Fearful of future, patients fight to save ACA and its protections

Laura Packard walked into her doctor's office last year with a nagging cough. When she emerged a few hours later, she did so with a Stage 4 cancer diagnosis.

Life can change that quickly.

Packard, a member of Protect our Care, has joined a growing number of Montanans fighting to save the state's Medicaid expansion and the Affordable Care Act, along with the protections it offers against yesteryear's questionable insurance practices.

That includes a ban on dropping coverage for preexisting conditions and setting a maximum payout for medical costs. Both were common insurance practices before the ACA took effect.

“Those of us who have gone through cancer or any other serious illness or accident have preexisting conditions,” Packard said. “There are 130 million Americans with preexisting conditions, and many of us aren't insurable without the protections of the ACA. Our lives can depend on having good insurance.”

Packard isn't alone in facing a costly medical diagnosis and an uncertain health care future. Amy Coseo, a small business owner, was diagnosed with cancer three years ago, and despite a recent scare, she remains cancer free.

“I started a small business six years ago because I was able to access care through the Affordable Care Act,” Coseo said. “But it's been an incredibly stressful period of time, wondering if I'm going to lose access. One of the most important protections of the ACA is the protection for people with preexisting conditions.”

Coseo and others who rely on the ACA's protections don't take their coverage for granted. In February, the Texas attorney general filed a lawsuit, arguing the ACA was unconstitutional because Republicans in Congress had successfully repealed the individual mandate.

Under normal circumstances, she said, the Department of Justice would defend federal law in court. But this time around, the department has declined to defend the constitutionality of the ACA and its most popular elements, including preexisting conditions.

“If the DOJ prevails, protections of the ACA in place for people with preexisting conditions would be gone overnight,” Coseo said. “What that means in Montana is that 425,900 people, which is more than half of us, would be at risk.”

Since its inception, the ACA has been polarized by partisan politics, with Republicans vowing to dismantle the law and Democrats fighting to preserve what's left of it.

That holds true in Montana as well, with health care front and center in this year's congressional races. The rate of uninsured Montanans has dropped more that 20 percent since the ACA went into effect, and roughly 100,000 residents have gained coverage through Medicaid expansion.

But Sen. Jon Tester and challenger Matt Rosendale have different views on the future of health care. Tester looks to improve the ACA and preserve its protections, while Rosendale seeks to repeal the health care act and replace it with less costly, short-term plans.

Tester has called those plans “junk insurance,” saying they would leave thousands of Montanans vulnerable. Rosendale says they would present options based on one's budget and needs. But as Montana advocates of the ACA contend, no one can foresee their future health.

“If anyone has heard those words – cancer – it's not something you ever expected,” said Coseo. “The first thing I asked was if my insurance would cover this. I think about what it's like to go through treatment, and what it's like to have the fear that you'll be denied access or lose it during treatment.”

Lisa Davey's struggles with health care predate the ACA, when her son was born premature at 25 weeks in 2005. At the time, she was a Ph.D student at UM and was covered by student health insurance.

Her son, Logan, had a brain hemorrhage on his first day of life. Now 13, he has undergone 15 brain surgeries and still requires frequent trips to Seattle for groundbreaking treatment, which is covered by Medicaid.

“If you can't pay for that, you don't get to try it,” said Davey. “The surgery cost $157,000 after the negotiated insurance rate. His private insurance, covered through his dad, refused to pay it because they viewed it as an elective surgery.”

Before the ACA, the family was covered by Blue Cross Blue Shield through the school. The insurance company had a $1 million maximum payout, a sum her son's medical care reached in his first year of life.

The ACA has made those caps illegal.

“It's not that 'We're done for this policy year,' it''s 'We're done for the rest of your life,'” said Davey. “His first hour of life cost $526,000, so it didn't take long to reach that $1 million payout. That meant he was not eligible for the Blue Cross Blue Shield plan for the rest of his life, until the ACA.”

But the ACA wasn't enacted until 2008, and for the first few years, Davey's husband searched long and hard for jobs not tied to the Blue Cross plan. Given the company's size, both nationally and in Montana, landing a job with an alternate plan was a challenging task.

The financial impacts, Davey said, are profound.

“He was able to get a job at Direct TV, which didn't use his degree or capabilities very well, but we were able to get insurance for Logan,” Davey said. “We're very, very grateful for the Affordable Care Act, and I worry a lot about if it goes away. It has made a huge difference for our family.”