Only 8,000 enroll in health plan for preexisting conditions

[eridani]

American Medical News
http://www.ama-assn.org/amednews/2010/12/27/gvsa1227.htm

As of Nov. 1, only 8,011 people were enrolled in the Pre-Existing Condition Insurance Plan, numbers from the Dept. of Health and Human Services show.

People who have been denied coverage by private insurers because of a preexisting condition and who have been uninsured for at least six months are eligible to participate in PCIP. The idea is to give patients who have no access to private coverage because of their condition a way to get insurance while they wait for the state-based health insurance exchanges to launch in 2014.

Almost 6 million Americans are potentially eligible for the program, which runs through 2013.

Comment by Don McCanne of PNHP: One of the highly touted transitional programs of the Patient Protection and Affordable Care Act is the temporary high risk health insurance pool program designed to provide health insurance for individuals with preexisting conditions. Until the state insurance exchanges are in operation in 2014, this program provides a source of insurance coverage for eligible individuals who have been rejected by private insurers because of preexisting conditions.

How successful has the program been so far? After four months of this three and one-half year program, 99.9 percent of eligible individuals have not yet been enrolled. Only 8,011 out of about 6,000,000 eligible have.

Several explanations have been advanced as to why participation is so low, but they are trivial compared to the most fundamental reason. Our fragmented, dysfunctional health financing system based on private insurance plans will never be capable of bringing everyone in and making the premiums and out-of-pocket spending affordable. As this program demonstrates, trying to apply patches to a rickety financing infrastructure will never be adequate to provide health security for everyone.

We need to dump the crumbling financing infrastructure based on the obsolete model of private plans and replace it with the sturdy structure of an improved Medicare that covers everyone.

My comment: I suppose that helping a few wealthy sick people is useful, but the rest of the sick population is stuck with the choice of being homeless or continuing to have no access to health care.

[Skittles]

1. probably the number of people who could afford it

[OKNancy]

2. I looked into it. At my age it would be $1000.00 per month

Not exactly affordable. I'm just holding out and hoping I stay alive until I'm eligible for Medicare.

[eridani]

3. Better gear up for the fight to defend Medicare, then n/t

[eomer]

19. Are you sure? The highest premium is $704 per month from what I could find.

Here is the source I found for the new federal high risk pool for Oklahoma:

http://www.healthcare.gov/law/provisions/preexisting/states/ok.html

It says that premiums range from $137 to $704 per month.

Is it possible you were looking at the older Oklahoma high risk pool that predated the new law? It charges premiums that are 150% of standard rates while the new federal pool charges standard rates (in other words, 100% of standard rates).

[OKNancy]

26. Yes, I probably looked at the wrong table. Still can't afford $704.00

and of course there is my husband too, although he is 4 years younger than I am.

[eomer]

30. I understand, it's not a big difference. Just wanted to make sure you had the right information,

just in case it would affect your decision.

I'm sorry, sincerely, that it doesn't help you. It's a real shame (a crime, actually) that very little was done to help right now people who need the help, right now.

[laconicsax]

4. I'd totally apply if I could afford it.

(In Oregon, it's state-run.)

I'm not in the position to shell out over $300-$400/month in premiums for myself, pay $3000-$7000 out of pocket for medication (with no out-of-pocket annual maximum), preventative care, immunizations, routine physicals, and still have to wait six months before I can even dream of getting covered for the pre-existing condition that's gotten me denied in the past.

But hey, at least I have the option of paying through the nose! That's what I voted for in '08, isn't it?

[eomer]

23. Maybe I'm not following you.

The new PCIP (whether state-run or federally administered) does have an annual out-of-pocket maximum, doesn't it? Here is a brief summary for Oregon:

http://www.healthcare.gov/law/provisions/preexisting/states/or.html

And I'm not following what you mean about the six months wait. It's that you have to wait six months after being denied coverage, isn't it? Once you've met that requirement and can enroll in the PCIP then you're covered right away for the pre-existing condition. Or am I misundertanding?

[laconicsax]

31. The Oregon program has maximums, just not for everything, and not everything counts towards

the deductible.

If I were to go to a doctor for a physical, immunization, and get a prescription, I'd have to pay as much as 100% out of pocket and none of it would count towards the deductible. All for the low, low price of $300-$400 per month in premiums ('cause I'm still relatively young).

[Recursion]

33. The pools got exempted from the preventative care requirement?

Every other plan in the country has to make that free.

[laconicsax]

42. Read the details for yourself:

http://www.oregon.gov/OPHP/OMIP/docs/member_handbook.pdf

Page 14 of the PDF (page 11 of the handbook):

Prescription medications do not accumulate toward the maximum out-of-pocket expense. Other services which do not accumulate toward the maximum out-of-pocket expense (as defined in the contract) include:

etc. The facing column also lists (among other things) dental care and eyeglasses as not covered. The previous page has a nice bold block of text which reads

The following out-of-pocket expenses do not accrue toward the medical deductible: prescription medications, emergency room co-pays, certain preventative care benefits and services, transplants performed at non-contracting facilities, and non-covered medical expenses.

