During a televised speech last year, President Obama announced, to much fanfare, that, if we only passed the bill, he implied, all people who currently who could not currently buy insurance "because of pre-existing conditions", would be given an opportunity they would not otherwise have had, to purchase it. A national high risk pool.
As always, the details were, and still are, unacceptably hazy. Although Americans should have realized they were being played, few people realized that this was an example of the adage that is something sounds too good to be true, it usually is.
So, implicitly- its now clear, that he also meant that ONLY those who otherwise could afford individual coverage which means only a very small percentage of us- would be helped.
It should have been obvious, because the COST to actually address the huge root problem ADEQUATELY for four years, would rival the cost of the six years represented by the actual bill. So, just as people who depend on premium caps and caps on out of pocket expenses are almost certain to be very disappointed when after waiting four years, they find those promises vanish into thin air, there was NO WAY that THAT promise would EVER actually HAPPEN.
Obama is where he is because he's a great speaker. Basically, he's a great promiser. But when he makes his promises, people should listen VERY carefully, because the exact wording always contains important clues to what he really means. In this case, very few people thought that he meant what he said only in the most minimal, literal sense. They should have understood, that Obama, being a lawyer, OFTEN does that. For example, an actuary would understand immediately that when Obama says "A normal family would pay less" he also means "A Family with one sick member will pay far more"- But few others would.
Later, during the struggles over the healthcare bill, $5 billion, (or $3.90 per year, per American) was allocated for the high risk pool to cover a four year period.
This surprised almost everybody who was not watching closely, because given the need, wouldn't one expect a sum proportionate to that need..
Yes, but.. More on that in a bit.
How does one who is sick and needs insurance but who can't buy it now get it? They don't. Thats usually a combination of two things, the absolutely obscene cost, and also unwillingness of the insurance companies to sell to a known risk.
Only one of those situations will qualify somebody to get into the high risk pool. They need to qualify, they may even need to try to pay, and for that reason, all indications are that its not going to be something many people qualify for.
Some background is in order..
Its estimated that approximately one fifth of the American population under 65 has a chronic medical condition of one kind or another making them "medically uninsurable" outside of large group plans. Indeed, many people both in the past, when individual insurance was far more affordable than it is today, as well as recently have tried and either became discouraged when they realized that it was far too expensive, or attempted to apply and then had been rejected from being able to buy individual insurance for both serious and increasingly, even minor medical issues. Also, individual insurance premiums have been increasing by double digit rates. Many people in individual plans saw increases of 20-45% this year, and its rumored that 60% increases are right around the corner.
Individual insurance, of qualifying quality (in other words, not a high deductible "catastrophic" plan, the only kind that most working people can afford.) for a family can easily cost many thousands of dollars a month. Even an adequate individual policy for a single healthy person can easily exceed two thousand dollars a month now. Keeping that in mind, the precondition placed on the Federal high risk pool that somebody have had qualifying insurance continuously in the recent past, and have already applied for - in other words, tried to buy, individual insurance and been rejected, and THEN wait six months, uninsured, seems as if its designed to make it impossible for most of those who need help to get it.
One can see why neither many politicians (since each sick person only has one vote, but they may use ten or even a hundred times more money than a healthy person) the Federal Government would not want to help expensive sick people.
Costs - intentionally uncontrolled by the politicians, who are rising, and the dependence on the insurance system is also an unnaturally artificial situation that encourages thievery.
Existing state High Risk pools set up (to make the politicians failure of clinging to the state religion of laissez-faire economics less obvious) are themselves collapsing under the huge subsidies that they need to consume in order to continue to perpetuate the illusion of fairness for a system that is inherently designed to prevent all but the richest sick from getting care.
For example, the informational page on naschip.org - the state high risk pool association site- about the state high risk pools says this:
"All state risk pools inherently lose money and need to be subsidized. While the individuals in risk pools pay somewhat higher premiums, roughly 50 percent of overall operating costs need to be subsidized. Subsidy mechanisms also vary from state to state -- some states assess all insurance carriers, HMO's and other insurance providers; others provide an appropriation from state general tax revenue; some states share funding of loss subsidies with the insurance industry using an assessment of insurance carriers and providing them a tax credit for the assessment, or other states have a special funding source, such as a tobacco tax, or a hospital or health care provider surcharge. "
So, they lose a lot of money? They are an expensive welfare program? They are not self sustaining? Imagine that!
