As the Supreme Court decides the fate of President Obama’s Affordable Care Act, what had been most often overlooked amid all of the fierce rhetoric and debate is the inescapable truth that the financial security and potential health outcomes for millions of ordinary Americans who have already benefited from the health reform law also hang in the balance.
PBS NewsHour profiled the five-member Hill family, who were forced to go uninsured for three months as they could not afford to pay the $7,972.25 per month (just shy of $100,000 per year) premium for health coverage. The astronomical fee was due in large part to the pre-existing conditions of their 17-year-old son, who struggled with leukemia, autism, and epilepsy. At the time of his diagnosis, the family had reasonably priced, high-quality employer based health insurance coverage through MetLife. But as the title agency started shopping around for better deals, the Hill family’s health plan changed to one with significantly higher deductibles and co-pays, where the maximum out-of-pocket was $8,000 per person and $35,000 for the family.
As her son’s health gradually deteriorated, Lisa Hill eventually quit her job and purchased coverage through COBRA. Still, the bills were overwhelming:
“And there are some of them that I will say we walked away from,” she said. “I had to say, ‘we’re not going to pay it. He is 18, he’s legally responsible himself and you’re going to have to write it off.’ With a $9,000 bill … I mean, how do you afford that?”
After Lisa had been unemployed for 18 months, the COBRA coverage eventually ran out, and the family’s only option became to transfer to a plan in the individual health care market — the one costing nearly $8,000 per month. But just when the Hill family became uninsured, debate erupted over health reform, and the Hills were gifted a glimmer of hope in “the part of the bill would prohibit insurance companies charging higher premiums to people with health problems or restricting coverage of pre-existing conditions.”
Three months after they lost coverage, the laborers’ union extended their plan to the Hill family. That allowed the Hills to pay $1,200 per month for a plan that includes dental, vision, and health. Doctor visits are $15. Prescriptions are $25.
And a few months after that, President Obama signed the health care reform bill into law, allowing Adam to stay on the family plan through age 26. He can go to his oncologist, neurologist, psychologist, psychiatrist, and primary care physician as needed. All for $15 per visit. And after the age of 26, Adam won’t be charged higher premiums because of his disorders. Insurance companies will be barred for charging higher rates for pre-existing conditions starting in 2014.
At least 2.5 million younger Americans now have health insurance as a result of the provision in the Affordable Care Act that allows adults to stay on their parents’ health care plans until 26 years of age, but should the Supreme Court strike down the ACA’s individual mandate on the basis of its ‘unconstitutionality,’ the pre-existing condition rule might also be jeopardized and millions of families like the Hills could end up without access to affordable coverage.