The Associated Press November5, 2009

WASHINGTON - You're afraid your cancer is back, and a health insurance
company just turned you down. Under the health care bills in Congress,
you could apply for coverage through a new high-risk pool that
President Barack Obama promises would immediately start serving
patients with pre-existing medical problems.

Wait a second. Read the fine print. You may have to be uninsured
for six months to qualify.

"If you are a cancer patient and have cancer now, you can't wait
six months to go into a plan because your condition can go from bad
to death," said Stephen Finan, a policy expert with the American
Cancer Society Cancer Action Network.

He called the waiting period in the Senate bill "unacceptable."

Advocates for people with serious health problems, as well as some
insurance experts, are raising questions about one of the most
important upfront benefits in the Democratic health care legislation:
a high-risk pool for the medically uninsurable.

Obama proposed the pool in his September health care speech to
Congress.

Intended to serve the most vulnerable as a temporary fail-safe, it
would stay in place until 2013. That's when insurance companies
would be banned from denying coverage because of medical problems.
Government subsidies to make coverage more affordable for millions
of uninsured would also start that year.

Is $5 billion enough to cover those in need? Now, concerns are being
raised about the design of the high-risk pools. In addition to the
six-month wait, there's a more fundamental issue - whether $5 billion
set aside for the three-year program is enough. The money would be
used to help people in poor health pay premiums.

Obama credits his Republican presidential rival, Sen. John McCain
of Arizona, for the risk-pools idea. But when the GOP candidate
proposed it in 2008, the estimated cost was $7 billion to $10 billion
a year.

The six-month wait is in the health care bill the Senate Finance
Committee approved last month. To qualify for the pool, patients
must be turned down for coverage because of a pre-existing condition
and uninsured for at least six months.

"If you are somebody with cancer or a heart condition who needs
immediate coverage and immediate treatment, that's not very helpful,"
said Karen Pollitz, a Georgetown University health policy professor.

Senate Finance staffers say the restriction is meant to prevent
people switching from more expensive coverage to take advantage of
government assistance.

Pelosi's plan doesn't have waiting period

But the House health care bill unveiled last week by Speaker Nancy
Pelosi, D-Calif., doesn't include a waiting period. Instead, it
would require insurance plans who "dump" seriously ill patients to
repay the federal pool.

"The House provision will provide immediate relief for people with
high-risk conditions who have no alternative for coverage," said
Finan. It may be easier to fix the waiting period than the financing.
Both the House and the Senate Finance bills set aside $5 billion
for the pools.

"It doesn't seem like it's near enough money," said Douglas
Holtz-Eakin, who was a top domestic policy adviser for McCain. The
McCain campaign ultimately concluded it could take as much as $20
billion a year to properly run risk pools, he said. The White House
says McCain's proposal was more elaborate and not directly comparable
to Obama's.

If the Democrats' risk pool starts running out of money, the
government may have to start a waiting list, raise premiums or take
other unpopular measures.

Congress could be asked for a bailout.

Several independent experts say concerns about the financing are
valid.

"It would seem that ($5 billion) is going to be small relative to
the need,"

said Thomas Buchmueller, a University of Michigan business professor.

Some 30 states now have risk pools for those who can't get health
insurance on the private market, covering about 200,000 people at
a cost of around $1 billion a year.

"This is clearly not going to be enough money to cover everybody,"
said Pollitz.

http://www.msnbc.msn.com/id/33654867/ns/health-health_care/

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