The Miami Herald

Ruling impacts millions of health care consumers

Having survived its most serious threat, the 2010 health care law moves forward, dented and dinged by the Supreme Court’s forensic-style ruling but still standing as the most comprehensive, costly and controversial overhaul that the nation’s fractured medical system has ever known.

“This is truly a hallelujah moment for families across America,” said Ron Pollack, executive director of the liberal health advocacy group Families USA. “It means families will get the peace of mind that health coverage and care will be there for them when they need it.”

While the bulk of the Patient Protection and Affordable Care Act’s most meaningful provisions won’t take effect until 2014, millions of Americans already are benefiting from the sweeping legislation that provides consumers unparalleled leverage in their dealings with health care providers and insurers.

Later this summer, nearly 13 million Americans will receive $1.1 billion in rebates from insurance companies — an average of $151 for each family policy — because of the law’s requirement that at least 80 percent of insurance premiums paid by consumers must go for medical care or quality improvement measures. Insurers that don’t meet the standard must pay a rebate to their policyholders by Aug. 1 for the difference, either in cash or by a reduction in premiums.

The health care law also requires plans with dependent coverage to insure adult children up to age 26. A government report found 3.1 million young adults gained health coverage because of the provision. From September 2010 to December 2011, the percentage of young adults ages 19 to 25 with health insurance has increased from 64.4 percent to 74.8 percent.

The court decision also continues the Pre-Existing Condition Insurance Plan, a temporary program that already extends coverage to more than 67,000 people who can’t get private health coverage because of ailments like cancer, diabetes, high blood pressure and asthma. The program is slated to end in 2014, when the law bars insurers from denying coverage or charging more to anyone based on their health status.

The pre-existing program has helped people like Marlys Cox of St. Petersburg, Fla., who contracted hepatitis C when she was 13 years old. In February, Cox, 57, paid for a mammogram and found out she had breast cancer. At the time she was uninsured.

“When I tried to go to the hospital, they all turned me away because I had no insurance and I am not below the poverty level,” she said. “They told me to go home and die. One suggested I go get hit by a car so I could be admitted to the emergency room.”

Now, Cox pays $376 a month for insurance, down from $1,100 a month.

“I never thought I would get to live a full life because of not having health insurance or not being able to afford it,” she said.One of the most important changes is the prohibition against annual or lifetime limits on benefits paid to policyholders who have major illnesses. Ed Burke of Palm Harbor, Fla., was born with hemophilia and contracted HIV and hepatitis C from a blood treatment. His costly treatment and medications have forced his wife and 11-year-old daughter to go uninsured.

Under the law, Burke’s family will receive coverage, and he will not have to worry about exceeding his coverage payout limits.

“This means I will be able to access the health care I need to stay around and watch my daughter grow up,” Burke said. “This is a great day for a lot of chronically ill Americans. Fifty years of discrimination went away today for me.”

America’s poor also will benefit from the high court’s ruling.

The law provides the nation’s 1,100-plus Community Health Centers with $11 billion in new funding over five years, which would double the number of patients served to 40 million. The money will build new centers and modernize and expand others.

By providing cost-effective preventive care for the urban and rural poor, health centers save money for the entire health system by reducing costly hospitalizations and emergency room visits. One study estimated the law will save up to $122 billion in health care costs from 2010 to 2015.

Because the Supreme Court ruling gives states the option of not participating in expanded Medicaid coverage, it remains to be seen how many cash-strapped states will participate.

Florida Gov. Rick Scott said Thursday that he and his staff are reviewing the court’s ruling. “I’ve got to read through the decision and make sure we understand it,” he said.

But if the health care law’s Medicaid expansion is adopted by all states, an estimated 22.4 million uninsured people — including more than 1.5 million Floridians — would likely get coverage by 2015 through Medicaid or through subsidized private coverage purchased through a state insurance exchange, according to estimates from Avalere, a health care consulting firm.




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