By Eileen Ambrose, The Baltimore Sun
April 1, 2012
The fate of the Affordable Care Act is in the hands of the Supreme Court justices. But in the court of public opinion, a large percentage of people polled recently want the law scrapped.
A CBS/New York Times survey found nearly half of those polled disapprove of the law, while 40 percent want the entire act overturned. Rasmussen Reports says 56 percent of people surveyed want the act repealed. And the Kaiser Family Foundation found that nearly six out of 10 people don't even know how health care reform affects them — though that didn't stop many of them from disliking it.
Consumers should be careful what they wish for. Have they forgotten all the stories of people being unable to buy coverage because of a pre-existing condition or dropped by their insurer like a hot coal when they became ill? The health care law would stop those practices.
The law doesn't take full effect until 2014, but many provisions have kicked in early and are improving lives. Chronically sick kids can't be denied insurance coverage anymore. Young adults can stay on their parents' insurance longer. And seniors get help paying for prescription drugs.
And, if polls can be trusted, most Americans want those things.
The hot-button issue is whether the government can require people to buy health insurance or pay a penalty for not doing so. This was originally a Republican idea, but now the insurance mandate is used as a political rallying cry by the GOP, which derisively dubs the law "Obamacare."
But people with insurance — which is most of us — should support the mandate. Because when the uninsured can't pay their medical bills, the cost is passed on to the insured through higher premiums. The uninsured add about $1,000 to a family's annual premium, according to a 2009 Families USA report.
It's unknown how the Supreme Court will rule, but court watchers say it doesn't look good for the mandate. Intrade, a prediction marketplace, says the chance that it will be shot down is 63 percent.
If so, protections for consumers with pre-existing conditions will likely go away, says Brad Herring, an associate professor of health economics at the Johns Hopkins Bloomberg School of Public Health.
And it's possible that other provisions seemingly unrelated to the mandate would be at risk, too, he adds. Pharmaceutical companies agreed to drug discounts for seniors only on the assumption that they would make up the loss through a greater number of people becoming insured, he says.
No one knows what other benefits could be lost. But with strong public opinion in favor of overturning the law — guaranteeing that our health system's problems won't be addressed by Congress for years — it's a good time to remind ourselves of the benefits we have received from health reform so far.
• Insurers can no longer deny coverage or charge a higher premium for a child under age 19 just because of a pre-existing condition. (This protection is due to kick in for adults in 2014.)
•Young adults without insurance at work can stay on their parents' plan until age 26. This provision expanded coverage in Maryland, which already required certain health plans to permit children to stay on a parent's insurance up to age 25.
The provision meant nearly 52,000 Marylanders were able to stay on a parent's plan as of June 2011, according to the federal Department of Health and Human Services.
• The creation of high-risk insurance pools in states so adults denied coverage before 2014 because of pre-existing conditions can have a place to buy affordable insurance. Maryland already had such a pool — the Maryland Health Insurance Plan — but the health act provided money to cover additional enrollees under a new federal pool, says Hopkins' Herring, who is an MHIP board director.
About 800 Marylanders have been enrolled in the new plan, which allows them to buy insurance from CareFirst at the market rate for a healthy person, Herring says. A marketing campaign also has been launched to reach Marylanders who are unaware of the program, he says.
• Patients no longer bear part of the cost for preventive care, such as flu shots, mammograms, well-child visits, and cholesterol and blood-pressure screenings. An estimated 1.15 million Marylanders have benefited from this.
•There are no more lifetime limits on health care benefits. This affects more than 2.25 million Marylanders under age 65.
• Tax credits are available to help small businesses pay for employee insurance. Businesses employing fewer than 25 workers who earn less than $50,000 annually can get a tax break worth up to 35 percent of premiums. (This would rise to 50 percent in 2014.)
• The law provides help with the Medicare Part D "doughnut hole," a gap in prescription drug coverage in which beneficiaries must pay for medications before insurance kicks in again. The law would eliminate the hole by 2020. Meanwhile, seniors received help paying for drugs when they reached the hole. More than 55,000 Marylanders in 2010 received a $250 rebate. And more than 52,000 Marylanders last year paid half-price for certain brand-name drugs.
•As of last year, insurers are now required to spend 80 percent to 85 percent of collected premiums on medical costs or improving patient care. Insurers that spend less than that must start giving customers a rebate this summer, says Sam Gibbs, a senior vice president with eHealthInsurance, an online insurance brokerage. "The theory is their premiums are too high," he says.
According to HHS, up to 9 million people could receive rebates worth as much as $1.4 billion.
These are a lot of numbers, but there are real people behind them.
Kids like Josias Lazo. The 7-year-old from Baltimore County is blind and suffers from cerebral palsy, chronic lung disease and a form of diabetes.
For years, his care was covered by Medicaid, the health program for the poor. But in 2009, his father's income rose at his landscaping business and Josias became ineligible for assistance.
Becy Lazo says she tried to buy insurance for her son but was turned down because of his pre-existing illness. Lazo was unaware of Maryland's high-risk pool. She says the family struggled to pay for Josias' care out of pocket.
"I didn't know what to do. He needed medication and doctors' visits. Everything was very expensive," his mother says. "It was very stressful."
Pediatrician Scott Krugman says he had to juggle Josias' care — determining what was absolutely critical and what the child could do without — to make it affordable for the parents. Even so, medical bills mounted. Lazo says she and her husband filed for bankruptcy in 2010.
Later that year, Josias became eligible for a private policy because of the Affordable Care Act. Now that Josias has insurance, his mother says, he gets the care he needs and the family has been able to keep up with the bills.
Pediatrician Ari Silver-Isenstadt, Krugman's colleague, says that while some of his young patients were covered under Medicaid, he saw many young parents going without insurance because their employer didn't provide it and they couldn't afford it on their own. "We would have sick people taking care of kids," he says.
That changed, he says, once these young parents were able to jump back on their own parents' insurance plan.
Silver-Isenstadt and other physicians attended a rally this week to support the law outside the Supreme Court. He says he finds it hard to believe that people could lose their insurance.
"I can't imagine a country where we could do that, just go backwards."
Unfortunately, it's very possible.
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