Dear Friends and Concerned Citizens,
I will be going through the recently enacted Healthcare Reform Bill with a fine toothed comb--unlike the majority of our elected officials that voted on it--and will apply over 20 years of healthcare experience in the trenches as a surgeon, emergency room physician, and a primary care/urgent care provider in interpreting it and posting all relevant aspects of the bill as they affect all of us, including providers and consumers.
In the first 26 pages of the bill under Division A (Affordable Healtcare Choices), Title I (Immediate Reforms)the bill discusses setting up high-risk pools of those that have been denied coverage for a variety of reasons--especially pre-existing conditions--so that they may obtain immediate and affordable coverage.
The problem is that Congress has appropriated 5 billion dollars--not including collected premiums)--to pay for direct medical care provided to those individuals. Now that may sound like a lot of money, but remember, that money must also go to pay administrative costs as well as direct medical care. Since this is a "high-risk" pool of patients, that, by definition means that their medical care is going to be much more costly--but, since they cannot be denied or charged more than anyone else (remember it is supposed to be affordable)that means the money will come from the 5 billion dollar pool which will be burned through very quickly.
Now the second problem--that was never told to the public--is that when the funds run out, then the Secretary of Health and Human Services may " reduce benefits, increase premiums, or establish waiting lists."
Don't believe me? See for yourself and pay attention to the last paragraph:
14 (1) IN GENERAL.—There is appropriated to the
15 Secretary, out of any moneys in the Treasury not
16 otherwise appropriated, $5,000,000,000 to pay
17 claims against (and administrative costs of) the
18 high-risk pool under this section in excess of the pre19
miums collected with respect to eligible individuals
20 enrolled in the high-risk pool. Such funds shall be
21 available without fiscal year limitation.
22 (2) INSUFFICIENT FUNDS.—If the Secretary es23
timates for any fiscal year that the aggregate
24 amounts available for payment of expenses of the
25 high-risk pool will be less than the amount of the ex-
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1 penses, the Secretary shall make such adjustments
2 as are necessary to eliminate such deficit, including
3 reducing benefits, increasing premiums, or estab4
lishing waiting lists.
And that is just in the first 26 pages and 11 of those were introduction and table of contents!
John R. Vigil, MD