Relief for families with high medical expenses
The Affordable Care Act's ban on insurance companies imposing lifetime limits on care is a big help for many families faced with long-term treatment that can run up against health-insurance expenses.
Seattle Times staff reporter
Every other morning, Kristian Prill Hamilton of Mountlake Terrace watches her 9-year-old son, Cole, prepare to treat his hemophilia.
After learning to do the treatment himself at a summer camp for hemophiliacs two years ago, Cole sterilizes the area on his arm, rubs numbing cream on it and inserts a needle into his vein with the solution that trains his blood to clot correctly.
"He has to find a vein to put the medicine in, so we built a routine in the morning," Hamilton said. "He has to get breakfast and have some juice to get his blood flowing. Then we infuse him, and he goes to school."
For many families, the tremendous expense of ongoing treatment — such as for cancer treatment or a transplant — can run up against health-insurance limits. But worries over mounting bills were soothed in 2010 with passage of the Affordable Care Act and its provision to ban insurance companies from imposing lifetime limits. On Thursday, the law was upheld.
Some 2.4 million state residents, including 580,000 children, are believed to have benefited from the prohibition on lifetime limits, according to the Department of Health and Human Services. Before the law, insurance companies commonly set $1 million to $2 million lifetime limits on coverage.
Hamilton's son is one of an estimated 600 hemophiliacs living in Washington. Hemophilia is a genetic disease in which the blood does not clot normally, so many patients require regular treatments, raising health-insurance costs.
For Cole, treatment includes $150,000 a year in medication, with his family paying more than $3,000, Hamilton said.
Since the amount of intravenous medication depends on the weight of a person, an adult male with hemophilia needs $300,000 a year worth of medication, according to the Bleeding Disorder Foundation of Washington.
Renee Balodis-Cox and her husband were both self-employed, but had to make a change because of their son's hemophilia. Her husband took a job where he could get better insurance.
Nikos, now 3, developed a complication last year requiring a port to be implanted, and daily intravenous treatments with almost four times the regular dose of medicine. The treatments cost $48,000 a month. The Carnation family pays $600 a month out-of-pocket.
"The (removal of the) lifetime cap and pre-existing conditions saved us," Balodis-Cox said. "Insurance wasn't affordable for us, especially with a kid with a severe medical condition. It was taking care of him or not living in complete poverty."
Without the lifetime caps, Hamilton said her son can live a relatively normal life unburdened by worries about access to health care.
"It's great to know he has the ability of getting insurance," she said. "We're not hitting the point where we don't know where our kid's next dose is coming from. That part's been such a huge relief."
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