CHICAGO (AP) — The mother of two disabled teens called Thursday’s Supreme Court ruling on the health care law wonderful because it bars insurance companies from setting lifetime limits for medical expenses — a big help to her family.
But a retiree on Medicare called it a “sad day” and worries that the law’s new rules coming in 2015 will interfere with treatments doctors can provide.
Across the country, some Americans haven’t been dramatically affected yet by the law, which will take a few years to reach full force. But many others say they have felt its effects already and have strong opinions about it.
Name: Becky Morefield
Home: Mahomet, Ill.
Occupation: Stay-at-home mom of two disabled teenagers
Insurance coverage: Private insurance through husband’s employer
As Morefield sees it, the health law allowed her son Tucker to die peacefully at home with private health insurance covering his care.
Tucker, one of three triplets with cerebral palsy, was always the most fragile of the siblings, Morefield said. Five years ago, he maxed out the $1 million lifetime limit in his family’s policy when he went into respiratory failure and was hospitalized for 12 weeks.
Hitting the lifetime limit meant the insurance company would no longer pay Tucker’s medical bills. The state of Illinois picked up the slack through a program for children with special health care needs. But the program put strict limits on certain medical supplies, leading the family to wash and reuse equipment meant for single use.
Tucker’s coverage was reinstated Jan. 1, 2011, because the health law barred lifetime dollar limits on coverage. He lived another 15 months covered by private insurance. At the end, he had doctor visits at home, oxygen and enough pain medication — all care that Morefield said would have been restricted under the state program.
“It was a blessing for us,” Morefield said. “People who’ve not had the ongoing medical things we’ve had don’t understand.”
Morefield reacted to the Supreme Court decision on Thursday, her birthday, with joy. She called it a great gift that will grant her and her husband peace of mind.
“It’s wonderful,” she said.
Name: Margo Criscuola
Occupation: Education consultant
Insurance coverage: Medicare
Criscuola is worried that a controversial board created by President Barack Obama’s health overhaul will ration health care and also dictate treatments to doctors. She has family members with a rare genetic condition that she said requires experimental therapies.
“I was listening to the radio this morning and heard the news. I think it’s a very sad day for this country, for our medical industry and for our health in this country,” Criscuola said.
“If you have a law that requires doctors’ treatments to be approved on the basis of their general effectiveness and doctors are not permitted to experiment with other kinds of approaches, that makes it very difficult for special diseases like these to be treated.”
The board, called the Independent Payment Advisory Board, is meant to hold down Medicare costs, beginning in 2015. Republicans are targeting the provision for repeal. Criscuola fears the board’s influence will go beyond Medicare and permeate the health care system. The White House has said the board is crucial to holding down costs and is barred by the law from rationing care.
The law also encourages a payment model for hospitals, insurers and doctors, called accountable care organizations, which Criscuola believes also will limit doctors’ choices in treating patients.
Criscuola has benefited from a provision in the health care law that provides free annual wellness exams to people with Medicare.
“Do I use it? Yeah. Is the benefit I receive from it more than if I had kept the money I paid into Social Security and Medicare payroll taxes and invested it myself? No. It’s considerably less,” she said. “Will it be around in 15, 20 years? Probably not.”
Name: Bev Veals
Home: Near Wilmington, N.C.
Occupation: Stay-at-home mom of a 17-year-old and a 20-year-old
Insurance coverage: Coverage under the new law for people with pre-existing conditions
On Thursday morning, waiting for the news, Veals was watching CNN, which initially reported incorrectly that the law had been overturned. She was tense with worry that she would lose her coverage.
“I’m totally, absolutely right now dazed because they first, initially said it had been overturned,” Veals said. “I’m sitting here gasping for breath. … Now they’re saying it’s being upheld.” She added: “It’s a relief.”
The expense of her breast cancer treatments led to bankruptcy and foreclosure for her family over a horrific 10-year period. Finally, it cost so much that she could no longer afford health insurance. She and her self-employed husband decided to drop her from the family’s insurance plan four years ago to reduce their monthly premiums from $1,700 to $400 a month.
