The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Obama Administration Presents State-by-State View of Status Quo and Impact of Health Care Reform

Posted by Alan on November 25, 2009

Most readers of this blog understand the benefits and problems of the health care system status quo. And they can make an educated guess at how the various health care reform proposals will impact their world. Most voters (and much of the media, I might add), don’t have as informed a view on these issues.

Into this vacuum comes the Obama Administration with a state-by-state description of the current health care system in the jurisdiction and its view as to the benefits health care reform will deliver to the states’ residents.

Yes, the site is aimed at building support for health care reform. Still, it provides some interesting data and observations. For example, it warns that the “amount of uncompensated care provided will more than double in 45 states” by 2019 as the number of uninsured grows by at least 10 percent in every state and by more than 30 percent in 29 states.

It’s worth spending some time. You may disagree with some of what’s presented. And some of it is inaccurate — it claims, for instance, that health care reform would establish a high risk pool in California, but the state already has one. And it seems to imply that 100% of the individual market would buy through the exchange, something no one is claiming (that I’m aware of). So read it with a handful of salt. However, the reports do provide an interesting, more granular glimpse into health care in America than is usually available. And the more detailed look we all give to reform, the better.


9 Responses to “Obama Administration Presents State-by-State View of Status Quo and Impact of Health Care Reform”

  1. JimK said

    Correction, to previous post. John may be exluded from his wife’s plan but the maximum exclusion period is twelve months.

  2. JimK said

    The link below is to an op-ed article in Sunday’s NY Times. I read the article and it tells the tragic story of an individual(John) who is denied coverage because of a pre-existing condition. Apparently the employee, because of his illness lost his job on April 18, 2009 and his wife attempted to add him to her existing employer based healthcare plan but was denied becuase of his pre-existing condition. According to the article he was also informed by the local ER not to return until he had insurance.
    Subsequent to his illness his wife quit her job to take care of her husband, which would then make the entire family ineligible for medical coverage. He then applied for medicaid and was approved but could not find any doctors willing to cover him because of the low reimbursement rates for medicaid patients.
    I am writing this is because the article seems at odds with my understanding of existing laws.
    For starters he had coverage within the twelve months prior to his wife’s application to add him to her group plan; under HIPAA it is my understanding that if you had coverage within the prior twelve months to your application for a new plan, a group based employer health plan cannot deny you coverage. Am I incorrect?
    The second item was the fact that the ER supposedly told John not to return to the ER until he had insurance coverage. This seems like a blatant disregard for the Emergency Medical Treatment and Active Labor Act. While I realize that there are some limitations on EMTALA, a blanket statement not to return until an individual has insurance covergage appears to be a prima facie violation of the Act. Again, am I incorrect?
    Finally, after his wife left her job, John qualified for Medicaid but was unable to find a doctor who would accept Medicaid. While I am sure their are doctors who are unwilling to accept Medicaid I find it hard to believe that John was unable to find any healthcare providers who are willing to accept Medicaid. Again am I wrong?
    While the Right propogates stories about Death Panels, this story seems the polar opposite, that is writing a story about a system that goes to any lengths to deny coverage and it seems to me at least that the story skirts the truth and disregards existing laws.

    • Alison said

      There may be circumstances at play that I am not aware of but loss of job is considered a “qualifying event” and allows immediate access to spouses coverage on the date of termination from the employees prior company plan. As long as the employee does this within 30 days of the “qualifying event” they are added on with no insertion of a pre existing period – unless they were not on the prior plan for 12 months. Then they would have a pre existing clause for the time left to serve between time covered and the 12 month period. The language “denied” would not be correct that the law states they have to take him. There may have been an issue of pre existing if he had not been on prior plan for 12 months. BUT- they honor 12 months of previous coverage as “credible coverage” from additional carriers as well. The only way this person could of entered the “pre existing” zone is if they allowed themselves to be totally uncovered for more than 90 days (period allowed here for a lapse – without posing penalty)

    • jimmy1920 said

      When this debate heated up almost a year ago, I heard similar stories, and was likewise skeptical for the same reasons. I learned that some insurance companies get around HIPAA by issuing contracts for six months so that you never have more than six months “continuous” coverage.

