Mar. 29--Even among families that stand to benefit from last week's passage of the health care law, opinions are split.
Like many Democrats, some Dallas-area families see the overhaul as a historic achievement that will lead to better health care for millions of Americans.
Like many Republicans, other local families fear government intrusion and stratospheric costs.
Last September, The Dallas Morning News profiled five families with challenging health insurance needs.
The News asked the Commonwealth Fund, a New York-based nonprofit, nonpartisan group that promotes health care improvements, to analyze how the legislation will affect them. Sara Collins, vice president of the Affordable Health Insurance program at the Commonwealth Fund, took on that task.
David Null, 40, was busy attending to children Hannah, 8, and Tatum, 12, when the health care measure passed. So he missed the last-minute maneuvering and has yet to plow through the 2,300-page bill.
But in October, he felt strongly enough about the topic to speak before a House subcommittee, pleading for help for families like his.
When Tatum was 7, she suffered acute liver failure. Her care, which included a liver transplant, has cost more than $1 million. The family's insurance policy at the time had a $25,000 lifetime maximum per medical event, which was quickly maxed out. The family ended up on Medicaid.
After the transplant, Null said, it became impossible to find an individual health insurance policy that would cover Tatum.
Since the new law eliminates lifetime coverage caps this year, "the problem this family faced of reaching the limit of their coverage would be eliminated," Collins said.
Null said premiums on a policy with no coverage limits might be higher, but boosting them too high would go against the spirit of the law, by making coverage unaffordable.
The Nulls also could benefit from provisions that prevent insurers from denying coverage to children with pre-existing conditions, Collins said.
Null, an independent contractor who cleans and maintains air conditioning systems, said during one search for an individual insurance policy, "I had an agent tell me, 'Don't waste your time applying; we won't even review it,' " if the application included Tatum.
"The reality is now they would have to take my application," said Null.
Null's children have "fantastic insurance coverage" through the Richardson Independent School District, where his wife, Sherry, works. Null is on a separate individual policy.
Long term, Null sees the health care overhaul as a boon for Tatum's future independence.
"She doesn't have to work for a large corporation ... to get benefits," he said.
Amy Townsend, 38, of Hurst was preparing last week for yet another round of treatments in her battle against breast cancer.
Like many Democrats, some Dallas-area families see the overhaul as a historic achievement that will lead to better health care for millions of Americans.
Like many Republicans, other local families fear government intrusion and stratospheric costs.
In addition to steeling herself for possible side effects, she and husband Jesse, 43, were preparing for the possibility that they might have to pay hundreds of dollars, up front, before radiation treatment can begin.
With both Amy and Jesse unemployed, the family buys health insurance through COBRA with a $5,500 yearly maximum for out-of-pocket expenses -- a threshold the family has not yet met. COBRA coverage generally lasts up to 18 months.
"We've got to come up with some money for next week," she said.
Though she still faces medical bills, Amy said she was against the health care act, fearing so-called death panels and government inefficiency.
The Townsend family might be eligible for Medicaid, suggested Collins of the Commonwealth Fund. Townsend wasn't interested.
"Every government program -- Social Security, Medicaid -- none of them work very well," she said.
The couple, who made $150,000 a year before the economic downturn, now lives on unemployment. The family pays for COBRA with severance money from Jesse's former employer, AT&T, that will last until the summer. That and a government subsidy keep the monthly premium payments to a manageable $160.
When the severance benefits and other subsidies are gone, Amy said, the family might have to look -- reluctantly -- at some of the options contained in the new health care law.
"If I get to the point where we couldn't afford to pay [for health insurance] maybe that would be a safety net," she said. "But if they force you to pay and you can't afford it, then you are back where you were."
Gwen and Alan Lummus of Dallas see the health care act as a step in the right direction -- though Alan said he'll likely be on Medicare before many of the money-saving benefits kick in.
The entrepreneurs, who own an online book accessories store called BookMateStore.com, are in Texas' high-risk insurance pool, paying about $750 a month each in premiums with a deductible of $7,500 each.
"We pay virtually everything out of pocket unless we have a major catastrophe," said Alan.
They also face a $500 deductible for prescription drugs.
Alan has diabetes "so none of his insulin is covered," said Gwen, 61. "That's all out of our pocket."
The two, who followed the health care debate closely, said they are glad some health care measure passed.
"The way the system was, it was unsustainable," said Gwen.
Collins said that in four years, anyone without employer coverage will be able to purchase coverage through state health insurance exchanges, with subsidies based on income. Alan Lummus hopes to be on Medicare by then, with Gwen not far behind.
Jose Rodriguez still hasn't been able to find reasonably priced health insurance to cover him, his wife and his two daughters, ages 11 and 16.
"We haven't been able to afford it," said Rodriguez, 52. "Personally, I haven't been able to come back and recoup from my business."
His company, which built granite countertops for homes and commercial buildings, went under last year because of the recession.
Today, he's trying to make a living as a business consultant and holds his breath that a major illness won't strike his family.
"Right now, we're uncovered," said Rodriguez, president of the Greater Grand Prairie Hispanic Chamber of Commerce. "We're paying as we need and praying that we won't face a horrible situation."
Rodriguez won't disclose how much he earns but said it's less than 30 percent of what he previously had earned. When shopping for family coverage, he said, the monthly premiums ranged from $1,000 to $2,000 a month.
Collins said starting in 2014, depending on his income, Rodriguez can either qualify for Medicaid, which has an income limit of up to $29,327 for a family of four, or he can buy subsidized coverage through the insurance exchange in his state.
More immediately, as a buyer of an individual health care policy, Rodriguez will benefit from new regulations that go into effect in six months that bar cancellation of policies when people become ill, Collins said.
Minimum standards on policies will increase the comprehensiveness of policies and thus their premiums. However, restrictions on underwriting and the mandate to have insurance will bring in more healthy young people and will lower premiums.
Rodriguez said while the health care legislation will benefit his family, he's concerned about its long-term effect on the U.S. economy.
"The government talks about huge deficits like we talk about pennies," he said. "Money is not going to fall from the sky. Somebody has got to pay for it."
For Gail Penry, who has lupus, there are good days and bad days.
"I have a lot of battles that I still fight all the time," said the 57-year-old Dallas woman. "Sometimes my body just won't work. My mind can command it, but it doesn't work."
Collins said Penry, who has been on COBRA disability insurance, will soon have coverage this year from Medicare, since she's nearing the end of the waiting period for people who become disabled and can't work.
"She would not be affected by the provisions in the bill that go into effect six months from now," Collins said.
Also, under the new law, there will be no out-of-pocket costs for preventive services in Medicare beginning this year, Collins said.
Penry said she's glad the health care legislation became law.
"I feel good about it," she said. "It's pathetic that people die because they don't have the money."
pyip@dallasnews.com;
krobinson@dallasnews.com
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