Jump in the Pool, Make $50

Medical Mutual of Ohio is the official carrier for Ohio's new ObamaPool©, and starting today, the pool is open for business:

"Medical Mutual will begin accepting applications for the Ohio High Risk Pool program, with coverage to be effective for the first enrollees on September 1, 2010."

What's interesting is that they're offering a finder's fee for agents to steer folks into the pool. As an agent, I'm pleased that any efforts I make to encourage folks to take advantage of the program will be rewarded in some way (unlike, say, Cigna). On the other hand, there are a lot of hoops through which to jump, which make the $50 "reward" somewhat questionable; for example, I'll have to confirm an individual's eligibility and help them complete and submit the paperwork (including some onerous documentation). I'll also need to collect and submit my new client's check, as well as my own "Broker Verification" form.

Those seeking to purchase coverage through the ObamaPool© have some hoops of their own, which include (among others):

" ■ Be a citizen or national of the United States or lawfully present in the United States;
■ Be uninsured for six months prior to the date the person applies for coverage;
■ Have a qualifying pre-existing condition as evidenced by a denial of coverage by two insurers, or by documentation from a healthcare provider."

My biggest issue is with the second: why six months? Why not 2 months? Or a year? This is arbitrariness for its own sake. In fact, it seems to me that the shorter the better for those who are uninsured. And isn't that one of the stated goals of ObamaCare©: to insure the uninsured?

Or am I missing something obvious?

I'm also having trouble with one of the alternate qualification requirements:

"Written certification by a licensed physician or nurse practitioner, issued within the past six months, certifying that the individual has a history of or suffers from a qualifying medical or health condition."

On the one hand, the site lists almost 100 different qualifying conditions, from Addison's Disease to Wolff-Parkinson-White Syndrome (no word on Zuska's Disease). And you'll need to bring that list with you to the doc. Which of course begs the question: who pays for that doc visit if you're uninsured?

I think we already know the answer to that.

So you have a very serious illness and need insurance. You've been uninsured for at least half a year, and now you can purchase insurance that can take effect in as little as two weeks' time. But what can you buy, and how much will it cost?

There are two plans available, one with a $1500 annual deductible, the other at $2500. Once that deductible's been met, there's an additional $3000 or $4950 in co-insurance, depending on which deductible you choose. The plans themselves appear to be based on the company's "Elite" plan configuration.

Both options include a $30 co-pay benefit for office visits ($50 for specialists), and a $40 urgent care co-pay. Nice. There's also first-dollar preventive benefits for things like mammograms and immunizations. Hospitalized? No problem, the plan takes care of 80% of your covered expenses after the deductible's met; unless it's an ER visit, for which you'll be dinged a reasonable $200 (which they'll forego if you end up admitted to the hospital).

There's even a prescription drug card benefit, including a break if you choose mail-order (home delivery). Heck it even covers "The Pill." All in all, a very nice plan (although I'll remind readers that, around here, we call that "Phantom Insurance").

And since this is part of ObamaCare©'s effort to reduce the number of uninsured, I'm sure it's a bargain.

Fortunately, the site includes handy rate charts, as well. Let's see how the numbers stack up:

Let's take a typical Columbus area resident, say a 27 year old non-smoker (interestingly, the rates are unisex). Should you opt for the $1500 plan, the monthly premium would be $150 (there's a 25% surcharge for smokers). The $2500 plan would save you $14 a month (or $168/year). Frankly, that's not even close to enough of a rate differential to encourage folks to opt for the higher deductible plan.

But let's compare that rate to those for a "healthy" 27 year old, using MMO's own plan design and rates. In that case, Joe would pay just $96 and Jane $133. But that's not the most interesting part: a 37 year old healthy Joe pays just $130 for the $1500 version, versus over $200 for his very sick twin brother. But a healthy 37 year old Jane pays about $190 a month, while her sickly twin pays just $16 more.

Which is actually a much bigger problem than one might think: according to the benefits recap, "Maternity Services" are covered. "Healthy" Jane would pay an additional $456 per month for this (optional) coverage, and have to wait 9 months for it to become effective. Not so for "sick and pregnant" Jane, whose coverage could be in effect in as little as a fortnight. In fact, "pregnancy (current)" is one of the automatic qualifiers for coverage.

