National Consumers League

SCOTUS decision on health care and what it means for you


By Steven Dorshkind, NCL public policy intern

On June 28, 2012, the Supreme Court upheld Affordable Care Act  as constitutional after much deliberation and a close 5 to 4 vote. What does this now mean for the average American? It means that a few changes will be going on in daily life to ensure that you live a healthier, longer life. With the Affordable Care Act, over 50 million Americans will have access to health care that has previously been out of reach for them financially. And, the Affordable Care Act includes many consumer protections that are intended to improve consumer interaction with health plans, and help to lead to a healthier you.

Picking an insurance plan will become more simple and straightforward under the ACA requirements. Companies are required to provide an easy -to-understand summary of what they offer and the costs of those benefits. This is called the Summary of Benefits and Coverage (SBC) and will allow consumers to easily compare different policies and choose the one that works best for you and your family. Like the energy rating on appliances or mileage stickers on cars, the SBC will provide a reference for comparison shopping for insurance.

Included in the ACA is the Patient’s Bill of Rights, roughly ten enumerated rights that include: the right to choose a doctor, providing coverage to those with pre-existing conditions, and keeping young adults covered on their parent’s plan. This bill of rights gives patients more power and protections than before, ensuring that they don’t fall victim to arbitrary rule changes and technicalities. Parents, your children will be allowed to stay on your insurance plan up until age 26, and they cannot be denied coverage based on pre-existing conditions. Children with pre-existing conditions cannot be denied for coverage by their parent’s insurer, and this protection will be extended to all Americans regardless of age in 2014.

Many Americans are concerned that they will not be allowed to keep their family doctor under the new health care law, but those concerns have been addressed.  The Affordable Care Act allows you to choose your doctor or keep your existing one. Women can visit an OB-GYN without a referral by their primary care MD.

Many people are also concerned about the cost of health care. The Affordable Care Act can provide support here as well. For those who cannot find a plan that is in their price range, Consumer Operated and Oriented Plans (CO-OPs) are a non-profit health insurer that can provide coverage. CO-OPs are run by you, the customer. CO-OP customers and members elect the board of directors and a majority of these people must be members of the CO-OP and they must use any profits to lower premiums, improve benefits, or improve the overall quality of health care. Think that starting a CO-OP will be too much work, or nearly impossible? Not to worry, the ACA addresses that as well. A small business, or an individual can apply for a federal loan to start a CO-OP health plan. The Affordable Insurance Exchange (AIE) in each state, a one stop marketplace where consumers can choose a private health plan the fits their needs, will help keep CO-OPs rates competitive to ensure that you get the best rate.

If you continue to use your current health insurer, and not a CO-OP, the ACA is also keeping consumer protection in mind. The ACA requires that insurers selling policies to individuals or small groups must spend at least 80 percent of the premiums on actual health care-related issues, or improving your health care as opposed to administration, overhead, and advertising. For those in groups of 50+ members, they must spend at least 85 percent on actual health care.

There are also provision in the ACA that help the elderly, and the Medicare program. The Affordable Care Act actually strengthens Medicare by extending the life of the Medicare Trust Fund until at least 2024, and by reducing waste, fraud, and abuse. The conditions of care between doctors and the overall quality of care will improve so that patients will be less likely to experience preventable re-admissions to the hospital for the same condition. The federal government will be instituting cost reductions in prescription drugs gradually over time for those who are in the “donut hole” of Medicare. The decision to accept this part is up to individual states. Many preventive screenings and other treatments are now free of charge to incentivize the elderly to seek preventive services.

Many countries around the world, rich and poor, have provided universal health care for their citizens for decades, and America is just now catching up. This new landmark legislation will bring the US into the league of nations that provide universal care and promote economic development otherwise stymied when productive citizens are bankrupted by health care costs. The Supreme Court’s decision upholding the Affordable Care Act is an important legal milestone and means that the goal of providing health insurance across the board to American consumers can at long last move forward.