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A View From the Front Lines of the Underinsured

Today’s Supreme Court to uphold the Affordable Care Act is great news for all Americans. But I’d like to share a few personal stories from people who I met when I served as Superintendent of Insurance in Maine—the sorts of people who will especially benefit from Obamacare.

—Betty had planned for her retirement and thought she had enough savings to stay privately insured until Medicare. But double-digit premium increases exhausted her savings. Betty was forced to take in a total stranger as a renter, in order to help pay for her monthly premiums so she could stay insured; she was too proud to ask her kids for help. “It is a matter of dignity,” she said.

—Melissa is an uninsured young woman who called an ambulance because her baby was sick. Because Melissa didn’t have insurance she was not allowed to ride to the hospital in the ambulance with her baby. Her baby died on the way to the hospital in that ambulance—without her mother, because she did not have insurance.

—Jane is insured but doesn’t have access to medical care because she and her husband, a lobsterman, have a high deductible policy. Since he has a medical condition that makes him pass out, Jane is forced to join him in his lobster boat to make sure he doesn’t drown. Since their insurance doesn’t pay benefits until the $15,000 deductible is met, they can’t afford for him to see a doctor.

—Sharon has two children, but is constantly in tears and full of guilt. She told me that managing her finances is always a juggling act—a question of whether to fix the car so she can get to work, or turn the heat on in the apartment. She is also forced to constantly pray that, if one of her children falls in school, that it doesn’t result in any injuries that require medical care, because she often just can’t afford a doctor for her kids. Her guilt doesn’t go away.

Betty, Melissa, Jane, and Sharon are now free to count on Obamacare. Betty will qualify for tax credits through the new marketplace exchange that will make her premiums affordable starting in 2014. Melissa will also have coverage through the new marketplace exchange and will never have to suffer the indignity of being uninsured. Jane and her husband will be able to get him the care he needs; in 2014 high deductibles won’t be allowed for new coverage and tax credits will help with premiums and out-of-pocket expenses like deductibles. Sharon, with coverage through the exchange, won’t have to choose between rent and a doctor’s visit for her kids. Essentially, today’s Supreme Court decision means that in 2014, health care coverage will be affordable, secure, and available for all middle-class and moderate income wage earners.    

Moreover, the Affordable Care Act is the best chance we have to fix many of the long-term problems with our health coverage system. The only way we can tackle the cost trend is by making sure that all people are covered, including those with very low or no income. That’s why I am confident that most states will choose to be partners with the federal government on the Medicaid side of the ACA, even though the Supreme Court decision no longer requires their cooperation. Ultimately, the ACA makes it a lot easier for states to make sure that businesses and families have secure, affordable, and good coverage. The law makes it easier for all states to create a private insurance market that works for consumers (not one that only works for the insurance industry) and a Medicaid program that is more efficient for state tax payers. Now we can add five Supreme Court justices to the list of people responsible for creating it.  

Mila Kofman is former superintendent of insurance of Maine and currently a research professor at Georgetown University.