Beneath health law’s botched rollout is basic benefit for millions of uninsured Americans

From The Washington Post:

Getting Americans health insurance is at the heart of the health law, the most significant change in health-care policy since the 1965 creation of Medicare, the federal program for the elderly, and Medicaid, the federal-state program for the poor and disabled. Such a dramatic expansion in coverage had eluded presidents, including Republican Richard Nixon and Democrat Bill Clinton, for decades.

This core mission has sometimes been obscured by the political and legal disputes that have dogged and, in important ways, altered the law. Strong research links having health insurance and being healthy. Having a health plan does not guarantee that a good doctor is within reach when a patient needs one. But insurance matters.

Various studies have found that children without insurance are less likely to get immunized or treated for a sore throat or even a ruptured appendix. Adults without coverage are less likely to get mammograms or prostate exams. If they have high blood pressure or diabetes, it is more likely to be out of control. If they have a stroke, it is more likely to leave lasting damage. The Institute of Medicine has said there’s “a chasm” between the health needs of uninsured people and their access to effective care — a gap that “results in needless illness, suffering and even death.”

In health-care economics, it is considered rational to provide coverage, so that people can readily get small medical problems taken care of before they become big, expensive, pent-up medical problems. But the gallbladder surgery Peterson is about to have and the unforeseen ailments that Munstock’s physical on Thursday could unearth also illustrate a risk for the health plans that have been signing up new patients under the law: Unless those plans also attract new customers who are young, healthy and inexpensive to insure, the rush of people like Peterson and Munstock is going to freight the new system with costs that are too heavy. Insurance rates could go up. Plans could drop out. Will it happen? No one knows.

That is the macro view. The micro view, for people who have been waiting for insurance for years, is financial protection. Hospitals frequently charge uninsured people two to four times what health insurers and government programs pay for hospital services, according to a 2007 Health Affairs study.

In the years since Medicare and Medicaid were created, there have been smaller expansions in government health-care coverage — public insurance for children of the working class, the addition of drug benefits to Medicare.

Still, nearly 48 million Americans were uninsured as of 2012, according to the most recent official figures — 11 million more than at the turn of the century, or almost one in every six people. More than 6.5 million children are uninsured.

The law wasn’t designed to help everyone who is uninsured. But it is likely to cover a big chunk — 32 million people, according to estimates from the Congressional Budget Office about the time Obama signed the 2,000-page legislation into law.

How many people will take up the offer remains to be seen. The CBO has estimated that 7 million will sign up for private plans by the end of the first annual open enrollment period on March 31, while another 9 million will enroll in an expanded Medicaid program or in the Children’s Health Insurance Program.

But with insurers canceling health plans that fail to meet new benefit standards for millions of individuals, and many Americans finding it difficult this past fall to use HealthCare.gov, it will be hard to know if the ranks of the uninsured will go up or down right away, health experts say. Starting next year, the law requires that most Americans have health insurance or risk a fine.

The creators of the law envisioned that about half the people who gain insurance would enroll in private health plans, the other half in Medicaid. The Supreme Court sliced into the second goal, ruling that states could opt out of the expansion, something that has occurred in many states led by Republicans.