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Health plan for the uninsured just got better

The feds have made it easier for those with pre-existing conditions to sign up for affordable coverage.

By Karen Datko Jun 8, 2011 6:06PM

Have you been enjoying the benefits of health care reform, like being able to keep your jobless adult child on your insurance plan, and getting mammograms and other preventive care without a co-pay?

 

Major improvements are coming July 1 to another part of health care reform -- a limited program of reasonably priced coverage for people who can't buy private health insurance because they've been sick in the past (those pre-existing conditions insurers want nothing to do with). It's a stopgap until 2014, when everyone will be able to buy health insurance, regardless of their medical history.

 

Here's how it works: All 50 states are required to provide a new type of high-risk pool, called a Pre-existing Condition Insurance Plan or PCIP, to people who have been denied coverage because of pre-existing conditions. States can either run their own plans or have the feds do it for them. Twenty-three states have gone that route.

 

Enrollment in PCIPs nationwide has been low -- only 18,313 people, far fewer than the 200,000 projected -- probably because the premiums have been too high for many folks. Plus, eligibility rules have limited the coverage to people who have applied for private insurance and been denied coverage in the last year. Post continues after video about other health care news.

Now the feds have cut the cost of premiums and streamlined the rules for the PCIPs they administer:

 

The premiums will drop by up to 40% in 17 of the 23 states next month, as well as Washington, D.C. The drop will be 18.4% in Tennessee. "A 50-year-old in Tennessee will be able to get comprehensive health coverage for as low as $305 per month," The Tennessean reports. In Florida, a 40% reduction means a person older than 55 will pay only $376 a month. That's a monthly savings of $150.

 

According to Kaiser Health News:

These decreases will help bring premiums closer to the rates in each state's individual insurance market. In the six states where high-risk plan premiums were already similar to what healthy people pay for individual plans, premiums will remain the same.

People still have to be uninsured for six months before they can enroll, but in those 23 states and D.C., they won't need to show that they've been denied coverage. They'll simply need a note from a doctor, physician's assistant or nurse practitioner "dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness," a U.S. Department of Health and Human Services press release said.

 

On or before Oct. 1, the government will pay insurance brokers $100 for each person they successfully refer to the PCIP coverage in the 23 states and D.C. Most of the states that run their own program already pay a fee, says Healthcare Finance News.

 

The federal government has informed the states that administer their own plans that they can make similar changes.

 

A $5 billion allocation that was part of health care reform pays for the programs. (You can learn more about PCIPs at this government website, and go here to learn more about the plan in your state.)

 

Another reason why so few people have enrolled --  when so many are in need -- is that many people still don't know that PCIPs are available. The Washington Post said:

As recently as late February, a poll conducted by Kaiser Family Foundation found that nearly half of Americans thought that health reform had been repealed or said they didn't know whether that was the case.

The Congressional Budget Office estimated that 4 million Americans would be eligible for PCIP. If you or someone you know is uninsured and has a pre-existing condition, this could be a life saver.

 

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76Comments
Jun 9, 2011 4:51AM
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People don't have Insurance because they can't afford it.  $305 pr month, I cant afford that
Low income families can't afford that.
Jun 9, 2011 7:29AM
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I pay $106 a week for health coverage.   The employer pays the other 2/3...meaning he pays almost $850 a month. 

 

Yet my health coverage does not pay for anything.  At first, it was because I had to pay a deductibleof $1500 per person or $3000 for the family per year.  After the deductible is met, I then have to pay 20% of medical costs.  This does not include the copays I must pay.

 

Now the health insurance company just denies my claims and trivializes serious health issues.  For example, my son had his first asthma attack.  It was late at night, and he just could not breathe.  He was turning a purplish blue. A call to the pediatrician's office and the nurse determined that to delay was not an option and an ambulance was needed to get immediate medical assistance. We were rushed to the ER, and it was there that he was diagnosed with asthma.

 

The insurance company is trivializing this by stating my son only had a cough and it was a minor illness, so they will not cover the bills that are over $2250.

 

So here we are in June...let us add up what has been paid so far...$106 a week for approximately 26 weeks...that is $2756...then we have my son's deductible of $1500...oh and the medical bills that should be paid but the insurance company refuses...$2250..so far that is $6506...then add another $1250 for a medical item not covered under the policy...and we havent even added all the co-pays. We are talking close to $8k in medical costs for my son. Heaven forbid if anyone else in my family gets sick.

