If private health insurance worked, we wouldn't need health reform

[Chadman]

I'd be interested to hear what Mags has to say about this article. It brings up some interesting points - not saying they are all accurate, but they make some sense to me. - C
------------------------------------------

If private health insurance worked, we wouldn't need health reform

Lost in the fight over health reform is a single, huge truth - if the private insurance market worked, there would be no need for reform.

We wouldn't be in this mess if private insurers were able to control cost inflation. And at the end of the day, that's what they are supposed to do. Sure they have lots of experience in underwriting and risk selection, and some have made some progress in some areas of disease management/mitigation, but UHC and Coventry and Wellpoint and HealthNet et al's 'experience' have not been able to consistently deliver lower health care costs.

I know there are lots of reasons/problems/complicating factors, but the stark reality is when it comes to controlling inflation, none of them have been able to.

Why not?

Several reasons, some good, some not so good, but all worth considering as we contemplate a new world built on one of the bills before Congress.

Health plans' best interest
As Maggie Mahar so eloquently and persistently reminds us, we live in a culture of 'Money-driven Medicine'. Health plans, providers, brokers, and suppliers are in this business to make money. For health plans, controlling costs means lower revenues, and this is one of those wonderful industries where top lines grow every year by ten percent plus - regardless of any increase in the number of customers (members). Wall Street loves top line growth and rewards companies that consistently grow their revenues.

Quite simply, it is not in a health plan's best interest to control cost, as most of their policyholders are going to stick with them regardless of the increase in premiums, and the business they lose they'll make up by stealing customers from other health plans.

Churn
Employers change plans every three or four years, so any 'investment' in reducing long term costs is an expense incurred by the current healthplan for the benefit of a competitor. This is particularly true for smaller groups, and is further exacerbated by the increased mobility of the workforce, which tends to change jobs more now than a couple decades ago.

Mindset
After the great explosion triggered by providers' negative reactions to capitation and employees' negative reaction to small provider networks, healthplans, led by UHC, adopted an 'open access' model, wherein members could go 'out of network' to receive care, albeit at a higher copay rate. Employers are certainly to blame for a failure to explain the logic behind and lack of will to stick with the tighter managed care models, but they've certainly paid a high price for their lack of foresight and will. The result of the 'dimming down' of managed care is the current employer-based health cost inflation.

Regardless, since the adoption of the open access model in the mid-nineties, consumers have gotten used to, and highly attached to, that model. Undoing that mindset is going to be painful, and health plans don't succeed by causing pain amongst their members.

Cost control by price control
Listen to health plan execs on their quarterly earnings calls, read their transcripts, review their press releases, look at their product offerings - see much in the way of real cost control? Strong disease management, medical homes, useful data on provider outcomes and costs presented in a way that Joe Sixpack or Maria Martinez can readily use?

Didn't think so. Sure, a few health plans (Aetna probably being the best among the for-profits) are making an honest effort, but most are not. Instead, health plans rely on price control - squeezing providers down as hard as they can on reimbursement rates for specific procedures - a practice that solves one part of the cost equation but does nothing to control utilization, and may well exacerbate it.

For-profit health plans operate in the best interests of their stockholders - not those of their members, providers, or society. That's how capitalism works. And not-for-profit health plans have to compete with the for-profits, a reality that has forced the Kaiser Permanentes and Group Healths to adopt many of the business practices of their competitors.

The net

The reason we need reform is the current 'free market' is not fixing society's problem. The reform we need is real, meaningful reform, with true cost control, not a few pilots here and a bit of disease management there and a couple of billion of comparative effectiveness research sprinkled on top of a layer of slightly-modified fee-for-service reimbursement.

 

[DOGS THAT BARK]

Yep public healthcare is the ticket--gov programs Medicare and Medicade are running 53 trillion in under funded obligations-can we have more please?

http://en.wikipedia.org/wiki/United_States_public_debt

Unfunded obligations
The U.S. government is committed under current law to mandatory payments for programs such as Medicare, Medicaid and Social Security. The GAO projects that payouts for these programs will significantly exceed tax revenues over the next 75 years. The Medicare Part A (hospital insurance) payouts already exceed program tax revenues and Social Security payroll taxes fully cover payouts only until 2017. These deficits require funding from other tax sources or borrowing.<SUP class=reference id=cite_ref-GAO_Citizens_Guide_42-1>[43]</SUP> The present value of these deficits or unfunded obligations is an estimated $41 trillion. This is the amount that would have to be set aside during 2008 such that the principal and interest would pay for the unfunded commitments through 2082. Approximately $7 trillion relates to Social Security, while $34 trillion relates to Medicare and Medicaid
________________________________

 

[Chadman]

Well, I'm not that excited about some of the parts of the bill, or the part you refer to, Wayne. But of course, most of us aren't that excited about doing nothing, like we have been forever. And this article addresses one of the main problems and sits at the root of cost control. Private health insurance companies have done nothing - nor have any interest in doing anything - to control the costs for the people they insure. In fact, they have fed into the system, and will continue to do so, unless there is something more to consider than merely passing along increases, and maintaining their bottom line.

