What is at risk with the Supreme Court’s healthcare ruling today?

I continue to be surprised and disappointed by the lack of knowledge about the Affordable Care Act and lack of support by the general public.  Polling shows that President Obama’s healthcare reform remains unpopular, despite pretty broad public support for the individual items contained in the Affordable Care Act, with the exception of the individual mandate.  You see, when you ask people if kids should be allowed to stay on their parent’s insurance until 26, or if people with pre-existing conditions should be able to get insurance coverage, or if there should be no lifetime dollar caps on what your insurance will pay for your care – most people are all in favor of these things.  What most people fail to understand is that you can’t have all those things without the individual mandate.  Those go hand in hand, at least if we want to have a free-market healthcare system.

I understand how people who have never been really sick, or never had a close family member with a major medical problem, might wonder how the Affordable Care Act helps them and therefore be against it.  I think that is a short-sighted view since almost everyone will get sick at some point, but I can sort of see where they could be coming from.  Almost everyone else who is against the Affordable Care Act falls into one of two camps:  1)  They are misinformed about what the reform does and/or does not do.  There are a lot of lies and misrepresentations about this issue out there.  If you are against the Affordable Care Act because you don’t know much about it or because you only watch Fox News or listen to Rush Limbaugh, please do me a favor and take 5 minutes to learn the facts (links to a few good sources below).   2)  They are against it because it came from the democrats and/or Barack Obama. I hope that this does not represent too many people, but I do believe some people are against it based purely on ideology – kind of ironic considering that the individual mandate idea originally came from a conservative think tank and was a central part of a Republican plan presented against the Clinton healthcare plan.

Today we will find out if the Supreme Court upholds all or part of the Affordable Care Act.  There is plenty of speculation about which way it will go – will they strike down or uphold all or part of it?  What will the ruling mean for healthcare reform and for the presidential election in the fall?  I will leave that talk to the journalists and political pundits.  I am interested in what this ruling will mean for me, for my children, for my family members.  I have a personal stake in this decision and so does every single one of us.  The Affordable Care Act is not perfect and it probably will not solve all the problems with our healthcare system, but it is a huge step in the right direction, in my opinion.  The Affordable Care Act will help me, my children, my family and friends, and you too.

Here are 10 things that the Affordable Care Act does that can help you or someone you love, and all of this is at risk today with the Supreme Court’s ruling.  Much of this information came from the Healthcare.gov site and from Ezra Klein’s Wonkblog at the Washington Post.

1.  Making healthcare more affordable to those that can’t afford it.  Ezra Klein describes that “Families making less than 133 percent of the poverty line — that’s about $29,000 for a family of four — will be covered through Medicaid. Between 133 percent and 400 percent of the poverty line —  $88,000 for a family of four – families will get tax credits on a sliding scale to help pay for private insurance.  For families making less than 400 percent of the poverty line, premiums are capped. So, between 150% and 200% of the poverty line, for instance, families won’t have to pay more than 6.3 percent of their income in premiums. Between 300 percent and 400 percent, they won’t have to pay more than 9.5 percent.”

2.  The individual mandate is not really much of a mandate at all.  Ezra Klein explains, “When the individual mandate is fully phased-in, those who can afford coverage — which is defined as insurance costing less than 8 percent of their annual income — but choose to forgo it will have to pay either $695 or 2.5 percent of the annual income, whichever is greater.”  So, there is an out for all those that don’t want the government telling them what to do with their healthcare or making them buy something they don’t want to buy.  You won’t get thrown in jail or have your house taken away if you don’t buy health insurance.  Pay the small penalty and guess what, you still get the benefit of being able to get health insurance when you really need it – because you are hit by a bus or have a baseball size tumor in your chest – thanks to the Affordable Care Act mandating coverage for people with preexisting conditions. You know what though, the individual mandate works because people generally want to buy health insurance if they can afford it and if it provides adequate coverage.  Based on the individual mandate in Massachusetts, about 95% of the residents are now covered thanks to the individual mandate.

3.  Insurance companies are not allowed to discriminate based on preexisting conditions. They ARE allowed to discriminate based on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5. to 1 ratio).  Before the Affordable Care Act, insurance companies could deny you coverage because your kid has a developmental delay or autism, because you were pregnant, because you had cancer 10 years ago, because you have high blood pressure, or because you have a history of back pain.  Insurance companies could also choose to cover you, but charge you insanely high rates because of anything they deemed a preexisting condition.  For example, A 22-year-old woman could be charged 150% the premium that a 22-year-old man paid, just because of gender.  Under the Affordable Care Act, insurers can’t charge women higher premiums than they charge men.

