In 1984, I paid my health insurance bill a tad late one month. Things were tight. But I'd had the same insurance company since I'd been a baby riding on my parents' policy. I didn't think twice about it.
Two weeks later, a letter came informing me that my payment was not just late - I was terminated. And since I had recently been diagnosed as bipolar (by their doctors!), my 'application' was being denied due to my 'pre-existing condition'. I didn't think it was fair, but I was 26 and healthy, and I thought I'd just apply somewhere else. I didn't know then what mental illness would cost me. I didn't know I'd ever be eligible again. And, darn it, I hadn't had the foresight to get married before I went crazy! I might have been able to sneak in on a husband's policy. Or not...
Ah, I see some of you know this story.
Three weeks ago, that injustice was at least technically righted. The new Health Reform Law requires that people with 'pre-existing' (is having the wrong genes pre-existent enough?) conditions such as mental illness will be able to buy insurance as part of a national high-risk pool - starting in September, I believe. By 2014, we cannot be denied coverage, period. This is a huge win for us, though I could wish the culmination came sooner. It no longer matters to me personally, since I am on MediCare. But before that happened, I had gone years without insurance. I know what it's like when you don't dare go to the hospital. I can't think of anything Washington has done that made me this happy for a long, long time. It's nice to know that my government is capable, at least once per century, of being humane.
There are some other benefits that folks with special chemistry will appreciate. If you have MediCare Part D as part of a Disability package, you will as usual receive coverage for the first $2,700 in pill bills, then be liable for the next $4,000 before government help kicks in again - the infamous 'doughnut hole' - BUT this year you will get a $250 rebate check. It's not much, but it'll help. After 2011, Part D participants will receive a 50% discount on all those brand names your insurer doesn't like to cover. In psychiatric research, it's often the newest breakthrough drugs that we need - the expensive ones that have no generics. So that 50% discount could make the difference in getting the help you need a decade before the patent expires.
Another great boon will be the end of lifetime caps. This is effective immediately. No one can tell us now that we can't check into the hospital again because we've been as loony as we're allowed to be for one lifetime. But annual caps can still be set, so I don't know how that's going to work.
What is not entirely clear is the issue of mental health parity. Obama's administration is solidly behind enforcing the 1996 Wellstone-Domenici Parity bill, for what it's worth. That bill provides that as of January 1, group health plans of more than 50 people, IF they offer mental health benefits as well as medical-surgical benefits, and IF you are employed full time, must offer them on an equal basis. In other words, no more of this "you can see a therapist 10 times a year" stuff (unless they are also limiting you to 10 medical visits!).
Up until now, such group plans were available mostly through employers. Most PASC patients who are seriously ill aren't employed, at least not full time. Hopefully the new high-risk pool will be considered such a ''group plan", even if it's not an employer. But that remains to be seen.
The other great eventual benefit is the government subsidies which will help buy health insurance, once that's legally required in 2014. So many of the PASC live near or below the poverty level. The law provides subsidy help for up to 400% of the poverty level, which currently stands at about $10,000 a year. This sounds adequate.
Right now, your best bet is to keep an eye on the Health & Human Services Department. They are required to set up & maintain a website which will supply information about these kind of health insurance options. They should be one of the first to tell us how to apply for the high-risk pools. It's not up yet, but hey, it's only been 3 weeks!
None of this is likely to improve the shortage of psychiatrists and psychologists who actually ACCEPT MediCare and MediCaid. And nothing yet guarantees that such professionals will accept the insurance of the high-risk pool.
But on the whole, this is the most encouraging news in 70 years - if you're not a Republican - so stay tuned to this Bat Channel and this Administration. (Hint: re-elect the representatives who did this for you. They put their jobs on the line. They stood behind us. Let's return the favor. )
