gardner was eventually able to get many of her medical bills covered retroactively. But her continued recovery has left her unable to work full-time. She nearly lost her home to foreclosure. But things are finally looking up. Gardner’s started her own pet-sitting business and already has a few clients. She says caring for animals is speeding her healing process.
"And they just want love, and they want you to throw a ball for them and play with them, and they're awesome. For me, it's the perfect job."
Gardner says being around the animals is helping her to feel normal again. It’s a feeling she lost during her battle with cancer.