Like many people I currently rely on the programs set up for people with pre-existing conditions (PCIP) that were established under the ACA. I was concerned given the degree of pessimism about the SCOTUS ruling that these programs would be immediately effected, so I called the NY Bridge Program myself and asked them for information. According to the woman on the phone, the NY Bridge Program (our name for the PCIP) is in effect until January of 2014 regardless of the outcome of the SCOTUS decision. After that, they just don't know as it's not clear what the court will rule.
EDIT: Others have heard more cautious info from reps at their PCIP programs, and I've changed the title of the diary to be include the words "some" and "likely" to acknoweldge a larger degree of uncertainty.
While I don't know for sure I do assume that this is the case in other states that have established PCIP (Pre-existing Conditions Insurance Programs).
A bit more over the fold why these programs are so valuable to some of us.
New York State is great in that pre-ACA it was already illegal to deny coverage based on having a pre-existing condition. That, however, does not mean that you can afford coverage that actually works for you if you have a chronic condition. In my own instance, I have to have access to brand pharmacy drugs to treat my HIV. These drugs are not available in generic form because of patent laws.
While I could have bought insurance pre-ACA, a plan that would have covered Atripla cost $1,300 a month. There were cheaper plans, however they all had catches -- mostly 50% co-insurance on brand pharmacy drugs. Since Atripla costs on the low end $1,700 per month, paying $500 a month for a premium plus $850 per month (after a $2,000 deductible) is the same as the higher cost plan that covers the drug with a $20 co-pay.
Through the PCIP established by the ACA I have been able to purchase insurance that covers brand pharmacy drugs with a $20 co-pay and has no deductible for $421 a month. I realize $421 a month for many people is still too high, however, it is 300% cheaper than the closest free market plan.
Before PCIP I relied on ADAP (AIDS Drug Assistance Program) a government-funded program which provides medications and doctor visits exclusively limited to HIV related health care. Were I in a car accident and needed emergency room care, or were I diagnosed with cancer, that would not have been covered -- only doctors, labs, and medications directly related to HIV. Again, NY State is great in that it offers these kinds of programs already. But ADAP, apart from being highly limited in its scope, has income eligibility requirements -- you must make under 48K per year. Since I had opportunity to make more money than ADAP allows, I choose to pay for the PCIP plan and un-enroll from ADAP.
What the ACA allows me to do is not only afford my health insurance, but enable me to make more money without having to worry about losing health care, thus making me less dependent on government programs now and in the future. This in turn allows me to reach my potential as person, potentially owning a home, keeping a savings account (ADAP does not allow too much savings), and be a wage-earning participant and active citizen of the country, not just a sick guy dependent on government assistance.
I guess it is some consolation to know that I will be OK for at least another 20 months, but you will excuse me if the thought of having the ACA overturned all or in part by a super conservative group of activist judges has a me a little pissed off. I don't want to have the shackles of dependency thrust back on me, ironically in the name of my own liberty, but if the exchanges do not kick in in 2014 then what choice do I have other than to figure out how the fuck to afford 26K a year in premiums or import medicines from India.
Yeah, Medicare for All is better policy, but this program was helping people. Lots of people, myself included, and I was very optimistic about the future. Today, not so much. If this is overturned I see a summer of finger pointing, I told you so's, and a return to the polarizing and dividing issues of the 2010 season that brought on electoral disaster for the Democrats. I agree in theory that people should not have to be forced to buy private products, but health insurance is not just a product, it is an system in which we are all interconnected and your own personal situation cannot be isolated from the situation of all of us. To be blunt, how you feel about being forced to be part of this system is so small when compared to the importance that this system exists and that it functions. The good of the many outweighs your own petty issues with authority. Health Insurance is not just a product; it is not a car, or broccoli, or any other stupid comparison like that -- it is means to assure delivery of a necessary service and if that service is administered by a private company or government agency, to be honest I just don't care and I don't think it matters.
In the event that this law is struck down please do not celebrate and do not delude yourself into thinking that this paves the way for single-payer. We will still have a GOP congress who's interest in health care does not extend beyond forcing women to get ultra sounds if they want to have an abortion. I guess that kind of health mandate is A-OK. Id sooner expect to get blood from a stone then a replacement bill from this Congress or the next one.
If you qualify for a PCIP program, get on it now -- you can find info on these at healthcare.gov. Who knows, these programs might not be around for much longer, but maybe those of us already enrolled will get grandfathered in. You never know.