And then it gets interesting:

The website offers a helpful FAQ section, under which we find the following: "What happens to my first payment if I am placed on the waiting list?" Ironically, this section is the first, last and only one to even mention the term "Waiting List." So I called up the helpful folks at MMO, where I confirmed what I'd already inferred: remember that the budget for the whole Ohio version of ObamaPool© is $150 million? You guessed it: when that initial funding is gone, then whoever's left behind has to wait for the next round (if and/or when). How many childbirths are going to chip away at that $150 mil before it's gone?

Your guess is as good as mine.

[Hat Tip: FoIB Beth D]

Throwing a Keystone into the Pool

Like Ohio, Pennsylvania's now opened up their High Risk ObamaPool©. Called the PA Fair Care Plan, it's also built on what looks like an off-the-shelf PPO plan, with a few "tweaks." For example, only generic meds are covered (unless none's available). And, of course:

"Maternity and Newborn Care (31 days): 80% after deductible"

That is, "same as any illness." As we've mentioned before, this is a terribly expensive benefit (and completely inappropriate as an insured expense), and often (generally?) not available in the "regular" individual market without great cost and additional waiting periods. And, of course, pregnancy is one of the eligibility "triggers." As in Ohio, one must be uninsured for the prior 6 months (or longer); unlike Ohio's plan, coverage is not effective almost immediately:

"On average, it takes four to six weeks for an application to be processed after we receive your 1st monthly premium payment."

That's helpful to the extent that Pennsylvania's $160 million ObamaPool© funding may not run out quite as quickly as Ohio's. And speaking of funding, it's interesting to note that the premium is "about $283.00" per month. So is that a good deal, or a bad one? Depends on one's perspective, doesn't it?

One must provide either proof that one has been denied coverage (or offered coverage with one or more exclusions) or a letter from one's physician "stating that [one has] an existing medical condition that may result in denial of creditable coverage by a health insurance company." The Pennsylvania list of acceptable medical conditions is actually two-and-a-half times as long as Ohio's.

Medical Mutual is the insurer of choice for Ohio's Pool; Pennsylvania has selected its Blue Cross carrier, Highmark. One wonders who lost that particular bet.

In the event, all of these plans are due to "sunset" at the end of 2013; the so-called "Exchanges" are due to come on-line the first of January, 2014. We all await with bated breath.

[Hat Tip: FoIB Bob D]

Punishing the Good Guys

[Caution: long rant ahead]

Last week, a good friend and colleague called to ask for help on what had become a rather complicated case. His clients, a husband and wife, were about to lose their health insurance - through no fault of their own - and had asked him for help. While he dabbles in this area, he's really a (very, very good) P&C guy, and turned to me for advice.

Bill and Mary are in their sixties (he's 68, she's 61). Bill was recently (May 3rd) laid off from his long-time job, in anticipation of the company closing its doors. He'd received his COBRA election info, but was unsure of his next step. He called my friend, who then called me.

Bill's going to be okay: he can (and will) pick up a Medicare Supplement plan, as well as his Part D coverage, on the "open market."

But Mary has a problem: after a thorough pre-screen, we've determined that she's uninsurable.

You're probably thinking "okay, Henry, what's the big deal? They've got the COBRA info, she'll just glom onto that."

Would that it were so simple:

In its infinite wisdom, the CongressCritters who drafted the Consolidated Omnibus Budget Reconciliation Act made it very clear that COBRA was a continuation of one's existing group coverage. Implicit in that definition is a major problem: if there's no group, then there's no continuation of that coverage, and so there's no insurance.

Period.

Which leaves Mary with very few, mostly sub-optimal [ed: why not just say "crappy?"] choices:

■ Open enrollment with a local HMO (with a very high premium and some major limitations)
■ Applying - and being declined - for coverage (which gets her on a state-mandated Guaranteed Issue plan)
■ A conversion plan (very expensive, verry crappy)
■ The new ObamaPool©

None of these are really great choices, but it's that last one that has me seething:

The ObamaPool© plan has decent benefits, reasonably decent rates, is Guaranteed Issue, and will cover her (numerous) pre-existing conditions.

There's just one catch:

She'll have to be uninsured for (at least) six months before she's eligible.

That's correct: she and Bill have played by the rules, staying insured even when times were tough, and she can't access the same coverage that her no-goodnik neighbor - who's never bothered to buy insurance, even though she could well afford it - is free to waltz in this afternoon and buy with basically a signature and a (smallish) check.

This is outrageous. Unconscionable. Immoral.

