Better late...

[Welcome Kaiser Network readers!]

I bookmarked this a week or so ago, but just now had an opportunity to blog on it. The North Carolina Healthcare blog tells us that the Tar Heel State's high-risk health insurance pool is making a big splash. The pool actually opened its gates back on October 20th (an auspicious date, indeed). According to the NCH folks, "Inclusive Health, also known as the North Carolina Health Insurance Risk Pool (NCHIRP), provides affordable, individual health insurance coverage for North Carolinians who do not have access to an employer health plan and face higher premiums due to a pre-existing medical condition."

Indeed.

Now where have we heard about such plans before?

Coverage for folks who opt in will begin the first of next year. Rates are age, sex and tobacco-use based, and apparently offer several deductible choices. Frankly, the first two options look like rather generic co-pay plans, while the third could be an HSA plan, were it not for the deductible (too high to qualify). Indeed, they look remarkably like plans available from any number of insurance carriers, but with the benefit (?) of being guaranteed issue. The NCH blog folks assure us that, while it's not "part of the state government," it does operate "under the supervision and control of its Board."

And who makes up this "Board?" Well, we're told its Executive Director is a gentleman by the name of Michael Keough. According to the NC Insurance Department, Mr Keough comes "from the NCRx and North Carolina Senior Care programs, where he served as project director since 2002. In that position he managed the nation's fastest growing state pharmacy assistance program, serving more than 100,000 senior citizens and managing a budget in excess of $80 million."

The "fastest growing state pharmacy program?" I'm sure Mr Keough is a fine fellow, and well-qualified (although he's apparently a graduate of a lesser university), but that experience does not bode well for keeping costs down. And we know what happens when costs continue to rise.

And looking through the pre-enrollment screening process, we find some other items of interest. For example, in order to "buy in" to the plan, one must not be eligible for Medicare or Medicaid, must be a legal US resident (yay!), and "must not have access to group coverage as an employee or as a dependent of an employee."

That last is particularly telling: how many Tar Heel State group plans are about to go down in flames as employers dump their policies in favor of pushing their employees into the state's trough? And what happens to costs then? But Henry, you cry, that's not going to happen! Why don't you mention that one of the eligibility "triggers" is that I've been rejected or rated up for medical insurance?

True enough, and that will limit the pool a bit, but you've missed the one that pretty much negates all the others: "I currently have similar health insurance coverage but at a single rate higher than that offered through Inclusive Health."

Ooops.

"Unhealthy" (i.e. "highly rated) groups and individual plans are about to become history. And what happens when all these less than ideal applicants flood the state plan? Regular readers have already figured that one out.

Which is not to say that the plan is completely without merit. For one thing, the plan designs seem pretty reasonable (not too much fluff), and there's an interesting pre-ex limitation that appeals: "Inclusive Health will exclude charges or expenses incurred during the applicable waiting period following the effective date of coverage for any condition for which medical advice, care, or treatment was recommended or received during the 12 month period immediately preceding the effective date of coverage." That waiver goes for a full six months for folks who sign up right away, and for a year for those who play "wait and see." My guess is that the sickest will be the quickest (to join up). But the plan, in a nod to HIPAA, includes the standard 63 day window, which means folks who drop their existing plans for the Inclusive Health policy have immediate cover for pre-ex (which reinforces my prediction about what happens to exiting policies).

And what about those rates? Well, for the ubiquitous 35 year old male non-smoker (is there any other kind?), the rate for the lowest deductible plan is a hefty $358 a month. Add another $115 if the gentleman likes his Marlboros (that's a 25% rate-up which is pretty much in line with the industry). A non-smoking female at that age pays a whopping $502. But that's not even the most interesting part:

Look as I might, I could find nothing about maternity coverage, yay or nay, in the plan descriptions. Since this doesn't appear to be excluded, what's to stop a young, say 20-something, female who finds herself "in the family way" from jumping on board? If she's early on, and one of the plan's trailblazers, she'd be covered after six months (sooner, if she'd had recent prior coverage). And at less than $300 a month, she'd have full coverage at delivery.

Wonder what that will do to rates?

And yet. Of all the plans we've seen so far, this one seems to me closest to dealing in a realistic way with at least the delivery of a reasonable product. I am qute concerned about what will happen to rates when heavy users start inundating the system with claims, and of course the adverse effect it seems to pose to the commercial market. But it's also the one with the least amount of "moving parts," which makes it more attractive than any of the others we've seen thus far.

