This (below) is a chart that tries to explain the new and old high risk pools, vs. single payer healthcare for all.
There are already 37 states with high risk pols but only 200,000 people use them because they are so expensive, and limited to those who were rejected by individual insurers.
The new pools would vary by state, starting out Federally funded but then, two years in, they would shifts the cost to the states. Kind of like a cable TV contract, the low introductory rate.. And, as many people find with any insurance that doesn't dilute risk on a very large pool, the costs high risk pools can be astronomical for both the states/Federal subsidizers and the insured.
I strongly recommend that you all read this description of what high risk pools are, and aren't.
People in the existing high risk pools pay premiums based on individual rates, plus substantial out of pocket costs on top of the premiums, (something that doesn't seem slated to change in the forseeable future, except for the poor.) But the state or whoever must subsidize those pools pays even more. This is a very expensive BandAid on a serious problem that single payer would solve, providing far better healthcare, far more cheaply.
Note the media is softly downplaying the HUGE differences in price between the group and individual market, as well as the different prices that will be paid for access to any plan, now or later by, for example, the self employed, (the individual exchanges.) vs. those in small groups, a difference required by the insurance companies, to preserve their profits in the lucrative individual market.
|Options for Patients With Pre-Existing Conditions Until 2014|
|State High Risk Pools||Federally Funded High Risk Pool||Single Payer 'Medicare for All'|
|Number of people covered||Currently around 200,000 nationally (a tiny fraction of the need) in 34 states in 2008.||Unknown, must have been uninsured for six months and uninsurable and be able to pay premiums that are approximately the same as high quality individual insurance,||Everybody, currently that's around 307,000,000 people, most healthy, some sick.|
|Percent of Costs Covered||"The high-risk pools are more expensive than normal insurance pools.||80% or more, depending on premiums and if the $5900 cap on any additional out of pocket expenses is reached. Total cost of premiums plus OOP expenses would be based on premiums and numerous variables but, especially for older patients, could easily be $30k-$35k/year or more(However, CAP on OOP costs and lower premiums may represent a substantial improvement from the current costs in state risk pools for new patients because many patients in the state high risk pools pay substantially more than $5950 in average OOP costs in addition to their premiums.)||100%|
|Cost to Patient||Very high as its based on individual rates but still lower than full self pay. Varies by age and state from low of approximately $ 500 - 600 for the young to over $3000/month/person|
Based on individual insurance rates, which are currently unaffordable to all but a few, times 125% to 200%
|Only 400% age-adjusted premium community rating compared to as much as 700% age price ratio in private indiv. plans.|
Still Very high as its based on individual rates, and they are unaffordable to all but a very few now, but Premium Price MAY still be lower than state pools for some, higher cost states/plans, approximately 100% of individual rates, so premiums could be as low as $500 to $2500 month. If OOP costs are capped at an additional $ 5950 a year, that is it. Once that limit has been reached, all additional non-premium spending may be reimbursed, pending funding. (Caps on OOP spending have the potential to balloon costs, so there is a potential that benefit may be lost)
|No PremiumsPaid for by Federal income taxes, May add 5 - 7% to income taxes, but cost would be offset by elimination of premiums and drug costs/co-pays, premium hikes, cost sharing, price gouging, etc. Lifetime increase in wealth at least $ 250,000/person (source NY Times Economix Blog US vs. Canada cost)|
|What Happens If I Miss One Payment?||Ineligible for benefits for waiting period (I think) could be from 6 months to as long as one year, (May need to rejoin waiting list/ may lose benefits) but presumably even sick still, I think must pay to prevent 'free riders'.||Ineligible for benefits for at least six months to prevent cancer patients, etc, gaming the system, Don't know if they still have to pay while barred from receiving benefits.||No Payments to Pay/Miss Everybody covered for life.|
|Cost to State||Huge, State must first fund 50% of ALL risk pool plans to bring cost down to individual price, THEN to reach $600 to $3000/patient/month, to make the price semi affordable, unlike individual plans cost, some generous states then add an additional subsidy. But its unsustainable. Current High Risk pools represent an extremely expensive Band Aid solution to the problem of unavailable health insurance that even with valiant efforts to succeed, fails the vast majority of those who need it because of its cost. Full price of some policies probably exceeds $ 4-5k/month- premiums paid||Cost would shift from Federal govt to states in 2 yrs||$0|
|Cost to Federal Government||None||Even higher than state plans based on the need to subsidized rates down to current individual plan prices.||Lower than any other method|
|Limits on Enrollment||Severe, many states require that applicants first have applied and attempted to pay first month of individual private coverage and been rejected for health reasons only, not cost. (An amount that can exceed $ 2000 - $ 3000/month) Rules typically pre qualify access to only those who can afford individual coverage (the well to do, generally) Some states allow those with severe, often terminal illnesses like some kinds of cancer, AIDS, etc, to bypass this process. Howver, state risk pools are struggling because of the huge cost.||Federal risk pool will have similar requirements to states with the addition of a six month waiting||None (cradle to grave)|
|Cost Control Mechanism(s) (if any)||None||None||single payer system able to negotiate prices from strength(i.e.'take it or leave it')|
|Limits on Out of Pocket Spending (by Patient)||Premiums huge, typically 200% of group plans- stark -especally when compared to group plans/(or COBRA)Generally no limit on out of pocket additional spending.||Premiums will be huge, then additional out of pocket costs will be limited at $5900/year. (Amounts spent over that may be reimbursed later.)||No out of pocket costs, except cost of transportation to and from appointments.|
|Limits on Covered Costs (to Patient)||Lifetime limits on benefits start at $300,000 which is low. States are having big problems funding existing pools.||Unknown, As it may run into funding problems, state may not be able to assume risk pools so risk pools may end before (expensive) guaranteed issue individual national HCR begins.||100% coverage|
|Limits on Cost to State||None||None after 2012||Best option for states|
|Limits on Cost to Federal Govt.||No cost||Two years of cost, currently only funded through 2010/early 2011 (estimate)Yearly cost could be comparble to yearly cost of HCR or more. Avoids single payer cost control mechanisms, like other HCR.||Huge savings from consolidation of all healthcare programs into one, savings on purchasing by negotiating strength. Could pay global average prices for drugs, etc. (1/4 of current prices)|
|Sustainable?||NO TOO EXPENSIVE||NO TOO EXPENSIVE||YES!|