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Thread: Health plans for high-risk patients attracting fewer, costing more than expected

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    Health plans for high-risk patients attracting fewer, costing more than expected

    i'm shocked i tell ya...shocked...never saw this coming.....

    Health plans for high-risk patients attracting fewer, costing more than expected

    By Amy Goldstein
    Washington Post Staff Writer
    Monday, December 27, 2010; 10:54 PM

    An early feature of the new health-care law that allows people who are already sick to get insurance to cover their medical costs isn't attracting as many customers as expected.

    In the meantime, in at least a few states, claims for medical care covered by the "high-risk pools" are proving very costly, and it is an open question whether the $5 billion allotted by Congress to start up the plans will be sufficient.

    Federal health officials contend the new insurance plans, designed solely for people who already are sick, are merely experiencing growing pains. It will take time to spread the word that they exist and to adjust prices and benefits so that the plans are as attractive as possible, the officials say.

    State-level directors of the plans agree, in part. But in interviews, they also said that the insurance premiums are unaffordable for some who need the coverage - and that some would-be customers are skittish about the plans because federal lawsuits and congressional Republicans are trying to overturn the entire law.

    The Pre-Existing Condition Insurance Plan, the program's official name, is an early test of President Obama's argument that people will embrace the politically divisive health-care overhaul once they see its advantages firsthand. According to some health-policy researchers, the success or failure of the pools also could foreshadow the complexities of making broader changes in health insurance by 2014, when states are to open new marketplaces - or exchanges - for Americans to buy coverage individually or in small groups.

    Under the sprawling health-care legislation that Democrats pushed through Congress in March, the special health plans were designed as a temporary coping mechanism for a small but important niche among the nation's 50 million uninsured: people who have been rejected by insurance companies because they already are sick.

    Twenty-seven states have created their own high-risk pools. The rest used an option in the law to let their residents buy coverage through a new federal health plan.

    In the spring, the Medicare program's chief actuary predicted that 375,000 people would sign up for the pool plans by the end of the year. Early last month, the Health and Human Services Department reported that just 8,000 people had enrolled. HHS officials declined to provide an update, although they collect such figures monthly, because they have decided to report them on a quarterly basis.

    "Like the rest of the country, we thought we'd have pretty much a stampede. That obviously hasn't materialized," said Michael Keough, executive director of North Carolina's plan. With nearly 700 participants, it is among the nation's largest so far, but it has one-third of the people expected by now.
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    According to interviews with administrators of nine of the state-run plans, only one - Colorado's - is close to its forecast enrollment. Maryland, the only jurisdiction in the Washington area that has created a plan, has 97 participants, compared with 19,000 in an older state high-risk pool, according to Kent McKinney, who directs both. HHS's November report said that Virginia had 75 participants in the federal plan. The District had none.

    Potential lifesaver

    The plans have been a boon and a heartbreak.

    "I don't mean to be gushy about it, but they potentially saved my life," said Maureen Murray, 50, of Arlington County, who had dropped her individual insurance policy in July 2009, after her work as a freelance video producer dried up. Murray was getting ready for a gym class in October when she "felt something go down my left side." It was a stroke. She was still at Alexandria's Mount Vernon Hospital when a CAT-scan detected an aneurysm on the left side of her brain.

    She was discharged two days before Halloween with a $25,000 hospital bill.
    This Story

    A friend recommended the new high-risk pool. Four days after Thanksgiving, she was approved. It will cover her surgery in January to repair the aneurysm. The plan's premiums, Murray said, are steep - $358 a month even after a rate reduction in January. "I'm in rough financial position, but . . . I can get another job," she said. Without the insurance, "I might not have that opportunity."

    Expensive coverage

    On the other hand, Will Wilson, 57, of Chicago said he is "really, really, really, really discouraged." After he received an AIDS diagnosis in 2002, he discovered that his insurance at the time paid only $1,500 for medicine each year. His AIDS drugs cost $3,000 a month. He ended up in bankruptcy.

