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In a surprise, Chief Justice John Roberts joined the four liberal members of the Supreme Court to uphold most provisions of the Affordable Health Care Act including the individual health care mandate.
The implications of the Supreme Court's decision are substantial for people with chronic illnesses, in general, and for people with chronic fatigue syndrome who often have with low incomes and difficulty purchasing health care. NBC News called the decision "a major victory for millions of Americans who either can’t purchase health insurance or have chronic illnesses."
With studies suggesting that ME/CFS costs the average family about $20,000 a year in lost wages, and with a recent CDC study findings that on direct medical costs averaging almost $6,000 annually, a significant portion of which is paid out of pocket, this is a community that could use some financial relief at the doctors office.
Republican presidential candidate Mitt Romney and other Republicans have vowed to repeal the bill in its entirety. Now that the most parts of the bill have passed muster at the Supreme Court the fate of the bill may be determined by the outcome of the upcoming election.
Pre-existing Illnesses
One of the most significant aspects of the Affordable Health Care Act is its clause preventing companies from restricting or barring coverage because of a pre-existing health condition. Prior to the enactment of the bill insurance companies could refuse to sell a policy, or charge several times more for it or exclude specific conditions from coverage. Under this bill insurance companies will not be allowed to jack up rates or exclude coverage for conditions when you become ill - a situation which drove many to bankruptcy or left them unable to afford insurance coverage.
Remarkably it appears that 'most' insurance companies won't even be able to charge more for people with pre-existing conditions. The government website states
"Under the Affordable Care Act, in 2014, most health insurers will no longer carve out needed benefits, charge higher premiums, put lifetime limits on coverage of key benefits, or deny coverage due to a person’s pre-existing condition"
The desire to cover pre-existing conditions drove the most controversial aspect the Bill, the individual mandate, which requires all Americans who can afford to, to have insurance so that the premiums for healthy people will help pay the costs of those who become ill.
The Uninsured
The law is designed to greatly reduce the number of people without health insurance - a problem afflicting many with ME/CFS. Estimates suggest that as many as 30 million people who do not now have health insurance will have it by 2014 Federal subsidies (which tap out at $44,000 a family) will enable millions of lower-income Americans who could not otherwise afford health insurance to have it.
Tax Credits Assist the Less Well Off
Insurance Exchanges
- Lower-income people will be eligible for Medicaid in states that provide that option. (Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid.) The court's decision to refuse to compel states which refuse to expand Medicaid eligibility to people with lower incomes to give up their already existing Medicaid funds may blunt the laws reach in some areas. A Department of Health and Human Services (DHHS) report found that a low-income family could save up to $14,900 a year using tax credits.
- Middle-class - Tax credits for those earning between 100% and 400% (@ $43,000) of the poverty line will be available to assist in buying insurance coverage. A Department of Health and Human Services (DHHS) report found that tax credits may help middle-class families save as much as $2,300 a year.
People buying individual policies and small businesses will be able to use 'insurance exchanges' to shop for policies. These exchanges will offer the same choice of health plans as congressmen or women currently have. Thus far 14 states, including California, Colorado and West Virginia, have already authorized the creation of these "exchanges". They are due to be enacted by Jan 1st, 2014. Find about more about insurance exchanges here. Check out a map on your state's progress in producing them.
The Already Insured
Companies with greater than 50 employees will be required to offer insurance or pay a penalty. If workers aren't satisfied with the options a company offers they are free to use the money the employer might have contributed to their insurance and use it to shop on the Insurance Exchanges.
It's not clear the effect the law will have on premiums. A DHHS report stated that 'all businesses' will 'likely see'reduced health care premiums of $2,000 per family by 2019.
Others
Improved and More Efficient Health Care
- Ending Lifetime Limits - the end of lifetime limits on health care will help those most severely stricken from sliding into bankruptcy and/or losing medical care.
