Love it or hate it, it looks like the Affordable Care Act (a/k/a "Obamacare") is here to stay. Few pieces of legislation in my memory have created such controversy and conflict during passage and implementation. Having practiced personal injury law in Houston for almost 20 years, I have learned quite a bit about the effects that health insurance have on a personal injury accident claim. From my perspective, Obamacare has significant potential to affect your rights in a personal injury claim in Texas.
I understand that there is significant debate about Obamacare, whether it is fair and right, whether it will work, and whether it will lower or raise health care costs in this country. It is not my purpose in this article to take sides in this sincere and important debate. I'm an attorney, not a legislator. It is not my job to write the law, rather, it is my job to help my clients understand it, and how it may affect their personal injury accident case. One of my great passions in life, and the purpose of my blog, is to help my neighbors here in Houston and throughout Texas understand the law and the impact it may have on their lives. I love to give information, because information is power, and nothing is better for a robust legal system than informed and empowered citizens.
There are two general aspects of Obamacare that have the potential for leaving a big footprint on personal injury claims brought by those who live in Houston and throughout Texas. The first of these is the individual mandate (the most controversial aspect of the law), but I'll come back to that in a moment. While the individual mandate tends to cause the most "ruckus" in political and conversational circles, the fact is that the bulk of the Affordable Care Act has more to do with regulating the operations, administration, and coverage of health care insurance than in forcing people to buy health insurance that they may or may not want. The greatest potential for Obamacare to affect personal injury claims in Texas is via the "meat and potatoes" of these detailed regulations.
You've probably heard by now that Obamacare requires insurance companies to provide health insurance coverage to individuals regardless of any pre-existing conditions, and to provide full coverage for those pre-existing conditions. One common concern among my personal injury clients when their cases are resolved is what will happen if they suffer a "flare up" of their injury. Texas law allows recovery for future medical care in a personal injury claim. When appropriate, I always make sure that the claims I make for my clients include appropriate amounts to cover any future medical expenses they may incur as a result of their injuries. Unfortunately, it is sometimes difficult or impossible to accurately predict the amount of future medical care that may be needed. Now my clients can rest assured that, no matter what happens with their health or the status of their injuries, because of the Affordable Care Act they will be able to have their injuries treated under any health insurance policy they may have in the future.
Another example of the effects of Obamacare on a personal injury accident claim: Any hospital that is a 501(c)(3) charitable hospital is now required under Obamacare to "limits amounts charged for emergency or other medically necessary care provided to individuals eligible for assistance under the financial assistance policy . . . to not more than the amounts generally billed to individuals who have insurance covering such care." This Federal code provision basically means that if a charitable hospital provides emergency or other care to someone who is uninsured, they are required to bill that individual no more than that which would be paid on behalf of someone who has health insurance. It is my experience that those involved in a serious car accident can be taken to the hospital and walk out with hundreds of thousands of dollars in medical bills and no way to pay. In the past, in many situations, those who appeared at a hospital's emergency room with critical injuries, but without health insurance could legally be billed five or ten times as much as what those individuals with health insurance would pay for the exact same services. Because of changes implemented in Obamacare, this disparity is beginning to be addressed.
Going back to the questions about what will happen to a seriously injured client in the future, many of my personal injury clients have suffered catastrophic injuries in car crash or other accident that may require a lifetime of monitoring and medical care. While I make every effort to insure that my clients will be well taken care of for the rest of their lives, that lingering question may always remain: "What if . . ?" Well, the good news is that this question now has an answer. Under The Affordable Care Act, lifetime limits, or "caps," on spending for essential medical services are now lifted. When I do my part to make sure that sufficient amounts are recovered for future medical care, any lingering concerns about sufficiency can now be limited by this provision of Obamacare.
So far, it appears that Obamacare will have a generally positive effect on my personal injury clients living in Houston and throughout Texas. There is one aspect of this law, however, that does cause me some concern in regard to my clients' personal injury and accident claims. Since the major tort reform laws were passed in Texas in 2003, Texas Civil Practices and Remedies Code §41.0105 has mandated that "recovery of medical or health care expenses incurred is limited to the amount actually paid or incurred by or on behalf of the claimant." What has this meant for my personal injury clients in Houston and Texas? Well, simply put, when one of my injured clients has health insurance, this Texas law prevents us personal injury lawyers from recovering as medical expenses anything greater than the sum total of what was paid by the health insurance company plus any co-pay or deductible owed by the client. While a provision of Obamacare discussed above may limit the amount charged by charitable hospitals to uninsured patients, that same provision does not apply to "for profit" hospitals (and believe me, there are plenty of those in Houston!)
Given this limitation of the Affordable Care Act, plus the effect of the individual mandate, my nightmare scenario as in making a personal injury claim is as follows: My client is injured in a car accident in Houston, is transported to a "for profit" hospital, and walks out with a medical bill of $50,000.00. If that client does not have health insurance, despite the federal mandate requiring coverage, what is to prevent an unscrupulous auto insurance company (and believe me, there are plenty of those in Texas!) from only agreeing to pay what the hospital would have been paid, had my client followed federal law and had health insurance coverage? This amount could end up being far less than the bill my client is actually required to pay! While this is a fight I would fight to the end to win on behalf of my personal injury client, it is a fight I would not have had to consider facing, absent the effects of Obamacare.
Article courtesy of Houston Peronal Injury Attorney Stewart Guss. I've been practicing personal injury law and helping folks in Houston, The Woodlands, Katy, Spring, Tomball, Cypress and throughout Texas navigate the law for almost 20 years after their serious personal injury accident claim.