We are punishing people for playing by the rules, for being responsible, productive citizens, for taking personal responsibility This isn't about politics, it's about something far more important: justice.

The ObamaPool©: Rest Period!

It's important to remember that, when we "passed the bill to read what's in it," we were told that some 4 million people would be jumping into the state-run ObamaPools©.

Would that it were so.

Talk about underselling:

"Barely a dozen Mainers have signed up for an insurance plan that covers pre-existing conditions, which has been available in the state for nearly a year."

Remember, this is highly subsidized coverage, which includes pre-existing conditions including maternity, at reasonable rates and no underwriting or exclusions for pre-existing conditions.

The underwhelming result?

"[O]nly 14 people have subscribed to the plan"

That's out of a total population of over 1.3 million people. If we take the (debunked) figure of (say) 15% uninsured, then we're talking about a potential client base of almost 200,000 people, of which a grand total of a baker's dozen + 1 have availed themselves.

Or, as the gummint might say, "success!"

Old Dog, New Trick: Apologia

Years ago, Saturday Night Live featured a funny sketch called "Common Knowledge," the point of which was to show that a lot of what we think we know is, in fact, wrong. This past summer, in one of my posts about Ohio's new ObamaPool©, I inadvertently mis-characterized how renewal rates are calculated in the individual market. I said:

"by law, carriers can't single out individual insureds for rate increases"

Turns out, there is no such law; the relevant section of the Ohio Revised Code (ORC) is silent as to this issue. This discrepancy was pointed out to me by the reporter who wrote the story on which that post was based, Ms Carrie Ghose; she emailed me yesterday to challenge my claim regarding renewals. After poring over the ORC (and checking with other sources), I found, to my dismay, that there is no such provision. I've updated the original post with this information, but in fairness to Ms Ghose, I wanted to make sure that our readers know the facts regarding renewal rates in the Ohio individual medical market.

About that "You can Keep your Current Insurance" Promise

Yeah, well, not so much:

As with so much of ObamaCare©, this one's going under the bus, as well. Recently, I pointed out that savvy folks will avoid buying major medical insurance altogether, opting instead for the much less expensive "penalty" (i.e. "tax"), secure in the knowledge that they can easily pick up coverage later. As Bob points out, though, these folks need to be aware that the ObamaPool may not be open to them at that time (or it may be, who knows). Regardless, Corporate America has already reached the same conclusion:

"The president didn't have to actually strong-arm companies into dumping their employee health insurance because his bill carried financial incentives to virtually guarantee that result ... like AT&T found out, paying $600 million in penalties will allow you to stop paying $2.4 billion for insurance."

Quite so. It seems to me that this is likely by design: what quicker way could there be to a so-called "Single Payer" (i.e. Government-run) system?

Maybe it's just TPC (The Phone Companies), because Verizon has also seen the light:

"To avoid additional costs and regulations, employers may consider exiting the employer health market and send employees" to state-run insurance exchanges."

Indeed.

[Hat Tip: PowerLine]

On the Oregon Trail

FoIB Holly R forwarded the link to this story, about which I can only ask "on what planet is Hannah Wallace living?" It is so full of inconsistencies and outright misinformation, one wonders how The Onion could possibly do better.

Let's start at the beginning, shall we?

"For a writer living in New York state, there were plenty of reasonably priced plans"

Really? The actual numbers tell a different story.

Ms Wallace continues apace:

"That’s largely because in Oregon, “medical underwriting”—during which insurance companies cherry-pick healthier customers ... it’s one of five states with so-called “guaranteed-issue” laws that mandate insurance companies cover anybody regardless of health status."

(See above)

“The last thing we want to be doing as a state is hampering that sector with high insurance costs. It’s exactly the wrong way to stimulate the economy ... Yet this is precisely what Oregon is doing by not providing affordable health insurance options."

We've written about Oregon's insurance situation before; they have a very effective (if lethal) way of dealing with increased health care costs (which, of course, drive health insurance costs).

But wait, there's more!

"The only plan I can find here that would cover my pre-existing condition costs more than half my rent"

This is another of those little "throwaway" canards that's never made any sense to me: what does one's rent have to do with one's insurance? If Ms Wallace lived with her parents, then her insurance would be infinitely higher than her rent, yet that is no more meaningless (or meaningful) than her comparison.

She continues:

"I don’t want just so I don’t become one of the 51 million Americans who are uninsured."

