The United States Supreme Court’s 6-3 decision upholding the ACA is good for Wisconsin workers compensation employees and employers. Yesterday, the Chief Justice Roberts’ majority opinion saved the controversial health care law that will define President Barack Obama’s administration for generations to come. The ruling holds that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal marketplaces. It staved off a major political showdown and a mad scramble in states that would have needed to act to prevent millions from losing health care coverage.
The ACA or Obamacare is important to Wisconsin employees with workers compensation claims for this very simple reason. When the worker’s compensation insurance company denies paying any more medical bills for a work-related injury, the injured worker can use health insurance to cover his medical bills. Unfortunately, not all injured employees have employer sponsored or paid health insurance. Because of Obamacare, injured workers can get health insurance through the federal exchange (Wisconsin’s governor refused to set up a state exchange). Moreover, the injured worker can afford the Obamacare premium because there is a tax credit or subsidy – this is what the Supreme Court upheld yesterday.
Here are some of the benefits of the ACA:
Coverage
Ends Pre-Existing Condition Exclusions: Under the Affordable Care Act, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can’t charge women more than men.
Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s health plan.
Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake.
Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of payment.
Costs
Ends Lifetime Limits on Coverage: Lifetime limits on most benefits are banned for all new health insurance plans.
Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.
Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care – not administrative costs.
Care
Covers Preventive Care at No Cost to You: You may be eligible for recommended preventive health services. No copayment.
Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.
Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan’s network.
