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Author Topic: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"  (Read 988 times)

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Offline Since1993

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http://nypost.com/2014/08/10/from-hiv-to-cancer-to-crones-obamacare-fails-the-sick/

From HIV To Cancer To Crohn's, ObamaCare Fails The Sick

It turns out ObamaCare didn’t solve the problem of “pre-existing conditions” after all. It made premiums more affordable for people with chronic health conditions that are expensive to treat — but at the price of sticking them with unaffordable co-payments for their medications.

The nonprofit AIDS Institute is suing four Florida health insurers for discriminating against HIV/AIDS patients. The complaint says these patients now face prohibitive out-of-pocket drug costs. Sadly, most of the plans sold via ObamaCare all across the country have similar problems — leaving those with chronic diseases without affordable access to the specialty drugs they need.

The Affordable Care Act limits the degree to which insurers can charge higher premiums for sicker patients. But ObamaCare plans found a way around these rules: impose higher out-of-pocket costs for all or most specialty drugs.

Consider the Florida suit. Carl Schmid, the AIDS Institute deputy executive director, says the plans follow a “pattern where every single [HIV/AIDS] drug for some plans was on the highest tier, including generics.” Under these policies, drug costs for AIDS patients can exceed $1,000 a month.

And Florida’s hardly unusual. A new report from consulting group Avalere Health found that a large majority of all ObamaCare exchange plans include similarly high out-of-pocket costs for patients with certain illnesses.

The breakdown of Silver plans (the most popular category) is particularly revealing. In seven classes of drugs for conditions from cancer to bipolar disorder, more than a fifth of these plans require patients to shoulder 40 percent of the medicine’s cost.

And 60 percent of Silver plans place all drugs for illnesses like multiple sclerosis and rheumatoid arthritis in the “formulary tier” with the highest level of cost-sharing.

Nearly every Silver plan across the country, in fact, puts at least one class of drug exclusively in the top cost-sharing tier. In effect, this leaves patients with a given condition — whether HIV or Crohn’s disease — without a single affordable treatment option.

Pre-ObamaCare, about half the states had a system in place for helping people with pre-existing conditions: state high-risk pool plans, which for years offered government-subsidized coverage to patients with pre-existing conditions. But the Affordable Care Act banned those pools.

So now, with exchange plans failing them, the chronically ill have nowhere left to go.

Allies of the insurance industry blame the drug companies for the high price of certain medicines. AARP policy adviser Leigh Purvis, for instance, says cost-sharing levels “wouldn’t be so high if the prices of drugs weren’t so high.” Health-policy advocate John Rother, meanwhile, claims that “reducing price is something [drug] companies could do tomorrow.”

But drug prices aren’t arbitrary. The average biopharmaceutical therapy takes $1.2 billion and anywhere from 10 to 15 years to bring to market. Firms must charge high prices for certain brand-name drugs to make back this substantial investment with enough left over to fund research into the next generation of treatments.

And while insurers like to complain that sophisticated therapies cost too much, they tend to ignore the far higher costs of denying these medicines to patients.

Increased co-pays result in “nonadherence,” failure to take prescribed medications. And that equals increased rates of hospitalization, chronic heart failure and premature death.

And this adds to health outlays: According to a recent study in the Annals of Internal Medicine, nonadherence costs the US health system from $100 billion to $289 billion a year.

In short, by making needed medications unaffordable — and by failing to cover newer, targeted therapies — insurers are jeopardizing patient health. And far from saving money, cutting off access to specialty drugs actually increases long-term health costs.

Specialty medications need to be treated as equivalent to other essential medical services — not as some luxury that only the wealthy can afford. But the ObamaCare law has only made the problem worse than ever.

Peter J. Pitts, a former Food and Drug Administration associate commissioner, is president of the Center for Medicine in the Public Interest.


Offline leatherman

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #1 on: August 12, 2014, 08:40:40 AM »
while I glanced through this article and a lot of it seems correct, I couldn't stand reading it because the reporting kept blaming the situation on "obamacare". The Affordable Care Act isn't the problem; the problem is the blood-sucking insurance industry sucking every last dime out of its customers.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Jeff G

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #2 on: August 12, 2014, 08:49:57 AM »
while I glanced through this article and a lot of it seems correct, I couldn't stand reading it because the reporting kept blaming the situation on "obamacare". The Affordable Care Act isn't the problem; the problem is the blood-sucking insurance industry sucking every last dime out of its customers.

True ^ . The high cost of meds to treat chronic condition's predates the ACA . Its true that the ACA does not address the core issues and pitfalls of a for profit healthcare system .