      But that doesn’t explain “denial”. Other than that Alison described it. What we find in our group is that employees have a hard time making the 30 day cut. Consequently the spouse may have had to wait for the regular open enrollment period. They lose any “Creditable” (not “credible”) coverage that way, but that still does not explain “denial”, unless it was denial of coverage for those specific services related to the pre-exisitng condition.

      this is one more reason why we need a single- payer system. Not only is the bureaucracy surrounding these rules needlessly complex, but they disrupt continuity of care. We can not improve care delivery until we have an efficient patient delivery system.


  3. Dave Wood said

    With or without Obamacare we are screwed.

    Without Obamacare the obesity/diabetes epidemic as well as the ageing population guarantees accelerating rises in spending on healthcare. In this scenario, the only question is how high will insurance premiums go, and how high will government spending go before everyone realizes that this American model we call American health care is dysfunctional, inefficient, and unfair. Tinkering with it will only slow down the trainwreck.

    If Obamacare passes, then we will see govt. spending accelerate even faster as this new giant entitlement gets going, premiums for private insurance will rise as the previously very sick and uninsured now get insured, thus passing all those high costs onto the backs of all of us rate payers.

    The Republicans are right that govt. spending will go up, and that the Democrats plans to pay for it will not come to pass, causing even higher Federal deficits, a weaker dollar worldwide, and a weaker economy overall since the Federal govt will be sucking billions out of the economy to fund the deficit, also raising pressure on interest rates in the process. There will be no dot com bubble like in the late 90s, nor will there be a real estate bubble like in 04 -07. We will see a jobless recovery like the one in 03-04. Remember Kerry campaigning how Bush was the only President to preside over 4 years without any new jobs?

    Health care is the only REAL item in our economy that has the true ability to bankrupt the nation, to lower our standard of living, to sap our wages without any real increase in productivity. Investment in health care does not raise our standard of living, it only fixes our ailing self inflicted wounds, and attempts to cover up our poor choices for lifestyle.


    • James S. Thornton said

      I tend to agree that things look pretty bleak here.

      Disorders associated with obesity and inactivity seem virtually unstoppable at this point.

      Alan’s point about huge growth in uncompensated health care makes me feel a bit like a sentient cow in an abattoir chute, if there is such a thing as a sentient cow. Maybe a pig is better example. Pigs to their credit do seem to know what is coming.

      The vision of the future seems to me to depend on the philosophy of the visionary.

      The free market types, if left to their own “remedies”, will bequeathe us a system no doubt familiar to most of the Third World: a paucity of very wealthy oligarchs that can afford the best healthcare money can buy, and a majority of shlubs who can’t afford bupkis and won’t get it, either, when ERs and the like can eventually start turning people away (you know legislation along these lines is coming.)

      The single payer types, if left to their remedies, will create a system that eventually taxes everybody fairly heavily, though it is arguable if the tax increases will be too much more than health premiums would have been, at least for lower middle class earners.

      Those now sucking cream off the medical industrial teat will find that the political class, by and large, are shoving them off the nipple, and specialists will no longer be quite the kings of the universe, or at least kings of the Country Club, they currently are. Ditto for drug king pins, equipment makers, etc. Big losers would be the highest end taxpayers and those who benefit from the pay-for-service model, where more is more, regardless of whether this is in the best interests of patients or not.

      The life is sacred crowd, if god forbid we are left to their tender mercies, will leave us with a population of fetuses, vegetables, and salvageable ancients on various forms of the life support, while anyone over 6 weeks or under Medicare’s new minimum age of 104 will be left to fend for themselves.

      Too many chiefs and too many fiefdoms. Very hard to see any light in this tunnel. In fact, I don’t think it’s a tunnel at all since there seems to be no exit on the other side. It’s more like a sarcophagus slowing drawing America in–poor folks at first, but the rest will soon enough follow.

