Ellicott City resident Marci Maisel has spent a lot of time worrying about her mentally disabled sister, Karen Smith. She worries about the thousands of dollars Smith has spent on health care, and the reality that Smith could go bankrupt if she needs to be hospitalized.

On June 28, following the Supreme Court's 5-4 decision to uphold the federal Patient Protection and Affordable Care Act, Maisel said she felt relief that soon her sister will be able to get more comprehensive coverage.

"It's exciting to know that every American is being able to get access to health care and not have to go bankrupt to do so," Maisel said.

Local health advocates also lauded the Supreme Court's decision, which legally validates the controversial health care law that is one of the biggest initiatives of President Barack Obama's term. Passed by Congress in 2010, the Affordable Care Act will require all citizens to have health insurance or pay a penalty on their annual income taxes.


Submit a Letter to the Editor for the Laurel Leader, Columbia Flier and Howard County Times

"The bill is not perfect, but it's a significant improvement over the current system," Howard County Health Officer Peter Beilenson said.

The president of the Horizon Foundation, a Columbia-based organization that works to address community health issues through grant-funded programs, was also pleased by the decision.

"The ruling will allow businesses in Howard County and Maryland to be more competitive with lower health care costs and a healthier work force and will afford greater access to health insurance for people who live and work in Howard County," President Nikki Highsmith Vernick said in a statement.

Years before the 2010 passage of the Affordable Care Act, Howard County, under the leadership of Beilenson and County Executive Ken Ulman, started a local program called Healthy Howard to provide health care access to the uninsured.

"Today's Supreme Court ruling ensures millions of Americans will now have access to health care," Ulman said in a statement. "Our Healthy Howard program, which has provided access to care for thousands of uninsured Howard County residents, can now serve as a model to connect Maryland citizens to quality health care."

The federal law makes obsolete the Healthy Howard program — which serves Howard County residents who earn an annual income less than 300 percent of the federal poverty level and who do not qualify for other health care programs — because it is not considered insurance.

"As of Jan. 1, 2014, Healthy Howard will go out of business," Beilenson said.

Healthy Howard Inc., the nonprofit that runs the program, however, will still promote healthy practices in restaurants, schools, child care facilities and workplaces. It will also run a more robust version of the Door to Health Care, a service that screens applicants for eligibility in multiple health insurance programs and enrolls those who qualify, all in one place.

"The door to is going to need to be the educator, the navigator (of the Affordable Care Act)," Beilenson said. "Because now there are thousands more (people) who will be eligible for health coverage under the bill, both Medicaid and under the exchange, we will have many folks coming in or calling."

Beilenson said he also expects people with insurance to call in and ask for information about the law and what it means for them.

For people who already have insurance through their jobs, the law "essentially doesn't mean anything," Beilenson said, noting "they'll have a few additional protections."

Seniors who already qualify for Medicare will see no difference, he added.

Expanded Medicaid

The law, however, does expand the government's Medicaid program for low-income individuals and families to cover people earning up to 138 percent of the federal poverty level.

Other low-income individuals and families making between 138 percent and 400 percent of the federal poverty level — which would be between about $28,000 and $88,000 for a family of four — would qualify for subsidizes under the health insurance exchange that Maryland and other states are required to form under the law, Beilenson said.

Smith does not currently qualify for Medicaid, but she will under its expansion as a part of the Affordable Care Act.

Maisel moved Smith, who has schizophrenia and bipolar mood disorder, from Alabama to Ellicott City three months ago so she could keep a better eye on her and the money she was spending on health care. In Alabama, Smith had incurred thousands of dollars of medical expenses, paying for hospital visits, medications and home care services that ate through much of her trust fund that was intended to last her entire life.

Because of her disability, Smith is not able to work, which Maisel said makes it difficult for her to get insurance. In deciding to move her sister to Howard County, Maisel looked for health care options for Smith and found Health Howard's Door to Health Care. Through the program, Maisel was able to enroll Smith in Primary Adult Care, a state health care program intended to be a stop-gap measure for low-income individuals who do not qualify for other programs.

While it provides a lot of benefits, PAC has its limitations. Maisel said under PAC, Smith can not see a specialist. If hospitalized, PAC only covers the emergency room visit, not the cost of the doctors or overnight stays.

Though Maisel still has to worry about the possibility of her sister being hospitalized in the next year and a half before the Affordable Care Act takes effect, the Supreme Court's decision shines some light on what has been a dark unknown.

"I feel relived that I don't have to worry in the longer term that she will be covered with insurance," Maisel said. "And there is hope."