TOPICS > Health

‘Good for Health’: Some Reforms Will Stay Regardless of Supreme Court Decision

June 11, 2012 at 12:00 AM EDT
UnitedHealthcare, one of the country's largest health insurers, said Monday it would keep several provisions of the federal health reform law intact, whether the Supreme Court rejects it or not. Ray Suarez and Health Affairs editor Susan Dentzer discuss how the court's impending decision will affect Americans' health care.
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GWEN IFILL: Now, Major health insurers announced today they plan to keep some provisions of the federal health reform law intact, whether the Supreme Court rejects it or not.

Ray Suarez has the story.

RAY SUAREZ: Much of the coverage of the Supreme Court’s impending decision has focused on the political stakes. But it’s being watched just as closely by the health care industry, doctors, hospitals, insurers, employers among them, and, of course, by patients.

Today, the country’s largest health insurer, UnitedHealthcare, serving 36 million members, said it would uphold several provisions even if the court overturns the law. Aetna and Humana followed with similar announcements this afternoon.

For more, we turn to Susan Dentzer, editor in chief of the journal Health Affairs. She’s an analyst for the NewsHour.

And, Susan, remind us where we’re at right now. Not all the provisions of the Affordable Care Act have taken effect. But which ones have and which ones have proved to be popular?

SUSAN DENTZER: Well, the ones that United said today it was keeping and that other insurers echoed are exactly those that have already gone into effect, first of all, for example, coverage of certain preventive measures, mammographies, colonoscopies without any cost-sharing or co-payments or deductibles by individuals, coverage of dependents, adult children, up to the age of 26, another very popular provision that most insurers have already implemented.

In addition to that, a requirement that there be a very expedited, very clear appeals process. Abolition of lifetime limits on insurance policies, so you can’t max out at a million dollars of total coverage and then have no insurance — in fact, no more lifetime limits. And then, in addition, a rule against rescissions of policies, so that, for example, if you sign up for a policy, you testify that you’re healthy, but then it’s suddenly discovered that you have cancer, it used to be the case that insurers could actually rescind the policy.

Now many of them have essentially decided not to do that. And, in fact, under the law, they don’t do that, they cannot do that. And instead they will only basically cancel a policy if it’s found that you somehow applied for it on a fraudulent basis. So, those are the core provisions that are already in effect and that these insurers have said that they will continue.

RAY SUAREZ: So, conversely, are there any big parts either still to come or already in place that either UnitedHealthcare or any of the other major insurers have said they’re not so sure about or they haven’t included in these announcements?

SUSAN DENTZER: That’s right.

Well, one of the big ones that United pointed to — and, of course, the other companies echoed this — that they could not move on by themselves is the requirement that children be covered up to the age of 19 without having preexisting condition restrictions held against them, so that, for example, your child with congenital heart disease, under the law, you’re going to have to be offered a — your family will have to be offered a plan and your preexisting heart disease cannot be — as a child cannot be excluded from that.

The insurers would have liked to have been able to say that they could move on their own without this. But think about it. If you are an insurer and you say I’m going to cover all children who are very, very sick, you’re in fact a magnet for families who are affected enrolling in your policy. It’s what is known in insurance as adverse selection.

So, no insurance company can do this on its own. The industry would have to do it jointly if the provisions of the Affordable Care Act were some reason stricken down. United said it wants to have this discussion with the industry. Could we keep this going? And in fact, I think that if the court does strike down that provision or other provisions, you would see the industry trying to coalesce around a plan to cover it.

They think that these things are now woven into the fabric of coverage is the phrase that some of them are using. They have already adapted to these changes. They think these are popular. They think these things are good for health and they want to maintain them.

RAY SUAREZ: Are there parts of this law that, without the mandate, if, let’s say, that were to be struck down, would become very uneconomic? Does the economics of the whole law hang together because of the mandate?

And without it, would the insurance companies be able to do some of the things that are required by the law?

SUSAN DENTZER: Well, to go back to the example of coverage of the children with preexisting conditions, that’s one that is very difficult to have insurers offer without a mandate.

Again, even if a bunch of insurers said we’re all going to do this, typically, if you had those kinds of policies, it would be families with ill children who would tend to sign up and maybe families who didn’t have ill children wouldn’t sign up.

So, you would get the same phenomenon of adverse selection. That’s part of the reason the insurers wanted this entire package and saw all of these reforms as very positive, but only with the addition of the individual mandate. If everybody, if every family has to have insurance, you can’t decide not to have it because I got lucky and my child wasn’t born with a preexisting condition and I can stay out of insurance.

Instead, everybody is in the pool. The costs of treating the sick people, children or adults, are spread across the very broad pool of healthier individuals because everybody is in insurance coverage. And that’s the way the system works.

RAY SUAREZ: Quickly, now that a bunch of big insurers have said, yes, we’re going to keep these provisions whether the law survives or not, are they still holding their breath to see what’s going to happen to their business model come decision day? What’s still pending that really is important?

SUSAN DENTZER: Well, in spite of the fact that these provisions already in effect are very important, we know that the bigger pieces are yet to come, for example, the broader move to offer coverage through health insurance exchanges, to couple that with federal subsidies and really move to — closer to universal coverage.

And that’s where the mandate piece is of great interest to the companies. The companies have said they do not see how the system will work if the individual mandate is struck down by the court and they would have to revisit the entire law at that point.

RAY SUAREZ: Susan Dentzer, thanks a lot.

SUSAN DENTZER: Great to be with you, Ray.

RAY SUAREZ: Online, we have much more on the health care reform law, including a primer on the coming Supreme Court ruling from The National Law Journal’s Marcia Coyle. That’s on our home page. Take a look.