The U.S. leads the pack in the percentage of older adults who have trouble paying their medical bills.
June 24--As a person with a lot to lose, Deborah Sferlazza anxiously awaits a ruling expected this week from the U.S. Supreme Court on President Barack Obama's landmark health care law.
Sferlazza, 54, a disabled Rochester elementary school principal with painful back-related problems, was rejected several times for insurance because of her pre-existing condition. Blue Cross Blue Shield of Michigan, which is required by state law to accept her, offered a policy she said she couldn't afford.
Last year, Sferlazza finally got coverage through a provision of the Obama administration's Affordable Care Act, which helps create temporary insurance plans for high-risk people through 2014, when broader reforms are set to take place.
The plan paid for surgery, physical therapy, medicine and doctor visits that have helped Sferlazza stop using a cane and pain drugs, she said last week.
"Without health reform, I'll be uninsurable again," said Sferlazza, whom the Free Press interviewed in March before the Supreme Court held hearings on challenges to the law.
The court is expected to rule on the future of the Affordable Care Act -- one of the biggest expansions of national health coverage since the creation of the federal Medicare and Medicaid health insurance programs in 1965 -- before its upcoming summer recess.
The new law would require most Americans to have health insurance or pay a tax penalty, beginning in 2014, and would greatly expand Medicaid. Both provisions were key parts of the challenge heard by the court.
A national business organization and 26 attorneys general, including Michigan'sBill Schuette, have sued over the law, calling it an unprecedented trampling of constitutional liberties and an unlimited reach by the federal government into the lives of its citizens.
"This is the first time ever in our nation's history that the federal government would force every citizen to purchase a product," Schuette said Friday in an interview. He said it may sound farfetched, but if the federal government can force people to buy health insurance, it also could require people to buy General Motors cars because the government owns stock in the company, he said.
Though the nation clearly needs to debate how to improve health care, "it needs to be done in a constitutional fashion," he said.
If the justices strike down the requirement to buy insurance, experts say it could cause an avalanche that would undo other provisions.
The mandate provides the "financial underpinnings" of the entire law, said Richard Miles, deputy director of Michigan'sBureau of Medicaid Policy and Health System Innovation. He is readying the state to expand its Medicaid program to an estimated 500,000 Michiganders. The law will extend care to anyone under 133% of the poverty limit -- $10,890 for a single adult, or $22,350 for a family of four, for example.
The Obama administration has asked the court, if it declares the mandate unconstitutional, to also overturn related provisions that require insurers to accept and cover people with pre-existing conditions at no higher cost.
If the pre-existing conditions provision is struck down, "I'll be back to square one," Sferlazza said.
The court's widely anticipated decision could take several forms. It could throw out the whole law, keep it or overturn some of its parts.
Experts are divided over what will happen if the court throws out the mandate but keeps intact the requirements that insurers accept all applicants and charge them the same as others.
The insurance industry predicts big hikes in insurance premiums and more uninsured people. Five different studies analyzed by America's Health Insurance Plans, a Washington, D.C., industry group, show a 7.8 million to 24 million rise in uninsured people and a 2.4% to 40% increase in health premiums.
By contrast, the Congressional Budget Office has estimated that 16 million people still would be likely to get insurance. The agency also predicts that premiums in the individual insurance market would be 15%-20% higher than if the law were implemented in full.
The variations show just how much of a guessing game it may be if some parts of the law are ruled unconstitutional.
Experts say many popular reforms will stay. Three large insurers -- Humana, Aetna and UnitedHealth Group -- already have said they intend to keep a provision that allows young adults up to age 26 to stay on a parent's insurance policy.
The ability of his oldest daughter, Erin, to be covered by his policy for a year "was huge," said Ronald Katz, 55, of Huntington Woods.
When she turned 26 this year, she had to replace the coverage with a student insurance policy that costs her $270 a month, he said. With a 21-year-old son at Wayne State University, a tough job market and trends to limit insurance benefits at some companies, Katz says his son, too, might benefit from being on the family insurance policy.
