Karon Law Blog

The Affordable Care Act: a Personal Injury Attorney’s Perspective

By Jonathan A. Karon

Health insurance has dominated the news lately, because of pending legislation to “repeal and replace” the Affordable Care Act (also known as the “ACA” or “Obamacare”). Because my clients are people who’ve been injured, I routinely become familiar with the details of their health insurance coverage. Particularly in automobile crash cases, where some of the medical bills are paid by auto insurance, this information is important for coordinating coverage to insure that covered medical bills are paid. As a result, I generally know who my clients’ insurance company is, what their deductibles and co-pays are and how much the bills are discounted by doctors and hospitals.

I’ve been a personal injury attorney since long before the Affordable Care Act was adopted and before Massachusetts adopted its own version of universal coverage when Mitt Romney was governor. Here are my conclusions, based on my observations of my clients’ insurance coverage. I do not claim that this is necessarily a statistically representative sample, nor do I claim to be a health care policy expert. But, here’s what I’ve observed.

First, most people have health insurance in Massachusetts since the Affordable Care Act was adopted. It is very rare that I see a Massachusetts resident who doesn’t have some form of health insurance. Ten years ago, that was not the case.  Then, although many of my clients were insured, many were not. Although hospital emergency rooms would not turn them away,  after that they frequently had to find a doctor willing to treat them in exchange for an assignment of benefits (a written promise to pay the doctor out of the proceeds of any recovery).

Now, almost everyone is covered. This seems to be due to the expansion of Medicaid, which in Massachusetts is called “MassHealth”. My understanding is that the ACA helped Massachusetts make MassHealth available to more people, particularly working people. As a result, I’ve seen a significant increase in the number of clients who have MassHealth coverage. As far as I can tell, it’s reasonably good coverage. I don’t recall having any clients who needed significant medical treatment who were unable to obtain it because they had MassHealth.

My second observation is that private health insurance deductibles and co-payments have gotten much worse. I routinely see middle class clients with policies with deductibles in the thousands of dollars. They generally also are paying increased co-payments. I’m very aware of this because in Massachusetts there is no-fault coverage for reimbursement of deductibles and co-pays, so part of my service is to help our clients obtain this reimbursement. I cannot say for sure that these increases have been caused by the ACA, but I can say that deductibles and co-payments have been getting dramatically higher in the past few years. If you have private health insurance, this is probably not news to you.

So, to summarize, almost everyone in Massachusetts seem to be covered, but private insurance deductibles and co-pays have significantly increased. Assuming that these are related to the Affordable Care Act then the verdict of this personal injury attorney would be that the law is working in some important ways and needs improvement in some other ways. As a small business person, ineligible for subsidies, I can suggest that premium increases are also an issue.   I’m not a health care policy expert, but it would seem that reasonable minds, if they wanted to work together, could come up with ways to address these problems and make the law work better. The current climate, however, makes me welcome the comfort of the Courtroom, where we have well established rules and even adversaries are expected to treat each other with respect.