We all have seen the cost explosion and result of doing nothing. And doing very little - which is the Republicans "plan" - which would never have been brought up at all if it weren't for the efforts of Dems - will continue to do very little to help any of us. Or the employers who have to pay for those who are happy about their current plans.

This is a part of the problem. It needs to be addressed.

 

[Chadman]

Do you think the Republicans would have ever come up with anything on these issues - other than possibly tort reform - on their own? Have they ever? Maybe they have. I'd like to know that.

And, do you think if the Dem bill does not pass, that the Republican plan will be brought up for vote by the Republicans? Or will it be tossed out, with a collective "whew!" and never mentioned again?

 

[DOGS THAT BARK]

Chad I'm all for any reform the gov can do to cut costs/fraud etc

I'm quite happy with my healthcare plan as many are.

I have not seen anything in current legislation where they have projected cuts on dr fee- hospital cost . So how do they plan on lowering costs.

You think having the gov run programs with their "unions" is going to be more efficient than ins co.

Only way gov plan can be cheeper than ins is if they don't have to balance their books like every other program ran in the red.

My reason for liking current plan is I pay my own way plus medicare/medicade/schips in taxes.

With gov plan- will get higher personal premium plus put millions more dependents on the diminishing tax payors bill..

I'll pass--

 

[THE KOD]

With gov plan- will get higher personal premium plus put millions more dependents on the diminishing tax payors bill..

I'll pass--

...............................................................

no you wont , you will pay or go to jail.

your such a cheapskate.

 

[Mags]

I'd be interested to hear what Mags has to say about this article. It brings up some interesting points - not saying they are all accurate, but they make some sense to me. - C
------------------------------------------

If private health insurance worked, we wouldn't need health reform

Lost in the fight over health reform is a single, huge truth - if the private insurance market worked, there would be no need for reform.

We wouldn't be in this mess if private insurers were able to control cost inflation. And at the end of the day, that's what they are supposed to do. Sure they have lots of experience in underwriting and risk selection, and some have made some progress in some areas of disease management/mitigation, but UHC and Coventry and Wellpoint and HealthNet et al's 'experience' have not been able to consistently deliver lower health care costs.

I know there are lots of reasons/problems/complicating factors, but the stark reality is when it comes to controlling inflation, none of them have been able to.

Why not?

Several reasons, some good, some not so good, but all worth considering as we contemplate a new world built on one of the bills before Congress.

Health plans' best interest
As Maggie Mahar so eloquently and persistently reminds us, we live in a culture of 'Money-driven Medicine'. Health plans, providers, brokers, and suppliers are in this business to make money. For health plans, controlling costs means lower revenues, and this is one of those wonderful industries where top lines grow every year by ten percent plus - regardless of any increase in the number of customers (members). Wall Street loves top line growth and rewards companies that consistently grow their revenues.

Quite simply, it is not in a health plan's best interest to control cost, as most of their policyholders are going to stick with them regardless of the increase in premiums, and the business they lose they'll make up by stealing customers from other health plans.

Churn
Employers change plans every three or four years, so any 'investment' in reducing long term costs is an expense incurred by the current healthplan for the benefit of a competitor. This is particularly true for smaller groups, and is further exacerbated by the increased mobility of the workforce, which tends to change jobs more now than a couple decades ago.

Mindset
After the great explosion triggered by providers' negative reactions to capitation and employees' negative reaction to small provider networks, healthplans, led by UHC, adopted an 'open access' model, wherein members could go 'out of network' to receive care, albeit at a higher copay rate. Employers are certainly to blame for a failure to explain the logic behind and lack of will to stick with the tighter managed care models, but they've certainly paid a high price for their lack of foresight and will. The result of the 'dimming down' of managed care is the current employer-based health cost inflation.

Regardless, since the adoption of the open access model in the mid-nineties, consumers have gotten used to, and highly attached to, that model. Undoing that mindset is going to be painful, and health plans don't succeed by causing pain amongst their members.

Cost control by price control
Listen to health plan execs on their quarterly earnings calls, read their transcripts, review their press releases, look at their product offerings - see much in the way of real cost control? Strong disease management, medical homes, useful data on provider outcomes and costs presented in a way that Joe Sixpack or Maria Martinez can readily use?

