Ten years into Obamacare, cost and access issues abound
Health care costs for some remain a personal challenge and a growing political concern
Caroline Corum holds medical receipts as she poses for a portrait outside of her home. (Caroline Brehman/CQ Roll Call)
By Lauren Clason, Emily Kopp, and Mary Ellen McIntire Posted March 10, 2020 at 11:40am
When Caroline Corum was first diagnosed with breast cancer, she hardly paid attention to the bills. As a 52-year-old nurse from Arlington, Va., Corum’s treatments were largely paid through insurance from her employer.
But that changed when the disease forced her to leave her job and take disability last year. Suddenly faced with exorbitant costs and the prospect of losing her doctors, Corum signed up for coverage with a nearly $700 monthly premium through the COBRA health insurance law, which lets former employees temporarily keep their employer insurance at a higher cost.
Although expensive, the plan offered no deductible and a $3,500 out-of-pocket spending limit. [Health politics: 2020 hopefuls differ on more than insurance coverage]
Her cheapest insurance plan option under the 2010 health care law, meanwhile, had a $600 premium with a $7,000 deductible and a $8,150 out-of-pocket cap. She only qualifies for a federal subsidy of less than $100 per month, she says, because of rental income from a studio she owns and her disability pay.
“To sum up, little or no overall cost difference,” Corum says, adding she prefers “the devil you know versus the devil you don’t know.”
All told, she estimates that she pays $1,500 a month for her medical care now. She projects she only has a few years before her savings are gone.
Corum’s case illustrates why, 10 years after the passage of the health care law that became known as the Affordable Care Act and which was intended to give patients less costly options, more work remains to be done.
To be sure, the 2010 law succeeded in significantly improving health insurance for many people facing difficult situations. People who qualify based on their incomes can typically get essentially free care if their state expanded Medicaid or federally subsidized insurance through new online marketplaces.
Before the law took effect, cancer patients like Corum sometimes couldn’t get private insurance at all. If they were lucky enough to find a plan that offered them coverage, patients with preexisting conditions often faced unaffordable bills or limited benefits.[House panels to take up surprise billing proposals]
It was this insurance practice of discriminating against preexisting conditions that President Barack Obama’s law sought to solve. But while it ushered in a number of much-needed changes to strengthen benefits and provided new coverage to more than 20 million people, the law did little to curb rising costs like premiums and deductibles. The law, as implemented, mostly ignored the underlying driver of those rates — the price of medical care and prescription drugs.
Even as the number of people with insurance has soared, costs for some consumers remain an intractable personal challenge and a growing political concern. The law has been a gift and a curse for both parties since 2010, helping propel Republicans into office in the years after its passage, but costing them the House in 2018 after a series of repeal attempts fell short in spectacular fashion.
Now Democrats are again staking their campaigns on health care as they acknowledge the law was not enough. Presidential contenders are split on how far to expand government-run coverage, but stand united in their belief that changes need to happen for patients like Corum.
Corum’s situation prompted her to get involved with advocacy groups like Health Care Voter, and to lobby for Democrats’ proposals to lower drug prices. She entered a clinical trial after the cancer spread to her liver, and says she’s fortunate to receive extra attention from physicians and have the cost of her treatments — which totaled nearly $40,000 in just one month last year — largely covered for now through either the trial or COBRA, officially called the Consolidated Omnibus Budget Reconciliation Act.
But her situation could turn dire in an instant. Metastatic breast cancer is a lifelong diagnosis, often resurfacing in other parts of the body.
“Literally you get up every morning and play Russian roulette,” she says. “You just don’t know.”