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Healthcare Ruling is Holiday for Sick US Child

by Kathy Jones on  June 30, 2012 at 11:59 PM Health Insurance News   - G J E 4
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Three-year-old Violet cried "happy holidays" when she saw her parents cheering in front of the TV when news on US healthcare reform broke on Thursday. Violet suffers from a rare and severe form of epilepsy.
Healthcare Ruling is Holiday for Sick US Child
Healthcare Ruling is Holiday for Sick US Child

Her mother, Julie Walters, laughed and said yes, it was indeed a holiday, for the family would no longer have to worry about how their daughter would keep health insurance coverage for her costly, lifelong condition.

"We are jumping for joy," Walters, 35, told AFP in a phone interview from her home in northern California. "It means we can live our lives not in fear."

While Violet's genetic disorder is rare, she is far from alone. As many as 129 million people -- almost one in two Americans -- have some kind of pre-existing condition, ranging from asthma to cancer, according to the Department of Health and Human Services.

In a highly anticipated decision likely to transform the future of healthcare in the United States, the Supreme Court ruled to uphold key parts of President Barack Obama's healthcare reform law to extend coverage to the sick.

The high court's ruling means that if Violet's parents ever lose their employer-granted coverage, they won't be denied the right to buy it for their daughter on the free market due to the child's pre-existing condition.

For millions of others, it means that having had an operation for conditions like a kidney stone or a Caesarean-section for the birth of a child will no longer prevent them from obtaining future health coverage.

Current provisions bar many Americans with chronic or past illnesses from obtaining health coverage. The Department of Health and Human Services estimates that 25 million people with pre-existing conditions are uninsured.

A key part of the Affordable Care Act establishes that as of 2014, insurers "can no longer use health status to determine eligibility, benefits, or premiums," said HHS.

The Supreme Court ruling also means that insurers cannot impose lifetime limits on the cost of a person's coverage.

That is particularly important for Violet. When she has a seizure, she stops breathing. The seizures come in clusters, and are unpredictable.

She had over a thousand seizures in her first two years of life. One hospital stay, lasting about two weeks, cost $250,000.

Walters' family was covered by health insurance provided by her husband's job at a video game company. But the industry can be volatile, and as parents they often worried what it might mean for their daughter's health if he had to change jobs.

"We were really fortunate that we had insurance. That was during a time when a lot of people were being laid off, and had my husband been laid off, because she has a pre-existing condition we wouldn't have been able to just go out on the market and buy her insurance," Walters said.

"So I don't know what would have happened. Even if you make a good salary, you can't pay bills like that."

Without the removal of lifetime limits on the total cost of a person's healthcare needs, Violet would exhaust her coverage in a few years' time, leaving her uninsurable for the rest of her life.

Walters, who works as a recruiter, is well aware that many people on the job market are looking for work simply to get desperately needed health coverage.

She hopes that healthcare reform will lead to a change of landscape for those people, too, allowing them to seek a job because they want it, not purely to maintain health care coverage.

"I talk to people every day who say, 'I need enough hours to get benefits.' It's sad," she said.

Obama signed healthcare reform into law in March 2010. Some of its provisions have already gone into effect, while others are being phased in over the coming years.

"Pediatricians have already seen firsthand that health reform works," said American Academy of Pediatrics president Robert Block, who hailed the ruling for its protection of children's health.

"Since the Affordable Care Act took effect, millions of children with pre-existing conditions gained health care coverage," he said.

"Our number one goal is to keep children healthy, and we can now do so knowing that a landmark law prioritizes children's health needs."

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