Didn't think so. Sure, a few health plans (Aetna probably being the best among the for-profits) are making an honest effort, but most are not. Instead, health plans rely on price control - squeezing providers down as hard as they can on reimbursement rates for specific procedures - a practice that solves one part of the cost equation but does nothing to control utilization, and may well exacerbate it.

For-profit health plans operate in the best interests of their stockholders - not those of their members, providers, or society. That's how capitalism works. And not-for-profit health plans have to compete with the for-profits, a reality that has forced the Kaiser Permanentes and Group Healths to adopt many of the business practices of their competitors.

The net

The reason we need reform is the current 'free market' is not fixing society's problem. The reform we need is real, meaningful reform, with true cost control, not a few pilots here and a bit of disease management there and a couple of billion of comparative effectiveness research sprinkled on top of a layer of slightly-modified fee-for-service reimbursement.

Chadman - I'll chime in here - the perspective is from the Individual market, which is the one from which most of the reform in progress is focused on.

Certainly insurers have some blame here, as do regulators. Insurers play under the rules that they are given - and some of them need to be tightened up for sure.

Cost control is tough. I would argue that insurers DO have an incentive to do so - the lower they can keep premiums, the more customers they keep. And acquistion costs to get new customers are high - underwriting costs, agent commission costs, and policy issue costs. The 2nd year is the most profitable year for an individual medical company.

In the Individual market, the typical customer keeps their plan for an average of 3 years. This is due to many factors, with one of the main factors that folks end up finding another job with group benefits and then dropping their coverage.

The difficult thing with cost control - insurers can squeeze providers all they want - but that's only 1/2 of the issue. Utilization is the key - and people are demanding more and more health care. A lot of this has to do with the poor health habits folks have - it is estimated that 75% of health care costs are due to poor behavior by consumers - being obese (heart, joint, diabetes), lack of exercise, and of course, tobacco products. There is not much insurers can do about this - short of rationing healthcare to keep costs down.

This is the most worrisome component of the current heatlh bills. While they claim to control costs, none do. They are signficantly underestimating the impact of costs due to the reforms. Premiiums WILL increase signficantly, although for some folks their "net" will be lower, as they will receive subsidies. Of course, this is nothing more than having additional cost shifting - from the "rich" to the poor - and will have no impact on future health care costs.

Their only a limited number of ways to cut down on health care costs:

1. Increasing the required loss ratio for health care companies - forcing them to run leaner and meaner. This IS being addressed in the current health care bills.

2. Tort reform - Dems won't touch this - they get too much money from the lawyers

3. Cutting reimbursement to doctors/hospitals. The current bills DO this in the Medicare marketplace - however, it is a shell game, as private insurance will increase to offset these decreases - i.e. cost shifting. No overall impact.

4. Fraud/Waste/Abuse. I hear a lot of numbers here - and most of the fraud, IMHO, today occurs in the government plans, with much less in the private plans. This will increase in the health care bills - as it is projected that the % of people in the US to be covered by government plans will increase from 61% to 76%. The government does not have the will or accountabilty to perform these functions - never has, and never will. No accountability - if they lose money, they know they can just raise taxes, and people are in unions, so even if they screw up, they know they are not accountable and cannot lose their jobs. Not so at a private company.

5. Here is the biggest one in my estimation - personal responsibility and control. It is estimated that 70% of the population will be considered OBESE by 2017 - and the following health care costs will be monumental. There is nothing in the bills currently to require personal responsibility. My idea would be to require anyone taking a government premium subsidy to submit to annual examinations and BMI targets - continue to hit them, you get the subsidy. Don't and they don't get $$$$. I think people overall would like this idea - to get free $$$$ you have to "qualify". This will never happen though - Americans do not like to be personally responsible.

I truly believe the current bills in front of the House and Senate will significanly increase health care costs - more than they are recognizing at this point. Much is made about preventative services saving money by keeping people healthier. Nothing could be further than the truth. Those services are a net increase in cost, due to the low hit rate of the tests (the new mammo recommendations are a great example - mammo's at age 40 are a huge money waster overall - but overall makes sense to do them as good "spent" money).

The other argument I hear is that by giving people insurance will lower costs and keep them out of the emergency room. Yes, there will be some small savings, BUT this will be more than offset by the increased utilization of doctor services and prescription drugs that this group did not have access to before. That is the biggest "miss" in the current analysis - the CBO assumes these folks are in average health and has no pent up medical demand. I will guarantee you that is not the case. We've had similiar situations with healthcare reform in KY, NJ and ME - where a guaranteed issue program was put into place. Costs skyrocketed, as people who couldn't get into the system now could, and use services like crazy.

Now, I'm not saying that is not good public policy - I'm just saying that it is gonna cost a lot of money.

Again, the utilization side is the best way to slow health care cost growth. Think of how many presecriptions people have and use each year. 10 years ago, that wasn't the case. People take a pill for everything - even for sex. Unreal. Since when is aging, and not being able to get a stiffy because you are too old to do so, a "sickness" that insurance should cover?

