Health insurance debate hits home - Lancaster Eagle Gazette

WASHINGTON -- The Patient Protection and Affordable Care Act, which became law in 2010, affects most major components of the U.S. health care system.

The U.S. Supreme Court is expected to issue a historic ruling before week's end that either will affirm or strike down the health care act in whole or in parts.

Here's a look at Ohio's role in the health insurance debate and the effect of the law on Buckeye residents.

» Ohio was one of the 26 states seeking to have the Affordable Care Act struck down by the courts through a lawsuit challenging its constitutionality.

» Sen. Sherrod Brown was one of the 58 Democrats and two Independents who voted in favor of the law. Then-Sen. George Voinovich was among the 39 Republicans voting "no." Sen. Rob Portman, who succeeded Voinovich, supports repealing the law. Cincinnati-area Reps. Steve Chabot, R-Westwood; Jean Schmidt, R-Miami Township; and John Boehner, R-West Chester, all support overturning the law.

» The Kasich administration has taken advantage of some provisions in the law, including initiatives to expand preventive, coordinated care. But it has resisted other elements, such as a requirement to set up a health insurance exchange, envisioned as a new one-stop marketplace for consumers to comparison shop for insurance.

» In November 2011, Ohio voters approved a ballot measure, by a vote of 67 percent to 33 percent, to exempt residents from various elements of the law, including the mandate requiring patients to buy insurance or face penalties.

How the law affects Ohioans:

Many of the major provisions in the health care law are not scheduled to begin until 2014. Other smaller, but popular, provisions already have kicked in. Here's a look at how some aspects of the bill that already have, or were expected to, affect Ohioans:

» Uninsured: About 14 percent (1.56 million) of Ohio residents don't have insurance. Under the law, some would become eligible for Medicaid and some would receive tax credits to help buy private insurance, starting in 2014. Others who don't qualify for assistance would have to buy insurance on their own or pay a penalty.

» Medicaid: The law's expansion of Medicaid, the joint federal-state health care program for the poor, is expected to increase Ohio's enrollment by almost 32 percent, compared to a 27 percent jump nationally, according to an analysis by the Urban Institute. That would reduce the number of uninsured adults in Ohio by 50 percent. Federal dollars flowing to Ohio for Medicaid recipients would increase 19.2 percent over the first five years, and state spending would increase 1.6 percent, the Urban Institute report shows.

» State-based exchange: Ohio and other states have until Jan. 1 to create an online insurance marketplace that is fully operational in 2014. Otherwise, the federal government will run it. Ohio received a $1 million federal exchange planning grant in 2010, but the state has yet to apply for additional funds to establish the exchange. Although Democrats in the state Legislature have pushed proposals to create a state-run exchange, Lt. Gov. Mary Taylor, who also is the state's insurance commissioner, has opposed those efforts and has called federal health reform a "catastrophic law."

» Insurance rebates: Ohio businesses and consumers will get an estimated $11.3 million in rebates this year from health insurers who spent more on administrative expenses and profits than allowed under the law. More than 143,000 Ohioans are expected to get rebates, with the average check per family estimated at $139, according to the Department of Health and Human Services.

» Young adults: Young adults up to age 26 can stay on their parents' insurance plans. As of June 2011, about 82,000 young adults in Ohio had gained coverage under this provision, according to HHS.

» Preventive care: The law requires health insurers to cover preventive services, such as flu shots and mammograms, without co-pays or other cost sharing. HHS said about 1.2 million seniors on Medicare received free preventive care in 2011, and 2.1 million Ohioans with private insurance now have access to free preventive care.

» Prescription drug coverage for Medicare recipients: Medicare sent $250 rebates to the 148,238 Ohioans who hit the Medicare prescription drug coverage gap known as the "doughnut hole" in 2010. In 2011, 185,014 seniors received a discount averaging $512 per person for brand-name drugs bought after they hit the coverage gap.

» Tax credits for small businesses: Businesses with fewer than 25 full-time workers and average wages of less than $50,000 can get tax credits to help pay for providing health insurance. An estimated 70 percent of Ohio small businesses were eligible for the credits in 2011, according to Families USA.

» Funding: So far, Ohio has received $197.5 million in federal funds under health reform for everything from public health programs, community health centers and educational and training programs.