Why do they spend all that money. (It must be a great deal..) Its very important to remember that, like the individual insurance that is sold to healthy people, these high risk pools are not for just anybody, increasingly, like high quality traditional insurance plans (only 2% of the plans sold today) they are not affordable by mainstream Americans, sick or not, who may NEED but cannot afford individual insurance now, because of its cost! THEY ARE FOR THE WELL TO DO. The Senators own peers, often small business owners, who need insurance that wont dump them when they get sick.
Again, a quote from "What is a Risk Pool?": LISTEN CLOSELY
"It is important to note that risk pools are not created expressly to serve the indigent or poor who cannot afford (individual) health insurance.
Risk pools are designed to serve people who would not otherwise have the right to purchase health insurance protection. The indigent can access coverage through state medical assistance, Medicaid or similar programs. However, some state risk pools do have a subsidy for lower income, medically uninsurable people. "
Studies have documented the failure of the individual insurance industry in providing an alternative for most Americans. Those who wish to sign up for state high risk pools, desperate after losing private insurance, often find that their individual insurance was not "of qualifying quality". These days, that is hideously expensive.
And BTW, the CBO expects that individual insurance "offered" through exchanges after 2014 will be too.
After all, as promised repeatedly to insurers by Senators, they cannot provide that much better a deal than private insurance that people would buy them in large enough numbers to threaten anything of the all important insurance companies core market, the HEALTHY employed. (This precondition guarantees that the public exchange options will be both unaffordable and unsustainable.)
From: Failure to Protect: Why the Individual Insurance Market Is Not a Viable Option for Most U.S. Families
"Between 2001 and 2007, an increasing share of adults with private insurance ... whether employer-based coverage or individual market plan .. spent a large amount of their income on premiums and out-of-pocket medical costs, were underinsured, and/or avoided needed health care because of costs. Those with coverage obtained in the individual market were the most affected.
Over the last three years, nearly three-quarters of people who tried to buy coverage in this market never actually purchased a plan, either because they could not find one that fit their needs or that they could afford, or because they were turned down due to a preexisting condition."
In the case of the high risk pool, only the second group, those who could afford, then, had actually applied for, but who were rejected, would get help after six more months. Then a war of attrition, insurance could ONLY be purchased by those who survived the waiting period, who both survived six months of being uninsured with an often serious medical condition, paying out of pocket for any medical care, and who had enough money after that to pay often obscenely high costs.
Its commonly known that the first six months of any serious disease are by far the most expensive) Of course, access only means permission to buy insurance at whatever price is asked. IF they still had enough money to pay premiums without missing any payments, as well as the uncovered costs of their care that this insurance did not cover.
The first, far larger group - those who tried to buy insurance, but found that they both could not afford it, and would not have been "offered" it, would not qualify.
For four long years, most of those who desperately need health care STILL wont get quality care.
They would have to "spend down" and then, once impoverished, (In some states, one cannot even own a working car, as it represents a saleable asset.) THEN apply for Medicaid, the program for the poor.
Then, if at any point, (say, they get a raise, or a bonus) they make more than the Medicaid cutoff, but less than enough to buy the expensive individual insurance, THEY GET DUMPED AND UNINSURABLE, THEY REMAIN ON THEIR OWN. UNTIL 2014, or until the GOP wins, or until, whenever, no light in the tunnel, really.. (Because the whole mess, both before and after 2014 is completely unfunded and unsustainable.)
Are you listening? That group that will (I think inevitably, due to their unwillingness to admit that the privatization insurance model has failed,) fall through their carefully placed cracks are, by design, basically almost all of us.
Maybe its not impossible- to get care. But, its close..