    Wilson, a tourist trolley guide, now gets help from the federal AIDS Drug Assistance Program, but he has no coverage for other kinds of care.

    Wilson remembers tears streaming down his face in February 2009, the night that he watched Obama vow to Congress, "Health-care reform cannot wait, it must not wait, and it will not wait another year!"

    Wilson became an activist for health reform, circulating petitions, going to demonstrations. And the day after the president signed the bill into law, a Chicago Sun-Times column quoted him as saying, "I've had a grin on my face all day" at the prospect of the high-risk pool he could join. That was before the rates were announced in July and Wilson discovered that the premium - nearly $600 a month - "was almost as much as my rent. It was like, no way! I was floored."

    The law contains rules to make the high-risk pools more affordable than older ones that many states have run; the new ones cannot charge more in premiums than the average premium for other individual insurance in a given state. But "the individual market is expensive," said Jean P. Hall, a University of Kansas researcher studying the new plans. "From my perspective, it is not a good match for people who have expensive conditions."

    HHS has made some changes for 2011 in the federal plan on which 23 states and the District are relying. It will have somewhat lower premiums and two new options with varying deductibles, according to Richard Popper, HHS's deputy director for insurance programs.

    The agency also is launching a more aggressive marketing campaign, Popper said, focused on states, including Virginia, whose residents have not had any kind of high-risk pool in the past. And the Social Security Administration has agreed to tell everyone it approves for disability benefits about the new health plans.

    Among the 27 states with their own plans, 17 have submitted changes for HHS to approve so they can lower premiums, adjust other costs or alter who is allowed to join.
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    And they are doing more marketing. Michigan is running Internet ads through Google. North Carolina is advertising on billboards across the state and on cable television.

    Fretting about challenges

    Whether the marketing and plan adjustments will translate into more customers remains unclear. Cecil Bykerk, the executive director for the new plans in Montana, Iowa and Alaska, said some people are wary over whether the health-care law - and the high-risk pools it has created - will last. "I think there is a lot of concern in the public with all the [federal court] challenges and all the political rhetoric about appeal," he said.

    Montana is one of a few states in which the medical bills from those who have joined are huge. New Hampshire's plan has only about 80 members, but they already have spent nearly double the $650,000 the state was allotted in federal money to help run the program, said J. Michael Degnan, its director.

    The spending, Degnan speculated, might slow down if it turns out that the early bills reflected a burst of pent-up need for care. HHS agreed to give New Hampshire more money, he added.

    When the law was passed, proponents of the special health plans feared the $5 billion would run out before 2014. Today, HHS's Popper says of that financial help: "We want to use it - make it last but also use it to effectively to get people covered."
    http://www.washingtonpost.com/wp-dyn...122702343.html

    it'll cover more, save money and cost people less....i'm from the government and i'm here to help.....

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    Obama's health care "reform" might turn out to be his well-deserved Waterloo, after all.


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    as long as hospitals cannot refuse emergency treatment, and people exploited this by giving fake names etc, (and the cost passed on to everyone) something (reform) was needed.

    either allow hospitals to let people die on their front steps or Obama care. (or even further a single option).

    there's no middle ground that makes sense. healthcare was going to bancrupt this nation... at least with this bill there's a chance it won't.

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    Quote Originally Posted by bitonti View Post
    as long as hospitals cannot refuse emergency treatment, and people exploited this by giving fake names etc, (and the cost passed on to everyone) something (reform) was needed.

    either allow hospitals to let people die on their front steps or Obama care. (or even further a single option).

    there's no middle ground that makes sense. healthcare was going to bancrupt this nation... at least with this bill there's a chance it won't.
    I had a family member in the hospital lately and I saw first hand SO MANY latinos that simply walk around like it is owed to them. They can't speak english and the way they just assume it is all taken care of is cause for some real concern.
    Last edited by southparkcpa; 12-30-2010 at 01:24 PM.

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    Quote Originally Posted by bitonti View Post
    as long as hospitals cannot refuse emergency treatment, and people exploited this by giving fake names etc, (and the cost passed on to everyone) something (reform) was needed.

    either allow hospitals to let people die on their front steps or Obama care. (or even further a single option).

    there's no middle ground that makes sense. healthcare was going to bancrupt this nation... at least with this bill there's a chance it won't.
    ROFLMAO.

    The left attitude of "our way is the only way" shines again. Throw federal money and control at a problem to make it go away. Ignore the potential consequences so we can kick back and feel proud of ourselves for "accomplishing change". Because coming up with alternative non-destructive methods is just too much work.

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    Quote Originally Posted by JetPotato View Post

    The left attitude of "our way is the only way" shines again.
    its not perfect but it's the only progress on this issue for 40 years. Republicans had 6 years of Prez Bush and control of congress, and didn't do anything on healthcare.

    there are aspects like eliminating pre-existing condition denials which are excellent. There are other aspects that aren't as great. but at least it's an attempt at functional gov't.

    At least Obama is trying to do something positive, instead of starting un-winnable wars 6000 miles away, without public support.

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    Quote Originally Posted by bitonti View Post
    its not perfect but it's the only progress on this issue for 40 years. Republicans had 6 years of Prez Bush and control of congress, and didn't do anything on healthcare.

    there are aspects like eliminating pre-existing condition denials which are excellent. There are other aspects that aren't as great. but at least it's an attempt at functional gov't.

    At least Obama is trying to do something positive, instead of starting un-winnable wars 6000 miles away, without public support.
    On cue, more lib laughs just in time for New Year.

    Ramming Socialized medicine down America's throat has been Priority One for libs since Truman's era.

    What public support did PPACA have from America?

    True, aspects of it have been eased in by degrees over decades via Medicare as especially Medicaid / various lavender blue states giving it away for free to a hordes of illegals and no-accounts (pushing them into bankruptcy)

    As for Bush, Medicare Part D (which is fine by me) was nothing?

    As for pre-existing conditions, what's fairer, making those with them
    pay higher premiums or making everyone pay more?

    For the un-patriots, their constant chatter always comes back to the cost of wars/defense which are a fraction of gov't waste and stimuloss pork. Which "unwinnable" war fought with namby-pamby lib ROE didn't we win? And without whose support? The terrorists and their left-wing American sympathizers?

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    Quote Originally Posted by Jungle Shift Jet View Post
    On cue, more lib laughs just in time for New Year.

    Ramming Socialized medicine down America's throat has been Priority One for libs since Truman's era.

    What public support did PPACA have from America?

    True, aspects of it have been eased in by degrees over decades via Medicare as especially Medicaid / various lavender blue states giving it away for free to a hordes of illegals and no-accounts (pushing them into bankruptcy)

    As for Bush, Medicare Part D (which is fine by me) was nothing?

    As for pre-existing conditions, what's fairer, making those with them
    pay higher premiums or making everyone pay more?

    For the un-patriots, their constant chatter always comes back to the cost of wars/defense which are a fraction of gov't waste and stimuloss pork. Which "unwinnable" war fought with namby-pamby lib ROE didn't we win? And without whose support? The terrorists and their left-wing American sympathizers?
    c'mon jsj- there's more public support for obamacare than there was for the iraq war....i mean, for one thing, just look at the results of the election after each event....

    can't help but laugh at obama apostles...

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    JSJ maybe you weren't aware that defense was the largest part of the gov't budget expenditure?


    you guys would probably be thrilled if this was a healthcare bill for Afghani's... hiring Halliburton to deliver healthcare to strangers 6000 miles away who don't even know what 9-11 was.

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    Quote Originally Posted by bitonti View Post
    JSJ maybe you weren't aware that defense was the largest part of the gov't budget expenditure?


    you guys would probably be thrilled if this was a healthcare bill for Afghani's... hiring Halliburton to deliver healthcare to strangers 6000 miles away who don't even know what 9-11 was.
    Now we're changing the subject from the wars you don't like to Dod/DHS/Defense as a whole? Halliburton is in the healthcare business?

    And despite your callous (and that's putting it mildly) comment about 9-11, an adult Afghani not knowing what 9-11 was is like a Nazi era German not knowing of the Holocaust-perhaps not personally culpable, but complicit in creating and /or perpetuating a culture or government that committed or enabled such murderous acts.

    Anyway that's just the budget, not the actual expense.

    According to the OMB the gov't wasted from fraud etc, outright $90B in FY09. That's almost double the cost of Big Sis, $55B which is lumped in w/ Defense ($750B) and almost the cost of the wars, said to be @ $100-125B.

    All a drop in the bucket compared to at least $1.3T in entitlements,
    of which Medicaid, the biggest ripoff of all, is at least $200B.
    So by coincidence you're right about providing healthcare to strangers
    being a drain-all illegals should be cut off, stat!

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    Quote Originally Posted by Jungle Shift Jet View Post
    ...but complicit in creating and /or perpetuating a culture or government that committed or enabled such murderous acts....
    Actually, that was the Saudi's. But I get the point you're driving at...which is "Flush is right. Everyone else is wrong."

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    Quote Originally Posted by PlumberKhan View Post
    Actually, that was the Saudi's. But I get the point you're driving at...which is "Flush is right. Everyone else is wrong."
    At least you didn't blame Cheney this time.
    Yes, the Saudi's etc. did help the Nazis too!
    You're preaching to the choir, I have no problem with annexing the whole lot. Has Obama found OBL yet?

    But get the rest right, willya?
    It's JSJ, and it's "JSJ is right and anti-American lib pukes are wrong".

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    Quote Originally Posted by Jungle Shift Jet View Post
    And despite your callous (and that's putting it mildly) comment about 9-11, an adult Afghani not knowing what 9-11 was is like a Nazi era German not knowing of the Holocaust-perhaps not personally culpable, but complicit in creating and /or perpetuating a culture or government that committed or enabled such murderous acts.
    um... not really.

    Fewer than one in 10 Afghans are aware of the 9/11 attacks and their precipitation of the war in Afghanistan, says a study from an international think tank.

    A report (PDF) from the International Council on Security and Development (ICOS) shows that 92 percent of those surveyed had never heard of the coordinated multiple attacks on US soil on September 11, 2001. It also shows that four in 10 Afghans believe the US is on their soil in order to "destroy Islam or occupy Afghanistan."

    http://www.icosgroup.net/documents/a..._variables.pdf

    as for medicare let me see the Republicans repeal it. Why didn't they absolish it when they had power? Oh that's right cause they talk crap about reducing the deficit but don't have the stones to do anything about it. they actually expand costs.

    Where will you be JSJ when Cry baby Boehner votes to raise the debt ceiling this spring?

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    Quote Originally Posted by bitonti View Post
    um... not really.




    as for medicare let me see the Republicans repeal it. Why didn't they absolish it when they had power? Oh that's right cause they talk crap about reducing the deficit but don't have the stones to do anything about it. they actually expand costs.

    Where will you be JSJ when Cry baby Boehner votes to raise the debt ceiling this spring?
    More laughs, as usual the only one talking crap is you...

    Um, did you know, all the 1500 men interviewed for that survey were between 15-29. This means that ten years ago, the youngest person interviewed was only FIVE and the oldest was NINETEEN when 9/11 occurred.
    That's like asking you about the Cold War, or even the Gulf War.
    Their ignorance, or yours, doesn't invalidate the war there. A sheep is a luxury there let alone a radio or TV.

    Amending or abolishing entitlements with mandated cost increases was opposed vehemently (Hands Off Social Security!) in the Bush era-you know, the one where the will of the people was adhered to? Medicare won't be repealed, but PPACA may be.
    Last edited by Jungle Shift Jet; 12-31-2010 at 07:37 PM.

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