- Honest Mistakes No Longer Cause for Insurance Withdrawl - for years insurance companies have found ways to deny coverage if they can find small mistakes in applications. Under the Affordable Care Act they will no longer be able to do that.
- Premium Payments Must Primarily go to Health Care Not Administrative Overhead and Marketing - a certain portion of your insurance payments are required to go to health care not administration or marketing or a portion of your fee will be rebated. In his comment on the Supreme Court decision President Obama stated that in Oct of this year 13 million people will receive insurance company rebates because their insurance company spent more in administrative and marketing costs than allowed.
- Medicare - Medicare recipients will keep getting discounts on prescription drugs to close a gap in coverage known as the "doughnut hole.
The bill provides a variety of means designed to make health care more efficient and effective. These include improvements to physician and hospital quality care reporting, development of outcome measures, a National Health Care strategy based on health care quality and testing a variety of models to improve health care delivery.
More Emphasis on Understanding and Treating Pain - Some of the less talked changes could have implications for people with ME/CFS. Section 4305, for instance, requires increased attention on treating chronic pain. Some of the requirements, which include the creation of a Pain Consortium to provide annual recommendations to the Director of the NIH, and the creation of an Inter-agency Pain Research Coordinating Committee tasked with identifying critical gaps in pain research and treatment, have already begun to be carried out.
Other programs include
Jan 1st, 2014
- A Value-based Purchasing Program - will provide hospitals financial incentives to increase their quality of care by providing more money to better performing hospitals. Hospitals will be required to publicly report a variety of performance results for heart attacks, infections, surgical care, pneumonia, etc. The government site reports "for the first time, hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide." This program will begin in October of this year.
- Reduced Billing Costs - the law standardizes billing and requires health plans to begin adopting and implementing rules for the electronic exchange of health information. The govt site states "Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improve the quality of care." This program will come into effect Oct, 2012.
- More Free Preventative Health Care - by Jan 1st 2013 insurance providers will be required to provide more free preventative health care services such as check ups and mammograms.
- 'Bundling' to Save Money - The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Under payment ;plan called “bundling,” hospitals, doctors, and providers are paid a flat rate care rather than using the current system where each service or test is billed separately to Medicare.
If the bill is not repealed, on Jan 1st, 2014 - just 18 months from now - most of the major changes (individual mandate, creation of Insurance Exchanges, Medicaid eligibility for low-income patients, tax credits for the middle class, etc.) will kick in. Click here for a timeline.
After that a few more changes are in store. For instance, by Jan 1st, 2015 physician payments will begin to be tied to the quality of health care they provide.
As more information becomes available on the Affordable Health Care Law's effect on people with chronic illnesses such as ME/CFS we'll report on it.
- Find the full text of the law here (984 pages)
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Supreme Court Lets Affordable Health Care Act Stand....Implications for ME/CFS
- Thread starter Phoenix Rising Team
- Start date
Very bad for all concerned. Not just people with CFS. Disaster. Only hope is election time.
Many needed reforms were included in the PPAHCA, but there was also a lot of baggage included which reinforces many of the things about our current structure which aren't working (and adds some new things which I think will cause further, faster failure). We could devise a better reform. American Medical Association has a suggestion (dated 2008) which I support.
http://www.ama-assn.org/resources/doc/washington/ama-proposal-health-reform-2008.pdf
http://www.ama-assn.org/resources/doc/washington/ama-proposal-health-reform-2008.pdf
I am not touching this one except to say that US healthcare costs are unsustainable with or without Obamacare. Either way the healthcare system is more like dealing with the DMV than Amazon or Apple. The real problem is that more and more the "customer" is not the patient but a third party like the government or insurance company. Republicans seem to be okay with this as they've not made much of an effort to change it themselves. Republicans aren't providing much balance on this issue. They appear to want a consolidation of power in healthcare as much as the Dems - just as long as it's "privatized"...economic statism is not just for the left!
