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article imageOp-Ed: When Obamacare stops treatment for cancer patients

By Mike White     Sep 22, 2014 in Politics
Jeffrey Rusch, a man from California, had 20 tumors in his brain, a large tumor in his lung and several others in his liver and bones. He started to receive treatment, only to later receive a notice his treatments weren't covered under Obamacare.
Rusch is not alone. The Internet is filled with stories who have been denied treatment and access to the best cancer hospitals and treatment centers because their care was not considered a medical necessity under the Affordable Care Act (Obamacare). I will seek to be fair in my editorial. There are also stories of people who did receive treatment because of the new law and will report on at least one. The problem is, while I am happy for people who have received the treatment, such incidents do not in any way minimize the mental anguish and physical problems of those denied treatment, and there seem to be more people that fall into that category than the other.
According to, Rusch, who is from Sonoma County, California, was rushed into treatment after learning from an MRI that he had 20 tumors on his brain, a tumor in his lungs, as well as the tumors in his bones and liver. Doctors in the hospital removed a half-liter of fluid from his lungs and attempted to reduce the swelling in his brain by giving him steroids. He was also given emergency chemotherapy.
While Rusch was still hospitalized, his family received a notice that from his insurance provider. It stated that his treatments did not full under the criteria for "medical necessity," which is a term used under the Affordable Care Act (Obamacare), but which is never defined.
"While the Patient Protection and Affordable Care Act (ACA) of 2010 promises to expand care to millions of Americans, how the bill will determine the meaning of medical necessity—the concept that continues to serve as the key means for regulating the utilization of health care services—remains an open question," Daniel Skinner, a Capital University professor, who was involved in a study on the term "medical necessity," said. "Instead of detailing what is and is not considered medically necessary, the ACA charges the U.S. Secretary of Health and Human Services with overseeing the processes by which these critical determinations will be made.”
According to the article, it is the failure to address what is a medical necessity which has tied the hands of insurance companies in cases like those of Rusch.
“It’s like an attack on my family. It feels that way,” Zoe Rusch, the wife of Jeffrey Rusch, explained, noting that her family has paid more than $100,000 premiums to the company since 2008.
Fox News reported one woman had her cancer treatments put on hold because of Obamacare, after she lost her doctors because of the new law. She then begged President Obama to amend the new law.
Josie Gracchi, who was on the show Fox and Friends, was diagnosed with ductal-invasive carcinoma.
“I would like my health care taken care of. I was insured," she spoke directly to the president, while on the show. "I think anyone who is going through a serious illness should have immediate responses. I shouldn’t have to wait months, weeks, to even be considered for surgery that I should have had weeks ago.”
She had to postpone her biopsy on January 3, as well as follow-up treatment at New York's Memorial Sloan-Kettering Cancer Center, the largest private cancer center in the world, after her insurance plan rolled into a new plan under Obamacare.
"My doctors are no longer available in my network, so the surgeons that I was dealing with … I no longer have access to,” she explained.
Gracchi added her doctor and the cancer center are attempting to work the situation out.
"It’s as if I’ve never had insurance at all,” Gracchi said.
According to, the "narrow networks" in the Affordable Care Act were specifically designed to guide patients to cheaper choices to control costs. The article reported a McKinsey and Company study has demonstrated that 38 percent of plans under the Affordable Care Act allow patients to choose from only 30 percent of the largest hospitals in their area. To me, that is not a lot and is limiting the choices of cancer patients to receive the best treatment.
Terri Durheim of Enid, Oklahoma, reported in the article that her son needs a pediatric cardiologist near to his home (cancer patients aren't the only was hurt by Obamacare). The closest doctor her Obamacare plan will cover is nearly an hour drive, however.
The article reported Associated Press has noted that only four of 19 of nationally recognized comprehensive cancer centers allow Obamacare patients access through the state exchanges.
"If you like the doctor you have, you can keep your doctor," President Obama had promised Americans. That obviously has not proven to be true in every case--in fact in multiple cases.
The New York Post reported that while Obamacare is supposed to guarantee coverage to those with pre-existing conditions, many are actually being denied care because of such conditions. Reportedly, many are paying more for treatment if they have cancer, if they are even allowed to receive any treatment.
The article reported the Affordable Care Act has made it necessary for reduce the number of doctors in insurance plans, and greatly reduce the amount they will pay for coverage for out-of-network services, because Obamacare really exists through "cut-rate HMO's."
Michael Cerpok, Fountain Hills, Arizona, a leukemia survivor, had a treatment bill of $350,000, but out-of-pocket expenses of only $4,500, because of insurance. Because of the new Affordable Care Act, however, his provider was forced to do away with Cerepok's old plan, so one which will meet the requirements could be established. Now, under the new law, Cerpok must pay the doctor who has helped him be a survivor for seven years, $26,000 a year.
The article does indeed report that many people will actually get better coverage and pay less under Obamacare. It added, however, that most patients will pay more money and receive less care.
According to, before Obamacare cancer patients traditionally paid a co-pay of $50-$90 a month for their medicine. Now, they might have to pay more than $2,500 for the same medicine.
The New York Times reported about Richard Streeter, 47, a truck driver and recreational vehicle repairman in Eugene, Oregon, who seems to be in the minority, because in his case if the law had been in effect, he might have received treatment sooner. That is only if the writer of the article is correct, and we have already read of many who failed to get adequate coverage under the law. He has a tumor in his colon.
Although he had health insurance for decades, in 2007, his employer quit providing it. He tried to buy insurance on his own, but because he had smoked all his life, he couldn't find something he could afford. He put off going to the doctor when he saw blood in his bowels and felt pain in his rectum.
A doctor said he would give him a colonoscopy for $300 and $300 when he could afford it. It turned out Streeter had cancer, and the doctor believes Obamacare could have helped him.
As we have seen, Obamacare might help many in some cases. It seems to hurt more than it helps, however. No doubt, there needed to be health insurance reform. It seems the government could have come up with something better than the Affordable Care Act, however.
This opinion article was written by an independent writer. The opinions and views expressed herein are those of the author and are not necessarily intended to reflect those of
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