These figures (below) from 2007 in the report Failure to Protect: Why the Individual Insurance Market Is Not a Viable Option for Most U.S. Families
also show clearly how few may be able to afford market rate individual insurance through the separate individual plan "exchanges" after 2014, especially if rates keep increasing by double digits as they have been.
Most Americans (more than 80%, as shown below) emphatically could not afford market rate individual insurance in 2007. (The last year that figures were available for)
Rates have also been increasing by double digit rates each year, so these figures, again, from 2007, probably understate the current problem, the situation is MUCH worse now.
The Individual Insurance Market Is Not an Affordable Option for Many People
Adults ages 19 to 64 with individual coverage or who tried to buy it in past three years who: | Total | Health problem | No health problem | <200% FPL* | 200%+ FPL* |
Found it very difficult or impossible to find coverage they needed (would not qualify) | 60% | 35% | 40% | 52% | 47% |
Found it very difficult or impossible to find affordable coverage(would not qualify) | 45 | 57 | 70 | 63 | 53 |
Were turned down (would qualify) charged a higher price (would not qualify) or excluded because of a preexisting condition (would qualify) | 26 | 36 | 47 | 39 | 34 |
Never bought a plan | 66 | 85 | 62 | 79 | 73 |
* FPL = federal poverty level.
Source: Failure to Protect: Why the Individual Insurance Market Is Not a Viable Option for Most U.S. Families
These policies, (Access to purchase at the asked price, whatever it is, (if one can afford the price), will be protected in some small ways in 2014, for example, unlike in Europe, where everyone is charged the same price, here the old will be charged more, so some who now are in the group who "Were turned down, charged a higher price, or excluded because of a preexisting condition" will become "Were prevented from buying, charged a higher price, because of the aging process which makes people more prone to illness."
The report makes it clear that the much hyped individual "access" which will become available to even those with pre-existing conditions who can pay the price - still won't be affordable to a very large majority of people. Even subsidies will not be able to make it affordable unless a great deal more money is allocated to the program in order to make up for the huge wasteage caused by the insurance system.
Even if you can afford to buy one of the cheaper individual policies, (if you were healthy) and are rejected, that expense may not represent an event that qualifies you for the high risk pool because it is not deemed to be "comparable". This happens all the time with state pools.
You may not qualify for the high risk pool or be able to afford the individual policy that the state exchanges will sell, even the bronze plan, which is probably like many current plans that are increasingly very limited in benefits. In other words, it wont cover all needed curative care like any and all European standard plans do. And older Americans will be forced to buy the lowest quality plans by the 300% increased costs. When they should be buying the best plan, so they don't get dumped when they get sick, as sooner or later WE ALL DO.
The Federal risk pool will presumably have better benefits than a 65% bronze plan, but it will almost certainly be very expensive, and/or require 50% subsidization, and for that reason, it will represent a very pricey "welfare" benefit in legislators eyes, one for the rich, like them, and so, should only be available to a limited "worthy" group.
Those who can jump through a very difficult series of hoops.. First, since individual policies are only affordable for the well to do, who CAN afford the thousands of dollars a month for individual insurance premiums- the Federal risk pool will only be able to be applied for to those who have tried, applied, (providing years of medical documentation to the insurance companies) and then been rejected- from purchasing it. Then, comes the waiting (dying?) period while uninsured, spending money that would possibly be used up, before one was even able to receive benefits. (Its unclear whether people would have to spend premiums while not receiving benefits, but I think its safe to say that that is a strong possibility, they claim that its to prevent those crafty sick folks from "gaming the system".)
These very elaborate exclusionary tricks are very telling and they show us where we are going if we allow those in Washington who cling to their religion of laissez-faire economics to steal our nation's future and pervert the health reform Americans waited EIGHT LONG YEARS FOR into a a FOUR HUNDRED THOUSAND LIFE DELAY followed by another bailout for the insurance industry- and create a set of punishing conditions that in the final analysis would AGAIN mean that only the well to do with chronic illnesses will be able to get reliable health care in America.
In the past, Democratic administrations took care to attempt to create social programs that offered manageable situations for those who played by the rules, however, we should not make that assumption about the current administration in this situation.