Nothing more than a gigatic tax that Obama said it WASN'T. OOOPS. ha. Guess we all know now. This has never worked anywhere.
Great article, Cort.
If the more fundamental aspects are left intact, it will help a lot of folks I know and love. It's a far cry from what I wanted and I don't think anyone was 100% comfortable with it, but it was the best that could be accomplished at the time. Some of the provisions included really common-sense strategies that will reduce costs and improve outcomes. Those are seldom talked about, but are probably among the more important.
It needs to be built upon and improved, I agree. And we'll really only know what impact it will have with some experience.
I like it when at least one of the Supreme's behaves in an unpredictable way. Gives me hope. WTG Chief Justice Roberts. The Sunday Morning talking heads are going to be fun to watch this weekend.
If the more fundamental aspects are left intact, it will help a lot of folks I know and love. It's a far cry from what I wanted and I don't think anyone was 100% comfortable with it, but it was the best that could be accomplished at the time. Some of the provisions included really common-sense strategies that will reduce costs and improve outcomes. Those are seldom talked about, but are probably among the more important.
It needs to be built upon and improved, I agree. And we'll really only know what impact it will have with some experience.
I like it when at least one of the Supreme's behaves in an unpredictable way. Gives me hope. WTG Chief Justice Roberts. The Sunday Morning talking heads are going to be fun to watch this weekend.
I don't think anybody said that, Merry. Certainly not me. Cheers.
I agree, I think it is horrible news for the country and it will not stand. Obama is finished, he has awakened a sleeping giant, good by Dems. He has killed his party, an overreach by gov't. Unfortunately it will just crash our economy much sooner than expected, if allowed to stand. Just about everything the gov't does is unsustainable and just distorts markets.
The things that the gov't subsidizes heavily, rise above inflation every year, look at education and health care. Typical inflation is about 3%, and the aforementioned industries rise about double of 3% if not more, year after year.
They are also behind the housing bubble, which we have not recovered from, and will not for years to come. If people want more massive meddling in our economy by the feds, than get ready for a massive implosion also.
GG
PS Hope I can keep donating monthly to this website and other worthy CFS causes. (The working poor).
Very interesting to read the comments about this from our US members. I can't comment on Obamacare, because I'm in the UK. But it's interesting to hear that some people on this forum are against it. From what I've heard about it, in the UK, I imagined that all people with CFS would be in favour of it. From a UK perspective, I've mainly heard that it was a long-overdue and well-needed bill. So it's interesting to hear people on this forum think otherwise. I imagined that most people would have @Merry's perspective on the issue. Anyway, I'm not expressing a view, because I don't know enough details, and I'm not a US citizen, so it doesn't affect me.
Very few American's want this mess. We have had freedom. This would not pass now if it were done again. It was a joke, NO one read it first.
I am so glad that this will help you gain access to medical care, Merry. There are some really nice and sensible provisions in this law. Looking at the list of provisions provided by Cort, I can't see anything that is not an improvement.
Making the insurance companies spend a percentage of your premiums on direct healthcare rather than administrative or advertising expenses is a good start. I have worked in healthcare all my working life and I have always thought that it should be non-profit. Not there yet.
Last week I went to a specialist and was waiting in line to pay my copay. The lady in front of me was charged 50 cents for her copay. I thought that was crazy as I have to pay $30.00 for mine and pay for insurance. Then I thought later that I was being unfair. Maybe that was all she could pay, so who was I to judge? I like the idea that everyone pays something. Some are freeloading when they could afford insurance, but don't and the cost is payed by those with insurance in higher costs for services. No one is above a medical emergency and we shouldn't expect others to pick up the costs. This bill helps most everyone afford insurance.
Great to hear it's good news for you personally Merry.
I'm really pleased to hear that.Sorry to hear the bill doesn't suit everyone.
In the UK we get 100% free healthcare (except for regular dentistry), paid for by taxes.
