The Shell Game

The recently passed Patient Protection and Affordable Care Act forces the State of Ohio to re-address our uninsured. Of particular interest is our population of high risk uninsured. These individuals are very unhealthy and have not been insured for over six months. The previous options available to our high-risk pool were both mediocre and expensive. Still, many of our unhealthiest accepted the available state mandated option. Today we are talking about those who did not.

According to the report published in the Plain Dealer this past Saturday, the federal government has allocated $152,000,000 to help cover these Ohioans until the new rules kick in, about four years from now. Medical Mutual of Ohio, a local not-for-profit, won the contract to manage the policies.

This is not free insurance. The individuals will be required to pay some yet to be determined premium. What does one hundred fifty-two million get you? The State’s best guess is 5,000 insureds. Based on my knowledge of the current premiums and benefits available to these individuals, that number might be a touch optimistic.

In a post dated June 29, 2009, The Real World, I noted that Governor Strickland’s budget included a premium reduction for the open enrollment policies available to Ohio’s unhealthiest citizens under age 65. The cost for this would be borne by Ohioans who pay for their own health coverage. We would, according to the State’s actuary, pay 5.5% more to help our neighbors acquire insurance. My clients can attest to their rising premiums.

The one hundred fifty-two million dollars is part of a total five billion dollar four year program. Let’s pretend that 5,000 is a real number. For our purposes, let’s pretend that all of these numbers are real, the federal government really has five billion dollars, and we really get our hundred fifty million. 5,000 beneficiaries would get only $30,400 towards their coverage. This is only $7,600 per year, a little over $600 per month. Is that even close to the actual cost of insuring these individuals?

The current Medical Mutual of Ohio premium for the Ohio Standard policy for a 60 year old male in Cuyahoga County is $1,403.08 per month after the recent rate reduction. We already know that that is not sufficient to pay claims. Will our soon to be insured make up the $800 per month difference? And, will the new federally designed policy be as awful as our current contract or will it be more generous and costly?

This, of course, does not even begin to address the fact that there are far more than 5,000 Ohioans who are both very unhealthy and in need of a different way to pay for their health care.

There was a time, not so long ago, that we were told that one of the main reasons we had to go to war was because of the way the Taliban treated the women of Afghanistan. We have been told that the purpose of health care reform was to cover the uninsured. The selectivity of our focus and actions make both arguments seem specious. Our government is perfectly happy to ignore the abuses of cooperative tyrants who provide us with cheap oil. And we have yet to show any real interest in devising, and FUNDING, a program to truly cover our unhealthiest and uninsured.

What we have is a shell game. More and more costs are being shifted to those of us with private insurance. All the while the federal government attempts to block insurers from raising rates to cover the true costs. Books must balance, at least in business.

My predictions of a few months ago still stand.


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8 Responses to The Shell Game

  1. Donna says:

    So, David, what are we supposed to do about the sickest uninsurable people? Are they just up shit creek, or is there a plan that would work?

  2. Dave Cunix says:

    We need to do more, but we first need to WANT to do more. The current bill revamps our system and addresses the uninsured by default. They are an afterthought.
    I laid out one set of options last summer. As quick and off-the-cuff as that exercise was, those actions would still bring the uninsured a lot closer to reasonable coverage than the administration's program.

  3. Dave Cunix says:

    Yes, Stuck Inside from August of last year. The program in today's blog is designed to fail. It is a failure because it doesn't cover enough people, because it isn't adequately funded, and because it puts additional pressure on the system by shifting costs to the privately insured. It lacks transparancy. There is no effort at cost containment. And when it does fail the people who imposed this will again act surprised and attempt to say that this is why we need a single payer system.
    It is terribly cynical, unless you assume that they are just incompetant.

  4. Dave Cunix says:

    This is from my favorite nurse, Holly Engel:

    My thoughts, again, being on the front lines — Billions for only 5000 people?? There are over 5000 people not insured in the greater Cleveland area!!!!!!!!!! There is still free health care for people. Yes, if you are uninsured, it is hard to have a primary care doctor. But docs that take people without insurance can still be found, most of them can be found at Metro and Huron Rd. And they are good doctors. There are Clinics there for people to see a doc on a regular basis. Part of the problem also is just to get folks to GO to the doc before they get really sick, before the high BP causes the need for dialysis, before the Diabetes becomes a huge comorbidity.

    People can also just go to ER, which unfortunately, is a big misuse of our healthcare system. One cannot be turned away from an ER for anything!!! A headache, hangnail, they still have to take you in! Recently, I needed a muscle relaxer,. I had such painful hard muscles in my hip and surgery was still two weeks away. No matter what we did, not helping. I called my primary, I called the surgeon's office, for three days!!!! Noone would call back, so we had to hit the ER. I apologized up and down, explained the lack of attention from phone calls to get a simple script. I was there maybe 15 min. Got what I wanted, no problem. Cost of script to me, $7.00, ER bill over $300, copay from me $50.00. All which with a simple return call could have been $7.00. So even those of us with insurance can contribute to high costs of Healthcare. There also needs to be consideration given to simple systems of caring for patients.

    Also, there is Medicaid for the poor and uninsured. As far as I know, none of these options will be going away. Medicare for when you are 65. If you don't have Medigap insurance, or just can't pay in general, they can't make you pay it all and they take the write-off which is an advantage.

    I have digressed from your real point, sorry. But this whole healthcare reform has just not been done correctly for what is really needed out on the frontline.

  5. […] June, in a post entitled The Shell Game, I discussed the five billion dollars the federal government had allocated to the Preexisting […]

  6. 0 For 2 | says:

    […] noted in June 2010, Medical Mutual of Ohio won the contract to administer this underfunded and poorly designed […]

  7. […] and suggests that we reinstate state run High Risk Pools.  The Republicans strongly criticized the transitional High Risk Pools of Obamacare.  They were, in part, correct.  Five Billion Dollars wasn’t enough even though this was just for […]

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