Obamacare May Not Cover Your Pre-existing Condition After All

For someone in the middle of a cancer treatment, or someone with a chronic condition, this can be extraordinarily distressing, and perhaps dangerous to their health.

Edie Littlefield Sundby writes in the Wall Street Journal that she is on the verge of losing her treatment program for stage-4 gallbladder cancer. Why? Her existing plan doesn’t meet the ACA standards, so it has to be canceled. Her treatment program involves doctors at both the Stanford and UC San Diego medical centers, and the M.D. Anderson Cancer Center in Texas – but there is no plan in the California exchange that includes both Stanford and UCSD centers in it network, much less M.D. Anderson. In fact, UCSD has joined only one provider network, and it’s a heretofore almost unknown type called an “Exclusive Provider Organization” (EPO). The “exclusive” means that in an EPO, coverage is provided exclusively within the network – there is no out-of-network coverage at, except what uninsured people get at the emergency room.

Despite the President’s repeated promises, there is no way Ms. Sundby can keep all of her current doctors, or her health plan, in the new system. Her preexisting condition doesn’t prevent her from enrolling in any of the new Obamacare exchange plans – but none of those plans actually cover the same treatment she was receiving for her preexisting condition.

Ms. Sundby’s predicament is probably not an isolated case. Abby Goodnough of the New York Times reports that many people are having extreme difficulty finding out whether the plans they are shopping on the exchanges will cover the current doctors or hospitals they go to, or the drugs they take.

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