LA Times
A look at how the new law will affect four people in different circumstances.
DIFFERENT SITUATIONS: Alex Osvaldsson is a college senior covered, for now, by his parents' policy; Laura Carpenter has battled cancer and no longer has insurance. (Michael Robinson Chavez / Los Angeles Times; Robert Durell / For The Times)
Most Americans will be affected by the overhaul of the nation's health insurance — some more directly than others.
Here is a look at four people — an uninsured woman with a pre-existing condition, a man happy with his current insurance plan, a college student and a self-employed professional — and how the new healthcare legislation will likely affect each of them in both the short and long term.
Individual experiences will vary, but some glimpses of the future can be seen already.
Laura Carpenter, 56, uninsured, Tuolumne, Calif.
At the same time she battled non- Hodgkin's lymphoma, Carpenter fought with Aetna U.S. Healthcare about its repeated attempts to cancel her insurance policy.
She was cut off for the final time — in September 2004 — because of what she describes as a simple postal error. At that point, Carpenter, a former marketing manager, was left without the coverage that paid for most of her treatments — treatments that she believes ultimately helped her beat cancer.
Unable to find another plan she could afford, she's now been without insurance for more than five years. It's been that long too since she's seen a doctor for follow-up tests related to her diagnosis. For Carpenter, health reform is a very welcome turn of events
"When I heard it was going to pass, I was kind of blown away it actually happened," she says. "I'm feeling cautiously optimistic. At this point, it would seem almost too good to be true to have coverage again."
People with pre-existing health conditions, such as Carpenter, are among those with the most to gain from the impending changes to the health insurance system.
Within 90 days of the bill becoming law — around mid-June — a new, but temporary, national high-risk pool for people with pre-existing health conditions will be established, extending the option to buy coverage to those who have gone without insurance for six months or longer.
Starting in 2014, the high-risk pool will be eliminated as people gain access to insurance through a national exchange, says Anthony Wright, executive director of Health Access California, a statewide advocacy group. Carpenter will then be eligible to buy a policy through the exchange, with the guarantee that her coverage can never again be pulled away.
Carpenter has gone for years without recommended post-cancer treatment checkups. She looks forward to going for doctor visits she's long been unable to afford, and to putting her mind at ease.
"In the back of my mind, I keep thinking it will be worse down the road because I didn't take care of some things," she says. "I have a list as long as your arm of illnesses I've had related" to non-Hodgkin's lymphoma.
Upon becoming eligible for health insurance once again, she says, "I'll probably get the tests done right away that I should have had before."
Laurence Rudolph, 62, Herndon, Va.
Rudolph, an independent contractor, is happy with his health insurance as is. The Blue Cross Blue Shield plan pays for preventive care and diagnostic tests and is accepted by the primary care physician who has a long history with his family.
"My wife's plan is not cheap … but it is a good plan and well worth it," he said. "Peace of mind is worth a lot."
And nothing in this law will require him to change his current insurance, said Anthony Wright, executive director of Health Access California. Not only will he get to keep the coverage, which he has through his wife's job with Fairfax County Public Schoolshttp://www.fcps.edu/index.shtml, but the family policy also costs less than $27,500 annually, the threshold for being taxed as a so-called Cadillac plan.
The only changes Rudolph and others in similar situations' might see pertain to some basic coverage standards for employer and individual plans. These include prohibiting lifetime maximum benefits, which about 41% of employer plans currently have, according to a report funded by the California Endowment; limiting annual out-of-pocket costs at $5,950, affecting about 23% of employers; providing preventive services at no cost to plan members, which would affect about 10% of plans; and requiring prescription drug coverage for small employers.
When insurance exchanges are created in 2014, individuals who pay more than about 8% of their income could opt to leave their employer's plan, take their employer's subsidy and shop the exchanges. Wright said. People in low-wage jobs are the most likely to exercise this option.
"This is radical reform of the individual market and an evolution for the employer-based market," Wright said. "They focused on where the major problems are."
Unlike some Americans who are currently insured, Rudolph is confident the greater changes are all for the good.
"Society benefits from everyone having healthcare," he said. "If everyone had insurance, there is a better chance that they will be getting good care from their doctors."
Rudolph said he and his family are pleased with their current insurance — and they have not had any major medical problems with which to contend.
