Millions of Americans CAN'T BUY Insurance Today (And Therefore Can't Get Health Care)

[berni_mccoy]

They have pre-existing conditions and are considered uninsurable. And they sure as hell can't afford to pay for their meds and doctor visits out of pocket. That will change after the passing of the HCR Bill.

[icee]

1. For those requiring subsidies to pay for insurance they will have

to go through a new government plan or one administered by Medicaid or CHIP. That will be real interesting.

[Dr.Phool]

12. I'll give you an idea how it will probably work.

They already have a model in place called the "Health Care Tax Credit".

A little background. I worked in the railroad division of LTV Steal for 31 years. When LTV went out of business, the Steelworkers lost their insurance the next day. But, there are different laws governing how a railroad can shut down. They had to set up a trust to cover our healthcare. It ran for four years until it ran out of money and we were cut off.

They changed plans several times. Sometimes we paid about $250 monthly towards our premiums. Sometimes we paid zero. For a couple of years we paid over $700. The Health Care Tax Credit will pay 65% of your premiums if you are over age 55 AND receiving a reduced PBGC pension. And it has to be an approved IRS plan.

A friend of mine , who was 60 wanted to keep Kaiser, which wasn't available, when we were paying $700 per month, so he opted out and was paying $650 for Kaiser. Now he had to join the "approved" plan. That plan, with the exact same benefits that he was paying $650 per month for, now cost $1700 per month. Now he had to send the IRS a check every month for $700, and they would kick in the other $1000, and mail the check to the insurer.

Anybody still believe this bill is to benefit us?

[icee]

23. Exactly. Maybe you can field some of these comments from

people touting the wonderfulness of subsidized mandates. The IRS? Oh, shit.

[Dr.Phool]

26. And they mistakenly gave my friend an unapproved policy.

One that was the same price as the approved subsidized policy, and he had to pay back a big pile of back taxes.

[icee]

27. Yep, And that is exactly what's going to happen.

[Lars39]

2. And some of us *with* insurance can't afford our meds and doctor visits

out of pocket.

[glowing]

5. Exactly, I'm thinking of having my hubby drop me and just cover him and son

to save on the money going out. I don't use it but once or twice a year... It certainly doesn't pay for me to have it.

[havocmom]

22. And with so many doctors retiring in frustration at mountains of different insurance rules

those with insurance AND a bit of coin for co-pays and meds STILL can't get medical care.

It is not just a problem of not having insurance. Health CARE is a mess.

[fasttense]

3. That will change 4 years after the passage of the bill. n/t

[berni_mccoy]

7. Sorry, you are 100% wrong. It happens immediately

Children cannot be denied coverage by Insurance companies as soon as the bill is signed.

Adults with PEC will be able to join a High Risk Pool of Federal plans no more than 90 days after the bill is signed.

[Feron]

11. Well if the high risk pool premiums are anything like the states..

nothing will change because very few will be able to afford the insurance. Basically the month to month premium can be as much as a mortgage payment and that's with a deductible of thousands.

Of course this time people will be forced to buy it in a few years and too bad if you don't qualify for a subsidy or can't afford it even with a subsidy. Hell I have insurance and a serious illness would ruin me financially.

Not to mention that there is nothing in the bill that will lower health insurance premiums. The bill sucks.

[berni_mccoy]

14. Subsidies apply to the high-risk pool as well and the pool premiums are capped

5k/year for an individual
10k/year for a family

And yes, this is a helluva lot less than I pay now and a helluva lot less than paying out of pocket for care.

For those who can't still afford that, subsidies kick in.

[Raineyb]

15. High risk pool = high premiums with high deductibles, high co-pays

and a lot of exemptions in coverage. Which generally means that if you can't afford to come out of pocket you can't afford to see a doctor. But you'll have insurance. Gee that's a win. :sarcasm:

Insurance you can't afford to use is no better than having no insurance at all.

What part of that are you having trouble understanding?

[berni_mccoy]

20. Read the bill. The High-Risk pool is premium capped and provides subsidies

for those who cannot afford it. Stop spreading lies please.

