Can Dems Really Help the "Uninsurables"?

Democratic Health Reform Plans Aim to Help Seriously Ill Get Coverage, But Eyebrows Raised Over Stipulation, Cost

(AP)  You're afraid your cancer is back, and a health insurance company just turned you down.

Under the health care bills in Congress, you could apply for coverage through a new high-risk pool that President Obama promises would immediately start serving patients with pre-existing medical problems.

Wait a second. Read the fine print. You may have to be uninsured for six months to qualify.

Special Report: Health Care Reform

"If you are a cancer patient and have cancer now, you can't wait six months to go into a plan because your condition can go from bad to death," said Stephen Finan, a policy expert with the American Cancer Society Cancer Action Network. He called the waiting period in the Senate bill "unacceptable."

Advocates for people with serious health problems, as well as some insurance experts, are raising questions about one of the most important upfront benefits in the Democratic health care legislation: a high-risk pool for the medically uninsurable.

Obama proposed the pool in his September health care speech to Congress. Intended to serve the most vulnerable as a temporary fail-safe, it would stay in place until 2013. That's when insurance companies would be banned from denying coverage because of medical problems. Government subsidies to make coverage more affordable for millions of uninsured would also start that year.

Now, concerns are being raised about the design of the high-risk pools. In addition to the six-month wait, there's a more fundamental issue - whether $5 billion set aside for the three-year program is enough. The money would be used to help people in poor health pay premiums.

Obama credits his Republican presidential rival, Sen. John McCain of Arizona, for the risk-pools idea. But when the GOP candidate proposed it in 2008, the estimated cost was $7 billion to $10 billion a year.

The six-month wait is in the health care bill the Senate Finance Committee approved last month. To qualify for the pool, patients must be turned down for coverage because of a pre-existing condition and uninsured for at least six months.

"If you are somebody with cancer or a heart condition who needs immediate coverage and immediate treatment, that's not very helpful," said Karen Pollitz, a Georgetown University health policy professor.

Senate Finance staffers say the restriction is meant to prevent people switching from more expensive coverage to take advantage of government assistance.

But the House health care bill unveiled last week by Speaker Nancy Pelosi, D-Calif., doesn't include a waiting period. Instead, it would require insurance plans who "dump" seriously ill patients to repay the federal pool. "The House provision will provide immediate relief for people with high-risk conditions who have no alternative for coverage," said Finan.

It may be easier to fix the waiting period than the financing.

Both the House and the Senate Finance bills set aside $5 billion for the pools.

"It doesn't seem like it's near enough money," said Douglas Holtz-Eakin, who was a top domestic policy adviser for McCain. The McCain campaign ultimately concluded it could take as much as $20 billion a year to properly run risk pools, he said. The White House says McCain's proposal was more elaborate and not directly comparable to Obama's.

If the Democrats' risk pool starts running out of money, the government may have to start a waiting list, raise premiums or take other unpopular measures. Congress could be asked for a bailout.

Several independent experts say concerns about the financing are valid.

"It would seem that ($5 billion) is going to be small relative to the need," said Thomas Buchmueller, a University of Michigan business professor.

Some 30 states now have risk pools for those who can't get health insurance on the private market, covering about 200,000 people at a cost of around $1 billion a year.

"This is clearly not going to be enough money to cover everybody," said Pollitz.

Insurance expert John Bertko, a visiting scholar at the Brookings Institution, said it may be possible to stretch the $5 billion, but there's a small margin for error.

Bertko said his "back of the envelope" math suggests there are about 1 million uninsured Americans in poor health, or five times the number currently covered by state high-risk pools. If all of them signed up for the new federal pool, it would burn through the $5 billion in a year.

However, people eligible for government benefits often fail to sign up. And if only one-third were to enroll, the budget could work.

That's cutting it close. "No doubt about that," said Bertko.

[stn_sage]

Wrong question! It should be: Will Dems Really Help the "Uninsurables"?

