Secondly, on the FSSA side of things the management is abysmal. Poorly organized, poorly trained representatives. I switched insurance companies at my annual renewal, and when I called in to make the change, about a month and a half before my renewal date, they said they could make the change effective the following month (a month early). I said I had been told that I could not under any circumstances change my insurance until my renewal date. The representative said, Oh no, that is not a problem, I can change you the beginning of the next month. Fool that I was I let her make the change. As a result my insurance change for the next month and then changed back on my renewal date. This is but one example of many problems I have had with the administration done by FSSA. I do have to allow that I have been told that they are trying to coordinate activities across several agencies and organizations, which does make things difficult. But it also took them four months to get my billing changed to reflect the change in my payment at my renewal date.

Third, I have an issue that is probably really an issue with insurance in general, but I hope it will be dealt with somewhere along the line in all of this reform. My spouse has Chronic Fatigue Immune Dysfunction Syndrome, an immune dysfunction for which there is no recognized treatment. The problem is, if you find a drug that actually works to improve the symptoms of the disorder, the insurance companies will not pay for it because it is not an approved for this disorder. But since there IS NO approved usage, they are effectively denying coverage for this disorder.

Fourth, and back on track, the forms are obscure and difficult to follow. I sometimes wonder in dealing with their forms if there is a place you can take a form to have its design made as unclear as possible. Then to add insult to injury, they are very unforgiving if you fail to provide something they asked for. You are given a very short time to respond, and if you do not respond within the time frame required you are out, your application is diapproved or you are kicked out of the system. If they ask for several things and you miss one of them, you are out, no second chance. And your rejection letter is for “Failure to cooperate” However given the poor design of the forms, regular “Failure to cooperate” is inevitable.

$1,100 deductible on a health plan for the poor.

Number of beneficiaries limited to the number that can be paid for out of a fraction of the state tax on cigarettes.

Not to worry, we poor die young and will soon be out of your way.

May God help you.

As one of the responders note this is unlike an HSA, in that there is no tax benefit, because individuals at low-incomes do not qualify for the tax breaks afforded by traditional HSAs. The POWER Accounts do, however, offer the ability to rollover remaining account balances. The entire balance rolls over if all preventive services are met, and if they are not completed, then only the individual’s prorated contribution would rollover. As one commenter notes, this is likely to be a “paltry” sum.

This is precisely, why we believe that the amount of the POWER Account or deductible should increase, especially for those with chronic diseases. This does not mean that individual’s contributions to the account would necessarily increase. Because this is a Medicaid program, we are bound by the 5% out of pocket maximum imposed by CMS. Therefore, the State would contribute to any increases in the deductible. This would hopefully be offset by a premium decrease that is already being paid by the State.

Persons with chronic diseases will likely blow through $1,100 very quickly, thus eliminating the financial incentives for healthy behaviors. By increasing the deductible, there would be greater financial incentives to complete requisite preventive care services and to manage the larger POWER Account more appropriately. Also, note that preventive health care services are not subject to the deductible.

As stated earlier, the intent of this program is philosophically centered on personal responsibility. Currently, over 68% of the HIP enrollees are below 100% FPL and 33% are not making any contributions. Therefore, contributions to the POWER Account are very minimal for most participants and may not be high enough to incentivise behavior change, certainly not for the individuals that are participating for free. We believe its worth considering whether increasing required contributions or requiring a minimum contribution, but to no more than the CMS 5% cap, will help participants value the taxpayers investment in their health.

As for the charge that this plan does not help the dialogue around reform, we say this. We understand that this is not a perfect solution or one without fault. But it is pragmatic; it represents a compromise between two parties and philosophical ideologies. This plan has created health care access and peace of mind for thousands of uninsured Hoosiers that had no place to go five months ago. It is an important step in the right direction and will hopefully serve as an example that reform and solutions are possible when there is committed leadership.

“Already, we see areas we would like to improve. The $1,100 deductible may be too low for those persons with chronic illnesses. We wonder if there should be additional copays for those individuals not paying up to the five percent CMS limit to further encourage appropriate utilization.”

Is this not counterproductive? Can you elaborate as to why increasing the deductible in an individual with chronic illness would help, not harm this needier patient?

Thanks.
Brad

For the authors to suggest the uninsured are what keeps the healthcare system from a perfect market system is borderline irresponsible. The authors know that there are numerous other reasons health transactions do not occur in a perfect market system: moral hazard for the insured, asymmetric information, opaque pricing structures, sorely lacking information on quality for all parties just to name a few.

If the uninsured all became insured the complexities of a health care service transaction would not be magically transformed into a perfect market system.