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Standing in the gap: Health care reform may come too late for some

All focus has shifted in the health care debate from whether there will be reform at all to whether the final version will contain a strong, robust, affordable public option. This is a good debate to have. I’ve weighed in with opinions on why I believe the public option is essential to any reform package, and why I believe the current buzz about allowing states to opt out of a public option is a bad idea. But the public option should not be the sole focus of the discussion in the weeks going forward.

No matter what passes, most health care reform provisions will not be effective until the year 2013. That’s the first year exchanges are available and the first year insurers will be banned from excluding anyone on the basis of pre-existing conditions. The only key provision to take effect immediately will be a ban on policy rescission. The delayed effective date is necessary to give everyone — insurers, employers, and individuals — time to understand their obligations under the new law and implement required changes.

That’s all fine and well if you’re employed, and your employer is large enough to provide a decent choice of plans and coverage. But in an economic recession where the ranks of the unemployed have swelled to epic proportions, there is a large and growing group of uninsured individuals who do not have access to even minimum levels of coverage right now. Among them, those of us belonging to the ‘baby boom’ generation who still have dependent children, might have dependent parents, don’t have jobs, and are 10-16 years away from Medicare eligibility.

President Obama’s September 9th speech to the Joint Session of Congress held this promise:

This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can’t get insurance today because they have preexisting medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill.

I have been privileged to participate in several telephone calls with Representatives and Senators working on health care reform, thanks to BlogHer and the Sunlight Foundation. In each phone call where I have been able to ask a question, I’ve asked the same one: What proposals are on the table to help those of us who are currently uninsured and have pre-existing conditions or dependents with pre-existing conditions? So far, I’ve asked Rep. George Miller and Senator Jeff Merkley on the phone and Nancy Pelosi via an invitation to post questions on Blogher’s facebook wall.

Rep. Miller’s office went above and beyond, getting a staffer to look into the question and letting me know that a Medicare buy-in was unlikely because they were concerned about getting more of the younger uninsureds covered, too and didn’t see a Medicare expansion/buy-in as offering wide enough coverage. The answer at that time was some sort of national ‘high-risk pool’.

Nancy Pelosi hasn’t responded to my written question yet, but I expect her reply this week. Senator Merkley was a bit more encouraging, but really wasn’t sure what form the ‘bridge coverage’ would take either. He questioned whether delayed effective dates made sense for states who already had the mechanisms in place to get some reforms up and running before 2013.

In other words, they know it’s an issue but haven’t come near a solution yet.

In the meantime, those of us who are self-employed or have been unfortunate to have lost jobs in the last year are caught in a vortex of no-win choices. COBRA costs are unsustainable for people who have lost their jobs. Small businesses and self-employed people cannot afford the ballooning premium increases.

At the same time, not having insurance means paying retail prices for everything. While an insurance company might pay $600 for a routine colonoscopy, our bills exceeded $4,000.00. While prescription medications might be negotiated at a discounted price, we are charged the full retail price unless we’re lucky enough to get a state-sponsored discount.

We can’t wait until 2013, and the problem with the proposed bridges is that they are intended to cover the uninsurable. I haven’t yet heard about any thought toward simply offering an affordable option to the uninsured.

Assuming reform passes, far too many of us will still be left in deep limbo. We can’t afford to be insured; we can’t afford not to be. If Congress doesn’t come up with some kind of solution for those of us who are ‘aging out’ of the workforce (yes, employers are not entirely in love with hiring people over age 50 because we’re expensive on the health care spectrum), this reform will represent very little reform at all.

To me, the best of all worlds is to create a high-risk pool for uninsurable Americans under age 50. For those over age 50, allow a Medicare buy-in at an actuarially determined amount that brings some positive cash flow into the system while giving those of us without any insurance peace of mind. Make it a one-time grandfather provision for anyone age 50 and over without insurance between now and 2013. After 2013, shift to the public option if necessary. Or not.

I would pay twice the ordinary Medicare premium for the right to opt in right now. It would also enable us to find coverage for healthy Ms. Dancer, and allow Sticks to enter a high-risk pool or look for employment with a company that offers health insurance.

What I cannot imagine? Holding on for 4 more years without any insurance whatsoever. That’s not change; it’s the status quo.

Cross-posted to US Health Crisis

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