[Raineyb]

28. I'm not spreading lies. YOU are the one who thinks that spreading

propaganda to get this pig in a poke passed is more important than actually reforming our health care system. And a high risk pool is EXACTLY what I described.

[ScreamingMeemie]

40. Stop believing what you're reading please.

Texas has this in place and, even with subsidies, it is far out of reach with little to no coverage on many preexisting conditions.

[laughingliberal]

21. It's a small problem. The main goal is to say 'We WON!!!' nt

[Raineyb]

29. Indeed. I'm willing to be the ones who most want to ignore what

high risk pools are are the ones who won't have to subject themselves to one.

[tigereye]

17. that is very good news.

Children should never be denied by any insurer. It's barbaric. (neither should anyone who is ill)

[ScreamingMeemie]

35. Please check into how much "high risk insurance pools" cost those

of us who cannot get "normal" coverage.

This is the one instance where mandatory health care is like mandatory auto insurance...high risk is code for "you won't be able to afford it". I can buy into the Texas high risk pool because I can't afford it. If I could it wouldn't cover much of the medical care. A subsidy will only go so far for so many. So no, it doesn't "happen immediately".

[Missy Vixen]

43. But...but...but It's INSURANCE!

:sarcasm:

We are also two headed straight towards the high-risk pool. The last quote we got? $1400 per month. IF the state accepts us. We could just about swing it if we lived in our car.

Those who are under 40, have no pre-existing conditions and receive health insurance from an employer have NO idea how much this is going to cost. What's more, they don't care.

:woohoo:

[dkf]

4. No. The problem is many doctors won't see someone without insurance

We have created a system where insurance is mandatory for access.

[glowing]

6. Really, a lot of Drs around me are dropping ins. and going with pay cash at the door.

[dkf]

39. Really?

We just changed our insurance and people were calling their doctors to find out if they are still accepted. Even though our insurance covers out of network a bunch of doctors wouldn't take our employees. Even if we paid up front out of pocket. They said it had something to do with what happens if there are complications.

We were frankly flabbergasted at that.

Maybe it is different in Hawaii because we have 92% coverage with two main providers.

[glowing]

42. Yes. It costs a lot of money for Drs to process paperwork. Primary Docs are in need.

I've lost many of my primary Docs to a move or a specialization.

[berni_mccoy]

8. If you've ever seen the bill to pay one of our specialists, it's massive

I'm fortunate enough to be able to pay it (I have to meet an out-of-pocket minimum before insurance will kick in).

Our insulin supplies alone are easily $600 / month.

Yes, millions cannot afford healthcare without health insurance.

[havocmom]

24. Some doctors are dropping patients WITH insurance because the cost of administration is too much.

Reading that more and more doctors going cash only. Others are just walking away from medicine because insurance red tape and rules make them see too many patients so they can afford the clerical staff and they do not feel they can really provide care anymore.

Now, those huge corporate clinics that employ more and more younger doctors, oh, yeah, they LOVE insurance.

[Name removed]

9. Deleted message

Sub-thread removed by moderator. Click here to review the message board rules.

[nightrain]

10. That's misleading berni... Many individuals still won't be able to afford to pay at least 5K

to purchase private corporate disease management insurance. And there are deductibles and co-pays on top of that. Not affordable.
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Those with pre-existing conditions might get a subsidy, and those subsidies are underfunded and up to 4 times as expensive. It will cover few people and the CMS report estimates that it will run out of money in 2011 or 2012. Only those who have been uninsured for more than six months will qualify for the high risk pool. Only 0.7% of those without insurance now will get coverage.

FDL factsheet--
http://fdlaction.firedoglake.com/2010/03/19/fact-sheet-the-truth-about-the-health-care-bill/

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These "subsides" are actually not so much subsidies for humans, but a transfer of taxpayer money that funds Cigna, BC, United's etc, obscene exec compensation packages. You read recently that Cigna announced its $110 million package to its former CEO?

