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TOPIC: (11/5/09) "Democrats' plan to help 'uninsurables' questioned" (AP)


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(11/5/09) "Democrats' plan to help 'uninsurables' questioned" (AP)
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Democrats' plan to help 'uninsurables' questioned

AP
US House eyes Saturday health care voteAFP/File – The US Capitol dome is seen in Washington, DC. The US House of Representatives was on course Wednesday …

WASHINGTON – You're afraid your cancer is back, and a health insurance company just turned you down.

Under the health care bills in Congress, you could apply for coverage through a new high-risk pool that President Barack Obama promises would immediately start serving patients with pre-existing medical problems.

Wait a second. Read the fine print. You may have to be uninsured for six months to qualify.

"If you are a cancer patient and have cancer now, you can't wait six months to go into a plan because your condition can go from bad to death," said Stephen Finan, a policy expert with the American Cancer Society Cancer Action Network. He called the waiting period in the Senate bill "unacceptable."

Advocates for people with serious health problems, as well as some insurance experts, are raising questions about one of the most important upfront benefits in the Democratic health care legislation: a high-risk pool for the medically uninsurable.

Obama proposed the pool in his September health care speech to Congress. Intended to serve the most vulnerable as a temporary fail-safe, it would stay in place until 2013. That's when insurance companies would be banned from denying coverage because of medical problems. Government subsidies would also start that year to make coverage more affordable for millions of uninsured.

Now there are concerns about the design of the high-risk pools. Besides the six-month wait, there's a more fundamental issue — whether $5 billion set aside for the three-year program is enough. The money would be used to help people in poor health pay premiums.

Obama credits his Republican presidential rival, Sen. John McCain of Arizona, for the risk-pools idea. But when the GOP candidate proposed it in 2008, the estimated annual cost was $7 billion to $10 billion.

The Senate Finance Committee approved the six-month wait in itshealth care bill last month. To qualify, patients must be turned down for coverage because of a pre-existing condition and uninsured for at least six months.

"If you are somebody with cancer or a heart condition who needs immediate coverage and immediate treatment, that's not very helpful," said Karen Pollitz, a Georgetown University health policy professor.

Senate Finance staffers say the restriction is meant to prevent people from dropping more expensive coverage to take advantage of government assistance.

But the House health care bill unveiled last week by Speaker Nancy Pelosi, D-Calif., doesn't include a waiting period. Instead, it would require insurance plans who "dump" seriously ill patients to repay the federal pool. "The House provision will provide immediate relief for people with high-risk conditions who have no alternative for coverage," said Finan.

It may be easier to fix the waiting period than the financing.

When Obama embraced high-risk pools, he made what sounded like a broad promise. "For those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill," the president said.

The House and Senate followed up by setting aside $5 billion for the pools.

"It doesn't seem like it's near enough money," said Douglas Holtz-Eakin, who was a top domestic policy adviser for McCain. The McCain campaign ultimately concluded it could take as much as $20 billion a year to properly run risk pools, he said. The White House says McCain's proposal was more elaborate and not directly comparable to Obama's.

A House Republican bill released this week would provide $25 billion over 10 years for risk pools and other insurance programs for people in poor health. However, unlike the Democratic proposals, the GOP bill overall would cover far fewer uninsured.

If the Democrats' risk pool starts running out of money, the government may have to start a waiting list, raise premiums or take other unpopular measures. Congress could be asked for a bailout.

Several independent experts say concerns about the financing are valid.

"It would seem that ($5 billion) is going to be small relative to the need," said Thomas Buchmueller, aUniversity of Michigan business professor.

Some 30 states now have risk pools for those who can't get health insurance on the private market, covering about 200,000 people at a cost of about $1 billion a year.

"This is clearly not going to be enough money to cover everybody," said Pollitz.

Insurance expert John Bertko, a visiting scholar at the Brookings Institution, said it may be possible to stretch the $5 billion, but there's a small margin for error.

Bertko said his "back of the envelope" math suggests there are about 1 million uninsured Americans in poor health, or five times the number currently covered by state high-risk pools. If all signed up for the new federal pool, it would burn through the $5 billion in a year.

However, people eligible for government benefits often fail to sign up. And if only one-third were to enroll, the budget could work.

That's cutting it close. "No doubt about that," said Bertko.

http://news.yahoo.com/s/ap/20091105/ap_on_bi_ge/us_health_care_

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Well, many of the people that will be affected by this voted for Omoron. It's sad that people are so gullable. Unfortunately, it will cost some of them their lives. Anyone who thinks this healthcare bill is going to be the answer to their prayers is very misguided. I feel sorry for them because in the end, they are the ones who are going to suffer the most.

I don't have the answers and I feel deeply compassionate towards anyone who cannot afford health insurance. I'm not sure what the answer is but it is not this healthcare bill. Everyone should have access to affordable health care - there is no question about that. Personally, I think we need to start kicking some asses and taking names in the insurance industry and force them to stop playing God and physician. How in the hell do we allow them to tell someone that they won't cover a certain medication when that is what the doctor prescribed??? When we make serious changes in what we allow insurance companies to do then I think we can accomplish having some sort of serious coverage for everyone. Until then.....we're screwed.

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I agree with you Sug. Everyone should have health care. It is a complicated issue, to be sure. I can't imagine the cancer patient having to wait 6 months for coverage.

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Maybe the six-month waiting period is Obama's idea of a cost-cutting measure...furious

I'm with Sug, I want everyone to have health insurance, even if I have to pay more in taxes.  We probably would pay less than we do now with emergency room visits being used in place of doctor visits.



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Another underfunded bad government program who helps no one just like No Child Left Behind. Obama doesn't give a damn about univerisal health care.

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Because of my own medical problems my attention span is low so I only skimmed it.

Nobody listens to me.  I have government insurance -medicaid. It is useless and they have denied me treatment to the point that it is too late and I tossed in the towel and am letting nature do it's thing.

People refuse to listen. Having government coverage does not translate to actual treatment.

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