After one year, health law already offers lifelines

For Immediate Release:

March 23, 2011

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USA Today Editorial

A year ago, the parents of a little girl in Ohio were worrying that they would soon exceed the lifetime limit on their health insurance. Taylor Wilhite had been diagnosed with leukemia at age 8, and her treatment — rounds of chemotherapy, a bone marrow transplant, long hospital stays — had been stupendously expensive.

 

"No one tells you that you have a cap" on coverage, says Amy Wilhite, Taylor's mother. When a social worker warned the Wilhites that they should check, they learned their limit was $1 million. By then, they had spent $770,000. Taylor's father's company managed to negotiate the maximum up to $1.5 million, but Taylor's oncologist said the cost of her care could hit $3 million to $4 million. "I was just frantic," Amy says.

As the cap got closer, the Wilhites began to put off care for conditions that weren't life-threatening, but the bills kept mounting. "The cost of medicine, you just wouldn't believe," says Amy. And hospital room charges — "you'd think she was in a resort."

The options for people near the limit weren't pretty. Cancel all but essential treatment, scramble for charity care, or contemplate bankruptcy. But then came a reprieve. The health reform legislation, which President Obama signed into law a year ago today, contained a provision that barred insurance companies from setting lifetime limits.

The provision took effect last September, and suddenly, one huge concern was gone. Taylor, now 12, isn't entirely out of the woods; her leukemia is in remission, but she needs continuing care and monitoring, and a hip that deteriorated during her procedures requires that she use a wheelchair to go long distances. But the Wilhites no longer have to worry about hitting the insurance limit — and, from now on, other people struggling with their own or a loved one's devastating illness won't have to endure the added anxiety that the money will run out.

Many of the key features of the controversial new health law — such as the mandate requiring most Americans to buy insurance and subsidies to help some people afford it — don't go into effect until 2014. Many smaller provisions have kicked in, however, and they have begun doing what the law was designed to do — change a dysfunctional status quo in which too many Americans couldn't get insurance, and even those with coverage had to worry about losing it just when they needed it most:

•Another provision that took effect last year made it possible for children to stay on their parents' health policies until age 26, a time when young people typically don't have jobs with medical coverage — and believe they're invulnerable anyway.

Terry Wallace first realized he had no coverage last year when he went to pick up an asthma inhaler and was asked to pay the full cost of more than $80. Insurance companies typically drop young adults from their parents' policies when they leave college, and Wallace had recently graduated from the University of Maryland. His parents became eligible to put him back on their policy when the provision went into effect in September, and the value of that option was proved just a month later.

Wallace had a green arrow as he made a left turn at an intersection, but another driver slammed into him, flipped his car over and left him hanging from his seat belt. Amazingly, Wallace escaped without a scratch. Had things gone differently, he could easily have been hospitalized; without insurance, the medical bills would have been enormous.

•Small businesses often struggle to stay afloat, let alone provide employee health insurance. The new law offers 35% tax credits to help many small companies buy medical coverage. Ken Weinstein had been helping to subsidize individual plans for his employees at PhillyOfficeRetail.com, which renovates and leases vacant commercial buildings in the Philadelphia area. But his people were paying too much or paying for skimpy coverage, and the tax breaks were enough to persuade him to buy a group policy. "For us, it made sense to get rid of the hodgepodge and become grown-ups," Weinstein says.

•With one huge exception, Medicare's prescription drug benefit is a boon to seniors such as Carolyn Friedman, a 70-year-old retired schoolteacher in Sunrise, Fla. Friedman has to fork over three $80 co-pays every month for each of the three brand-name epilepsy drugs her neurologist insists she take, but Medicare picks up the rest — more than $600 a month — until she hits the "doughnut hole," the gap in which seniors have to pay full price until they qualify for renewed coverage.

The gap forces many seniors on fixed incomes to make hard choices — some skimp on food or cut up their pills to make them last longer. Friedman has skipped her annual mammogram for three years to save money.

The new law phases out the doughnut hole by 2020, but there's some relief before then. Last year, seniors got a check for $250. "Better than nothing," says Friedman, who had to pay more than $4,000 in the gap. This year, there's a 50% discount on brand-name drugs that could save her $1,800. When the gap is gone, Friedman says, "I'm going to take a vacation."

•For millions of Americans, though, there's no vacation from the apprehension they'll feel until the law goes into full effect three years from now, assuming it survives legal and political attacks.

In the Florida Panhandle, Debra Doughtery's son Matt, 24, was diagnosed with cystic fibrosis at age 4 and has struggled ever since. The disease fills his lungs with mucus, cuts his life expectancy and has required Dougherty and her son to cobble together coverage from Medicare and Medicaid that could be lost if Matt ever makes too much money to qualify. Pre-existing conditions such as cystic fibrosis make it difficult or impossible to get affordable private insurance, something that will change in 2014.

"When people are fighting for their life, they shouldn't have to fight for insurance, too," says Dougherty of the two-decade struggle to keep her son alive. "It just kills me."

The new health law has its share of flaws. Most notably, it does a better job of expanding access to coverage than it does of controlling medical costs.

Even so, lawmakers who talk about repealing what they deride as "ObamaCare," without offering any realistic alternative for replacing it, have an obligation to think about the misery the law is already alleviating for people such as the Wilhites, and the hope it offers for millions more.

 

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