MI high risk pool helping those with pre exsisting conditions

[SpartanDem]

Deri Mick is left to wonder whether the health insurance he just got through Michigan's new program for the hard-to-insure came in time to help.

Mick, 46, of Swartz Creek was set to have kidney cancer surgery last week at the University of Michigan. But tests found more cancer than expected. He awaits further tests and possibly chemotherapy.

Through Michigan's new high-risk insurance pool, Mick, who hasn't had insurance for nine years, was able to get coverage that will cost him $350 a month. The program, which began offering coverage Oct. 1, is open to any adult 19-64 who has been rejected for insurance in Michigan. It will accept the first 3,500 applicants.
Mick was turned down earlier in September by Blue Cross Blue Shield of Michigan, which can legally refuse to offer insurance to people with a pre-existing condition for a period of six months from the time of the request. But the company referred Mick to the new pool.

"I'm going to be high risk all my life," said Mick, a divorced father of two who earns $38,000 a year. He hopes he will qualify for some financial help in 2014, when broader health reforms begin, including subsidies for lower-income people, particularly those earning less than $40,000 a year.



Read more: High-risk insurance pool accepts patients with pre-existing conditions | freep.com | Detroit Free Press http://www.freep.com/article/20101011/NEWS06/10110383/1322/High-risk-insurance-pool-accepts-patients-with-pre-existing-conditions#ixzz124jGjigq


2014 can't come soon enough you are going a lot more stories like when the full reforms kick in.

[mstinamotorcity]

1. Thanks Dems for

helping to make it possible for another citizen to be helped with Healthcare.We wish him much success in becoming healthy.

[JNelson6563]

2. Good news!

Thanks for posting.

Julie

[dflprincess]

3. It would be interesting to know what the deductibles & copays are

I checked out what was available in Minnesota to see if my brother could get something besides COBRA but for what the COBRA costs ($397/month) the high risk pool had a $10,000 deductible.

From the article referenced in the OP, here is the age/premium chart.

AGE MONTHLY PREMIUM
19-24 $181.60
25-29 $240.65
30-34 $255.83
35-39 $260.06
40-44 $295.83
45-49 $350.08
50-54 $447.08
55-59 $563.27
60-64 $686.61

For people making less than $40,000/year I'd hardly call it affordable for the 45+ crowd. And this is just "coverage", we don't know how much care they'll actually be able to access.

[Michigan-Arizona]

4. I'd hardly call it affordable for the 45+ crowd

Wow, you got that right, hubby & I will both be in the 60-64 range & will no way be able to afford that, thanks so much for posting those figure's.

[frazzled]

5. You have to remember two things

(1) This is temporary until the exchanges and government assistance based on income kicks in. It's a stop-gap measure that is far better than what this group of people currently have--which is absolutely nothing. Less than nothing, actually, because they are likely to go completely bankrupt trying to save their own lives.

(2) This is high-risk insurance for people who have been denied coverage altogether because their health is too risky. That is to say, everyone who needs (or qualified for) it has a condition that is likely to cost hundreds and hundreds of thousands of dollars. This is not normal insurance for regular people. You can imagine what this man's kidney cancer surgery and treatments will cost. To have no insurance would be to incur a debt far greater than the cost of the premiums plus the $10K.

It's not ideal, but if you are the one with a life-threatening condition, it's the difference between hope and not just total personal devastation but financial ruin for the entire family.

Unless your brother is otherwise uninsurable, his COBRA is fairly cheap (as these things go). Six years ago my daughter was laid off and her COBRA was $600 a month ... and she was in her mid-twenties. We of course had to scrape together the money to help her pay for it, because, doh, she was unemployed.

The age thing is a little depressing. I reallize it is based in actuarial calculations: older people in general use more medical care than younger people. But it still feels discriminatory. After all, if this is a high-risk pool, it seems like the risk is perhaps more evenly spread across age groups. Cancer is cancer whether you're 25 or 55.

[dflprincess]

6. The COBRA is cheap because it has a $2,000 deductible

and an 80/20 copay after that on the next 2 or 3 thousand. When you're income is $1,100/month in disability that's pretty hefty. I'll bet your daughter's COBRA was for more of a PPO plan that actually paid for some things.

