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Under ACA, Self-Employed Father Can't Buy Coverage For His Child With Cancer


We're going to start today with a conversation about one of the key issues members of Congress will face when they come back to town this week, which is health policy. Republicans in particular are under pressure to deliver on their campaign promises to overturn the Affordable Care Act. To that end, Senate Republicans hope to vote soon on a sweeping tax bill that would repeal the requirement that most people have health insurance - the so-called individual mandate, which is one of the pillars of the ACA.

But while Congress is sorting all this out, individuals still have to make decisions about their health care and insurance. So we've been sharing stories of how people's lives have been affected by the ACA. A few months ago, we heard from Molly Young, a young woman fighting breast cancer, who felt her life was saved because she received insurance through the ACA.


MOLLY YOUNG: Without coverage - without this treatment, I would just die. And that's it. And it's terrifying to hear how little people like me can matter in these issues. We're not really focusing on actual human lives. We're just looking at dollars and cents, which is a very morbid way to go about it.

MARTIN: Today, we have a different perspective from Christopher Briggs. We read about him and his family in The Washington Post. Christopher Briggs is self-employed. He had been buying Anthem Health Insurance on the private market for himself, his wife and nine children for several years. But when the price for his policy went up astronomically, he switched to buying Anthem Insurance on the Virginia Health Exchanges under the Affordable Care Act. That saved him about $1,000 a month in insurance premiums. Before we go much further, you should know a few things about Christopher Briggs. He is a Republican who voted for Donald Trump, and one of his children was diagnosed with leukemia in 2015.

CHRISTOPHER BRIGGS: I think the ACA should be repealed. I think it was a manifest failure. I think my daughter, in a way, is kind of the face of the failure of the ACA because if a health care system can't provide for a 4-year-old with cancer, then it really has a structural defect that needs to be radically redone.

MARTIN: His 4-year-old daughter, Collette, receives much of her chemotherapy in a hospital setting.

BRIGGS: She receives chemotherapy in the spine - in the spinal column, which, for obvious reasons, you want to do in a hospital setting because if anything goes wrong, there are people there to take care of it. And that's done - it was done at Fairfax Hospital.

MARTIN: The problem is his health insurer, Anthem, which had included his nearest hospital and its network - that's Fairfax Hospital - announced it was pulling out of Virginia. In a statement in August, Anthem said it was pulling out due to instability in the markets. Then in September, Anthem announced a return to Virginia but not to Loudon County, where the Briggs family lives.

BRIGGS: Once I figured that out, I started to panic because if Anthem wasn't going to be a provider, who would be? And we discovered it was Cigna. And in researching what they would cover, it became clear pretty quickly that they would not cover anything at Fairfax Hospital where she receives the kind of care that needs hospitalization.

MARTIN: For Briggs, his biggest concern is that the hospital he says he needs to attend is not in Cigna's network. The big hospitals Cigna does cover for pediatric cancer treatment are in Richmond or Charlottesville, Va., much further away than the hospital in Fairfax.

BRIGGS: When you're dealing with a child with cancer who needs to be hospitalized, another hour going somewhere else is really prohibitive. I'll give you an example. One of the things that cancer patients - leukemia patients - face is, of course, a compromised immune system. This is a white blood cell disease. So the way they treat it currently is to sort of kill all the good white blood cells, too. So she's very prone to infection. So when she spikes a fever of 100.4, which, as any parent will know, this is a fever you can get at almost any day, there's automatic hospitalization because they don't know what she's got.

MARTIN: The Briggs family has three weeks to register under open enrollment on the exchanges. Christopher Briggs is considering all his options, including going from being self-employed to hiring employees just so he can qualify for employer health insurance or even move to a county with better coverage.

BRIGGS: Think of where we are, right? We found out that Cigna was definitively not going to cover the hospital we needed just a few weeks ago. To pull off a move, I have to either rent my house, and then move into another rental or sell my house and buy another house or some combination of that. I mean, this is literally impossible to do. And one thing is I can't afford it. And the other thing is - let's say I've managed to pull that off - there is nothing that will guarantee me that this time next year that plan won't vanish. And so what am I supposed to do, zip zip code cross - hop across the country, chasing an illusory stability in the individual market? I literally can't do that.

MARTIN: What conclusion do you draw from all this? Because I'm sure that some people who support the ACA will say, well, see this is exactly why, you know, the efforts to undermine it aren't unfair - they're destabilizing the marketplace, making things impossible for people in the real world to live with. You know, there are - other people will say, you know, this is why the whole thing is a disaster, and they need to blow it up and start over. And you know, this is your life. This is not like a hypothetical.


MARTIN: So if you don't mind, I would like to ask, you know, what conclusion you draw from all this?

BRIGGS: You know, it's a very difficult issue. And I think anybody who has been forced to think about health care because of an existential crisis like this is mystified at sort of the complexity of it all. I'm a Republican. I have been critical of several Republicans for decades because when they had control - under the Bush years, for instance - of the White House and both houses of Congress, you know, my situation was such that I could buy affordable health care. I was absolutely aware that that was not - had not been pushed out far enough to the margins. And there was good reason for that.

I mean, I think purchasing health care across state lines would have widened the risk pools, may have made it available to even yet more people - should've been tried, at least. And for the Republicans not to have tried to do that meant that we had an untenable situation, which is that the well-to-do of the middle class was getting health care. But those who needed it on the periphery were not getting it. And so what you had is the response by the other party, which was to centralize this process and, in fact, push it to the periphery. My frank opinion is that hasn't worked. We're down - not down to one, two choices or - I have no choice now.

Let me say this, though. When the Republicans gained control of all of the levers of government, the criticism of the establishment Republicans that they didn't have a plan ready to go is, in fact, a valid one. I mean, my goodness, for the better part of a decade, they've been complaining about Obamacare and promising to repeal and replace. And then they have absolutely nothing to replace it with. And Donald Trump, I think, was right to be frustrated that he was promised this and it wasn't delivered. And I was actually very heartened as a Republican who voted for Donald Trump that he actually was willing to cut a deal on a completely different issue with Chuck Schumer and the Democrats. Something has to be done here.

MARTIN: I don't know what to say other than to wish your family the very best...

BRIGGS: Well, thank you.

MARTIN: ...And to thank you for being willing to talk about something difficult.

BRIGGS: My wife and I are deeply grateful that you asked us to come in. Thank you very much.

MARTIN: That was Christopher Briggs of Purcellville, Va. He's struggling to find a health insurer under the Affordable Care Act that will cover his daughter's hospitalized leukemia treatments. He was kind enough to join us in our studios in Washington, D.C. We reached out to Cigna. They said they're in active discussions with the Briggs family about the 2018 enrollment and hope that the hospital will work with Cigna to provide fair and affordable options for Loudon County residents negatively impacted by the departure of other carriers.

Since we initially spoke with Christopher Briggs, his Congresswoman, Barbara Comstock, has reached out to him. And Mr. Briggs tells us that his congresswoman is working with the insurance companies and the hospital to find possible solutions. Transcript provided by NPR, Copyright NPR.