27 Apr 2015 The Health Care You Get Will Depend on Your Political Clout–Specialty Drug Edition Redux

Ben Boychuk of the Manhattan Institute is having trouble with ObamaCare.  Specifically, his son Benjamin needs injections of human growth hormone, a specialty drug.  According to Boychuk:

My son Benjamin has a serious growth hormone deficiency. He’ll be 13 years old in May but could easily pass for a boy of 8 or 9. In fact, many 8- and 9-year-olds are taller than him. He’s a full head shorter than all of his pals in seventh grade….

Several trips to his pediatrician along with a couple simple tests to assess Benjamin’s bone age confirmed with data what we could see with our own eyes. Our boy wasn’t just in the bottom percentile in average height for kids his age – he was in the sub-basement.

Shouldn’t Benjamin’s growth hormone be covered under health insurance, especially after ObamaCare’s coverage mandates went into effect?  Well, no:

Obamacare’s critics – many on the left as well as the right – weren’t wrong when they complained that the law would be a gift to insurance companies. Although the law capped out-of-pocket medical expenses, specialty drugs were exempt. But that only perverted an already distorted marketplace, encouraging insurers to raise consumer costs while narrowing their choices.

I’d highly recommend reading the full article to see the frustrations the Boychuks are going through as they try get a drug approval from their insurance company and deal with the constantly shifting amount they will have to pay out of pocket.  If you haven’t already guessed, it’s not cheap.  Here’s a Gofundme account to help cover the costs of Benjamin’s treatments that you can donate to, if you are so inclined.

So, why are specialty drugs exempt from ObamaCare’ out-of-pocket cap?  After all, it is generally the sickest of the sick who need specialty drugs, and aren’t those the people that the oh-so compassionate ObamaCare are supposed to protect?

Back in spring of 2013, some press reports came out noting that specialty drugs were exempt from ObamaCare’s out-of-pocket caps.  Here is how I explained the exemption:

The very sick are relatively few in number, which means they amount to a very limited number of voters, too limited to have much impact on elections…

It’s not entirely clear how many people take specialty drugs.  The best statistic appears to come from this study by the Center for Studying Health System Change which estimates that “specialty drugs are prescribed for only one in every 100 commercial health plan enrollees.”

To apply that to enrollees in the exchanges, we’ll add the number of people who, according to the Census Bureau, bought their insurance directly (i.e. didn’t get it from their employer) to those who are uninsured. The first is about 30,244,000 and the second is 48,613,000 for a total of 78,857,000.  One in 100 of those equals 788,570, and that is how we get a rough estimate of the number of people in the exchanges who will need specialty drugs.

So, how much political power is that?   Well, divide it by 435 House Districts and you get about 1,813 potential voters.  Most House elections are decided by margins considerably larger than that.   Divide it by 50 states and you get about 15,771 votes.  In 2012 only two Senate elections, North Dakota and Nevada, were decided by margins less than that.

And…let’s not forget that people aren’t taking specialty drugs unless they’re quite ill.  That means they probably aren’t organizing get-out-the-vote drives, protests, lobbying efforts, etc.

We’ll be seeing a lot more of this in ObamaCare in the months and years to come.