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Saturday, July 7, 2012 - Page updated at 05:00 p.m.
Update from health insurer only good news, in his view
By Dan Newman
Special to The Times
LIKE many Americans, I'm interested in the impact of the Supreme Court ruling on the Patient Protection and Affordable Care Act, widely known as "Obamacare," but unlike most, I learned the stakes through a letter from my health insurer.
As our family business manager for claims with UnitedHealth, the largest health-insurance firm in America, I receive a lot of letters about adjustments to coverage and rates. Even as coverage shrinks, health premiums rise, having more than doubled since 1999.
But the letter prompted by the new law carried no such dismal news, and instead made these promises:
• Immunizations and recommended preventive care shall be covered in full.
• Annual limits on essential benefits are removed. "Essential Benefits" include ambulatory care, hospitalization, maternity and newborn care and pediatric services.
• Coverage may no longer be denied for pre-existing conditions for those under 19.
• Lifetime dollar limits are removed.
• Dependent children may be covered under a parent's plan through age 26.
• Your coverage may no longer be rescinded unless you commit fraud.
• You have a right to immediate, external appeal of any claim.
That's it. That summary of the two-page letter details the effects of the Affordable Care Act as they pertain to everyone in my family, as to others with UnitedHealth and similar insurance. Which provision makes people so angry?
People certainly are angry. According to a Rasmussen Reports poll done after the Supreme Court's ruling, 52 percent of Americans still want the entire law repealed, but it's difficult to see which of the above amendments cause such ire. Greater support of preventive care? Increased allowance for essential benefits? Surely not the coverage of pre-existing conditions in children, which UnitedHealth pledged to revoke if the court allowed.
I'm grateful that provision stands. As the father of a toddler with type 1 diabetes, I struggle to pay out-of-pocket for preventive care, but for years, I couldn't opt for a better plan — surely, the best benefit of a free-market system — without a lapse in coverage.
Now I can, if states live up to their calling to provide the health-insurance exchanges sought by an expected 30 million Americans. Washington state is on track to offer four different programs covering from 60 percent to 90 percent of the costs of "essential" benefits by 2014, a year ahead of the extended deadline, but other states won't be ready, ever, unless further compelled. "I don't think it makes sense to do those," said Louisiana Gov. Bobby Jindal, a position echoed by Wisconsin and South Carolina.
I understand the basic wariness. As Americans, we're suspicious of any mandate, as Justice Antonin Scalia voiced when he suggested that next the government could compel people to "buy broccoli."
But that slippery-slope argument has proved false with our few existing duties. You must register for the draft, if male, but the government has not instituted compulsory-public service. You must report for jury duty, but the government does not demand that you vote. And we don't have to buy broccoli, despite decades of a compulsory-health insurance payment for anyone in the workforce, in the form of Medicare and Medicaid.
The new payments are hardly radical. Essentially, the government proposes a tax on each adult of $95 in 2014, $325 in 2015, and $695 adjusted for inflation after that (or a 1 to 2.5 percent tax on wealthier households) as the penalty for not buying insurance.
But it is also offering a tax break of the same amount to everyone who does buy insurance. Taxation and tax deductions are mainstays of government, not some outlandish new power, and they are here again applied for common good. So are the amendments adopted under the law by UnitedHealth and similar insurers.
I process insurance letters nearly every day, and only once have I received notification of coverage better than the previous year. Here's hoping the state Legislature recognizes those real, legal and lasting benefits.Dan Newman's writing has appeared in The Washington Post and The Wall Street Journal. He works part-time as an economics researcher for his family firm and lives in Seattle.
Copyright © The Seattle Times Company
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