 

As it is...we are fast approaching bankruptcy.  The greed of the insurance companies is astounding. They practice in murder for profit if you sit down and really think about it...and yet they are not held accountable. I was told by their M.D. that I should not have received medical tratment for an uncontrollable asthma attack for my child. Now if I follow that directive should my child suffer another attack, it is a strong possibility that he could suffer brain damage due to lack of oxygen or even death. But hey that's ok...as long as the CEO can afford another overpriced rolex.

 

Quite frankly...when physical harm or a death results from the practices of these health insurance companies...those involved in the process...all the way up to the CEO should be criminally prosecuted.  Throw them in jail with the hardened criminals and let them get what is coming to them.  And should they need medical attention after a well deserved beating...just deny it because it is not medically necessary to keep these sociopaths alive.

Jun 9, 2011 1:58PM
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Why are we so timid about blaming the doctors for some of this problem ?   $145 for a 3 minute visit that was $95 just 6 months ago ?    And they don't want medicare patients because they only get $87 for that 3 minute visit ?   Poor babies !
Jun 9, 2011 10:47AM
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What works for the Europeans is cost sharing and higher taxes.  They don't pay so much for their military so that money can be used for other things and everyone pays into the health plan.  That's how they're able to give everyone free health care.

 

I know that kind of thinking is anathema to Americans, but we can't keep going the way we are with ever-rising health care costs.  We just can't.  First it will bankrupt individuals, then companies, then the nation.  It's unsustainable.  (And that's not even getting into pre-conditions and rising co-pays.)

 

As long as everyone has access to health care through the ER and Medicaid without paying anything into it, hospitals and doctors will continue to subsidize their care through higher rates to the rest of us.  They have no choice.

 

We need some sort of national health care program.  Single payer, if not public option.  And we need to pay for it out of our military budget and taxes.  I know, no one wants to hear this, but do you have a better solution?  One not driven by party lines?

Jun 9, 2011 8:42AM
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Wow only $305 a month....! Now if I just had a job I could buy coverage....
Jun 9, 2011 10:46AM
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I don't know what kind of healthcare some of you have, but mines have always been  expensive and it goes up each year. The co-pay has tripled, the price of medicine doubled and I always have to pay the doctor even with having 2 insurances. I consider being able to have my college age children insured to age 26 a blessing. I have 2 out and one in, the 2 out are job-hunting every day  without success as of yet. I consider Computer science and civil engineering good degrees, and in a good economy they would have jobs. The pre-condition clause is also a blessing because insurances drops you as soon as you develop any condition that last more than a year. Some one mentioned not wanting government in their business, I guess they are about to relocate to another country. The government can intervene on my behalf any time and save my behind from the insurance rip offs, and the hospital rip off. too, I've been there I know those two very well.  My employer does not pay all of my healthcare insurance, I pay half. The difference is he gets a  tax  reduction for his employees. I just pay through the lower body for mines. AMERICA  definitely is not a socialist country,  we the people do not own this manure;, the wealth and control is held by the rich and powerful, we are living like a dictatorship.  The President does not control America, Big Money does; "The Have It "are few, but the" Have not are many ,and in a few more years we will have even less, but don't thank Obama for that, Thank the Republican Party, America's benefactors for the rich and powerful.
Jun 9, 2011 8:52AM
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Why don`t we just cut out all the BS and make it a crime to be poor in america?

 

Forcing minimum wage workers to pay 1/4 to 1/3 of their weekly pay for health ins is just insane. If they can`t afford to pay that much then they will be labeled a criminal?

 

It`s cheaper for everyone if we make sure that everyone has affordable health care. people without health care will usually end up on disability and we all pay more taxes for their disability checks.Keep them healthy and off the disability roles and we will all benefit in the long run.

Jun 9, 2011 7:49AM
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since when is 300-400 a month for health insurance  "affordable"?
Jun 9, 2011 8:14AM
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As recently as late February, a poll conducted by Kaiser Family Foundation found that nearly half of Americans thought that health reform had been repealed or said they didn't know whether that was the case.

That explains a lot.

Jun 9, 2011 12:10PM
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 I thought they said AFFORDABLE insurance?  Even with a 40% discount your still paying  $305.00 a month.   Sorry, but that is still NOT affordable insurance!  Maybe, if you cut that price by 50% then it still NOT affordable for most people!  Our US GOV. needs to get a clue, most of the people do not make enough money to pay the high rates for insurance. If insurance is going to cost more than $100.00 a month for coverage, people will not get it!
Jun 9, 2011 2:00PM
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Now go after the HMO's.

