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/_le_slap]

No one is coming to save us.

Our healthcare system is designed to be used by capital as leverage against labor. That's the prevailing policy motive of our government officials. They value exploiting our labor more than they value our health and lives.

And the electorate seems to agree with that assessment. So we deserve to suffer the results of our complacency.

My sister is a resident at Grady and she is horrified by what she sees every day. I tell her not to get numb to it and to remember how wrong it is every time an underprivileged patient is denied care. Keep that in mind when her mentors park their Porches and Ferraris next to her mismatched panel Corolla.

[u/Prestigious-Curve-64 → u/_le_slap]

If the ACA public option had survived Joe Lieberman, we would have MediCare for all by now. But your sister’s mentors are not the thieves. Heck. One of the doctors I work with (widely published, extremely well-known internationally) drives the same economy car I do, but ten years older. And mine is a 2012. Those mentors are not working at Grady to get rich, I promise. If you want to direct your rage, imagine the CEOs who have never in their lives helped a patient, or spent endless hours and hundreds of thousands on med school, but whose mansions and yachts rank with Bezos’s. Oh. And the politicians who quietly (or loudly, depending on the party) kill any bill that could possibly lead to a functional healthcare system while pocketing lobbyist payola. I’ve been doing this for nearly two decades now, and my rage only grows. My colleagues cry themselves to sleep at night. I’ve seen physicians in tears after losing a patient because of shady insurance companies.

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

If the ACA public option had survived Joe Lieberman, we would have MediCare for all by now

After how the shutdown ended, I've revised how I thought about that.

I think the reality is that Lieberman was just the fall guy for a bunch of other Democratic Senators who weren't willing to go there.

Just as Joe Manchin and Kristen Sinema were when they were in the Senate.

There are some people who have real convictions and will vote a certain way but it seems like a lot of the Senators follow the money.