This month, the U.S. Supreme Court is expected to rule on the constitutionality of the Affordable Care Act, the health care overhaul backed by President Barack Obama and passed by Congress in March 2010 over fierce Republican opposition.
The law has been challenged by a number of states and organizations that object to some or all provisions, including the individual mandate that requires all Americans to buy insurance or pay a fine.
Last week, I attended a White House town hall meeting on womens health, where U.S. Secretary of Health and Human Services Kathleen Sebelius outlined provisions of the law that are particularly helpful to women and children.
It seems obvious that the Obama administration hasnt done a good job of explaining this complex package to the public. And it appeared to be a goal of this meeting to get the message out. Heres part of the case they made:
Sebelius noted that, before the Affordable Care Act, women could be charged up to 50 percent more for health insurance than men.
Just being born a woman was, in insurance parlance, a pre-existing condition, she said.
Starting in 2014, insurers will not be able to charge women higher premiums than they charge men.
By 2014, the new law will also make it illegal for insurers to deny coverage to people who have pre-existing medical conditions, such as breast cancer or having been pregnant, Sebelius said. The new law has already made it illegal to deny coverage to children with pre-existing conditions.
Also, by 2014, each state will have established health exchanges that enable consumers to buy insurance at more competitive prices than they could get as individuals.
Some other provisions that are already in effect include:
• Children can stay on their parents health insurance until they turn 26 (unless their employer offers coverage).
• Medicare and new private health plans are required to provide preventive services, such as mammograms, colonoscopies and vaccinations, without co-pays. New private plans are also required to cover well-child visits, without co-pays, from birth to 21. (As time passes, existing plans will also be required to offer this coverage at no cost.)
• A Patients Bill of Rights prohibits insurers from setting lifetime limits on coverage.
One of the town hall speakers was Robyn Martin, who grew up on the Outer Banks and now lives in Maryland. Her 10-month-old son, Jax, was born with a genetic heart defect for which he needed surgery and medicines. Before the Affordable Care Act, Sebelius said an insurer could have denied coverage for Jax or could have covered him but excluded treatment for his heart condition.
Thats called medical underwriting, she said. And that will no longer be legal.
If the Supreme Court strikes down the law, Sebelius said, Much of what weve described today would cease to exist.
But she added: We still remain confident and optimistic that the law was well within the purview of Congress. Were working as hard as we can to get ready for 2014.