I think most people really appreciate our NHS, and despite the negative things you probably hear about it on this forum (including from me), I think it does a brilliant job with most medical issues.
But it does often let us down, as it doesn't have the resources to be perfect.
It tends to serve acute and emergency problems very well, but neglects many chronic problems like CFS/ME and depression.
I think most people really appreciate our NHS, and despite the negative things you probably hear about it on this forum (including from me), I think it does a brilliant job with most medical issues.
But it does often let us down, as it doesn't have the resources to be perfect.
It tends to serve acute and emergency problems very well, but neglects many chronic problems like CFS/ME and depression.
To say Roberts disappointed conservatives is an understatements....he certainly has guts
.. Personally I see the law as being very helpful and was happy to see it passed.
I'm afraid very few Americans understand what's in the bill. There's been a well-financed misinformation campaign.
I disagree that it was a joke. It was the product of a decades-long effort to provide healthcare to every American. And now the Supreme Court has ruled it's constitutional.
There's still a lot of work to be done.
As a CFS patient and former healthcare worker, the bill is not perfect but then few things are. As the saying goes, "Don't let the perfect be the enemy of the good." I support it and am glad it passed.
I have family in Canada and friends in Europe who have lived in the US. When I first became ill, one of the first things everyone was concerned about was how I would continue to get healthcare if I no longer had a job and whether I would be bankrupt by medical costs. (50% of bankruptcies in the US are related to medical illness) My Canadian relatives have endured cancer and serious strokes but no one became bankrupt and from what I could see, their care did not suffer. A friend offered to help me pay for care but I was lucky to have worked for an employer who covered my healthcare for an extended period initially and then to have enough money to buy the same-level insurance under COBRA until I was approved for Medicare.
Patients I have had in the past and many people on this forum aren't so lucky. If they're not covered by spousal/ parental insurance, aren't financially well-off enough, can't work enough to get insurance benefits, or their employer doesn't offer insurance, they're hung out to dry unless and until they get approved by Medicare. Approval as we know can take years and is not guaranteed. We see this on the forum regularly. It's true insurance doesn't cover many things people with CFS may want to get tested for or for particular treatments but insurance does pay for RULING OUT other illnesses that can cause your symptoms. AND that is very important. How many times have people here said "you might want to get checked out for such and such"? Besides which, having CFS doesn't protect you from other medical conditions.
It's interesting to read some interviews of people on the street as some express that they are against it but with further details from the reporter or some more contemplation,their answer becomes less certain and some adopt a more "let's wait and see" attitude.
I have family in Canada and friends in Europe who have lived in the US. When I first became ill, one of the first things everyone was concerned about was how I would continue to get healthcare if I no longer had a job and whether I would be bankrupt by medical costs. (50% of bankruptcies in the US are related to medical illness) My Canadian relatives have endured cancer and serious strokes but no one became bankrupt and from what I could see, their care did not suffer. A friend offered to help me pay for care but I was lucky to have worked for an employer who covered my healthcare for an extended period initially and then to have enough money to buy the same-level insurance under COBRA until I was approved for Medicare.
Patients I have had in the past and many people on this forum aren't so lucky. If they're not covered by spousal/ parental insurance, aren't financially well-off enough, can't work enough to get insurance benefits, or their employer doesn't offer insurance, they're hung out to dry unless and until they get approved by Medicare. Approval as we know can take years and is not guaranteed. We see this on the forum regularly. It's true insurance doesn't cover many things people with CFS may want to get tested for or for particular treatments but insurance does pay for RULING OUT other illnesses that can cause your symptoms. AND that is very important. How many times have people here said "you might want to get checked out for such and such"? Besides which, having CFS doesn't protect you from other medical conditions.
It's interesting to read some interviews of people on the street as some express that they are against it but with further details from the reporter or some more contemplation,their answer becomes less certain and some adopt a more "let's wait and see" attitude.