Low-cost coverage in Obama health plan not for all

[Demeter]

Source: AP

It's an eagerly awaited early benefit of President Barack Obama's health care overhaul: affordable coverage for Americans with medical problems who can't get a private insurer to even take a look. Starting in July, a special high-risk pool will offer coverage to uninsured people with pre-existing health conditions at a cost similar to what everyone else pays. It's the first test of whether the administration can deliver on Obama's vision within the budget Congress set.

But some vulnerable patients are probably going to feel a little cheated. Consider this coverage wrinkle: Suppose your cancer is in remission. You had to quit your job while you were having chemotherapy, and your employer coverage ran out. You can't find a private insurer who'll take you, but you're lucky to live in a state that has its own high-risk pool. Still, you have to struggle to pay the premiums, well above standard insurance because sicker people are in the group. Yet as the federal program is designed, you wouldn't be able to switch over and take advantage of significant savings.

The reason: You have to be uninsured to qualify for the new plan...That means some 200,000 patients now enrolled in more than 30 state high-risk insurance pools will be stuck paying higher premiums. Many are on tight budgets, drawing down their savings and borrowing from family members.

Premiums in the new federal pool are expected to be 10 percent to 50 percent lower than current state rates, said Richard Popper, who directs Maryland's program. Co-payments and deductibles are also expected to be considerably lower. But the only way current beneficiaries could get the federal coverage would be to drop out of their state pool and go uninsured for six months...A recent report by Medicare economists warns that the program could go through $4 billion in its first year, and run out of money as early as 2011...



Read more: http://news.yahoo.com/s/ap/20100416/ap_on_bi_ge/us_health_overhaul_high_risk

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This is the insanity that comes from "compromise" instead of real reform.

This is gaming people's lives and families' very existence.

This is the folly of permitting corruption to run amuck in high places for decades without prosecution. Whether it's war crimes, white collar fraud or election buying, it must be prosecuted, so that real reform is possible.

[Warren Stupidity]

1. So the complaint here is that people already covered in a plan

will not be covered in some other plan? Yes of course it would be better if everyone could switch to lower cost better coverage plans, or better yet, if we had the courage to finish the mission that FDR, HST, JFK and LBJ set out on by extending medicare to everyone, but we didn't do that. What we did was a compromise that remains far better than what we have now. Not perfect by any means, full of teh stupid, but at least a step in the right direction 45 years after medicare passed.

AP is a hit man for the corporate establishment.

[Vinca]

3. I'll let you know how my application to the pool works out.

Trying not to get my hopes up because the last "affordable" high risk pool I might have joined was 4 times my mortgage payment.

[No Elephants]

17. AP stinks big time, but it is not responsible for the flaws in the so called health

care reform bill, some of which you detail yourself.

What's your beef about this particular story, though? Do you feel people should not know the info in the story? Is the info given false? What's the problem?

Blaming the media is one of my favorite sports, too, but it goes only so far. At some point, politicians have to take some responsibility, even if they are Democrats.

BTW, the complaint of the article appears to be absence of affordable insurance for some folk, not that people can't get coverage by two plans.

[totodeinhere]

22. You are right to provide this information to people.

But it's just that some people have their head stuck so far up Obama's ass that they do not want to hear anything negative whether it is useful information or not.

edited for typo

[EFerrari]

20. I agree that this artilcle is meant to scare and to upset people. n/t

[totodeinhere]

23. But are the details in the article true or not? If the article gives false facts, then please...

let us know specifically what that is. But if the article is accurate, then scary or not, it is information that people in that situation need to know.

[EFerrari]

24. This article is so confusing that it's nearly impossible

to decipher what the writer is trying to say. It's obfuscating and the headline is alarming. This is not a delivery of information, it's a hit piece.

I hate this bill but there is no need to gratuitously frighten people, especially people who are already ill.

[Iowa]

31. Nah... the gist of the article is very straightforward...

If you're already in a high cost state plan, where you're struggling to pay premiums that are well above standard insurance rates, you are not allowed to enroll in the new plan unless you drop your current coverage and go uninsured for six months.

What's so confusing about that? Anyone with a fifth-grade education can decipher that in two seconds.

