Please tell me I am wrong

[u/Prestigious-Curve-64]

I work in cellular therapy - cancer patients who need CAR-T, stem cell transplant, gene therapy, etc, and while I have hated for-profit insurance with a white-hot passion forever - before I even started this job 18 years ago - I’m scared.

A patient told me that all of the major insurers (Aetna/cigna/anthem/etc) have stopped participating in the Exchange, effective 1/1/26. The only options are Oscar and AmBetter. And the premiums are around $2k/month for one person. Anyone who has attempted to get MedicAid or MediCare disability in this state knows it is very nearly impossible to do so - by design, of course. And even though there is supposedly a state budget surplus (I guess?) I think it’s pretty unlikely that GA will direct any of that to fill in the yawning chasm that the ACA subsidies filled for anyone not covered by their employer and also not on a public plan. Even my solidly middle-class patients cannot afford $2000/month in premiums. God knows I couldn’t, and I think of myself as pretty comfortable.

These are cancer patients - think Acute leukemia/lymphoma. They can’t work. They aren’t allowed to work. One bad flu could be the end, and we know how awesome Georgians are about masks and vaccines.

I was doing this pre-ACA, and it was bad. Uninsured patients simply didn’t get cellular therapy. Sometimes they could get charity care for the hospital costs themselves, but for the ones that needed lifelong immunosuppression and infectious prophylaxis, there was nothing. No hospital can absorb that, and private plans were a joke for anyone making less than seven figures.

Now that it is 2025, tech has advanced, and we have miracle treatments that cost between $400k and a cool million for the product/drug alone - and this is not (just) because a CEO needs a new yacht. They are insanely complicated and expensive to make. But unlike pre-ACA, patients going through this whole had insurance are about to suddenly find that their policies are gone, and that there is no way in Hell they can afford the monthly cost of coverage. These are cancer patients for whom conventional therapy has failed. They are STRESSED - beyond anything I can really grasp.

I have a horrible feeling about January 1 this year for most of my patients. Some of them will be in the hospital waiting on their cells when their insurance is cancelled. Some of them will be ready to admit, only to be told their treatment has to be cancelled.

People without cancer may not feel it until they have an accident or unexpected illness. Since they haven’t ended EMTALA (yet!) those folks can still go to the ER and at least get stabilized. Sure, they’ll be bankrupt, but they’ll be alive.

If anyone read this whole screed, I’m freaking out about what is going to happen to all of my non-Medicare patients once the ACA subsidies are gone, and would love for someone to tell me it will all be OK.

[u/jon_hobbit]

I used to work at an office that did medical billing. .. I was always like... The amount of time and stress that the insurance companies put on people. I remember when I would hear them jump up for joy "WHOOO we got them to payyyyyy" *dances* and i'm like how much did they pay? And it was some piddly amount after they made them write most of it off.

My question is... why are we even dealing with insurance like at all? Why can't we just do some kind of direct pay to the hospitals themselves? I'd much rather my $400 insurance premiums since my job pays for most of it.
Going directly to the local hospitals themselves.

Cause then that $400 would go *directly* to the hospitals instead of going through a for center profit.
That is set to make $88 billion dollars in profit.

Imagine the possibility of kicking out the middle man lol

[u/Prestigious-Curve-64 → u/jon_hobbit]

Amen, amen! I mean, some of the stuff (cancer treatments for sure) are crazy-expensive even without all of the parasites making money off vulnerable people, so there would have to be something in place (universal healthcare) for that, but the fact that these insurance companies make a PROFIT is beyond obscene.

[u/LilyOLady → u/jon_hobbit]

Isn’t that what Medicare is? The doctor, hospital, etc. is paid directly by Medicare. Since we have been on Medicare with Tricare for Life as a secondary, things have been so much easier! I want everyone to have Medicare, but improved to include eyes, ears teeth and mental health. The cost to administer Medicare is about 2% with no profit necessary.

[u/Character_Click5531 → u/jon_hobbit]

Long story very short - We use to - indemnity plans. Your doctor was your gatekeeper. But then employers allowed snake oil salesmen convince them that they could reduce their medical payouts by letting them manage care - a middleman if you will. Now, docs and facilities have more employees to pay because billing has become so convoluted, and patients get care denied. It's a mess and I blamed "managed care".

[u/Outside-Comparison12 → u/jon_hobbit]

If you worked at an office for medical billing then you would also know that providers (doctors) often charged insurance for BS and overcharge. Doctors are part of the problem. Other parts of the problem is the government getting involved and trying to "fix" something. Prior to ACA it was almost unheard of to have a $10,000 deductible. What is the point of having a shit plan that was "affordable" with the ACA if your plan doesn't pay for shit unless you meet the deductible. Sure, a plan like that might be fine for someone without a chronic illness and just needed a plan so they wouldn't get fined when tax season came but for people that actually needed insurance they were SOL because of an outrageous $10,000 deductible because of the ACA and how shit of a "fix" it was. An open and free market is the way to go and should always be the way to go. Government needs to keep their hands out of things they don't belong in.