In the House bill now - immediate National High Risk Pool program effective January 1, 2010 - HUGE!

[Phoebe Loosinhouse]

temporary program that disappears when the Health Insurance Exchange is set up

{The following is my synopsis of pages 16-23 of the health plan released today - it's just my reading of it, so read it for yourself and please tell me if you interpret something differently.}
http://docs.house.gov/rules/health/111_ahcaa.pdf

It appears that you have to have been uninsured for 6 months before applying for this program. Cannot be eligible for employer based health (not including Cobra- which makes me think that if you are eligible for Cobra you would not be eligible for this. Good news on that is that Cobra has to be picked up within a defined period after your job ends - I think it is 60 days, so at worst this would add that 2 month period to the 6 month uninsured phase)

Eligible:
*Anyone who has not had health insurance for 6 months or
*has been denied due to prior condition or offered coverage that limited the condition or
*offered coverage that was higher than this risk pool coverage(!)(that seems good) oops! something sneaky about they can offset that part of the premium that is due to age in order to determine if the offered premium is really higher or
*has an eligible medical condition

Enrollment:
*have to be eligible and a resident of one of the 50 states or DC
* if you were insured during the previous 6 months have to say why coverage discontinued PL - see, this confuses me - do you have to be uninsured for 6 months or not?

*Insurers and employers cannot try to dump people into this program or encourage them to disenroll from employer program or they will have to pay back the cost of the medical care provided for that person ***** (Note by PL - they need to add heavy fines here - if they just have to reimburse the care they would have provided anyway, they will still try to do it and consider themselves ahead of the game every time they don't get caught wheras if they run the risk of gigantic punative fines, they won't attempt it in the first place)

Costs
*Premium can only vary by age and is capped at 2:1 ratio from lowest premium
*costs can't exceed 125% of comparable premium offered in private market (Note by PL - how does that drive down costs? Should be capped at 80% or lower to drive down costs in the private market)
*can be adjusted by area
*benefits have to be equal to "essential benefits package described in section 222
*deductable no higher than $1500 for an idividual, family to be determined
*no annual or lifetime limits
*max out of pocket 5K a year for individual, 10K for family
*NO PRE-EXISTING EXCLUSIONS

and then a bunch of stuff about the state's responsibilities, etc. etc. - don't feel up to wading through that stuff right now.

**************************************************************************************

Overall, not too bad. I think this offers real hope and real change for people with medical problems and no coverage and all who don't have coverage through their employers. I think it's a too bad that there has to be a doughnut hole in coverage for 6 months - a lot of bad stuff can happen in six months. I don't know what the purpose of that gap is for. Maybe they don't want to be enrolling and unenrolling people who are just temporarily without insurance for a short term due to unemployment. The vast majority of the uninsured have probably already gone without for longer than 6 months.

[DrToast]

1. Lots of good stuff goes into effect right away

1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE — Reduces the donut hole by $500 and institutes a 50% discount on brand-name drugs, effective January 1, 2010.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) — Creates a temporary insurance program until the Exchange is available for individuals who have been uninsured for several months or have been denied a policy because of pre-existing conditions.

3. BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage.

4. ENDS RESCISSIONS—Prohibits insurers from nullifying or rescinding a patient’s policy when they file a claim for benefits, except in the case of fraud.

5. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE— Requires health plans to allow young people through age 26 to remain on their parents’ insurance policy, at the parents’ choice.

6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE—Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.

7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES—Improves the low-income protection programs in Medicare to assure more individuals are able to access this vital help.

8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE— Prohibits Medicare Advantage plans from charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.

9. IMMEDIATE SUNSHINE ON PRICE GOUGING—Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases.

10. CONTINUITY FOR DISPLACED WORKERS—Allows Americans to keep their COBRA coverage until the Exchange is in place and they can access affordable coverage.