And again with the oft-debunked number of uninsured (anyone else notice how that number keeps growing, despite the advent of wonderful ObamaCare©?). It's a bogus number to begin with; that it keeps growing is itself a wonder.

Are we done yet? Of course not:

“What really needs to happen for you is that it needs to be 2014 ... when the new Patient Protection and Affordable Care Act ... will eventually force insurance companies to cover everyone, pre-existing conditions or not. They have had to cover sick children since September; adults, however, have to wait until January 1, 2014—three long years away."

Except they haven't; healthy kids hardest hit. And if you want to see what's in store for '14, you need look no farther than the current ObamaPool© programs. These are guaranteed issue plans which cover all pre-existing conditions (sound familiar, Hannah?), yet their reception has been, well, underwhelming. Why would any rational person believe that's going to change in 3 years?

Bu the very best (well, funniest) line comes near the end:

"For freelancers ... Massachusetts is mecca"

Oh, absolutely, it's just been so successful! If that's Mecca, then one shudders to think what Armageddon looks like.

Deadlines, Shmeadlines [UPDATED!]

Have you seen the specs for the new ObamaPool(s)?

No?

Well, don't feel bad: neither has anyone else, despite the fact that they're required to be up and running in less than a month.

What's that?

You need health care, and you were told you'd have it "any day now?"

You mean like no exclusions for pre-existing conditions for folks under 19? Sorry, but that doesn't really take effect right away.

What about that pesky lifetime limit on expenses? Certainly that's going "live" in September, right? Nope. Sorry!

Well, of course the rules on "Arbitrary Rescissions of Insurance Coverage" (which are really no different than those currently in effect in all 57 states) will become "the law of the land" come September 23rd, right? Um, how do I tell you this? In a word: No.

The little-known fact is that all these rules (and a few more besides) don't actually take effect on September 23rd. As healthcare giant Cigna reminds us via email:

"All provisions are effective on the first plan anniversary on or after 9/23/2010" [emphasis added]

But I thought "People are dying, we have to pass something - anything - right now!"

Ahem.

BREAKING: Thanks to FoIB Rick B, we've just learned that the State of Ohio "plans to designate Medical Mutual of Ohio as the non-profit entity that will operate the temporary high risk pool program for Ohioans, as created through the federal Patient Protection and Affordable Care Act, in order to provide uninsured people with pre-existing conditions the opportunity to purchase more affordable health insurance."

They'll have about $150 million top play with [ed: look for that to be gone toot-sweet]; no word yet on benefits or premium structure.

They do provide this handy number for Bereft Buckeyes to call: 1-800-686-1526, and have set up a handy website, as well.

Congratulations to Medical Mutual!

[ed: or is that condolences? Time will tell]

Punishing the Good Guys: An Update

About a month ago, we reported on the travails of Bill and Mary, two hard-working folks who played by the rules and, as a result of circumstances beyond their control, were punished for doing so. Specifically, Mary is not eligible to take a dip in the Ohio ObamaPool© because she was recently insured. She was left with few options, none of them particularly appealing.

Recently, Bill learned about an "exciting new insurance" product that promised to cover Mary's health woes. But he had to act quickly (within 24 hours!) because "open enrollment" for this plan ended the next day ("the 17th!").

First, no legitimate insurance carrier ends "open enrollment" on anything other than the end of a given month. Second, any kind of "deal" is going to be a deal the day after tomorrow, too, else it's not really "a deal" at all. My colleague knew this when Bill came to him for advice, and was promptly referred back to me to confirm that this wasn't what it appeared to be. I'll give Bill credit: he did call me, and listened as I explained all the tell-tale signs of a rip-off.

And, of course, our words fell on deaf ears.

And why shouldn't they have? What, after all, did we offer as an alternative? What safety nets existed to help Mary? As my colleague mused, "of course he was grasping at straws, we can't give him a drink."

Indeed.

Here's a first: Fire Sale on Health Insurance

Last we checked, the goofy ObamaPool© program had few takers, and the new numbers aren't encouraging; only "about 18,000 people nationwide have enrolled in the plan over the past year."

Keep in mind, the Congressional Budget Office had estimated that something like 4 million Americans would qualify for the program. That's a response rate of less than one-half of one percent.

Ouch.

So the program's a bust, even though it offers immediate coverage for pre-existing conditions (even maternity!) at extremely competitive rates. A normal, profit-driven insurer would take stock, examine the marketplace, and immediately close it down.

