nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Saturday, July 3, 2010

High-Risk Health Insurance Pools Are...At Risk...Due To Underfunding

"Did you fix public opinion yet, Daddy?"  "Uh...we have a plan."
I feel like a broken record here.  For two years, I've been talking about the four-legged stool upon which health care reform can be built:  coverage, cost, access, and quality.  (See the archives going back 2 years.  You can start here)

For about the fiftieth time, I note that just blindly implementing a coverage plan, with little attention to consequences in the other areas, can lead to failure.  As noted in the Fox News Health blog (July 2), the implementation of high-risk pools--key to the Administration's efforts to turn around public opinion against their signature legislation-- is faltering:
1.  10 states are working through administrative problems which will take months to resolve.

2.  Michigan is just accepting bids from companies to manage the program. Illinois is also in the bidding process.
3.  California is still involved in passing laws to allow the program to take hold
4.  Florida is concerned that the $350 million they are allocated won’t be sufficient.
5.  To qualify, a person must be without health insurance for 6 months. There is concern that the program will be filled up too quickly and will have to be capped in several states. The Congressional Budget Office, and Richard Foster, chief actuary of HHS, have determined that the $5 billion may run out by 2011.
6.  There is a great deal of variability between the states which may delay implementation and create additional bureaucratic tie-ups.. Several states, including Colorado, Maryland, North Carolina, and California, already have high risk pools and want the federal government to fund them. Several other states, including Michigan, New York, and Pennsylvania, don’t have the pools but will establish them with federal funds. Another group of states, including Texas and Alabama, won’t use their pools and want the feds to make new ones. And another group including Arizona, Georgia, Nevada, and Virginia, have never had pools and have asked the feds to make them.
7. Some states, including Virginia and Louisiana, are in the process of suing the federal government over the possible unconstitutionality of the whole health reform bill, and would hardly seem motivated in the meantime to administer part of it.
8.  Finally, those who want this federal support but who are already insured through the pre-existing high risk pools in 35 states will first have to drop the insurance they do have for 6 months in order to qualify. [emphasis mine]
Highlighting item #5, there's too little money to pay for the care people need in the high-risk pool.  In statements to the press (The Hill blog, July 1) the Administration admitted they may be forced to turn people away:
Uninsured sick people could start applying for participation in the high-risk insurance pools on Thursday.  Healthcare experts of all stripes warned during the healthcare debate that $5 billion would likely not last until 2014 [when the main elements of the program take effect]. Millions of Americans cannot find affordable healthcare because of their pre-existing conditions, and that amount would only cover a couple hundred thousand people, according to a recent study by the chief Medicare actuary.
Officials have admitted the problem and say they could reduce benefits (uh, mean "ration" them?), reduce the number taken into the program, or re-distribute the funds between states to balance need.

It's the last strategy that bothers me the most.  The HCR law allows the Secretary of HHS great power to "limit enrollment in the plan ... nationally or on a state-by-state basis."  This gives Sibelius a ton of political weight:  "You don't like our health care reform? Well, it so happens that I think we'll give some of your money to some other state."  The Administration can use its funding to coerce states into line.

Do you REALLY think they will hesitate to play political games with the power of the purse?  It's an American tradition.

What a farce.  We have a law the most don't want.  The Administration wants to get those benefits out there to bribe people into accepting that law.  But they don't have the money...and are considering breaking promises that would hurt patients (by limiting enrollment or care) in order to meet their political goal.

It's like, "Who cares how many get hurt?  We need a political success."

Your government in action.
Doc D

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