We really need full National Healthcare. It's the only way to reduce the corruption in healthcare. I worked in it for twelve years and saw so much waste. It truly makes you sick.

Jun 9, 2011 8:02AM
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If you have a beef with the new health care program, then that is all right.  I do have issues with some parts of it.  But I am tired of people going on about it is helping people on welfare.  People on welfare already get free health care.  You may not know that since you may not deal with it or know much about the system.  But this is about low income working families that do not have the cash to afford health care.

 

The middle class and up are covered for the most part as well as those on welfare for health care.  But the ones in the middle of these two groups are the ones who have a very hard time affording health care.

 

For those of us with jobs that have health insurance, we are blessed.  It is a big difference paying around $100 a month at your job compared to  $300 and up.  Just go to one of the health insurance web sites and do a free quote estimate to see the prices.  You will be amazed with the high prices for most decent plans. 

 

This is about low income families that are hard workers, but just can't afford a good health care insurance.  Sure, you can always find someone abusing the system.  But think about someone you may know that is hard working, but just making it from one pay day to the next because they do not make a lot of money.  And yes like I said, I do not like some parts of this bill.  But I have no problem with the concept of helping a hard working low income family that is struggling so they can afford a doctor. 

Jun 9, 2011 11:16AM
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Quote:  Would someone, please anyone, show me how having health insurance is so great.  Anyone????

 

Do I really need to tell you?  Apparently so...here's my personal reason why:

 

In 1992 I was 36 years old and never had health issues.  One day I woke up and felt like I had the flu.  After a couple of days of not seeing any improvement, I went to my doctor (I had insurance at the time).  I went into the doctor, he did a blood test, found unusual results, was worried and said I needed to get a cat scan.  I got the cat scan (paid by insurance) and found stage 4 lymphoma in my liver and spleen (stage 4 is when it travels to other organs).  I was checked for any cancer in my lymph nodes (thankfully none was found) and did a bone marrow test.  I then went thru chemo for 6 months (I did not work for 13 mnonths but had disability insurance to help cover bills - another godsend), got rid of the cancer (thank god) and have been in remission since (my oncologist said after 5 years the possibility of return is nil).  After all the tests, retests, repeated cat scans and treatment, I never paid a penny out of pocket.

 

Now, does that explain to you why insurance (health and other types) can be a lifesaver????

 

Also, for those that are writing here that malpractice insurance is the only reason why health care is so expensive, prove it.  I haven't seen one bit of evidence here (other than some one "hearing" someone else got a huge award for some small mistake a doctor made).  Let's see some actual statistics if we're going to have a intelligent debate about malpractice, rather than regurgitating the remarks conservative pundits make.

Jun 9, 2011 11:27AM
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All this bickering!!!!!!!    You know even when I had a job and my employer paid 2/3 rds of my premium I still could not afford my share of my insurance.  Now that I lost my job, how does anyone think I can pay it now?  I keep pinching my penny so hard now for so long old Abe's head is just about to pop off.  All my life working, raising children, working some more, losing my job, 401 K gone and heavily taxed on that for early withdrawal, I really don't care any more.  I hope the 2012 end of the world wobbling earth comes true.  This world needs to start over again.  Maybe the next inhabitants will not be so greedy.     

Jun 9, 2011 6:37AM
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"Have you been enjoying the benefits of health care reform like being able to keep your jobless adult child on your insurance plan, and getting mammograms and other preventive care without a co-pay?"

What kind of a bias question is that?  No, I'm not enjoying any of it.  Keep your deadbeat child on your insurance plan?  Lets encourage our kids to stay dependent until 26.  Geez, what a joke.

