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.

– Fatima Najiy

Gov. Dave Heineman (R-NE) vetoed a bill on Friday that would have restored prenatal care for pregnant women who are undocumented immigrants because, Heineman explained, some of those funds could wind up at groups like Planned Parenthood. “I oppose providing taxpayer benefits to illegal immigrants,” he said in a press release. “I oppose providing taxpayer funding to vendors that perform or promote abortions.” A Planned Parenthood official said the group does not provide prenatal services at its Nebraska clinics.

But Heineman’s comments angered the bill’s supporters, including an anti-abortion group, and underscores a key debate surrounding the bill:

State Sen. Kathy Campbell of Lincoln, the chief sponsor of the bill, said she was “disturbed” that the comment about Planned Parenthood wasn’t raised until after the measure had progressed through three rounds of debate in the Legislature. [...]

Supporters and opponents of LB 599 agree on one point: It is a difficult issue that pits the protection of unborn babies against the distribution of taxpayer benefits to illegal immigrants.

Heineman on Friday repeated his argument that taxes paid by “hardworking Nebraskans” should not be used for women who violated immigration laws, and that passage of LB 599 would make the state “a sanctuary” for illegal immigrants. [...]

While Heineman said it was not a “pro-life issue,” many supporters of the bill said that is the basis of their support.

“This bill fundamentally respects the life that is created,” said Omaha Sen. Jeremy Nord­quist, regardless of the mother’s immigration status.

The bill’s proponents say the charge is a last-minute attempt to stop the bill that has divided anti-abortion groups and anti-immigration groups. The Nebraska legislature will vote Wednesday to attempt to override the governor’s veto.

If the effects of Massachusetts health care reform law offer a preview of how Obamacare will transform the country, then a new report from the Massachusetts Taxpayers Foundation has some promising news for the national law. According to the group, annual spending on the state’s Chapter 58 reform has grown modestly — in line with projections — while the state’s near universal coverage rate resulted in a decrease spending on uncompensated care:

Annual spending for programs affected by Chapter 58 grew from $1.041 billion in fiscal 2006 to $1.947 billion in fiscal 2011, an increase of approximately $906 million. The
state’s share of this spending increase is $453 million, or 50 percent of the total. While critics periodically claim that health reform has been a “budget buster,” additional state spending attributable to the health reform law accounted for only 1.4 percent of the Commonwealth’s $32 billion budget in fiscal 2011. Over the five full fiscal years since the law was implemented, the incremental additional state cost per year has averaged $91 million, an amount that is well within projections made prior to the law’s enactment. [...]

[A]nnual state spending for uncompensated care dropped by $118 million over the first five years of reform. Annual Health Safety Net (HSN) spending fell by one-third from fiscal 2006 to fiscal 2008, reflecting a more than 50 percent decline in the number of inpatient discharges and outpatient visits for which HSN payments were made during that period.

Massachusetts’ success may provide a template for states implementing the national measure, which includes cost control provisions — like investments in comparative effectiveness research, electronic health records, and delivery system reforms — that will result in greater health savings for the nation. But for now, this report is just another example of the contrast between the doomsday predictions of conservatives and the reality of reform.