By Jim Freeburg
Multiple Sclerosis Society
Despite the significant improvements to our health care system for people with chronic conditions, like multiple sclerosis, cancer, heart disease, or arthritis, there is still a lot of work to be done to realize the full potential of Obamacare.
With the new health care exchanges, patients are expected to be smart consumers of health care, but they are not given the tools to do so. Without more information, patients cannot shop around for the best price and highest quality health care. Trained navigators provide help in-person and over the phone, but they do not have all the information they need either. This is unfair, and lawmakers should realize that we can do better.
According to the Centers for Disease Control, people with chronic conditions account for more than 75 percent of our nation’s health care costs. Many of these costs could be avoided if patients had more information about where they can receive the best care. We should prioritize assisting people with a chronic illness if we are serious about making health care more affordable.
Much of the attention around health insurance has focused on the affordability of insurance premiums. People with chronic conditions, however, should pay more attention to their total out-of-pocket costs when choosing a plan. Out-of-pocket costs can vary widely between plans and it is very difficult to figure out which plan is best.
Luckily, a new out-of-pocket cost calculator from the National Health Council can help you understand the difference between bronze, silver, and gold plans. If our lawmakers wanted, we could make the tool even better for Washington consumers to tell patients exactly which plan is best for their health care.
But first, we need to do some other work before consumers can start to be smart shoppers. To start, people with chronic conditions need to know what prescription drugs are covered by which health plan and how much they cost – before they purchase a plan. Currently, Washington’s exchange, HealthPlanFinder, does not have an easy way to look up this information. Because coverage varies so widely from plan to plan, people could pay $350 for a month’s worth of multiple sclerosis treatment, or $3,500, and they won’t know this until they sign up for a plan.
Second, pharmaceutical companies need to let patients know if they will be helping with the cost of expensive treatments. Conflicting guidance from the federal government about the legality of prescription assistance programs has meant that people who rely on these financial assistance programs don’t know if they will get a better deal on HealthPlanFinder.
Third, and perhaps most importantly, health insurance companies and health care providers must be transparent about their pricing. Prices for the exact same treatment vary widely from clinic to clinic for seemingly no apparent reason. Until consumers can see which plans can get them better deals, we won’t actually know which health plans are higher quality than others and deserve our business.
Legislation in Olympia attempts to address this problem, but unfortunately, it excludes prescription drugs.
People with chronic conditions have much to like in Obamacare – no more pre-existing conditions, a cap on out-of-pocket costs and help with premiums. But we still have a long way to go until we actually get affordable and accessible health care.
Seattle-based Jim Freeburg is the advocacy director for the Greater Northwest Chapter of the National Multiple Sclerosis Society.
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