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The Supreme Court Health Care Drama – What Does it Mean?


The Supreme Court Justices

It was like watching a movie.  It had suspense, drama and an unexpected plot twist.  Who knew that a legal decision by the Supreme Court of the United States could produce such a drama?!  It sure did, though, with its ruling upholding the Affordable Care Act.  In their haste to be the first to report the decision, two major media outlets (CNN and Fox News) got it wrong and reported that the Court had overturned the law.  But, it wasn’t so.  The unexpected plot twist came in the form of Chief Justice John Roberts, a recognized conservative Justice who unexpectedly sided with four non-conservative Justices to uphold the controversial health care reform law. Very few saw that one coming.  While the law is now settled, the “hue and cry” from both proponents and opponents of the law will continue at least through the Presidential election in November. But after time, the roar will slowly diminish and the law will continue to be implemented. (For a non-partisan video discussion of the Supreme Court’s ruling, courtesy of Kaiser Health News, please go to the health care reform section of IDF’s Advocacy center on the IDF website http://primaryimmune.org/idf-advocacy-center )

But what does this all mean to the primary immunodeficiency community and other people with rare and chronic diseases? It means:

Presently

  • Adult children up to age 26 can remain on their parents’ health insurance policies
  • Children up to age 19 cannot be denied coverage because of a pre-existing condition
  • An insurance company cannot take your coverage away from you should you become sick.
  • The Medicare Part D (prescription program) “donut hole” will begin closing.
  • Preventive screenings and wellness programs will continue with no co-payments.

Beginning January 1, 2014

  • No one can be denied coverage because of pre-existing conditions
  • Women will not have to pay higher premiums than a man just because she is a woman.
  • There will be annual limits on the amount of money a person or family must pay out-of-their pocket.
  • A family of four, earning up to $89,400 ( family of two – up to $58,840) will have their premiums subsidized.
  • Uniform appeal procedures will be in all plans.
  • There will be a uniform summary of benefits documents to enable consumers to be better able to compare insurance plans on an “apples to apples” basis.

Two critical components of the law are the establishment of state health exchanges and the requirement that all plans must cover “essential benefits”.  The state health exchanges are designed to allow people to be able to shop for an individual insurance plan that is right for them.  The essential benefits requirement is designed to make sure that all insurance plans can be compared easily and to make sure that insurance companies don’t use benefit coverage as a means to “cherry-pick” or discriminate.  States are in the process of establishing their exchanges as well as determining the essential benefits components for their states.

There are numerous other components of the law, but the insurance components are the most important immediate concerns to the primary immunodeficiency community.  There are many provisions in the law that will benefit our community.  But we all know that the “devil is in the details”.  IDF has been and will continue to be active in monitoring and advocating on behalf of the primary immunodeficiency community.

Stay informed.  Please continue to view the IDF Policy Matters blog http://idfpolicymatters.org and the Health Care Reform section of the Advocacy Center http://primaryimmune.org/idf-advocacy-center on the IDF website.  If you have a question pertaining to the Affordable Care Act, either submit it as your comment on this blog or click on the “Contact” button at the top of this blog page.  We will get back to you with an answer.

Larry LaMotte
VP of Public Policy

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