The Sky Is Not Falling

The elderly couple wanted to give me a Power of Attorney...

A Power of Attorney.  The elderly couple wanted to give me a Power of Attorney.  They were convinced that President Obama is going to win re-election and that their Medicare coverage is in jeopardy.  What happens when(!) he changes Medicare and they don’t get into my office fast enough to be protected? 

Can we give you a Power of Attorney to change our policies so that we have the right coverage? 

It was Republican Week at my office.  I can normally tell whether my clients are Democrats or Republicans just by the questions they ask.  The talking heads on FOX create a climate of fear and misinformation on some parts of the Patient Protection and Affordable Care Act (PPACA).  Rachel Maddow and Ed Schultz create a competing sense of dread and foreboding amongst their viewers. 

I watch both channels so that I can anticipate my clients’ concerns. 

My last post, Collateral Damage, noted the unintended consequences of a badly written piece of legislation.  But, the PPACA has helped a lot of people.  In the interest of fairness, we should spend a moment or two discussing a few of those victories.  All of these examples are from last week.  And all involved Republicans.  Key details have been changed to protect the identities of all involved. 

Bruce has been self-employed for over ten years.  He was covered under his spouse’s health policy.  When they divorced, he took full advantage of COBRA for the entire thirty-six months.  The story then gets murky.  Either a bad agent sold him a crappy policy or he cheaped out and purchased something that did not meet his needs.  Either way, his health got worse, the mediocre policy didn’t pay for his care, and the premium became unaffordable.  Bruce is now an unhealthy 56 year old with no insurance facing possible surgery. 

Bruce will qualify for the Ohio High Risk Pool policy.  The premium isn’t cheap, $428 per month. It would be far worse if there wasn’t premium support built into the legislation.  The Ohio High Risk Pool is not for everyone.  Not everyone qualifies.  The rules are complicated.  But the PPACA is a lifeline for Bruce and he wasn’t the only winner last week. 

Jane is another Ohio High Risk Pool winner.  She is 61.  Jane was terminated by a major local employer last November.  She could have been covered through COBRA if she could have afforded it.  She couldn’t.  She has a number of preexisting conditions that would result in an automatic decline if she applied for individual health insurance.  Jane qualifies for the Ohio High Risk Pool policy and the $428 premium may be a challenge, but she has had a year without insurance.  $428 is a gift. 

The Ohio High Risk Pool plan is not placed through an agent’s office.  I have nothing to do with it and I am not compensated for helping people access this insurance.  Educating the uninsured is just part of doing the right thing. 

Amanda has four sons, two in college, one in middle school, and her youngest is only 8.  They are all healthy except for Billy, age 14.  Billy is in remission, thank G-d, but he has had hundreds of thousands of dollars of medical care.  He might not require additional expensive care.  Who knows?  I would have had a very hard time covering Billy three years ago.  Today?  No big deal.  Amanda is healthy.  The insurers will readily approve her.  Billy and his brothers will go through underwriting to determine price, not insurability.  The price will be a little higher, but the cost of insurance won’t even begin to reflect the potential cost of care. 

The PPACA allows Amanda to purchase affordable health insurance for her entire family.  To deny this is to deny reality. 

I completely understood why the elderly couple was afraid.  All day long they are bombarded with solicitations for different Medicare plans, pleas to support candidates who will fix Medicare, and television reports that the sky is falling.  Whatever healthy skepticism they may have once had has been beaten down by the constant repetition of the same facts

The elderly couple came to my office to be protected.  What they need was to be reassured. 

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Linda Ellis October 31, 2012 at 05:44 PM
I am pleased to see positive comments regarding the Ohio High Risk Pool, which I am currently on myself with the $428 per month premium. Many need to learn more about what plans were in place prior to the passage of the ACA (AKA Obamacare). The Ohio High Risk Pool came about due to the ACA. The only plans Ohio had were "Open-Enrollment" plans which Ohio still has. There are several details with the "Open-Enrollment" plans, however. To summarize, if someone loses their COBRA after 18 months and are rejected for coverage in the private market and are not able to obtain health insurance any other way right away, then the "Open-Enrollment" plans are an option, however, and this is a BIG however, premiums -- particularly for older Ohioans -- are even more expensive than those in the 2 plans offered through the Ohio High Risk Pool. "Open-Enrollment" plans' premiums can range roughly from $800 to $2,100 per month for someone older than 55. I know because I became uninsured in June of 2010. Just the opposite of the Ohio High Risk Pool, a person who recently has lost their health insurance can enroll or attempt to enroll in a "Open-Enrollment" plan -- but it had better be within a 63 day window in order for their pre-existing conditions to be immediately covered. With the Ohio High Risk Pool a person must be uninsured 6 months. If the ACA "Obamacare" is repealed, I fear Ohio will only have "Open-Enrollment" plans & few can afford them. More Ohioans will be uninsured.
Dave Cunix October 31, 2012 at 06:09 PM
Linda: I am glad you were able to secure coverage. The Ohio High Risk Pool is an important safety valve. We have to have an option for everyone.
Linda Ellis October 31, 2012 at 06:15 PM
Thanks Dave. I appreciate your comment. It was rather rough for me at age 60 to become uninsured as I did because I took an expensive medication and was due to have rotator cuff surgery. Four private insurers turned me down flat. My spouse was already on Medicare and I didn't qualify for Medicaid; and no new employer-sponsored health insurance to replace what I had lost after COBRA ended. I wouldn't wish the situation I had on my worst enemy. As high as the OHRP premiums (called contributions as you know by Med. Mutual who oversees the OHRP) the $428 (I had the $575 in 2011 with the $1,500 deductible) it was more affordable than the Open-Enrollment plans - any of those plans!!! Being uninsured was not easy, and I was denied a blood draw because of it. I truly would not wish to see Romney elected who would repeal the ACA and replace it with nothing. He would leave it to the states. We know Mary Taylor is very much against "Obamacare." If you look at the ODI website; Dave, you'll note that the "Open-Enrollment Toolkit" is a featured link. To locate a link to the OHRP, you have to hunt around the website to find it.
Holly Vogel-Engel November 01, 2012 at 01:54 PM
$428/mo is still a lot of money, but if it pays $40,000 in hospital bills for a surgery it is worth it.
Linda Ellis November 01, 2012 at 02:07 PM
Yes, $428 is a lot of money, Holly, but if you were to go onto the website of: ehealthinsurance.com, look up the private insurers in our state of Ohio, pick a plan, and get a quote, you won't find a decent plan truly much cheaper than that. If you want lower co-pays, and lower deductibles (not $5 or $10 thousand dollars!) then your premiums are going to be over $400 per month. My big point is that if you are rejected in the private market, you won't be able to get even a private plan!!! You'll be turned down. Then, if you are not able to obtain health insurance any other way; and it can and does happen to people who are rejected in the private market and have no new job with employer-sponsored health insurance, or a spouse, Medicare or Medicaid, then you will be uninsured because the "Open-Enrollment" plans in place here in Ohio have the most expensive rates. More people need to be aware of these "Open-Enrollment" plans. They are listed on the ODI website with toll-free numbers and websites for each insurance carrier and you'll learn quite quickly just how much you would have to pay if you enroll within 63 days of losing your 18 months of creditble coverage. That is where the Ohio High Risk Pool comes into play in this equation. There is the 6 months of being uninsured wait, which is its biggest detractor, but if you can go uninsured, the OHRP is the better bet oer an "Open-Enrollment" plan because the rates are still so much less.


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