She spent the next 27 months uninsured. Then in 2011 she signed up for insurance made possible by the new law. The program helps people who have been turned away by insurance companies because of pre-existing medical conditions. She now pays $377 a month for her insurance with a $1,000 deductible, meaning she pays that much out of pocket before the coverage starts.
“It has only been a little over a year for me, but I can’t tell you the dignity being covered brings,” Veals said. “My biggest fear was I would have to beg for help to cover medical bills. Panhandling to pay a doctor’s bill … not my idea of the American Dream.”
Though raised as a Republican, Veals said her politics are changing.
“As a conservative, I believed if you can’t make your way, you don’t get your way. Now I’ve cost more medically than I will ever be able to make. I’ve changed my political stance because of this,” she said. “It doesn’t do our economy any good when we have so many people having to file for medical bankruptcy.”
Schreiber’s young and healthy, but still had reason to worry about the Supreme Court decision. He works for a small business and is responsible for switching the company to a new health insurance plan. He has found a plan at a reasonable price, but that price won’t be locked in until August.
Early Thursday, he was concerned that the price would jump with a confusing decision on the health care law, or if the court overturned it. Like many other Americans, he saw contradictory news reports about the ruling and “my heart dropped.”
He repeatedly refreshed the Web pages on his computer screen and, finally, when the ruling became clear, “it was a relief.”
The company is among the 30 percent of businesses with fewer than 10 employees that offer health coverage. Small businesses often pay more for insurance than large companies.
Schreiber is hoping his company can qualify for a tax credit made available by the health care law for small businesses that provide health insurance. The tax credit is one of the most popular ideas in the health law, according to opinion polls, but only about 4 percent of potentially eligible businesses claimed it in 2010.
Before he turned 26, Schreiber was insured for a year on his mother’s health plan because of another provision in the health care law. The law isn’t perfect, Schreiber said, but “it’s a starting point to move forward.”
Name: Carlton Grimmett Home: Atlanta Age: 43 Employment: Night security guard at upscale apartment complex Coverage: Uninsured
Two years ago, Grimmett had a job with good insurance and a wife with diabetes and other health problems. But then his job, doing plumbing and HVAC work at an Atlanta university, was outsourced and he no longer could cover his wife’s medical bills.
His wife had to stop going to the private doctors she was seeing, and her husband tried to get her into care elsewhere. But at other facilities, they encountered paperwork, delays and foot dragging, he said. Her health deteriorated.
“When you don’t have insurance, they treat you different,” he said.
In January 2011, Mary Grimmett started struggling to breathe and was rushed to Grady Memorial, Atlanta’s safety net hospital. She qualified for a program that provides discounted and even free care to uninsured people who qualify. But by that time she had pneumonia (as well as a broken ankle that needed surgery) and was very sick.
She spent two weeks in the hospital and then died of congestive heart failure — a complication of her other illnesses. She was 39.
Today, Grimmett has a job, making $25,000 a year, but he still has no insurance. Under the new health care law, he will be eligible for a government tax credit to help with the cost of buying private health insurance.
That would reduce his estimated annual premiums for health coverage from $5,054 to $1,726. He might have to pay additional copays for doctor visits, but his income would make him eligible for modest subsidies to help with those out-of-pocket expenses.
He is healthy, but the loss of his wife was a tragic lesson in the importance of coverage, he said. When he heard about the Supreme Court ruling from others at a nonprofit where he was volunteering, he said he felt grateful to Obama for helping the poor.
“He’s listening to the voice of Jehovah God,” he said. He added: “I’m grateful for the hope and opportunity to have health insurance, not just myself but all people who can’t afford health insurance. It’s a great thing that has taken place today.”
Photo credit: (AP Photo/Kathy Willens)
AP Medical Writer Mike Stobbe contributed from Atlanta.
AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson