Category Archives: high-risk pools

Health Reform and the Orphan Called the Individual Health-Insurance Market

Last week, the buzz in Washington, D.C., where I heard numerous lectures and personally talked to two U.S. representatives and two U.S. senators, was about impending health-care legislation in the Senate and particularly focused on the imminent crisis in Iowa, where there probably will be no insurers for the individual insurance market in 94 of its 99 counties in 2018.

Seventy thousand Iowans may not have health insurance next year in a state that prides itself as an insurance state. Iowa is the poster child for the deficiencies in the individual insurance market. Across the nation, only a few counties in Tennessee have that known potential for 2018, though several potential fixes are being discussed at the federal and state levels.

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Health Reform and High-Risk Pools

United States House of Representatives Speaker Paul Ryan is right. High-risk pools could be the solution that solves some of the current problems with our health-care system.

Even though high-risk pools have not worked in the past (most immediate for me is the example of my home state, Iowa); even though I believe that states have neither the expertise, the competency, nor the will to run high-risk pools; even though I have railed time and again against high-risk pools as being anti-universal coverage, I now propose a new concept for high-risk pools.

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Health Reform and Post-Truth Politics

As a physician, I have a hard time understanding post-truth politics. Wikipedia defines the post-truth culture as “a political culture in which debate is framed largely by appeals to emotion disconnected from the details of policy and by the repeated assertion of talking points to which factual rebuttals are ignored… . (It) differs from traditional contesting. … Falsifying of truth  … (is viewed as) … of secondary importance.”

I live in a world where the absolute values of lab tests — such as INR levels (the international normalized ratio (INR) is calculated from the result of a prothrombin time (PT) test, which is used to help detect and diagnose a bleeding disorder or excessive clotting disorder; the INR is used to monitor how well a blood-thinning medication is working to prevent blood clots), ejection fractions (which measure the percentage of blood leaving the heart each time it contracts), creatinine levels (used to assess kidney function), and hemoglobin levels (hemoglobin is the substance in red blood cells that carries oxygen) — affect function, quality of life, and the potential life or death for my patients. I live in a world where, for my geriatric patients, the commonly accepted truth of gravity plays a huge role in falls. I spend much of my time as a geriatrician trying to prevent falls and treating the outcome of falls. In my 32 years of practice, I have seen how details of policy and falsifying of truth have tangible consequences.

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Health Reform and Pre-Existing Conditions

I was tempted to titled this blog entry Health Reform and “I Won’t Let People Die in the Streets.” I also was tempted to describe the November 8 election as the day health reform died. One retort could be that the Republicans are now in charge of health reform. They need to play offense as opposed to only playing defense. And we should move forward.

For starters, let’s discuss the dual action of repealing the Affordable Care Act (ACA) and maintaining the Republican pledge not have individuals with pre-existing conditions be excluded from health insurance in the post-ACA world.

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Health Reform and Medicare for All … Seniors

One of my favorite movies is White Christmas, which starred Bing Crosby and Rose Mary Clooney. In one scene, Rose Mary Clooney’s character sings a song in a nightclub about her unhappiness with Bing Crosby’s character. She sings, “Love, you didn’t do right by me … you planned romance that just hadn’t a chance, and I am through.”

In a fashion similar to that Irving Berlin song, after years of touting private health insurance by helping to create the Healthy and Well Kids in Iowa (HAWK-I) — Iowa’s CHIP program, and working with CoOportunity Health — Iowa’s health-care co-op that went bankrupt, I have come to the conclusion that the private health-insurance market under the Affordable Care Act (known as the ACA or Obamacare) has not done “right by me.” More importantly, it has not “done right”  the citizens of the country. For reasons that I will clarify later, I now support expanding Medicare to individuals 55 years of age in a graduated, voluntary enrollment process.

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Being Thankful this Health-Reform Season

Jim is a 56-year-old man with diabetes who has been my patient for several years; he is a subcontractor in the construction field in a county seat. (I changed his name and those of others whose examples I cite in this blog.) He is divorced with grown children and is devoted to his grandson. He has been uninsured for years due to his medical problems. Starting January 1, he will have health insurance through the Exchange, which allows people to explore subsidies and to compare and sign up for plans. An insurance agent who would not have had any options to offer my patient last year drove to Jim’s home twice from metropolitan Des Moines to set him up with his new policy.

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