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Over the coming two months, Americans will begin to really feel the effects of our bold new 21st century healthcare system.

The first event (not connected to the Patient Protection and Affordable Care Act) is that the first round of COBRA subsidies will begin to expire.

The largest single group of people set to collectively roll-off of the COBRA subsidy could be the group that loses their subsidies in June. Anyone qualifying for the subsidy between September 2008 and March 2009 -- a six month period when unemployment increased from 6.2% to 8.4%(2) -- will have reached the end of their 15 subsidized months of COBRA in June 2010.

What will happen to these people? Many will join the ranks of the uninsured.

In the rest of the industrialized world, if you lose your job, you don't lose you right to healthcare.

Even though the end of the COBRA subsidies is not tied to the PATIENT PROTECTION AND AFFORDABLE HEALTHCARE ACT, some Americans voters might legitimately say, "I'm confused! Where's my protection? Where's my affordable healthcare, my affordable insurance?"

Before I go any further, let's review some of the immediate benefits, lest I be accused of not acknowledging how good things are.

Children can stay on their parents polices until 26. Check.

We know insurers aren't supposed to take your premium dollars for a decade then cancel you when you get sick. Check.

Seniors will get a check for $250, a down payment on closing the donut hole. Check.

Tax credits for really small business, if you qualify. Check.

Now we're approaching the first real big test of PPACA.  The Temporary High Risk Pool. This is when the pedal will meet the metal.

We can differ on the electoral consequences of  the very clumsily named PATIENT PROTECTION AND AFFORDABLE CARE ACT bill butting heads with the reality of life in the United States. Gosh, don't these politicians know if you claim bragging rights to legislation, it damn well better deliver the benefits of its artfully crafted name.

But surely  we can all agree that it is heartbreaking and unacceptable that millions of American voters families will be forced to drop their coverage when their COBRA subsidies expire, because health care and health insurance remains unaffordable.

The end of the federal COBRA subsidy could affect millions of Americans. Between September 2008 and March 2009 alone (the period during which the first to lose their subsidies originally lost their jobs), over 3 million Americans were added to the numbers of the unemployed. Many of these, along with their dependent spouses and children, enrolled in COBRA and benefited from the subsidy.

Some of those rolling off the subsidy may be able to continue their COBRA coverage for three additional months, though their costs will increase substantially. Those who can't afford COBRA without the subsidy will be forced to seek more affordable alternatives immediately or risk going uninsured.

I will never apologize, nor should you, for feeling deep shame that we live in a country where this deplorable state of affairs continues to exist despite the passage of this earth shattering, landmark legislation. Sure you can be patient and wait until the exchanges open in 2014 and some additional subsidies kick in in--if you're not sick, if you are not being treated for cancer or some other life threatening illness. For just one moment, put yourself in the shoes of the other guy.  

What about that patient with cancer being treated and facing the loss of her COBRA benefits? Well maybe she can get into a high risk pool. Well maybe she can't.  This is reality for millions of American voters families. Ignore it at your own peril.

Imagine how different life would be for all Americans if the law of the land was HR4769, the Medicare for All Buy in bill introduced by Alan Grayson. But it isn't, so we deal with this craptacular insanity.

Are the new temporary High Risk Pools affordable in the new era of Affordable Healthcare in the United States?  Not according to HHS Secretary Sebilius.

That doesn't mean coverage under the new program will be cheap: Premiums could still amount to several hundred dollars a month. As a result, the high-risk pools "won't be an effective strategy for a lot of people," Health and Human Services Secretary Kathleen Sebelius acknowledged in a recent speech.

So returning to our American who is losing COBRA subsidies. Can she get into the temporary High Risk Pool?No she can't.

Not based on how the legislation is written. You must be uninsured for six months to qualify!  Will HHS address the problem of those losing their COBRA subsidies, will they be entitled to transition to a high rick pool? It's not likely, because there isn't even enough money for all those who will apply, who have been uninsured and denied coverage by the insurance corporations due to pre-existing conditions.

Governor Ed Rendell of Pennsylvania says the high risk pool money allocated to his state will only cover 1/10 of those who qualify! Will there be a lottery?

I dare say, how the High Risk Pool plays out, will begin to define healthcare health insurance reform for the American people.

But make no mistake, no matter how you may try to twist yourself into a pretzel, healthcare in the United States remains on a fully unsustainable trajectory.

It is unsustainable on the most elementary level, that healthcare is a basic right of what a ciivilized nation owes its citizens--and it isn't in the United States.  It remains unsustainable politically and some believe, myself included, that will be the undoing for many Democratic politicians who own and supported this and promised the American people, that bending the cost curve would be a fundamental result.

And it remains unsustainable on a fiscal level, which holds the American people  hostage to the predatory for-profit insurance industry, which skims 30% of every precious healthcare dollar.

Sadly the Patient Protection and Affordable Care Act, raises our expectations, but fails to deliver a healthcare system where healthcare is a right not a privilege.

Making it affordable will be close to impossible if you leave the insurance corporations at the heart of our healthcare system as the experience in Massachsetts demonstrates. If you cap their rates, they say they lose money.

Stay tuned.

We welcome and thank you for your support in fighting insurer atrocities.

The funds donated to the Progressive Congress Action Fund, a 501(C)4 not for profit,  will be used  to advocate on behalf of the progressive agenda, to advance progressive legislation, and may include payments to individuals engaged in fund raising.

Originally posted to nyceve on Tue May 18, 2010 at 07:17 AM PDT.

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