10 Your Rights to Healthcare Healthcare can profoundly affect our most basic rights: life, liberty, and the pursuit of happiness. Without good health, our ability to pursue happiness — to have meaningful work, engage in recreation, or be socially active — can be diminished. Our liberty — the freedom to go where we choose — can become more limited. Ultimately, without good healthcare, we can lose our lives. So, making certain that those with chronic illnesses or disabilities have equal access to healthcare is an essential protection. Over the years, legislators have attempted to address the issue in a number of ways. In 1965, the creation of Medicare and Medicaid protected those most likely not to have health insurance through an employer — seniors, people with disabilities, and children affected by poverty. Twenty years later, COBRA protection allowed individuals who did have employer-provided health insurance to maintain that insurance after leaving their jobs. However, these protections didn’t help with one particular problem: the difficulty of getting or maintaining health insurance when chronically ill. Insurance companies often declined to cover individuals with expensive illnesses under pre-existing condition clauses, set limits on the total lifetime cost they would cover, or canceled the policies of those who received a costly diagnosis. To address this issue, 35 states created high-risk insurance pools, to allow those individuals who were chronically ill to purchase insurance if they were denied other coverage or had a policy canceled. This imperfect solution allowed manyto get coverage, but at a significantlyhigher cost. The ACA brought substantial new protections for those with chronic illness, ensuring equal treatment with those privileged to have good health. Under the current legislation, insurers may not refuse coverage for a pre-existing condition, nor can they cancel your insurance or limit your coverage because you are diagnosed with an expensive illness. It also included the vital right to appeal insurer’s decisions and have your appeal heard by a third party. Appealing an Insurer’s Decision Have you had this experience? You walk up to the pharmacy counter to pick up a new prescription. The prescription is ready, but the cost is much higher than you anticipated. The pharmacist tells you that your insurance declined to cover the cost. How frustrating! Many people with MS experience this, or similar situations — such as when an insurance company declines to authorize an MRI, or visits with a physical therapist. In such circumstances, it can feel as though the insurance company is essentially overriding decisions you and your doctor made about what is important for your health. However, you have the right to appeal the insurer’s decision. In deciding whether or not to appeal, it helps to understand the appeals process.