[Recursion]

43. Well, so the $0 you pay for the checkup and immunizations won't count...

...towards your deductible.

I'll be the first to agree with you that not counting prescription drugs is an absolute travesty.

[bread_and_roses]

5. That six month waiting period is so cruel -

among the other stupidities and inequities of this bastardized muddle that always stood out for me. Why make people wait six months? Hoping they'll die? You can bankrupt yourself with six days care in this country, hell - six hours in some instances - never mind six months. All it can do is make people sicker by the time they can get care - presuming they can afford it, which most won't be able to - and what the hell does "affordable" mean anyway?

Every time I see someone tout this mess as a victory the top of my head blows off.

[Recursion]

16. It's the same rationale as the once-a-year open season

And it keeps insurance companies from dumping everybody in September to take advantage of that.

That is, it sucks, but without it premiums would have to be about twice what they are to keep the thing afloat.

[bread_and_roses]

17. It sucks because it is embedded in a for-profit system

and so has to serve for-profit ends. Like everything else in this worthless bill.

[Recursion]

20. Nope. The Federal PCIP is government-run

And the insurers that do the underlying provisioning are taking a loss as a condition of participating in the Federal market.

So, the issue is not insurers' profit. The issue is how much treatments in the US cost.

[bread_and_roses]

25. as long as insurers are involved in any of our medical care

then every part of the system has to work to assure that their profits are not harmed. So if that means that the gov takes the sickest, while the for-profits get the premiums of the healthy, then that too is part of protecting the vampire profiteers. It's all of a piece.

As for the cost of our medical care, all we need to do is look to countries that have a universal system to bring it down. Again, protecting profits.

[Recursion]

29. You're stating that because other countries have a universal social insurance system

their prices are lower.

Now, let's look at emphysema patients. Notice how they all have yellow fingernails? They must have emphysema because of their yellow fingernails. Let's paint our fingernails yellow and we'll get emphysema too.

You have cause and effect backwards, IMO. Other countries can afford universal social insurance systems because their providers make less money than ours do. There are lots of reasons for that; a big one is that their doctors and nurses don't need to make as much money as ours do, because they don't come out of med school with half a million dollars in debt. And, frankly, they can pay less for drugs and medical devices because the insanely high amount we're paying subsidizes that.

[bread_and_roses]

57. The connections between for-profit health "insurance" and the cost of care is supported by

hundreds of articles, studies, etc readily available - as I think you know full well.

Of course the insane cost of a medical degree in this country is part of the picture - as is our entire vampire capitalist system - nothing exists in a vacuum, and everything is related. There is no more necessity for education to cost so much than this is for the existence of private insurance in health care. They are both outcomes of a rotten, for-profit-driven system that shovels wealth upward.

I had to laugh at your attempt at condescension - go teach your grandmother to scramble eggs.

For the life of me, I cannot tell if you are defending this predator system, or defending the ludicrous notion that the Bill passed is an actual "reform," or if you are simply arguing from within the conventional "things as they are" frame - however, since all have the same outcome, I guess it doesn't much matter.

Defend it all you want, take the status quo as a forever given if that suits you - the reality is that the Oligarchs are sucking the life out of us in this arena as elsewhere, and this deliberate farce of a program will not get the numbers the care they need - just like the rest of this farce of a "reform." People will just keep dying and going broke as long as we decide to comply with their demands.

[TheKentuckian]

59. I don't think the entire industry is as "clean" as you do.

The existence of the insurance cartel pushes prices upwards at all times. They are designed to pass through as many dollars as possible by any means necessary.

The odds of cartel collusion are as close to 100% as possible while leaving any fleeting shadows and the possibility of the whole ball of wax from the insurance cartel to facilities to pharma to the captured state regulators acting in substantial concert to get as large a chunk of the economy go through their hands as possible I'd guess are fairly extreme as well.

[blindpig]

44. Keep the insurance company investors afloat, you mean.

We don't need them, take those parasites out of the equation and things become more affordable immediately.

Why does my doctor offer 50% discount for the self-payer?

[Recursion]

45. Even Medicare has an open season policy, for the same reason

You can't just join Part B whenever you feel like it.

[SoCalDem]

6. How many of the "eligible" are now unemployed? or cut back to minimum hours?

This is the stupidest way ever to insure the "un-insurable" ones..by dumping them all into one pool, they guaranteed that the costs would be astronomical..as well as the premiums.. The reason insurance ever works is because the risk is spread out over a WIDE range.. Not everyone will have a fire, but if everyone has insurance , the money not paid out more than covers the occasional fire, and allows the insurers to pocket the rest as profit..

