The most recent one to hit the media’s attention is that of 31 year-old Arijit Gurha, a graduate student at the University of Arizona who was recently diagnosed with stage 4 colon cancer.
Unfortunately for him, his Aetna student health plan had a $300,000 lifetime benefit limit. Needless to say, the plan offered little protection to him once his cancer was discovered.
Arijit’s story has a happy ending, thanks to three very different aspects of the ACA: (1) a new provision that says that student health plans can no longer have lifetime benefit limits or unreasonable annual limits, (2) the new pre-existing condition insurance plan, and (3) the new scrutiny that the ACA has brought onto both health insurer profits and spending through the new MLR rules, and on consumer protections.
See, Arijit was eventually given the option of securing coverage through a newly renegotiated student health plan or the PCIP. However, his six months spent undergoing lifesaving cancer treatments with no health insurance benefits left him with over $100,000 of debt.
His fundraising blog, aptly titled poopstrong.org, helped him raise some money, but it wasn’t enough. So, Arijit decided to put Aenta’s feet to the fire by utilizing his Twitter account. The New York Times’ Well Blog has a great account of the conversation that ensued, which you can read here. But the amazing thing is that IT WORKED. Yes, that’s right, in the end, Aetna agreed to pay the over $100,000 debt he had accrued since hitting his lifetime max.
How was this possible, you ask? Well basically, it had to do with what I’d like to refer to as the PoopStrong Effect. Basically, because of the new consumer protections written into the ACA, health insurance profits and spending have begun receiving a whole lot of attention from the mainstream media. Pair this with a young person with an incredibly compelling story and the power of the internet behind him, and a forthcoming law that will change the rules in his favor, and you’ve got yourself the perfect conditions to bring forth some serious health plan PR damage control.
Two years ago, before the ACA became law, the PoopStrong Effect would have never been possible. Remember the 2007 Michael Moore film “Sicko”? A great conversation starter, but it didn’t do much to help the folks profiled in the film who had suffered from insurance industry abuses. Yet today, a young guy with cancer and a twitter account is able to move a mountain.
The landscape has certainly changed, hasn’t it? And for that, we can thank the ACA.