Time, of course, will tell.

Cavalcade of Risk #64 is up!

SuperSaver presents this week's roundup of risky posts, with a veritable pantheon of thought-provoking entries.

Be sure to stop by.

And please consider hosting one yourself. It's fun and easy, and all it takes is an email.

AARP, UHC and Chuck

From yesterday's McPaper:

"Insurance is supposed to limit your exposure to the potentially high cost of a serious illness, and these plans do the opposite..."

So says Sen Chuck Grassley of the Senate Finance Committee. That august body is investigating the famed AARP's foray into the marketing of individual health plans. What many folks may not know is that, in addition to the usual MedSupps, AARP and its sales partner, UHC, have been pushing "limited benefit" or "mini-med" plans. The problem is, these plans are often marketed to folks who don't understand that they can leave some major holes.

We've written extensively on mini-meds, and have concluded that, in certain circumstances, they make a lot of sense. Folks who can't qualify for or afford a true "major med" plan can benefit from these limited benefit policies, which offer reduced coverages at a reduced cost.

You get what you pay for.

But the dark side is that unscrupulous vendors often push them as viable and attractive alternatives to major med -- or even group -- plans. Now, there's nothing in the article that explicitly states that this is the case with AARP/UHC, but I can tell our readers from personal experience that these plans do not go out of their way to inform the public of their limitations.

[ed: In fairness, brochures and other sales literature for "regular" plans could do a better job of disclosure, as well. That's why having a professional agent on your side can be such a boon]

About two years ago, I had a client come in to discuss one of these plans. She was covered by a major med with a "decent" deductible, but the renewal was bothersome. She had received some literature from AARP, and wanted my advice. I've always tried to be upfront with my clients; if another plan, that I can't duplicate, would better serve them, I'm happy to let them "jump ship," content with the knowledge that "they'll be back," and I've built up invaluable goodwill.

In that case, she brought in the AARP/UHC mini-med info. We discussed it at length, and she realized that what she had was far better for her in the case of a large claim, which was her primary concern. I was able to pursuade her that increasing the deductible on her existing plan would bring the cost more in line, and she wouldn't be giving up the coverage on the back end by doing so.

But how many "seniors" know to discuss this with their agent, or even think about it? Here comes this very inexpensive offer in the mail, it looks good, so why not make the switch?

Well, if you have no other choice, then maybe that's appropriate. But in too many instances, folks do have a choice, and in their ignorance, make the wrong one. By the way, I didn't choose the word "ignorance" as a pejorative, but to illustrate that not everyone's an insurance expert.

Present company excepted, of course.

The "chutzpah" award, however, goes to AARP VP David Sloane, who, when confronted with the fruit of his company's perhaps questionable sales practices, complained that it wasn't their fault, but that until America "reforms the system and gives everyone access to coverage," these plans provide an alternative. Of course, he neglects to point out that "the system" isn't responsible for AARP's advertising and marketing issues.

BlogRoll Update

As previously noted, we rarely update the blogroll; we're firm believers in "less is more." Nevertheless, it's appropriate to revisit that decision from time to time, and to add blogs that we feel our readers will truly enjoy and find useful.

Such is the case with the inimitable Dr Val, whose work we were proud to recently host. Her new site holds a lot of promise, and we're proud to add it.

Carnival of Personal Finance now online

The Sun's Financial Diary hosts this week's Carnival of Personal Finance. As usual, there's a lot of great info, and Sun does a great job of organizing it for us.

Check it out.

From the Mailbag: Liz E Weighs In

Got an email today from a gentleman at American Progress, touting Elizabeth Edwards' most recent "insight" into health insurance. According to the email, Liz thinks it's a scandal that women often pay more than men for health insurance. Of course, there's a very good reason for this: biologically, there's at least one kind of major claim that many women will make that no man ever will.

And senior citizens generally have more health issues than 20-somethings, which is one of the primary reasons why Medicare is going broke.

But of course, when the playing field is leveled, that won't be a problem:

"I have often argued that buying health insurance is not the same as purchasing a refrigerator or a microwave. Health insurance is not another consumer good for which everyone pays the same price. Sick people are more expensive to insure than healthy people, the old accrue more cost than the young. For this reason, Senator John McCain’s belief in the dysfunctional and discriminatory individual market is fundamentally at odds with the point of health insurance, which requires that we share risks and pool costs."