"Being part of a large group, they don't drop you," he said. "We have an emergency brake, but the whole notion is that you don't know until you pull that brake. There are a lot of people out there who think they have one, until they get sick and pull it and it's not there."
Some of Rudolph's concerns about healthcare reform include a potential rise in costs and a strain on doctors' offices by an influx of newly insured patients. Wright said one of the goals of the reform is to contain the growth in healthcare costs. He said approximately 10% of premiums go toward subsidizing care for the uninsured — so if reform covers a large portion of those individuals, premiums should eventually decline.
Alex Osvaldsson, 22, college student, Irvine
For Osvaldsson, a senior at UC Irvine, the insurance changes will come just in the nick of time. With his 23rd birthday and college graduation both coming up this June, he was about to lose two insurance policies: His parents' plan, which only allows dependent children coverage until the age of 18 or 23 if, like Osvaldsson, they are enrolled in college, and secondary insurance through UC Irvine's undergraduate student health insurance plan. That ends for Osvaldsson upon graduation.
"This is a lot of weight off my shoulders," he says about the passage of the healthcare bill and an included provision (scheduled to go into effect in six months) allowing young adults to remain on their parents' insurance plan until the age of 26. "I'd feel uneasy if I didn't have good coverage."
Young adults in their 20s comprise the group most likely to be uninsured, says Anthony Wright, executive director of Health Access California. "Some people wrongly attribute this to a phenomenon that they call ‘young invincible,' and the idea that young people somehow don't want coverage. They do want coverage but are more likely to be low income, going to school or have a job that doesn't provide it."
Upon graduation, Osvaldsson is planning to attend art school. Had healthcare reform not allowed him to remain on his parents' plan, he would have gone to the individual insurance market and California health insurance quotes for coverage. But without a full-time job, he would have needed his parents to pay for it.
Even without chronic illnesses or a history of health problems, the expense would have been $93 each month, with only one paid doctor's visit a year and a $2,900 deductible.
"I wouldn't be able to pay that on my own. [My parents] are in a position to do that, but if they were really hurting right now, I would have either taken the risk and opted out or looked for work instead of going further in school."
Still, Osvaldsson will have to find a way to bridge the gap in coverage between his 23rd birthday in June and the provision kicking in sometime in September — and possibly longer — depending upon when his parents' plan has open enrollment.
Osvaldsson is pleased about the bill's passage as he thinks ahead to a day when his now-perfect health may change.
"I think [not being able to deny coverage] for pre-existing conditions is great," he says of the health reform bill. "If down the road I develop a condition, I won't have to worry about being dropped or not covered because I need services."
Geoff Williams, 40, self-employed, Loveland, Ohio
Freelance writer Williams has a high-deductible health insurance plan coupled with a health savings account for his family of four. Should any of them experience a major health problem, he could end up paying a maximum of $12,000 a year in medical expenses between his premiums and the deductible.
Williams, who has been self-employed since 1997, purchases insurance on the individual market. His former "affordable but crummy" insurance, also bought on the open market, left him paying off his daughter's eye surgery four years after the procedure. He increased his benefits until his premiums hit $1,200 monthly two years ago, when he switched to the plan he has now. It costs $500 a month and has a $6,000 annual deductible. The plan pays for some preventive care, such as an annual physical, but Williams pays more than he would on "a regular plan" for other physician visits.
This is the roller-coaster ride that many individuals take annually — watching premiums and deductibles increase while benefits decrease. And this is why Williams was "thrilled" to see the healthcare overhaul signed into law.
"I honestly have no idea if it will be better or not, but the system seems pretty broken for the self-employed and people with pre-existing conditions," he said. "I think something had to be done, so I applaud them. I'm optimistic."
People shopping the individual market will be affected greatly by the reform. They can no longer be denied insurance due to pre-existing conditions and, if they make $88,200 a year or less for a family of four, will be eligible for subsidies to help pay for coverage.
"I wouldn't turn down any subsidy, and I think if you're going to insist that people have health insurance — and if health insurance rates don't come down — the government probably will have to offer some subsidies," he said.
The individual market is currently the least efficient and most expensive way to get coverage, said Anthony Wright, executive director of Health Access California. The health insurance exchanges, scheduled to start in 2014, will likely give individuals market power and better rates, he said.