We also need to get away from the routine maintenance health costs from being covered by insurance. These are no different, in nature, than oil changes that auto insurers don't cover. Part of being human is getting annual checkups, etc. You know they are coming, and can save and prepare for them. Insurance is supposed to be for unplanned events - sickness and injury. Somehow people view health insurance differently than any type of insurance. And here's the catch - overall people would be better off by NOT having plans cover routine costs - if they set the premium savings they'd get by not having companies pay for it, and set the money aside to cover these services in the future. But, again, that would require personal accountability by people - and we know that, as a whole, our country as very little of that today - just look at average credit card debt of people - buying things they don't have the money for currently.

Somehow, someway, we need people to get heathier on their own - and provide financial incentives (or penalties) to do so.

Lastly, the way we deliver care (fee for service) is another way to slow down costs. But this is a tough system to change. All the rhetoric of "paying for good outcomes, not services" sounds great, but is VERY difficult to implement. How in the world do you accurately message "good outcomes"?

I hope this was the type of response you were hoping to get.

 

[Mags]

Do you think the Republicans would have ever come up with anything on these issues - other than possibly tort reform - on their own? Have they ever? Maybe they have. I'd like to know that.

No they haven't. And being a Republican myself, I'm disappointed. They have created their own mess (and ours) by not addressing it.

I just wish it wasn't a bunch of poliiticians making decisions on this (I watch the Senate hearings every day). I want to scream when I hear some of the things that BOTH sides say - blatant untruths and stupid comments. This is WAY too complex of an issue and 16% of the economy. They need brighter minds that understand the healthcare business making recommendations and decisions. Possibly a task force of industry actuaries, CBO folks, doctors, hospitals, etc would be a much better way to go.

And, do you think if the Dem bill does not pass, that the Republican plan will be brought up for vote by the Republicans?

Don't worry - after watching today, I have NO doubt that a DEM bill will pass. They have WAY too much at stake politically for it not to pass. And that is the scary thing - it WILL be a bad bill, and will not only raise costs overall, but it will have a number of unintended consequences that nobody will have predicted. God help us.

Or will it be tossed out, with a collective "whew!" and never mentioned again?

I get so frustrated when I hear the Dems saying "Doing nothing is not an option". I agree we need to do something. However, passing a bad bill that could/would makes things worse overall is not better than the status quo.

If you are going to blow up 16% of the nations' ecomony - when the economy is struggling to begin with - well, I think we should take the appropriate time to do the right thing. And having a partisan bill is not the right thing. Get the BEST minds together, redesign this thing, and truly control costs and provide universal access. There are ways to do it.

But no bill that affects this much of our economy should pass unless it gets a majority of the votes from BOTH parties. That way everyone is on board, and nobody points fingers at the other if there are problems.

Unbalanced, unchecked government (either party) usually ends up with the worst and most abuse legislation possible.

 

[Mags]

...............................................................

no you wont , you will pay or go to jail.

your such a cheapskate.

Scott,

Based on many of your comments, I'm guessing you are one that will benefit from the free insurance? I somehow doubt that you are one of those that will have to pay signficantly more costs to ensure others have insurance.

It is a lot easier to vote yourself free benefits, than to vote to take more out of your own pocket to give others free stuff......

Now, if you made $500K a year or something like that, I'll bet you'd be singing a different tune.. but since you are gonna be getting more governement assistance than you currently do, I'm sure you are all over this.

Understand there are 2 (or more) perspectives on this - not just your own.

 

[DOGS THAT BARK]

...............................................................

no you wont , you will pay or go to jail.

your such a cheapskate.

Scott You think those millions that will be forced to be added to the rolls will be footing the tab--sheez

Go to google search--type in-

Gumby-healthcare reform-premiums-SUBSIDIES-Da Base

Bottom Line--
The prob we now have is 65 mill that pay no taxes--who are naturally for any free benefits subsidized by others.

