Many Texans already feeling effects of health care reform

March 27, 2012 3:42:38 PM PDT
Protestors surrounded the U.S. Supreme Court on Monday morning as justices began three days of historic hearings on President Barack Obama's healthcare reform law. Two years after parts of the law took effect, the Supreme Court is being asked to overturn it.

Monday's argument was about whether the court can even hear this case before it all goes into effect. A decision won't be announced until June. But we're not waiting. In partnership with the Texas Tribune, we are investigating changes already made to the way you get health care here in Houston.

Our reporting partners at the Texas Tribune crunched the data statewide, looking at where the uninsured are in Texas. Houston is No. 1 -- most in the state.

Here, nearly 650,000 people are without insurance, but there are several other cities in the area where more than 20 percent of the population is uninsured.

Unless the law is overturned, everyone will be forced to buy insurance or pay a penalty in 2014, but Texas families are seeing changes in care already.

Young adults up to age 26 can stay on their parents' insurance. Pre-existing conditions are covered in many cases, and as one Houston family found, the caps on lifetime benefits have been lifted.

Joshua Lacivita is now seven years old, but some of Houston's best doctors once told his mother he'd never be here.

"I just remember seeing him bleed out," Elizabeth Lacivita said.

Josh was born with severe heart defects; he had no pulmonary artery and developed a potentially fatal staph infection just days after birth.

"They told me I needed to baptize him right now because he wasn't going to make it through the night," Lacivita said.

He made it that night, but didn't leave the Texas Children's Hospital ICU for four months.

Joshua had four surgeries before his first birthday and six more since -- and more medicine than you can imagine.

"My husband bought little clocks. Medicines were six (o'clock), seven, then nine, then 12, then three, then six, then nine, then 12. Then it starts over," Lacivita said. "Texas Children's bill was $1.8 (million)."

The bills kept adding up.

"At three months, my husband's lifetime max of $1 million was met," Lacivita said.

The family had great health insurance, but like so many policies, the fine print capped coverage at a million dollars per person.

"You spent $1 million in three months?" we asked.

"And he was there four months," Lacivita said.

The Texas Children's bill was $1.8 million.

The family's insurance plan kicked Joshua off, forcing him into a high-risk pool in Texas that cost the family almost $1,000 a month for six years.

Earlier this year, Joshua is back on his family plan, thanks to a part of the Federal Health Care Reform Act that did away with lifetime caps on insurance policies.

The White House estimates 7.5 million Texans had them on their policies.

The court this week isn't fighting over lifetime caps but other issues. Joshua's mother wishes they would stop fighting it at all.

"There's a lot of the people opposed to it, but I can tell you that a lot of people that are opposed have never had a family member who's been touched with a life-threatening illness, debilitating, that maxed out their limits. They would not have the same stance that they have now," Lacivita said.

No one is arguing that inside the court this week, but if the law is overturned, that provision may be overturned as well.

On Wednesday, we continue our look at changes we're already seeing. The growth of Medicaid in Texas is huge but nothing compared to what will happen in 2014 when the state is set for a Medicaid expansion. It will come at a time when doctors are getting out of the system.


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