The same goes for any type of insurance.. the more people IN the pool, the less it can cost to everyone, and the more coverage people get.

When you narrow the scope and only include the sickest, you have a recipe for failure.. Sick people probably make less money, and are the least likely to be able to afford ANYTHING out-of-pocket for health care..

[old mark]

7. I pay over $600 per month for my health insurance, which is PA state supported, and there is no way

I could go without it for 6 months. They add rules designed to keep people out, then point to the fact that so few are in.

Politics as usual in the US - lie to me and manipulate me for your agenda.


mark

[vi5]

8. Again, the biggest flaw with this "reform"

was that it didn't make healthcare more affordable and it didn't provide an option outside of the private, for profit healthcare system. Because heaven forbid our modern democrats do something to imply that the free market, supply side economic model isn't just the best thing in the world.

So yeah, anyone who can afford the insurance but was previously denied is lucky and it's a good thing for them. But far too many people still cannot afford several hundred extra dollars a month just for the right to have a private insurance company cover some of their medical costs.

[boppers]

9. My wife and I would have to pay 3,600 a month for it.

That's how much her meds cost.

3,600.

A month.

The problem is not insurance.

[Vinca]

15. My husband and I would be looking at $3,000 a month.

We're self-employed and the past few years have been so bad it would be darn close to 100% of our net income.

[MedicalAdmin]

18. But insurance is a large part of the problem.

My own meds cost about $400 per month ( which I can't afford so I do without) . The same cost in Canada for
The same drugs made by the same pharmacy company at the same facility? $14.

Yup more than 2000% more for exactly the same drugs and ya gotta ask why. It's about the skimming and outright theft. But the insurance companies are murderers too. It's murder for profit and the pharmacy execs, the banksters, and the insurance ghouls all need to have all their I'll gotten gains seized and their lives ended. Their families need to be stripped of all assets and put to death as well. They are a sickness and need to be removed for the good of humanity.

That's my rant of the day.

[area51]

49. +1

Insurance agencies are serial killers. Why would letting the status quo continue ever be considered a good idea?

[eomer]

28. The premiums in Oregon range from $221 to $714 per month

Or were you making some other point that I missed? My apologies if so.

The page for info on the Oregon version of the PCIP:
http://www.healthcare.gov/law/provisions/preexisting/states/or.html

[laconicsax]

32. The $221 figure is for 18-19 year olds at the highest deductible.

Read the tables for yourself: http://www.oregon.gov/OPHP/OMIP/docs/member_handbook.pdf

The premiums are listed on page 20.

A 35-year old would pay between $309 and $428 per month in premiums and still have out of pocket expenses that may not count toward an annual maximum.

For a 50-year old, the monthly rates are from $485 to $671 per month.

Such a bargain!

[Recursion]

34. That's cheaper than my good non-profit group plan

It's just that my employer pays most of that.

[laconicsax]

39. Uh huh. And that is comparable because?

If you're eligible for these plans, you aren't going to have an employer covering any of the cost.

[Recursion]

41. Right, but the money still has to come from somewhere (nt)

[eomer]

50. Right, I was replying to boppers #9 who said it would cost $3600/month for the two of them.

Maybe they were making a point about deductibles, out-of-pocket, etc. and I thought it was worth clarifying so someone reading it doesn't go away with a mistaken impression.

[boppers]

58. Well, it was a slightly different point.

She can get coverage (thus, is not part of the groups eligible for the state coverage of people rejected for their conditions), but the coverage and treatment costs for her are incredibly expensive.

Infliximab, for example, isn't cheap.

"Infliximab can cost $19,000 to $22,000 a year per patient wholesale, according to Centocor.<6> Remicade is typically covered under major medical insurance (rather than prescription drug insurance)."

http://en.wikipedia.org/wiki/Infliximab

That's our costliest drug, but it gives you an idea of how much some people have to pay for the privilege of being able to.... walk, sit up, move their arms, luxuries like that.

[eomer]

60. OK, thanks.

"the privilege of being able to.... walk, sit up, move their arms, luxuries like that", which is the reason we should have a universal right to healthcare. It's amazing that a universal right proposal can't even make it into the debate because of the stranglehold (literally) that the corporate media has on us.

Best wishes to you and your wife.

[Stinky The Clown]

10. Thisis the very antitheis of what a liberal would put in place.

This is the very definition of what a protector of the status quo would put in place.

[blindpig]

46. I don't believe there is a difference.

But I also believe that a lot of self identified liberals would not be so if they understood what 'liberalism' really is, the left hand of capitalist political philosophy.

[eomer]

61. A lot of self identified liberals...

...in the US are in favor of some variation of regulated capitalism. Most people in the group I just described would be in favor of single payer and a universal right to healthcare, I believe.

That is different than the status quo.