Answer: NO!

[actornaught]

As long as the dems attempt to appease the unappeaseable 'pubs, the bill will suck out loud. I've yet to see any 'pub content that didn't have the stink of corporate sabotage.

A High Risk Pool is ridiculous. Try one pool, Citizens of the USA. Anything else is a loser.

[bobbyduck1]

Any system where anyone is "uninsurable" in a non-third world country is barbaric to say the least.

We spend 16%-18% of GDP for health care and rank far down the list for the quality of that care. Other civilised countries have made profiting from illness illegal, have the dreaded "socialist medicine" and pay 6% to 8% of GDP for better care, and EVERYONE is covered, and NOONE goes bankrupt.

This is a no-brainer, single payer, not-for-profit health care is the only real change that will matter.

[rocketjl]

So what we have is all flash up front, until 'they' gain complete control of the health care system. Once the knife is in too deep, they will go whatever way they had originally planned to go. Noticed this by reading the BBC news, the National Health Sys folks in England are now on to employers to change procedures to reduce hob stress on people. NHS says it leads to health problems and high health costs. We all want health reform, but not what the democrats and Obama are offering, the cost is too great, and it take a lot of money also.

[j_mcdonald-2009]

"the cost is too great, and it take a lot of money also"

When you were reading the BBC news did you happen to notice anywhere that their costs are ONE HALF of ours? How on Earth does that translate into your conclusion?

????? Costs cut in half => the cost is too great ?????

[doc_holliday76]

by Portage15:
"Unless present bills in Congress remove the profit motive and improve underlying management fundamentals, once the smoke clears we will continue to rank 37th in efficiency, and No. 1 in cost."
---------------------------------------------------






This is absolutely true, no matter what ideological reasoning is behind those still carrying water for the for-profit insurance industry making billions on the sickness of Americans, instead of a system that promotes wellness and preventative care.

This only means that the entire system will have to fail in the near future before we have REAL health care reform, which more than likely will be some sort of single-payer universal health care system.

[hungry1968-17]

by louiville35 November 5, 2009 9:34 AM EST

hungry no you are wrong again.

I give you a hint the democrats vote to break the filibuster and bring it to a vote THEN they are free to vote against it. That way they look good to Democrats AND the folks back home.

It's done ALL the time or didn't you take political science or pay attention in school. (they pointed that bait and switch out to me in grade school)

Having trouble thinking outside the box today?







I'm not surprised at all, that you have NO CLUE how our government works.

The filibuster will prevent ANY VOTES from being taken on the measure, which will stall it endlessly, effectively killing it.

You need AT LEAST 60 votes to break the filibuster, and AGAIN - the democrats cannot count on the conservatives from their party, because they are too beholden with the bribes from the insurance companies, to worry about what's best for America.

You're getting there, but you're not there yet.

[dmwj2]

LOL - you got skooled!

[louiville35]

by hungry1968-17 November 5, 2009 9:04 AM EST
No dummy. Try to educate yourself and catch up.

If there are less than 60 votes for something in the senate, then the minority can endlessly filibuster the legislation. (Which should be illegal.)

The senate has a TOTAL of 60 democrats, and of those at least 8 are conservatives that will vote AGAINST America's best interest, while looking out for the health insurance companies profits.

That's why the legislation is being watered down to the point that it's virtually ineffective - because they're trying to appease the conservatives.
=============================================================================

hungry no you are wrong again.

I give you a hint the democrats vote to break the filibuster and bring it to a vote THEN they are free to vote against it. That way they look good to Democrats AND the folks back home.

It's done ALL the time or didn't you take political science or pay attention in school. (they pointed that bait and switch out to me in grade school)

Having trouble thinking outside the box today?

[jroach31]

Insure the uninsurable? Nah.

In a market based health care system, if they are injured or dying, they get trauma treatment at the ER, then it's back out the door. It's a win-win! The hospitals get to take their savings and their houses, and they die pretty quick and save the rest of us money.

What's not to like about that?

[Portage15]

What?s clear is that so called ?free-market? medical industry policies (written by insurance and hospital campaign contributors) do not serve the American public. ?Extending coverage? by pumping billions of dollars into an already bloated insurance industry is a short term band aid. It does not solve the underlying problems of inefficient distribution of services, high costs, and a profit driven industry dominated by entrepreneurs and middlemen. What?s unfortunate is that high quality non-profit clinic models successfully operating today are all but ignored. BOTTOM LINE: the U.S. healthcare profession must refocus to exclusively deliver high quality medical and dental services at a reasonable cost, no longer just to enrich ?provider? corporations (insurers, doctors and hospitals). Unless present bills in Congress remove the profit motive and improve underlying management fundamentals, once the smoke clears we will continue to rank 37th in efficiency, and No. 1 in cost.

[louiville35]

If you were smart enough to realize how bad they were trying to F you, you would probably also be smart enough to realize that "blue dog democrats" are CONSERVATIVES.

Like I said dummy, it's the republicans AND conservatives that are F'ing this country. - by hungry1968-17 November 5, 2009 8:20 AM EST
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Temper Temper, Democrats still have majorities if you take out the Blue dog Democrats, right? or didn't you check? (it only takes 51 to pass a bill in the senate) But since your party hasn't attracted liberal/moderate republicans kind of says a lot about the nature of the ultra left bill being presented, doesn't it?

[hungry1968-17]

No dummy. Try to educate yourself and catch up.

If there are less than 60 votes for something in the senate, then the minority can endlessly filibuster the legislation. (Which should be illegal.)

The senate has a TOTAL of 60 democrats, and of those at least 8 are conservatives that will vote AGAINST America's best interest, while looking out for the health insurance companies profits.

That's why the legislation is being watered down to the point that it's virtually ineffective - because they're trying to appease the conservatives.

[jsachse]

Interesting, you call someone a dummy and then you get the count wrong. There aren't 60 democrats in the senate.

[actornaught]

by hungry1968-17 November 5, 2009 9:04 AM EST
...the minority can endlessly filibuster...

Unless they do Reconciliation, like w did to get the tax cuts for the wealthy (something the neocon comedians forcibly forget)...

[hungry1968-17]

by louiville35 November 5, 2009 8:15 AM EST
Well I'm glad you have tied that to conservatives and republicans but don't you guys hold majorities?

I other words just pass healthcare, you don't need them.

Other wise playing that card sounds kind of childish, like johnny complaining that Jimmy "won't play with me", don't you think?







If you were smart enough to realize how bad they were trying to F you, you would probably also be smart enough to realize that "blue dog democrats" are CONSERVATIVES.

Like I said dummy, it's the republicans AND conservatives that are F'ing this country.

[askagain]

louiville35 - With only two months left to the year, that is a good question. The big concern should be getting something good. From what we keep reading, there seem to be many potential pitfalls. Underfunding and the waiting period for the proposed high risk pools might be a real cause for concern.

[louiville35]

Any bets on whether health care will pass this year?

[hungry1968-17]

It won't. The republicans, conservatives, and other insurance company lobbyists will see to it.

[louiville35]

Well I'm glad you have tied that to conservatives and republicans but don't you guys hold majorities?

I other words just pass healthcare, you don't need them.

Other wise playing that card sounds kind of childish, like johnny complaining that Jimmy "won't play with me", don't you think?

[dmwj2]

I do not think a GOOD bill will pass... If a bill is passed, it is going to be worse than the tax code... loopholes from hell... restrictions, limitations, requirements... all to appease conservatives and the healthcare and insurance industries. I truly think it would be best to throw all of this out, and just open Medicare/caid up to everyone, and base premiums on income. With a large pool, we could deffinately negotiate better terms with providers. Push it through with 51 via reconciliation, if that is an option.