Shortly after enrolling in a health insurance plan through the Affordable Care Act, Rebecca Nelson, a local musician who grew up in Whitefish, discovered a lump on her breast.
Her mother had survived breast cancer twice, and her father had non-Hodgkin’s lymphoma, so Nelson was more vigilant about self-exams than most women her age, and well aware of her family history.
Still, at 38, she was caught off guard when her oncologist diagnosed her as having an aggressive tumor that would require surgery and chemotherapy.
Additional genetic testing showed that Nelson had inherited a variation of the BRCA2 gene that made her more susceptible to breast cancer, so her doctors recommended a double mastectomy as a preventative surgery given her high level of risk.
Despite the shock of being diagnosed with cancer, Nelson said her anxiety would have been far greater had she not been enrolled in a health insurance plan through the Affordable Care Act (ACA), or Obamacare.
Prior to enrolling in a health insurance plan through the ACA, Nelson had a minimal plan through Blue Cross Blue Shield with a high deductible. Under Obamacare, she paid a relatively low deductible of $3,000 and all of her care was covered.
“It helped keep me from going into debt and it provided me with excellent care when I might not have been able to afford that quality of care with my old insurance plan,” Nelson said.
While the overall perception of the Affordable Care Act has been mixed, due in large part to a botched website rollout and recent premium increases, Obama’s hallmark legislation has come with big benefits for people like Nelson, while helping roughly 20 million Americans gain health coverage.
Critics of the ACA have complained of rising deductibles, smaller networks of doctors and hospitals and fewer choices of insurance plans. But it also allows young adults to remain covered under their parents’ insurance plans until age 26, forces insurance companies to cover those with preexisting conditions, covers preventative health care, and ends lifetime limits on essential coverage.
The ACA has given many Americans a lifeline for buying health insurance, often for the first time. Nelson’s husband and band-mate in the local funk group 20 Grand, Vincent Rannazzisi, is one of those people.
For nearly two decades, Rannazzisi’s autoimmune disorder was misdiagnosed, first as gout and then as pseudo-gout. He had half of his toe amputated due to severe inflammation, then paid to have an orthopedic surgeon amputate his other big toe.
Through it all, he had zero health insurance.
“Finally, after we enrolled in the ACA, I got insurance and a referral to a rheumatologist,” he said.
The doctor prescribed immunosuppressants that have turned back the inflammation in all but one toe, and drugs that would cost him thousands of dollars every month are covered under the ACA.
“I just don’t even know where we would be without that diagnosis for Vinnie,” Nelson said. “I feel that the Affordable Care Act was directly responsible for him getting the proper diagnosis and resolving years of frustration. We were always paying for stuff out of pocket for Vinnie, so he wasn’t getting the care and treatment he deserved.”
With President Donald Trump’s backing, congressional Republicans have settled on a fast track to repeal the tax and spending provisions of the 2010 Affordable Care Act.
But critics say repealing Obamacare won’t slow rising health care costs alone, nor will it enable more Americans to obtain health insurance.
The Trump administration and congressional Republicans are expected to release more specific proposals in the coming weeks, explaining how they plan to replace the heath care reforms and subsidies in the ACA.
Nelson, who has called and written Montana’s entire Congressional delegation, said she’s keeping an anxious eye on the GOP’s next steps, particularly because her future coverage hinges on her cancer being covered as a preexisting condition.
“I told them that I think that the choice to repeal the Affordable Care Act without a replacement plan was extremely reckless and endangers millions of people, especially when we are uncertain whether preexisting conditions can be covered,” she said.
Because Nelson inherited the BRCA2 gene, she’s also at an elevated risk of ovarian cancer, and her doctors have recommended an oophorectomy before she turns 44.
However, the procedure comes with other health risks the earlier it is performed, including heart problems, osteoporosis and cognitive decline. Her uncertainty over whether future coverage will include preexisting conditions “has me stressed about whether I should accelerate the surgery date,” she said.
“Going forward, my cancer will be covered as a preexisting condition, so it is extremely important to me that it remains intact,” she said.
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