One of the first provisions of the PPACA to come into effect was the establishment of a set of high-risk insurance pools across the country. A Federal program for states that did not want to run their own, and state programs running in accord with Federal guidelines for those states that wanted to create their own programs.
These pools, which are to provide insurance coverage for Americans denied health insurance because of pre-existing conditions -- at costs no greater than what people without pre-existing conditions are paying -- were scheduled to come online July 1st. And for the most part, the Federal programs did start accepting applications on that date. State programs, subject to the vagaries of individual state bureaucracies, were somewhat slower.
But as of September 1st, almost every one of the 26 states that chose to have their own program was either already providing coverage or at least accepting applications (and planning on coverage beginning October 1).
The fact that such a complex Federal program -- which had to create myriad rules and regulations and interface with 26 state governments -- could achieve this in a timely manner, without tales of massive waste, fraud, abuse or scandals of any kind is a tribute to
Katherine Kathleen Sebelius, Secretary of Health and Human Services, and the team she chose to implement the plan.
Not that you'd know it if you weren't paying very careful attention. Despite the fact that these pools are now providing tens of thousands of people with insurance coverage and medical treatment if they need it -- people who couldn't obtain it before at any price -- you'd barely know from the press coverage or from the administration that the program was operational and helping people.
But I'll lend a hand. Here's some clippings from the few stories out there about how the pool is helping.
"It's a great day for me," said Cathy Allen, 47, a consultant from Marblehead, Ohio, who is enrolled in the state's high-risk pool.
Allen was diagnosed with systemic lupus, a disease that attacks the immune system, while in college. Despite being free of any inflammations for nearly 20 years, Allen said private insurance companies have denied her coverage.
"It's been incredibly stressful, but now I've got some peace of mind," said Allen, who, under terms of the risk pool, pays a monthly coverage rate of $293, comparable to what someone her age without a pre-existing condition would pay.
When James Howard was diagnosed with brain cancer in March he did not know how he would pay for radiation treatments costing $87,000 and $2,300 a week for chemotherapy...
After his diagnosis, UnitedHealth revoked Howard's policy on the grounds that his was a pre-existing condition. A Texas high-risk insurance pool would have paid for his treatments, but only after a year...
Then he learned that he was eligible for another high-risk insurance pool created by healthcare reforms passed earlier this year... He applied for enrollment in July when it opened.
"I've been to the doctors. I'm on my radiation treatments. I'm getting my pills in the mail," Howard said. "Everybody's talked negatively about the Obama reform plan and all that stuff. There's more to it than that."
For the last five or six years, Jeff Acton has gone without health insurance while hoping that his irregular heartbeat wouldn't land him in the hospital.
"I was always worried that if something did happen, I'd get this big monster bill in front of me, and I never wanted to have to do that," he said.
Acton, of Fulton, Mo., recently enrolled in a new program created by the federal health care overhaul that allows uninsured people with pre-existing medical conditions to apply for high-risk insurance pools in each state...
"The majority of the insurances I did enroll for wouldn't accept me because of my height and weight, the prescription medicine, or I'm just too high-risk," said Acton, who owns a refrigeration and appliance company.
Acton, 43, said he cobbled together some basic insurance for doctors' visits and the six medications he takes, but the coverage was not inclusive.
"They skimmed the surface ..." but they wouldn't take care of anything major," he said.
Missouri's high-risk insurance plan is comprehensive and covers 80 percent of medical and prescription costs, but it's not free. Premiums range from $423 to more than $900 a month and must stay comparable to what a healthy person would pay for private insurance in the marketplace. The plan carries a $1,000 deductible, with a maximum yearly out-of-pocket cost to consumers of about $6,000 for medical care and prescriptions.
All I have to say is that my son finally got to see a doctor for the first time in years because of the new high risk pool. No doctor would take him before.
My son doesn't want to be disabled and live on taxpayer money for the rest of his life just to get health care. He wants to work. He wants to be a productive member of society. If he has adequate health care, he can.
A month after its launch, Pennsylvania's new high-risk insurance program has received 2,600 applications, meaning there still are plenty of slots available before the state Insurance Department hits its initial cap of 3,500 enrollees.
Good stories! With tens of thousands already enrolled, there should be hundreds of stories like this. But there's not. These represent the sum total of all such news stories that I can identify via Google News searches for the last month!
Are there glitches? Sure. For instance, no one can quite figure out why only 32 Iowans have applied to-date to Iowa's program.
Would it better if there were less stringent rules on who was eligible, and more money for the program? Of course. Would it be better if insurance premiums were lower? Most definitely (for all Americans!). But the bottom line is, within the constraints that Congress set the program to, people are being helped, treatment is being provided, and lives are likely being saved.
Here's a table with information about the high risk pools in all 50 states. For those states running their own programs, clicking on the state link gets you to the program's website (where I could locate the site), which provides instructions and forms for applying to the program.
The table also shows the premiums charged for a 50-year old non-smoker, for a policy with a $2500 deducible (unless otherwise noted; state programs are not always structured with this option). Clicking on the 'Premium' link gets you to a web page describing the rate structure in detail. Rates range from $283/month in Pennsylvania (what a deal!), to $1003 in Alaska (WTF?).
For states with Federal programs, information about applying can be found by clicking the appropriate state on the map at HealthCare.gov.
|State||Premium (50 ns)||Type|
|Alaska||$1006 (1500 deductible)||S|
|District of Columbia||?||S|
|Iowa||$385 ($1000 deductible)||S|
|Maryland||$328 (or less; $1500 ddctbl)||S|
|Oregon||$544 ($750 deductible)||S|
|Rhode Island||$430 ($1000 deductible)||S|
|South Dakota||$456 ($2000 deductible)||S|
Starting September 23rd, less than two weeks from today, many provisions of the PPACA take effect:
- Young adults will be allowed to stay on their parent's plan until they turn 26 years old.
- All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.
- In the past, insurance companies could search for an error, or other technical mistake, on a customer's application and use this error to deny payment for services when he or she got sick. The new law makes this illegal.
- The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process.
- Insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.
- Insurance companies' use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans.
- For new plans and existing group plans: The new law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition.
- New funding to support the construction of and expansion of services at community health centers, allowing these centers to serve some 20 million new patients across the country.
(For some of these provisions, some insurance companies agreed to implement them prior to September 23).
My vote is to put Sebelius in charge of a nationwide single-payer program. But that's just a pipe dream. For the nonce, this is what we have.
Update: The search facility web page to find Federal Health Centers, which in the comments was noted as being broken, now seems to be fixed. Searches I've tried work.