Questions remain about health care coverages as law kicks in
As of Jan. 1 next year, under the Affordable Care Act, insurance companies cannot discriminate against patients with pre-existing conditions.
“All those policies are open and available to anyone regardless of health status,” Highmark spokeswoman Kristin Ash said.
“Every one of these people or the vast majority of these people, are going to get a better deal, where they were paying higher rates than the average person,” U.S. Rep. Mike Doyle, D-Forest Hills, said.
Former Munhall police chief James Beserock has questions.
Beserock, 61, remembers a letter written by Doyle in April 2010 that said the law would cap annual out-of-pocket costs at $6,200 for individuals and $12,400 for families who purchase insurance through an exchange or are insured by small businesses.
That information was relayed by other Democratic lawmakers when the Affordable Care Act, popularly known as ObamaCare, was passed.
Beserock said he wonders if that's still true.
“Doyle's office can't answer that,” Beserock, who sent an inquiry to Doyle's offices in Penn Hills and Washington, said on Friday.
“Where in the law does it state your health insurance company can drop you and force you into (an) insurance exchange?” he asked a Doyle caseworker.
His inquiry was in response to a letter received by Beserock and other Highmark customers two weeks ago, informing them that their plans will be discontinued at the end of the year.
“You will be required to obtain new replacement coverage,” according to the letter dated Sept. 5.
Such coverage will be available through the federal government's exchange, or Health Insurance Marketplace, beginning Tuesday.
Doyle and Ash pointed out that Highmark's letter indicated that a selection of plans would be available, including Highmark programs, and that Beserock would have more benefits in his 2014 plan than he has now.
Prior to ObamaCare, Ash said, “Highmark, as a Blue Cross Blue Shield plan in the state, had to offer what we in the industry call a ‘guaranteed issue' plan.
“Because of our nonprofit status we would take anyone in these guaranteed issue programs regardless of their health status,” Ash said. “Highmark was the only one in Western Pennsylvania that was required to do that. We were what you could call the insurer of last resort.”
In other words, while most insurers could exclude adults with pre-existing conditions in accordance with state and federal laws, Highmark could not.
UPMC Health Plan did not reject patients with pre-existing conditions, spokesman William P. Modoono said.
A “high risk” insurance pool known as the Pre-Existing Condition Insurance Plan was established this year at a cost of about $241 a month to Pennsylvanians who were able to sign on.
More than 100,000 signed on across the nation, but the plan stopped accepting new applications.
That issue will become moot on Jan. 1.
A federal government-run website stressed that, starting in 2014, ObamaCare guarantees that all Americans, regardless of health status or pre-existing conditions, will have access to affordable insurance coverage.
“There has been so much confusion and so much bad information going out,” Doyle said. “There will be bumps along the way. There are going to be glitches. Western Pennsylvanians are going to get a tremendous deal here. We will get some of the lowest rates in the country and some of the lowest rates in the state.”
Beserock, who has been retired for a decade, has not pressed Highmark about the issue. But he was not convinced about what Doyle was saying.
“What is happening is not what he wrote to me,” Beserock said, going back to the April 2010 letter. “He can't answer what's in it. He can't answer what's passed and that's the part that's annoying.”
On Thursday Doyle said numbers released by the U.S. Department of Health and Human Services are proof that the Affordable Care Act “is working as we intended.”
HHS said a 27-year-old living in Pittsburgh could pay as little as $104 a month for a catastrophic plan, $119 for a bronze-level plan, $134 for a silver-level plan and $169 for a gold-level plan.
Doyle said that compares favorably to national averages of $129, $151, $170, and $205, respectively.
Others do not agree that the Affordable Care Act is working.
“The Highmark case is another reason why this law is not ready for prime time, and why the president should agree to give the same delay to individual Americans that he gave to big business,” U.S. Rep. Tim Murphy, R-Upper St. Clair, said. “That is why I voted to pass the Fairness for American Families Act this summer.
That bill would postpone the individual requirement to buy health insurance, but it has seen no action in the Senate.
Patrick Cloonan is a staff writer for Trib Total Media. He can be reached at 412-664-9161, ext. 1967, or email@example.com.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- McKeesport Area student’s Project Christmas expands in 2nd year
- Charity helps dozens of McKeesport area children in need get new shoes
- Munhall garbage collection rates to increase
- McKeesport man sentenced to house arrest in armed robbery
- Brass plaque stolen from McKeesport veterans memorial
- Jamie’s Dream Team founder says she will press on despite new illness
- Clairton students reference positive ‘Frozen’-themed lessons
- McKeesport nonprofit, Youth Works ensure Allied Health students can continue training
- Polka musician ‘Mr. December’ bringing his fiddle to McKeesport lodge
- Elizabeth Forward marks 35th year of senior holiday breakfast
- Businessman responds to Brewster shale tax proposal