Patient and Family Directly Affected by the Supreme Court's Decision on the Affordable Care Act

Today's Supreme Court decision to largely uphold the constitutionality of the Affordable Care Act (ACA) affects thousands of Colorado children with complex or chronic medical conditions, including a boy born with severe hemophilia.

Long-time Children's Hospital Colorado patient Thomas Wilkes and his parents, Nathan and Sonji, are directly impacted by the Supreme Court's decision regarding the ACA. Thomas was born in 2003 and diagnosed with hemophilia. His father Nathan worked for a company with good insurance, but after Thomas was born, the company's insurance rates increased dramatically, and the insurer instituted a new $1 million lifetime benefit cap.

Forced to change jobs and insurance companies due to lifetime benefit caps

Due to the cost of Thomas's care, the Wilkes family hit the $1 million cap in early 2007 and switched Thomas's coverage to Cover Colorado, the state's high-risk insurance pool for individuals with preexisting conditions. But Cover Colorado also has a $1 million lifetime cap. So Nathan started his own small business in order to buy coverage on the small-group insurance market, and he was able to find a plan for his business with a $6 million lifetime cap. The cost of Thomas's care is currently running over $1 million per year.

Now, as a result of the ACA's consumer protection and insurance reform measures, for the first time there's no lifetime benefit cap.

All kids deserve access to quality, affordable healthcare

"Thomas needs access to care, not just for quality of life, but for life itself," said Sonji Wilkes, Thomas's mother. "Today's decision is a welcome relief and guarantees that the critical consumer protections of the ACA will continue to aid Thomas and thousands of other children as they grow into adulthood."

Children need access to care to grow up healthy and strong. Under the insurance reform and consumer protection provisions of the ACA, 291,000 Colorado children with pre-existing health conditions now cannot be denied insurance coverage. More than 40,000 young adults under age 26 have gained health insurance coverage through a parent's plan. And just like Thomas and the Wilkes family, 521,000 children and their families no longer have to worry about lifetime benefit limits on their insurance coverage.

Watch a video about how the Supreme Court decision will help the Wilkes family

What Does the Affordable Care Act Mean for You?

While the Affordable Care Act will move forward, it will take time to sort out the full impact on kids’ health and on Children’s Hospital Colorado.

If you have questions or would like to learn more, please join the Advocacy team at the Lunch and Learn event on “What the Affordable Care Act Means for You” from 12:00 –1:00pm on Tuesday, July 17 in Mt. Yale Conference Room. Please RSVP for this event.