Those Already Ill Have High Stake in Health Ruling
By SABRINA TAVERNISE
BATAVIA, Ohio — The tumor grew like a thick vine up the back of Eric Richter’s leg, reminding him every time he sat down that he was a man without insurance. In April, when it was close to bursting through his skin, he went to the emergency room. Doctors told him it was malignant and urged surgery.
His wife called every major insurance company she found on the Internet, but none would cover him: His cancer was a pre-existing condition. In desperation, the Richters agreed to pay half their hospital bill, knowing they could never afford it on their combined salaries of $36,000 a year.
No other group of Americans faces higher stakes in the impending Supreme Court ruling on the Affordable Care Act than those with pre-existing conditions. The law, once its major provisions take effect, would prohibit insurance companies from turning people away or charging them more because they are sick. In exchange, most Americans would be required to have insurance, broadening the base of paying customers with an infusion of healthy people. Those who did not buy insurance would be subject to financial penalties.
The Government Accountability Office estimates that 36 million to 122 million adults under 65 have a pre-existing condition. As many as 17 million do not have insurance. Many try to buy coverage on the individual market, but in most states that is either impossible or too costly.
Billions of Dollars Are in Play Over Health Care Law
By REED ABELSON
PEEKSKILL, N.Y. — In this small city about an hour from Manhattan, pregnant teenagers, laid-off professionals and day laborers without insurance receive care at a community health center that has been part of the social fabric here for nearly four decades.
Because of the sweeping federal health care law passed two years ago, the center, part of the Hudson River HealthCare network, received a $4.5 million grant last month to expand. It plans to add six more medical and seven more dental exam rooms, allowing it to see as many as 5,000 additional patients, many of whom are without insurance, on Medicaid or have limited coverage. An additional 730 community centers or so like it are to be renovated or built across the country in the next two years for patients like that.
Unless the Supreme Court says otherwise.
By the end of June, the court is expected to decide whether some or all of the Obama administration’s health care law is constitutional. While speculation has focused on how the decision would affect the future of the nation’s health insurance market, little attention has been paid to the tens of billions of dollars in federal money appropriated for a host of other provisions in the law.
Insurers Seek to Soften Their Image, No Matter How Court Rules on Health Act
By TANZINA VEGA
As the country waits to see how the Supreme Court will rule on the Affordable Care Act, health insurance companies are taking matters into their own hands.
Over the past year, many of the largest insurance companies in the country, including Aetna, Cigna and Humana, have introduced elaborate marketing campaigns to reposition themselves as consumer-friendly health care companies, not just insurance providers. The insurers have been preparing for the possibility that the court may uphold the most controversial provision in the legislation — the individual mandate that would require people to buy health insurance or face a fine.
While a majority of Americans would still be left to choose among the options their employers offer, a favorable ruling would expand the market for the insurance companies, allowing them to sell directly to millions of uninsured Americans.
Insurers say that even if the mandate is struck down, they will press forward with their strategy because future success will depend on engaging directly with the consumer. “I expect to see a fair amount of competition for the public’s attention,” said Michael B. McCallister, chairman and chief executive of Humana. “The individual relationship is going to be ever more important.”
The new efforts include themed messages like a “Go You” campaign by Cigna, as well as loyalty and rewards programs that take a page directly from the marketing playbook of traditional retailers.
The campaigns represent a departure for insurers, who had previously directed their marketing to wholesale business accounts, not individual consumers. The shift in strategy may become necessary no matter what happens with the health care act, but it is fraught with challenges for an industry that is better known for causing consumer headaches than for curing them.
Medical businesses await Supreme Court ruling on Obamacare
Putting health care on the right track
By Donald M. Berwick,
Robert Samuelson castigated President Obama in a recent column [“The folly of Obamacare,” op-ed, June 18] for a lack of “judgment” in getting his landmark health-reform law passed. I profoundly disagree.Obamacare is helping our nation achieve health care that is excellent, accessible to all and affordable. In the 17 months that I led the Centers for Medicare and Medicaid Services (CMS), I saw how this law is helping tens of millions of families and is finally putting our health-care system on the right track.
Samuelson is right to be concerned about health-care costs. We’ve been on an unsustainable path for decades. But while he offers no remedy beyond the broken status quo, the president’s reform helps us make health care sustainable the right way: by improving it, not cutting it.
Some people believe that the only way to address this problem is to shift costs to consumers. Obamacare has a far better approach: reduce health-care costs by providing better care and promoting better health.
The law does this by targeting the underlying drivers of high health-care costs: It supports and rewards caregivers for preventing complications of care, like health-care-associated infections, which saves both lives and money. The CMS, for example, has set ambitious goals to reduce complications that, if met, would save 60,000 lives and $35 billion in just three years. The law also emphasizes preventive care and cracks down hard on waste and fraud. Last year the government recaptured a record $4 billion. It fosters transparency, so everyone can tell the best performers from the rest. Rather than paying for volume, the law helps us pay for value.
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