If you are a business owner or managing your personal finances, having some degree of certainty is key.

Sure, there will be changes to the plan. An unexpected health expense. A downturn in the economy. But for someone looking at a budget and trying to manage expenses, the more confidence in numbers the better.

Unfortunately, certainty has lacked with the Affordable Care Act.

The president's signature piece of legislation has steadily caused more individuals to become skeptical. It shouldn't come as a surprise. Any law made up of thousands of pages with only minimal time to review starts behind the eight ball. But it was signed, and over time we have learned more about the law's flaws.

A story in the March 19 Southeast Missourian by The Associated Press highlighted another problem that proponents had glossed over previously. The Affordable Care Act limits access to many of the country's top cancer hospitals. Four of 19 top cancer centers included in an AP survey said patients through all insurance companies in their state's exchange are covered. However, others said some policies purchased through the exchange are not included. Problem is that it's extremely difficult if not impossible to determine when buying through an exchange what hospitals are or are not included. For example, the Siteman Cancer Center at Barnes-Jewish Hospital in St. Louis was listed as a center where not all policies are accepted.

There are many hospitals around the country, including local medical centers, that provide cancer care. It's also key to realize that many of the top centers around the country continue research that, it is hoped, will go a long way in treatment and prevention of this horrible disease.

It's one thing to know of limited access before making a health insurance purchase. There are insurance policies outside of the exchange that make it clear which providers are considered in-network. If you know up front, that's one thing. However, for a person to be mandated a purchase of health insurance and not know what is covered, that's a scary proposition.

President Obama's administration said insurers will be under closer scrutiny in the next year and cancer care is of importance. However, the lack of certainty over costs and care is not good for anyone.