Affordable Care Act

Law would affect thousands of uninsured locals

By Nick Tabor, New Era Staff Writer 

Spring Stillman, who has diabetes and a liver disease, has lived without health insurance since she was 18.

Stillman, now 37, handles bookkeeping for her husband’s flooring business, so she doesn’t have a large employer to provide benefits. But even when she worked at an accounting company for eight years, she couldn’t get insurance because of her pre-existing conditions.

Though St. Luke Free Clinic helps her a great deal, her insulin and pills cost more than $400 a month, and she pays more than $300 a month for cancer, heart and life insurance policies. And she’s still paying off a hospital bill from 2002.

She would gladly pay $500 a month for health insurance if she found a plan that gave enough benefits in return.

She inherited her condition from her parents. She watches her diet closely and exercises daily.

“I look like a body builder,” she said. “It’s because I have no fat content on my body.”

But still, she never forgets a health disaster would destroy her finances.

By this coming Thursday, the U.S. Supreme Court will rule on whether the Patient Protection and Affordable Care Act — commonly called Obamacare — violates the Constitution.

Experts disagree on whether the law would solve the country’s biggest health-care problems or create a disaster.

Either way, for Stillman, and many thousands like her in Christian County alone, it would likely change everything.

Uninsured rate

The U.S. Census Bureau reported in 2009 that 18 percent of Christian County’s adults were uninsured. This doesn’t count people older than 65, as they typically qualify for Medicare.

This comes out to 12,569 people.

But the estimate may be far too low.

The Kentucky Health Issues Poll, which two nonprofits conducted late last year, found that 32 percent of western Kentucky’s adult residents lacked health insurance. For Christian County, this comes out to more than 22,000 people.

The county’s uninsured rate has typically been close to the statewide rate.

These figures don’t distinguish between people who can’t afford health insurance and those who simply choose not to buy it.

Broad impact

A high ratio of uninsured people affects everyone in a given population, said Jodi Mitchell, director of Kentucky Voices for Health.

Federal law forbids hospitals to turn away patients who need urgent treatment, regardless of ability to pay. But hospitals generally don’t have to provide preventive care.

This explains why poor people sometimes develop chronic illnesses, like diabetes, that doctors could help prevent. When the poor end up in the emergency room, their treatment costs far more than preventive care would have cost, Mitchell said.

To make up for their losses, hospitals increase the prices of medical services, and insurance companies pass on the costs to those who buy insurance, Mitchell said.

“Somebody has to pay for that uncompensated care,” she said. “It’s also a drain on state governments and local governments, who are putting dollars in to cover charitable care.”

Mark Pyle, director of the Christian County Health Department, said this area’s uninsured rate is contributing to his department’s major budget deficit.

The high uninsured rates in Christian County and Kentucky in general might also help explain the state’s poor health rankings.

Installing Obamacare

The Affordable Care Act aims to give everyone access to treatment by requiring insurance companies to take on all clients, regardless of preexisting conditions, such as Stillman’s.

In exchange, the law requires everyone to buy insurance or pay extra in their yearly taxes. In theory, this would prevent healthy people from going without insurance until they became ill — effectively taking advantage of insurance companies.

Almost all major countries that rely on private insurance companies have similar laws. But the U.S. Supreme Court may decide the government can’t force anyone to buy insurance.

Mack Major, a consultant at Higgins Insurance Inc., voiced a theory many experts share: Without the mandate, the entire law would fall apart. The model depends on healthy people paying for insurance to subsidize unhealthy clients’ costs.

But if the law stands, Kentucky will create an online exchange service, where uninsured people can shop around for coverage plans. Mitchell said these will resemble virtual shopping malls.

In states that don’t create their own exchanges, the federal government will provide the same service.

Stillman remains dubious. Several months ago she looked at a plan that would have cost her $299 a month. It would have covered four doctor visits a year but no hospital visits or prescriptions, she said.

If the government forces her to buy insurance, she wonders, will better options than this one open up?

“If it is actually going to be affordable and help pay for things, I think it would be a great thing,” Stillman said of the new law. “I just hope that’s what it’s going to do.”