Patient's bill soars as Obama's health law program falters

By Ricardo Alonso-Zaldivar

Associated Press

Published: Monday, Sept. 9 2013 11:06 a.m. MDT

But there was a catch: They had already met their deductible in the North Carolina plan, and also reached their annual out-of-pocket maximum of $6,250.

With the federal plan, they would have another deductible of $1,000 for the rest of 2013, and a total of $3,125 in out-of-pocket costs before reaching that plan's catastrophic limit. Deductibles and copayments shift some financial responsibility to patients.

"We are paying 18 months of deductibles and out-of-pocket cost for one year's worth of coverage to two insurance companies," said Scott Veals.

The problems with PCIP bubbled up in February, when federal officials unexpectedly announced an enrollment freeze. Although fewer people had signed up than originally expected, very costly cases were draining its budget.

A few months later, federal officials gave states running their own PCIP plans an ultimatum: take on some financial risk or turn the programs back to Washington at midyear. In those 17 states, Washington put in new cost-sharing requirements to help keep the program financially viable through the end of the year.

If the administration saw problems coming, Obama's budget did not reflect it. The president did not request any new funds for PCIP.

The No. 2 House Republican did make an attempt to pump more money in, but it was fraught with politics. Majority Leader Eric Cantor of Virginia proposed to divert funds from elsewhere in the health care law, unacceptable to Democrats. His idea also failed to get Republican support.

"Our elected officials, some of whom have been impacted by cancer, must come together to identify a bipartisan solution to fund this program for the remainder of 2013," said Emily Shetty, who handles federal policy and lobbying for the Leukemia & Lymphoma Society.

Veals and her husband say they are looking forward to full implementation of the health care law next year. But getting through the next few months will be a struggle.

"We both knew there would be bumps along the road but we never thought there would be this kind of bump," she said.

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