But this is ObamaCare©, so the gummint's response would be?

Of course:

"The federal government said Tuesday that it will slash premiums by 40 percent to entice more Arizonans to join a high-risk insurance plan for people with pre-existing medical conditions." [emphasis added]

Rest assured, the Grand Canyon State won't be the only one to reap the benefits; with the $5 billion initial seed money already on the table, the other 56 states won't be far behind in demanding their fair share of the premium reduction bonanza.

The good news, such as it is, is the the Federales may be onto something with this wrinkle:

"In addition to reducing premiums and making it easier for people to enroll, the federal government will expand its outreach to the business community ... Sayen said Medicare officials this fall plan to reach out to insurance brokers ... to reach more potential customers."

Gee, where have we heard this idea before?

The catch?

"He said it is too early to tell what type of commission may be available to insurance brokers."

More rocket-surgery from Washington.

ObamaCare©: Another Victim's Tale

As previously noted (here and here), very few weeks go by without at least one of us having to help a client deal with the consequences of ObamaCare©. This time, it's an old friend of mine whose family is quickly exhausting their COBRA coverage, and who need to find a place to land once it's gone later this summer.

Fred and Ethel are in their early 50's, and both have health issues serious enough to earn them declines in the open market. Their 13 year old daughter, in perfectly good health, is ineligible for her own plan because neither Mom nor Dad are insurable.

Or is she?

Bob recently pointed out two potential plans that might work: the first is a Short Term Medical, the other is a quasi-limited benefit plan. Both are from the same carrier, which has apparently decided that it will continue to offer child-only plans in these configurations.

So what's my beef?

First, the Short Term Medical plan is, well, only good for a short term (6 months at a time, to a maximum of two years in Ohio). And, it excludes coverage for pre-existing conditions (including those that develop during a previous STM's term). On the other hand, it's inexpensive and it does provide some coverage.

The other plan, which we'll call HA, may cover pre-existing conditions (depending on whether they were disclosed and underwritten), and doesn't have a built-in time limit. It's basically a limited benefit plan with some additional bells and whistles. It, too, is relatively inexpensive.

Fred and Ethel, though, are basically SOL: once COBRA runs out, their only real option is a (so-called) HIPAA Plan. This is expensive, mediocre coverage, but it does cover pre-existing conditions. Another option might have been the richer benefits and lower premiums of the ObamaPool©, but they're ineligible for that because they actually played by the rules and made the responsible decision to remain insured.

Oh, Brave New System.

The Sad (Real) Faces of ObamaCare©

Yesterday, I had to turn away two prospective insureds. That's happened before ObamaCare© was a gleam in Ol' Nancy's eyes, but it was particularly troublesome because there are fewer choices now on which these folks can "land."

Let me explain:

Steve is a 45 year old gentleman who was laid off from his job last month. He's eligible for COBRA, but his means are (obviously) more limited, and the cost is prohibitive. With ARRA subsidies gone, he's stuck. Compounding his troubles is the fact that he's way to short for his weight, and has a number of other health issues. In fact, but for one "glitch," he'd be a prime candidate for the ObamaPool©.

Unfortunately, he's been insured within the past half-year, so he's outta luck, and outta the 'Pool©.

Then there's Tonya, a young lady in her late 20's, a single mom with a healthy five year old. Her employer offers a very nice group insurance plan, which just experienced a 35%+ rate increase, much (most?) of which comes courtesy of ObamaCare©. She'd like to jump off, but she has a number of problems.

No, her height and weight are within normal guidelines, but she's a Type I diabetic, and therefore uninsurable in the "regular" market. The 'Pool© might be a great option for her, but - you guessed it - no can do. Adding insult to injury, she can't do what we used to do: peel Junior off the group plan and put him on his own, much less expensive, policy. It's really a nasty trick, because even though we could write Junior on a plan with Mom, if Mom doesn't qualify (and she doesn't), Junior's not eligible. Then again, it's doubtful now that they'd save any money if they could get him his own plan.

I guess now that we're seeing what's in the bill....

Some reflections on the "Pool" [UPDATED]

[Please scroll down for update]

I've been giving more thought to the whole process of the new Ohio ObamaPool©, and have come to two conclusions (thus far):

There are some rather stringent requirements put on me as an agent (see below), a relatively meager "finders fee" associated with steering folks to the Pool, and the likelihood that this will be a fairly labor-intensive process. So, I've decided to charge a non-refundable $50 retainer, upfront, before I will answer any questions about the Pool or help folks through the process of accessing it. As this is a "non-commissionable" product, I feel justified in doing so.

