Insurance Pool to Offer Reduced-Rate Coverage

[babylonsister]

Insurance Pool to Offer Reduced-Rate Coverage
By ROBERT PEAR
Published: April 2, 2010



WASHINGTON — In one of its first steps to carry out the new health care law, the Obama administration announced Friday that it was establishing a temporary insurance pool where uninsured people with medical problems could buy coverage at reduced rates.

Kathleen Sebelius, the secretary of health and human services, said the program would “help provide affordable insurance for Americans who have been locked out of the insurance market.”

Federal health officials said the program would be available from late June of this year to Jan. 1, 2014, when private insurers will be required to accept all applicants without varying premiums on account of a person’s medical condition.

Under the new law, Ms. Sebelius can sign contracts with states to operate insurance pools meeting federal standards. The federal government can operate the pool directly or hire a nonprofit organization to run it in any state that does not want to do so.

To qualify for the high-risk pool, a consumer must have a pre-existing condition and must have been uninsured for the six months before filing an application.

more...

http://www.nytimes.com/2010/04/03/health/policy/03health.html?hpw

[NJmaverick]

1. This is the change we voted for

[ima_sinnic]

2. how do you (or "they") know if you have a PEC if you haven't seen a dr for yrs? (nt)

[Phx_Dem]

3. I hope they quickly expand it to include people who can't get insurance, but

do not have pre-existing conditions. That would greatly expand the size the pool and, hopefully, give them more negotiating leverage in addition to allowing people who are out of work to get insurance.

[eridani]

4. Reduced from what starting point? State high risk pools are all overpriced garbage

And it doesn't matter what kind of subsidies thare are if people can't afford co-pays and deductible.

[eomer]

7. Reduced down to standard rates.

State high-risk pools currently charge from 125% to 200% of standard rates. The new pools will charge standard rates. In other words, they will charge the same rate charged on average for similar coverage by insurers in the area for regular groups.

There is a max out-of-pocket of $5,950 per person per year. There will be other minimum requirements set by HHS.

This is all from the OP article, by the way.

This won't help everyone who needs help (some won't be able to afford the premiums plus the out-of-pocket) but it should help many.

[eridani]

8. Look for some more really huge increases in regular rates, then

You read it here first.

[eomer]

9. Probably, but not because it has anything to do with the new high-risk pools.

If anything these high-risk pools will make it easier for insurance companies to dump people with expensive conditions out of their plans between now and 2014, and thereby have a downward effect on average insured premium rates.

[eridani]

10. And you don't think that this is going to screw the taxpaying public badly? n/t

[eomer]

11. No, I think for once my tax money will go to something I want it to.

This money will go directly to pay for health care for people who otherwise couldn't get it.

[eridani]

14. Wrong. It will go to insurance companies, who may or may not provide actual care n/t

[eomer]

16. No, the tax money will go to pay claims for people who are uninsured due to pre-existing conditions.

Here is the relevant provision of the bill (emphasis mine):

17 (g) FUNDING; TERMINATION OF AUTHORITY.—
18     (1) IN GENERAL.—There is appropriated to the
19 Secretary, out of any moneys in the Treasury not oth-
20 erwise appropriated, $5,000,000,000 to pay claims
21 against (and the administrative costs of) the high risk
22 pool under this section that are in excess of the
23 amount of premiums collected from eligible individ-
24 uals enrolled in the high risk pool.

http://ritterim.files.wordpress.com/2010/03/senate_bill.pdf

HHS is allowed under the law to contract out the administration of the pools, but only to state entities or to non-profits. I don't see where the for-profit insurance companies have any piece of the tax money going into these pools.

[eridani]

18. The insurance companies still get to pass judgments on care, as far as I can see n/t

[frazzled]

15. They have to charge you the same rate as a non-sick person

That is huge. That is not like the current state pools (in my understanding). Just being able to get insured will be huge for this group of people.

[impik]

5. Stupid country, can't understand what an amazing president you have right now

[OneGrassRoot]

12. ...

;)

:toast:

[denimgirly]

6. When u think about it...It doesnt technically solve much -- Subsidies doesnt resolve

it but hey maybe someone in the high-risk pool will be able to afford it somehow after subsidies? I still find it strange that Insurers can charge anything they want and the government is ok with paying it when the smart thing is to just be a single payer system and dump the insurers all together.

[totodeinhere]

13. I'll be willing to bet you that even at reduced rates most people won't be able to afford it.

I am anxious to see what those rates actually are and what people will have to do to try to qualify for subsidies. I hope that it won't involve a mountain of red tape and paperwork that will discourage people from trying to apply in the first place, but I am not optimistic.

[City Lights]

17. Does anyone know what happens to insured people with a rider for a pre-existing condition?

People with riders for pre-existing conditions technically have insurance, however, the insurance they have doesn't cover their pre-existing condition.

Does anyone know if people in this situation can get a supplemental policy through the high-risk pool for the condition that isn't covered through their primary health insurance company?