The Real ObamaCare Horror Story

Recently, Senator Harry Reid addressed the American people from the Senate floor and solemnly claimed that “there’s plenty of horror stories being told,” about ObamaCare. “All of them are untrue, but they’re being told all over America.”

In essence, the senator called me and numerous other Americans being impacted by ObamaCare liars. I have been called many names before, but liar was not one of them. My most recent title before Harry accused me of being a liar was Multiple Sclerosis (MS) patient.

I was diagnosed in 2012 after a significant episode that attacked both my brain and spinal cord. During this episode, I experienced dizziness, nausea, “brain fog”, tingling, numbness, stiffness from the waist down to my toes, lack of balance, inability to walk and extreme fatigue. I needed help to do the basic functions of life. As a mother of 3 young children, this was a very difficult time.

Once I was properly diagnosed, I was put on intravenous steroids to calm down the active lesions and then long-term MS medication consisting of daily shots intended to decrease the frequency of relapses. Within a week of starting my MS therapy, the “brain fog” lifted and the dizziness subsided. The next year was spent recovering. To date, I still have occasional dizziness. I continue to battle fatigue and struggle with stiffness and tingling from the knees down, but I can walk with a slight limp. Quite frankly, I see my recovery as a miraculous gift from God.

However, my medicine is expensive. A yearly supply of my primary MS medication is over $40,000. Thankfully, my husband and I have always carried insurance. Under our plan, my medications are covered between 80%-90%. My MS medications are processed through a specialty pharmacy. Coordination between the insurance company and the specialty pharmacy must take place to confirm patient coverage. In addition, it is important that the claims are processed and paid for by the insurance company quickly or else the pharmacy will not ship the drug if there is any outstanding balance due. To date, our private insurance has approved and paid for all my medications in a timely manner. Given the difficulty Americans have had just signing up for ObamaCare and confirming enrollment, I have no doubt that MS patients insured through ObamaCare will experience difficulty receiving their specialty medications due to errors and non-payment . This can be devastating for people with MS because a break in the medication can lead to relapses.

Furthermore, it has been reported that ObamaCare policies do not cover some MS medications, leaving the patient to shoulder the cost. These expenses would not be applied to the large deductibles of the Obamacare policies. What does that mean? According to Dr. Scott Gottlieb, a practicing physician and Resident Fellow at the American Enterprise Institute, “If the medicine that you need isn't on that list, it's not covered at all. You have to pay completely out of pocket to get that medicine, and the money you spend doesn't count against your deductible and it doesn't count against your out of pocket limits, so you're basically on your own.”

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Furthermore, the Washington Post reports, “ insurers selling policies on the exchanges have pared their drug benefits significantly more, according to health advocates, patients, and industry analysts. The plans are curbing their lists of covered drugs and limiting quantities, requiring prior authorizations and insisting on “fail first” or “step therapy” protocols that compel doctors to prescribe a certain drug first before moving on to another -- even if it’s not the physician’s and patient’s drug of choice.”

“2014 is going to be a scary year. People are going to have to stop taking medicines they are already stable on because of this,” said [Daniel] Kantor, the immediate past president of the Southern MS Consortium, a group of doctors, social workers and advocates who work with patients with the condition.

ObamaCare establishes minimum levels of coverage for drugs. In order for insurers to balance the costs and risks forced upon them by ObamaCare, insurers are opting for the minimum coverage they must provide as mandated by the law. Employer-based insurance plans are adopting some of the stringent prescription drug benefit designs used in ObamaCare. “We are already seeing interest” one leading health care analyst told the Post.

MS affects everyone differently. Some people only experience mild symptoms. Others have severe attacks that leave them disabled. As much as government bureaucrats want to implement impersonal-one-size-fits all plans, no such treatment exists for MS. Each case must be looked at individually and be treated as such.

Another problem with ObamaCare is that it was so broadly written, there is room for the enforcement of multiple out-of pocket limits applied to a single patient! MS patients need more than just a primary-care doctor. We also need specialists to deal with the damage done to our central nervous systems. The law is written so that each of these might lead to a separate out-of -pocket limit depending on how plans do the math. Furthermore, the administration has delayed until 2015 a provision that limits how much out-of pocket money people may have to spend on their own health care.

According to the New York Times, “Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.”

Bad news about ObamaCare just keeps coming. Dr. Hal Scherz, Founder and President of Docs4Patient Care and Dr. Jeff English Director of Clinical Research at the MS Center of Atlanta have written a piece titled, “ObamaCare: We need an Earmark to Treat that Disease” to alert patients about the rationing of vital services by government. According to the article,

 “CMS (Center for Medicare and Medicaid Services) is notifying doctors about overutilization of services. My partners and I were among those contacted.  Apparently, some of us ordered 40% more radiology tests than our "peers" did last year.  (They did not bother to define “peers.)

Those of us with a heavy concentration of multiple sclerosis (MS) patients were the only ones above the average.  MS patients require radiology tests (predominantly MRI’s) for diagnosis and for routine follow-up in order to properly manage their care.  The same cost problem exists with drug prescribing because medications used for MS are very expensive, which is obviously out of the control of physicians.”

They further write that in order to control costs, “There will be rationing of care by bureaucrats in Washington who are looking at statistics instead of patients.”  They warn, “How can physicians protect themselves from the iron fist of the Federal government?  Quite simply, by taking care of healthy people.”

In closing, it is Harry that is the liar, not I and the many others that have seen and are concerned about the negative impacts of ObamaCare. I will not be intimidated into silence by those in power. Compared to MS that I battle every second of every minute of every day, Reid, Obama and the rest of their lot are small potatoes that would be unable to stand in my shoes for even a moment. God willing, I will continue to stand tall and warn my fellow Americans about ObamaCare. The question is, who will Americans believe?

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