Supreme Court decision on national health reform law keeps California programs intact

Many California consumers were thrilled with the U.S. Supreme Court decision Thursday to uphold the national health reform law, but a doctor's group cautioned that at least one problem lies ahead.

"This is a victory for consumers and especially for California," said Anthony Wright, executive director of Health Access California, a statewide consumer group. "No state in the nation had more at stake.

"This removes the cloud," he added. "There will be no more political speeches in the Legislature saying we should hold off on bills until the Supreme Court rules."

Also pleased were people who worried about losing consumer protections provided under the law, including Newark resident Shavon Walker. At age 37, she has diabetes, high blood pressure and other health problems. She has coverage through her husband's job but had feared that if she lost that, no insurers would accept her because of her medical condition.

Now beginning in 2014, she will no longer have to worry about that. The law will prohibit insurers from rejecting people because of pre-existing health conditions.

"My husband and I both are grateful for this," Walker said. "We'd rather pay a tax than an astronomically high bill in the emergency room."

Others took a more cautious approach, however. The California Medical Association, representing more than 35,000 physicians, described its reaction as "mixed."

CMA has vigorously supported the mandate that most

Americans have health insurance and other reforms, including requiring insurers to accept people regardless of pre-existing health problems.

But it noted that with as many as 3 million uninsured people expected to enter the Medi-Cal program when it is expanded in 2014, getting access to doctors will continue to be a problem. Because of low reimbursement rates, many doctors do not accept Medi-Cal patients.

Recent reports have found that 50 percent of Medi-Cal patients have difficulty finding a physician.

The Affordable Care Act "builds reform on the broken foundations of Medicare and Medicaid without addressing the underlying problems and inadequate funding," said CMA President James Hay. "CMA will continue to work to fix those ills."

Access to doctors may also be an issue for the thousands of children who will be moved into Medi-Cal with this week's decision by state lawmakers to cancel the Healthy Families program in a budget-cutting move.

Others said the Supreme Court's decision will benefit California financially by easing the burden of caring for the uninsured. They note that beginning in 2014, the state is expected to receive nearly $9 billion a year in federal funds to expand Medi-Cal.

"For our state, today's decision is both a fiscal blessing and a clear signal that there should be no more excuses," said Daniel Zingale, senior vice president of The California Endowment, a statewide health foundation. "Covering the uninsured currently costs our state nearly $10 billion per year and we need to continue to move full speed ahead to ensure that millions of Californians take advantage of the new options and consumer protections provided by the law."

The Supreme Court decision will enable California to continue moving aggressively to implement the law, including setting up a new insurance marketplace for consumers and expanding Medi-Cal in 2014.

The ruling saves programs and consumer protections affecting millions of Californians and will bring billions of dollars in additional federal revenue to the state.

California, with 7 million uninsured residents, has been at the forefront of states seeking to put the reforms in place.

California programs that will survive, to the relief of participants, include:

Low-Income Health Program: More than 400,000 low-income, mostly childless adults are receiving coverage through interim programs in 47 counties. These programs were set up in antieople are to be transferred to Medi-Cal when it expands in 2014.

Pre-Existing Condition Insurance Plan: Nearly 11,000 people are covered under this plan set up for those whose health problems make it difficult, if not impossible, to obtain insurance. This program, funded through the national health reform law, will last until 2014 when insurers can no longer reject people based on their medical condition.

California Health Benefit Exchange: The state plans to open a marketplace in 2014 where many consumers can choose a health plan and determine whether they qualify for subsidies. The state has hired staff and is making policy decisions to begin pre-enrolling people in October 2013.

Many consumers, meanwhile, were closely following what would happen with benefits they are receiving under the law.

These will now continue, including:

Help for seniors who hit a Medicare prescription drug coverage gap known as "the doughnut hole."

The elimination of lifetime caps on health insurance benefits.

Free annual wellness visits for Medicare recipients and free preventive services such as mammograms and colonoscopies.

Insurance company rebates. These are required when insurers fail to spend at least 80 percent of premiums on medical care and quality improvement, rather than salaries and other administrative costs. Nearly 1.9 million Californians will receive $73.9 million in rebates this summer, averaging $65 per family.

A requirement that beginning in 2014, insurers accept all people, regardless of pre-existing health problems.

Young adults will be able to remain on their parents' health insurance policies up to age 26.

Insurers can no longer reject children under 18 because of their health problems.

New health insurance policies must cover maternity services beginning Sunday.

Insurers can no longer cancel people's coverage when they become ill because of unintentional misrepresentations on their applications.

Sandy Kleffman covers health. Contact her at 510-293-2478. Follow her at Twitter.com/skleffman.

Source: http://www.insidebayarea.com/news/ci_20962362/supreme-court-decision-national-health-reform-law-keeps?source=rss

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