Then you have the other side of coin-main stream america-

Americans Like Their Coverage: High Satisfaction with Quality and Current Coverage [FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Tens of millions of Americans rely on their current health plan to provide quality, affordable coverage for themselves and their families. Public opinion surveys consistently find that Americans are highly satisfied with their current health plan coverage. Ensuring that people who are satisfied with their current coverage can keep it is a foundation of health care reform. [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Satisfaction with Quality, Current Coverage [/FONT][/FONT]CNN/Opinion Research: [FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]CNN/Opinion Research released its latest poll on the public‟s view of the health care reform debate. One of the key findings from the poll:
74% of people are satisfied with their personal health insurance coverage.1
83% of people are satisfied with their own health care.2
[/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]1 [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]CNN/Opinion Research Poll, July 31-August 3, 2009. [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]2 [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Ibid. [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]3 [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Employee Benefit Research Institute, 2009 Health Confidence Survey, July 2009. [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]4 [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Fox News/Opinion Dynamics Poll, July 21-22, 2009. [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]5 [/FONT][/FONT][FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Ibid
[/FONT][/FONT]Employee Benefits Research Institute: [FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]The Employee Benefits Research Institute released its findings from the 2009 Health Confidence Survey (HCS):
Fifty-eight percent of those with health insurance coverage are extremely or very satisfied with their current plan, and approximately one-third (30 percent) are somewhat satisfied.3
[/FONT][/FONT]Fox News/Opinion Dynamics: [FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Fox News/Opinion Dynamics released its latest poll on American‟s attitudes on a variety of issues including health care reform and the current health care system. Here are some of the key findings related to people‟s personal health care coverage:
84% of people surveyed said the quality of their personal health insurance was either excellent or good.4
83% of people surveyed said the quality of care they receive is either excellent or good.5
[/FONT][/FONT]++++++++++++++++++++++++++++

Conclusion --guess it comes down to which side of coin one is on:shrug:

 

[THE KOD]

Scott,

Based on many of your comments, I'm guessing you are one that will benefit from the free insurance? I somehow doubt that you are one of those that will have to pay signficantly more costs to ensure others have insurance.

It is a lot easier to vote yourself free benefits, than to vote to take more out of your own pocket to give others free stuff......

Now, if you made $500K a year or something like that, I'll bet you'd be singing a different tune.. but since you are gonna be getting more governement assistance than you currently do, I'm sure you are all over this.

Understand there are 2 (or more) perspectives on this - not just your own.

.................................................................

Your right I will benift from it.

Right now I am in a situation where I do not have health insurance and have been turned down over and over for pre existing conditions.

Even the cheap health insurance wont take me and my wife at this time.

So yes I am bitter and want changes so that the insurance companys cannot continue to fawk over familys like me.

 

[Mags]

.................................................................

Your right I will benift from it.

Right now I am in a situation where I do not have health insurance and have been turned down over and over for pre existing conditions.

Even the cheap health insurance wont take me and my wife at this time.

So yes I am bitter and want changes so that the insurance companys cannot continue to fawk over familys like me.

Well, a couple of things:

1. You have to understand that, if you are already sick, it is difficult for an Individual Medical insurer to take on a new policy for which it is guaranteed to lose money. This is not much different than an auto insurer agreeing to insure a car that is already been in an accident - and paying for the damage. The ONLY way this type of system will work is if:

Everyone HAS to be covered - to ensure the sick and healthy are in the system AND

Strong financial/jail type penalties for those who do not comply. The penalties in the bills currently will NOT do this.

2. For your current situation, you have 2 fairly easy remedies:

One - get a job with healthcare benefits. The vast majority of companies with 50 employees or more offer good health insurance. Not sure if you work or not, but that is an option. Based on your messages, I'm guessing that you are retired or not employed.

Two - if "Scott from Atlanta" is a true nickname, you have access in GA to guaranteed issue state plans through the state. They basically assign you to a company, who has to take you. It is not the cheapest option, but at least in GA you do have access to coverage if you want it.

Good luck.

 

[Chadman]

Mags, thanks so much for your thoughts and effort in responding to this. I have much I'd like to talk about on this issue, and you are one of the few that are knowledgeable and civil when it comes to talking about it. If you could, check back every so often, I want to post more thoughts and get your take on them. Wayne, I also consider you to be knowledgeable on this, and respect your opinions, some of them, at least. But I do think that your career choice and political leanings cloud many of these issues, and we certainly don't share the same views. But, at least we can talk about it. More later, have to make money now to help pay my COBRA costs...

 

[Mags]

Mags, thanks so much for your thoughts and effort in responding to this. I have much I'd like to talk about on this issue, and you are one of the few that are knowledgeable and civil when it comes to talking about it. If you could, check back every so often, I want to post more thoughts and get your take on them. Wayne, I also consider you to be knowledgeable on this, and respect your opinions, some of them, at least. But I do think that your career choice and political leanings cloud many of these issues, and we certainly don't share the same views. But, at least we can talk about it. More later, have to make money now to help pay my COBRA costs...

Chad - I always enjoy talking about health care and health care reform. The general public has such little understanding of the whole issue - which is certainly understandable due to all the moving pieces and the complexity. I certainly do not have all the answers - I just have a little more insight into this than the average Joe.

Other folks tend to look at this issue ONLY as "how does it affect me"? And since healthcare is an expensive item, it tends to make people very upset (like Scott and Wayne). One's position on healthcare reform is all about how it affects them personally - and I get that.

