THE TREATMENT FEBRUARY 9, 2009
-
Read Later
READ LATERAvailable only to subscribers. SUBSCRIBE TODAY
-
Listen
ARTICLE AUDIO
- Font Size
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access WeBlog
and is a regular contributor to the Treatment.
Of the health provisions in the economic recovery package, we’ve written about the need for Medicaid funds to prevent gruesome cuts that would deny coverage for millions at the state level; and about the hope (now only in the House version) of temporarily expanding Medicaid for newly-unemployed adults, beginning to close the gaping hole in our current safety net. Another major provision (in both bills, although the House version is more expansive) are subsidies for COBRA, the option that workers have when they leave a job to continue their group coverage through their employer--as long as they pay 100 percent of the premium, plus 2 percent administrative costs. For those “between jobs,” that’s a hefty price--for example, it would be a ridiculously large portion of unemployment benefits. But COBRA doesn’t just provide workers continuity of care, the security of the same level of benefits they previously enjoyed, and access to their previous employers’ group discount—it’s often the only choice many have. For those who don’t have other access to group coverage (like, through a spouse), COBRA may be your only option. Outside of five Northeast states with guaranteed issue requirements (Maine, Vermont, Massachusetts, New York, New Jersey), individuals buying coverage by themselves are at risk of being denied coverage--at any price--due to their health status. If you think that doesn’t concern you, think again. I used to joke that living over 45 was a “pre-existing condition.” But I’ve seen folks in their 20s with denial letters, and seemingly healthy people of all ages get denied coverage for relatively minor ailments.
Check out the intense standardized questionnaire to get coverage in Washington state, which at least has put some oversight over the process. In California and many other states, insurers can ask their own questions, and can have different criteria of who is denied or not. Here’s the basic disclosure in California for the many reasons you can be denied coverage--even for ailments you may not know you have. In the wild west of the individual insurance market, anybody can be denied. So group coverage through COBRA is the last hope to ensure that many who lose their job don’t lose their coverage, but it only will really work if it can subsidized to a point to be affordable. For some, a Medicaid expansion would be more affordable and make more sense, which is why the House version includes that option as well. Both are needed to be included in the final package. And then we need to move on to overall health reform to end the practice of allowing insurers in the individual market to play Russian Roulette with consumers’ coverage.
--Anthony Wright
6 comments
Yes, COBRA's essential. It's also a bad joke. The cost is ruinous for anyone outside the top bracket.
If Obama accomplishes anything, it must be getting single payor done. Why is the man not focused on two or three big things? WTF is he allowing Pelosi et al to lard his stimulus plan with all sorts of extraneous junk, and not focusing like a laser beam on the one huge policy change that, more than any other, would reduce American families' economic security and aid small business formation?
- teplukhin2you
February 10, 2009 at 7:15am
cirrection to above: reduce US families' economic INsecurity
- teplukhin2you
February 10, 2009 at 9:48am
Why not just put them into Medicaid? Seriously? Why should we pay ridiculous amounts for top-dollar healthcare? Everyone's a single-payer advocate until it's time for them to hop into the pool. Government should at least start by moving everyone with "government healthcare" -- public assistance and government workers -- onto one system.
- prnoonan
February 10, 2009 at 11:10am
Tep, I agree that health care reform is essential, but single payer is not the way to go. It has zero chance of passing, and what do you propose to do with all of the insurance company workers who will then be unemployed, not to mention the billions that investors have put into them. Single payer is a pipe dream.
- blackton
February 10, 2009 at 11:23am
blackton, tep -
The answer: the government needs to become an insurance company. I should be able to purchase from the Fed an insurance package in a range that balances my needs against my costs, just as I can from a private insurer. The difference is that the gov't cannot turn me down for previous conditions. It wouldn't be a big change, like forcing people to buy insurance or companies to pay for it; it would just be available as an option.
Admittedly, yes, this may initially result in the gov't getting stuck with the insurance companies' rejects, but doesn't it anyway? Over time, with the option of non-employer-based (read: portable) health insurance available, healthy, insurable people would switch, especially if employers gave them incentive to do so. For example, a company like Wal-Mart might say, "Look, we don't provide health insurance, but we'll kick in for your gov't insurance." Or the Fed could just mandate that employers either provide insurance or kick X amount per wage dollar over to the employee's gov't insurance premiums. Either way, I think most companies would jump at that option, since it frees them of many responsibilities.
For the newly unemployed, the gov't could be more forgiving than a private insurer, allowing maybe a three- or six-month grace period for you to start paying premiums again before loss of benefits and/or being forcibly switched to lower-level Medicaid benefits. It could also allow you to purchase a lower, but still decent, level of benefits - something no private insurer will do for you if you can't afford COBRA at your ex-employer's benefit level. And again, even if my benefits lapse, at least when I get back to work, I won't have to worry about the pre-existing condition clauses that cause so much grief in the current system. *AND* I won't have to change physicians, either - big advantage.
In the long run, we would be slowly weaning people off of employer-sponsored health insurance, which is the big first step. We may also be weaning them off private health insurance, though smart insurers would make some sort of similar packages available. However, I think private companies would be hard-pressed to provide the sort of security that the gov't packages offered. In the end, I think they would have to settle for selling high-end supplemental insurance. But the key phrase here is "in the end" - it would take a long time to change completely, giving the existing system, and the employees thereof, time to acclimate.
Thoughts?
- dhauck
February 10, 2009 at 12:58pm
dhauck - great idea, all for it. Is anyone in Congress proposing this? Thanks, T
- teplukhin2you
February 11, 2009 at 1:30pm