As I replied to our correspondent, this dramatically illustrates the problem with the idea that health insurance should be community rated; i.e everyone should pay the same premium. Risk is all about probability, and insurance is about asessing and pricing for those probabilities. It is most assuredly not about "sharing" risks, which would imply that we all pay the same.

As Bob has pointed out, this way of thinking leads to the conclusion that folks with poor credit should pay the same interest rate as those with good credit (credit worthiness is, after all, simply another expression of risk).

Come to think of it, that's exactly what the Democratic congress just did.

Fancy that.

Safety Nets with Holes?

"Economic troubles are driving states to scale back safety-net health-coverage programs -- even as they brace for more residents who will need help paying for care."

Not good news.

And yet, when one takes a more focused look at the facts, it's not clear that this is a "bad thing." The program most "at risk" is Medicaid, a cooperative venture between the states and the Feds. Medicaid provides funds for health insurance for some 50 million of our fellow citizens (not to mention a few non-citizens). For many of those states, it also represents almost half of their annual budgets. Cutting these expenses is one way for these states to more easily bring their own numbers into line.

So what Medicaid programs are being tossed?

■ Well, as we reported a few weeks ago, Hawaii's well-meaning but poorly executed plan to cover its uninsured children. As Bob noted at the time, "they must rely on taxes to support the system...Medicaid is available for a family earning $73k? I guess Hawaii has a different definition of poor."

■ In South Carolina, they're considering major cuts in funding for mental health coverage. My question would be, if the gummint thinks it shouldn't have to pay for this, why does it mandate such coverage for commercial insurance policies?

■ This past July, California slashed hospital reimbursements by 10%. As a result, Jan Emerson of the California Hospital Association believes that more hospitals will choose to opt out of the program. So what happens when we have nationalized health care, and the Feds slash reimbursement by 10% (or more)? How do providers drop out of that?

■ The Bay State, subject of quite a few posts here, cut almost $300 million from its Medicaid budget; that included some $40 million that was earmarked for the Cambridge Health Alliance, which provides care low-income residents. How much money were they already throwing at these programs, if they can cut $300 million?

Inquiring minds want to know.

Cavalcade of Risk #64: Submissions Due

SuperSaver hosts next week's Cavalcade of Risk. Submissions are due by next Monday (the 3rd), and should include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit via Blog Carnival or email.

PLEASE submit posts on risk-related topics only (not personal finance tips and the like).

Thank You!

We're now scheduling for early 2009 (!), so please drop us a line to reserve your slot.

Terrific Client Tricks

Yesterday, a client taught me something.

I've been working with this particular client, we'll call her Shirley, for a few weeks; she's been shopping for additional life insurance. We found an appropriate plan, and she completed the application. I explained to her that I would submit this to the carrier, and order a "paramed" exam, at the carrier's expense, as part of the underwriting process.

Almost all companies require a "paramed" when the amount at risk (the face amount, or "death benefit") exceeds a certain amount, typically $100,000. This generally consists of a few additional health questions, and the "drawing" of blood and urine. She asked me what was being tested, and I replied, "oh, for HIV, cholesterol, liver enzymes, tobacco, drug use, that kind of thing." I presumed, based on past experience, that this would be sufficient.

But it wasn't.

She wanted to know exactly what was being tested, and asked if I had a list. I must admit, I was a bit taken aback by this. In fact, I was a bit miffed, although I really had no right to be. I answered that I'd call the underwriter, to see if such a list existed.

It did, although he sounded as surprised as I had. He agreed to fax it to me.

But a funny thing happened between the time Shirley asked for the list and the time I spoke with the underwriter (a matter of a few minutes): I realized that not only was I wrong to be angry with her, she was actually the very first person who had ever asked me for such a list. As I pondered that, I realized that she was absolutely right, and that it was I who should be chagrined: why hadn't any other client ever asked for this? It seems to me that this is important; after all, how many times do we give blood and urine for testing? I daresay not very often, so it makes sense to know precisely what's being tested.

After I received the fax, I scanned and emailed it to Shirley, along with the information that, once the policy was issued, all the test results would be made available to her (this is a free service offered by that carrier). A few minutes later, I followed up with another email thanking her for making me take a second look - heck, a first look! - at this routine process.

I'd call that a good day.

Happy Wonkereen!

Yeah, that title's pretty lame, but David Harlow's Health Wonk Review, Samhein Edition, is certainly a treat. David, host of the HealthBlawg, is one of our premier health policy bloggers, and his HWR is packed with great posts.

Trust me, that's no mean trick.