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There are insufficient regulations (possible) to prohibit these disease management corporations and drug makers from raising their rates, as we are now experiencing. Regulations and fines are now a "cost of doing busness", rather than any deterrent to unethical and usurious corporate behavior.

source--"When drug makers' profits outweigh penalties"

http://www.washingtonpost.com/wp-dyn/content/article/2010/03/19/AR2010031905578.html

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As Kucinich said, we are building on sand. Ever-shifting, not for human use (health care sevices), but for corporate benefit, sand. The cost-controlling mechanisms have all but been excluded from the bill. We are in for a ride at our own expense (literally).

[berni_mccoy]

13. Subsidies apply to those who can't afford it.

This is true of the high-risk pool. And no, it's not misleading. You should edit that part of your comment.

[nightrain]

16. the "subsidies" don't cover the entire cost of the premiums, which leaves

many thousands to pay before maybe getting a tax credit. PLUS high deductibles and copays. THAT'S the unaffordable part. 0.7% of those without insurance now will get coverage, and it is likely to run out of money in 2011 and 2012.

You didn't respond to the remainder of the issues I raised, interestingly. Selective and inaccurate.

[tigereye]

19. it's ironic given how much profit those insurers make - I really think the

whole damn thing should be run and regulated like a public utility.

[nightrain]

36. **crickets** **crickets**

[Dr.Phool]

18. See my post above about subsidized policies.

And if you buy a subsidized policy with high deductibles and co-pays, only the insurance company wins if you can't afford any of those.

They could have done this fucking thing right the first time, with H.R.676. But no, they had to take care of the insurance and pharmaceutical industries. And the Frist family.

[laughingliberal]

25. Frist family is 100% correct

Even more than the insurance corporations, the hospital corps make out big time in this bill. The high cost of hospital care with the subsequent propaganda campaign for a 'free market' solution was the first domino that fell, leading to the skyrocketing costs and decreasing quality we now see in our health care system. Nothing was done to address this. We (and by 'we' I mean the administration) accepted a deal to keep a public option out in return for an ad campaign by the hospital corps to support HCR. It is at the bottom of the entire problem. The high cost of hospital care gives the insurance companies an excuse for their high premiums. And it all goes downhill from there.

[Dr.Phool]

30. And, I've never done the research, but,

I'd be willing to place a large wager that they all own huge blocks of each others stock.

It's the only reason I can think of, as to why the health insurance companies don't scream bloody murder about high prescription and hospital prices.

[laughingliberal]

32. That would make sense

I would believe that in a heartbeat. We know the insurance companies invest their revenue. The lie at the bottom of the whole tort reform crap is that the malpractice insurance rates are climbing because of lawsuits. The malpractice insurance rates started climbing when they lost their ass on investments during the crash in the 80's.

[nightrain]

33. yes. I'm concerned that your friend's example will be our future on a macro level.

It's so curious that I don't see the proponents of these short-term "fixes" address the real world, actual, problems. Including virtually none of the known cost-controls is a recipe for more disaster, at OUR expense! That's not an issue to the millionaires and billionaires (in Congress and elsewhere), but it certainly is to middle and lower income people who currently can't afford these premiums and deductibles, and co-pays.

[enlightenment]

38. Perhaps you should edit your comment instead.

There is nothing in the Bill that directly states that individuals in the high-risk pool will be eligible for the subsidy program as it is discussed for the Exchanges.

(c) Qualified High Risk Pool-
(1) IN GENERAL- Amounts made available under this section shall be used to establish a qualified high risk pool that meets the requirements of paragraph (2).
(2) REQUIREMENTS- A qualified high risk pool meets the requirements of this paragraph if such pool -

(A) provides to all eligible individuals health insurance coverage that does not impose any preexisting condition exclusion with respect to such coverage;

(B) provides health insurance coverage -

(i) in which the issuer’s share of the total allowed costs of benefits provided under such coverage is not less than 65 percent of such costs; and
(ii) that has an out of pocket limit not greater than the applicable amount described in section 223(c)(2) of the Internal Revenue Code of 1986 for the year involved, except that the Secretary may modify such limit if necessary to ensure the pool meets the actuarial value limit under clause (i);
(C) ensures that with respect to the premium rate charged for health insurance coverage offered to eligible individuals through the high risk pool, such rate shall -
(i) except as provided in clause (ii), vary only as provided for under section 2701 of the Public Health Service Act (as amended by this Act and notwithstanding the date on which such amendments take effect);
(ii) vary on the basis of age by a factor of not greater than 4 to 1; and
(iii) be established at a standard rate for a standard population; and
(D) meets any other requirements determined appropriate by the Secretary.

