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California Wins with Affordable Care Act Decision

Posted: Jul 08, 2012

The recent Supreme Court Decision upholding the Affordable Care Act has led to the nearly inevitable – and wholly irrelevant – discussion of “winners” and “losers.” Over the next few days, talking heads will ask the critical questions of our time:

“Who’s up? Who’s down?”

“Is this good for President Obama, or bad for Governor Romney?”

“Who lost? Who won?”

Over the next few weeks, there will be no shortage of legal analysis. There will be no shortage of political analysis. But there will be a disappointing lack of human analysis.

But if one looks through the lens of healthy community, then one can see million of winners, especially here in California. And the state is stronger when every Californian has an opportunity to live a long, healthy life.

Jan Steckel, for instance, is a winner.

Jan was a pediatrician in Oakland until chronic pain resulting from three back operations left her with excruciating pain that ended her career. Jan’s medical costs threatened to force her family from their home. But because the Affordable Care Act, Jan will be able to stay in her home. The Affordable Care Act has already helped alleviate some of the financial burden Jan carries, and will eventually close the “donut hole” in Medicare prescription drug coverage that costs her over $4,000 a year in out-of-pocket charges.

Carolyn Cunningham,too, is a winner.

As a mental health practitioner in Los Angeles, Carolyn has seen patients – to their detriment – resist diagnoses for fear of being dropped by their insurers. With two pre-existing conditions of her own, Carolyn was priced out of her insurance when her COBRA premiums spiraled out of control. Turning to the private insurance market, Carolyn was denied coverage due to her existing conditions – leaving her uninsured and forced to pay exorbitant out-of-pocket fees.

“It’s like I was being blamed and blacklisted for a condition I never wanted,” she says.

Because of the Affordable Care Act, Carolyn was able to join California’s Pre-existing Condition Insurance Program (PCIP), which brought her prescription cost down from $250 a month to $25. Because of the Affordable Care Act, insurers won’t be able to deny coverage to people who are – or were once – sick. Pre-existing conditions will be a thing of the past in 2014.

And Cameron Rath is a winner.

Cameron is 23 years old and has suffered from Myelodysplastic Syndrome, an incurable blood and bone marrow disease, since he was 14. His illness has required numerous procedures and surgeries, tests, hospitalizations, and medications -- such that half of his family’s income goes toward his medical costs. Because of a lifetime limit on how much his insurer would pay for his health care needs, Cameron faced the real possibility that his insurance would simply run out.

But now he doesn’t need to worry about that happening. The Affordable Care Act has ended the practice of placing lifetime limits on policies, so Cameron does not have to worry about maxing out his insurance and his health deteriorating. Additionally, because Cameron is under 26, he can continue to receive the health coverage that he needs through his parent’s insurance.

Jan, Carolyn and Cameron are only three examples of Californians who will benefit from full implementation of the Affordable Care Act. But they’re not unique. In fact, every Californian is a winner.

More than six million Californians have already taken advantage of free preventive care services under the new law, and almost six million more uninsured Californians are expected to sign up for much-needed health insurance by the time the Affordable Care Act is fully implemented.

With the Affordable Care Act in place, no Californian can be denied insurance due to a pre-existing condition, and no Californian can be dropped from their insurance because they get sick. The law also requires insurance companies to spend at least 80 percent of premium dollars on direct medical care or to improve the quality of care, instead of on overhead, executive salaries and advertising. If an insurer fails to meet that threshold, they must pay a rebate to their enrollees.

Additionally, because of small business tax credits created by the Affordable Care Act, this year 375,000 small businesses in California were eligible to get a tax credit for providing health insurance for 2.4 million employees.

The simple truth is this: The Affordable Care Act is making California a healthier place. It empowers each of us to take control of our own health care, and requires insurance companies to use our premiums for medical care, not executive bonuses and advertising.

The Supreme Court Decision ensures the Affordable Care Act’s ability to live up to its name. And because of that, we all win.

Daniel Zingale is Senior Vice President for policy, communications, and public affairs at the California Endowment.

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