Offline Miss Philicia

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #3 on: August 12, 2014, 08:53:48 AM »
This is what happens when one links to the Murdoch owned New York Post, a repellant rag if ever there was one.
"I’ve slept with enough men to know that I’m not gay"

Offline leatherman

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #4 on: August 12, 2014, 09:12:50 AM »
Here's an article which explains the situation more realistically

Quote
Patient advocates say some insurance companies are making HIV and AIDS drugs unaffordable in plans issued through the Affordable Care Act by shifting much of the cost to customers.

While the issue applies broadly to all patients with chronic illnesses that require expensive medication, HIV and AIDS advocates say they were the first to file a formal complaint with the government about pricing.

Under President Barack Obama’s health law, insurance companies are forbidden from turning away consumers with pre-existing conditions. But advocacy groups allege insurance companies are discouraging HIV and AIDS patients, who are expensive to cover, by requiring them to pay a percentage of costly medications instead of a flat co-pay, essentially pricing the medications out of reach.

Several insurance companies are also impeding access to services by requiring re-authorization for drugs consumers have been taking for years or making the claims process difficult, says Carl Schmid, deputy executive director of The AIDS Institute. The group filed a complaint with U.S. Health and Human Services officials this summer against four Florida insurance companies, and advocates in other states are considering similar action.

The complaint filed with federal health officials alleges Humana, CoventryOne, Cigna and Preferred Medical are violating the federal health law by discouraging consumers with HIV and AIDS from choosing those plans because they wouldn’t be able to afford the high co-insurance rates.

Georgia advocates are planning to file a similar complaint with federal officials, said Dr. Melanie Thompson, who has several patients unable to afford the medicines under their new insurance plans. Advocacy groups say they are finding similar problems with some exchange plans in Ohio, California and Illinois.
. . .

for the rest of this article use this link
http://washington.cbslocal.com/2014/08/06/advocates-insurance-companies-making-hiv-aids-drugs-unaffordable-under-obamacare-exchange/

and an article that is slanted yet details an individual's situation in SC with increased drug costs to the patient
http://www.buzzfeed.com/davidtuller/hiv-drug-costs-spiking
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline mecch

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“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline bmancanfly

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #6 on: August 12, 2014, 09:53:31 AM »
The slanted headline of the article in the OP tells you all you need to know.  But what else can you expect from the Post.

I shopped for policies on the Fed exchange for FL and was very surprised at how good the coverage was.  Not to say that some insurance companies aren't trying to game the system.  But why would someone with HIV purchase a Silver plan?  If you have one of the most serious and expensive diseases,  maybe you ought to look into buying better coverage.  Silver plans a pretty bare bones coverage.

The notion that the ACA has create this problem is a fallacy.  The ACA makes it less worthwhile for insurance co's to do this since their profit is capped now at 20%.  There will be no windfall for them if they are successful.  This practice has been going on long before the ACA.  Still plenty of loopholes to be plugged but not as dire as it might seem.

Not to mention that people with HIV often couldn't get coverage at all before the ACA.

It does seem like some of the insurance co's are trying to blatantly drive the poz away when they categorize all HIV drugs in the highest tier when there are now generics available (with more to come soon).
"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Offline OneTampa

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #7 on: August 12, 2014, 10:43:35 AM »
Have to admit seeing the first article put a bitter taste in my mouth.

Humana is the insurer for the group health coverage of a prospective employer. I assume the information presented to me with the quoted monthly premiums for different level coverage, drug formularies, and co-pays offer some rein in.
"He is my oldest child. The shy and retiring one over there with the Haitian headdress serving pescaíto frito."

Offline Since1993

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #8 on: August 12, 2014, 04:05:23 PM »

I shopped for policies on the Fed exchange for FL and was very surprised at how good the coverage was.  Not to say that some insurance companies aren't trying to game the system. But why would someone with HIV purchase a Silver plan?  If you have one of the most serious and expensive diseases,  maybe you ought to look into buying better coverage.  Silver plans a pretty bare bones coverage.

Not to mention that people with HIV often couldn't get coverage at all before the ACA.


In order to receive Ryan White Part B/ADAP assistance, anyone who chooses an ACA plan must choose a Silver Plan. You must also fulfill your states Ryan White Part B/ADAP eligibility requirements.

