11:29am

Tue March 22, 2011
Affordable Care Act

One Year Later, Two New Hips

The Affordable Care Act turns a year old this week. While there are calls to repeal it, many have benefited from it including a Colorado bartender that insurers refused to cover.

Bartender John Barthell hardly fit the fast pace of the dancing-up-a-storm Grizzly Rose Saloon and Dance Emporium in Denver. While patrons’ feet stomped to the beat of wailing country music last summer, Barthell limped in agony from one thirsty customer to another around the long wraparound bar covered with carvings and burned-in brand marks.

The arthritis in Barthell’s hips was so painful that he feared he wouldn’t be able to keep working, potentially ending up homeless.  But that same arthritis made insurance companies refuse to sell him a health care policy. Without insurance, there was no way he could manage to pay for the two hip replacements he needed.

“I could barely walk,” Barthell said. Constant pain overwhelmed his life. He figured he would soon be unable to continue bartending, and unable to find other job. “When you’re that hampered, it’s hard to present yourself as a viable candidate for work,” he noted.

“It occurred to me, am I going to be homeless? If I lose my home, if I can’t get a job to support myself, what do I do?” Barthell said.

His life changed dramatically after he learned about one of the major consumer protections written into the new healthcare law, which marks its one-year anniversary this week.

Barthell, 55, became one of 610 Coloradans so far who has received health insurance – despite his pre-existing conditions – from a new federally subsidized state program called Getting Us Covered. He pays $500 a month for his policy, the same as someone his age without pre-existing conditions.

With the help of a friend, he found the program at www.gettinguscovered.org, followed the instructions and signed up. 

“The day the insurance went into effect was Sept. 1, and I was in the doctor’s office at 9 a.m. that morning,” Barthell said. “I had my first surgery two weeks later.”

“It’s really changed my life – it’s been that significant,” he added.  “It changes your whole perspective when that pain goes away.”

The ability to buy insurance despite pre-existing conditions is just one of a number of consumer protections in the healthcare reform law that took effect in the law’s first year.

Renee Hopkins of Getting Us Covered said the program should be able to cover about 4,000 people in Colorado. Many of them do not have pending healthcare needs. “Just the fact that they can sleep at night and they have coverage” is what is important to them, she said.

“Insurance carriers can and do turn people away for almost anything,” Hopkins said of common past practices. “We have a lot of members who are surprised they were denied insurance, because of a condition that they were diagnosed with years ago or because they take prescriptions for high blood pressure or high cholesterol, but are perfectly healthy otherwise.”

Under the provisions of the new law, in 2014, nearly everyone will be required to buy insurance. That will broaden the risk, and insurers will be barred from refusing to provide insurance due to pre-existing conditions. As a result of a pending lawsuit from opponents of the reforms, the Supreme Court is expected to decide whether requiring Americans to buy insurance is constitutional.

Healthcare reform opponent Linda Gorman of the Independence Institute said she opposes the cost and complexity of the new health care law, and the extension of a payroll tax to higher incomes. In the case of Getting Us Covered, she believes the small number of applicants means that in fact, few Coloradans have difficulty finding insurance.

She also thinks it was a waste of start-up money to create Getting Us Covered for only three years.

Colorado has $90 million from the federal government for Getting Us Covered, or about $600 per month per patient over three years, to cover any added claims.

Other key points of the health care bill that have taken effect over the past year include:

  • Children cannot be denied coverage due to pre-existing conditions. (Most insurers in Colorado – with the exception of two companies – reacted to this provision by halting sales of individual insurance for children.)
  • Children can stay on parents’ insurance policies to age 26.
  • Insurance companies can no long cancel policies as soon as there’s a major claim, without proving fraud.
  • Insurers cannot put lifetime limits on coverage.
  • Health savings accounts no longer cover over-the-counter products.
  • Medicare patients have access to new benefits, including preventive exams.

www.ColoradoPublicNews.org

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