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Who benefits from health care ruling?

Here are likely consequences for 5 key groups from the Supreme Court's Affordable Care Act decision. The ruling will impact 2 of those groups more than the others.

By MSN Money Partner Jun 28, 2012 3:29PM

This post comes from Quentin Fottrell at partner site SmartMoney.

 

The Supreme Court's decision to uphold the key provisions of President Obama's Affordable Care Act will benefit two groups the most, experts say: older Americans and the self-employed.

 

The court found the individual mandate, the requirement that all Americans purchase health insurance, is constitutional. Signed into law two years ago, the sweeping reform is expected to give 30 million more Americans access to health insurance by 2014, making preventative care available to many who in the past avoided seeking treatment until absolutely necessary.

 

It also requires insurers to give people free access to blood pressure, cancer, diabetes and cholesterol tests. "This is the biggest change in health care in this country in a generation," says Susan Nash, a partner in the law firm McDermott, Will & Emery. (Post continues below.)

That said, the law will impact certain groups more than others. Younger and healthier Americans who have had cheaper premiums and higher deductibles will be forced to pay more, while the expansion of Medicaid will benefit poorer and sicker Americans who couldn't afford health care until now, says Wendell Potter, a former vice-president of corporate communications at Cigna.

 

Image: United States Supreme Court (© Hisham F Ibrahim/Photodisc Red/Getty Images)Of course, even experts say it's unclear how quickly some of these changes will take hold. For example, some question whether all states will be able to roll out online "exchanges" designed to allow people to shop for individual insurance plans by 2014.

 

Some things may not change much at all. With or without Obamacare, most analysts say that health insurance premiums will continue to rise.

 

"Consolidation within the industry means that people will have less choice," says Alex Morozov, a senior health care analyst at Morningstar. In fact, the two largest insurance companies have a 70% market share in nearly half of the 50 states, according to the American Medical Association. In 54% of metropolitan markets, at least one insurer has a market share of 50% or more, the report found.

 

Here are some of the likely consequences of the court's decision for five key groups -- and what might have happened had the decision gone the other way:

 

1. Those with pre-existing conditions

Insurers will no longer be allowed to deny coverage to people with pre-existing conditions.

 

The policy is already went in effect for people under 19 and will apply to all age groups after 2014, Nash says. Some 12.6 million non-elderly adults have been deemed ineligible for coverage because of a pre-existing condition, charged a higher premium or refused coverage for their condition, according to a government report.

 

What was at stake: "These people would have been most at risk of not being able to obtain or afford health care," says Lisa Zamosky, a health care consultant and former health insurance executive.

 

Studies show that pre-existing conditions present a growing problem for Americans: 50 million to 129 million have some type of pre-existing health condition and one in five is uninsured, according to a 2011 report by the Department of Health and Human Services.

 

2. Young adults under 26

Under a provision of the law that already went into effect, people under age 26 can now be covered under their parents' insurance. Some 6.6 million young adults were added to their parents' plans after the law was signed in 2010, according to a recent survey by the Commonwealth Fund, a private U.S. foundation.

 

"It's really one of the most popular provisions," Nash says, "and makes it worthwhile for parents to be part of a good employer-based insurance plan."

 

What was at stake: Three major insurers -- Humana, Aetna and UnitedHealth -- said they would have kept the provision regardless of how the court ruled. But not all insurers were ready to commit. Joe Mundy, a spokesman for Cigna, one of the largest U.S. health insurance companies, said no decision had been made. And even if insurers had kept the provision, Potter says the employer (not the insurer) would have had the final say.

 

3. Those who buy their own insurance

The new law will require states to provide online "exchanges" with the aim of making it easier for people to find and afford individual plans that suit their needs. This, plus the pre-existing conditions mandate, will help self-employed and unemployed people get more affordable and complete coverage, Nash says.

 

Currently,  16 million adults, 60% of individials who shopped for coverage in the open market, found it "very difficult or impossible" to find an individual plan they could afford, according to a 2011 Commonwealth Fund report (.pdf file). Nearly three in five adults -- or 43 million people -- are uninsured.

 

What was at stake: In most U.S. states, those applying for individual plans are often given more rigorous medical examinations and given premiums rated on health, gender and age, Potter says. The self-employed would have remained the most uninsured, he says.

 

Jessica Waltman, a spokeswoman for the National Association of Health Underwriters, says employers often subsidize their employee benefits, and -- since group insurance policies carry less risk -- they're often less expensive.

 

4. People who get insurance through work

The impact will be minimal for this group, with one exception: The law halves the cap on "flexible spending accounts" -- which allow employees to use pretax income to pay for health expenses -- at $2,500, and limits spending from them to prescription medicines. Before the law was passed, most companies allowed employees to put $3,000 to $5,000 into these accounts from their gross salary to pay for a wide array of expenses.