So, I try to just put info out there, and TRY to keep personal opinions and inflamatory comments to a minimum. Sometimes I'm successful, sometimes not.

Feel free to get my # or email from Jack - I'd be more than happy to share what knowledge I have, if you find it to be helpful......

 

[DOGS THAT BARK]

Mags
Believe Ga is one of few states withouthigh risk pool


State risk pools and where to contact them


<!--This info will be used on the state page and on the risk pool roundup page -->
<!--THUMBS UP-->

<!--THUMBS UP-->Alabama Health Insurance Plan
Toll-free 1-800-513-1384 or (334) 353-8924
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->

Alaska Comprehensive Health Insurance Association
Toll-free 1-888-290-0616
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Arkansas Comprehensive Health Insurance Plan
Toll-free 1-800-285-6477
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->California Major Risk Medical Insurance Program
Toll-free 1-800-289-6574 or (916) 324-4695
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->CoverColorado
(303) 863-1960 or toll-free 1-866-787-9129 (M-F 8am?5pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Connecticut Health Reinsurance Association
Toll-free 1-800-842-0004 (M-F 9am-4pm EST)
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<!--THUMBS UP-->Florida Comprehensive Health Association (closed to new enrollees since 1991)
(850) 309-1200
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<!--THUMBS UP-->Idaho Individual High Risk Reinsurance Pool
(link is to a PDF on program)
Toll-free 1-800-721-3272 (In-state only)
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<!--THUMBS UP-->Illinois Comprehensive Health Insurance Plan
Toll-free 1-866-851-2751 (in-state only) or (217) 782-6333
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<!--THUMBS UP-->Indiana Comprehensive Health Association (click "guest" for access, then choose "ICHIA")
Toll-free 1-800-552-7921 or (317) 614-2000
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Health Insurance Plan of Iowa
Toll-free 1-877-793-6880 (M-F 8am-5pm CST)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Kansas Health Insurance Association
Toll-free 1-800-362-9290 (M-F 8am-5pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Kentucky Access
Toll-free 1-866-405-6145
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Louisiana Health Plan
Toll-free 1-800-736-0947 or (504) 926-6245
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Maryland Health Insurance Plan
Toll-free 1-888-444-9016 (M-F 8am-5pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Minnesota Comprehensive Health Association
Toll-free 1-866-894-8053
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Mississippi Comprehensive Health Insurance Risk Pool
Toll-free 1-888-820-9400
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Montana Comprehensive Health Association
Toll-free 1-800-447-7828
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Nebraska Comprehensive Health Insurance Pool
(402) 343-3574 or toll-free 1-877-348-4304 (M-F 8am-4:30pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->New Hampshire Health Plan
Toll-free 1-877-888-6447
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->New Mexico Medical Insurance Pool
(505) 622-4711
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--> <!--THUMBS UP-->North Carolina Health Insurance Risk Pool (NCHIRP)
Toll-free 1-866-665-2117
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Comprehensive Health Association of North Dakota (North Dakota health insurance risk pool)
Toll-free 1-800-737-0016 or (701) 277-2271
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Oklahoma Health Insurance High Risk Pool
Toll-free 1-800-255-6065 or (913) 362-0040
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Oregon Medical Insurance Pool
Toll-free 1-800-848-7280 or (503) 225-6620 (M-F 8am-5pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->South Carolina Health Insurance Pool
Toll-free Phone 1-800-868-2500, ext. 42757, or 1-803-788-0500, ext. 42757
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->South Dakota Risk Pool
605-773-3148 (ask for a Risk Pool representative)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Tennessee's Tenncare Program
1-888-486-9355
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Texas Health Insurance Risk Pool
1-888-398-3927
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Utah Comprehensive Health Insurance Pool
Toll-free 1-800-705-9173 or (801) 442-6660
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Washington State Health Insurance Pool
Toll-free 1-800-877-5187
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->West Virginia Health Insurance Plan
1-866-445-8491
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Wisconsin Health Insurance Risk Sharing Plan
Toll-free 1-800-828-4777
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Wyoming Health Insurance Pool (scroll down)
(307) 634-1393


<!-- end "content_body" -->http://www.healthinsurance.org/risk_pools/



<!-- end "module_column" -->

 

[Mags]

Mags
Believe Ga is one of few states withouthigh risk pool


State risk pools and where to contact them


<!--This info will be used on the state page and on the risk pool roundup page -->
<!--THUMBS UP-->

<!--THUMBS UP-->Alabama Health Insurance Plan
Toll-free 1-800-513-1384 or (334) 353-8924
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->

