High Stakes for Pre-existing Conditions

At stake in particular was coverage for anyone with a pre-existing condition, says Neeraj Sood, PhD, associate professor at the School of Pharmacy and director of International Programs at the Leonard D. Schaeffer Center for Health Policy and Economics, both at the University of Southern California. “If the law had been repealed, people with chronic conditions would most likely not have been able to get affordable coverage. They are the big winners because of this Supreme Court decision.”

Currently, the access to care law states that children younger than 18 cannot be denied coverage because of a pre-existing condition.  Adults with pre-existing conditions don’t yet have that protection but can enroll in a pre-existing condition insurance plan, or PCIP, which is subsidized by the federal government.  “But in 2014 that hurdle will disappear,” says Sood. “Anyone with a pre-existing condition cannot be denied coverage.”

Although the amount people will have to pay for coverage is not yet clear, the law establishes health insurance exchanges, or a marketplace where insurance companies will now compete with each other, explains Sood. “There will be three to four kinds of plans available that will vary in terms of generosity, but it will be clear whether you are buying a ‘gold’ or ‘bronze’ plan. And all insurance companies will be competing in this marketplace so that should lower premiums for everyone,” he says.

For people like Janine Jones, a 25-year-old college student with juvenile arthritis and fibromyalgia in Placentia, Calif., the ruling comes as a tremendous relief. “Now, I have the option of getting my own insurance in 2014,” says Jones who is covered under her mother’s insurance policy until she is 26. “And I can’t be penalized for having a pre-existing condition.… Now I can make decisions about my life based on what I want to do, … not just on what’s going to keep me healthy.”

Access to Preventive and Coordinated Care

Coverage for preventive care will be expanded. “Because of the Affordable Care Act, many aspects of health care screenings are covered,” says Jan Wyatt, 63, a retired nurse and nurse practitioner in Round Hill, Va. Wyatt, who is also chair of the Public Policy Committee for the National Board of Directors of the Arthritis Foundation, has had rheumatoid arthritis, or RA, for eight years and also has osteoarthritis, or OA. “When you have RA and OA, you are at risk for other chronic conditions, so it’s important to have good screenings and access to physicals so those can be detected earlier.”  

She notes that preventive care is important not only for people who have arthritis. “The incidence of arthritis is only growing as the population ages,” says Wyatt. According to the Centers for Disease Control and Prevention, or CDC, arthritis is expected to affect 67 million Americans by 2030. “Now with a focus on prevention, providers may be very attuned to assessing patients for arthritis risk.”

The law also establishes a Prevention and Public Health Fund, which will help finance proven prevention programs that address chronic health issues like obesity and smoking, while providing grants to local communities to develop wellness services.