 

What was at stake: Employer-based plans would have continued to withhold several key benefits, experts say. For example, they would maintain "lifetime limits" where coverage stops for emergencies and chronic conditions after a certain threshold (usually around $1 million), Nash says.

 

Companies would also have continued to impose annual limits on certain out-of-network services -- such as infertility treatments, chiropody and Lasik eye surgery.

 

5. Baby boomers

Boomers under the age of 65 will see greater benefits now that the law has been upheld, says David Certner, legislative policy director for AARP.

 

Obamacare puts limits on how much insurers can charge people because of their age and provides subsidies for those with low incomes. The law also closes the so-called "doughnut hole" -- the gap in coverage where Medicare beneficiaries must pay $4,000 out of pocket for prescription drugs if they exceed a threshold of $2,700 before coverage kicks back in.

What was at stake: Most of those over the age of 65 and on Medicare would have seen little difference to their policies, experts say.

 

But those close to retirement had the most to lose, Certner says. They faced higher premiums and potentially more exclusions for pre-existing conditions, he says. In fact, some 30% of 50- to 64-year-olds spend a tenth of their family income on health care, versus just 18% for 19- to 49-year-olds spending at that level, according to AARP.

 

More from SmartMoney and MSN Money:

116Comments
Jun 28, 2012 6:22PM
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It figures, Congress wants all Americans to pay for health insurance. However, we end up paying for 13 million illegal immigrants as well.This country gives everything to those who have broken the law and continue to do so. Being an illegal in this country sure does pay off. Thanks Congress !!!!!!!!

Jun 28, 2012 9:04PM
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I have employer paid insurance and i pay a portion that portion keeps rising every year it seems and so does the copays and the presciption costs while the insurance company pockets more and more and more.  That is all the health care crisis is.  The Insurance Companys want to make alot of money.  The CEO's like living like third world dictators.  The Drug Company's want to make alot of money.  The for profit hospitals want to make a lot of money small hospital where I live the CEO makes 4 millon a year and he only has a BBA   and the last time I was in that hospital it was so understaffed I saw a nurse carryng garbage to the elevator on midnite shift. I swear this nurse worked non stop all nite and she was only in my room once at the start of the shift. 

What we need.  Single payer National Heath Insurance for all Americans and all Including congress and the President and his family on the same plan.  Cut all these profiteers and medicade and medicare theives out and we could get good care for one to two hundred dollars a month for all Americans.  Thats what the majority of the people want.

Jun 28, 2012 7:05PM
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Who gains ?  The ones that don't work or don't pay taxes or both.
Jun 28, 2012 9:36PM
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The vast majority of Americans like the provisions in the healthcare act but they just don't like the idea of having to pay for it. That is no surprise there. Everyone likes something for nothing. Everyone likes driving on roads but don't like paying the taxes for the roads. Everyone likes quality public schools but bitch nonstop about paying property taxes and on and on.

The truth is that the individual mandate and having everyone paying into the insurance pool should have been passed when Congress forced/mandated  hospitals to provide care to everyone regardless of if they could pay or not. That should have been unconstitutional, but it wasn't, and if it is considered fair that hospitals should have to provide care for free, then it isn't asking too much that people be asked to help pay for that care. We know they will attempt to get it for free sooner or later and that is what is currently wrong with the system.

 If republicans were truly against socialism they should have been fighting to get that hospital mandate over turned. Grocery stores are not forced to provide food for free to hungry starving people and no other business is forced to provide it's services and it's labor for free. Even the insurance companies that take all the money in premiums and do nothing, aren't forced to provide payment for those who are covered. Routinely denying coverage and dropping the people when they really need the coverage most is typical behavior for insurance companies. I think they got off easy as they should have been forced to pay 90% of the premiums in direct care instead of 80%, so perhaps the doctors and hospitals who bust their ****-es to actually save lives get paid what they are worth instead of being nickeled  and dimed and cheated by the insurance companies. Doctors are making on average the same low six figure salaries they were making 30yrs ago while insurance executives are making double and triple that for shuffling paper around and dropping coverage for people. It is a disgrace. 
Jun 28, 2012 7:02PM
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The Supreme Court and the government found a loophole to get this through the American people. From now on this loophole will give the power to the government to control you life!! America was shot dead today!!!
Jun 29, 2012 11:32AM
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Someday.  Probably not far into the future, there will be no health insurance.  People will eventually realize what a dirty, wasteful business health insurance is, and the public option will be the only option.  Right now we are content to allow the few to make amazing money on the suffering of the many.  One day, the many will get tired of it.  Remember 1776.

