High risk insurance pools: opinions?

My question isn’t intended to be political, but I’m sure someone will take it there because it will potentially be the result of political actions happening now in the Senate and the House.

So, what does everyone think about the “High Risk Pools”? How will this affect you and your care? I’m very concerned about these pools making our care for Liam unaffordable…so far, I’ve not heard great things about them.

We are lucky (now) that my husband’s insurance is employer-sponsored and excellent. They essentially fund their own insurance pool and only contract with Blue Cross for the window dressing so the terms are still very generous and they have enough employees that they can absorb the costs of the people with high insurance costs. So i don’t think it will imminently affect us.

Long-term I think high risk pools have been tested in states and have been demonstrated to not work. I am not sure if there is some way to make them better. Given how happy insurance companies are to kick people off their plans, It’s possible that anyone with any kind of condition (from allergies to acne to cancer) could eventually be lumped into such a pool, in which case they might be a little more expensive than the rest of the pool but maybe not quite as expensive as they could be, when they included fewer people, most of whom who were sicker and genuinely use a lot more care.

I think it’s just too early to say though as so far there seems to be a lot of incompetence and boobery going on in the whole health care debate and it’s not clear anyone there can pass anything. So we shall see. I would call my senators, but I’m pretty sure Nancy Pelosi is not in favor of the Republican efforts anyways. :slight_smile:

The thing is all this uncertainty has definitely influenced our economic decisions already. We for instance are probably not going to buy a house anytime soon, despite having a bunch of money saved up and being crammed into a 2 bedroom where we literally cannot all fit at the dinner table, because the idea of taking on any kind of long-term debt obligations when we may need that pile of cash to care for Samson just weighs heavily on us. We are pretty risk-averse people financially, but I imagine that others who are in similar situations are also making similar tradeoffs.

I am very worried about my son’s well being once he becomes an adult, but I am just hoping they can cure diabetes or at least make it so that it doesn’t require hourly care and routine prescription fills by the time he gets there. So that somehow we can stash up all the supplies he needs for several years in case he is ever unemployed, etc. We have about 20 years.

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I have had experience with MRMIP in California about 9 years ago and was pleasantly surprised with the quality of the plan and how well it worked for my wife and me. Far, far better than anything cooked up by the ACA.

I was 57 at the time so my premiums were on the high side, but the premiums for children and young adults were quite reasonable for such a robust plan.

Philosophically I think that we as diabetics should not expect the lion’s share of our medical expenses be paid by other, healthier people. High Risk pools should allow us to obtain health insurance, but we should not expect to pay what healthy policyholders do. We should expect to pay more.

We are in the same boat as your family… Right now. Hope we are fortunate enough to stay on this place. It just depresses me that our sons are going to be punished, basically, for getting a disease they didn’t ask for… And would love to not have.

I think people with diseases they brought onto themselves by virtue of their own lifestyle choices should be expected to pay more…I don’t believe someone like my three year old, who by no fault of his own, contracted this (or any) disease, should be punished… which is basically what a high risk pool is. :frowning:

But California ACA plans are also MUCH MUCH better than plans in other states, according to nonpartisan sources like Kaiser Family Foundation, so I’m not sure if your past plan would be better than any ACA plan you could have gotten in California at the same age. It’s sort of an impossible experiment to run for yourself personally.

Also, California is a huge state so a high risk pool can be much larger than in, say, Alaska.

I am happy to pay somewhat more for a sick child versus a well one – but I guess I have a fundamental philosophical disagreement when it comes to the how much question. I think good health is so largely a matter of luck and/or other things out of our control that I think no one in this country should have to go hungry, file for bankruptcy, stick in a horrible, awful job, or live in poverty in order to be able to care for their health. I am happy to shoulder at least some of the higher medical expenses of someone like my dad, or someone who has a lot of kids, or someone who was young and healthy and got hit by a car, etc., in exchange for the security of knowing that if it happens to me, I will not have my life completely destroyed.

I also think expecting others to shoulder their own expense actually worsens the overall economy. I know people like us are consuming a lot less (i.e. spending less $$) in other parts of the economy not only to offset these expenses but in anticipation of catastrophic expenses. I imagine many others make similar calculations.


I wish I could express how much I agree with this…Maybe fifty trillion percent may get close.

Acknowledged. That is why I would be in favor of a federally guaranteed high risk pool administered by the individual states. I’m not saying that people with pre-existing conditions should be left out in the cold, but to treat them exactly the same as people who are perfectly healthy is not feasible financially.

As much as you don’t want to pay exorbitant premiums for Samson, I don’t want his friends and his friends parents to pay what would amount to equally exorbitant premiums.

KFF agrees that a minority of patients use the majority of medical services:

The plan to provide seed money for state’s high risk pools and a substantial yearly subsidy as has been proposed is fair to everyone.

No one knows what tomorrow will bring. Sharing costs covers those sick now as will as those who may (will) get sick later. Everyone chopping in a little more for everyone else. This way the healthy and the sick are covered equality when they are both sick or healthy.

These days, It’s often not a question of if… But when… With regards to some disease.

Honestly in our case it is not personal yet. We are very fortunate, we could afford to pay for all of Samson’s routine costs out of pocket if needed (though one catastrophe could bankrupt us). And I’m fine with him paying more – maybe twice as much as an equivalent 2-year-old.
But the differences in all these plans (Republican, Democratic, blah blah), is really just about numbers. How much more is fair? And the reality is that a 55-year-old cancer survivor has a risk that makes them 20 or 30 times more expensive than someone who is 20 years old with no diagnosed health conditions. Samson’s typical care, out of pocket, full-price, is probably $20,000. His brother (who gets a fair number of ear infections) likely racks up about $1,000 in costs over the year. Should Samson pay 20 times as much as Zane? So we have to subsidize some people at the top end of the expenses using funds from people at the bottom. That’s insurance.