[EFerrari]

32. I think someone with a 5th grade education wrote it. Maybe that's their audience. n/t

[Iowa]

34. I don't think so. It's pretty obvious that the article was written for a general audience...

It wouldn't take much more than a fifth grade education to understand the essence of the article, but actually, that's pretty typical for mass media pieces designed for general consumption.

[mdmc]

37. AP is just making the case for single payer

Health insurance is not access to affordable medical treatment..

[proudohioan]

2. So sad......

and I'm afraid that we will be hearing a lot of stories similar to that scenario.

[fasttense]

4. I wouldn't get to upset over this story.

The AP has a habit of printing false information, some people call it lies.

[No Elephants]

18. Which part of this particular story is false, though? See Reply 17.

[xchrom]

5. Recommend

[ChicagoSuz219]

6. In effect, what you're saying is...

...nothing changed in that scenario. The patient's situation didn't get better... or worse.

They may qualify for other state-run programs like foods stamps, etc. to offset the costs.

[amandabeech]

9. I can't afford my state pool by $250 a month.

I have to be conservative with my expenditures, because I can't get a permanent job and now temp. When I work, temp pays decently, but work has been scarce.

Nonetheless, I don't qualify for any benefits whatsoever, in large part because I don't have children.

When the new health care bill goes into effect, that insurance will be more than my state pool if I have a really good year temping and make too much for any subsidy. Without the subsidy, insurance will take 19% of my gross. I don't have any tax deductions, so that 19% becomes a much greater percentage of my take home. This is largely due to my age, which results in much larger premiums under the Obama plan just as it does with the state pool.

My only hope is getting a real job with benefits. However, my resume has huge holes in it because I've had to deal with serious family problems and an extremely unusual and frightening event in my personal life that has left me with many symptoms of PTSD.

I know several older people who are in the same situation as me. We're being tossed to the side of the road when we still have a lot of life left in us. All we can do for healthcare is count down the days to Medicare and hope that we can get a cheap medigap package--like that's going to happen.

[ChicagoSuz219]

36. It's not all doom & gloom...

...there are many provisions in HCR that will still be able to help you. 10,000 more clinics will be opened throughout the US. Not every ailment, treatment requires a doctor, specialist or hospital. I believe payments are based on a sliding scale. Planned Parenthood is much more affordable for Women's stuff.

I seem to remember when I worked temp that after 6 months, I was eligible to get their health insurance. Check it out.

I don't know what your skill set is, but there will be something like 4-million new jobs related to healthcare starting in the near future. You may have to update your skills &/or learn something new... ex. medical billing.

There will be free &/or no-co-pay preventative screenings like mammograms, prostate exams, pap smears, colonoscopies, etc. There are subsidies if you don't make enough money.

If your PTSD is severe enough, you may qualify for disability. Then, you'd be eligible for Medicare or Medicaid.

If you're over 50, stay in touch w/AARP. They may be able to guide you thru the system & see what's available to you. You may also want to visit your Congressperson's office & see if they can give you some suggestions.

I wish you the best.

[shotten99]

7. Huh. So cancel your old policy 5 days before the pools go into effect

[NorthCarolina]

10. I think you have to have been uninsured for a period far longer than 5 days

in order to qualify.

[Bette Noir]

15. Six months.

[Bluenorthwest]

13. You have to be denied, you can not drop to get new

[No Elephants]

19. That is a more of a huge gamble than you think. One morning, I woke feeling great and

by 11 am was in the Emergency Room, very, very, very sick. I was, and still am, considered incredibly lucky to have survived.

BTW, are you sure what you suggest works under the health care reform bill, or are you just posting totally irresponsibly?

Ordinarily, I don't mind too much when someone does that. But, in this case, someone following your advice could, as a result, be up shit's creek without a paddle; and this is way too serious for that.

[ixion]

8. This is why I don't call it "reform"

because the gamed playing field still exists, it's just changed shape a bit.

[hayu_lol]

11. The only answer to the healthcare problem...

was to establish a SINGLE-PAYER NATIONAL HEALTH PLAN for the people of this country.

Congress failed to do that. Like Medicare, Part D, this plan takes good care of both the Insurance Companies and Big Pharma.

This bill 'reforms' the patients and not the for profit companies that want the people's blood.

[Omaha Steve]

12. Next step

Public option and or single payer. Problem solved.

