Last updated on April 17, 2014 at 14:51 EDT

National Patient Advocate Foundation Commends Supreme Court Decision to Uphold Health Reform Law and Key Patient Coverage Provisions

June 28, 2012

Law’s Elimination of Pre-Existing Conditions as an Insurance Barrier, Removal of Annual and Lifetime Caps on Coverage, and Limit on Out-of-Pocket Health Care Costs Essential to Improving Americans’ Access to Health Care

WASHINGTON, June 28, 2012 /PRNewswire-USNewswire/ — The National Patient Advocate Foundation (NPAF) today applauded the U.S. Supreme Court decision to uphold the Patient Protection and Affordable Care Act (PPACA) and its important insurance coverage protections for patients, including the elimination of pre-existing conditions as a barrier to coverage, the elimination of annual and lifetime caps on insurance coverage and the capping of out-of-pocket health care expenditures.

“The protections under the PPACA are especially important to the patients served by the Patient Advocate Foundation, because each of them determines, first, whether a patient will have access to important health services, and second, whether a patient can afford the health care they require,” said Nancy Davenport-Ennis, founder and CEO of NPAF. “We are pleased that the Supreme Court has opted to maintain these key provisions by upholding the PPACA, and we look forward to working with policymakers and the broader health care community in making certain that these patient protections continue to assist the millions of Americans that they were intended to help.”

NPAF has long supported legislative efforts to remove pre-existing condition coverage exclusions and additional barriers to health care for patients. For example, the Foundation conducted extensive research, compiled wide-ranging patient stories and worked closely with Representative Joe Courtney (D-CT) to introduce the Preexisting Condition Exclusion Patient Protection Act in 2007, which would have eliminated pre-existing condition exclusions and waiting periods for all individuals regardless of health status or insurance type. With the Court’s ruling that the individual mandate can stay as part of Congress’s power under a taxing clause, this means that almost every American will be required to buy health insurance by 2014, which will help fund a number of insurance reforms designed to dramatically expand access to affordable, quality health care. Key provisions include:

    1)           Effective in 2014, eliminates the
                 use of pre-existing conditions
                 to deny or impose waiting periods
                 on insurance coverage. About
                 12.3% of patients assisted by
                 Patient Advocate Foundation (PAF)
                 reported issues with pre-
                 existing conditions or
                 underwriting in 2011, which is a
                 decrease of 25.9% from 2010
                 (16.6%).[1]With the maintenance
                 of this protection, NPAF expects
                 this figure to continue to
                 drastically decrease.
    2)           Eliminates the placement of annual
                 and lifetime caps on insurance
                 coverage. In 2011, 47% of the
                 patients contacting PAF for
                 assistance involving benefit
                 maximums had exhausted their
                 annual maximum benefit, a 6.6%
                 increase from 2010.  However,
                 5.3% of patients had exhausted
                 their lifetime maximum which is
                 an 8.4% decrease from 2010.
                 PPACA banned plans beginning on
                 or after September 23, 2010 from
                 cutting off policyholders'
                 coverage for healthcare services
                 when a lifetime benefit was
                 reached, which may explain this
                 decrease.  The law phases out
                 annual limits over a period of
                 three years and will completely
                 ban annual caps January 1, 2014.
    3)           Imposes a cap on the out-of-
                 pocket expenses patients must pay
                 to receive care. Insurance plans
                 that require high out-of-pocket
                 healthcare expenses impede the
                 ability of some insured to access
                 health care, in that their access
                 is limited to the amount they can
                 afford to pay.

“Despite the expected additional political challenges that may ensue from today’s ruling, NPAF joins the Supreme Court in believing that these and other fundamental provisions providing improved patient access to affordable care should be maintained,” added Davenport-Ennis. “NPAF will continue to offer our support to the insurance industry in rolling out these vital reforms and making certain that quality, affordable coverage is available to the millions of men, women and children in our nation who are currently uninsured or underinsured.”

[1] 2011 Patient Data Analysis Report, page 3. Patient Advocate Foundation

SOURCE National Patient Advocate Foundation

Source: PR Newswire