Affordable Care Act puts consumers first

If the Supreme Court chooses to play politics and strikes down the
Affordable Care Act, more than just its reputation will be at stake.
Many of the commonsense health insurance reforms that Americans have
waited to see for more than a century will be lost — including new
rules making insurance transparent and accountable.

Before the Affordable Care Act, health insurance was essentially a black box. Consumers often could not figure out what they were getting because the details of health insurance plans were often buried in lengthy documents full of legal and actuarial terms, and the definitions of key terms such as “hospitalization,” “outpatient care” or “out-of-pocket limit” varied from plan to plan. One practically needed a team of lawyers just to understand the fine print of a coverage policy. As a result, Americans would buy coverage they thought was comprehensive, only to realize once they actually got sick that it had huge gaps.

{mosads}For many, this lack of transparency resulted in unexpected medical expenses and significant debt. In fact, 31 percent of working-age adults who had problems with medical bills or medical debt in 2010 were insured at the time care was provided.

We do not buy food products without checking the nutrition facts — minimum information presented in a standard format — so we can make informed purchases. But until now, health insurance did not have a set of transparent, standard “coverage facts.” The Affordable Care Act changes that. Starting this September, insurers have to clearly communicate basic information about their plans — things like deductibles, out-of-pocket expenses and limits and services not covered by the plan — in a standardized format, so consumers can make sense of the plans being offered.

These new summaries of benefits and coverage are in plain English and are designed to be more helpful than the several-hundred page book on a plan that families used to have to sort through when comparing options. They also include a few real-life examples of how a plan would work in specific situations.

According to a recent report by Families USA, 174 million Americans under 65 will benefit from these summaries, including more than 90 percent of Americans insured through a job-based plan. That includes 2.3 million men and women under 65 in my state of Connecticut — more than 75 percent of the non-elderly population.

In short, these summaries will dramatically increase transparency and accountability in the health insurance industry. Consumers will no longer be forced to take a stab in the dark when it comes to their health insurance. Instead, they will be able to make informed choices about the best insurance plan for themselves and their families.

And this is just one of the many benefits for consumers included in the Affordable Care Act. Thanks to healthcare reform, insurers cannot subject individuals to a lifetime benefit cap, and annual caps are being phased out. Children can no longer be denied coverage due to a pre-existing condition. Young people across the country can stay on their parents’ plans until age 26. Seniors have immediate relief from high drug costs. Maternity care and pediatric care must be covered by insurers. Women can no longer be overcharged for the same coverage, and having a child or a C-section, or being a victim of domestic violence, is no longer a “pre-existing condition.” And all Americans enjoy preventive and wellness coverage for recommended services without a copay.

And even more reforms are on the way. The new private health insurance exchanges to come in 2014 will introduce real competition to the insurance market and make the process of buying coverage more efficient and transparent.

We know for a fact that these are reforms that would not be made by insurers on their own. In 2009, the Center for American Progress asked all of the nation’s seven largest for-profit insurers to disclose their overall rates of claim denials and break down the reason for the denials. They all declined. According to a study by the National Women’s Law Center, more than 90 percent of the best-selling plans in states that have not already banned gender rating still charge women more than men for the same coverage.

The Affordable Care Act is needed to transfer power back to consumers and their doctors. When the full law is in effect, families will be healthier and have more control over their health decisions. It would be a tragedy for both Americans’ confidence in our judiciary and the health and well-being of the American people if the Supreme Court were to strike the act down.

DeLauro is a member of the House Appropriations Committee.