My family has much to be thankful for this holiday season. But there is one thing, in particular, that stands out.
We are thankful for Obamacare.
Had it not been for the Affordable Care Act, my sister-in-law, Sharon, likely would not be here this year to celebrate Thanksgiving or Christmas.
In the summer of 2015, she was diagnosed with stage 4 lung cancer. By the time doctors figured it out, the tumors had metastasized to her spine. The pain was so unbearable that she couldn’t sit or stand.
"It was like I was between the clutches of a lion’s teeth and I couldn’t get out," Sharon said recently. "I don’t think many people come back from stage 4. I never told my family, but I was preparing to die."
Her family never told her, either. But this time last year, we were preparing to say goodbye.
Just a few months before her diagnosis, neither Sharon nor my brother, Winston, had health insurance. She owns a children’s day care facility and he owns a small trucking business. With so many expenses, there was no money left for medical coverage.
So like many Americans who work hard every day to make a living, they placed health insurance on the back burner. But in late 2014, as soon as they were eligible, both of them signed up for Obamacare.
Though Sharon’s cancer has been in remission since March, our family has another concern now. Will she be able to continue the medical treatments that are keeping her alive?
For many people with life-threatening illnesses such as cancer, diabetes, heart conditions and even depression, Obamacare has meant the difference between life and death. Prior to health care reform, people like them would have been uninsurable and would not have had access to needed medical treatments.
You can bet that these folks followed the presidential campaign closely. And now, their greatest fear is that Donald Trump is going to take their health care away.
Throughout his presidential campaign, Trump repeatedly pledged to repeal and replace Obamacare. And the Republican-led Congress is overcome with joy that their next attempt to repeal the law — something they’ve tried more than 50 times over the last six years — could finally be successful.
The only hope for Sharon and some 20 million other Americans with Obamacare is that Trump will have a change of heart.
Recently, the president-elect has given us reason to be hopeful. In interviews since the election, Trump said that after meeting with President Barack Obama, he is considering saving some aspects of the Affordable Care Act.
Vows to "repeal and replace" have been softened with "amend."
During their first meeting in the Oval Office two days after the election, Obama urged Trump to at least try to preserve some aspects of the law. Afterward, Trump said he would like to keep the provision forbidding insurance companies from denying coverage based on pre-existing conditions. He said he also favors allowing young people to remain on their parents’ health care plans until the age of 26.
"I told him I will look at his suggestions, and out of respect, I will do that," he told The Wall Street Journal.
We can only hope that he listens to Obama, because so far, Trump hasn’t come up with anything better.
No one ever claimed that Obamacare was perfect, not even Obama.
Insurance premiums are skyrocketing. Insurance companies are pulling out, leaving consumers with fewer coverage choices. And in some parts of the country, the poorest people are ineligible for Obamacare.
Some would argue that Obamacare is failing because of people like Sharon. Namely, she’s a 64-year-old Baby Boomer who needs expensive medical care.
I would argue, though, that the program was specifically designed for people like her. Access to affordable health care should be the right of every American.
Through the insurance exchange, Sharon, who lives in Georgia, was able to get an affordable policy with Humana. After chemotherapy failed, she was given the opportunity to try a new immunotherapy drug called Opdivo, which received FDA approval to treat advanced lung cancer in October 2015.
It’s extremely expensive, about $12,000 a month. Her insurance has paid almost all of the costs.
Dr. Wassim Mchayleh, her oncologist, described it as a form of targeted therapy that has proved to be very promising in trials.
"It’s different from chemotherapy, which kills the cancer cells but also the good cells at the same time," said Mchayleh, medical director at West Georgia Oncology in LaGrange, Ga. "This drug targets a specific group of cells that carry a specific mutation.
"It’s changing the way we treat cancer," he said. "We have patients who have been on Sharon’s drug over a year now, and they’re still in remission."
What Mchayleh doesn’t don’t know yet, though, is what would happen if the treatments stopped. Sharon hates to think about that.
"If I didn’t have Obamacare, I would just be waiting my time. There’s no way I would have gotten proper care," said Sharon, who has gone back to work full time. "I don’t have any medical bills that aren’t paid. And that’s one less thing I have to worry about."
That’s a problem, though, for Obamacare.
The program was supposed to entice enough younger, healthier people to sign up and offset the insurance companies’ costs for covering the nation’s aging baby boomers. But that didn’t happen.
Young people weren’t convinced that they even needed health care. So they opted to pay the penalties, which in many cases were lower than the price of the premiums.
As a result, Obamacare became a money grinder for insurance companies unable to make a profit. So they did what most companies would do in similar situations — they walked away. And with costs rising and competition dwindling within the health care exchange, insurance companies in some cases quadrupled their rates.
Humana, in fact, withdrew from the exchange, forcing Sharon and Winston to find another provider. They signed up with Blue Cross Blue Shield, the only insurer available to them, and will pay a much higher premium next year. And at this point, they still don’t know how much, if any, of Sharon’s treatments will be covered.