"If they create an exchange, I would look into it," Williams said, adding that his current plan "is kind of the poor man's health insurance, but it is working for us. But at the same time, I may jettison it if I can."
Here is a look at four people — an uninsured woman with a pre-existing condition, a man happy with his current insurance plan, a college student and a self-employed professional — and how the new healthcare legislation will likely affect each of them in both the short and long term.
Individual experiences will vary, but some glimpses of the future can be seen already.
Laura Carpenter, 56, uninsured, Tuolumne, Calif.
At the same time she battled non- Hodgkin's lymphoma, Carpenter fought with Aetna U.S. Healthcare about its repeated attempts to cancel her insurance policy.
She was cut off for the final time — in September 2004 — because of what she describes as a simple postal error. At that point, Carpenter, a former marketing manager, was left without the coverage that paid for most of her treatments — treatments that she believes ultimately helped her beat cancer.
Unable to find another plan she could afford, she's now been without insurance for more than five years. It's been that long too since she's seen a doctor for follow-up tests related to her diagnosis. For Carpenter, health reform is a very welcome turn of events
"When I heard it was going to pass, I was kind of blown away it actually happened," she says. "I'm feeling cautiously optimistic. At this point, it would seem almost too good to be true to have coverage again."
People with pre-existing health conditions, such as Carpenter, are among those with the most to gain from the impending changes to the health insurance system.
Within 90 days of the bill becoming law — around mid-June — a new, but temporary, national high-risk pool for people with pre-existing health conditions will be established, extending the option to buy coverage to those who have gone without insurance for six months or longer.
Starting in 2014, the high-risk pool will be eliminated as people gain access to insurance through a national exchange, says Anthony Wright, executive director of Health Access California, a statewide advocacy group. Carpenter will then be eligible to buy a policy through the exchange, with the guarantee that her coverage can never again be pulled away.
Carpenter has gone for years without recommended post-cancer treatment checkups. She looks forward to going for doctor visits she's long been unable to afford, and to putting her mind at ease.
"In the back of my mind, I keep thinking it will be worse down the road because I didn't take care of some things," she says. "I have a list as long as your arm of illnesses I've had related" to non-Hodgkin's lymphoma.
Upon becoming eligible for health insurance once again, she says, "I'll probably get the tests done right away that I should have had before."
Laurence Rudolph, 62, Herndon, Va.
Rudolph, an independent contractor, is happy with his health insurance as is. The Blue Cross Blue Shield plan pays for preventive care and diagnostic tests and is accepted by the primary care physician who has a long history with his family.
"My wife's plan is not cheap … but it is a good plan and well worth it," he said. "Peace of mind is worth a lot."
And nothing in this law will require him to change his current insurance, said Anthony Wright, executive director of Health Access California. Not only will he get to keep the coverage, which he has through his wife's job with Fairfax County Public Schoolshttp://www.fcps.edu/index.shtml, but the family policy also costs less than $27,500 annually, the threshold for being taxed as a so-called Cadillac plan.
The only changes Rudolph and others in similar situations' might see pertain to some basic coverage standards for employer and individual plans. These include prohibiting lifetime maximum benefits, which about 41% of employer plans currently have, according to a report funded by the California Endowment; limiting annual out-of-pocket costs at $5,950, affecting about 23% of employers; providing preventive services at no cost to plan members, which would affect about 10% of plans; and requiring prescription drug coverage for small employers.
When insurance exchanges are created in 2014, individuals who pay more than about 8% of their income could opt to leave their employer's plan, take their employer's subsidy and shop the exchanges. Wright said. People in low-wage jobs are the most likely to exercise this option.
"This is radical reform of the individual market and an evolution for the employer-based market," Wright said. "They focused on where the major problems are."
Unlike some Americans who are currently insured, Rudolph is confident the greater changes are all for the good.
"Society benefits from everyone having healthcare," he said. "If everyone had insurance, there is a better chance that they will be getting good care from their doctors."
Rudolph said he and his family are pleased with their current insurance — and they have not had any major medical problems with which to contend.
"Being part of a large group, they don't drop you," he said. "We have an emergency brake, but the whole notion is that you don't know until you pull that brake. There are a lot of people out there who think they have one, until they get sick and pull it and it's not there."