And what's so "labor intensive" about it? Well, consider that, in order to "sell" one of these, I need to complete and submit a special Broker Verification Form with each "application," and that this will require some fairly heavy pre-screening on my own part. And there's this rather daunting verbiage to which I am required to attest:

"I certify that I understand the eligibility, enrollment and anti-dumping requirements required by Section 1101 of [ObamaCare©] and I have explained these requirements to the applicant ... and that the enclosed application is complete and meets these requirements."

Okay, that seems pretty straightforward, but, as FoIB Rick B wondered:

"[O]ut of curiosity, as an agent, if a pregnant woman came to you and knew the high-risk pool would allow her to get immediate coverage. Assume she already has coverage, but her plan excludes maternity, how would you advise her?"

Under "normal" circumstances, it's up to the applicant/insured to prove prior coverage (via a Certificate of Creditable Coverage). It seems to me, then, that the carrier acknowledges that it has no way to independently verify prior cover. So, if someone comes to the new Pool, and is otherwise eligible (denied or waivered, pregnant, etc), how would Medical Mutual (MMO) prove that this individual had previous coverage (assuming it wasn't with MMO)?

For example: Sally is insured with Humana under an individual plan with no maternity coverage. She's now 3 months pregnant. Why not submit an app for the Pool, mark "no" for prior insurance, and have immediate cover for the pregnancy? Marking "no" means that MMO would have to prove a negative; i.e. how would they be able to prove she DID have coverage? And if I was not her agent for the Humana plan, how would I be any the wiser?

One answer might be for MMO or HHS Secretary Shecantbeserious to contact Sally's doctor. But if she's preggers, especially early on, why not just switch doc's? At $5000 or $6000 (or more!) for the claim, there's a pretty powerful incentive to be "creative."

Comments?

UPDATE [8-19-10]: A colleague with whom I was discussing this pointed out - correctly, I think - that in this instance Sally isn't really lying when she answers "no" to prior coverage. After all, her Humana plan does not cover her for maternity; therefore she is, technically, uninsured.

That's what "is" means, right?

ObamaCare© Dreamin': I've got some questions

Currently, and since the advent of HIPAA, I can go from a group plan to another group plan, or an individual plan to a group plan, on a guaranteed issue basis, and any pre-existing conditions will be covered immediately.

[ed: Yes, there are a variety of hoops through which to jump, but assume those for sake of discussion]

In order to accomplish this, I need but a simple piece of paper, called a Certificate of Creditable Coverage, which "proves" that I've been covered for (at least) the previous 12 months. Absent this Cert, my new employer's carrier can delay covering any pre-existing conditions for a while.

Yes, yes, Henry. What's your point?

Well, as long as I have that little piece of paper, I can prove prior coverage, which is the point of the exercise, and demonstrates that one can, in fact, prove a positive.

But can one prove a negative?

Implicit in the PCIP (ObamaPool©) program is the applicant's assertion that he has not been insured during the previous six months. Which leads us to Question #1:

How does the Pool's© lifeguard prove that I did?

Follow up question: by what mechanism is the new carrier allowed to investigate the veracity of my claim?

Next, we turn our attention to the problem of the child; that is, the fact that one can no longer buy a child-only policy. Carriers which have gone this route (and I'm aware of none that haven't) generally allow a child to be covered if at least one of his parents is also on the policy. Which brings us to Question #2:

What happens when Mom and Junior apply and are issued a policy, and a month later Mom drops coverage on herself?

Follow-up question: by what mechanism would the carrier be allowed to then cancel coverage on Junior?

Well?

Speaking of Pools (ObamaPools©, that is)

Why, you might ask, are we spending so much time on the so-called "high risk pools" for folks who've had difficulty obtaining insurance on their own? The reason is quite simple: the pools are exemplars of how ObamaCare© will ultimately work (or not work). The premise was that there are millions upon millions of people who couldn't qualify for and/or afford health insurance on the open market because the evil, greedy, incompetent insurance companies were being difficult.

So what's the solution?

A government-instituted plan that is every bit as difficult to obtain, and likely even more expensive than that which it's ostensibly to replace. You may wonder, how can I say this with a straight face?

Easily.