Moronic Carrier Tricks

Over at Workers Comp Insider, Jon Coppelman reports on some serious shenanigans on the part of the Long Island Railroad. Turns out, over 90% of their "retirees" have done so on their disability insurers' nickel. In fact, Aflac reports that 1 in 4 of their LIRR policyholders have "cashed in" on their policies.

Why is this a "moronic carrier trick," you ask?

Well, as Jon points out, the carrier knew this, and still seemed not to care that they were apparently being gamed.

Read the whole thing.

A VERY Fast 'Rounds

Kim at Emergiblog hosts this week's Grand Rounds, with a race-inspired theme that keeps thing moving right along.
Speed on over!

If Wishes Were Money...

I routinely look through our logs to get an idea of where traffic's coming from, which stories seem to be getting the most "play," and because, well, it's interesting to see what kinds of folks stop by here (don't worry, I can't tell who you are, just what kinds of things folks in general seem to find most interesting).

So I see a link from a place called Blog$hares (that's not a typo), which is "a fantasy stock market where weblogs are the companies. Players invest fictional dollars in a wide spectrum of blogs. Blogs are valued by both incoming and outgoing links, and can add value to other blogs by linking to them."

Kind of like a fantasy football league, but with fake "stock" based on industry. The insurance category boasts an even dozen "players," including our friends Joe Paduda and Julie Ferguson, even the RiskProf himself.

I was quite surprised to see our stock valued north of $80,000 a share (by comparison, the next highest was just over $54,000; the bulk hovered around a thousand or so). I have no idea why our stock is so high - not that I'm complaining! - and of course it's one thing to see this at "B$," and quite another to try to buy a cup of coffee with it. Regular readers know that we accept no advertising here, so it's truly a labor of love.

But if I could cash out at $80 grand a pop...

Stupid (Government) Agency Tricks

[Welcome Google Finance readers!]

"The Treasury Department is looking at ways to aid insurance companies as part of the rescue package announced earlier this month."

You have got to be kidding!

Oh, you're not?

The Feds are now talking about diverting between $50 and a $100 billion of our tax dollars to carriers owning "distressed assets." Hey, I'm distressed by this foolhardy scheme; where's my bailout?

As we pointed out last month, insurers buying up mortgages, and then watching their value plummet, is a time-honored tradition. If they're not going to face consequences for ill-advised investment decisions, why would they ever stop? Rewarding bad behavior is a sure-fire way to encourage its repetition. You don't give your puppy a treat for peeing on the carpet, so why would the Feds be giving away so much of our money to these carriers?

We've already seen how "responsibly" at least one such beneficiary has behaved, why would we assume that its erstwhile competitors would be any more careful with "free money?"

On the other hand, at least some carriers are taking their fiduciary responsibility seriously:

"In recent weeks, insurance companies including Hartford Financial Services and MetLife [have] raised capital."

Hartford glommed on to about $2 and a half million from Germany's Allianz, while MetLife sold off about $2 billion in stock. Good on them for addressing the issue from the corporate boardroom, not the U S Treasury.

High Blood Pressure? That Stinks!

[Welcome FoxNews readers!]

Sometimes, we at IB face a dilemna: as a "family-friendly" blog, where do we draw the line between licentious and useful? For example, did you know that that which makes flatulence odoriferous (and the delight of 5th grade boys the world over) also serves a more noble bodily function?

"A smelly rotten-egg gas in farts controls blood pressure in mice, a new study finds."

Sorry, but science is science.

Turns out, the gas is created by bacteria making its home in our digestive system, and that (according to new research) it helps regulate blood pressure by acting as a sort of "steam valve," much like the little gizmo on top of a pressure cooker. That gas, hydrogen sulfide, is responsible for the offending aroma.

The scary part, one supposes, comes from its potential application in medical tech. According to Dr Solomon Snyder, a neuroscientist at Johns Hopkins, "(n)ow that we know hydrogen sulfide’s role in regulating blood pressure, it may be possible to design drug therapies that enhance its formation as an alternative to the current methods of treatment for hypertension.”

Well, it was only a matter of time that we'd get from medical marijuana to medicinal methane.

Doing vs Talking

There's an old saying about the weather, and it appears that the same holds true with regard to health care:

"The Institute for Healthcare Improvement (IHI) announced...the progress of the...5 Million Lives Campaign, a national effort to help U.S. hospitals dramatically reduce incidents of avoidable medical harm."

Right out of the chute, that seems like a good idea.