Also while I agree that the minority of people use the majority of healthcare costs, I think the numbers also need to be sliced and diced a different way to get a true sense of the fairness. I think some crazy amount like 75% of medical expenses are incurred in the last 6 months of life – and most of us will have those last 6 months at some point. So while yes, there are just a few people guzzling up all the healthcare $$ at any one time, over time, that is all of us.

Where things really need to change is in how we treat people at that end stage – how hospitals are organized, how much care a person can receive at home in a less expensive setting, and other factors like that. Not death panels but just a much better, cheaper version of home care for many folks. It seems like so much of hospitalization is going in the opposite direction though.

@TiaG You bring up an excellent point. Our health care system is so screwed up, including pharma, health insurance, and government intervention, that there are not enough funds to go around.

You saw what happened with ACA, and how fundamentally flawed it was (Maybe not so much in concept as in implementation, thanks to greedy parties in the bill). The only way to right the healthcare ship is to allow the free market to stabilize it. Yes, government will have to participate to a certain extent to be sure nobody is left out. But remember, MRMIP was a private insurance initiative partnered with the state government. So it can work.

Is free market what’s causing epi pens to be sold at $600 when it’s $50 in other countries? Or insulin to be grossely overpriced competitively? Free market to me equates to higher prices due to corporate greed.

IMO, Big Pharma should have its wings clipped (be regulated) as far as much they are able to push up drug prices annually. And if outside a reasonable amount be required to justify that price hike.

But this will never happen as long as big pharma can hire lobbyists to buy off legislators. The whole system is sickening to me…Greed greed greed… It’s never enough.

I do not believe there is such a thing as the “free market” for health care, even if you completely remove any requirements for insurance companies to actually insure people against actual illness. The whole industry is just so heavily regulated, from drug and device approval to hospital architecture to durable medical equipment to medical licensure, that there is no way to dramatically reduce costs by removing insurance regulations unless you also largely remove all the other infrastructure regulating healthcare that has cropped up over a century and a half. That would involve starting from scratch in a way that is simply political pipe dream. Though who knows, maybe the Republicans are putting forward such an unpopular plan in the hopes that it will cause the entire edifice of healthcare to collapse and it will have to be rebuilt from the ground up.

Now I’m the kind of person who would be happy to conduct medical experiments on myself and might conceivably try to manufacture glucagon in my home lab. I feel enough confidence in my own ability to interpret statistical data and set up clinical trials, and I conceptually understand the cost-benefits ratios that go into experimental drugs or procedures that I’d accept personal risk if I took an unapproved drug. But I suspect I’m a bit of a crackpot in this respect. And I am positive that the majority of Americans wouldn’t want to make their own healthcare decisions on such a dramatic scale.

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Actually, no. It’s the sweet deal pharma got from the ACA, the unbelievable hill the FDA requires generics to climb, and general government interference that causes epipens to cost $600. It has nothing to do with, and is anathema to free market principles.

5 Reasons Prescription Drugs are so Expensive

  • Drug manufacturers in the U.S. set their own prices, and that’s not the norm elsewhere in the world. (aka - corporate greed)
  • We allow “government-protected monopolies” for certain drugs, preventing generics from coming to market to reduce prices.
  • The FDA takes a long time to approve generic drugs.
  • Sometimes, state laws and other “well-intentioned” federal policies limit generics’ abilities to keep costs down.
  • Drug prices aren’t really justified by R&D.

Change all this…and we’ll have good pricing on our presriptions.

My family was on a Risk Pool insurance plan in Oregon for almost two years. The insurance was much better than my current employer provided, but was on the high side of costs, although those with less resources than I, were helped by the state. My family and I paid the full price ($1900 per month), but the prescription benefit was unbelievable, no copays on recurring prescriptions, no copays on routine visits and bloodwork, first time you need a copay is when you were at an emergency room. It was actually nice, since you knew exactly how much was coming out of pocket and also had comfort in that unless an emergency happened everything else was covered.

They shut it down as soon as the ACA passed, otherwise we would still have it.

For that amount of out-of-pocket each month, I would HOPE none of that other stuff cost anything! That’s a second mortgage!

$22,812 per year! :: staggers ::

Harold you are right, except this first point is because of the forces of the other three points. Change those other forces and allow free market conditions to prevail and watch drug prices plummet. But if you use the government to control drug prices like they do in other countries then the only thing to plummet will be innovation.

To be honest that is what comprehensive insurance costs, it is just hidden at most workplaces. If you had to pay that, you would be more aware, or choose a plan with a different balance point. If everyone who wanted comprehensive coverage spent that, some important questions would be asked by the consumer.

Also, universal coverage/single payer in this country is a very difficult thing. We constantly get compared to European countries or Canada which both have a much easier use case than the US for how many miles they need to cover. In the US we are so huge, that we would need so many more centers than any of the other systems, that I question if it could be done efficiently. I.e. bureaucratic waste would be magnified many times by how big our system of hospitals that would be needed. Whereas in many European countries they have 5-6 specialty hospitals.

have to quibble that Canada is not so small in size :slight_smile:, though in population, yes!