There are built-in advantages choosing a Silver Plan by way of Cost-Sharing Reductions (CSR).  If your income is <250% of the Federal Poverty Level (FPL)($29,175 for a household of 1) you qualify for CSR which further reduces the amount applicants pay for medical co-pays, prescription co-pays, annual deductible and annual maximum out-of-pocket. In essence, the CSR improves your plan to that of a Gold Plan, without the added premium. 

CSR is only offered to those who choose a Silver Plan, HIV+ or not.

Also, if your income is <400% of FPL ($45,960 for a household of 1), you would receive Advanced Premium Tax Credits (APTC) which reduces your monthly insurance premium amount.

After APTC and CSR are applied, Ryan White Part B would pay the remainder of your monthly premium and ADAP the remainder your HIV medicine co-pay.  Some states Ryan White Part B goes further and also pays co-pays for all outpatient medical.

Someone who is HIV+, who opts not to choose a Silver Plan, cannot benefit from CSR or Ryan White Part B/ADAP, but they can receive APTC.  The only feasible reason someone HIV+ would choose a Gold or Platinum Plan is if their income is greater than 250% of the FPL and/or they aren't eligible for Ryan White Part B/ADAP assistance. 




Offline bmancanfly

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #9 on: August 12, 2014, 04:27:51 PM »
All the more reason for single payer.   ;)
"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Offline Since1993

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #10 on: August 12, 2014, 04:52:20 PM »
What the article fails to consider is the Silver Plan Cost-Sharing Reductions (CSR) for those whose income is < 250% of the Federal Poverty Level (FPL) which reduces the amount of co-pays for medical and medications, annual deductible and maximum out-of-pocket.

Also, the article fails to mention Ryan White Part B/ADAP assistance for those who choose an ACA Silver Plan that receive HIV medications, or Co-Pay assistance programs available from the Drug Manufacturers.

The article is definitely politically slanted against the Affordable Care Act, otherwise stated as,  "ObamaCare".  I felt it lacked balance.  I agree with this statement from the article, "Specialty medications need to be treated as equivalent to other essential medical services — not as some luxury that only the wealthy can afford."
 
I disagree with the author premise that "Obamacare fails the sick".  Au contraire.  I'm the first generation of disabled Americans living with AIDS, who is not Medicaid-eligible, who relies on "ObamaCare" for medical insurance until Medicare-eligibility.  In fact, "ObamaCare" has improved my access to healthcare providers because without it, I would have been uninsured until Medicare-eligibility. 

Those who are HIV+, that carry an ACA plan who are not eligible for Ryan White Part B/ADAP assistance or Cost-Sharing Reductions offered by Silver Plans because their income is too high, carry a higher burden of out-of-pocket expense without co-pay assistance from the Drug Manufacturers.  The article fails to make this distinction.


Offline tednlou2

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #11 on: August 12, 2014, 05:03:12 PM »
I think a Medicare-For-All system would be best.  It is amazing to me how repubs have convinced people a system like that would be all government-run hospitals and docs.  It would be no different than Medicare is now.  And, people love their Medicare.  But, Medicare Part D would have to be able to negotiate drug prices.  If the majority were in one system, it would seem that would keep costs much lower.  I'm no policy or financial expert, but it would seem like it should work that way. 

The problem is so many will say we cannot shut down private companies, as that would cost tens of thousands of jobs.  Those companies could be contracted to process claims and be phone reps.  I worked for Anthem, in their Medicare division.  We only dealt with Medicare claims.  But, we know these insurance companies will not go down without a fight.  They have hundreds of millions to lobby congress. 

And, let people decide.  You can join Medicare or stay with your insurance company.  It will be a free market and I think Medicare would win.  If insurance companies cannot survive, that's just how things work. 

Offline Since1993

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #12 on: August 12, 2014, 05:17:41 PM »
And, people love their Medicare.

"I hate Medicare", said no one ever.  Yes indeed, people love their Medicare!  Can you imagine what life for the elderly and disabled would be like without it?  Cringe at the thought.

Offline mecch

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #13 on: August 12, 2014, 05:33:06 PM »
"As we all know" the US had the most expensive and the worst health care among so called "developed" i.e. rich nations.