But it gets better:

"The Campaign [asked] hospitals to introduce up to 11 evidence-based health care interventions and to engage their trustees in the effort, in order to protect patients across the nation from five million incidents of medical harm over a 24-month period..."

That's a lot of "incidents," although we don't know how many are simply prescribing the wrong aspirin versus removing the wrong kidney. The goal as stated is certainly admirable, but a perhaps unintended side effect caught my attention:

Over 4,000 hospitals (representing almost 80% of the available beds nationally) participated in the program, and "(e)ight other countries have launched initiatives inspired by the Campaign." These included some whose systems we've, um, discussed here at IB, including the MVNHS© and Our Neighbors to the North© . Which begs the question: if socialized medicine is so great, and our system so bad, how come these two stalwarts (not to mention Sweden and Japan) feel it necessary to address the issue of "avoidable medical harm?"

Just wonderin'.

Easy Come, Easy Go

In case you were worried that erstwhile insurance behemoth AIG wouldn't be able to spend our money fast enough, have no fear:

"The troubled insurance giant American International Group already has consumed three-quarters of a federal $123 billion rescue loan, a little more than a month after the government stepped in to save the company from bankruptcy."

By my calculations, that means they're burning through almost $3 million a day, every day (hey, at least they're not slacking on the weekends!). Of course, dropping a few million here and there on "entertainment" helps.

As of yesterday, they'd used up about $100,000,000 to (and ya gotta love this phrasing) "pay off bad bets the company made in guaranteeing other firms' risky mortgage investments." Wouldn't it have been cheaper to just bet it all at the craps table?

"Wall Street analysts said this is a vulnerable juncture for the insurance giant."

No kidding.

From the Mailbag: Is that a fact?

As we've mentioned, we get some interesting email here at IB. Recently, aspiring author Doug Perednia, M.D. wrote to us, questioning the veracity of a recent article in US News and World Report. It seems that a Dr Bernadine Healy, whose imagination is surpassed only by her paranoia, penned a rather misinformed screed against health insurance, and the carriers that underwrite it.

Specifically, Dr Doug cited this passage from the diatribe:

"Denials that produce the most disputes are those where insurers judge the care to be unnecessary or unproven, pitting a proverbial sick David against a multibillion-dollar Goliath. What few Davids know is that insurance contracts by law grant companies the legal right to manage a patient's care, including denying it, sight unseen, and give them the final say, if challenged. Unless the state steps in."

Although there's a lot of other misinformation in the linked article, we'll concentrate on the issues raised by Dr Doug. As per SOP, I forwarded the good doctor's email to my (more than) capable co-bloggers, and then proceeded to respond directly.

I replied:

■ insurance contracts by law grant companies the legal right to manage a patient's care

No, that is just silly. Insurers no more manage one's care than your car dealer tells you what kind of air freshener you can hang on the mirror. Insurers cannot, and do not, tell you what procedures or medicines you can utilize, only whether (and/or how much) they'll pay for them. And even these issues are subject to a claims review process, which is included in policies.

■ the most disputes are those where insurers judge the care to be unnecessary or unproven

I would also question her assertion that most claims disputes have to do with medical necessity (which would be the correct terminology). I haven't seen any figures which would support this (although, to be fair, I haven't seen any to refute it, either). I'd like to see some citation(s) to back this up. Perhaps Dr Healy will oblige you on that score; please let me know if she does, because that would make an interesting post, as well.

Bob was even more specific:

There are certainly a lot of goofy statements in that link.

Just to name a few . . .

■ the 17-year-old girl who died before her liver transplant was approved

Not sure if we are talking about the same case or not, but the liver transplant was covered extensively at InsureBlog.

■ the people in California whose insurers canceled their policies retroactively after they got sick

As for the folks in CA with retroactive cancellation, we've also covered that as well.

Quite a few misstatements in the article. But I had to chuckle at this one:

"Andrew Cuomo of New York has launched a nationwide investigation into schemes that low-ball reimbursement and stick patients with bills insurance companies should have paid. "All too often," Cuomo says, "insurers play a game of deny, delay, and deceive." His pursuit is in full throttle and has the advantages of his bully pulpit and his power of subpoena to pierce the opaque veil that patients never can."

This is the same Andrew Cuomo appointed by President Clinton to head up the FHA and authorized the expansion of mortgage lending to low income, and otherwise unqualified loan applicants.

Of course we all know how well that worked . . .

