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Questions remain about health care coverages as law kicks in

| Monday, Sept. 30, 2013, 4:11 a.m.

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

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