The exchanges are not going to offer anything that's much better. This bill is all about "coverage" and transfering billions of private and public dollars into the hands of the same old insurance companies. Absolutely nothing in the insurance act gurarantees access to care.

BTW premiums plus a $10K deductible will still spell financial ruin for someone making less than $40k - especially if the condition carries over from one benefit year to the next. But, like today, Americans can continue to declare bankruptcy when their medical bills wipe them out.

We needed change that would provide us access to care, not give the insurance companies continued access to our wallets.

[frazzled]

7. Tell it to the guy who needs cancer treatment and chemo

The point is this: we can continue to advocate for a government-run, single-payer system, but the money for it will have to come from somewhere. In this economic (and political) climate, that's not going to happen before a lot of us die (some sooner than later, if we're ill). In the meantime, a system that moves us in that direction and can be refined is preferable to the status quo: which is what your brother currently has and what people facing even worse situations have.

And I do believe these reforms are the foot in the door we need to move in that direction. As more and more people enter the exchanges (which we can see in the near future, as the McDonalds of the world refuse to offer the kind of insurance required in the new law), there will be a large number of people receiving government assistance in premium payments. (For those McDonald's workers on minimum wage, the premiums are going to be very minimal and the insurance a whole order of magnitude better than what they currently have, which might cover a strep throat prescription and one x-ray right now). Changes in the law will come, as they did for both Social Security and Medicare. SS was quite deficient in its original form.

We've got to be positive about the steps forward, no matter how tiny. They move us in the right direction. Aiming for perfection and, failing that, accepting the horrific status quo will actually get us nowhere closer to that goal. Nothing would change this year or next year or next decade even to bring us closer to a more equitable system. Passing something now on which we can hang our hats and move inch by inch and foot by foot closer to a better system is far preferable.

(On the personal end: After my daughter's COBRA ran out (and I forget what it consisted of), she was uninsurable for a while because of a preexisting condition. It was a nightmare. All the money in the world couldn't buy her insurance, and we were praying every day she wouldn't get sick. Fortunately, she got a full-time job with decent benefits eventually.)

As for the bankruptcy: yes, possibly. But $15,000 in one year (for premiums plus a $10K deductible on that kidney surgery) is something we could raise the money for on this community in about 30 minutes. A $350,000 bill would be harder for friends, family, and community to cover. And that would probably be a low estimate for what the gentleman in the OP's example is facing. If my husband got a $9,300 bill for 24-hours of IV-antibiotics for an infection last month (our insurance covered it ... but if it hadn't we'd be stuck with the bill), imagine what major surgery and months of therapy costs. We're lucky to have good insurance through work (an HMO plan with no deductible in network and fairly decent copays). I hope everyone can get insurance like that, even if it is from a private company.

[zipplewrath]

18. Broke is broke

"And I do believe these reforms are the foot in the door we need to move in that direction. As more and more people enter the exchanges (which we can see in the near future, as the McDonalds of the world refuse to offer the kind of insurance required in the new law), there will be a large number of people receiving government assistance in premium payments. (For those McDonald's workers on minimum wage, the premiums are going to be very minimal and the insurance a whole order of magnitude better than what they currently have, which might cover a strep throat prescription and one x-ray right now).

Believe? This is faith based politics? Your declarations sound very nice, but they don't match up well with the facts. Unless these folks qualify for medicaid, even with government subsidies, they will have "unaffordable" insurance. They come with huge deductibles and copays, and the monthly premiums. Yes, there will be "covered" preventative care. That's great for folks that are healthy. They shouldn't be buying the mandated insurance anyway as it will be cheaper to pay the fine and wait until they get sick to obtain health insurance. But those with "pre-existing conditions" or folks over 45 are going to be getting subsidized health insurance they can't afford to use. And that doesn't even mention those that the bill specifically exempts from the mandate because their premiums will be too high, even with a subsidy.

And by 2014, health CARE costs will have risen at roughly 6% a year, per the White House estimates. And they will keep rising at that rate. Declaring bankruptcy sounds nice, but you still won't be getting health CARE. And for the truly expensive operations and treatments, medical services are learning to get payment UP FRONT for much of this. You can declare bankruptcy, but no one is going to pay those costs up front then. It sounds nice to say that this is "better than nothing" but if you go bankrupt, it doesn't really matter that you went bankrupt $5000 later than you otherwise would. Not when you're facing $50,000 in charges you need to prepay.


