0 For 2

Friday, May 24, 2013


The Patient Protection and Affordable Care Act (PPACA) was supposed to cure two intractable problems:

  1. Access to Health Care

  2. The Cost of Health Care


  3. Of course, if you have been paying attention, you know that the PPACA has nothing to do with the access to health care or its price. Instead, the law is about the access and pricing of insurance. We were going to eliminate the scourge of 40 million uninsureds and make the premiums more reasonable.

    Today’s post is a quick status report on those two goals.

    * * *


    Nobody wants to be a political football. It is nobody’s goal to be the hot potato. So think what it must be like to be on the Ohio High Risk Pool policy. This is the interim program the federal government created to serve as a bridge until the PPACA becomes fully functional at the end of this year. To qualify you had to have significant medical issues and to have been uninsured for over six months.

    As noted in June 2010, Medical Mutual of Ohio won the contract to administer this underfunded and poorly designed program. Since then we have had the federal government try to change the rules and even attempt to throw some of our unhealthiest Ohioans off the program.

    Access to this bridge was blocked months ago. With funding running out, the program was closed to new enrollees. Today’s news was as inevitable as it was unwelcome. The federal government will take over the Ohio High Risk Pool at the end of next month. As of July 1st all Ohio members will be transferred to the federally run Pre-existing Condition Insurance plan (PCIP). Coverage? Price? Networks? Who knows? All of this information will be officially released sometime in the next five weeks or so.

    If you have a significant heart condition or stage 4 cancer and have relied on the high risk pool this last year, you might be concerned about this change. But don’t worry, as my friend and fellow agent Dave R. noted, “The people that underfunded this are the same people that decide funding for the unaffordable health care act. They refused to give the States the additional funds to keep the program in place for another five months”.

    If we really cared about providing access (insurance) to the unhealthiest amongst us, we would be ready to provide the funds necessary to get the job done. Here’s a hint – it is going to take a lot of cash.

    * * *


    This was an EXCELLENT piece in Time". Which is why nobody read it. Time and its like minded media partners are about as frequently consulted on the news of today as the New York Sun of "Yes, Virginia" fame.


    The above comment was posted by one of my readers, a local librarian. When challenged by other readers, he noted, “Nobody read it. That issue never moved from it's (sic) spot on the shelf until I placed the next unread issue of Time in its place.” I wish he was wrong. I wish dozens of visitors to his branch would have read Steven Brill’s Bitter Pill, Why Medical Bills Are Killing Us, a special edition of Time Magazine before someone had “accidently” taken it home.

    But it didn’t matter.

    Kathleen Sebelius, the Secretary of Health and Human Service (HHS), read and more importantly responded to Brill’s well-researched report. On May 8th Sebelius and the Centers for Medicare and Medicaid Services (CMS) released the actual charges for the 100 most commonly performed inpatient procedures. CMS even admitted that the document dump was in part due to Time.

    Shedding light on the incomprehensible and often indefensible pricing structure of our nation’s hospital was a public service. The national news covered it extensively. Local TV stations and newspapers combed the data for the specific pricing for hospitals in their service areas. Even online publications like the AOL Patch covered this news. Did you read the report? Probably not. Did your Congressman/Congresswoman read it? Maybe. But I will bet that the legislative aides have now read Brill and are now familiar with the term “chargemaster” and what that means to you.

    The links are all here. It is up to you. Do you want to be just another patron at that unnamed library or do you want to know the numbers? Neither Health Care nor Insurance will ever be affordable until we understand and begin to control costs.

    Our two stated goals – access and affordability – remain largely untouched and unsolved. That leaves us, for the moment, 0 for 2.   DAVE   www.bcandb.com