REPEAL this monstrosity!
Jun 9, 2011 12:55PM
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It's nice to know that I can now get coverage, however I still can't afford it !  
Jun 9, 2011 1:00PM
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Ok, so here I am, a cancer survivor, working for $8.50 an hour. I earn about $1350 a month, take home about $1100, my newfound medical coverage is $468 a month.  Yea right, I'm really going to jump all over that new coverage !!!
Jun 9, 2011 8:10AM
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How stupid is this. The government keeps rolling out ideas that no one can afford. First it was the "Save Your Home", which no one including myself qualified for because my income was too low. So I lost my house. Right now out of my disability check I am paying the $98 for Medicare and $50 for the supplemental and still owe a ton of doctor bills due to the high costs of co-pays and other items neither program will pay for.  If they would just improve the Medicare program so that it would cover more, then supplementals wouldn't have to be purchased. But instead they bring out and tout insurance for those who are uninsurable.  Well, most people that are that sick are not working so I am not sure where the stupid government thinks these people are going to be able to come up with that much money. Plus, I see no where it outlines what other hidden costs are involved in these plans.  Come on Washington - if you can't do better than this then just stop wasting the taxpayer money on committees that come up with the ideas that aren't going to work and use that money to help people pay for plans that are decent and without hidden costs.
Jun 9, 2011 12:06PM
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It's laughable how little people actually know about the healthcare system. Everyone is complaining about the money grubbing insurance companies, their profits are less than 1% of healthcare spending =  fact. Not the unfounded numbers people are throwing around here. The price of healthcare is so expensive for all of us because of so many individuals abusing the system.

 

Doctors charging for services never performed, script mills (writing unnecessary prescriptions, then selling them on the black market), uninsured going to the emergency room after they are very ill for something that probably could of been prevented. The list goes on and on. There is plenty of blame to go around.

 

I hear so much complaining about health care reform, do you people think you are never going to get sick or age? No your just gonna piss and moan about having to have insurance now but will probably expect the taxpayers to take care of your medical costs when you become sick. EVERYONE DOES NEED INSURANCE. Wake up.

Jun 9, 2011 9:57AM
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I'm sad to say that the healthcare reform that was and is to be enacted has fallen woefully short of what was promised and what is needed.   The reason for the low enrollment #s in this new and unimproved program is attributable to 2 MAJOR issues: 1.  The still exorbitant cost for a nation with climbing unemployment & no substantive jobs available and, 2. the fact that most Americans have not clue ONE as to the fact that any aspect of the program had been implemented to begin with and, even if they were, the requirement of being denied for coverage altogether is NOT the critical qualifying event for most people.  Oh, an insurance company WILL underwrite you for healthcare, but those pesky premiums & 12 - 24 month pre-existing condition clauses will come right along with your revoltingly high and pesky premiums and astronomical out of pocket requirements.  Basically, you're front loading THEIR cost to insure you later,  and even THEN they could deny coverage and/or cancel your coverage before you get benefit ONE from your policy after waiting for 12 - 24 months.  That's tantamount to paying for home repairs before they ever really needed and actually being STUPID enough to think the contractor will show up on demand some 12 - 24 months or more down the road. It takes a Street Degree to know how absurd that proposition would be. The Health Care Reform Act is a failure in every aspect of the word. It FAILS to close the gaps necessary to get critically necessary PAID FOR health care coverage to Americans who both deserve and need those benefits. Notice I said "PAID FOR" because the majority of Americans, at least on the Main Street level, pay some, most or all of their health insurance premiums. It is the FEW who rely on subsidy programs like Medicaid and TRUST me when I tell you, Medicaid falls woefully short of delivery quality healthcare to it's clients. I've seen Medicaid NOT work for even the most basic of needs and it's heartbreaking when there is a child involved.  

 

In closing, I am of the opinion that much like automobile insurance is required, health care COVERAGE must be required. Now, here's the rub: I don't believe the health insurance behemoths DESERVE to still be in business in America.  They routinely deny critical and covered health care claims on purely arbitrary , redefine "emergency" on almost a daily basis, limit your access to a finite # of physicians and specialists in their networks without ANY performance or background information on their network physicians,  steer their insured into programs designed to stall, stall and stall some more by making it nothing short of a goat-rope to get timely and appropriate treatment for, in many cases, critical medical needs, goad, harass and full on terrorize the insured with the constant threat that anything and everything the insured has been paying for is in the INSURERS' sole discretion to pay or not to pay.

 

We cannot rely on the government to provide a single payer option because the only thing it can do is run itself into the ground.  We can't trust the private sector insurers for all of the reasons, and more, listed above.  So, in essence, we're skewed, barbequed and full on screwed.  It sickens my heart to see how corrupt & inept our governmental leaders have become.  It further sickens me to read of enormous salaries and even more enormous bonuses being paid to the same people who thrive and prosper off the backs of the victimized American people.  First you sell off our industries to foreign workers & foreign governments, THEN our economy eventually starts to show the wear & tear of this failed policy by taking a nose dive, THEN Americans lose their jobs and opportunistic Big Biz is not only LOVING it, they're making record profits and paying themselves HAAUGE bonuses after WE BAILED THEM OUT!!???  What's wrong with this picture, Americans? 

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