HCR ended up saving the feds alot of money in Medicaid and Medicare future payments. It helped somewhere between 3 - 5% of the population otherwise. And it will still leave 25 million people without insurance. And even more without access to health CARE.

But believe what you will.

[dflprincess]

20. You are aware that not ever preexisting condition is catastrophic?

Some are chronic (like diabetes) and they can cost a lot of money every year.

You might manage to hold a benefit for a person and raise enough money to cover their out of pocket expenses one year - but can the people in the community afford to do it every year? And what happens when there are 10 or 20 or 100 people who need that help? You may be content with a system where benefits have to held to pay a person's medical bills, but I am not. I think it's disgusting and we should all be ashamed of it.

These changes were not reforms - reform would have been access to care, not mandated "coverage". The CBO estitmates that while there will be an initial drop in the uninsured, by 2019 that number will be climbing again and no estimates have been given on how many people will be underinsured. We are going to be right back where we started.

All this act does is by time for an industry that is going to collapse of its own weight. In the long run we would have been better off to let it fail sooner rather than later.

[bornskeptic]

19. Why do you feel it necessary to post nonsense like this?

The exchanges are not going to offer anything that's much better. This bill is all about "coverage" and transfering billions of private and public dollars into the hands of the same old insurance companies. Absolutely nothing in the insurance act gurarantees access to care.

BTW premiums plus a $10K deductible will still spell financial ruin for someone making less than $40k - especially if the condition carries over from one benefit year to the next. But, like today, Americans can continue to declare bankruptcy when their medical bills wipe them out.

It's rather obvious you have no idea what the insurance offered on the exchange will be like. A single individual making $40,000 falls below 400% of the Federal Poverty Level, so he or she will be eligible for the subsidy, which means that that individual's cost for a policy with 70% of actuarial value will be no more than 9.7% of his or her income, or $3880 annually, which comes to about $325 per month. There will not be any policies offered on the exchange with $10,000 deductibles, as out-of-pocket costs are limited to $5950. If that sounds like a lot, compare it to Medicare, which has no limit on out-of-pocket costs.I'm not an actuary, but I'm pretty sure that a policy with a 70% actuarial value can't mathematically have a deductible of over about $2000.

I have insurance with approximately a 70% actuarial value through my employer. It has an $800 deductible and 30% coinsurance to a maximum of $3200, but preventive care and lab tests are not subject to the deductible, so most years I only have to pay office visit and prescription drug copays out of pocket. This year a comprehensive physical and a colonoscopy, billed at about $1700 total cost me only $100 in copays. Preventive care and tests on policies in 2014 will be covered without out of ocket costs, so for many people the deductible and coinsurance won't even come into play in a normal year. The details of the various 70% AV policy will of course not be the same as mine, but they will have to be pretty much equivalent in value. If the deductible is higher, the coinsurance or copays will necessarily be lower. Whatever the details, insurance with 70% actuarial value is pretty good insurance.

[ClarkUSA]

23. Good question. Some people make a habit of it here. Thanks for the fact check, born skeptic.

The Perpetually Outraged never liked Barack Obama in the first place so now that he has become president, everything he says or does is minimized, dismissed, or demonized. Mostly the latter, if you hadn't already noticed. ;)

dfl princess said:

<< BTW premiums plus a $10K deductible will still spell financial ruin for someone making less than $40k - especially if the condition carries over from one benefit year to the next. But, like today, Americans can continue to declare bankruptcy when their medical bills wipe them out.>>

You said:

It's rather obvious you have no idea what the insurance offered on the exchange will be like. A single individual making $40,000 falls below 400% of the Federal Poverty Level, so he or she will be eligible for the subsidy, which means that that individual's cost for a policy with 70% of actuarial value will be no more than 9.7% of his or her income, or $3880 annually, which comes to about $325 per month. There will not be any policies offered on the exchange with $10,000 deductibles, as out-of-pocket costs are limited to $5950. If that sounds like a lot, compare it to Medicare, which has no limit on out-of-pocket costs.I'm not an actuary, but I'm pretty sure that a policy with a 70% actuarial value can't mathematically have a deductible of over about $2000.