Alaska Comprehensive Health Insurance Association
Toll-free 1-888-290-0616
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Arkansas Comprehensive Health Insurance Plan
Toll-free 1-800-285-6477
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->California Major Risk Medical Insurance Program
Toll-free 1-800-289-6574 or (916) 324-4695
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->CoverColorado
(303) 863-1960 or toll-free 1-866-787-9129 (M-F 8am?5pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Connecticut Health Reinsurance Association
Toll-free 1-800-842-0004 (M-F 9am-4pm EST)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Florida Comprehensive Health Association (closed to new enrollees since 1991)
(850) 309-1200
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Idaho Individual High Risk Reinsurance Pool
(link is to a PDF on program)
Toll-free 1-800-721-3272 (In-state only)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Illinois Comprehensive Health Insurance Plan
Toll-free 1-866-851-2751 (in-state only) or (217) 782-6333
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Indiana Comprehensive Health Association (click "guest" for access, then choose "ICHIA")
Toll-free 1-800-552-7921 or (317) 614-2000
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Health Insurance Plan of Iowa
Toll-free 1-877-793-6880 (M-F 8am-5pm CST)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Kansas Health Insurance Association
Toll-free 1-800-362-9290 (M-F 8am-5pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Kentucky Access
Toll-free 1-866-405-6145
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Louisiana Health Plan
Toll-free 1-800-736-0947 or (504) 926-6245
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Maryland Health Insurance Plan
Toll-free 1-888-444-9016 (M-F 8am-5pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Minnesota Comprehensive Health Association
Toll-free 1-866-894-8053
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Mississippi Comprehensive Health Insurance Risk Pool
Toll-free 1-888-820-9400
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Montana Comprehensive Health Association
Toll-free 1-800-447-7828
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->Nebraska Comprehensive Health Insurance Pool
(402) 343-3574 or toll-free 1-877-348-4304 (M-F 8am-4:30pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP-->

<!--THUMBS UP-->New Hampshire Health Plan
Toll-free 1-877-888-6447
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->New Mexico Medical Insurance Pool
(505) 622-4711
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--> <!--THUMBS UP-->North Carolina Health Insurance Risk Pool (NCHIRP)
Toll-free 1-866-665-2117
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Comprehensive Health Association of North Dakota (North Dakota health insurance risk pool)
Toll-free 1-800-737-0016 or (701) 277-2271
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Oklahoma Health Insurance High Risk Pool
Toll-free 1-800-255-6065 or (913) 362-0040
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Oregon Medical Insurance Pool
Toll-free 1-800-848-7280 or (503) 225-6620 (M-F 8am-5pm)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->South Carolina Health Insurance Pool
Toll-free Phone 1-800-868-2500, ext. 42757, or 1-803-788-0500, ext. 42757
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->South Dakota Risk Pool
605-773-3148 (ask for a Risk Pool representative)
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Tennessee's Tenncare Program
1-888-486-9355
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Texas Health Insurance Risk Pool
1-888-398-3927
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Utah Comprehensive Health Insurance Pool
Toll-free 1-800-705-9173 or (801) 442-6660
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Washington State Health Insurance Pool
Toll-free 1-800-877-5187
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->West Virginia Health Insurance Plan
1-866-445-8491
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Wisconsin Health Insurance Risk Sharing Plan
Toll-free 1-800-828-4777
<!--This info will be used on the state page and on the risk pool roundup page --><!--THUMBS UP--><!--THUMBS UP-->Wyoming Health Insurance Pool (scroll down)
(307) 634-1393


<!-- end "content_body" -->http://www.healthinsurance.org/risk_pools/



<!-- end "module_column" -->

DTB:

That is true - their HIPPA alternative (every state had to choose a way to comply with HIPAA) is to "assign" these polcies to carriers doing business in the state via an assigment system at the state DOI. The benefit package is state determined, but the risk is actually on each insurers paper.

Insurance companies would prefer risk pool - that way the risk is shared, and the companies pay in via a surchage on health premiums. With the GA model, you may get "assigned" worse than average risks by the state - and get screwed as a company.

Other states without a risk pool require companies to offer their 2 most popular plans (such as AZ and MO). Other states have chosen BCBS to be their "carrier of last resort", which means they have to take these folks guaranteed issue. MI is a state that uses this approach.

 

[THE KOD]

Well, a couple of things:

1. You have to understand that, if you are already sick, it is difficult for an Individual Medical insurer to take on a new policy for which it is guaranteed to lose money. This is not much different than an auto insurer agreeing to insure a car that is already been in an accident - and paying for the damage. The ONLY way this type of system will work is if:

Everyone HAS to be covered - to ensure the sick and healthy are in the system AND

Strong financial/jail type penalties for those who do not comply. The penalties in the bills currently will NOT do this.

2. For your current situation, you have 2 fairly easy remedies:

One - get a job with healthcare benefits. The vast majority of companies with 50 employees or more offer good health insurance. Not sure if you work or not, but that is an option. Based on your messages, I'm guessing that you are retired or not employed.