These exclusions are intentionally punishing, and they are designed to dump those who need help the most. A candid comment made during the campaign by Obama's head economist predicted as much, those one fifth of Americans are expensive to insure. No wonder Obama always promised only to save "average families" money.
Obama's habit of using "lawyer's English" to spin what in essence turn out to be bullshot promises should be a wake up call to Americans and an important thing to keep in mind as we grapple with our leaders irresponsibility. By letting insurance industry CEOs and lobbyists write healthcare bills and their politicians and their dirty money run healthcare instead of doctors and patients its clear, that democracy and the Democratic Party is in serious need of a complete renewal or replacement.
After Obama's failure to stand up for or even make the minimal credible effort to deliver AFFORDABLE QUALITY health care, when the rest of the developed world enjoys it- probably means that Obama and many other Dems, undoubtably won't be re-elected! The high risk pool seems to be the first test of their mettle, and from the convoluted rule set it doesn't look like its going to be one they pass.
It should be noted that insurers wrote the Senate bill, and also that the state high risk pools were the model for the public option concept, and given that the state high risk pools lose money and require subsidization at approximately 50%, how could Obama have stood there claiming that "public option" would be affordable or self sustaining and have the media let him get away with it?
By the same logic, it seems reasonable to assume with almost no doubt that the high risk pool will NOT represent an acceptable option for millions of Americans who need it, just as individual insurance now doesn't. For the same reason, the "reform" after 2014 I think doesn't even remotely have a chance of being affordable, quality health care. The money allocated to prop up the broken insurance model isn't even marginally credible in that respect. ($290/year/American)
Even the pre-conditions placed on the high risk pool, though, can't explain away the ludicrously low 5 billion dollar ($3.90 per American, per year) figure put forward as supporting a high risk pool for four years has not been challenged more.
That should have immediately raised a red flag for all of us because it makes incredibly obvious the utter lack of sincerity these political elites lack and their real world unwillingness in attacking this problem.
Contrast that $2.90 a year per capita represented by the $5billion in the risk pool, or $290 a year per capita for the subsidies for the individual or group insurance (that unsubsidized, 4/5 of us can't afford) with the $4500 a year per capita (52%) of the Federal budget we currently spend on wars, both current, past and future. (Including the longest war in American history, the one in Afghanistan)
Clearly, the oh-too-smart "political caste" are proud of themselves for their pulling the wool over our eyes. I'm sure the lobyists and the Senators laugh in their private elevator together for pushing this important issue off the TV screen and out of the blogosphere so cheaply.
Its pretty clear what its REAL purpose is, though- A high risk pool represents that necessary element needed so that people will not be able to say that getting coverage is impossible for that one fifth of the American people who would need it, should they not have a job. Extremely difficult financially, out of the reach of 95%, maybe, but impossible, no.
They feel that by making this magnanimous gesture, (while blocking any discussion of single payer health care, which actually would make quality healthcare affordable for everybody, ending medical segregation and the caste system) they NOW cannot be accused of murder for perpetrating this hideous insurance injustice on America for so long. After all, some people manage. You and the millions of others in your situation, just must all be failures.. sorry.
The average American ends up spending ONE QUARTER MILLION MORE DOLLARS OVER THEIR LIFETIMES MORE than the average Canadian on healthcare because of this waste and corruption. And Canadians by all measures, get far BETTER health care!
Please don't let them waste four more years of our time padding their pockets while Americans confused by their lies and denial are delayed by empty hope from realizing that this system is broken, and taking action to bring about REAL, not fake, responsible political change.
Demand that they stop playing their games with our nation's people futures and lives.
Other countries solve this problem.
Its not rocket science.
Overviews of Single Payer Health Care
(from PNHP and Health Care for All Illinois)
The Physicians Proposal for National Health Insurance
Key Features of Single-Payer
Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act
A great overview of the need for and logic of a single-payer system.
Liberal Benefits, Conservative Spending
Public Citizen's Response to the Citizens' Health Care Working Groups Interim Recommendations
Rep. Dennis Kucinich Tackles Health Care
Rep. Kucinich talks with Truthdig about the health care crisis in America.