These are the worst on WHO rankings:

http://www.photius.com/rankings/healthranks.html

I started the copy paste at Haiti because (in my quick review I think) thats the bottom of the barrel for North, Central and South Americas

138       Haiti
139       Gabon
140       Kenya
141       Marshall Islands
142       Kiribati
143       Burundi
144       China
145       Mongolia
146       Gambia
147       Maldives
148       Papua New Guinea
149       Uganda
150       Nepal
151       Kyrgystan
152       Togo
153       Turkmenistan
154       Tajikistan
155       Zimbabwe
156       Tanzania
157       Djibouti
158       Eritrea
159       Madagascar
160       Vietnam
161       Guinea
162       Mauritania
163       Mali
164       Cameroon
165       Laos
166       Congo
167       North Korea
168       Namibia
169       Botswana
170       Niger
171       Equatorial Guinea
172       Rwanda
173       Afghanistan
174       Cambodia
175       South     Africa
176       Guinea-Bissau
177       Swaziland
178       Chad
179       Somalia
180       Ethiopia
181       Angola
182       Zambia
183       Lesotho
184       Mozambique
185       Malawi
186       Liberia
187       Nigeria
188       Democratic Republic of   the Congo
189       Central   African   Republic
190       Myanmar
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline mecch

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #14 on: August 12, 2014, 05:35:46 PM »
Rich countries, (and some... not so rich):

1         France
2         Italy
3         San Marino
4         Andorra
5         Malta
6         Singapore
7         Spain
8         Oman
9         Austria
10        Japan
11        Norway
12        Portugal
13        Monaco
14        Greece
15        Iceland
16        Luxembourg
17        Netherlands
18        United  Kingdom
19        Ireland
20        Switzerland
21        Belgium
22        Colombia
23        Sweden
24        Cyprus
25        Germany
26        Saudi Arabia
27        United  Arab  Emirates
28        Israel
29        Morocco
30        Canada
31        Finland
32        Australia
33        Chile
34        Denmark
35        Dominica
36        Costa Rica
37        United States of America


signed,

french-speaking commie pinko faggot expat

NOTE these figures are OLD (2000!) because the WHO stopped making the list as it was "too complex" to figure out...  >:(
« Last Edit: August 12, 2014, 05:41:43 PM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline bmancanfly

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #15 on: August 12, 2014, 05:37:49 PM »
I'm the first generation of disabled Americans living with AIDS, who is not Medicaid-eligible

Not sure what you meant by this,  could you explain?

--------------------

The implication in the article that somehow HIV poz people,  as a group,  are worse off under the ACA is simply not true.

Think about all the effort and money that goes into managing the alphabet soup of aid programs.  Plus what a byzantine maze the patient (often times when not well) has to navigate.  What a waste.  A simple Medicare type system would not only be simpler but cheaper.
"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Offline Joe K

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #16 on: August 12, 2014, 06:12:18 PM »
From the article:

"But drug prices aren’t arbitrary. The average biopharmaceutical therapy takes $1.2 billion and anywhere from 10 to 15 years to bring to market. Firms must charge high prices for certain brand-name drugs to make back this substantial investment with enough left over to fund research into the next generation of treatments."

While the cost of drug development is expensive, most drug companies spend a lot more on advertising than they do on R&D.  If they stopped spending all that money to advertise drugs, they could reduce prices by an order of magnitude.

Sooner or later, the economics of health care is going to roll over the drug industry and impose price controls.

Joe

Offline elf

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #17 on: August 13, 2014, 08:28:26 PM »
Pricing of new drugs is outrageous:

Quote
Even At $900 (Vs. $84,000 In US) Hep C Cure Sovaldi's Cost Could Be Unacceptable In India

The price of Gilead’s new hepatitis C drug, Sovaldi, has been the topic of much debate. Although Sovaldi cures hepatitis C in more than 90% of those who for whom it has been prescribed, the 12 week course of treatment in the U.S. is $84,000, which comes to $1,000 a pill. While curing hepatitis C saves lives and prevents a lot of downstream healthcare costs for patients who, without this drug, could ultimately develop liver cancer or require a liver transplant, payers and politicians are in an uproar for a variety of reasons, not the least of which is that the drug is priced much higher in the U.S. than in the rest of the world. For example, in  Europe, where the government negotiates the price,  Sovaldi’s price tag is on the order of $55,000/patient.


http://www.forbes.com/sites/johnlamattina/2014/08/08/even-at-900-per-cure-sovaldis-cost-could-be-unacceptable-in-india/

Offline Since1993

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Re: NY Post: "From HIV To Cancer To Crohn's, ObamaCare Fails The Sick"
« Reply #18 on: August 16, 2014, 02:40:17 AM »

"I'm the first generation of disabled Americans living with AIDS, who is not Medicaid-eligible"

Not sure what you meant by this,  could you explain?

You snipped-off the last part of my quote, which quantifies:

"I'm the first generation of disabled Americans living with AIDS, who is not Medicaid-eligible, who relies on "ObamaCare" for medical insurance until Medicare-eligibility." 

 


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