The Republican lawsuit targets reinsurance that helps insurance companies provide universal coverage without accounting for pre-existing conditions.
March 23--Raynard Ebron knows it is important to have health insurance and to see his doctor regularly.
But that's pretty much all the 20-year-old Bridgeport resident knows about the intricacies of health care -- that and the fact that his job at Chino's Deli in Bridgeport doesn't provide insurance. If he'd had to find his own coverage when he turned 18, it would have been a challenge to say the least.
Fortunately for him, under the federal health care reform legislation passed two years ago, he and his two older siblings can still be covered through their mother's insurance, even though they are considered adults.
Friday marks the second anniversary of the passage of the Affordable Care Act, the sweeping health reform legislation that by 2014 is supposed to provide 32 million Americans with access to health insurance. That major piece of the legislation hasn't yet fallen into place, and its fate will depend largely on the U.S. Supreme Court's decision on the act's constitutionality. Arguments before the court begin Monday and are expected to focus primarily on the section of the act that requires people to buy insurance and imposes a financial penalty on those who don't.
While insurers have already put some of the provisions in place, there are several things that still need to be done, including:
Creating by September user-friendly summaries of standard benefits for people shopping for coverage;
Preparing to sell coverage on state-based exchanges that will allow individuals and employees of small businesses to shop for insurance starting in 2014;
Offering coverage to everyone who applies, and ending the exclusion of people with pre-existing conditions starting in 2014;
Stopping pricing coverage based on a person's health status;
Starting to pay an industrywide insurer fee that begins at $8 billion in 2014 and increases afterward.
Many effects of health reform have already been felt by thousands of state residents. For instance, there's the provision that allows Ebron and his siblings to get care -- children younger than 26 are now covered under their parents' insurance. According to the U.S. Department of Health Human Services, 2.5 million people younger than 26 nationwide have gained coverage, including 20,090 in Connecticut.
Loretta Ebron, of Bridgeport, said she is very relieved her children now have coverage. Ebron, a HUSKY eligibility outreach worker at Optimus Health Care in Bridgeport, frequently works with people who have a hard time finding benefits, so she said she is grateful for the passage of the health act.
"All of my kids are working on building their careers, and this is one less headache they'll have to deal with," she said.
Yet opinion on the legislation is mixed throughout the state. Many residents say they are still struggling with high insurance premiums and are skeptical about how they have been helped by health care reform.
BENEFITS OF REFORM
In addition to expanding coverage for young adults, the Affordable Care Act also provides new coverage options to those who have been uninsured for at least six months because of a pre-existing condition. As of the end of 2011, 163 previously uninsured residents of Connecticut who were locked out of the coverage system because of a pre-existing condition are now insured through a new Pre-Existing Condition Insurance Plan that was created under the health reform act.
Sidney Schnoll, a former doctor living in Westport, has two sons younger than 26. One of them, 25-year-old Noah, had trouble finding an insurer that would cover him because he has a congenital heart defect, considered a pre-existing condition. Prior to the act's passage, Noah, who lives in New York, was uninsured. Now, he's able to be covered under his parents' insurance.
As someone who has worked in medicine, Schnoll said he was outraged that it took this long for his son and people like him to get access to the care they need.
"To me, it was unconscionable that the insurance industry would turn him down," he said. "Without the Affordable Care Act, he still wouldn't have any coverage."
Other changes that have taken hold in the state include progress on establishing a health insurance exchange, through which currently uninsured consumers can shop for health plans. Connecticut received more than $7 million to establish a health insurance exchange, and Gov. Dannel P. Malloy signed legislation last summer that helped establish a framework for the state's program. Malloy also established the state Office of Health Reform and Innovation to implement facets of federal reform.
Regardless of what happens with the Supreme Court arguments, the state is committed to changing the way health coverage is doled out, said Jeannette DeJesus, special adviser to the governor on health reform.
"Whether this law is overturned or not, we definitely need to make considerable changes, and we will continue to address these issues head-on," she said.
But some aren't so enthusiastic about the legislation, including Patrick O'Hara, of Monroe. O'Hara owns his own business -- O'Hara's Nursery in Monroe -- and pays for his own health insurance. For 17 years, he was insured by HealthNet. Before the passage of the Affordable Care Act, he said, he paid a premium of $1,440 a month. The next year, his premiums soared to $1,880 a month. He recently switched to a high-deductible health plan with Aetna, where his premiums are much lower. But he said he is still unimpressed with health care reform efforts.
"My overall experience is that they haven't fixed health care," O'Hara said. "All they've done is create an environment of mandatory coverage."
The exact impact of health care reform on insurance premiums is unclear. In September of last year, the Kaiser Family Foundation found that after several years of relatively modest increases, average annual premiums for employer-sponsored family health coverage increased to $15,073 in 2011, up 9 percent from the previous years. Premiums increased by an average of 7.5 percent in 2011, and were expected to rise an average of 7 percent in 2012, according to a study by Aon Corporation, a global human resource consulting and outsourcing business.
The Aon report found overall average projected increases due to health reform were reported to be 1.5 percent for 2011. However, these increases varied depending on the plan, ranging from an increase of 4.7 percent for individual policies to 0.8 percent for large group policies.
Because of the increases, it's understandable people like O'Hara are frustrated with the health reform act and feel it does not have a positive impact on their lives, said John Rother, president and CEO of the National Coalition on Health Care, a Washington-based advocacy group.
"Health care is still too expensive -- much more so than in almost any other country," he said.
Though Rother acknowledged there's still a long way to go before health care in this country is as affordable and accessible as it should be, the last two years have represented a step forward for many Americans. For example, while health care premiums are still a challenge for many, he pointed out that the act has taken steps to keep those rates manageable. One of the act's provisions requires insurance companies proposing a rate increase of 10 percent or more to publicly justify their actions. At least one insurer in Connecticut has already been affected by the act -- Anthem Blue Cross, which requested a rate hike of 12.9 percent. After review, the request was limited to a 3.9 percent increase.
And while some complain about the costs, many others say they are grateful for what the act provides and look forward to further reforms.
"I'm definitely looking forward to additional benefits under federal reform," said Barbara Edinberg, director of Research for the Bridgeport Child Advocacy Coalition, which works with low-income and underserved populations.
Many people the coalition serves likely couldn't afford their own coverage and have to go without insurance -- and, most likely, without medical care.
"We know how detrimental it is when a child or adult goes without insurance coverage or medical care," she said.
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