No, Obamacare Might Not Cover Your Preexisting Condition

Posted by on Nov 05, 2013 at 7:39 am

Key to understanding this distinction is that having “health coverage” is not the same as actually obtaining “health care.” The insurance plan has to take anyone who wants to enroll, regardless of their health status or health history – but they don’t have to provide the same treatments, the same doctors, or the same medications that a patient has been receiving.

For someone in the middle of a cancer treatment, or someone with a chronic condition, this can be almost equivalent to losing insurance entirely.

Edie Littlefield Sundby writes in the Wall Street Journal that she is on the verge of losing her treatment program for stage-4 gallbladder cancer. Why? Her existing plan doesn’t meet the ACA standards, so it has to be canceled. Her treatment program involves doctors at both the Stanford and UC San Diego medical centers, and the M.D. Anderson Cancer Center in Texas – but there is no plan in the California exchange that includes both Stanford and UCSD centers in it network, much less M.D. Anderson. In fact, UCSD has joined only one provider network, and it’s a heretofore almost unknown type called an “Exclusive Provider Organization” (EPO). The “exclusive” means that in an EPO, coverage is provided exclusively within the network – there is no out-of-network coverage at, except what uninsured people get at the emergency room.

Despite the President’s repeated promises, there is no way Ms. Sundby can keep her doctors, or her health plan, in the new system. Her preexisting condition doesn’t prevent her from enrolling in any of the new Obamacare exchange plans – but none of those plans actually cover the treatment for her preexisting condition.

Full story.

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