4.  More of your premium dollars will be used for your care.  Ezra Klein explains that “The law requires insurers to spend between 80 and 85 percent of every premium dollar on medical care (as opposed to administration, advertising, etc). If insurers exceed this threshold, they have to rebate the excess to their customers. This policy is already in effect, and insurers are expected to rebate $1.1 billion this year.”

5.  Insurance Plans will be required to cover preventive services without out-of-pocket costs.  This means you will not have a co-pay or any out-of-pocket expense for things like mammograms, well-baby and child visits, breastfeeding support and equipment, vaccinations, and colonoscopies.  To see a more complete list of preventive services that will be covered, go to the healthcare.gov site.

6.  Kids under 26 can stay on their parents’ insurance policy.  This makes very good since so many young people are still in college or technical school, graduate school, or trying to get established in a job or profession during their early 20’s.  This allows many more young, healthy people to be covered for a reasonable cost.

7.  Insurance companies can no longer put a lifetime cap on your medical expenses.  Before the Affordable Care Act, many plans put an individual dollar cap on lifetime insurance payments , often around one million dollars.  That may sound like a lot of money, but anyone who has ever really been sick can tell you otherwise.  Healthcare is expensive –  insanely expensive.  For example, if you get cancer and need a stem cell transplant in your 20’s, you could use $500,000 of your lifetime benefit – not leaving much room for another major medical problem.  If you have a baby born prematurely, you could easily rack up hundreds of thousands of dollars in medical costs, before that child even leaves the hospital.  The Affordable Care Act prevents lifetime caps on insurance benefits, meaning you will actually be able to use your insurance when you really need it, even if your needs exceed some arbitrary dollar amount.

8.  The Affordable Care Act helps people with Medicare by protecting current benefits and offering new ones that will reduce costs.  It also helps to close the “donut hole” (gap in pharmaceutical drug coverage) for seniors by cutting the cost of prescriptions in half, saving them money.

9.  Increased coverage for workers at small businesses and tax breaks for small businesses that provide health insurance to employees.  Ezra Klein describes that “small businesses that have fewer than 10 employees, average wages beneath $25,000, and that provide insurance for their workers will get a 50 percent tax credit on their contribution. The tax credit reaches up to small businesses with up to 50 employees and average wages of $50,000, though it gets smaller as the business get bigger and richer. The credit lasts for two years, though many think Congress will be pressured to extend it, which would raise the long-term cost of the legislation.”

10.  Healthcare reform without increasing the deficit?  There is widespread disagreement and conflicting reports all over the media on this, but Ezra Klein noted that “the law is expected to spend a bit over $1 trillion in the next 10 years. The law’s spending cuts — many of which fall on Medicare — and tax increases are expected to either save or raise a bit more than that, which is why the Congressional Budget Office estimates that it will slightly reduce the deficit. (There’s been some confusion on this point lately, but no, the CBO has not changed its mind about this.) As time goes on, the savings are projected to grow more quickly than the spending, and CBO expects that the law will cut the deficit by around a trillion dollars in its second decade.”

We’ll find out very soon what the Supreme Court decides on the fate of healthcare reform and the Affordable Care Act.  Even if you disagree, what do you think about all or part of these 10 features and benefits of the reform?  If you agree that our healthcare system needs reform, but are not in support of the Affordable Care Act, even after educating yourself about what it includes, how would you propose we reform the system?  As a family with several preexisting conditions – cancer, developmental delays, 3 pregnancies and c-sections – I need the Affordable Care Act to be upheld.  As a citizen, taxpayer, consumer, and part of the health care delivery system, I anxiously await this important decision and hope it is upheld.

A few links to read more:

http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/24/11-facts-about-the-affordable-care-act/

http://www.healthcare.gov/news/factsheets/2011/08/women.html

http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/26/the-irony-of-the-individual-mandate/

http://www.washingtonpost.com/blogs/ezra-klein/post/health-reform-with-a-mandate-the-massachusetts-story/2012/06/18/gJQAfohImV_blog.html


2 thoughts on “What is at risk with the Supreme Court’s healthcare ruling today?

  1. The Supreme Court upheld the individual mandate (as a tax, not as part of commerce clause – still need to read more to be informed on what, if anything, this may change) and the Affordable Care Act. A good day for patients and a good decision by the Supreme Court in my opinion.

  2. Pingback: Goodbye Bristol-Myers Squibb | fivespinningplates

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