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Health Reform Profiles: A 6-Month Check-Up

Last winter, the NewsHour spoke to six people about their health insurance situations: a small business owner, an underinsured woman who was struggling to pay for health care and others.

We also asked a panel of health policy analysts to examine how each person might fare under reform, painting a picture of how a new health care law could affect each of the six, along with many other people in similar situations across the country.

Now, nine months later, health care reform has moved from bill to law. Even as Republicans vow to repeal it, significant consumer-protection provisions have begun to go into effect — including new rules that ban lifetime dollar limits on coverage, allow young adults to stay on their parents’ insurance plans, and prevent insurers from capriciously revoking coverage after a customer becomes ill, among others.

Still, the bulk of the law, the part that will restructure the health insurance marketplace and dramatically expand coverage in the U.S., has three more years of ramping up before it takes effect in 2014.

In the interim, we checked back with several of the people we spoke with in December to see how they’re faring and whether any of the preliminary changes in the health reform law have affected them.

Carri Schiff

Previously: Underinsured

Last year, Carri Schiff, a television producer in Florida, was racking up major health-care expenses even though she had insurance. She spent at least $14,000 on health care costs in 2009. Her insurance covered her and her two college-aged daughters, one of whom had long-term health problems.

Schiff was one of the estimated 25 million Americans who are underinsured: They have health insurance, but their plans, with high deductibles, premiums and out-of-pocket costs, still leave them paying at least 10 percent — and sometimes much more — of their income on health care.

Our analysts said that health reform might not provide much relief to Schiff.

“When people have decent coverage — which this is, it’s not great but it’s decent — we’re not making big changes to affordability, because it costs money and there’s not the political will to do it,” Linda Blumberg, a health policy researcher at the Urban Institute, said last year.

In the past year, Schiff has become Schiff-Levy — she got married in March. With that, she’s about to change insurance plans as well, joining a family plan with her husband. She says she’s glad to save the money on premiums, although she’s not particularly optimistic about the new plan. “It’s not much better,” she says, “but we’re being redundant in our paying, so it’ll be cheaper to be on a family plan.”

She is also glad to see one provision of the law go into effect — the new rule that allows young adults to stay on their parents’ plans until age 26. Both of her daughters would likely otherwise have aged out of her plan in the next couple of years — and her younger daughter, with a long-term illness on her record, might have had trouble finding insurance on her own. This way, she can stay on Schiff-Levy’s health insurance for another five years, if necessary.

Helene Mullaney

Previously: Employed and covered

Meanwhile, for one of the people we spoke to, not much has changed this year. Helene Mullaney is a behavioral scientist at a large nonprofit research firm. She has good health insurance, and her employer pays 90 percent of the premium.

“This is going to be a short interview,” she said when we called. “Everything is the same.”

That’s not surprising. None of the provisions that have gone into effect this year would affect anyone in a large-group employer plan.

And the provision arguably most likely to do so — a tax on expensive health care plans that cost more than $10,200 for individual coverage and $27,500 for family coverage — doesn’t go into effect until 2018.

Michael Lintz

Previously: Covered by Medicare

For Michael Lintz, a retired addictions counselor in Washington, D.C., not much has changed either — Lintz is still covered by Medicare.

He did receive a $250 check in the mail this summer, along with every other senior who fell into the Medicare “donut hole” — the prescription drug coverage gap. The health reform law aims to close that gap, starting small with just the rebate this year. But next year, seniors who fall into the gap will receive a 50 percent discount on their prescriptions. Then, the law mandates that the coverage gap gradually be closed until it is eliminated entirely in 2020.

Lintz says he spent more than $5,000 on prescription drugs this year, so the $250 rebate is just “a drop in the bucket.”

“But it’s something,” Lintz says. “It at least shows the government is recognizing that the [Medicare Part D] law is very much flawed.”

The larger changes to Medicare that are the subject of so much controversy have not yet begun to go into effect.

Jordan Resnick

Previously: Small business owner

When we spoke to Jordan Resnick last winter, the owner of a small real estate title company in Bethesda, Md., was struggling to pay 68 percent of the health insurance premiums for his employees. The monthly premium for a family plan had risen from $790 per month in 2006 to $1,280 in 2009.

This year, the monthly price tag jumped to $1,500 — and Resnick gave up. He no longer provides insurance for his three full-time employees (although they do have the option of signing up for a plan if they want to pay the full premium).

“Essentially we got crushed,” he says.

Resnick could be the face of the debate that erupted last month between health insurers and the Obama administration over rising costs.

Some insurers, who raised their rates as much as 20 percent this year, attributed significant portions of the rate hike to changes brought about by the health reform. Health and Human Services Secretary Kathleen Sebelius fired back quickly, blasting what she called the “misinformation” and sending a letter to the association America’s Health Insurance Plans saying that “We will not stand idly by as insurers blame their premium hikes and increased profits on the requirement that they provide consumers with basic protections.”

Resnick, meanwhile, has yet to look into the small business tax credits that went into effect this year and are intended to provide relief and an incentive for small businesses to provide insurance. Based on his payroll last year he would have been right on the border of qualifying for the credit — firms with fewer than 25 workers and an average pay of less than $50,000 per person can qualify. Resnick’s payroll was right around that cut-off.

But because the value of the tax credit diminishes as the average pay increases, Resnick likely would not receive the full credit.

“The tax credits could influence our decision, but probably not,” he said. “It’s hard to believe it would make up for the additional expenses that have come in the last few years. It was $800 for a family plan just a few years ago. And now it’s $1,500.”

All of the above updates, of course, come with a caveat. The changes coming under the health reform law will phase in slowly over the next three years, and the most important ones won’t come until 2014 — so a six-month update is just the tip of the iceberg.

Also, while the NewsHour aimed last year to profile people in a broad swath of insurance situations, most of the key consumer-protection provisions that went into effect recently — such as a ban on denying children insurance based on pre-existing conditions and a ban on lifetime limits on coverage — have not touched any of our profilees. However, other news outlets such as the New York Times and Kaiser Health News talked last week to some of the many people who have been helped by these new provisions.