Obamacare in the Balance: Will the Court Ruling Really Matter?

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ObamacareOn Thursday, the Supreme Court will issue its landmark ruling in the case of U.S. Department of Health and Human Services v. Florida, or as it's more colloquially known: Republicans vs. Obamacare.

Until the justices speak, only one thing can be known for certain: The decision will change the lives of tens of millions of Americans.

The Story So Far

It's been more than two years since the Patient Protection and Affordable Care Act -- aka Obamacare -- became law. On the one hand, it runs to thousands of pages of new rules, yet it still falls short of a total solution to the nation's health care problems.

Make no mistake. The law has makes significant changes:
  • There's a ban on "lifetime limits" on the amount of benefits an insured person can collect.
  • Insurers must justify decisions to increase insurance premiums.
  • 50,000 children age 18 and under have been able to obtain coverage despite pre-existing conditions.
  • Millions of women can now receive mammograms and other preventive care with no deductibles and no copays.
  • 2.5 million children are now able to stay on their parents' health insurance policies up through age 25.
  • 5.1 million seniors are receiving discounts on prescription drugs, helping to fill the Medicare Part D "doughnut hole."
Yet a recent poll conducted by Rasmussen Reports shows that two years after it was signed into law, a majority of Americans feel they've haven't benefited at all from Obamacare's passage.

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More worrisomely for the law's supporters, the number of voters who say they've been hurt by the law outnumbers those who say they've been helped by a factor of two: 26% of voters polled pointed to higher health insurance premiums, and layoffs from employers unable to afford insurance, as the primary "results" of Obamacare -- versus only 13% who say they've been helped by it.

One reason many people think Obamacare has hurt them, or at least not helped, is that many of the law's biggest benefits haven't taken effect yet. If Obamacare survives the Supreme Court's ax, it will still be another year and a half -- 2014 -- before the major provisions kick in. Benefits such as:
  • A universal prohibition on denying coverage for pre-existing conditions.
  • Prohibition of capping the annual amount that will be paid out on a patient's claims.
  • Requiring insurers to cover the cost of experimental treatments.
  • Tax credits for "low-income" consumers -- as much as $43,000 annual income for an individual, or $88,000 for a family of four.
  • Establishment of "insurance exchanges" -- a competitive market for insurance plans.
  • Health-care tax credits for small businesses.
  • And most importantly, the "individual mandate" -- a requirement that everyone in America either buy a health insurance policy or pay a penalty.


The Road Ahead

It's this last provision that's most questionable. The court must first decide whether health care is part of "interstate commerce." And second, it must decide whether Congress can use the Constitution's Commerce Clause to require Americans to buy insurance -- a novel question of law.

If the court finds in the negative on either point, then the individual mandate goes away -- and we're in a real pickle. The insurance industry will be saddled with a host of expensive benefits it must provide, but not enough money to pay for them. Insurance rates will skyrocket -- perhaps by as much as 40%.

Recognizing this, the court could well decide that Obamacare is unworkable without the mandate, and wipe the whole thing off the map. In this case, all the changes instituted over the past two years could go away.

Or not.

Jeffrey Young, writing for our sister site, Huffington Post Business, points out that health-care providers have already instituted "new consumer protections to health plans, [altered] the way medical providers get paid and [taken steps] to improve health and save money. Experts say the push by President Barack Obama's health care reform has created an unstoppable momentum."

Obamacare in the Balance: Will the Court Ruling Really Matter?

This one could be an innocent mistake. There are many departments within a hospital, and it can be difficult for each one to know what the other is putting on the tab. For example, the hospital may charge for your anesthesia, and the anesthesiologist might charge you again. A quick review of your bill should reveal mistakes like this.

If you can, pay attention at the hospital (or designate somebody else) to make sure you only get billed for services actually provided. Sometimes the slip-ups are easy to overlook, like being charged for an extra dose of antibiotics that was never actually administered.

This is another easy one for the average person to miss. You may be diagnosed and treated for the flu, but charged for treatment of bronchitis. A quick Google search can help you verify the codes on your bills.

When Goldstein first started looking over his daughter's bills, this was one of the first things that stood out to him. "When I looked at my bill for my daughter, the operating room charge was $7,400. I thought that was excessive for a 20-minute procedure. The hospital tried to justify the cost by stating that it took an hour and a half to reset my daughter's leg, which means they charged me for the time it took to prepare and set up, which they are not allowed to do." The physician fee schedule search tool at the Centers for Medicare & Medicaid Services website provides payment rates to use for comparison purposes.

This is a tough one. Most doctors are independent contractors, not hospital employees. So while you may go to an in-network hospital, it's not uncommon for an out-of-network doctor to treat you. Unless you ask, you have no way of knowing up front. In emergency situations, asking your doctor what insurance he accepts is likely the last thing on your mind. But if you or someone you are with has the presence of mind to ask, your savings account may thank you for it later.

Excessive hospital billing practices will continue unless consumers get smart about examining and questioning the cost of care.

According to Goldstein, "Less than 15% of patients ask if their bill can be lowered. Of those who do ask to have their bill lowered, approximately 40% receive a discount."

Goldstein's advice: Don't pay any medical bill until you have had a chance to try and negotiate for a lower fee. And if you find fraudulent charges on your bill, it's your right to speak up. The more people who do, the more difficult it will become for unfair billing practices to continue.

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In short, the possibility that the Supreme Court might kill Obamacare outright this week sounds scary, but it may not be as frightening as it sounds.

Motley Fool contributor Rich Smith has no investment-related dog in this fight, neither owning stock nor selling it short in any health care companies.
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