HCR -- Federal Medical Insurance Pool (FMIP)

This letter was posted at The Health Care Blog yesterday:

This is our true story about Obama Care, 

In 2010 my wife and I, both retired and in our early 60s, went to a local insurance agent to secure private health care. We were both turned down for coverage. I was turned down because a minor, pre-cancerous lesion was removed from my face several years earlier and Barbara because she had had a hysterectomy 15 years earlier. We didn’t smoke or drink and enjoyed reasonably good health over the years. After this first rejection we applied through a different agent. This time I was approved and my wife was turned down because she had a minor, laparoscopic procedure on her knee 2-3 years earlier. 

In the summer of 2011 Barbara was diagnosed with stage 4 esophageal cancer. After this devastating diagnosis and being well aware of the financial realities related catastrophic health emergencies my next stop was a bankruptcy attorney. This is what he told me, “In Oregon, a medical facility has the right to take everything a person owns except for $50,000. “It is the law of the land”, the attorney explained, “The medical industry can set whatever price they want, there is no control over what they can charge and they have absolute collectability. “ And so, it should be clear to anyone reading this that we were drowning in fear and despair as we faced a life threatening illness and financial ruin at this late stage of our lives. 

Soon after the above events our daughter called to tell us she thought we would qualify for the Federal Medical Insurance Pool, (FMIP is Obama-Care). I checked with a local insurance agent who told me we would not qualify. But later my other daughter called, telling us that it appeared Barbara would indeed, qualify for FMIP benefits and faxed the application to me. I called the number on the FMIP Application, expecting to wait on “hold” along with a series of pressing 1 for this option for 2 for that option and was surprised when a woman answered the phone directly after the second ring. 

I explained our situation; having lost employer sponsored health insurance, having been turned down for private health insurance and now the necessity for immediate treatment of my wife’s catastrophic illness. We faxed our application to her and were informed within 2 days that we met the criteria for ObamaCare and that our coverage would begin the first day of the next month. About a week later the cancer treatment hospital called asking “how we would be paying for my wife’s treatment.” I told them she had been approved for the FMIP ObamaCare. They checked their records and already had the necessary information for my wife to begin her treatments. 

There is a lot of mis-information out there about ObamaCare and I just want people to know that because of the fast and efficient response from ObamaCare my wife and I were able to battle her devastating illness and not have to live with distraction and the fear of financial ruin.

This letter says a lot. If there were a way to simplify the system I would be the first to rejoice, but there is not. Since America does not have a national government-run healthcare system (despite the endless mindless repetition of that phrase) we are all on our own when it comes to finding insurance and medical care.

Here is a link that may be helpful:

Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools
Updated: July 2013
Includes latest material on implementing health reform: The Pre-existing Condition Insurance Plan (PCIP)

To aid uninsurable individuals, 35 states implemented high-risk health insurance pools over three decades. The Federal health reform law of 2010 provides $5 billion among all 50 states, for newly created or add-on expanded programs run by states or by a designated insurer, if states choose those options. 27 states had done so by fall 2010. 23 states deferred to the federal government to handle the new programs.

As of July 1, 2013, 17 States (AR, CA, CO, IA, IL, KS, MI, MO, NH, NY, NC, OH, OR, SD, UT, WA) had begun the process of transitioning their state operated Pre-existing Condition Insurance Plans (PCIPs) to federally operated PCIPs, a process that is coordinated by HHS and CCIIO. Only 10 states (AK, CT, MD, ME, MT, NJ, NM, OK, RI, WI) continue to operate their own, state-only PCIP or high-risk pool. 

For millions of Americans with a pre-existing medical condition, health insurance can be an unattainable goal. In the absence of laws requiring insurers to provide individual coverage to people with pre-existing conditions, many of these people joined the ranks of the uninsured. These uninsurable individuals have sought coverage, but have been unable to purchase it because they have been rejected or because they have been offered coverage only at unaffordable, high premium rates. Because of their often complex or costly health conditions, uninsurable individuals are the segment of the larger uninsured population that most needs health insurance coverage.

In response to the problems of uninsurable individuals, 35 states set up high-risk health insurance pools over a 25 year span, from 1976 to 2009. Across these 35 states, the national enrollment was 221,879 by December 31, 2010. This compared to 200,047 as of December 2007. This is about 1.8 percent of the individual market enrollment, but is up to 25 percent of the individual market documented to be subject to denials or "adverse underwriting" restrictions due to pre-existing medical conditions.

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As this letter indicates, anyone who thinks America has the best health care system in the world simply has not been paying attention. These people are not outliers. They are everyday people with medical challenges that can affect anyone.

The complexities of medical problems are great, not because we have "government-run health care" but because we do NOT have government-run health care. Instead we have a scramble of federal, state and private plans, many with overlapping coverage, others with none at all for those most in need of coverage.

PPACA is not the solution. But it is the latest attempt to chip away at improving the mess this train wreck has become. For those who have secure employment, good insurance and reasonably good health it is not a problem. Even if they or a family member presents with a complex or expensive condition there may be pain, suffering and grief, but the problems that money and medical science can address are minimized.

I have highlighted above the sections that make it impossible to do more than advise readers with medical problems to "check with your state insurance authority, whatever that may be" and wish them the best of luck.