April 01, 2012|By Eileen Ambrose, The Baltimore Sun
• The law provides help with the Medicare Part D "doughnut hole," a gap in prescription drug coverage in which beneficiaries must pay for medications before insurance kicks in again. The law would eliminate the hole by 2020. Meanwhile, seniors received help paying for drugs when they reached the hole. More than 55,000 Marylanders in 2010 received a $250 rebate. And more than 52,000 Marylanders last year paid half-price for certain brand-name drugs.
•As of last year, insurers are now required to spend 80 percent to 85 percent of collected premiums on medical costs or improving patient care. Insurers that spend less than that must start giving customers a rebate this summer, says Sam Gibbs, a senior vice president with eHealthInsurance, an online insurance brokerage. "The theory is their premiums are too high," he says.
According to HHS, up to 9 million people could receive rebates worth as much as $1.4 billion.
These are a lot of numbers, but there are real people behind them.
Kids like Josias Lazo. The 7-year-old from Baltimore County is blind and suffers from cerebral palsy, chronic lung disease and a form of diabetes.
For years, his care was covered by Medicaid, the health program for the poor. But in 2009, his father's income rose at his landscaping business and Josias became ineligible for assistance.
Becy Lazo says she tried to buy insurance for her son but was turned down because of his pre-existing illness. Lazo was unaware of Maryland's high-risk pool. She says the family struggled to pay for Josias' care out of pocket.
"I didn't know what to do. He needed medication and doctors' visits. Everything was very expensive," his mother says. "It was very stressful."
Pediatrician Scott Krugman says he had to juggle Josias' care — determining what was absolutely critical and what the child could do without — to make it affordable for the parents. Even so, medical bills mounted. Lazo says she and her husband filed for bankruptcy in 2010.
Later that year, Josias became eligible for a private policy because of the Affordable Care Act. Now that Josias has insurance, his mother says, he gets the care he needs and the family has been able to keep up with the bills.
Pediatrician Ari Silver-Isenstadt, Krugman's colleague, says that while some of his young patients were covered under Medicaid, he saw many young parents going without insurance because their employer didn't provide it and they couldn't afford it on their own. "We would have sick people taking care of kids," he says.
That changed, he says, once these young parents were able to jump back on their own parents' insurance plan.
Silver-Isenstadt and other physicians attended a rally this week to support the law outside the Supreme Court. He says he finds it hard to believe that people could lose their insurance.
"I can't imagine a country where we could do that, just go backwards."
Unfortunately, it's very possible.
eileen.ambrose@baltsun.com
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