Aurora tragedy shows value of health reform

My 18-year-old is away at a summer college class. Last weekend, she took in a late movie with friends, sending an enthusiastic early-morning tweet: “The Dark Knight was Amazing!!”

She tweeted from Whitewater, Wisconsin, not Aurora, Colorado. My heart still skips an extra beat when I consider the people whose lives were ended or permanently altered by a madman with an assault rifle.

There’s much to say about this incident from a public safety perspective. I happen to co-direct the University of Chicago Crime Lab. So I’ve thought about these issues. See, for example, here and here.

That’s not my purpose today. Instead, I want to note four ways the everyday needs of recovering victims in this tragedy underscore some issues addressed in health reform we might otherwise ignore.

The importance of universal coverage, even for young and healthy people

Midnight moviegoers are a young and healthy crowd. They don’t have a lot of money. Many take a chance and go uninsured. That understandable bet imposes costs and risks on others. It can also go badly wrong. Caleb Medley, who is uninsured, was shot in the eye and now may face $2 million in medical bills.

Stories like these illustrate why everyone should carry at least some level of health insurance coverage such as the “bronze” plans that will be provided in health insurance exchanges under the Affordable Care Act. For the same reason, ACA allows new young adults 19 to 26 to remain on their parents’ employer-based coverage. Because of this, three million people are covered who would otherwise be insured. That’s important for these young people.

This coverage is also important for the doctors, hospitals, rehabilitation facilities, and others who will care for people. Charities and hospitals are apparently stepping in to help Aurora victims and to limit their bills. That’s humane and wise after a nationally-mourned tragedy. Yet one can’t do this every time. What about some other patient who was just as badly injured because he crashed his bike? Hundreds of Chicagoans are shot every year. Many are uninsured.

The importance of an essential health benefit

Suppose you suffered a serious gunshot wound and required regular physical therapy in your recovery. Here’s a pop quiz: How many such sessions would your own insurance plan actually cover? What should they cover to balance patients’ human need with the need to provide disciplined coverage customers can actually afford?

When I think about my own insurance … I have no idea. Nobody can answer questions like that. We shouldn’t have to. Too many things can go wrong. Too many complex services are potentially valuable. Insurers can’t cover everything. They and their customers need fair and transparent guidelines in working this out.

ACA helps to address these issues by establishing standards for an essential health benefit. Simply put, plans offered within the new exchanges will be required to offer benefits that match prevailing standards for plans offered by small employers. The new law establishes a stronger appeals process if you have been unfairly denied coverage for a service your insurer should cover. It bans unethical industry practices such as the rescission of sick or injured peoples’ policies based on innocent paperwork errors.

The new law also provides funds for research so that citizens, government, and private insurers have a better idea about the actual effectiveness of new drugs, medical devices, and therapies. As we search for better strategies to help (say) gunshot victims, such research is extremely important.

The importance of eliminating caps on coverage for catastrophic illness and injury

Even if Caleb Medley were insured, he and his family might have gotten a rude surprise by exceeding his policy’s annual or lifetime dollar caps. As I’ve noted here before, that’s roughly what happened to a football star in our south Chicagoland community who was rendered quadriplegic on the gridiron. ACA eliminated these lifetime caps. It is phasing out these annual limits by 2014. The current annual limit is $1.25 million. The cap will rise to $2 million two months from now.

The importance of eliminating discrimination based on pre-existing conditions

Thirty-one percent of working-age adults who tried to purchase an insurance plan in the individual market “were turned down, charged a higher price, or had a condition excluded because of a preexisting condition.” Survivors of these Aurora shootings may face many challenges which would make them vulnerable to such policies. Maybe they face a chronic health challenge or partial disability. Maybe they require help for depression or PTSD as a result of this experience. ACA bans discrimination on the basis of such conditions.

I could go on, but the point is clear. It’s easy to debate health reform in the abstract, without always seeing the human faces. It’s not always easy to explain many details of the new law. Aurora’s tragedy reminds us that there are real people out there with an urgent stake in this. Many have been helped – and will receive more help in the future – because of health reform. That’s something to be proud of in defending this new and politically embattled law.

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has written about health policy for the Washington Post, New York Times, New Republic, The Huffington Post and many other publications. His essay, “Lessons from an Emergency Room Nightmare,” was selected for The Best American Medical Writing, 2009.