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Win, Lose or Draw, Health Care Reform Pushes Forward States, insurers stand firm on benefits

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By Chris Levister

In the hands of the nine Supreme Court justices, the fate of the Patient Protection and Affordable Care Act, a.k.a. ‘Obamacare’, is arguably one of the most anticipated legal verdicts in recent U.S. memory. A decision by the Court is expected any day now. The decision will be controversial no matter what direction the Court goes, as the public is fairly evenly split on the law.

In the meantime across the nation the health care landscape is changing at breakneck speed. Many states, healthcare providers and some major insurers aren’t waiting. Three of the biggest U.S. health insurers announced this week that they plan to keep some of the popular benefits and consumer protections required by the federal health overhaul legislation even if the Supreme Court strikes down all or part of the law. UnitedHealth Group, Aetna Inc. and Humana all said they will continue to allow young people to stay on their parents’ pans until the age of 26, provide preventative benefits such as immunizations without any out-of-pocket expense and offer a third-party appeals process for coverage denials

When the law was passed by Congress and signed by President Barack Obama, two years ago, California quickly got the ball rolling.

It was the first state to set up the reform bill's core feature, a health benefits exchange - a marketplace for consumers and small businesses to pick and choose among various insurance plans - that is scheduled to open in 2014. The exchange has already received $40 million in federal seed money and is expecting additional funds this summer.

"California passed a law to have an exchange, and the commitment will be there no matter what,” said David Panush, director of government relations for the California Health Benefit Exchange. “Rather than trying to crystal-ball what the court may or may not do, we’ve got our foot on the pedal and we’re going full speed ahead.”

The state has already begun to overhaul its Medi-Cal program in anticipation of the influx of new patients and officials are relying more heavily on managed care plans to reduce costs and provide comprehensive care.

Exchange officials have recently started designing strategies to make it easier for individuals to sign up, such as presenting information in multiple languages, designing a user-friendly webpage and training employees to offer help with online enrollment. The insurance exchanges, a creation of the Patient Protection and Affordable Care Act, are designed to be a place where consumers who don’t get coverage through work can purchase it at an affordable price in a way that allows them to easily compare the costs and benefits of competing plans. For health insurers, it promises access to millions of potential new customers, many of whom will get subsidies to help them afford coverage.

It will also serve as a portal to connect individuals with Medi-Cal with individual and small group coverage based on their income level. Individuals who earn up to 133% of the federal poverty level will be eligible for Medi-Cal. People earning between 133% and 400% of poverty will be eligible for private coverage subsidized on a sliding scale. The exchanges can offer large group coverage in 2017.

If you’re applying for unemployment online there could be links to the Exchange. If you’re changing your address at the DMV a clerk may offer you information on how to enroll. “To the degree that we take advantage of all the points of contact, you bring people into the system. Outreach and enrollment is vital,” said Panush. GETTING THE MESSAGE OUT

As the healthcare reform controversy plays out in real time, there is a nagging worry that those Americans with the greatest health risk will be left behind. The benefits of health care reform are unrecognized and unappreciated by most women, says national health care activist Byllye Avery.

“Even people who are enjoying some of the benefits don’t seem to be aware of it,” Avery, told an audience at Grand Valley State University in Michigan Tuesday. Avery, the founder of the Black Women’s Health Imperative said later in an online post, insurers must provide cancer screenings, wellness visits and maternity care at no cost to the patient. Patients also pay no fee for blood pressure, diabetes and cholesterol screenings, smoking cessation counseling and breastfeeding education. “We get screening for domestic violence,” she said. “One in four African American and Latino women is abused, so it’s very important for physicians to ask questions about domestic violence.” Also, insurers may not deny patients coverage because of pre-existing conditions. “With the coming insurance exchanges, people as individuals will actually be able to pay for health care,” Avery added.

She cited the example of her daughter, who paid $600 a month to buy health insurance in Chicago while working a part-time job. After her job ended, she returned home to Massachusetts where Republican presidential candidate (then governor) Mitt Romney helped establish an ‘Affordable Care-like’ health insurance exchange, and was able to buy similar coverage for $113 a month. Even as she touted the benefits of health care reform, Avery said she is “very, very worried” about the decision expected this month by the U.S. Supreme Court, which is considering challenges to the new law.

However, if the justices overturn the Affordable Care Act, she said she hopes it will provoke a backlash from supporters. “People have said we’re going to start demanding universal health care,” she said. “Sometimes, something has to happen to make people angry enough to take to the streets to say access to health care is a human right.”

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