|By Alex Nixon, The Pittsburgh Tribune-Review|
|McClatchy-Tribune Information Services|
The court's ruling could profoundly affect the Joyce family and millions of others across the nation. Among questions the justices are expected to address are two that attracted the most attention for consumer impact: Can the government force people to buy health insurance? If not, should the entire law be nullified?
"In the center ring is definitely the question about the individual mandate," said
Joyce, 55, a part-time farm worker from Cecil, and her 21-year-old daughter, a hair stylist, have chronic medical conditions. That makes it difficult and costly to obtain insurance without coverage from an employer's group plan. Joyce's husband, a truck driver, provided insurance for the family until last year when his company reclassified his job and cut the benefit.
They pay nearly
If the court upholds the law, in 2014 it would bar insurers from excluding people because of chronic conditions. By that year, states must have established health insurance exchanges for people to buy insurance at competitive rates. Both aspects could help the Joyces.
But if the court strikes down the law, Joyce worries that a serious illness or accident could drain the family's savings.
"We were always the ones that thought, if something happens, that our children could come to us and we could help them. Now I'm afraid that we couldn't do that. We'd be the ones in their basement," she said. "I feel vulnerable, I guess."
Supporters say millions of Americans are benefiting from portions of the law, including:
--More than 5.1 million people with
--About 100,000 Pennsylvanians who purchased individual health insurance and will receive rebates from insurers;
--About 50,000 adults with pre-existing conditions, including nearly 5,000 in this state, covered through a government-subsidized program;
--An estimated 3.4 million young adults receiving coverage on their parents' plans until age 26.
Critics are skeptical of those numbers and say negative consequences outweigh the positive ones.
"This was not a well-thought-out piece of legislation to start with," said
The law forces new costs onto employers, said Haislmaier, who predicted many employers may stop providing insurance to workers. The
Many businesses "don't know a lot about the law" or how it will affect them, said
The law makes available tax credits to help small businesses pay for health insurance for employees and an estimated 160,700 companies in the state qualify. Yet it's unknown how many take advantage of the incentives.
"Like anything involved with the government, there are always strings attached," Anderson said.
An estimated 89,000 young adults in
Though she may not need it, Humphries said insurance could keep her from acquiring medical debt if she required hospitalization for an accident or illness.
"That's how so many people in America are going bankrupt right now," she said.
The numbers are inflated, Haislmaier counters, contending that many young adults simply switched from employer-provided insurance to parental plans because of better deals. "You're not really insuring anyone new," he said.
Either way, the benefit does not cost health insurers much money because most people in their early 20s are healthy, according to a recent study from consulting firm Aon Hewitt. It found that the provision enabling young adults to stay on their parents' plans increased premium costs around the country an average of 1.5 percent in 2011.
A report last month touted another aspect of the law, which requires insurers to spend 80 percent to 85 percent of premium dollars, depending on plan size, on medical care rather than on administrative costs. In
The provision "actually encourages the insurers to ignore fraud," Haislmaier said. The cost of paying claims reviewers falls under administrative costs, and the more claims that are paid, the less likely a rebate will be given, he said. "It's completely backward."
The requirement that all Americans buy insurance is essential for insurers to pay for wider benefits and protections that take effect in 2014, such as the prohibition on denying coverage for pre-existing conditions, said
Without the mandate providing insurers with millions of new premium-paying customers -- especially young, healthy customers -- the industry couldn't afford to cover sick people, Maruca said.
"If the individual mandate is struck down but the rest of the law stands, the insurance industry is going to be in pretty serious trouble," he said.
A Bloomberg Government report this month estimated insurance companies could get
"When you're talking about
Affordable Care Act
--Insurance premium tax credits for small business
--Insurers can't exclude children younger than 19 for pre-existing conditions
--Temporary, federally funded health insurance plans for adults with pre-existing conditions
--Insurers cannot drop people from coverage when they get sick
--Co-pays eliminated for preventative care
--Preventative care free under
--Young adults can stay on parents' insurance until age 26
--Lifetime limits on coverage banned
--Insurers required to spend a greater percentage of premium dollars on medical services
--Insurers must publicly justify large rate increases on small business and individual plans
By the numbers
Benefit, Number in U.S., Number in Pa.
Young adults on parents' insurance, 3.4 million, 89,100
Children with pre-existing conditions getting coverage, 4.9 million, 177,900
Small businesses eligible for tax credits, 4 million, 160,700
Adults with pre-existing conditions getting coverage, 50,000, 4,816
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