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No Obamacare Plans Cover Treatment at Houston’s Top Cancer Center

If you're a cancer patient at a cutting edge center like MD Anderson in Houston, you're not going to be covered by ACA insurance in 2016.
Image via Flickr/faungg (CC BY-ND 2.0)
If you're a cancer patient at a cutting edge center like MD Anderson in Houston, you're not going to be covered by ACA insurance in 2016.

From Texas Standard

The  healthcare marketplace is open once again, but if you look closely at the offered insurance plans you might find something lacking: coverage for specialized treatments.

Preferred provider organizations, or PPOs, often cover specialized treatment like care for cancer patients. But the loss of individual-market plan PPOs will affect tens of thousands of people who buy their insurance privately rather than through an employer. Before the Affordable Care Act, it was the way most people who did not have employer insurance got coverage.

Jenny Deam, with the Houston Chronicle,  investigates the disappearance of these plans. She says there will no longer be any plans, by any carrier on the federal exchange for the Houston area, that cover treatment at the  MD Anderson Cancer Center. How the marketplace got that way, she says, is a little unclear.

"The PPOs had started disappearing a couple of years ago," she says. "The last one in Houston was Blue Cross Blue Shield of Texas and they  announced in the summer that they were getting rid of them, that they were no longer sustainable. PPOs with their wider range of network and hospitals... are very expensive."

What insurers have done instead is shift people in the individual market and on the healthcare exchange to HMOs, which are usually less expensive. The downside, Deam says, is that patients with specialized and complex medical needs will have limited coverage.

In her investigation, Deam profiled one cancer patient, Martha Gardenier, who was told by a doctor that she needed to start making end-of-life preparations. She sought a second opinion from MD Anderson, and began to see her situation improve from Stage 3 to Stage 1 cancer. This experience showed Gardenier that not all doctors who treat cancer are created equal – that she was getting better care at MD Anderson.

Now, it's as if that carpet is being pulled out from under her. Gardenier will no longer will have a PPO that will cover the costs as it once did. She's going to have to pay out-of-pocket for care that could reach $10,000 a month.

"Since that article appeared, I've had just dozen of emails, many from other patients who tell the same story," Deam says. "They specifically got an insurance plan that covered MD Anderson.... [Gardenier is] a pretty stark example of somebody who had been pretty much told 'There's nothing more we can do for you,' and she entered a clinical trial, highly experimental, at MD Anderson. And it worked. People like that don't want to hear that cancer treatment is interchangeable."

Listen to the full interview in the audio player above.

Copyright 2020 KUT 90.5. To see more, visit KUT 90.5.

Texas Standard reporter Joy Diaz has amassed a lengthy and highly recognized body of work in public media reporting. Prior to joining Texas Standard, Joy was a reporter with Austin NPR station KUT on and off since 2005. There, she covered city news and politics, education, healthcare and immigration.
Emily Donahue is KUT’s news director. She has spent more than two decades in broadcast journalism and launched KUT’s news department in 2001. Previously, Emily was part of the Peabody-award winning team at Marketplace as producer of the Marketplace Morning Report. Since coming to KUT, Emily has overseen a doubling of the news staff and content, the accumulation of more than 50 local, national and international awards for journalistic excellence and served on several boards, including the Texas Associated Press Broadcasters and as a member of the 2011 Texas Association of Broadcasters Open Government Task Force. Emily lives in Austin and is currently working on her Master’s in Journalism from the University of Texas at Austin.