And Mike took issue with this one:

■ insurers judge the care to be unnecessary or unproven

I would only add that "unnecessary" and "unproven" are two very different reasons. Lumping the two of them together does not yield a meaningful statistic. Sort of like saying that more than 90% of deaths in the U.S. last year were the result of the common cold or some other cause.

Since I'd hate to run up the score, we'll leave it at that.

Health/Insurance Trends: Fall Edition

[Welcome Industry Radar readers!]

First up, Health Savings Accounts (HSA's) take a bounce:

UnitedHealthcare, which has certainly earned our disdain over the years, redeems itself with some timely and useful information about HSA market penetration. They studied the claims activities of over 200,000 of their HSA clients for a full year, and then drew some conclusions based on that information.

Since they used 2006 as their benchmark year, all the numbers in the study reflect experience with employer-based (i.e. group) plans; their purchase of Golden Rule, and thus its book of individual clients, wasn't part of this.

And remember, the typical HSA plan comprises two separate components: a high deductible health plan (insurance) and a health savings account (money). Just because one buys the insurance plan doesn't mean that one also opens up the savings account. But according to the study, employees whose employers seeded the accounts were 6 times more likely to open one than those whose employers simply made it available.

This makes sense: employees saw value in something which their employers were willing to at least partially fund; and of course, no one wants to leave their employer's cash on the table.

Something else interesting, and this mirrors my own experience, is that small employers seem to have adopted these plans in much bigger proportions than larger ones.

One other terrific piece of news: it apears that we can finally put to rest the canard that such plans appeal more to higher income folks than to "Joe the Plumber." Turns out, a higher percentage of folks making under $25,000 a year signed up for an HSA plan than folks pulling down $100,000 or more.

UPDATE: Bob has more on this, including two terrific videos with extraordinary insights from non-insurance folks.

One of the benefits of High Deductible plans, especially HSA compliant ones, is lower rates. But plan design is only one factor in that equation; reducing utilization and claims can really help, as well. And one way to reduce health care costs is by making healthier lifestyle choices.

Or having them made for you:

"Taking the employee wellness program to another level, a local company is refusing to hire smokers unless they enter a program to help them quit..."We decided not to hire smokers because they add additional expense to our health plan and our ongoing operation," said Dennis Curran, chief human resources officer for USI's Midwestern region."

Frankly, I think that this is a good thing: although I'm not a proponent of government initiatives that require private enterprises to be smoke-free, I certainly agree that it's in their best interest to do so. And helping the bottom line is one more benefit of going that route.

[Hat Tip: Holly Robinson]

Dog Bites Man, Film/Study at 11:00

We get some interesting email here at IB. Partly, it's that we've been around for almost 4 years, so we've built some "cred," and partly it's because we occupy a kind of unique niche: mostly insurance, but also part health news, and often the intersection of the two.

Here's an example of that "fusion:"

I received an email from Sharon Rapport of the Corporation for Supportive Housing. This is a non-profit based in California, whose mission is to help "communities create permanent housing with services to prevent and end homelessness." Now ordinarily, this would seem to have nothing to do with either insurance or health news, but they've released the results of a recent study that shows an interesting, and relevant, trend:

"A report issued today...provides evaluation data from six California counties demonstrating that programs that provide services to "frequent users" of emergency rooms decrease costly emergency room visits and hospitalizations for many patients."

I rather flippantly replied to Ms Rapport: "In a way, this is kind of a "d'uh!" but it's also interesting." [ed: I've apologized to her for my flippant tone] I think the reason I responded that way was because its sad that something which seems so obvious -- on-going, supervised and routine health care means fewer ER visits -- requires a (presumably costly) study. But the results are interesting, and ultimately helpful. If it takes a homeless advocacy group to get folks to understand the importance of preventive care, then so be it.

It also shows something else. If we assume that a non-trivial segment of the uninsured population are also homeless (I offer no proof of this, only supposition), then it seems to me that tax dollars may be well-spent on programs which encourage that cohort to seek more routine care, and enables them to afford it.

As part of the study, the CSH and other advocacy groups set up an intriguing pilot program. Starting some 6 years ago, the "Initiative...provided or connected frequent [ER and hospital] users to medical and mental health care, substance abuse treatment, transportation, housing and benefits." And the results were surprisingly positive:

"(A) 61% decrease in emergency department visits and a 62% decrease in inpatient days" for folks who participated in the study's various programs. That's some serious numbers. And since we know that helath care costs directly impact health insurance costs, there are some valuable lessons to be learned from this.

Kudos to CHS, and Thank You to Sharon Rapport.