Consumers who benefit from health care law relish Supreme Court ruling
WASHINGTON – 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.
They include people like 21-year-old Abby Schanfield of Minneapolis. Schanfield was born with toxoplasmosis, a rare parasitic infection, which forces her to undergo regular brain and eye surgeries, and she could eventually lose vision in one eye.
“Needless to say, my health insurance is very expensive, and being able to be on (my parents’) plan until I’m 26 is a source of security that I’ve never really known before because my life is very uncertain,” Schanfield said recently. “The future is very uncertain.”
Schanfield wants to be a community organizer, and her new health coverage under the law gives her “more time to access a job and determine where I’m going in the future,” she said.
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. “I believe that President Obama saved my life.”
Speaking from the East Room of the White House, where he signed the measure into law, Obama stressed the importance of the health insurance changes ushered in by the law.
“They won’t be able to charge you more just because you’re a woman,” Obama said. “They won’t be able to bill you into bankruptcy. If you’re sick, you’ll finally have the same chance to get quality affordable health care as anyone else. And if you can’t afford the premiums, you’ll receive a credit that helps pay for it.”
A look at the ruling upholding Obamacare
WHAT DOES THE RULING MEAN TO ME?
The Supreme Court decision upholding President Barack Obama's health care law affects nearly every American. The law tells almost everyone they must have health coverage and guarantees it will be available to them even if they are already ill or need hugely expensive care. It helps the poor and many middle-class people afford coverage.
WHAT THE JUSTICES SAID
The high court upheld almost all of the law, including the most disputed part: the mandate that virtually all Americans have health insurance or pay a fine. The court said that fine is essentially a tax, and that's why the government has the power to impose it.
The ruling limited the law's plan to expand the Medicaid insurance program for the poor, a joint effort of the federal government and states. It says the U.S. government cannot withhold a state's entire Medicaid allotment if it doesn't participate in the expansion.
Chief Justice John Roberts sided with the court's four liberal justices — Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor — to form the 5-4 majority.
HUGE POLITICAL IMPACT
The court upheld Obama's signature legislative achievement. Final word from the court amplifies the most polarizing issue of his re-election campaign against Republican Mitt Romney.
GOP lawmakers and Romney have promised to repeal the law if they are in power after the November election.
WHAT NOW?
The 2010 health care law will keep taking effect. It's expected to bring coverage to about 30 million uninsured people. Overall, more than 9 in 10 eligible Americans will be covered.
Some parts are already in effect: Young adults can stay on their parents' insurance up to age 26. Insurers can't deny coverage to children with health problems. Limits on how much policies will pay out to each person over a lifetime are eliminated. Hundreds of older people already are saving money through improved Medicare prescription benefits. And co-payments for preventive care for all ages have been eliminated.
WHAT'S NEXT?
Starting in 2014, almost everyone will be required to be insured or pay a fine. There are subsidies to help people who can't afford coverage. Most employers will face fines if they don't offer coverage for their workers. Newly created insurance markets will make it easier for individuals and small businesses to buy affordable coverage. And Medicaid will be expanded to cover more low-income people.
Insurers will be prohibited from denying coverage to people with medical problems or charging those people more. They won't be able to charge women more, either. During the transition to 2014, a special program for people with pre-existing health problems helps these people get coverage.
An assortment of tax increases, health industry fees and Medicare cuts will help pay for the changes.
STILL, NOT EVERYONE WILL BE COVERED
An estimated 26 million people will remain without coverage once the law is fully implemented, including illegal immigrants, people who don't sign up and choose to face the fines instead, and those who can't afford it even with the subsidies. That number could be higher, depending on whether any states refuse the Medicaid expansion.
THE TAXING TRUTH
When the law was before Congress, Obama and Democrats avoided calling its penalty for going uninsured a "tax." But the administration argued before the Supreme Court that the law was constitutional as a federal tax. The court rejected two other Obama administration arguments for the law but accepted the tax one.
In 2016, after the law is fully in place, about 4 million people will pay the penalty to the Internal Revenue Service for being uninsured, the Congressional Budget Office has estimated. They would pay $695 per uninsured adult or 2.5 percent of family income, up to $12,500 per year.
The IRS can't prosecute violators or place liens against them, however. Its only enforcement option may be withholding money from refunds.
WHAT ARE REPUBLICANS SAYING?
"Obamacare was bad law yesterday. It's bad law today," Romney said after the ruling.
The Republican-led House already has voted for repeal but can't push it forward so long as Obama's in the White House and Democrats lead the Senate — making the November elections crucial.
Senate Republican Leader Mitch McConnell called the court decision "a fresh start on the road to repeal."
OBAMA'S REACTION
Obama says the decision upholds the fundamental principle that in the wealthiest nation on earth, no one should be ruined financially by an illness or accident.
He called it "a victory for people all over this country whose lives will be more secure because of this law."
ABOUT THAT MANDATE
Many parts of the law have proven popular. But the insurance mandate is widely disliked.
Each time AP has asked in polls, more than 8 in 10 Americans have said the government should not have the right to require everyone to buy health insurance.
The public also has tilted against the law as a whole over the two years since it was passed. About half opposed it and a third were in favor in an AP-GfK poll shortly before the Supreme Court ruled.