11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

12. HELP FOR EARLY RETIREES—Creates a $10 billon fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

13. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for a doubling of the number of patients seen by the centers over the next 5 years.

14. INCREASING NUMBER OF PRIMARY CARE DOCTORS — Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals.

http://www.dailykos.com/storyonly/2009/10/29/798476/-The-2010-Reforms-in-the-House-Healthcare-Reform-Bill

[vaberella]

3. Thank you Congress. Thank you President Obama. I love my President. I love my President.

I love my President. Seriously....they really came through for me and millions of people.

[vaberella]

2. HOLY SHIT!! If this is true I just got Health Insurance on the PUBLIC PLAN!!! Wahhhha!!

:woohoo: :woohoo: :woohoo: :woohoo: :woohoo:

[Phoebe Loosinhouse]

4. Not so fast, cherie. It depends on how much of this bill actually makes it through in the merge

The Congressional bill is supposed to be much stronger than the one that our dear Senators are crafting. That's why it is important that we read and understand this bill so it won't be easy for the Baucus's and the Snowes and the Lincolns and the Liebermans to pout and give away stuff that affects US, THEIR EMPLOYERS.

DON'T MAKE IT EASY FOR THEM! Ask your Senators - why do you want to kill me off? My Congressman doesn't want to.

Also, once all this good stuff is out there, it will be harder and harder for the Republicans to be obstructionists without looking like the self-serving aholes they are.

[vaberella]

18. Neither does my congressman or Senators...I've got Weiner and Schumer.

Damn...I was getting all excited. Okay, I'll still be working. I was so damned excited.

[ramapo]

5. NOT SO BAD?????

The first thing I looked at, and which immediately infuriated me, is that pre-existing condition exclusions are not banned until 2013.

2013????????????? WTF is up with that???

This SUCKS and I'll tell you why.

My son had a brain tumor. Benign. Removed seven years ago. End of medical story.

He finished college this year. Stayed in Illinois so staying on my plan was not an option.

He applied for individual insurance, provided his medical history, and basically got laughed at by the insurance company for even applying. He was told, NO WAY YOU EVER GET INSURANCE AS AN INDIVIDUAL.

He is now on a crappy plan, leftover from college, and I pray nothing happens to him.

He doesn't even have a condition. He's not under treatment.

AND in SIX MONTHS HE WON'T HAVE INSURANCE.

Now I'm reading about this high-risk pool and it is a POS. I could've done a better job writing it up.

Illinois has limited coverage that he might be able to get come next year. He would be restricted as to doctors, coverage, etc. What about this high-risk pool? What doctors will he be able to see? Hospitals? What about his choices? Looks like NONE. JUST DON't GET SICK UNTIL 2013.

[Phoebe Loosinhouse]

6. The High Risk Pool that I summarized (as best I could) does NOT HAVE pre-exisitng conditions

and this plan is effective January 1, 2010 - in 2 months. I would think you would be happy that relief is in sight for your son. I have no idea what doctors and hospitals he could use - where do you get NONE?

I have friends that are uninsured due to age, employment status or previous conditions and I guarantee you they will look at this High Risk Pool that starts in TWO MONTHS as manna from heaven. If it makes it through the merger

[uponit7771]

9. There have be HRP but they havne't been affordable, hopefully this will be

[ramapo]

10. WHY 2013????

My point is, not made in previous post due to my blood pressure now reaching new heights,:

Why is the ban on pre-existing conditions not IMMEDIATE? Why this gift to insurance companies? Why not open coverage up January 1, 2010? Do we think insurance companies will just go out of business if they have to suddenly insure EVERYBODY? Isn't that the point of all of this??

I'm looking at the high-risk pool and trying to be happy about it. It seems to me that it should not be necessary.

Maybe I'm missing something. Perhaps it is the skeleton of the now-defunct public option and it will prove to the country that government run health insurance can work.