Jun 29, 2012 9:27AM
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Joker...this is not a race issue. And while I fall mostly toward your perspective, you do disservice to this President when you invoke race. This is about money, fairness, and equity. Not race. I hope you manage to see that otherwise you'll do more harm than good in making your case. Regards. 
Jun 28, 2012 5:29PM
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Everybody loses.  Heres yet another example of passing a law that ideally makes everyone "feel" better.  However, there is no way this country can afford it.  Your congress at work.  

Washington has sold the American people out!!!  The band plays on...
Jun 28, 2012 8:57PM
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The bottom line regarding the healthcare plan is, regardless whether you like it or not, that it represents a complete takeover of  every  American's health and the decisions related to it. While the specifics are important, the dominance and control of the federal government in an area previously reserved for decisions by each individual is a serious threat to all individual freedoms and will eventually lead to government takeover in other areas of life. This is Obama and a determination to reduce this country to second class status as a pathetic socialistic handout society. 

 

Jun 28, 2012 8:06PM
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What about the tons of new taxes on everyone?  You didn't say a damn word about that liberal.
Jun 28, 2012 5:02PM
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Sounds real good but with the increase in medication by the drug companies the seniors will be in the same spot or even worse than before====people will never be able to afford this, and to put a fine on people who don't comply is not constitutional regardless of what the supreme court had to say for Obama coursed his way through this.
Jun 29, 2012 11:15AM
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Things Still Lacking:
1. An individual mandate makes it illegal for any individual to not carry health insurance coverage, HOWEVER, there is no part of this law that will limit what the Health Insurance Companies can charge for that coverage and no so-called "Government Option" to offer everyone cheaper coverages.  So YES, preexisting conditions can now not be discriminated against in any way except for price.  How many middle-class Americans can afford $1,200-$2,000 per month in insurance premiums?

Jun 29, 2012 1:13PM
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Who wins?
Liberals win, if they want you to buy something, all they have to do is tax you if you don't buy it.

The Federal Government can say everybody must buy an electric car and if you don't you will be taxed. OR
they could say that everybody has to go to Yellowstone every year and if you don't you will be taxed.
So who won? The people that want to take your freedom of choice away.

Jun 29, 2012 2:41PM
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An opinion now isn't worth much.  We probably won't know the full implications of all this for a couple of years!
Jun 29, 2012 11:17AM
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Clearly, the insurance industry will benefit more than anyone else.  After all, they invested huge amounts of money to defeat the 'public option' in the first place.  They really should have called this the 'Health Insurance Bill".  It has very little to do with actual health care.  I find it shocking that we in America fully realize that we have a health care system that is completely out of control, where costs are growing exponentially, yet we reject any type of direct care (public option) in favor of insurance.  Insurance is a BUSINESS people!  That means there will be billions and billions of dollars taken in profits and overhead that could have gone to patient care.  That is just stupid.
Jun 28, 2012 8:09PM
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They front loaded this crap with sugar to make people think how nice it is.  The poison comes later when the private market is destroyed and gone.  Then the only choice will be the government and the chains of slavery are alive and well.  Roberts stole your freedom with his sellout of the people and the protection of his so called legacy.
Jun 28, 2012 5:30PM
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The politicians with a Socialist agenda win.

The citizens, the taxpayers lose... big time. Hope everyone enjoys losing 50% or more of their yearly earnings to the government, as well as having to wait for (or be denied completely) their much needed healthcare, because that's coming.

Jun 29, 2012 11:29AM
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Who gains? Insurance companies, Pharmaceutical companies, Medical bankers, Medical facilities, other related industries, Wall Street and anyone that participates in it and politicians related to their campaigns on either side.

Who loses? All the rest of us. There is no affordable medical care in America anymore and hasn't been for some time. This is not the answer to that problem but it is the one we got. A resounding, "We don't give a rip about the patient, just their money or potential for generating money." It's called Medical Banking and you and I are deposits!

Jun 28, 2012 6:07PM
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Euro dies on passage of OBUMERECARE by Supreme Court.  Death panel says no HOPE only CHANGE - new currency name will be KING OBAMA RUBLES.

 

I THINK I WILL PARTY LIKE IT IS 1999!!!

 

The U. S. stock market is down then up then confused.  No problem - The U. S. Supreme Court has now set the stage for THE OBAMA SOCIALIST STATES OF AMERICA!!!

 

For all those who died for US TO HAVE OUR FREEDOMS - I am sorry but President Obama does not care what you did - he has his Marxist Socialist Agenda that trumps what you did for your country! 

Jun 28, 2012 6:54PM
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washington does give a damn about the american people. the house the congress and all the politics in washington get health care for the rest of there lives at the expense of guess who  the tax payers. the family phones haven't  stopped ringing we all agree to switch from democrats to republicans' and ill bet there's going to be millions more. we din't need them running our lives
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