[Recursion]

11. Insurance companies aren't making money on Federal PCIP

I'm not sure if they are in individual states; Federally HHS set it up as a loss-leader required to get into the Federal market (CA just did a similar thing).

This is just how much it costs to cover sick people. I wish it were less. But this is how much it costs.

[MedicalAdmin]

21. This is NOT the cost of care.

It is the cost of care in the corrupt USA system. In civilized countries it is reasonable.

[Recursion]

22. So, it is the cost of care

It's just that the cost of care isn't what it should be.

Give doctors student loan forgiveness if they work at FQHC's. Break the AMA's stranglehold over med school enrollments that keeps the number of doctors artificially low. That would do a lot to solve these problems.

[MedicalAdmin]

24. Right on brother

You and I are on the same page on this. One of the ways to contain costs is to not make doctors and nurses dead broke and insanely in debt before they ever work. The average doc starts with at least 250000 to half a million in debt before they get their first job at an age when other folks have savings and a home.

There is a better way and you just mentioned some of them.

[Recursion]

27. And that level of debt is increasingly difficult for a GP to work out from under

And it's GP's that we are really going to need to start treating the 50 million people currently locked out of the system. Meanwhile, oncologists get to buy chemo drugs from pharma companies and sell them at a markup to patients. It's enough to make me bang my head against the wall.

[lonestarnot]

12. What a fucking nightmare.

[Vinca]

13. I wanted to enroll in it, but our state opted to use the existing state program

and it's just too expensive. Allowing access to medical care doesn't make large piles of cash magically appear.

[hobbit709]

14. If it wasn't for my VA coverage

I'd be dead. I can barely afford the $56/mo copay for my meds. They would cost more than $800/mo if I had to pay for it outright. This year I made about $10K.

[Ron Green]

35. Medicare for All!

[Missy Vixen]

36. We're eligible. We can't afford it.

It's either pay the premiums and skip essentials, or go without. Of course, we are not alone.

This is a bailout of the health insurance industry. Period.

[jtown1123]

38. Thanks. It boggles my mind that these articles failed to mention

that the reason for the lack of sign ups was a cost barrier.

[Missy Vixen]

40. The parties that wrote and were interviewed for the article

do not want it made clear that the reason why people aren't signing up is cost. After all, this will be yet another program deemed "a success", and those who can't afford it are simply "unmotivated" or "don't care about the burden they are to others".

You KNOW it's coming.

:eyes:

[jtown1123]

37. What do these plans cost? Not one news article has explained if pple can even afford them.

[Motown_Johnny]

47. I saw a piece on TV last night, $600.00 a month was mentioned

as an example explaining that these are expensive right now and that they are a stop gap until 2014 when the other reforms kick in.

NBC or MSNBC, not sure where I saw it but it was one of those.

[Caretha]

48. I remember

when the Health Care Reform bill was passed that many DUERS were trumpeting how great this particular part of the bill was, and that made up for the lack of a any form of public option or single payer option, and those who said this wasn't going to work were just selfish and wanted a "pony".

Where or where are those Duers now so they can remind us "unpragmatic" leftists how right they were and how we were wrong?

8011 Big whoopee f'in deal. Insane is what it was and insane is what it still is. I need someone to remind me how "unpragmatic" I am.

[Recursion]

51. A lot of us think a public option wouldn't be any cheaper (nt)

[Caretha]

52. It seems to work well

for other Industrialized nations, but what the hell do they know....they're "unpragmatic" too, I guess.

[Recursion]

53. They have healthier, richer populations to start with and their doctors make less

I look at them and say that they have lower delivery costs which is why they can afford universal social medical insurance.

You look at them and say they have universal social medical insurance which is why they have lower costs.

Have you ever read the McAllen, TX Medicare study?

PCIP is already run not-for-profit. Any pool faces the exact same actuarial realities, and has to take in as much as it pays out. Loading up the people we already know are sick into one pool is stupid, but too many of the rest of us don't want to see our premiums go up by the amount it would take to cover them.

[Caretha]

54. I'm quite cognizant

of the differences in other societies of Industrialized nations. I also realize that you have to start somewhere, and that having tunnel vision doesn't allow for any progress. In fact you begin to sound like a broken record.

[MisterP]

55. their job is to keep DUers off the streets and within the "reform within the party" frame

so they don't pursue non-electoral politics or create a Third Option with policies that 70% of Americans want and against constant compromise--a party that will educate and listen to members instead of screaming that they're ungrateful, insolent brats who should have their faces trampled into the mud for daring to question the best laws passed since FDR, JFK, and LBJ

[tpsbmam]

56. 100% unaffordable for me in NC. The low numbers don't surprise me at all.

The premiums for even the worst plan is way out of my price range. The whole thing for most people is a cruel joke. All of the ballyhooing by Obama about how fantastic this is just makes me madder.

:mad: