Part I in a series on healthcare gaps
 
Wow, let's all celebrate the fact that the historic healthcare bill promises coverage for pre-existing conditions!  Or wait, should we?  Can we?  NO!  Because the problem with being a human being with a "previous medical episode" whether it was a one-time event or part of a chronic health condition is more an issue of the price tag of the insurance policy, not the availability of the insurance policy, as well as having coverage for the type of treatment that is reasonable by the specialist for your condition.  Mandating that sick people have the supposed "privilege" of being insurable is merely forcing them into a horrific expense that they probably cannot take on with a chronic or acute medical condition, especially if it has forced them out of work.  And while Obamacare in theory creates these "high risk pools" for buyers to get insurance in the open market, it completely fails to address the affordability issue.  And, affordability is the primary prohibitive factor in individuals obtaining private insurance.  The creation of this "sicky risk pool" is yet another boondoggle for the insurance industry:  guaranteed, mandated revenue from the chronically ill, and no accompanying price controls with regard to premiums, co-pays, or definition of qualifying factors for being dumped into this category.  
 
Many early retirees have faced this issue with heart conditions, multiple sclerosis, diabetes, lupus, back pain, and countless other medical diagnosis.  Many people continue to work with these diagnoses as their conditions are not disabling.  However, these are conditions which can in extreme cases be completely disabling.  More likely, they are simply impediments to a perfect insurance company rating for an insured.  And, if you've had that bulging disc for a while or that atriol fibrolation since you were a child, you already know how difficult that is to get treatment for a pre-existing condition if you have ever changed employers, and therefore changed insurance plans.  Obamacare may, in theory, give you the ability to be covered by an insurance policy.  And while Obamacare mandates that you buy it, it fails to address how you should pay for it.  More specifically, it fails to address maximum premium levels that can be charged to participants in this risk pool.  And, it unfairly punishes those who do not have lifestyle diseases (self-imposed diseases).  It also fails to eliminate any limitations of treatment that might be imposed upon the chronically ill by either the terms of the policy or some bean counter at the insurance company who "monitors" your progress.
 
Many people who are somewhat disabled, but still able to work in their 50's and 60's, who are not yet qualified for Medicare retirement health coverage are falling into this expensive abyss.  They have to carry their own expensive private insurance for these conditions in addition to their employer coverage that excluded their medical condition if they don't want to run the risk of bankruptcy due to medical bills.  A brief survey of people in this dilemma bracket shows that they oftentimes pay between $1,025 and $5,500 per individual per month in premiums.  This is a straight out of pocket cost, usually coming from retirement funds.  However, this of expense pales in comparison to someone who has truly been seriously ill or disabled and is trying to find a way back to work. 
 
Many Americans are aware that Social Security based on work history has been available to disabled Americans since the program was extended in 1962.  Shortly thereafter, Medicare, as well, accompanied these meager financial, but lifesaving benefits.  To qualify for these benefits you must either have had, or are expected to have a disabling condition for at least 12 months wherein you are not only unable to do your current or former job, but not any job.  It's a higher standard than most private disability plans which are generally activated if you are found to no longer be able to do the job you were last working. 
 
The Social Security Disability approval process is onerous at best, and is a financial net of last resort for those with a physical disability or chronic illness.  Americans without a work history stand to gain a minimum level of benefits as well as Medicare as their primary insurance and Medicaid as their secondary insurance.  Americans with work experience have a higher burden of proof of disability and a more onerous process to get benefits.  The approval of benefits can happen at any of four stages.  Theses consist of the initial written application which is submitted with doctor’s reports to a state administrator who rules on it, the review of the original finding, the hearing process in front of a Federal Administrative Law Judge, and lastly, the appeals process.  Currently, in some states, such as Florida, the process of even getting to the hearing stage is averaging 36 months due to the backlog of cases. 
 
Currently, with the economy ailing, more and more of those people who are in their 50's and 60's who were tolerating their medical conditions while employed, are now applying for SS Disability Benefits because they cannot find work and cannot afford health insurance or healthcare.  They are hoping to ensure their income with SSD benefits based on their work history and be rewarded with Medicare merely to have the dignity of healthcare coverage. 
 
This exposes two enormous factors that were not factored into the price tag of this pre-existing condition coverage either for the Federal Government or individual:  the price of risk pool insurance and the price of this entire implosion of added Medicare and Medicaid beneficiaries due to unemployment.  These never reached the desk of the Government Accounting Office.  When the premium bills reach the desks of the chronically ill, added to their already ailing symptoms will be SOB (shortness of breath) and MI (myocardial infarction or, in layman's terms, heart attacks.)  

Kimberly Wilcox is currently freelance writing about financial politics, as well as Healthcare policy, specifically, Chemical Injury and its medical & lifestyle consequences.  She is a lifestyle coach to others with chemical injury, chronic fatigue, autism, Gulf War Syndrome & Fibromyalgia, as well as to professional athletes desiring peak performance without use of illegal PED's.  She is an expert on Green Living and her new book will soon be published about the Green Life that she has been forced to live for the last decade.