      • Alan said

        OK. Time to take a deep breath here. I don’t think things are quite as bleak as you describe here, James. Consider:

        1. We’re likely to see a health care reform bill signed into law early next year.

        2. Most of its provisions won’t take effect until 2014 — plenty of time to smooth out the transition (as much as is possible) and maybe even have a chance to tweak the reforms into better shape. But even if the law is enacted as is …
        3. Things have a way of working out. Do a search on this blog for “better than feared” and re-read those posts. It ALWAYS comes out better than feared (OK, it also always turns out worse than promised, but where looking at the glass half full here — and besides, they’re promising a lot).

        3. The status quo will change to the chagrin of the “free market types” as you call them. Single payer won’t happen, much to its advocate’s dismay. And yes, we have a lot of chefs in the kitchen, but the meal still seems to get served.

        4. Would it be nice to have a better system than the one we do today(whatever that might look like) right away? Yes. Would it be nice to have a perfect system? Yes. But in reality, what’s important is to make a start and to keep working toward the perfect knowing we’ll never get there.

        This isn’t a tunnel or a sarcophagus. It’s a process and its messy. But it’ll work out. Hang in there.

        • James S. Thornton said

          Bless you, Alan. You are the most natural cognitive behavioral therapeutic blogger I have ever had the good fortune to wander into the orbit of.

          Sorry for the tortured sentence there, but thanks. Truly.

          I must say that I am a bit a’feared that the implementation time to reform, assuming this does go through is some form or another, will just be an excuse for AHIP to turn the screws even more viciously on us in the private individual insurance market.

          You see drug companies do this with branded drugs going off patent (or even approaching the patent expiration date.)

          And if you happened to catch the excellent Frontline last night on the credit card industry, credit card issuers are using the 8-9 month window before new regulations kick in to really turn the screws on current debtors, jack up unfair fees, and virtually guarantee a crop of indentured servants–sorry, I mean profit sources–in perpetuity.

          My own insurance, currently at $1711.50 per month as I have mentioned frequently on this blog, is set for renewal in March. Usually there is a transition month where it goes up slightly, followed by the next month where the new amount is made manifest.

          I always start feeling a bit like a pack mule this time of the year, getting ready to be fitted for a new yoke heavier that the current one, which is already breaking my back.

          Okay. Need to breath.

          Need to go back and read your sage counsel over again, and tell myself: it might not get as good as I hope, but it probably won’t get as bad as I fear.

      • Dave Wood said

        James you mention that the so called free market types aka conservatives, would have the richest buying the best money can offer and leaving the rest of us saps with third world health care.

        Note that there are currently two European nations ie. Holland and Switzerland, that indeed have totally private insurance based more choice and more competition systems that are working quite well. The Swiss pay about 80% what we do, and the Dutch about 60% while having almost 100% compliance with the individual mandate. ( one note- Americans will never have anything near 100% compliance with any govt. mandate)the point being that it can be done, and it works quite well over there.

        Alan seems to think the my pessimism is exaggerated, that indeed we are not paying DOUBLE what the Europeans pay per capita, we do not have higher incidence of heart disease, diabetes, infant mortality, obesity, inflammatory diseases like asthma, arthritis, excema, and allergies, and that Obama care is a giant leap forward.

        Is it also false Alan that the states are already spending around 30% of their budgets for health care and they are broke? That the Federal govt. has been totally inept at running Medicare, which just announced through the OMB director that the rate of “BAD PAYMENTS” aka fraud, went up from 10% in 07 to 14% in 08.

        Is it true that 71% of all the currently uninsured children in America currently qualify for some govt health care program, but they don’t sign up, for whatever reason? That is according to a study in the journal Health Affairs.

        Obamacare is a very small step in the right direction. I only pray that single payer will be allowed in Vermont or Oregon in the future, along with the conservatives beloved private based systems.
        Take health care local where it happens, and where it belongs. No more Federal involvement.

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