I have insurance with approximately a 70% actuarial value through my employer. It has an $800 deductible and 30% coinsurance to a maximum of $3200, but preventive care and lab tests are not subject to the deductible, so most years I only have to pay office visit and prescription drug copays out of pocket. This year a comprehensive physical and a colonoscopy, billed at about $1700 total cost me only $100 in copays. Preventive care and tests on policies in 2014 will be covered without out of ocket costs, so for many people the deductible and coinsurance won't even come into play in a normal year. The details of the various 70% AV policy will of course not be the same as mine, but they will have to be pretty much equivalent in value. If the deductible is higher, the coinsurance or copays will necessarily be lower. Whatever the details, insurance with 70% actuarial value is pretty good insurance.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=472978&mesg_id=473945

Bookmarked for future "nonsense" rebuttal. I say:

:yourock:

[Safetykitten]

8. Ah, the weekly "Great Stories in Heathcare Fantasyland" and you better be glad!

Because it's working, except for most people.

[ClarkUSA]

9. Do you have anything to offer except snark? Deri Mick and his loved ones are pretty "glad" alright.

Without HCR, he'd be looking at a death sentence. Now, he has a chance. I don't know about you, but I'm happy HCR passed so it could save lives like his.

[Safetykitten]

10. I am sure they are, they won the stay alive lottery. What a brutal and cruel situation, yet

lets make sure, again and again that people who lost are reminded every day of the failure that we applaud.

[ClarkUSA]

11. "What a brutal and cruel situation" it would be for Deri Mick and others if HCR hadn't passed.

[Safetykitten]

12. Yes, for them it works. Healthcare for them, while standing on piles of dead bodies.

that people seem to not see or care, because it's about making sure you can claim victory.

[ClarkUSA]

13. Uh huh. That's what this OP is about: how HCR is working for Deri Micks. Do you "care" about that?

Do you "see" that?

Or is it "about making sure you can claim" defeat?

[Safetykitten]

14. The constant need for approval of this HCR turd does nothing but

alienate and marginalize the MILLIONS that have no hope of getting any.

Why not just put a discalimer on the Happy HCR Horshit posts.

"The above post and information in it recognizes that the massive HCR bill did nothing for the majority of people who had no healthcare and desperately needed it. By posting this positive HCR post, no claim is made that it has made a difference in anyone's life except for the small percentage that won the High Risk Pool Lottery."

[Mimosa]

16. I just got rejected for affordable health insurance

There's no help for me. :(

[Mimosa]

17. Saferykitten, you nailed something important

The healthcare reform travesty happened to have alienated millions of independent (the 'persuadable middle' who actually determine whether Rs or Ds get a majority) voters who were actually hoping for a single payer medicare for all type system. The people wanted that. The corporations and their vassals (Congress and the Senate) said NO.

[ClarkUSA]

24. Do you have proof for any of your claims?

<< The healthcare reform travesty happened to have alienated millions of independent (the 'persuadable middle' who actually determine whether Rs or Ds get a majority) voters who were actually hoping for a single payer medicare for all type system. >>

Where'd you get this from? I have never heard any poll touting this claim.

<< The corporations and their vassals (Congress and the Senate) said NO.>>

Actually, no one ever said single payer was ever a possibility at any time during the debate, so this is just rhetoric.

[ClarkUSA]

21. The constant need to demonize and throw turds at HCR does nothing but make me...

:boring:

[Mimosa]

25. Easy to be smug when you have health insurance you can afford

Many of us don't and there aren't affordable options for those who aren't at the bottom (Medicaid) or elderly (Medicare).

You don't care that many people are sick and can't afford care. Why don't you go back to the party of 'I got mine'? And put an R in your circle? because that is what you sound like.

[Mimosa]

15. It will accept the first 3,500 applicants.

What about others who need help?

[ClarkUSA]

22. No one ever promised that HCR would help everyone immediately, did they?

From the OP source:

"Creation of the pool is the first of two important aspects of health reform coming to Michigan. The next big expansion comes in 2014 with state-run health exchanges that will provide subsidies to help more people purchase health insurance."

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=472978&mesg_id=472978