One of President Obama's main selling points for pushing for the biggest overhaul of the U.S. health care system in decades was that it would end the insurance companies' odious practice of denying people medical coverage because of their preexisting medical conditions. One recently released study questions whether the government is adequately funding a temporary fix to the problem.
Patients with preexisting medical conditions who have lacked insurance for six months would be placed in high-risk insurance pools until broader reforms take effect in January 2014 under The Patient Protection and Affordable Care Act. According to the National Institute of Health Care Reform, the $5 billion allocated to fund the program over four years will only cover as few as 200,000 people a year. The pools are set to open July 1. Thirty five states operate their own programs.
"It is likely that policymakers at both the federal and state level will have to choose between two basic courses. They can simply open the doors to programs that are more generous than most current state pools and allow the programs to reach capacity," writes Mark Merlis, a health policy consultant, in a report released by the think tank, which is funded by automakers and their unions. "Or they can look for ways to limit entry to the program to those most in need and/or to stretch the dollars to serve more people."
The U.S. Department of Health and Human Services disputes Merlis' findings, spokeswoman Jessica Santillo told The New York Times. The Times said the government "questioned the study's assumptions about how many people would be eligible for risk pools, and the cost of covering them." Disputes over assumptions in health care estimates are common and seemingly endless.
According to Ron Pollack, executive director of Families USA, there are about 57.2 million people with a "diagnosed preexisting condition" and experts are unsure how many of them are eligible to participate in high-risk pools.
"It's hard to say how many people are going to apply for the risk pools," Pollack says in an interview, adding that an imperfect solution to the problem is preferable to the current situation. "This big problem has existed for a long time ... [now] it is going to be a problem of the past."
As the Times notes, the federal pool premiums will be cheaper than the state programs, which are unaffordable for many patients. The health care reform also does not take into account whether someone without insurance for six months chose not to buy coverage, according to Merlis.
Though the health care reform law is deeply flawed, getting rid of "preexisting conditions" is a worthy goal. They have long been the bane of health care experts and patients. After health care reform was passed, insurers said they have long wanted to make the practice a "thing of the past."
Ridding the health care system of this practice may be more costly and time consuming than expected.
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