This morning's email brought a missive from Medical Mutual of Ohio, the insurer tasked with implementing the Buckeye State's new ObamaPool©. Here are the requirements for eligibility:

■ Be a citizen or national of the U.S. or lawfully present in the U.S. (documentation will be required) [Really? Have we moved to Arizona now?]

■ Be uninsured for six months prior to application date. [Hence: folks who will now drop their current coverage in order to jump in the pool]

■ Be ineligible for coverage under the federal Medicare program, Medicaid program, [SCHIP] or an employer-sponsored group health plan, unless the individual is subject to a mandatory initial waiting period. [Essentially expanding the Medicaid rolls]

■ Have a qualifying pre-existing condition as evidenced by a denial of coverage by two insurers or by documentation from a health professional. [More hoops through which to jump]

I'll just pick on that last item: in order to qualify, one must now apply to, and be denied by, two separate carriers. Imagine now that hundreds, perhaps thousands of new applications begin flooding the carriers still in the Ohio market which are being sent in specifically to be denied. Carriers, already short-staffed, will have to give these the same attention as legitimate applications, thereby holding up coverage for folks who actually applied in good faith. How many of these will grow disgusted and throw in the towel? And would that be considered by ObamaCare© proponents as a bug or a feature?

Perhaps they'll go the alternate route, and now hundreds, perhaps thousands of new patients will be flooding doctor's offices specifically to determine whether or not hey have a qualifying medical condition. What kind of strain is that going to put on an already shrinking provider population? And who's going to pay for that?

This is a microcosm of how ill-conceived ObamaCare© really is. But remember, we had to "pass it to learn what's in it."

Wolverines jump in the pool [UPDATED]

[Please scroll down for update]

"Michigan is set to launch a subsidized insurance pool for people who haven't been able to get coverage because of a pre-existing health condition, but it's not clear if the program will be big enough to handle everyone who wants to buy in."

Really?

"[B]ig enough to handle everyone who wants to buy in[?]"

One supposes that they honestly believe that they'll attract more than, say, New Jersey, but I'm not convinced. In order to be eligible, ObamaCare© requires that one be uninsured for at least six months, and (of course) be "uninsurable." In the event, the Grand Opening is tomorrow (August 31st), and officials estimate that there are some 3,500 Michiganders [ed: Michiganders?] who may qualify. As with Pennsylvania, coverage doesn't begin immediately; the earliest available effective date is October 1st.

Michigan has been given some $140 million as seed money for their version of the ObamaPool©, which tracks with Pennsylvania's $160 and Ohio's $150 million. They're also counting on folks ponying up anywhere from $200 to $700 a month in premiums (which are age- but not sex-rated). And of course it's a typical, generic co-pay plan (aka Phantom Insurance), which will increase utilization and, hence, costs. How much different (read: better) such plans would work if they were built on an HSA high deductible chassis. But we can't have that pesky personal responsibility component, can we?

There is, however, some good news: this plan, unlike some others, does not count a current pregnancy as a qualifying pre-existing condition (I confirmed this with the folks running the program). That should help delay the inevitable financial melt-down.

On the other hand, though, is this world-class non-sequitor:

"Plan administrators say the coverage will be more comprehensive and in many cases less expensive than typical Michigan policies for individuals."

Hunh?! More coverage at lower rates? Guess who pays for that?

But it gets better (or worse, depending on one's perspective):

"Many of those who will be in the plan aren't able to get commercial coverage at any price because they're so expensive to insure."

Let's see if I follow this: "more" coverage at "lower prices" for folks who can't get health insurance in the open (competitive) market because they're too "expensive" to insure.

Only in Lansing (or DC) could someone say that with a straight face.

[Hat Tip: FoIB Holly R]

[UPDATE]: While we've had our issues with Best's insurance ratings services in the past, they're still the "go-to" folks when trying ascertain a carrier's financial outlook. And based on Best's analysis, one has to wonder what the rocket surgeons in Lansing were smoking when they awarded this little plum:

"[Physicians Health Plan of Mid-Michigan]

Financial Strength Ratings
Rating: NR-5 (Not Formally Followed)
Outlook: Not Applicable
Action: Affirmed
Effective Date: May 21, 2010"

A rating of "NR-5" means that this carrier isn't even on Best's radar. Does this mean that the company's on the rocks? Of course not, but it does give one pause: after all, a carrier's financial ability is only as good as its underlying strength.

Or apparent lack of thereof.