"I never imagined I'd be in this position," intimates a stunned Lois Wadace. Like many Americans in the recent downturn, Wadace no longer has access to employer-sponsored insurance plan. A Kaiser Health News article in today's Washington Post chronicles the stories of Wadace and other members of the "new uninsured" who have been forced to scramble to cobble together health coverage in tough economic times.

In the near term, the newly uninsured have been forced to cut back on doctors visits, reduce their use of necessary (and costly) prescription drugs, attempt to navigate the tricky waters of the individual insurance market, and search for care in free clinics and emergency rooms. Access, literally, sometimes depends on the luck of the draw.

But, as the Post article points out, there are glimmers of hope. The House and Senate both recently passed an expansion and re-authorization of the SCHIP bill which will extend vital coverage to more children (and in certain cases their parents). And, as we noted before, the pending stimulus bills in the House and Senate contain components aimed at helping patch together insurance coverage.

Among the short-term patches included in the stimulus are increased funding for two important health programs: COBRA and Medicaid.

COBRA allows people to continue their employer-sponsored health coverage for a period of time even after they become unemployed. Under both the House and Senate stimulus bills, COBRA premiums for eligible individuals (those "involuntarily separated" from their jobs during the recession) will be subsidized by the government. As the Post article notes, without these subsidies, former employees must generally pay the full cost of their health coverage, which can range anywhere from $400 to $1000 a month. Most people who lose their jobs can't afford that. The stimulus provision means that instead, they will only pay 35 percent of the premium (compared to the 25 percent the currently employed pay for coverage). The House would subsidize this coverage for 12 months and the Senate for nine.

The second major health program addressed in the stimulus is Medicaid. Both versions of the bill make a few small fixes like expanding the Temporary Medical Assistance (TMA) program and the Qualified Individual Program which help small portions of the Medicaid population.

The bigger patch centers around increasing the Medicaid FMAP rate (the formula determining the size of the federal government's contribution to Medicaid, which is a joint state and federal program). The House would go further by expanding Medicaid eligibility. The Senate is a bit more conservative, increasing DSH (disproportionate share payments) for certain states and resolving past payment for Medicare and Medicaid eligible individuals.

The House and Senate would both increase state FMAP rates, provided that states do not restrict eligibility for the program. The House would increase state rates by 4.9 percent across the board while the Senate would increase them by 7.6 percent (if states pay 90 percent of claims within 30 days). Additionally, both bills would offer further increases to states with unemployment rates that have increased by 1.5 percentage points or more. While both rate increases will help states maintain eligibility levels in such an important program, the Senate bill has the added bonus of incenting states to pay their bills as quickly as possible. This action will ensure that the economic activity driven by Medicaid spending will happen as quickly as possible.

The House goes a step further in dealing with Medicaid and allows for a program expansion. Under their proposal the federal government would pay all of the cost of an expansion for individuals (and their dependents) receiving unemployment benefits (or who have exhausted those benefits) and have no coverage. They would also expand the program to people who are "involuntarily" unemployed who receive food stamps or whose family income is below 200 percent of the poverty level ($44,100 for a family of four).

The Senate doesn't expand Medicaid eligibility but does provide states with a bit more money to help cover their citizens. They provide money to states with low DSH payments relative to what the state spends on medical care and they resolve an outstanding debt regarding payment for people who are both Medicare and Medicaid eligible.

While we applaud these patches in people's health coverage, (and hope that the inclusion of health coverage in the stimulus signals a long-term commitment on the part of Congress) the bill is only a short-term solution. For many of the "new uninsured," these steps will help them maintain coverage until the economy rebounds. But, the need for these short-term patches only further proves that our health system is on an unsustainable path. With continued inaction on health reform, the cracks in the system that appeared during this economic crisis will become much harder to fix.