Recently a client was telling me that her friend was totally dragging herself to work every day after her chemo therapy. She has stage 4 colon cancer. She works because she needs her health insurance. She is so weak, her husband drives her to work. Mind you the husband is working and makes good money.

Please let me educate anyone out there who has this situation.

 First. There is Cobra or CalCobra. This means that if you quit or are fired you get an extension of your health benefits for 18 months and another 18 months if you are working for a California employer.

Second. If you are laid off (or fired for not showing up because you are sick like this lady) you should be eligible for the Stimulus Act subsidy. This subsidy will pay for 65% of your Cobra premium for 9 months. After that you will need to pay for the entire premium on your own. I am willing to bet that subsidy act will be extended.

Third. When your Cobra runs out you will be eligible for a HIPAA Guaranteed Issue plan from one of the main insurance companies. Personally my favorite is Anthem’s plan. It is a only little more expensive than a standard PPO. The key is to purchase this HIPAA GI plan at the end of your Cobra plan and before 63 days has passed.

Finally: After I updated my client’s education she said “oh.” She did tell me her friend actually liked going to work and it was only for 2 to 3 hours a day.  I think she was doing an emotional stress test on me!

Moral to the Story: Beware the emotional sound bites!

Apology: I am very sad for this woman. If she were my client I would be coaching her on the best access and use of her health insurance. This would be the very least I could do and that wouldn’t be enough.  My comments on this issue are meant to inform.

We have been told that Medicare (retirement program) will run out of money by 2017. That means citizens born in 1952 may not have access to their Medicare programs.  Most will want to enroll in Medicare so that they can save money on their health insurance.  Those people have planned their retirement with the notion that they will save money on their health insurance. Please tell me what will happen when Medicare is insolvent? The big question. If we cannot fund what we have promised, how can we fund a program that gives a Medicare type program to every American no matter their age?

I had the opportunity to attend a meeting, hosted by San Diegans for Healthcare Coverage. This is a group of like-minded people comprised mainly of physicians, community leaders and community clinic managers. There were no insurance companies or pharmaceutical companies represented.
The topic of the July 17th meeting was ”Voices for Reform”. In preparation for the meeting I was able to read a 35 page short version of the New Healthcare legislation going through the house.
The various speakers repeated over and over again that “We need  to push this through because there wouldn’t be another chance. We will never have another chance.” I totally disagree with that concept.  This legislation is Mediocre at best.  Half baked legislation takes a lot less time and most people won’t notice until it is too late. Like the Leaning Tower of Piza.

 The legislation is filled with addtional spending. NO SAVINGS at all could be found. In fact more spending was added. Long term care, visiting nurses for pregnant moms and midwives to help pregnant moms deliver. Also planned for us are new skilled nursing facilities. The plan would also administer training for those employed by those facilities.  We can look forward to additional schooling for physicians and nurses. The plan would eliminate the  limitation on Medicare’s pharmacy plan.   No one would be turned away, except if the person was not legally in this country. I guess guest workers and visitors are accepted.  The Federal Goverment would oversee it all. 

By the way I keep mentioning the “saving money” issue. It is because that has been the promise for National Healthcare.
Recently the AMA remarked that they endorsed the program. Dr. Robert Hertzka (past president of the CMA) said that it was after the AMA programs like MediCare and MediCal had an infusion of money. This expenditure  was to make up for the underpayment for MediCare and MediCal. Stay tuned on that remark. I am still verifying it.
If you check out the web page that tracks Stimulus money, you will find stimulus money under “grants”. The targets are MediCal and other social programs. I could not find any other documentation on these grants. Perhaps this is what Dr. Hertzka was speaking of. Perhaps the timing on this was connected to the AMA endorsement??? Check out www.recovery.gov

Insurance companies already use their group buying power when negotiating with hospitals and doctors for better rates. In fact the doctors and hospitals don’t want anyone knowing what they “settle for.” Hospitals and doctors are not allowed to disclose  their low reimbursement from MediCal (different then Medicare). It is known that Medicare pays below 15% of the usual customary and reasonable rate for office visits, services and hospitalization.  Medical groups have made it known that they pass on their losses to the commercial market. In other words if you have private or company paid insurance it is higher because you are paying for the losses caused by Government contracts.  Medicare could be considered a “big buying power” example, yet doctors point out that they lose on those contracts.

Consider this: When asked where we will get the money for the Federal Government Health Plan, it is noted that savings can come from Medicare cuts.  How will cutting costs in the Medicare reimbursement  help finance the Federal Government’s plan to provide affordable health insurance? That seems like taking money out of the family piggy bank instead of trimming real cost. The result may be that your private plan will continue to increase in premium.