Some of Rudolph's concerns about healthcare reform include a potential rise in costs and a strain on doctors' offices by an influx of newly insured patients. Wright said one of the goals of the reform is to contain the growth in healthcare costs. He said approximately 10% of premiums go toward subsidizing care for the uninsured — so if reform covers a large portion of those individuals, premiums should eventually decline.
Alex Osvaldsson, 22, college student, Irvine
For Osvaldsson, a senior at UC Irvine, the insurance changes will come just in the nick of time. With his 23rd birthday and college graduation both coming up this June, he was about to lose two insurance policies: His parents' plan, which only allows dependent children coverage until the age of 18 or 23 if, like Osvaldsson, they are enrolled in college, and secondary insurance through UC Irvine's undergraduate student health insurance plan. That ends for Osvaldsson upon graduation.
"This is a lot of weight off my shoulders," he says about the passage of the healthcare bill and an included provision (scheduled to go into effect in six months) allowing young adults to remain on their parents' insurance plan until the age of 26. "I'd feel uneasy if I didn't have good coverage."
Young adults in their 20s comprise the group most likely to be uninsured, says Anthony Wright, executive director of Health Access California. "Some people wrongly attribute this to a phenomenon that they call ‘young invincible,' and the idea that young people somehow don't want coverage. They do want coverage but are more likely to be low income, going to school or have a job that doesn't provide it."
Upon graduation, Osvaldsson is planning to attend art school. Had healthcare reform not allowed him to remain on his parents' plan, he would have gone to the individual insurance market and California health insurance quotes for coverage. But without a full-time job, he would have needed his parents to pay for it.
Even without chronic illnesses or a history of health problems, the expense would have been $93 each month, with only one paid doctor's visit a year and a $2,900 deductible.
"I wouldn't be able to pay that on my own. [My parents] are in a position to do that, but if they were really hurting right now, I would have either taken the risk and opted out or looked for work instead of going further in school."
Still, Osvaldsson will have to find a way to bridge the gap in coverage between his 23rd birthday in June and the provision kicking in sometime in September — and possibly longer — depending upon when his parents' plan has open enrollment.
Osvaldsson is pleased about the bill's passage as he thinks ahead to a day when his now-perfect health may change.
"I think [not being able to deny coverage] for pre-existing conditions is great," he says of the health reform bill. "If down the road I develop a condition, I won't have to worry about being dropped or not covered because I need services."
Geoff Williams, 40, self-employed, Loveland, Ohio
Freelance writer Williams has a high-deductible health insurance plan coupled with a health savings account for his family of four. Should any of them experience a major health problem, he could end up paying a maximum of $12,000 a year in medical expenses between his premiums and the deductible.
Williams, who has been self-employed since 1997, purchases insurance on the individual market. His former "affordable but crummy" insurance, also bought on the open market, left him paying off his daughter's eye surgery four years after the procedure. He increased his benefits until his premiums hit $1,200 monthly two years ago, when he switched to the plan he has now. It costs $500 a month and has a $6,000 annual deductible. The plan pays for some preventive care, such as an annual physical, but Williams pays more than he would on "a regular plan" for other physician visits.
This is the roller-coaster ride that many individuals take annually — watching premiums and deductibles increase while benefits decrease. And this is why Williams was "thrilled" to see the healthcare overhaul signed into law.
"I honestly have no idea if it will be better or not, but the system seems pretty broken for the self-employed and people with pre-existing conditions," he said. "I think something had to be done, so I applaud them. I'm optimistic."
People shopping the individual market will be affected greatly by the reform. They can no longer be denied insurance due to pre-existing conditions and, if they make $88,200 a year or less for a family of four, will be eligible for subsidies to help pay for coverage.
"I wouldn't turn down any subsidy, and I think if you're going to insist that people have health insurance — and if health insurance rates don't come down — the government probably will have to offer some subsidies," he said.
The individual market is currently the least efficient and most expensive way to get coverage, said Anthony Wright, executive director of Health Access California. The health insurance exchanges, scheduled to start in 2014, will likely give individuals market power and better rates, he said.
"If they create an exchange, I would look into it," Williams said, adding that his current plan "is kind of the poor man's health insurance, but it is working for us. But at the same time, I may jettison it if I can."
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