Plain Truths About Health Care Reform from Plain, Wisconsin
“Losing health care coverage just before your due date is not something you read about in “What to Expect When Expecting.” Who would expect to lose their health insurance just when they needed it the most, but that is just what happened to a family from Plain, Wisconsin.”
-JoAnn Volk, Waiting for 2014: One Family’s Story, How the ACA’s essential health benefits may help Henry get the health care he needs to grow and thrive.
Our friends at the Georgetown University Center for Health Insurance Reform blogged this past week on another Georgetown blog we frequent (Say Ahhh!) about a family from Wisconsin. The Ferstl family lost their employer-sponsored health insurance when Aaron was laid off from his job, only a few weeks before their son Henry was born. Paying for COBRA around delivery and hospital expenses was difficult enough for the family, but Henry also suffered a stroke in utero, resulting in cerebral palsy affecting his brain and ability to control the right side of his body. He will need extra care to help with his development.
The coverage the Ferstl’s could buy into through Beth’s small employer was nowhere near as comprehensive as the COBRA from Aaron’s large employer. This is particularly true for the physical and occupational therapies Henry needs because of his developmental delays. He is getting some, but not all that his doctor says he needs. Often, small group plans do not cover all the needed services in these habilitative and rehabilitative categories.
Thanks to the Affordable Care Act, benefits are likely to be much more comprehensive in 2014. Insurers who sell in the small group and individual market will have to meet new “essential health benefit” standards, to ensure that necessary benefits (like habilitative and rehabilitative services) are covered for children like Henry. There’s still work to be done on a state level to determine these benefit standards. We will keep you updated through the WCCF blog about Wisconsin’s process.
Sara Eskrich