[dotymed]

14. If most truly sick patients

go without medical care or prescriptions to manage their conditions, they (I) would die. Is that "taking one for the team?"

[high density]

16. The program is a gap-filler until other changes take effect.

Is the AP really this stupid?

[No Elephants]

21. Tell that to people who struggle and/or die while waiting for the changes.

Medicare was enacted under LBJ. Prescription medications got no coverage at all until Dummya]'s giveaway to the pharmaceutical industry. And Obamacare just improved it --but only after putting the kibosh--again--on drug reimportation from Canada.

Medicare is still not ideal. And it's been something like 50 years already, and still counting. But, no problem--unless you or a loved one is among those who died and/or went bankrupty while waiting for those allegedly inevitable improvements.

As far as who's "really that stupid," maybe AP decided to write a story about what we actually have in place and not what maybe someday we may have perhaps, if, uh, you know, whenever 60 truly liberal senators--not counting Blue Dogs or DLCers, take over the Senate. And maybe not even then. Because getting to the Senate seems to turn liberals into pod people. And, then maybe we can have the next increment, although not a totally great bill.

ETA: Make that whenever truly liberal senators--not counting Blue Dogs or DLCers--take over the Senate WHILE the House has a truly liberal majority--not counting Blue Dogs or DLCers--and a Democrat who wants to risk improvement is in the WH. And maybe not even then.

[high density]

25. The bill has already been signed by President Obama

The changes are coming. The AP is whining about a temporary program as a gap between now and when it is implemented. Things don't happen overnight.

Health and Human Services Secretary Kathleen Sebelius calls the federal risk pool a first step toward ending insurance discrimination against people with health problems. But HHS officials say Congress wrote the rules and there's nothing they can do to open up the program to people now in state pools. The federal pool is designed for the uninsured.

The program will be temporary, a bridge to 2014, when denial of coverage for medical reasons will be against the law, and new insurance markets will offer taxpayer subsidized coverage for millions. Number crunchers at Medicare estimate that 375,000 people will sign up this year.

[Demeter]

26. There Is Nothing "Temporary" about Death

and most disabilities are for life. This "gap" will be full of dead taxpaying citizens, which I object to. And you or I could be one of them.

[high density]

27. Yes, that is quite obvious.

I still fail to see how we change this situation, short of building a time machine and passing these items a decade ago. Changes of this size are going to take time to implement, and more people are unfortunately going to be hurt in the interim. They're trying to bridge the gap the best they can, but these temporary programs aren't ever engineered to be comprehensive fixers.

[OhioChick]

28. I completely agree with your comments. n/t

[Demeter]

30. Thank you. I Appreciate the Support!

[supernova]

29. I will qualify for the high-risk pools

I have been out of work and uninsured since fall of 08. I also have a preexisting condition, for which the PE exemptions usually apply, even when I can get group coverage.

This condition of mine doesn't cause problems, but requires life-long followup and might require future surgery if my status changes for the worse.

I'm also a mid-life woman.

I'm anxious to find out what my premiums will be in the interim pools. I don't know what I'll do. My SO fortunately just landed what promises to be a very good permanent job with bennies, but he has a probationary 3-month contracting period. So, I'll have to do some comparing before I sign up with either one.

edit: The AP article is skewed. The HR pools in the HIR act are not meant for people who already have a solution, however unsatisfactory. The pools are meant for people who have no insurance resources at all. We are legion. And again, these will go away in 2014 when the ins cos will have to start charging everybody the same rates.

Yes, I wish we had gone for single payer. That's what I desperately want. But it seems we have to go through this delusional half-phase for our leaders who don't understand that this ultimately will not fix healthcare delivery in America.

[Zhade]

33. We warned the pro-HIR people of this, but they refused to hear us.

Listen next time.

Please?

[ima_sinnic]

35. if one has been uninsured for years, as I have been, how do they know if they have a PEC?

I "suspect" or assume I have one more "pre-existing conditions"--I'm 64, ferchrissake, and have various aches and pains and other things that aren't as good as they used to be, but there is no "official record" anywhere of anything.

will I qualify for that pool?
thank goodness I can get Medicare in slightly less than a year. but there must be others like me, self-employed and without a real medical record--what about them?