"Will there be a job when he graduates?" Katz asked. "Knowing he'll have health insurance through me is very helpful."
Whatever the court's decision, political wrangling will continue as new members of Congress, along with whoever wins the presidency, are expected to try to dismantle the law or move ahead with implementing it. And other parts of it may be challenged in coming months.
Much at stake in state
With 1.1 million uninsured people and declining numbers of employers providing insurance, particularly to new workers, Michigan has lots at stake. It will have to scramble if the law is upheld, setting up a key provision of the law creating a statewide system, or exchange, through which consumers and small businesses could purchase insurance in 2014.
The Republican-dominated Legislature last year refused nearly $10 million in federal funds that would help create the system, saying it preferred to wait for the Supreme Court ruling before creating a program that might get scrapped, depending on what the court does.
A deadline to apply for additional federal money for the exchange comes Friday, though the federal government soon will announce other opportunities for states to get funds, according to a spokesman for the U.S. Department of Health and Human Services.
Michigan health experts, such as Marianne Udow-Phillips, director of the Ann Arbor-based Center for Health Care Research & Transformation, still predict "it will be a huge challenge for Michigan to have a state exchange up and operational in time."
States face a Jan. 1, 2013, deadline to create an exchange or risk the federal government doing it for them.
Overall, Americans slightly oppose the entire health reform law, by a 51%-43% margin, though 1 in 6 opposes it because the law doesn't go far enough, according to polls conducted as recently as late May.
U.S. Health and Human Services Secretary Kathleen Sebelius, who visited Detroit last week, said the law is unpopular because "change is hard" and people have been inundated with false information from multimillion-dollar advertising campaigns from opponents.
The law has been blasted by religious groups opposed to a provision that requires health plans to offer contraceptive services.
"They are taking our religious freedoms away and demanding that our religious institutions pay for abortions," said Lynn Mills, a Livonia mother and member of Pro Life Detroit, who braved 97-degree heat last week to protest the law outside a Detroit clinic where Sebelius was announcing $128.6 million in new grants for health care clinics nationwide under the health care law.
"I'd rather see the Catholic Church drop all of their charities rather than have any of their hospitals pay for one abortion," Mills said.
An HHS official reiterated Friday that the law does not cover abortions or RU-486, the so-called abortion pill.
In February, the Obama administration passed a new policy it said it hoped would appease concerns. The new rules will require insurers to provide contraception benefits to women, but it exempts faith-based organizations from having to share in that cost for their employees.
Divisions arise early
The health care law, adopted in 2010, became divisive early on, with tea party and other opponents swarming public meetings.
Dubbed Obamacare, the law has become one of the biggest issues in this fall's presidential and other races. Republican nominee Mitt Romney, whose own state of Massachusetts adopted a forerunner of the health reform law, has vowed to overturn whatever is left once the Supreme Court issues its ruling.
But provisions of the law continued to click into place as recently as last week, such as the new money Sebelius announced for six Michigan community health centers.
Other parts of the law benefit health care, health industry experts say, and are very likely to stay, including measures to improve hospital care and patient safety and to make the complicated world of health insurance more understandable.
"It doesn't matter what the Supreme Court does," said Gene Michalski, CEO of the Royal Oak-based Beaumont Health System. "We're going to do what we think we need to do, which is continue to strive for even better quality, even better service, at a lower cost."
Arylssa Heard, a Detroit mother of two, said she hopes there is affordable insurance coverage ahead for her.
Heard, who is unemployed and uninsured, pays $50 for visits to a Beaumont Hospital clinic that provides discounted rates to people without health insurance. Recently, she opted not to go there for an appointment because she didn't have money to put gas in her car to get her to the Royal Oak clinic and the family needed groceries, said Heard, whom the Free Press interviewed earlier this year.
If the Supreme Court throws out the law or overturns portions of it that would let her buy an affordable health insurance policy, Heard said, "my alternative will be to go back to the ER."
Contact Patricia Anstett: 313-222-5021 or email@example.com
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