[uponit7771]

11. 2013 makes no sense ot me and gives KKKons too long to reverse everything

[Phoebe Loosinhouse]

12. Can you share with me the page where it says that pre-exisitng

conditions are not phased out until 2013?

My post was exclusively about the High Risk Pool and I haven't had a chance to read the rest of it

Pre-exisiting conditions usually kicks in most as a factor when someone is unemployed. When you get insurance through an employer there is usually no pre-exsisting exclusions UNLESS you have had a gap in coverage, at least that has been my experience.

[ramapo]

20. Individuals get screwed

Case in point my son. He had been covered under my group policy. He now lives out-of-state. Has no insurance through his part-time job. Applied for individual insurance in Illinois. There are no protections there. Doesn't matter if you've had continuous coverage as in NJ where we have guaranteed(but expensive) issue. He was rejected due to medical history. There is a high risk, insurer of last resort pool but it is not great coverage.

I am reading the bill but the 2013 reference was in the timeline summary.

[Phoebe Loosinhouse]

21. I still still think your son will be able to get coverage in the High Risk Pool

effective almost immediately (if this part of the bill survives) with no pre-existing exclusion. I would assume (always risky) that probably the same doctors and hospitals that accept Medicare would possibly be providers for this new group. I don't know that, it just seems to be logical.

[Phoebe Loosinhouse]

16. After wading through more of this stuff I think you are correct about

pre-exisitng conditions, ( unless you qualify for the high risk pool which basically means you are unemployed and uninsured, probably because you couldn't afford COBRA) being delayed until 2013.

Pre-exisiting is addressed on page 95 and seems to fall in the categories of implementation described on page 82.

I agree with you that that is completely unacceptable. We need to find out clearly and specifically in this bill what we like and want to keep and what we want to have improved.

The Senate version will be worse than this version.

[uponit7771]

7. Buu Buh Buh

[Phoebe Loosinhouse]

8. Not getting your point - don't know if it's positive or negative. Clarify please.

[Cha]

13. Yeah, what does

mean, uponit?:)

[ipaint]

14. If you can't afford insurance how does this help?

Are the premiums dependant on what you make and what if your unemployed?

[Phoebe Loosinhouse]

15. I agree with you that ultimately it will be all about actual premium costs.

I guess we'll have to get a real figure and find out about the subsidies in order to find out what actual cost would be.

I wasn't too happy to see that this high risk pool cost tops out at 125% of the private market for the same coverage. (Again, I'm not an insurance or legal maven,and possibly I am reading it wrong) I don't see how that lowers costs or helps anyone.

[Clio the Leo]

17. Yay! I like to see happy Phoebe!!!!

The President alluded to this in his speech. Isn't it cool?

[Phoebe Loosinhouse]

19. I opened up the bill and I saw this as the first substantive section

and I was indeed very happy. My greatest thrill is that this takes place immediately.

As some have pointed out it will be all about what the actual end cost is. We have no way of really knowing that at this point.

[Jim Lane]

22. My attempt to answer your "this confuses me"

I haven't read the bill. I'm going only by your summary.

Eligibility for the HRP has four conditions, but they're disjunctive. It says "or" so you can get in if you meet any one of the four. Uninsured for six months is one of them, but there are others.

Suppose you had health insurance through your job. You were laid off and went on COBRA, but your COBRA ran out last month (or you couldn't afford it in the first place and didn't get it). You've tried to get individual coverage, but you've been denied everywhere because of a pre-existing condition. Based on the second of the four conditions, you're eligible for the HRP, even though you were insured within the last six months. It's just that, under the rule summarized in "Enrollment", you must say why your coverage was discontinued.

So, no, you don't have to be uininsured for six months.

[ProgressOnTheMove]

23. This is what a legend Gov./Dr. Dean is I remember him saying he negotiated to get this in the bill..

in some way he seems to have a lot of influence still. He said some of this had to kick in straight away so people could feel the effects and would see them through the 2010 mid-terms. Dean from way back has said this will pass into law.