Two - if "Scott from Atlanta" is a true nickname, you have access in GA to guaranteed issue state plans through the state. They basically assign you to a company, who has to take you. It is not the cheapest option, but at least in GA you do have access to coverage if you want it.

Good luck.

..............................................................

Mags

I am not already sick. I take cholestrol pills and have high blood pressure.

I was told directly by Blue Cross that taking cholestrol medicine was in their denial area.

Wtf ? how many millions of people in the USA take this medicine. Thats pathetic.

I am self employed. My wife lost our insurance when she was in a major traffic accident and was layed off from her job.

And during this time of struggle my wife had a emergency appendecomy rupture. For four days in the hospital over 30 thousand dollars.

Bitter . Yes I am bitter. I want health insurance that I can afford and will cover me for major events. Just the major stuff would be fine with me.

I cannot tell you the number of companies we have applied for that have turned us down.

Its not right that any American does not have access to the same coverage as DTB

 

[Mags]

..............................................................

Mags

I am not already sick. I take cholestrol pills and have high blood pressure.

I was told directly by Blue Cross that taking cholestrol medicine was in their denial area.

Wtf ? how many millions of people in the USA take this medicine. Thats pathetic.

I am self employed. My wife lost our insurance when she was in a major traffic accident and was layed off from her job.

And during this time of struggle my wife had a emergency appendecomy rupture. For four days in the hospital over 30 thousand dollars.

Bitter . Yes I am bitter. I want health insurance that I can afford and will cover me for major events. Just the major stuff would be fine with me.

I cannot tell you the number of companies we have applied for that have turned us down.

Its not right that any American does not have access to the same coverage as DTB

Sorry to hear about all the problems. You certainly fit the bill regarding someone who should have access, at reasonable prices.

Usually cholesteral drugs won't get you denied, unless you have one of the following:

1. Taking 3 drugs for blood pressure/hypertension
2. Having a corresponding issue, such as being overweight
3. Blood pressure is considered uncontrolled.

Call the state - you can get coverage in GA, via the state plan mechanism. The rates are typically 2x what the private industry would charge you, if you are completely healthy if I remember right.

 

[THE KOD]

Sorry to hear about all the problems. You certainly fit the bill regarding someone who should have access, at reasonable prices.

Usually cholesteral drugs won't get you denied, unless you have one of the following:

1. Taking 3 drugs for blood pressure/hypertension
2. Having a corresponding issue, such as being overweight
3. Blood pressure is considered uncontrolled.

Call the state - you can get coverage in GA, via the state plan mechanism. The rates are typically 2x what the private industry would charge you, if you are completely healthy if I remember right.

.............................................................

just take benicar for bp;
Not overwieght at 198 6' tall

blood pressure is controlled . Had to take a nuclear stress test two weeks ago when a EKG came up showing restrictions. I just got the results , it came out ok but cost me 2200 more dollars.

Fortunately even without my wifes income we make enough to have a good lifestyle . But shit things can get out of hand with just one stay in hospital. And that makes no differance if you have insurance or not.

Something has to change with this health shit.

Change we can believe in.

I dont really care as long as its affordable and comparable with DTBs. If he pays 3500 for full good coverage, they want me to pay 6800 for the same coverage.

I says that bullshit. This is where Inssurance companys have been fawking over us for so many years. It affects proper health care that must be available for all Americans. Look at the bankruptys associated with health care costs . Its incredible
the average people that are over their heads in medical debt.
I will call GA State on monday.

I will let you know what they say .

thanks

 

[Mags]

.............................................................

just take benicar for bp;
Not overwieght at 198 6' tall

blood pressure is controlled . Had to take a nuclear stress test two weeks ago when a EKG came up showing restrictions. I just got the results , it came out ok but cost me 2200 more dollars.

Fortunately even without my wifes income we make enough to have a good lifestyle . But shit things can get out of hand with just one stay in hospital. And that makes no differance if you have insurance or not.

Something has to change with this health shit.

Change we can believe in.

I dont really care as long as its affordable and comparable with DTBs.

I will call GA State on monday.

I will let you know what they say .

thanks

Scott - I checked my high risk pool handbook - and I have bad news. GA is 1 of 5 states that does not have a program to help you. The one I was referring to, the "assignment" system, only applies to those folks that come from a self funded plan (typically large employers self fund their medical costs).

I'm sorry to say that my idea won't help you.

What we really need is a national high risk pool for individuals in situations such as yourself. I'm self employed also (and healthy), but I get group benefits through my wife's work.

Good luck....

FYI - The only "change you can believe in" are the ones that we make ourselves....

Don't count on the government to do it.......