So - yes, a high-risk pool will go into effect. It will cover not less than 65% and charge 'cost-sharing' of $5000 or $10000 (that's the section 223 of the IRS code) . . .unless the Secretary decides that needs to change to meet the actuarial value limit of 65%, which could mean more out of pocket or less . . .
The premium will not be substantively higher in the pool then it would be for a person without a pre-existing condition (that's the bit covered under section 2701 of the Public Health Act) - however, it can vary as much as 4 to 1 based on age. That is potentially FOUR times as much for an older person than a younger person.

(d) Eligible Individual- An individual shall be deemed to be an eligible individual for purposes of this section if such individual -
(1) is a citizen or national of the United States or is lawfully present in the United States (as determined in accordance with section 1411);
(2) has not been covered under creditable coverage (as defined in section 2701(c)(1) of the Public Health Service Act as in effect on the date of enactment of this Act) during the 6-month period prior to the date on which such individual is applying for coverage through the high risk pool; and
(3) has a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary.

So - you would also have to meet a few requirements for this: be a citizen and lawfully present.
Have been uninsured for at least 6 months prior to applying for coverage. Too bad if you just lost coverage in the last 5 months, I guess.
Have a pre-existing condition that falls under the 'guidance' issued by the Secretary. That hasn't been released yet, but one assumes it will be fairly comprehensive.

Of course, it's not that simple.

(2) HIGH-RISK INDIVIDUAL; PAYMENT AMOUNTS- The Secretary shall include the following in the provisions under paragraph (1):
(A) DETERMINATION OF HIGH-RISK INDIVIDUALS- The method by which individuals will be identified as high risk individuals for purposes of the reinsurance program established under this section. Such method shall provide for identification of individuals as high-risk individuals on the basis of -
(i) a list of at least 50 but not more than 100 medical conditions that are identified as high-risk conditions and that may be based on the identification of diagnostic and procedure codes that are indicative of individuals with pre-existing, high-risk conditions;
(ii) any other comparable objective method of identification recommended by the American Academy of Actuaries.

(B) PAYMENT AMOUNT- The formula for determining the amount of payments that will be paid to health insurance issuers described in paragraph (1)(A) that insure high-risk individuals. Such formula shall provide for the equitable allocation of available funds through reconciliation and may be designed -
(i) to provide a schedule of payments that specifies the amount that will be paid for each of the conditions identified under subparagraph (A); or
(ii) to use any other comparable method for determining payment amounts that is recommended by the American Academy of Actuaries and that encourages the use of care coordination and care management programs for high risk conditions.

Ah - there's a bit more information about that 'guidance' - best hope that your pre-existing condition is on that list.
Those Actuaries will also help determine how much money the insurance companies will get from high-risk folks in exchange for the wondrous 65% coverage. Wow. That's nice of them, isn't it?

And, finally, that pesky funding issue . . .

(g) Funding; Termination of Authority -
(1) IN GENERAL- There is appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $5,000,000,000 to pay claims against (and the administrative costs of) the high risk pool under this section that are in excess of the amount of premiums collected from eligible individuals enrolled in the high risk pool. Such funds shall be available without fiscal year limitation.

(2) INSUFFICIENT FUNDS- If the Secretary estimates for any fiscal year that the aggregate amounts available for the payment of the expenses of the high risk pool will be less than the actual amount of such expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit.

So - there will be monies available to help fund this pool - but there is nothing about subsidy to individuals, nor any elucidation as to how that money will be made available or to whom.

[Donnachaidh]

31. fearmongering - the breakfast of champions.

:rofl:

[laughingliberal]

34. +1 nt

[spoony]

37. +1!

[berni_mccoy]

41. And you're very good at it. Kill the bill, right? Got it.