Month: April 2010

Health Care Reform: The Administration Will Not Get Out of Its Own Way

One of the key provisions of the healthcare reform legislation, also known as the Patent Protection and Affordability Act, is to provide all Americans with access to healthcare insurance. Now written into law is consumer protection requiring insurance companies to cover all individuals including those with preexisting conditions.

The law goes further by providing subsidies to those unable to afford insurance based on income, age, and geographic regions. While the formulas used to determine the subsidy levels can be confusing, the basic premise is simply that more people will be able to afford their coverage. As we all know, millions of Americans who want and try to buy health insurance are denied the privilege every day because they have a preexisting condition. Until recently, the insurance companies were never obligated to cover them at any price. Depending on what state you live in, you may be fortunate enough to have state mandated coverage requiring insurers to sell you a policy, but in many cases the premiums for those policies are unaffordable for most or do not provide coverage for the very aliment for which access to healthcare is critical.

Since most of the major health insurance reforms do not start until 2014, so as to provide the various governmental agencies and states the time needed to set up the new healthcare delivery system, a stopgap measure was written into the law. This measure provides $5 billion of immediate funding for a high-risk pool to cover many of those who are currently unable to get insurance. Currently, the government does not have a plan to fully implement the program. Many states already have high-risk pools for their residents. The rules vary state to state in terms of what kind of coverage is provided and the conditions to qualify. Meaning someone in New York State would have completely different protections from someone living in Indiana. The federal government wants to leverage off of existing state programs rather than start from scratch. For those states that do not have a high-risk pool, the federal government will create one.

Complicating the plan is Georgia. The State has decided they will not participate in the federal high-risk pool and is forcing the government to create some mechanism to ensure that the coverage still gets to residents who need it most. While this situation is politically motivated, it should not be surprising to anyone that how to implement this program is getting more complicated each day. The pool is supposed to be available within three months of the signing of the law or June 30th.

Each week on Healthcare Connect (Sirius 114/XM 119), we take calls/questions from listeners on healthcare reform, healthcare insurance, doctor bills, hospital bills, COBRA, or any topic where we can provide non-partisan useful information on navigating the current system. We have helped hundreds of people with their problems since the show started 2 years ago and it has been tremendously rewarding for me to able to do it each week. My co-hosts Allison Vogel and Matt Penziner, put in a great deal of time each week with me trying to make our crazy healthcare system a little easier to understand.

It should come as no surprise to many that the number one question on the show recently is related to how to access the new federal high-risk pool. Further, many people did not even realize their own states actually had a program for which they may qualify. Since the information is not yet available, I thought it would be great to have someone from the government agency charged with writing the rules, the Health and Human Services Department (HHS), come on the show and answer some of the basic questions from my listeners:

1. What are the rules to qualify? The only rule that is clearly understood is that you must not have been able to get health insurance coverage because of a preexisting condition for the previous six months.

2. What are the specific healthcare conditions that qualify – asthma? cancer? etc?

3. Will a subsidy be provided if one can get the coverage but cannot afford the cost?

4. How and when will information on the program be released?

After reaching out to our contacts at HHS, we were told they would not come on air to answer questions. I have had representatives from HHS on the show before on various healthcare reform topics before the law was passed, but this time no one would talk. No reason was provided but I am fairly certain it is because HHS has no idea how they are going to implement this program. What I find most troubling is that they will not even speak to those who supported the reform and are trying to help. One has to ask, at what point is this administration going to figure out the public has a deep mistrust of government right now. It was very difficult to get the reform passed and those like myself who supported it most, want to be able to explain it to the public. It is only when more people understand how this reform is going to work and help everyone that they will embrace change.

There is nothing wrong with not having a detailed road-map on how this will all work. What is wrong is ignoring the public’s desire to have their questions answered. It creates another opportunity for those who were opposed to reform to accuse the administration of poor planning, incompetence, or even worse, it provides them an opportunity to sway public opinion against this transformational legislation. It is time to answer the questions not hide and get out in front of the story. I hope the Secretary of Health and Human Services will reconsider her position of silence and talk to us. It’s probably in the administrations best interest and certainly in all of ours.{jcomments on}

Some Recent Questions to RubinHealth

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Here are some of the types of questions RubinHealth has received since the passing of the recent Healthcare Bill.  This is a complex topic that many people have questions about, so feel free to email us or call into Dr. Radio on Sirius Radio – Thursdays between 12 and 2 EST- at 877-698-3627, and hopefully RubinHealth can help you understand what matters most to you.

Q: My parents are both elderly (over 85) and they have what I refer to as a supplemental insurance policy to their Medicare. They believe that with the new legislation they will no longer be able to have such a poliPreviewcy. Can you clarify whether or not this is true? Without a doubt, this must be a flash point issue for seniors who need and can afford this kind of supplemental policy.

A: Your parents will be able to maintain their supplemental policy. That does NOT change after reform.  No services will be cut by Medicare.

Q: When will Medicare Advantage be abolished? Will it be in 2014 or before?

A: Medicare Advantage Plans are NOT being abolished. The government is going to reduce payments to the plans which will lower their profit margins. The plans themselves will still be offered to the public via the private insurance markets.

Q: Our son is in his late twenties and has a severe precondition. He has an extremely limited individual insurance policy that partly covers medicines, limited laboratory tests, but no hospitalization, Emergency Room visits, imaging, or physicians. His yearly income is below the poverty level for a single person, and he works full time.

Should he drop the policy and apply for the high risk pool insurance coverage? Only individuals without insurance coverage qualify for the pool. Would he qualify for Medicaid coverage (despite his ability to work) given his current income? Being that his current coverage is negligible, the current policy can be dispensed with.

A: The rules for the high risk pool are still under development so we are going to have to wait a bit to get an answer. Given his income, in 2014, he is going to qualify for Medicaid which will offer far more benefits than he has today.  This is based on his income which will need to be less than 133% of the federal poverty level for a single person, which is true for him.

The catch now is he has to get to 2014.  The legislation says you must be without insurance (and unable to get it) for the previous six months.  In this case, he has partial insurance so we have to wait and see what they say. Further, I would not want your son to be without insurance for the six month waiting period.  For now, he should keep his coverage and give a few weeks for the rules of this high risk plan to come out.


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