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Uninsured Utahns

"I hate relying on charity when we work hard and are willing to pay our premiums."
Small businesses drop health coverage, as costs rise, leaving Utah families uninsured.

Allisan and her husband were doing everything right.  They were both working, had health insurance through their employer, and were excited to start their family.  However, 7 months into her pregnancy, she and her family found themselves uninsured.  Hit hard by the recession, the cost of providing employees with health coverage was just too much for her small business employer.

Since their company no longer offered benefits, they weren’t eligible for COBRA.  And they couldn’t buy an individual plan because pregnancy is considered a pre-existing condition! Left with no other options, they accrued over $10,000 in medical debt from the birth of their baby girl.

Luckily the hospital and pediatrician gave us breaks on the amount we owed, but I hate relying on charity when we work hard and are willing to pay our insurance premiums,” says Allisan.  “Something has to change!  Health care costs way too much, and insurance companies shouldn’t be allowed to discriminate against pregnant women or anyone else with a so-called pre-existing condition.”   

Here is how the Patient Protection and Affordable Care Act will help Allisan and her family:

  • In September 2010 a temporary high-risk pool called the Pre-Existing Condition Insurance Plan (PCIP) will provide immediate access to insurance for Utahns who for at least 6 months have not been able to get coverage because of a pre-existing condition. This pool will operate until 2014 when the full health reforms come online.
  • Lower income Utahns will be eligible for subsidies to help them purchase coverage through the high-risk pool.  PCIP has consumer protections to ensure you get quality insurance. The plan must cover at least 65% of a patient care costs and cap out of pocket charges at $5,950 a year for an individual or for a family, $11,900. The plan cannot exclude coverage of pre-existing conditions or charge older Utahns more than younger people.
  • Starting September 2010, insurers cannot discriminate against children based on pre-existing conditions.
  • In 2014, insurers cannot discriminate against anyone based on pre-existing conditions.
  • Individuals and families will be able to shop for and compare affordable plans on a new transparent, online marketplace called an Exchange.
  • Families may receive subsidies to help buy coverage from their state’s health insurance exchange.  Based on income, there will be a cap to the amount charged for premiums and out-of-pocket expenses will also be capped.
  • If they still cannot afford to buy insurance, they could apply for a hardship waiver and subsidies will be provided to families with incomes of up to 400 percent of the poverty level