High Risk Insurance Pools Begin This Week

By John Ballard

Another feature of the Affordable Care Act begins Tuesday as high-risk insurance pools are formed with federal support.

IF you have any kind of chronic medical condition and you�ve been shopping for health insurance, you know how insanely difficult it is to find an insurer that will cover you at all, let alone at an affordable rate.

For some people, relief may be on the way starting July 1. That is the day when the federal government will start paying for new insurance programs aimed at providing relatively affordable coverage for uninsured people with pre-existing conditions.

Under the new health care law, the government has earmarked $5 billion for states to set up high-risk pools, as the programs are called, for people who have been uninsured for six months or longer. The pools are to provide a bridge for people most in need of coverage until the insurance exchanges begin operating in 2014. The pools will have no restrictions based on pre-existing conditions; coverage starts immediately and comes with no annual or lifetime limits. Deductibles and co-payments will be kept low.

�

Under the new law, each state can decide whether it wants to run the new high-risk pool or have the federal government run the program instead. At last count, about 30 states have opted to run their own programs.

Those states have filed a proposal with the government outlining a list of pre-existing conditions that will help define who is eligible for each pool. Many states already have high-risk pools that provide an infrastructure; nevertheless, the existing risk pools will be run independently of the new ones.

Most states are waiting for approval of these guidelines from the federal Department of Health and Human Services, which is administering most of the health law changes.

About 18 states have opted for the federal government to run the high-risk programs instead. The department has not yet provided details about how these pools will work.

My guess is that few readers of this blog, if any, will be affected. Followup details are at the link. The main reason for my posting is that the timing corresponds with yet another GOP effort to torpedo health care reform by opposing the nomination of Dr. Berwick to head CMS.

There is a range of reasons that states may decide not to participate in the national pool, but I'm certain that the list includes more than a few GOP-controlled states which will do anything necessary to prevent this important measure from being successful. I already know without looking that most elected representatives from my own state will be among the opposition. I'm more embarrassed now being from Georgia than when Lester Maddox became governor. 

Dr. Berwick is clean as a pin, the perfect candidate to head CMS. He has the enthusiastic support of all the right professionals. But for political reasons his nomination will be another opportunity for continued partisan carping and misrepresentation to pollute the broadcast and print media coming out of Washington. I will be watching C-SPAN closely to see if anyone uses both hands to drink from water glasses during Congressional hearings. It will be an indication that the slime in the room is so thick that drinking with one hand might risk spilling. (And Lord knows we don't need any more spills.)

When the NY Times prints a hit piece we can be sure the fight will be serious.

President Obama�s nominee to run Medicare and Medicaid, Dr. Donald M. Berwick, is a man with a mission, a preacher and a teacher who has been showing hospitals how they can save lives and money by zealously adhering to clinical protocols for the treatment of patients.

Hospital executives who have worked with Dr. Berwick describe him as a visionary, inspiring leader.

But a battle has erupted over his nomination, suggesting that Dr. Berwick faces a long uphill struggle to win Senate confirmation.

Republicans are using the nomination to revive their arguments against the new health care law, which they see as a potent issue in this fall�s elections, and Dr. Berwick has given them plenty of ammunition.

In two decades as a professor of health policy and as a prolific writer, he has spoken of the need to ration health care and cap spending and has confessed to a love affair with the British health care system. He has made numerous public appearances to talk about health care and has published a book of his speeches on the topic.

Mr. Obama nominated Dr. Berwick on April 19 to be administrator of the Centers for Medicare and Medicaid Services, the largest purchaser of health care in the United States. The post has been vacant since October 2006, and the need to fill it has become more pressing with passage of the new law. The agency must write and enforce dozens of regulations to expand Medicaid, trim Medicare and test new ways to deliver care.

In the short space of a thousand words the writer successfully includes no less than twenty references that I would call "bloody shirt words or phrases" -- words like rationing (7 times), death panels, love of the British NHS, revolution, ammunition, uphill struggle, or calling the current system stupid.  Of thirty paragraphs such negative language appears over twenty times. And this appears in the New York Times!

Past posts about Dr. Berwick are long ago on record, and professional endorsements continue to pour in. This is from the American Hospital Association (pdf) to the Senate HELP (Health, Education, Labor and Pensions) Committee. 

Dr. Berwick has dedicated his career to improving the quality and safety of our nation�s health care system, and
will bring a wealth of knowledge and practical experience to CMS from his perspective as a physician, teacher and
passionate advocate for high-quality care.

A founder of the Institute for Healthcare Improvement (IHI), he has worked tirelessly toward improving outcomes
for patients, achieving dramatic advances in quality, patient safety and performance improvement. IHI�s
innovative, collaborative approaches�which involve bringing together all members of the health care delivery
team�have produced real breakthroughs in efforts to disseminate best practices and train health care professionals.
His leadership has led to concrete improvements in efforts to reduce health care-associated infections and increase
care coordination�yielding positive results for patients across the nation.

He also has served as an elected member of the Institute of Medicine and as chair of the National Advisory Council
of the Agency for Healthcare Research and Quality.

Dr. Berwick is a trusted and respected voice within the health care community. His knowledge of our health care
delivery system and how it is influenced by the multiple forces of regulation, payment, transparency and public
policy make him well-qualified to implement provisions in the recently enacted health reform law. Dr. Berwick�s
experiences from his lifelong quest to find better and safer ways to deliver care will greatly inform and enhance the
implementation health care reform.

Most of the smart people still seem to be in agreement that Dr. Berwick's nomination is not in trouble. But we can expect to see plenty of suggestive, if not outright nasty language in the coming days and weeks as those who want more than anything for health care reform to look like a failure.